Treating Patients During Ramadan


Religion often plays a role of importance in people’s lives. When those people are your patients, it’s vital for you to be aware when religious observances can affect their health.

For Muslims, the holy month of Ramadan (May 6-June 4, 2019) includes as one of its tenets fasting between dawn and sunset. Such a practice can be challenging for healthy people; patients who wish to engage in fasting vary from some who simply should not fast to others for whom modifications in their medications and/or habits will suffice.

Certain groups are considered exempt from the fast: the elderly; those who are pregnant, nursing, or menstruating; travelers; and the ill. Some observant Muslims who fall into one or more of these categories will wish to fast anyway. When you have such patients, you will want to be certain you provide guidance that helps them maintain both the fast and their health.

Diabetes

Diabetes affects approximately 90 million Muslims worldwide, and nearly 80 percent of them are believed to fast during Ramadan. For those with uncontrolled diabetes, Muslim scholars and physicians recommend against fasting. You will enhance the fast for your well-controlled patients with diabetes by going over their plans for Ramadan with them. Some such patients have occasionally eaten a too-large meal either before sunrise or after sunset, spurring a hyperglycemic episode. Explaining to your patients that they should eat two or three healthy meals divided between before sunrise and after sunset will reduce the likelihood of such episodes. Specific recommendations for modifying their insulin or non-insulin medications can be found here.

Cardiovascular diseases

Patients with a number of cardiovascular diseases that are either acute or not well controlled should not fast. For example, those who have recently undergone a cardiac intervention, including surgery, or who have had a recent myocardial infarction, who have decompensated heart failure, or whose high blood pressure is not controlled should be advised not to fast.

Well-controlled cardiovascular diseases, on the other hand, should not necessarily interfere with your patients’ fasting during Ramadan, although making medication changes at this time should be done with care. Introducing a diuretic to a newly-diagnosed patient with hypertension is problematic, while oral anticoagulants and statins can be continued. All patients should be advised to maintain a healthy diet throughout the lengthy period without food.

General advice for fasting  

Even for healthy Muslim patients, fasting can be stressful on the body. Here is some general advice for such patients from Lida Faroqi, DPM, director of clinical research, DISCOVeR Lab:

  • “Avoid dehydration, especially when Ramadan occurs in a hot season, by drinking ample amount of fluids between sunset and dawn;
  • maintain a well-balanced, healthy diet that is rich in fiber and low in salt and glycemic index;
  • if patients would like to exercise, encourage them to do so after sunset;
  • have structured and consistent lifestyle modifications in order to avoid rapid weight gain after Ramadan ends.”

In addition, she says, “it is important to be knowledgeable about the basics of Ramadan, exemptions from fasting, treatments and procedures that invalidate fasting, and the effects of fasting on managing diabetes and cardiovascular and other common diseases.” 

While the purpose of fasting during Ramadan is spiritual, its observation can challenge the physical health of those who fast. Discussing their plans for Ramadan with your observant Muslim patients may forestall exacerbations of their illnesses and contribute to them achieving important spiritual goals.

Learn More

View Lida Faroqi’s comprehensive guide to patient care during Ramadan here:

http://med.stanford.edu/content/dam/sm/care/RAMADAN-2019-Faroqi.pdf