Your health during Ramadan

When Roxanne completed her nursing course in Norway, her friends expected her to stay and work there because of the high salaries and excellent living standards.

She, however, remembered her vow to return home to use her skills to serve her people, especially the poor, deprived and vulnerable.

So, after taking attachments in areas she felt would be important for her work back home, Roxanne returned to Ghana feeling well-prepared for the task ahead.

As fate would have it, she met, fell in love with and married Rahman Mohammed, a staunch Muslim who was happy for Roxanne to either become a Muslim or remain the Christian that she was.

Whilst pondering on her religious choices, Roxanne was ushered into her first Ramadan, where she was confronted with professional issues she had never before considered.

Being the wife of Rahman, a very prominent Muslim leader, Roxanne was also seen as a leader in the Muslim community.

And being a leader and a nurse, the community came to her with all their Ramadan health questions.

Since Muslims fasting during Ramadan are expected to go without food, liquids, tobacco and medicines, including oral medicines, during the period of the fast, what should Muslims who have diabetes, epilepsy, asthma or high blood pressure do during Ramadan?

 What essential health advice can Muslims be given for them to properly fulfil their religious obligations whilst maintaining their physical health?

What is Ramadan?

Every Muslim is expected to observe the five pillars of Islam namely confession of faith (Shahadah), worship in the form of prayer (Salat), fasting during the month of Ramadan (Sawm), almsgiving (Zakat) and pilgrimage to Mecca at least once in their lifetime (Hajj).

Ramadan is the ninth and holiest month in the Islamic lunar calendar.

It is a month that all Muslims (except those forbidden by Islamic law) are expected to fast, give alms, carry out charitable activities and get involved in spiritual activities including frequent prayer.

Fasting during Ramadan involves a complete non-intake of food and fluids.

Whilst fasting is mandatory for all Muslims from the age of puberty, Islamic law is very clear that anyone who is sick should not fast.

Indeed, Islamic law forbids fasting by anyone whose health will be harmed as a result of fasting.

Pregnant women, breastfeeding mothers, pre-puberty children, the elderly, those travelling long distances, those with mental health issues and those receiving treatment like dialysis are prevented from fasting.

Menstruating women are also not permitted to fast.

Those who are unable to fast may compensate for this by either fasting later or by carrying out the fidyah i.e. giving donations to less fortunate people. 

Ramadan, health

Fasting during Ramadan can have health implications for those with existing health conditions.

Patients with high blood pressure, diabetes, epilepsy, asthma, and other chronic conditions are usually exempted from fasting.

However, the majority of these patients still insist on fasting. 

They are, therefore, keen to receive advice and support from health professionals on how to manage their disease conditions and medications when fasting. 

In the area of medicines, it is important to stress that whilst Islamic scholars have all fully agreed that the intake of oral medicines breaks the fast, there are differences of opinion regarding the intake of other types of medicines.

 Taking injections, oral metered-dose inhalers (for asthma), eye drops, nasal drops, ear drops, suppositories and pessaries are seen by some Islamic scholars as not breaking the fast whilst other scholars are vehement that the intake of these break the fast.

Definitive guidance should, therefore, be sought from one’s religious leaders.

Regardless of whatever medications need to be taken, however, a combination of careful planning and advice from pharmacists or doctors may help Muslims who want to fast to undertake the fast without compromising their health. 

Ramadan and Diabetes

Diabetes is one of the most difficult conditions to manage during fasting.

Diabetics who take insulin should, as a rule, not fast. 

Those who take oral medications to control their diabetes may fast for as long as they have consulted their pharmacist and doctor to manage their medication schedule.

 Diabetics who fast are strongly encouraged to measure their blood sugar levels every 2-4 hours.

Blood glucose measurement is not regarded as breaking the fast.

 The main thing to watch out for is “hypo” (hypoglycaemia) – a situation in which the blood sugar levels fall dangerously low, accompanied by signs like sweating, anxiety, trembling, intense hunger and palpitations.

Patients with “hypo” need to take in sugar or sugary drinks immediately.

 Diabetics whose blood sugar levels fall below four millimoles per litre (mmol/L) should break the fast immediately and take in sugar and/or starchy foods as advised by their healthcare workers.

High blood pressure, asthma, epilepsy

Patients with high blood pressure, asthma and epilepsy may opt to fast.

They should, however, consult their pharmacist or doctor for alternative medications since in some cases, long-acting medications may be prescribed, which need to be taken only once a day and could thus be taken during the non-fasting hours.

Advice should be sought by asthmatics from their religious leaders on whether the use of oral inhalers breaks the fast.

Those with conditions requiring antibiotics should opt for “once or twice daily” antibiotics rather than those which need to be taken thrice or four times daily since the former can be easily aligned with the fasting hours.

Advice should be sought from pharmacists regarding the tricky issue of when and how to take those medicines which need to be taken before, with or after food.

Ramadan is the holy month of fasting for Muslims and is observed as such by many.

However, there are those for whom Ramadan poses health challenges to their spiritual and religious obligations.

Healthcare workers, especially pharmacists, can help these people by discussing their medicine requirements and suggesting dosage forms or formulations that can be least intrusive to fasting and that permit such pious people to carry out their important spiritual responsibilities without compromising their cherished physical health.

 May Allah guide us all.