Fasting when ill

PHOTO: Fasting when ill

Ramadhan, the ninth month of the Islam lunar calendar, is a month of spiritual cleansing, when Muslims from all over the world practise self-restraint and self-discipline.

Ramadhan also allows Muslims to get a glimpse into and understand the plight of the less privileged, i.e. the hungry, thirsty and poor.

In addition, fasting during Ramadhan is not only limited to refraining from eating and drinking, but also involves doing good deeds, restraining from anger, and exercising personal discipline.

Fasting can be obligatory, optional, or prohibited, depending on the health condition of the person. It is obligatory for all healthy, adult Muslims, while the sick or weak, children, travellers and menstruating women are exempt from fasting.

However, some Muslims who are ill or sick, do not seek this exemption, and insist on fasting in any circumstance. If not supervised by health professionals, fasting during an illness may cause problems.

Optional or obligatory?

A Muslim suffering from a minor ailment may still be able to fast, so long as it does not affect his or her health in any way.

However, those who suffer from more acute conditions, requiring medication every day, or two to three times daily, may need advice on whether it is still possible to fast, perhaps by altering their dosing regimen.

For example, drugs such as antibiotics, which require regular and frequent intake, can be problematic for fasting patients.

An alternative to this could be providing drugs with longer half-lives, which means that it can be taken less frequently, eg every 12 hours or once daily.

There are also other alternative routes of drug administration that can help fasting patients. Individuals who suffer from mild forms of angina pectoris (chest pain), for example, could benefit from taking the medication as a patch rather than as tablets.

This means that the drug would enter the blood stream through the skin, and not orally, which would break the fast.

Those with chronic diseases

Fasting for those with chronic diseases

For diabetic patients, in cases whereby the diabetes is controlled by diet alone, the individual may fast, with even a possible improvement to his condition.

However, diabetics who are on medication, along with dietary control, should remain cautious if they decide to fast.

Patients should consult their doctor for medical advice and dosage adjustment before fasting.

Furthermore, if they were to develop low blood sugar symptoms during the day, they should end their fast immediately.

In healthy adults, fasting blood sugar levels are usually between 70 and 99 mg/dL; however, symptoms of low blood sugar occur when blood sugar levels fall below 70 mg/dL, and may include:

  • Nausea
  • Extreme hunger
  • Cold, clammy, wet skin, and/or excessive sweating that is not caused by exercise
  • Rapid heartbeat
  • Numbness, tingling of the fingertips/lips, or trembling

Patients who suffer from "stable" heart disease, which means they have a heart condition but remain stable as long as they take their medication, may also fast. These patients should check with their doctors first, to ensure that they are fit enough to fast, and to get advice on their medication.

Medications should still be taken; however, the timing and dosage may change to ensure best results. For example, if you usually take aspirin in the morning with your breakfast, your doctor may change it to after you break fast.

This is because aspirin can cause gastric irritation in some people, and during fasting, when the stomach is empty for long periods, it can worsen the condition.

Similarly, those who suffer from hypertension, or high blood pressure, may also fast, with the condition that they take their medication regularly.

In fact, studies and research done have shown that fasting has been found to help lower blood pressure levels, though it is possible that other factors such as rest and less stress may have also played a role in this.

Check with your doctor to change your medication dosage or time, and ensure that your doctor gives you the green light to fast before doing so.

In short, individuals with medical conditions that require daily medication, such as those mentioned above, and other diseases including arthritis, hypothyroidism, or even asthma, should get approval from their doctors before fasting. For some of these individuals, fasting can still be carried out; however, for those who are unstable, or require medications three to four times a day, it is best not to fast, and to look after your health first.

There are also other health conditions - not chronic - which are more prevalent during the fasting period, and one of these include kidney stones. Individuals who have had a history of kidney stones are often at an increased risk of developing them during Ramadhan. Lack of water intake may cause dehydration, which can increase the risk of kidney stones.

Therefore, individuals who are prone to developing kidney stones, and find it difficult to manage their condition, should not fast. In any case or situation, health should always come first.

Digestive diseases

Digestive diseases during Ramadhan

During Ramadhan, it is also not surprising to find digestive diseases on the rise.

Disorders such as heartburn, gastritis, and even peptic ulcers often escalate during the fasting period. The increase of acid levels in an empty stomach is often the reason for aggravating the conditions mentioned above.

By adhering to well-balanced and healthy meals during sahur and iftar, people can reduce the occurrence of such disorders.

It is best to avoid spicy foods, fatty foods, and even caffeinated beverages to prevent further aggravation of these symptoms.

In addition, pregnant and nursing mothers are usually exempted from fasting, as it is important to look after the health of your child first.

Nursing mothers need enough nourishment to ensure that they can provide the best for their child.

Generally, Islam offers exemptions to particular individuals, including those who are ill or sick, pregnant or nursing, and of course children, from fasting during Ramadhan.

Some patients may still be able to observe their fast, as long as their health is not adversely affected during this time.

However, it is still important to get advice from your trusted health professional about changing prescription dosages or route of administration, and to always ensure that fasting occurs under medical supervision.

Datuk Dr Muhammad Radzi Abu Hassan is a consultant gastroenterologist. The author is not associated with and does not endorse any brands or products. This article is courtesy of the Healthy Tummies Advisory Board and supported by the VITAGEN Healthy Tummies Programme.