fasting associated adverse effects

Islamic Fasting associated Adverse Effects

Dr P. Naina Mohamed PhD

Pharmacologist

Introduction The Prophet Muhammad (PBUH) said that fasting is a shield which protects a person from sin

and lustful desires.

Islamic fasting is observed during the holy month of Ramadan.

Apart from Ramadan, Muslims are encouraged to observe fasting on the following days too…

The 9th and 10th , or 10th and 11th days of Muharram (First month of Islamic Calendar).

Any 6 days of Shawwal (Tenth month of Islamic Calendar).

Mondays and Thursdays of every week, if possible.

13th, 14th, and 15th day of every Islamic month.

9th day of Dhu'I-Hijja (12th Month of Islamic Calendar).

During the months of Rajab (7th month) and Sha'aban (8th month) before Ramadan, if possible.

Devoted Muslims keep themselves refrain from food, drinks, smoking and sexual activities from the dawn to the dusk, during Ramadan Fasting.

Fasting helps to control one's desires and to focus more on devoting Allah (swt).

Islamic Fasting Islamic fasting is similar to Alternate Day Fasting (ADF), since the feast and fast periods of Islamic fasting lasts 12 hours in

average.

Animal studies have been shown that Alternate Day Fasting (ADF) extend the lifespan and prevent the development of

Cardiovascular disease (CVD) (Reduction of Cholesterol levels, Heart rate and Blood Pressure)

Diabetes (Improved insulin sensitivity)

Kidney disease

Cancers (Decreased Inflammation, Pro-inflammatory cytokines IL-1b, IL-6, Tumour Necrosis Factor)

https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-9-57

http://ajcn.nutrition.org/content/86/1/7.long

Islamic fasting is a healthy non pharmacological means for minimizing the risk factors and improving health.

Islamic Fasting can also provide other health benefits such as

Detoxification

Higher levels of endorphins

Regeneration of immune cells (Damaged Immune cells are recycled to save energy)

Overcome Addictions (Smoking, Caffeine, etc)

Weight loss (Reduction of waist circumference, Body Mass Index, Body fat)

https://www.ncbi.nlm.nih.gov/pubmed/26013791


http://ajcn.nutrition.org/content/86/1/7.long


Physiology of Fasting

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2909082/

Islamic FastingAbstinence from Food and Drinks

Decreased glucose level

Suppression of Insulin secretion

Secretion of Glucagon and

Catecholamines

Glycogenolysis(App 12 hrs of

fasting)

Release of Fatty acids from Adipocytes (Lipid

cells) for Gluconeogenesis and

Ketogenesis

Remaining glucose is reserved for the

metabolism of Brain cells and RBCs &

Ketone bodies serve as alternative body fuel for numerous cells


Islamic Fasting associated Adverse Effects

Dehydration

Headache

Hypoglycemia

Heartburn

Constipation

Muscle cramps

Anemia

Dehydration

Though Islamic fasting is associated with Dehydration, there was no detrimental effects on health attributed directly to intermittent negative water balance.

http://www.nature.com/ejcn/journal/v57/n2s/full/1601899a.html

Islamic FastingNo fluid intake during fasting

hoursDehydration


TIPS to minimise Fasting associated Dehydration

Drink enough water and fluids between Iftar and Suhour.

Consume more fruits and vegetables with high water content like Watermelon, Tomatoes, Cucumber, Grapes, etc.

Avoid Salty and spicy foods which increase the feeling of thirst.

Avoid consuming high fat and fried foods especially at Suhour which may lead to thirst.

Eat less or no sweets which increase thirst.

Avoid Caffeinated beverages like energy drinks. Caffeine can increase the fluid loss and thirst due to its Diuretic activity.

Minimise or avoid smoking which slows down salivation and induce Dry mouth and Thirst.

Avoid direct sun exposure to reduce sweating.

Indulge in physical activity only during non fasting hours to replenish lost fluids during exercise.



Headache

Lack of sleep, Stress and Dehydration may also contribute to the Fasting associastedHeadache.

It affects at least 40% of the fasting individuals mainly of headache prone individuals.

Duration of fasting increases the frequency of Headache.

https://link.springer.com/article/10.1007%2Fs11916-010-0119-5

Islamic Fasting

Caffeine withdrawal & Hypoglycemia

Headache

https://link.springer.com/article/10.1007/s11916-010-0119-5

TIPS to minimise Fasting associated Headache

Reduce the consumption of Tea, Coffee and Cigarette gradually one or two weeks before Ramadan.

A cup of strong coffee at Suhour (Pre-dawn meal) may prevent Ramadan headache occurring due to caffeine withdrawal.

Eating foods with low glycaemic index value would minimise the risk of headache induced by Hypoglycemia.

Drink large amounts of water and fluids between Iftar and Suhour to avoid headache induced by Dehydration.

Sleep at least 7 hours a day.

Hypoglycemia


Islamic fasting

Decreased food intake and Consuming too

much refined carbohydrates at suhour

Hypoglycemia


TIPS to prevent Hypoglycemia

Predawn (Suhour) meal is a must to prevent the risk of Hypoglycemia.

At Suhour, eat more complex carbohydrates (Slow-digesting foods) such as barley, wheat, oats, beans, lentils, brown rice and nuts.

Avoid quickly digestible foods containing sugar, white flour or other refined carbohydrates.

Avoid consuming Sweets at suhour.

Eat vegetables such as broccoli, cucumber, and carrots which provide fiber and essential nutrients.

Drink enough water and fluids between Iftar and Suhour.

Avoid excessive physical activity while fasting.

Get enough sleep.

Heartburn

Consuming a high volume of food, especially during the Iftar meal, may increase the risk of Heartburn and GERD.


Islamic FastingBulky, Fatty and

fried foodsDelayed gastric

emptyingHeartburn


TIPS to minimise Heartburn

Avoid spicy, bulky and fatty foods to prevent heartburn induced by Ramadan fasting.

Avoid carbonated drinks which may increase gastric acidity.

Avoid eating a lot at once. Divide iftar meals in two portions.

Drink a glass of Milk which may help to minimise Heartburn.

Do not lie down right after meals.

Avoid excessive use of Analgesics.

Take Antacids, if required.

Limit or Quit Smoking.

Constipation

Constipation may result due to the consumption of Less fibrous diet, too much refined foods and too little water.


Islamic fastingChanges in Diet

and Sleep patterns

Irregular and decreased bowel

movement Constipation


TIPS to reduce Constipation

Avoid excessive refined foods such as Paratha and other Maidha made foods.

Consume Slow-digesting and more fibrous foods like whole grains such as Oats, Pulses, Wheat, Lentils, Flax seeds, etc.

Eat fiber-rich fruits like Apples, Bananas, Papayas, Passion fruit, Figs, Avocados, etc.

Have snack on fiber-rich dried fruits (Dates , Dried apricots, Figs, Prunes).

Increase fiber-rich vegetables like Beans, Peas and Chickpeas.

Drink large quantities of fluids like Water, Fresh fruit juices, Vegetable soups, etc.

Probiotics like yoghurt helps in preventing constipation.

Get moving and maintain the activity level.

Muscle cramps

Low levels of minerals such as Potassium, Sodium, Calcium, and Magnesium can contribute to cramps.

Fluids keep muscle cells hydrated and less irritable and help muscles contract and relax.

Islamic fasting

Inadequate Liquids and

foods containing minerals

Decreased Potassium, Sodium,

Magnesium and Calcium

levels

Muscle cramps

TIPS to prevent Muscle cramps

Drink plenty of fluids, preferably fruit and vegetable juices, Soups and dairy drinks.

Drink more water to avoid dehydration and cramps.

Eat foods rich in minerals such as Vegetables, Fruits, Dairy products, Meat and Dates.

Dates are a very good source of dietary potassium and it has a wide range of essential nutrients such as protein, fiber, Iron, calcium, magnesium, selenium, boron, cobalt, copper, fluorine, manganese, and zinc.

Magnesium rich foods include whole-grain breads and cereals, nuts, and beans.

Potassium found more in fruits and vegetables, especially bananas, oranges, etc.

Good source of Calcium is Dairy foods.

Avoid sleeping toes pointed to prevent nighttime calf cramps.

Do not tuck in bed sheets too tightly to avoid bending toes downward.

Anemia

Consume more amount of iron-rich foods (Dates, Dried Apricots, Raisins, Nuts, red meat, Soya bean, Spinach, etc.) to avoid the risk of Anemia during the month of Ramadan.

https://www.nature.com/ejcn/journal/v60/n7/full/1602393a.html

Islamic Fasting

Decreased Hemoglobin (Hb),

Packed Cell Volume (PCV)and RBCs

Elevated risk of Anemia

https://www.nature.com/ejcn/journal/v60/n7/full/1602393a.html

TIPS to prevent Anemia

Eat Iron-rich foods such as Spinach, Broccoli, Apricot, Garlic, etc.

Dates are rich in iron and regular consumption of Dates helps in the formation of haemoglobin.

Include Lentils which are a good source of iron.

Iron found in animal products such as meat, poultry, and fish might be absorbed better by the body.

Plant source of iron include beans, pulses, and green leafy vegetables.

The absorption of Iron could be increased by eating with foods containing Vitamin C, such as lemon and tomato.

Avoid drinking coffee and tea with meals as this can reduce the amount of iron absorption.

Calcium-rich dairy products may interfere with the absorption of Iron.

Decreased Sleep Quality

Daytime sleepiness may result due to decreased sleep quality.


Islamic Fasting

Delayed meal time & High Protein (More than 50 gm) and

High Calorie (More than 1200 Kcal) food

at Iftar

Thermogenic effect

Increased bedtime body temperature

Decreased Sleep quality


TIPS to improve Sleep Quality

Avoid over eating before sleeping.

Performing wudu before bed may reduce body temperature.

Get exposed to sunlight especially in the first half of the day, to strengthen circadian rhythm.

Avoid or decrease exposure to artificial light.

Keep electronic devices such as Mobile phones, Tablets and Laptops out of the bedroom.

Maintain the bedroom quiet, dark, and a little bit cool.

Avoid sleeping on the back and sleeping on the side can improve the quality of sleep by reducing sleep apnea and snoring.

Maintain a regular bed time, even during weekends.

Avoid caffeinated drinks such as Energy drinks, Coffee, Tea, Cola drinks, etc. at least before 4-6 hours of bedtime.

Conclusion Though Islamic fasting is associated with some adverse effects, there was no detrimental effects on

health attributed directly to them, in health individuals. And the adverse effects of fasting could be minimized very easily by following the preventive measures.

The chronic patients with Diabetes, Coronary Artery Disease (CAD), Cancer, Ulcer, Urolithiasis, Chronic Kidney Disease (CKD), etc. should consult the healthcare professionals before observing Fasting.

Moreover, Islam exempts the Sick, Travelers and Pregnant, Breast Feeding and Menstruating women from fasting.

Islamic Fasting can be good for health if it's done correctly. And it causes many physiological, biochemical, metabolic and spiritual changes in the body.

Eat a balanced diet containing fruit and vegetables, wholegrains, pulses, meat, fish, milk and dairy foods, etc.

Avoid eating deep-fried foods (Pakoras, Samosas, etc), Sweets (Gulab jamun, Rasgulla, etc.), Fatty foods (Parathas, Oily curries, Greasy pastries, etc).

Drink a lot of fluids like Water, Fresh fruit juices, Soups, etc.

References

Pharmacotherapy: A Pathophysiologic Approach, 10e

Joseph T. DiPiro, Robert L. Talbert, Gary C. Yee, Gary R. Matzke, Barbara G. Wells, L. Michael Posey

Physical Therapy Ethics

Donald L. Gabard, Mike W. Martin

Improvised Medicine: Providing Care in Extreme Environments, 2e

Kenneth V. Iserson

Maingot's Abdominal Operations, 12e

Michael J. Zinner, Stanley W. Ashley

Fasting In Islam And The Month Of Ramadan

Ramadanali

References




http://onlinelibrary.wiley.com/doi/10.1046/j.1526-4610.1999.3907490.x/full

https://thejournalofheadacheandpain.springeropen.com/articles/10.1007/s10194-010-0242-z


http://jpma.org.pk/supplement_details.php?article_id=179







http://onlinelibrary.wiley.com/doi/10.1046/j.1526-4610.1999.3907490.x/full

https://thejournalofheadacheandpain.springeropen.com/articles/10.1007/s10194-010-0242-z


http://jpma.org.pk/supplement_details.php?article_id=179




fasting associated adverse effects

Health & Medicine