Page 20 - Urdu Link - May 25, 2018

P20 – PAKISTAN LINK – MAY 25, 2018 COMMENTARY
n By Shahid Athar, MD, FACP, Ramadan Fasting and Muslim Patients
FACE like Inderal LA or Tenormin can
Indiana be given once a day before Sahar.
Those with severe hypertension or
uslims worldwide ob- heart diseases should not fast at all.
serve total fasting (no Those with Migraine Head-
Mfood or water) between ache: Even in tension headache,
dawn to sunset in the month of dehydration, or low blood sugar
Ramadan. They do will aggravate the symptoms, but in
so not for losing migraine during fasting, there is an
weight or any medi- increase in blood-free fatty acids,
cal benefit, but as which will directly affect the se-
fasting is ordained verity or precipitation of migraine
in the Qur’an which through release of Catecholamines.
says. Patients with migraines are advised
“O you who believe! Fasting not to fast.
is prescribed to you, as it was pre-
scribed for those before you (i.e. Pregnant Women (Normal
Jews, & Christians) so that you may Pregnancy): This is not an easy situ-
(learn) self-restraint.”(2:183) ation. Pregnancy is not a medical
According to Islamic laws, illness, therefore, the same exemp-
children below the age of 12, sick tion does not apply. There is no
patients, travelers, and women who mention of such exemption in the
are menstruating or nursing a baby, Holy Qur’an. However, the Proph-
are exempt from fasting. Besides et said the pregnant and nursing
staying away from food or water for women do not fast. This is in line
the whole day, they are asked to stay with God not wanting anyone, even
away from sex, smoking or miscon- a small fetus, to suffer. There is no
duct during the period of fast. In way of knowing, the damage to the
addition, they are encouraged to do unborn child until the delivery, and
more acts of piety, i.e. prayer, char- that might be too late.
ity, or reading Qur’an during this tions were that Ramadan Fasting a mild exercise in terms of caloric eride before the commencement In my humble opinion, during
month. had beneficial effects on health, output. of Ramadan and at its end. I note the first and third trimester (three
Food is needed by the body to especially on blood Glucose, blood Ramadan fasting is actually an a marked improvement at the end. months) women should not fast.
provide energy for immediate use pressure, lipid profile and weight. exercise in self-discipline. For those As I am not overweight, thank God, If however, Ramadan happens to
by burning up carbohydrates, that No serious adverse effects were who are chain smokers, or nibble weight loss is minimal. The few come during the second trimester
is, sugar. Excess of carbohydrates noted (ref 7-10 ). food constantly, or drink coffee ev- pounds I lose, I regain soon after. (4th-6th months) of pregnancy, a
which cannot be used is stored up ery hour, it is a good way to break Fasting in Ramadan will be a great woman may elect to fast provided
as fat tissue in the muscles, and Why Islamic Fasting Is Dif- the habit, hoping that the effect will blessing for the overweight whether that (1) her own health is good, and
as glycogen in the liver for future ferent from Other Types of Fast- continue after the month is over. with or without mild diabetes (type (2) it is done with the permission of
use. Insulin, a hormone from the ing (ref. 7) Psychological effects of Rama- II). It benefits those also who are her obstetrician and under close su-
pancreas, lowers blood sugar and As compared to other diet dan fasting are also well document- given to smoking or nibbling. They pervision. The possible damage to
diverts it to other forms of energy plans, in fasting during Ramadan, ed by the observations of people can rid themselves of these addic- the fetus may not be from malnutri-
storage, that is, glycogen. To be ef- there is no malnutrition or inade- who fast. They describe a feeling tions in this month. tion provided the Iftar and Sahoor
fective, insulin has to be bound to quate calorie intake since there is no of inner peace and tranquility. The are adequate, but from dehydra-
binding sites called receptor. Obese restriction on the type or amount of Fasting for Medical Patients: tion, from prolonged (10-14 hours)
people lack receptor; therefore, food intake during Iftaar or Sahar. Diabetics who are Suggested Guidelines (ref. 10) abstinence from water. Therefore, it
they cannot utilize their insulin. This was confirmed by M.M. Hus- As mentioned earlier, patients is recommended that Muslim pa-
This leads to Insulin Resistance and saini (ref. 6) during Ramadan 1974 controlled by diet are exempt from fasting. But some tients, if they do fast, do so under
Glucose Intolerance. when he conducted dietary analysis alone can fast and do decide to fast. For physicians medical supervision.
When one fasts (or decreases of Muslim students at the Univer- hopefully with weight treating Muslim patients, the fol-
carbohydrate intake drastically), it sity of North Dakota State Univer- lowing guidelines are suggested: References
lowers his blood glucose and insu- sity at Fargo. He concluded that the reduction, their Diabetic Patients: Diabetics 1. Bistrian, B.R., “Semi-star-
lin level. This causes breakdown of calorie intake of Muslim students diabetes may even who are controlled by diet alone vation Diet Recent Development”,
glycogen from the liver to provide during fasting was at two-thirds of be cured or at least can fast and hopefully with weight Diabetic Care, November 1978.
glucose for energy need and break- NCR-RDA. improved. Diabetics reduction, their diabetes may even 2. Blackbum, G.L., et al., “Met-
down of fat from adipose tissue to Fasting in Ramadan is volun- be cured or at least improved. Dia- abolic Changes On PSMF diet,”
provide for energy needs. tarily undertaken. It is not a pre- who are taking oral betics who are taking oral hypogly- Diabetes, June 1976.
On the basis of the human scribed imposition by a physician. hypoglycemia agents cemia agents along with the diet 3. Cott, A., “Fasting Is A Way
physiology described above, semi- In the hypothalamus part of the along with the diet should exercise extreme caution of Life”, New York: Bantam Books,
starvation (ketogenic) diets have brain there is a center called “lipo- if they decide to fast. They should 1977.
been devised for effective weight stat” which controls the body mass. should exercise reduce their dose to one-third, and 4. Hirsch, Jules, “Hypothalmic
control. These diets provide calcu- When severe and rapid weight loss extreme caution if they take the drug not in the morning, Control of Appetite” Hospital Prac-
lated amount of protein in divided is achieved by starvation diet, the decide to fast. They but with Iftar in the evening. If they tices, February 1984.
doses with plenty of water, multi- center does not recognize it as nor- should reduce their develop low blood sugar symptoms 5. Khurane, R.C., “Modified
vitamins, etc. These effectively low- mal and re-programs itself to cause in the daytime, they should break Ketogenic Diet For Obesity”, Can-
er weight, blood sugar, but because weight gain rapidly once the person dose to one-third, and the fast immediately. Diabetics tak- cer Monthly Digest, July 1973.
of their side-effects, should be used goes off the starvation diet. So the take the drug not in ing insulin should not fast. If they 6. Hussaini, N.M., Journal of
only under the supervision of phy- only effective way of losing weight the morning, but with do, at their own risk, they should Islamic Medical Association, Octo-
sicians. is slow, self-controlled, and gradual do so under close supervision and ber 1982.
Total fasting reduces or elimi- weight loss by modifying our be- Iftar in the evening. make drastic changes in the insu- 7. Athar, S., “Therapeutic Ben-
nates hunger and causes rapid havior and the attitude about eating If they develop low lin dose. For example, eliminate efits of Ramadan Fasting “, Islamic
weight loss. In 1975, Allan Cott in while eliminating excess food. Ra- blood sugar symptoms short acting Insulin altogether and Horizon, May 1984.
his “Fasting as a Way of Life” noted madan is a month of self-regulation in the daytime, they take only NPH or Lantus Insulin 8. Soliman, N., “Effects of Fast-
that “fasting brings a wholesome and self-training in terms of food after Iftar or before Sahoor. DPP-4 ing During Ramadan”, Journal of
physiological rest for the digestive intake thereby causing, hopefully, a should break the fast inhibitor like Januvia which curbs Islamic Medical Association, No-
tract and central nervous system permanent change in lipostat read- immediately. Diabetics appetite can also be considered as it vember 1987.
and normalizes metabolism.” It ing. taking insulin should does not cause hypoglycemia. Dia- 9. F. Azizi, et al., “Evaluation
must be pointed out, however, that In Islamic fasting, we are not betics, if they fast, should still take of Certain Hormones And Blood
there are also many adverse effects subjected to a diet of selective food not fast a diabetic diet during Iftar, Sahoor Constituents During Islamic Fast-
of total fasting. That includes hypo- only (i.e. protein only, fruits only, and dinner. The sweet snacks com- ing Month”, Journal of Islamic
kalemia and cardiac arrhythmia as- etc). An early breakfast, before mon in Ramadan are not good for Medical Association, Nov. 1987.
sociated with low calorie starvation dawn, is taken and then at sun- Prophet has advised them: “If one their disease. They should check 10. Athar, S., “Fasting For Med-
diets used in unsupervised manner. set fast is broken with something slanders you or aggresses against their blood sugar before breakfast ical Patients - Suggested Guide-
sweet, i.e., dates, fruits, juices to you, tell them I am fasting”. Thus and after ending their fast. line,” Islamic Horizon, May 1985
Studies on Islamic Fasting warrant any hypoglycemia followed personal hostility during the month Hypertensive or Cardiac Pa-
There have been many studies by a regular dinner later on. is minimal. tients: Those who have mild to (Shahid Athar, MD, FACP,
on Ramadan Fasting. In 1996, an Additional prayers are pre- It is my personal experience moderate high blood pressure FACE, an endocrinologist, is author
international conference was held scribed after the dinner, which helps that within the first few days of Ra- along with being overweight should of “Islamic Perspective in Medicine”
in Casablanca, Morocco, under metabolize the food. Using a calorie madan, I begin to feel better even be encouraged to fast, since fast- (ATP) and “Health Concerns for
King Hasan Foundation for Health counter, I counted the number of before losing a single pound. I work ing may help to lower their blood Believers” (KAZI). (sathar3624@
in Ramadan and about 50 papers calories burnt during extra prayer more and pray more; physical stam- pressure. They should see their aol.com , www.islam-usa.com). He
were presented including those by called Traveeh. They amounted to ina and mental alertness improve. physician to adjust medicines. For is the recipient of 2011 Dr Ahmed
Dr Soliman ( Jordan ), Azizi (Iran), 200 calories. Islamic prayer called As I have my own lab in the office, I example, the dose of water pill (di- El-Kadi Award from Islamic Medi-
Naomani (USA) and Athar(USA). Salat uses all the muscles and joints usually check my chemistry, that is, uretic) should be reduced for fear of cal Association of North America
The conclusions of these presenta- and can be placed in the category of blood glucose, cholesterol, triglyc- dehydration and long acting agents (www.imana.org)
www.PakistanLink.com