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Ramadan Fasting and Muslim Patients

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Weight loss of 1.7-3.8 Kg (obese lost more weight than non obese) ... D. 5-10 lb weight loss. Thus Fasting is advised for stable NIDDM. NIDDM- Recommendations ... – PowerPoint PPT presentation

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Title: Ramadan Fasting and Muslim Patients


1
Shahid Athar, MD, FACP, FACE Author, Islamic Per
spective in Medicine (ATP)
2
Ramadan Fasting and Muslim Patients
3
Abstract
  • Fasting from dawn to dusk in the holy month of
    Ramadan for healthy adult Muslims has been
    ordained and physically sick Muslims are exempt
    from it. However many Muslims with mild to
    moderate Diabetes, Hypertension and other medical
    conditions do want to fast. The purpose of this
    presentation is make some recommendations as to
    how they can fast safely in light of research on
    fasting

4
Quran 2183
  • O you who believe! Fasting has been prescribed
    to you as it was prescribed to those before you
    so that you attain Taqwa (self restraint , God
    Awareness)

5
Who Cannot Fast
  • 1. Physically sick ( Quran 2 184-185)
  • 2. Traveler on a journey (above)
  • 3. Women during menstruation
  • 4. ? Pregnant and lactating women
  • 5. pre pubertal children

6
Physiological Effects of Fasting
  • On Calorie intake
  • On fluid /water intake
  • Effects on Digestive System
  • - Kidneys
  • - Endocrine glands
  • - Lipid Metabolism
  • - Respiratory system
  • - Neurological System

7
Uniqueness of Islamic Fasting
  • It is a voluntary undertaking rather than being
    ordered by a physician
  • There is no selective food intake i.e. protein
    only, juice only, fruit only , water only etc
  • There is no total calorie malnutrition i.e. it
    not a semi starvation diet.
  • An exercise in self discipline i.e. from constant
    nibbling , drinking, smoking etc
  • Psychological effect and additional prayer

8
Effects of Fasting on Carbohydrate Metabolism
  • 1. Slight fall in serum Glucose (to 60 mg)
  • 2. Serum Insulin decreases due to 1
  • 3. Serum Glucagon and Growth Hormone increases
    due to 1
  • 4. Increase in sympathetic activity
  • 5. Increase in liver Cyclic AMP due to 4

9
CHO Metabolism in Ramadan
  • Slight decrease in first week then normalization
    by day 20 and some rise in the last week
  • 22 children develop hypoglycemia
    (BG
  • Increase Gluconeogenesis in liver

10
Fasting and Lipid Metabolism
  • Decrease in both Total Cholesterol and
    Triglycerides in first few days then rise to pre
    fasting levels
  • Increase in HDL-C
  • Effects are variable according to quality and
    quantity of food consumed at Iftaar and Sahur

11
Endocrine functions in Fasting
  • Fall in free T3 but rise in rT3
  • Slight fall in total T4 (due to fall in TBG) but
    normal freeT4 and TSH
  • TSH response to TRH unchanged
  • Serum Testosterone, LH, FSH may be normal or
    slightly low but GNRH response is normal
  • Plasma Prolactin and PTH are normal

12
Renal Function in Fasting
  • Urinary volume, osmolality, solute and
    electrolyte excretion remain normal
  • Slight increase in BUN (insignificant)
  • Increase in Uric acid (less in Ramadan fasting
    than in prolonged fasting)

13
Other Effects of Fasting
  • Slight rise in Bilirubin but no change in SGOT or
    SGPT
  • Fall in Gastric secretions
  • No change in Heart rate and BP
  • No change in Ca or Electrolytes
  • No change in Hb, blood counts or Fe store

14
Other Effects of Fasting
  • Weight loss of 1.7-3.8 Kg (obese lost more weight
    than non obese)
  • Decrease in appetite due to ketosis and increase
    in Beta-endorphins
  • Fewer suicide in Ramadan than in other months
    (reported in Jordan)
  • No change in outcome of pregnancy or in birth
    weight in those who fasted and those who did not
    (reported in Gambia)

15
Patients who should not fast
  • Diabetes Mellitus Type 1
  • Chronic Renal Failure including Renal Transplant
    and Nephrolithiasis
  • Severe cardiac and pulmonary conditions
  • G.I. Bleed and acute ulcers
  • Severe Epilepsy
  • Severe Migraine

16
General advice for those who fast
  • Consult your (Muslim) doctor first
  • Practice fasting in Shaban first
  • With the approval of physician switch to either
    long acting or twice daily medication
  • Elderly patients on NSAID should have frequent
    monitoring of renal functions
  • Anticoagulant and Antiepileptic medications
    should be given at night .

17
Fasting for NIDDM (ref3)
  • Benefits of Fasting in Ramadan
  • A. Better control of Diabetes
  • B. Better control of Hypertension
  • C. Better control of Lipid
  • D. 5-10 lb weight loss
  • Thus Fasting is advised for stable NIDDM

18
NIDDM- Recommendations
  • Control your Diabetes for two months prior to
    Ramadan bringing HbA1c to
  • Discontinue Metformin a week before fast
  • Drugs like Actos, Avandia , Glucotol XL are safer
    than Diabeta, Amyril , and Starlix
  • Continue Diabetic diet in Iftaar and Sahur

19
Fasting for those on Insulin
  • Consult your Diabetologist (Muslim) first
  • Discontinue Insulin mixtures such as 70/30 ,
    75/25, or Regular Insulin
  • If on NPH then reduce the total dose by 20 and
    take 2/3 at Iftaar and 1/3 at Sahur
  • If on Lantus then reduce by 20 and take at night
    -Titrate by 2 units ( BG 120-140)
  • Take 4-6 units of fast acting Insulin such as
    Novolog or Humalog before two meals

20
Monitoring for IDDM
  • Finger stick BG after Iftaar and before sahur
  • BG if feeling bad (low)
  • Terminate fast if BS below 60 or over 400
  • No exercise before Iftaar
  • Drink plenty of water at iftaar and Sahur

21
Questions from Muslims
  • Fasting and Pregnancy
  • Fasting and Nursing
  • Blood draw during Fasting
  • Medications during Fasting
  • -Tablets, inhalers, patches , injections
  • Exercise / Sports during Fasting
  • Mouth washes and gums during Fasting

22
References
  • Azizi , F et all Evaluation of blood hormones
    and constituents in Ramadan JIMA, Nov. 1987
  • Soliman , N Effects of Fasting during Ramadan
    JIMA Nov 1987
  • Athar, Shahid Management of NIDDM during Islamic
    Fasting in Ramadan JIMA vol 27 1995
  • Athar , Shahid Fasting for Medical
    Patients-suggested guidelines Islamic Horizon,
    May 85
  • Athar , Shahid Therapeutic Benefits of Ramadan
    Fasting Islamic Horizon May 84

23
Some Parting Thoughts
  • Fasting is for Me and I (Allah) only will reward
    it (Hadith Qudsi)
  • While fasting , if one does not give up
    falsehood in words and actions , then Allah has
    no need of him giving up food and drink (saying
    of Prophet Muhammad-pbuh)
  • HAVE A BLESSED RAMADAN

24
THANK YOU
  • WWW.IMANA.ORG
  • WWW.ISLAM-USA.COM
  • WWW.IIIM.ORG
  • SATHAR3624_at_AOL.COM

25
Salaam from Sheikh Deedat
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