The document discusses Ramadan, the Islamic holy month of fasting. It provides religious context for fasting from verses in the Quran and explains the various dimensions of fasting including behavioral, religious, social and spiritual. It discusses requirements of fasting from dawn to sunset and exceptions. It also provides health recommendations for fasting including types of foods to consume for Iftar (evening meal) and Sahoor (pre-dawn meal) as well as staying hydrated. The document is aimed at providing guidance to Muslims observing Ramadan on how to fast safely based on research, especially for those with medical conditions like diabetes.

1. Ramzan 2012
How blessed you are to be a Muslim and able to
practice self control via a basic human need like
food and drink, while receiving the blessings of
God at the same time and improving your health.
Ramzan Mubarak.

3. Quran 2:183
To those who believe, fasting is decreed upon
you as fasting was decreed upon those before
you so that you may become righteous.

4. Quran 2:184
A limited number of days. For those whoever
among you is ill or on a journey - an equal
number of days from other days.
And upon those who are able to fast, but with
hardship - a ransom of feeding a poor person for
each day they do not fast. And whoever
volunteers to give more - it is better for him.
But to fast is best for you, if you only knew it.

5. Quran 2:185
The month of Ramadan in which the Qur'an was
revealed, a guidance for the people and clear
proofs of guidance and criterion. So whoever
sees the month, let him fast it; and whoever is ill
or on a journey - then an equal number of other
days. Allah intends for you ease and does not
intend for you hardship and for you to complete
the period and to glorify Allah for that which He
has guided you. And perhaps you will be
grateful.

7. Six Pillars of Faith
Believing in
The uniqueness of God
The Angels
The Revealed Books of God
The Messengers of God
The Day of Judgment, Resurrection, and
Afterlife
Divine Destiny including human free-will

9. Ramadan & Fasting
Five Pillars of Islam
Testimony of Faith
Daily 5 Time Prayer
Fasting during Ramadan
Alms-giving (Obligatory Annual
Charity)
The Pilgrimage to Mecca

11. The Month RAMADAN
The ninth month of the Islamic lunar
calendar.
Muslims are required to fast from dawn
to sunset.

13. The Requirements
Abstaining from
Food
Drink
Intimate Intercourse
s not only to restrain from food and drink, fasting is to refrain from ob
Hadith (Prophetic Tradition)

15. The Four Dimensions of Ramadan
The behavioral dimension
The religious dimension
The social dimension
The spiritual dimension

17. The behavioral dimension.
Fasting in Ramadan
is a means of
learning self-control

19. The religious dimension.
Fasting is a way of
experiencing hunger
and thus learning
sincere thankfulness
and appreciation for all
of God's bounties.

21. The social dimension.
Ramadan is a time for developing empathy/sympathy for the less
fortunate and generosity
People are more generous, more cordial, and more ready than at
other times of the year to do good and charitable work.

23. The spiritual dimension.
Fasting during Ramadan is an act of
obedience.
It leads to sincere thankfulness, which is the
heart of worship.
It also empowers our spiritual side over our
physical tendencies.

25. Ramadan is about…
Ramadan is a time of
intensive worship and devotion to God,
of reading The Qur`an and Reflecting
on its teachings,
of comprehensive thanksgiving,
giving to charity,
practicing self-control and kindness,
of training oneself to be a better person
spiritually and
improving relationship with others.

27. ISLAM
Islam is the religion that is articulated by Qur’an
and the prophet of Hz.Muhammed.
Islam started to evolve by the 7th century . In
610. At the age of 40, Hz.Muhammad started
receiving revelations from God.
These revelations are sent to Hz.Muhammed
from God by means of the Angel Gibreel.

29. Fasting
ing, drinking, and sexual intercourse from dawn ezan to dusk ezan
elations started to be sent on Ramadan.

31. Iftar Dinner
At sunset,the family get together and have the fast breaking
dinner called ‘iftar’. Iftar Dinner is important for us. People
generally invite their relatives, neighbours for iftar dinner.This
helps to improve relations.All of them sit around the table and
wait for dusk ezan and there is also Ramadan cannon in some
countries. The purpose of the cannon is to signal the Muslims
that the daily Ramadan fast is over and the iftar, their long-
awaited evening sustenance, is at hand

33. Date
Date is very important for the Islam Food Culture.Date is a fruit
which mentioned in Quran and it is also healthy fruit.
When dusk comes most people prefer eating date.It is the Sunna
(the sayings and doings of Mohammed , which form a
basis).breaking the fast with olive or date is welcomed.

35. Iftar Starters
Iftar Dinner starts with kinds of starters.The most important ones are
date and olive.

37. Iftar Suggestions
A warm soup for iftar is usually recommended
Drinking sufficient water and juices between Iftar and bedtime is
useful to avoid dehydration and for detoxification of the digestive
system
For the pre-dawn meal, a milk-based food which is slow-digesting is
recommended. Yoghourts are popular for this meal

39. Soups
Soup is recommended for the Iftar

41. Vegetable Food
For starters vegetables are also recommended however many
people indulge in heavy fried foods.
It is better to start of with light in the iftar so you do not
overwhelm your digestive system.

43. Salads
Salad and season salads are recommedned
during iftar.

45. Fruit Desserts
Fruit desserts are recommeded at after the end
of the iftar dinner.
Try to avoid junk food with complex chemicals
like titanium dioxide or sodium benzoate.

47. Sahur
It is an Islamic term referring to the meal Sahur, the
big early-morning meal to be eaten before the fast
begins again at sunrise. had early in the morning.

49. Sahur
Try to eat food that doesn't digest quickly... like a hot
cup of milk with a whole wheat bagel and cheese (it
holds up for long before being digested) also for
water, it's always good to take watery fruits or
vegetable such as watermelon or cucumber and
lettuce as the body can use the water longer than
simply a cup of water.

51. Sahur
Most experts recommend a light Suhur that may
include complex carbohydrates that are found in
foods that contain grains and seeds like barley,
wheat, oats, millet, semolina, beans, lentils,
whole meal flour and unpolished rice

53. Suggestions
It is recommended that people should drink plenty of
water during Suhoor and Iftar, along with a balanced
diet made up of vegetables, fruits, protein, milk,
yogurt and some saltine snacks.

55. Suggestions
One should also sleep well and have rested before
going to work, and wear clean light-weight and loose
fitting clothing.

56. Suggestions
Get a high intake of water during non-fasting hours
to overcome heat stress and replenish the low levels
of water in one’s body during this time.

57. Social Benefits Of Ramadan
Ramadan help people examine their lives, to remind
themselves of virtues like charity, compassion and
forgiveness, and to avoid vices like cupidity, selfishness
and dishonesty People help the poor people.Most of the
people go to the mosques and they feel themselves closer
the god.
Since the focus of Ramadan is to deprive oneself of
worldly things, charity and giving are strongly encouraged.
Many Muslims give a portion of their earnings to charity so
as to aid the poor and suffering; others purchase food,
clothing and gifts for the needy.

58. m:
hid Athar, MD, FACP, FACE
hor, “Islamic Perspective in Medicine” (

59. Ramadan Fasting and
Muslim Patients

60. 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”

61. Quran 2:183
“ 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)”

62. 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

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

64. 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

65. 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

66. 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 <40mg/dl)
Increase Gluconeogenesis in liver

67. 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

68. 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

69. 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)

70. 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

71. 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)

72. 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

73. 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 .

74. Fasting for NIDDM (ref:3)
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

75. NIDDM- Recommendations
Control your Diabetes for two months prior to
Ramadan bringing HbA1c to < 8
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

76. 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

77. 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

78. 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

79. 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

80. 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

81. Ramzan Mubarak
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