Managing health conditions during Ramadan

Your choice

Ramadan can do a lot of good for your health, happiness, amd spiritual wellness. If you have a medical condition that makes fasting during Ramadan unsafe, you can choose not to fast. This guidance comes from the Muslim Council of Britain (MCB)1, and many other Islamic councils worldwide, but ultimately this is a personal decision.

Dr Ammad Mahmood is a clinical lecturer in neurology at the University of Glasgow and co-author of the paper Advising patients with existing conditions about fasting during Ramadan: "Generally, I've found that people don't want to be exempt," he says. "As a medical professional, convincing someone not to fast is very difficult, especially if their condition leaves them in a grey area."

Being in a grey area means that there's no clearcut answer as to whether you should fast. For example, your doctor may have safety concerns, but the lack of research around your medical condition during Ramadan could make it hard to know just how detrimental fasting could be to your health.

"Ultimately, the decision of whether to participate in Ramadan always rests with you," says the doctor. "As medical professionals, we recognise how important it is for people to identify with their religious authority. Even if you are medically exempt from participating in Ramadan fasting, spiritual health is also very important."

But no matter what you decide, if you have a health condition that could be affected by Ramadan, speak to your GP or condition specialist. As well as helping you understand any risks, they can help with Ramadan fasting preparation, management, and support to keep you safe and feeling as well as possible during the holy month.

Advice for all medical conditions during Ramadan

No matter your health condition, Dr Mahmood recommends you think about these steps:

1. Preparation

"Preparation is really important. We encourage you to start planning for Ramadan 2-3 months ahead, because any changes to how you manage your condition can take time to implement. Forming a strategy in advance gives you the time to speak to your GP, condition specialist, or pharmacist about any adjustments you'll need to make to safely manage your condition."

2. Personalised strategies

The decisions you make with your healthcare expert will depend on your specific illness and its severity. According to Dr Mahmood, this could include:

• Considering trial fasting - fasting before Ramadan can allow you to test how it affects your health, and to stop if problems arise.

• Deciding whether your condition is compatible with fasting.

• Discussing appropriate changes to your medications.

• Making relevant lifestyle adjustments - this may involve thinking about how your diet changes during Ramadan, as well as your changing sleep patterns and the effects of fatigue on your illness.

3. Alternative options

For many Muslims living with or without medical conditions, fasting during Ramadan - a style that can also be described as intermittant fasting - is beneficial for the mind and body. For some health conditions, it's a question of moderation.

"Some health conditions aren't affected by fasting so long as you take a break from it every fourth or fifth day," says the doctor. "For this reason, some people choose to take these days off - rather than fasting consecutively for the full 29-30 days - and then make up these days by fasting for a longer period overall."

Another alternative that can work for some is observing Ramadan in winter, instead of spring or summer. This is because certain conditions only become a challenge when Ramadan daylight fasting hours are long. Observing Ramadan in winter, when fasting hours are much shorter, could help to keep you safe and your condition under better control.

Of course, there are many considerations when thinking about doing Ramadan differently. For example, observing Ramadan at a different time to your family and friends can bring its own set of challenges. Changing how you observe Ramadan is a big decision, but remember that making adjustments for the right reasons, like your health, is totally acceptable.

4. Signs during fasting

No matter how prepared you may be feeling, Dr Mahmood says that it's important that you know the symptoms to look out for during Ramadan that require you to seek medical help, or to stop abstaining from food or medication, to prevent serious or permanent damage to your health. These symptoms and actions will depend on your condition.

Heath conditions and Ramadan - a closer look

Ramadan can benefit your health and wellbeing in many ways, but refraining from food, drink, and medications between suhoor (the pre dawn meal) and iftar (the after sunset meal) can be dangerous with certain health conditions.

Diabetes and Ramadan

There is more research from the British Islamic Medical Association (BIMA) on managing diabetes over Ramadan than any other health condition². However, it's not enough to trawl the internet for information - you need to speak with your GP or diabetes specialist as their advice will be tailored to you and how severe your diabetes is.

"Someone with well controlled type 2 diabetes may just need a review of their medications, but someone with type 1 or more severe type 2 diabetes may need to consider more measures for safely controlling their insulin over Ramadan," says Dr Mahmood. You can find out more about potential precautions here.

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Cardiovascular conditions and Ramadan

People with cardiovascular conditions - which involve the heart and blood vessels - also need to plan for the month of Ramadan. For example²:

• Blood pressure - dehydration caused by fasting can lead to dangerous peaks and dips in blood pressure. If you already have low or high blood pressure, your doctor may review your medication and recommend you use a home blood pressure monitoring device.

• Coronary heart disease - a history of heart disease may put you at a low to moderate risk of further injury during fasting, and this risk increases if you pause rehabilitation sessions during Ramadan. It's important to review your regular medications and discuss any plans to not take them with an expert.

• Recent heart attack or heart surgery - if you have had either of these within six weeks of Ramadan, many experts recommend that fasting is too high risk.

Although data is limited, experts have attempted to group cardiovascular conditions into low- moderate risk, high risk, and very high risk³.

Mental illness and Ramadan

More research is needed on mental illnesses and Ramadan, but in his research, Dr Mahmood has found evidence that fasting during Ramadan could be safe for people with certain mental health conditions, such as schizophrenia and bipolar disorder⁴.

However, there are greater conflicts and higher risks for fasting with other mental health conditions. Eating disorders - like anorexia, bulimia, and binge eating - can be particularly difficult to manage at Ramadan. Speak to your doctor about getting extra support and management help during this time.

Cancer and Ramadan

There's currently not a lot of research on managing cancer during Ramadan, but after consulting with an oncologist, Dr Mahmood says this was the most important message:

"Even though some people are medically exempt from participating in Ramadan fasting, spiritual health is also very important - and this can be especially true for the people living with a cancer diagnosis. It's first and foremost your choice to fast, but no matter what you decide, speak to your specialist. They can find ways to support you and your health through Ramadan."

Pregnancy and Ramadan

Although pregnant women are permitted by Islamic law to not fast, it's thought that up to nine in 10 choose to fast for at least part of Ramadan⁵. The evidence around maternal diet restriction is mixed, However, many experts advise against Ramadan fasting during pregnancy because it may increase the likelihood of⁶:

• Gestational diabetes in the mother.

• Kidney problems in the mother.

• Miscarriage.

• Low birth weight and other special care needs in the baby.

Other studies have found no health differences between babies born to mothers who have fasted and those who haven't. These dangers will very much depend on how long you fast for, and other factors such as your stage of pregnancy and overall health.

Further reading

1. Muslim Council of Britain: Ramadan guide.

2. British Islamic Medical Association: Ramadan compendium.

3. Akhtar et al: Ramadan fasting: recommendations for patients with cardiovascular disease.

4. Mahmood et al: Advising patients with existing conditions about fasting during Ramadan.

5. Glaziet et al: The effect of Ramadan fasting during pregnancy on perinatal outcomes: a systematic review and meta-analysis.

6. Mirghani et al: Diet restriction in Ramadan and the effect of fasting on glucose levels in pregnancy.

like winter fasting may be safe.