Tips for Health Care and Guide

Professionals.

Guidance notes on the Muslim fast during Ramadan

The Muslim fast during the month of Ramadan provides 

an opportunity for health professionals to promote 

health improvement among Muslims by offering lifestyle 

advice on topics such as diet and smoking cessation. 

      It is important to recognize that the Muslim community, 

like any other, is diverse. This results in differences of 

perception and practice among Muslim patients. The 

start of Ramadan advances 11 days every year as it is 

based on a lunar calendar and will sometimes fall in the 

summer months, resulting in a more onerous fast than 

when it is in the winter months. In 2007 Ramadan starts 

in mid-September.

     Fasting during Ramadan is intended as a discipline and 

requires abstinence from anything taken orally during 

the hours of daylight, each consecutive day for a month. 

This includes water and smoking. Bleeding will also 

preclude the fast for that day. Fasting is a requirement 

after puberty for all able-bodied Muslims of sound mind 

and good health, but there are concessions for those 

who are on a journey or who are ill, as well as for women 

during menstruation, pregnancy or breastfeeding. The 

concessions range from a complete exemption from 

fasting, for example for insulin-dependent diabetics, 

to a requirement to make up the fast at a later date in 

the case of those who are travelling or who have their 

periods.

      A charitable contribution as compensation can 

serve as an alternative to keeping the fast later. 

Since the month of Ramadan is an important time across 

the community, many patients will endeavor to keep 

their fasts during this time. With some conditions, this 

can clearly be harmful. The concessions exist specifically 

to ensure that people do not fast where it would be 

detrimental to their health, and this is very reasonable 

advice to give to patients and made up later.

(eg ophthalmic, dermatological, neurological), fasting 

may have no impact and can continue as normal. If 

oral medication is required, fasting can be facilitated 

by reducing dosing to once or twice daily. Topical 

medication, including patches, is acceptable, but 

injections are not as they may draw blood. 

     On diseases affecting the cardiovascular, renal and 

gastrointestinal systems, such as hypertension, renal 

impairment and peptic ulcers. Although fasting is possible 

in many of these circumstances, it may not be well 

tolerated physiologically, particularly in older patients – and 

these may be the very patients who are most adamant 

that they wish to perform their fasts. In some cases where 

a chronic illness has taken a long while to stabilize and 

maintain, adjusting medication around the hours of fasting 

may simply be impractical and potentially harmful.

Nutrition and hydration are paramount and, while fasting 

is permissible, it is medically better for the mother to 

utilize the concession and compensate for or make up 

the missed fasts.

    Examinations, do not invalidate the fast. Clinical 

investigations such as blood tests, or those requiring 

intravenous access or oral contrast, would preclude 

the fast during those particular days. Where these are 

elective outpatient investigations, many patients may 

prefer to reschedule them outside Ramadan. Urgent 

investigations should clearly not be delayed.

   Each situation needs to be judged on its own merits, in 

the context of the patient’s observance of Ramadan. 

   A comprehensive guide is not possible, but the examples 

above serve to illustrate that there is Islamic guidance to ensure that fasting is not prejudicial to a patient’s health.

Poor control of diabetes

    Those injecting insulin are advised not to fast, as the potential 
risk to health, both in the short and long term, of not taking 
insulin is too great. 
People who have their diabetes under control using tablets
 should ensure that they visit their GP prior to Ramadan, in 
order to discuss any possible changes to their drug regime 
 which would facilitate a safe fast. If not, such patients are 
at risk of poor control of their diabetes during and outside the fasting times.
   Regular self-monitoring of your blood glucose is strongly 
advised. Low blood sugar levels (a ‘hypo’) are dangerous, and if untreated may lead to fainting or fits, and hence must be 
strictly avoided. Feeling dizzy, sweaty and disorientated may 
all suggest a hypo. If this is suspected, you should immediately 
have a sugary drink, or place sugar or a sugar-rich sweet below the tongue.
Long-acting tablets, such as Glibenclamide, increase the risk 
of having a hypo, and should be changed to a shorter-acting 
variety before you embark on a fast.
Diabetics with further complications, such as angina or heart 
failure, stroke, retinopathy (eye disease), nephropathy (kidney 
disease) or neuropathy (nerve disease of feet/hands with 
numbness/loss of feeling) should seek careful advice from their doctor before starting a fast