The most important issue in Islam after prayers and Zakat, is fasting during Ramadhan which is one of the five pillars of Islam as mentioned in the Hadith of the Prophet (peace be on him):
“Islam is based on five pillars; (1) To testify that there is no God except Allah, and Muhammad is the Messenger of Allah (2) To offer Salat (prayer). (3) To pay Zakat (obligatory charity) (4) To observe Saum (fasting during the month of Ramadan) and (5) to perform Hajj ( pilgrimage to Makkah).”
In Islam, fasting is unique due to the following reasons:
1. As compared to other diet plans, in fasting during Ramadan, there is no malnutrition or inadequate calorie intake since there is no restriction on the type or amount of food intake during Iftaar or Sahar. This was confirmed by M.M.Hussaini during Ramadan 1974 when he conducted dietary analysis of Muslim students at the University of North Dakota State University at Fargo. He concluded that calorie intake of Muslim students during fasting was at two thirds of NCR‐ RDA.
2. Fasting, in Ramadan is voluntarily undertaken. It is not a prescribed imposition from a physician. In the hypothalamus part of the brain there is a center called “lipostat” which controls the body mass. When severe and rapid weight loss is achieved by starvation diet, the center does not recognize this as normal and, therefore reprograms itself to cause weight gain rapidly once the person goes off the starvation diet. So the only effective way of losing weight is slow, self-controlled, and gradual weight loss by modifying our behavior, and the attitude about eating while eliminating excess food. Ramadan is a month of self‐ regulation and self‐training in terms of food intake thereby causing hopefully, a permanent change in lipostat reading.
3. In Islamic fasting, we are not subjected to a diet of selective food only (i.e. protein only, fruits only etc). An early breakfast, before dawn is taken and then at sunset fast is broken with something sweet i.e. dates, fruits, juices to warrant any hypoglycemia followed by a regular dinner later on.
4. Additional prayers are prescribed after the dinner, which helps metabolize the food. Using a calorie counter, Calories burnt during extra prayer called Taraweeh is about 200 calories. Islamic prayer called Salat uses all the muscles and joints and can be placed in the category of a mild exercise in terms of caloric output.
5. Ramadan fasting is actually an exercise in self-discipline. For those who are a chain smoker, or nibble food constantly, or drink coffee every hour, it is a good way to break the habit, hoping that the effect will continue after the month is over.
6. Psychological effect of Ramadan fasting are also well observed by the description of people who fast. They describe a feeling of inner peace and tranquility. The prophet has advised us:
“If one slanders you or aggresses against you, tell them I am fasting”. Thus personal hostility during the month is minimal.
It is of much importance that some of the diseases that are associated with fasting must be mentioned so as to clear out some misconceptions.
Obesity and high blood pressure
Victims of these diseases are encouraged to fast since fasting may help to lower their weight and blood pressure respectively. They should see their physician to adjust medicines. For example, the dose of water pill (diuretic) should be reduced for fear of dehydration and long acting agents like Inderal LA or Tenormin can be given once a day before Sahar. Those with severe hypertension or heart diseases should not fast at all.
Pregnant Women (Normal Pregnancy); this is not an easy situation. Pregnancy is not a medical illness; therefore, the same exemption does not apply. There is no mention of such exemption in Qur’an. However, the Prophet said the pregnant and nursing women do not fast. This is in line with Allah not wanting anyone, even a small fetus, to suffer. There is no way of knowing, the damage to the unborn child until the delivery, and that might be too late. In my humble opinion, during the first and third trimester (three months) women should not fast. If however, Ramadan happens to come during the second trimester (4th‐6th months) of pregnancy, women may elect to fast provided that her own health is good, and (2) it is done with the permission of her obstetrician and under close supervision. The possible damage to the fetus may not be from malnutrition provided the Iftar and Sahoor are adequate, but from dehydration, from prolonged (10‐14 hours) abstinence from water. Therefore it is recommended that Muslim patients, if they do fast, do so under medical supervision.
Those with Migraine Headache: Even in tension headache, dehydration, or low blood sugar will aggravate the symptoms, but in migraine during fasting, there is an increase in blood free fatty acids, which will directly affect the severity or precipitation of migraine through release of Catecholamines. Patients with migraines are advised not to fast.
Diabetic Patients who are controlled by diet alone can fast and hopefully with weight reduction,
their diabetes may even be cured or at least improved. Diabetics who are taking oral hypoglycemia agents along with the diet should exercise extreme caution if they decide to fast. They should reduce their dose to one‐third, and take the drug not in the morning, but with Iftar in the evening. If they develop low blood sugar symptoms in the daytime, they should break the fast immediately. Diabetics taking insulin should not fast. If they do, at their own risk, they should do so under close supervision and make drastic changes in the insulin dose. For example, eliminate short acting Insulin altogether and take only NPH or Lantus Insulin after Iftar or before Sahoor.
Diabetics, if they fast, should still take a diabetic diet during Iftar, Sahoor and din‐ner. The sweet snacks common inRamadan are not good for their disease. They should check their blood sugar before breakfast and after ending their fast. Diabetic Patients: Diabetics who are controlled by diet alone can fast and hopefully with weight reduction, their diabetes may even be cured or at least improved. Diabetics who are taking oral hypoglycemia agents along with the diet should exercise extreme caution if they decide to fast.
Frequent vomiting also may cause dehydration which may become worse when one is fasting.
[Fasting for] a limited number of days. So whoever among you is ill or on a journey the prescribed number (Should be made up) from days later (Qur’an 2:184)