An Anthology of Religious Observances: Ramadan, Eid al-Fitr, and Fasting with Chronic Conditions

Ramadan is the ninth month on the Islamic lunar calendar and is believed to be the month in which the Holy Qur’an was revealed to the Prophet Muhammad (Peace Be Upon Him). During Ramadan, Muslims fast from dawn to dusk. Not only do they abstain from eating and drinking, but they are also encouraged to pray more often, read more Qur’an, and give to charity. Muslims wake up before dawn to eat a meal called suhoor. The fasting period lasts from dawn to dusk, after which Muslims can break their fast during a meal called iftar. Different cultures around the world have different traditions for what they eat during suhoor and iftar, however, Muslims usually break their fast with dates, as recommended by Prophet Muhammad (PBUH). In Islam, fasting is considered an act of worship to God, allowing individuals to become more compassionate to the needy, break bad habits, and put good deeds into everyday practice.

Eid al-Fitr is an Islamic celebration that marks the end of Ramadan. “Eid al-Fitr” translates to “the festival of breaking the fast”. Eid al-Fitr starts with a communal prayer at an Islamic place of worship known as the Masjid or Mosque, followed by visiting the graves of relatives who have died, giving charity, exchanging gifts, and eating special and ethnic foods with loved ones. Additional activities include staying up the night before Eid for the moon sighting and applying henna. The moon sighting is completed by different Islamic committees that look for the crescent moon in the sky which signifies that Eid has begun. All in all, Eid al-Fitr is a much-anticipated Islamic holiday that Muslims look forward to all year long!

Fasting with Chronic Conditions

Diabetes

Muslims with diabetes may choose to fast during Ramadan and should consult their doctor on how to manage diabetes while fasting. People with diabetes should avoid eating foods that are high in fat or sugar (such as fried snacks and ghee) during Ramadan and outside of Ramadan. Rather, they are advised to eat complex carbohydrates at suhoor and simple carbohydrates and foods with low glycemic indices when breaking their fast at iftar. Grains, wheat, and rice are best for eating before and after fasting, as they release energy slowly.

High Blood Pressure

People who take medication for high blood pressure or hypertension and choose to fast during Ramadan should consult their doctor before fasting. Their doctor can help determine if they need to adjust their medication doses and figure out the best times to take medication either during suhoor or iftar. At all times of the year and especially during Ramadan, both healthy people and people with high blood pressure should avoid foods that are high in salt or sodium (such as salted nuts and processed meats) as these foods increase blood pressure. Patients are recommended to consume less stimulants such as caffeine and to drink lots of water and fluid during suhoor to maintain their blood pressure and avoid dehydration.

Chronic Kidney Disease

A major concern for Muslims with chronic kidney disease concerns observing Ramadan. People who have chronic kidney disease, who are on dialysis, or who received a kidney transplant should consult their doctor before fasting. It is important to follow your doctor’s advice and to review medication and eating schedules before committing to fast during Ramadan. It is not a good idea to fast if a person with chronic kidney disease is peeing frequently or suffers from recent or rapidly worsening kidney injury. If a person experiences rapid weight loss or weight gain, swelling in their face, new or worsening swelling in their lower limbs, fatigue and shortness of breath, or any other new symptoms while fasting during the day, they should stop fasting and consult a doctor as these symptoms may signal nutrient imbalances or other health concerns. When breaking the fast, people with chronic kidney disease should avoid or eat less of foods that are high in sodium, potassium, and phosphates (like dates, apricots, fried foods, beans, and carbonated drinks). People are recommended to drink 1-2 liters of water when breaking their fast to rehydrate while also taking care not to drink in excess, especially if they are on dialysis. Finally, people with chronic kidney disease should not fast without first eating suhoor, the pre-dawn meal, to make sure they have enough energy and fluid balance before starting to fast for the day.

Written by: Aysha Afzal, Tibyan Ahmed, Noor Al Kaabi, Junayd Hussain, Hadia Rafiqzad

Medical advice reviewed by Dr. Istvan Mucsi

References

Advice for Kidney Patients during Ramadan. (n.d.). Retrieved September 06, 2020, from https://www.hamad.qa/EN/your health/Ramadan Health/Health Information/Pages/Kidney-Patients.aspx

Abolaban, H., & Al-Moujahed, A. (2017). Muslim patients in Ramadan: A review for primary care physicians. Avicenna journal of medicine, 7(3), 81–87. https://doi.org/10.4103/ajm.AJM_76_17

Ahmad, S., & Chowdhury, T. A. (2019). Fasting during Ramadan in people with chronic kidney disease: a review of the literature. Therapeutic advances in endocrinology and metabolism, 10, 2042018819889019. https://doi.org/10.1177/2042018819889019

Augustyn, A. (Ed.). (2020, April 23). Eid al-Fitr. Retrieved September 06, 2020, from https://www.britannica.com/topic/Eid-al-Fitr

Bragazzi N. L. (2014). Ramadan fasting and chronic kidney disease: A systematic review. Journal of research in medical sciences : the official journal of Isfahan University of Medical Sciences, 19(7), 665–676.

Karamat, M. A., Syed, A., & Hanif, W. (2010). Review of diabetes management and guidelines during Ramadan. Journal of the Royal Society of Medicine, 103(4), 139–147. https://doi.org/10.1258/jrsm.2010.090254

Shao, Y., Lim, G.J., Chua, C.L., Wong, Y.F., Yeoh, E.C.K., Low, S.K.M., & Sum, C.F. (2018). The effect of Ramadan fasting and continuing sodium-glucose co-transporter-2 (SGLT2) inhibitor use on ketonemia, blood pressure and renal function in Muslim patients with type 2 diabetes. Diabetes Research and Clinical Practise, 142, 85-91. https://doi.org/10.1016/j.diabres.2018.05.022