As Salaamu Alaikum!
There are over 1.58 billion Muslims in the world. The majority of
them observe total fasting (no food or water) between dawn and sunset
during the month of Ramadan. They do so not to lose weight or for any
medical benefit, but because it is ordained in the Quran which says,
"O
you who believe! Fasting is prescribed to you, as it was prescribed for
those before you (i.e. Jews and Christians) so that you may (learn)
self-restraine" (2:183).
Food is needed by the body to provide energy for immediate use. This
is done by burning up carbohydrates, that is, sugar. Excess of
carbohydrates which cannot be used are stored up as fat tissue in the
muscles and as glycogen in the liver for future use. Insulin, a hormone
from the pancreas, lowers blood sugar and diverts it to other forms of
energy storage, that is, glycogen. To be effective, insulin has to be
bound to binding sites called receptors. Obese people lack receptors.
Therefore, they cannot utilize their insulin. This may lead to glucose
intolerance.
When one fasts (or decreases carbohydrate intake drastically), it
lowers one's blood glucose and insulin level. This causes a breakdown of
glycogen from the liver to provide glucose for energy needs and
break-down of fat from adipose tissue to provide for energy needs. On
the basis of human physiology described above, semi-starvation
(ketogenic diets) have been devised for effective weight control. These
diets provide a calculated amount of protein in divided doses with
plenty of water, multivitamins, etc. These effectively lower weight and
blood sugar, but because of their side effects, should be used only
under the supervision of physicians.
Total fasting reduces or eliminates hunger and causes rapid weight loss. In 1975, Allan Cott in his
Fasting as a Way of Life,noted,
"Fasting brings a wholesome physiological rest for the digestive tract and central nervous system and normalizes metabolism."
It must be pointed out, however, that there are also many adverse
effects of total fasting. That includes hypokalemia and cardiac
arrhythmia associated with low calorie starvation diets used in
unsupervised programs.
STUDIES ON ISLAMIC FASTING
Dr. Soliman from University Hospital , Amman , Jordan has reported
that during the month of Ramadan 1404 AH (June-July, 1984 AD) healthy
Muslim volunteers@2 males and 26 females ranging in age from 15-64 and
16-28 years respectively-were studied. They were weighed and their blood
levels of cortisol, testosterone, Na, K, urea, glucose, total
cholesterol, high density lipoprotein (HDL), low density lipoprotein
(LDL), triglycerides (TG) and serum osmolality were measured at the
beginning and at the end of Ramadan. There was significant loss of
weight in males from a mean of 73.8 +/-6.2 kg to 72.0 +/-7.1 kg (P less
than 0.01) and in females from 55.2 +/-4.8 to 54.6 +/-4.2 kg (P less
than 0.05). Blood glucose levels rose in males from 77.7 +/-23.6 mg/dl
to 90.2 +/31.2 mg/dl (P less than 0.05) and in females from 76.0 +/-7.6
mg/dl to 84.5 +/-11.1 mg/di (P less than 0.002). All other parameters
did not show significant changes.
Dr. F. Azizi and his associates from the University of Medical
Sciences , Tehran , Iran has reported the following. Serum levels of
glucose, bilirubin, calcium, phosphorus, protein, albumin, FSH, LH,
testosterone, prolactin, TSH, T4, T3, and T3 uptake, as well as
prolactin and TSH responses to TRH were evaluated in a group of nine
healthy men before and on the 10th, 20th, and 29th days of Ramadan. Mean
body weight decreased from 65.4 +/- 9.1 to 61.6 +/- 9.0 kg at 29th day.
Serum glucose decreased from 82 +/- 4 mg/dl on the 10th day, and
increased thereafter (76 +/- 3 and 84 +/- 5 on the 20th and 29th days of
fasting respectively). Serum bilirubin increased from 0.56 +/- 0.17 to 1
43 +/-.52 mg/dl on the 10th day, and decreased thereafter ( I. I. +/-
0.4 on the 20th and 29th days). All changes returned to basal values
four weeks after fasting. There were no significant changes in serum
levels of Ca, P. protein, albumin, and any of the measured hormones.
Prolactin and TSH responses
to TPH were also unaltered. He concluded that 1) intermittent abstinence
from food and drink for 17 hours a day for 29 days does not alter male
reproductive hormones, hypothalamic-pituitary- thyroid axis or
peripheral metabolism of thyroid hormones and 2) physicians caring for
Muslims should be aware of changes of glucose and bilirubin during
Ramadan.
Therefore it is concluded from the above
two studies that the pre- scribed fast does not cause any adverse
medical effect and on the contrary, may have some beneficial effect on
weight and lipid metabolism.
WHY ISLAMIC FASTING IS DIFFERENT FROM ORHER TYPES OF FASTING
The prescribed fast of Muslims is different from the so-called "Diet
Plans" because it has beneficial features of both plans. Its unique
medical benefits are due to the following factors:
- As compared to other diet plans, fasting in Ramadan does not cause
malnutrition or inadequate calorie intake since there is no restriction
on the type or amount of food intake before beginning the fast or upon
ending the fast at sunset. This was confirmed by M.M. Hussaini in 1974,
when he conducted dietary analysis of Muslim students at the University
of North Dakota, State University at Fargo during Ramadan. He concluded
that calorie intake of Muslim students during fasting was at two-thirds
of NCR-RDA.
- Fasting in Ramadan is voluntarily undertaken. It is not a prescribed
imposition from a physician. In the hypothalamus part of the brain
there is a center called "lipostat" which controls the body mass. When
severe and rapid weight loss is achieved by starvation diet, the center
does not recognize this as normal and, therefore, reprograms itself to
cause weight gain rapidly once the person goes off the starvation diet.
So the only effective way of losing weight is slow, self-controlled, and
gradual weight loss which can be achieved by modifying our behavior and
changing our attitude about eating especially by eliminating excess
food. Ramadan is a month of self-regulation and self-training in terms
of food intake thereby causing hopefully, a permanent change in lipostat
reading.
- With the prescribed fast, Muslims are not subjected to a diet of
selective food only (i.e. protein only, fruits only etc.). An early
breakfast, before dawn is taken and then at sunset the fast is broken
with something sweet i.e. dates, fruits, juices to offset any
hypoglycemia followed by a regular dinner later on.
- Additional prayers are prescribed after
dinner which help metabolize the food. Using a calorie counter, I
counted the amount of calories burnt during the special night prayer of
Ramadan (tarawih). It amounted to 200 calories. This form of prayer as
well as the five daily prescribed prayers use all the muscles and joints
and can be considered a mild form of exercise in terms of calorie
output.
- Ramadan fasting is actually an exercise in self discipline. For
those who are chain smokers or who nibble food constantly, or drink
coffee every hour, it is a good way to break the habit.
- The psychological effect of Ramadan fasting are also well observed
by the description of people who fast. They describe a feeling of inner
peace and tranquility. The Prophet (Sallallahu Alaihi Wassallam) advised
those fasting, "If one slanders you or aggresses against you, tell him
'I am fasting."' Thus personal hostility during the month is minimal.
The crime rate in Muslim countries falls during this month.
It is my experience that within the first few days of Ramadan, I
begin to feel better even before losing a single pound. I work more and
pray more. My physical stamina and mental alertness improve. As I have
my own lab in the office, I usually check my chemistry, that is, blood
glucose, cholesterol, and triglyceride before the commencement of
Ramadan and at its end. I note marked improvement at the end. As I am
not overweight, thank God, weight loss is minimal. The few pounds I
lose, I regain soon after. Fasting in Ramadan will be a great blessing
for the overweight whether with or without mild diabetes (Type 11). It
benefits those also who are given to smoking or nibbling. They can rid
themselves of these addictions in this month.
FASTING FOR MEDICAL PATIENTS: SUGGESTED GUIDELINES
As mentioned earlier, the sick are exempt from fasting. But some, for
whatever reasons, do decide to observe fasting. For physicians treating
Muslim patients, the following guidelines are suggested.
Diabetic Patients: Diabetics who are controlled by
diet alone can fast and hopefully, with weight reduction, their diabetes
may even be cured or at least improved. Diabetics who are taking oral
hypoglycemia agents like Orinase along with the diet should exercise
extreme caution if they decide to fast. They should reduce their dose to
one-third and take the drug not in the morning, but in the evening at
the time of ending the fast. If they develop low blood sugar symptoms in
the daytime, they should end the fast immediately. Diabetics taking
insulin should not fast. If they do, at their own risk, they should do
so under close supervision and make drastic changes in the insulin dose.
For example, they should eliminate regular insulin altogether and take
only NPH in divided doses after ending the fast or before the pre-fast
breakfast. Diabetics, if they fast, should still take a diabetic diet
during the pre-dawn meal, the ending of the fast meal, and dinner.
The sweet snacks common in Ramadan are not good for their disease. They
should check their blood sugar before breakfast and after ending their
fast.
Hypertensive or Cardiac Patients: Those who have
mild to moderate high blood pressure along with being overweight should
be encouraged to fast, since fasting may help to lower their blood
pressure. They should see their physician to adjust medication. For
example, the dose of water pill (diuretic) should be reduced to avoid
dehydration, and long acting agents like Inderal LA or Tenormin can be
given once a day before the pre-dawn meal. Those with severe
hypertension or heart diseases should not fast at all.
Migraine Headache: Even in tension headache,
dehydration or low blood sugar will aggravate the symptoms, but in
migraine during fasting, there is an increase in blood free fatty acids
which will directly affect the severity or precipitation of migraine
through release of catecholamine. Patients with migraines are advised
not to fast.
Pregnant Women (normal pregnancy): This is not an
easy situation. Pregnancy is not a medical illness. Therefore, the same
exemption does not apply. There is no mention of such exemption in the
Quran. However, the Prophet Sallallahu Alaihi Wassallam said that
pregnant and nursing women do not have to fast. This is in line with
Allah Subhanahu wa Ta’ala not wanting anyone, even a small fetus, to
suffer. There is no way of knowing the damage to the unborn child until
delivery, and that might be too late. In my humble opinion, during the
first and third trimester (three months) women should not fast. If
however, Ramadan happens to come during the second trimester (4th-6th
months) of pregnancy, a women may elect to fast provided that 1) her own
health is good, and 2) it is done with the pen-nission of her
obstetrician and under close supervision. The possible damage to the
fetus may not be from malnutrition provided the Iftaar and Sahoor are
adequate, but
from dehydration, from prolonged (10-14 hours) abstinence of water.
Therefore it is recommended that Muslim patients, if they do fast, do so under medical supervision.
By Shahid Athar
SubhanAllah, This article clearly reminds us of this verse in the Holy Qur’an:
“Which of the favours of your Lord, will you deny?”
www.ewaytoquran.tk