Review
English
Salem A. Beshyah*, Waseem Fathalla, Abdulkarim Saleh, Abdulrazzak Al Kaddour, Mohamed Noshi, Husni Al Hateethi, Nameer Al-Saadawi, Hussein Elsiesi, Numan Amir, Mohamed Almarzouqi, Ali Khalil, Mahmoud Benbarka, Urooj Ahmed, Huda Ezzeddin Mustafa, Wael Al-Mahmeed
Ramadan Fasting Interest Group, Institutes of Medicine, Cardiac Sciences and Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.
IJMBS 2010, 2(5):240-257
Abstract
The day time fasting of Ramadan is observed annually by millions of adult Moslems all over the world. Some may have mild, moderate or severe medical conditions. They may seek advice on feasibility and safety of fasting and/or their management. Physicians ought to have a working knowledge about the religious rules of Ramadan fast and their medical implications. In this article we present a concise summary of the proceedings of a series of symposia. Their objectives were to review the effects of Ramadan fasting on the health of Moslem patients with various chronic medical conditions and to propose practical management strategies. An initial introductory Islamic perspective on fasting to sets the scene for the following presentations. The religious rulings excluding patients with acute and chronic medical conditions from fasting were highlighted. The roles of the medical professional in guiding patients on best ways to make informed decisions to fast and feast safely were stressed. Available evidence from published literature and clinical practice was reviewed and practical guidance covering the major body systems was given. Generally speaking, fasting in Ramadan is possible for most stable chronically ill patients under medical supervision. The effect of fasting on health issues should be explained to patients well ahead of starting the holy month. Counselling patients about their use of medications as well as their suitability to undertake the fast is a major step in health care for Moslem patients. Available observations cover a spectrum of chronic medical conditions affecting various body systems. These include renal, hematological cardiac, neurological, rheumatologic, gastroenterological, endocrine conditions and drug therapy during Ramadan. Changes in the parameters of clinical functions in healthy people and in non renal patients were minimal, insignificant and remained within the normal range. Patients on hemodialysis could fast safely on non dialysis days. Stable renal transplant recipients do not seem to sustain any risk from fasting after the first year. No evidence of increased risk of renal stones and colic was found during Ramadan. No consistent rise in cardiac events was observed during Ramadan. Hypertension needs special treatment manipulations. Headache and risk of seizures are two neurological conditions with relevance to fasting. These can be managed by simple medical measures. Peptic acid disease complications may increase by the long fasting, however treatment with peptic disease medications reduces the risks. Hematological conditions influenced by dehydration such as sickle disease are better managed by adequate hydration particularly under stressful circumstances. Rheumatological conditions can be managed by usual therapies during Ramadan. Diabetes received most attention from the medical profession for obvious reasons. Several expert statements were published. Where the risk of hypoglycemia or hyperglycemia is increased many would advise against fasting. Patients controlled by simple regimens with low risk of hypoglycemia patients may be able to fast safely. Changes in medication aim at adjusting the amount and timing of the drug administration to match calorie intake thus preventing hypoglycemia in the day time and hyperglycemia after sunset. In conclusion, management of the medical patients during Ramadan represents a special challenge to patients alike. Taking on this challenge is an opportunity to test the cultural-competence of health services.
Keywords: Ramadan Fasting and The Medical Patient: An Overview for Clinicians
Link/DOI: http://journals.sfu.ca/ijmbs/index.php/ijmbs/article/view/137/243