Ramadan is a yearly event in the Islamic calendar, a holy month of prayer, reflection and sacrifice, and fasting is an important part of this. A strict fast means nothing to pass the lips during daylight hours – so no food, drink or smoking. Some include medications in this, but the Qur’an teaches that you should not act in a way that harms your health, which may leave you feeling in doubt about what to do. A set of guidelines has been put forward by specialists in the NHS, in collaboration with national groups representing Muslims, to protect your health during Ramadan. It’s important to remember that this is guidance. Your health and your personal beliefs are individual to you, so if you have any doubts about the right path forward, seek advice. You can speak to your healthcare team – your doctor or hospital specialist if you have one – and you can speak to your local Imam or any other Muslim leader that you trust.
Depending on the time of year and where you live in the world, Ramadan can mean fasting for anything from 11 hours to 22 hours. Muslim leaders say that you are not obligated to fast if it puts your health at risk, and especially for the summer months or hot climates, you may need to make adjustments to keep yourself well. So if you need to take medications at this time, for example, you are taking something such as antibiotics several times per day, diuretics (water tablets) or inhalers twice a day, or regular painkillers, it’s important to keep these spaced out. Accepted practice is that it is acceptable to break your fast for this if medications can’t safely be confined to the hours after dark. Diabetes poses a particular problem, as the aim is to keep blood sugar levels steady throughout the day for the best control. If you are on insulin or are on certain diabetic medications, you may be at risk of dangerously low blood sugar levels (hypoglycaemia) during your fasts. Fasting may pose an even greater risk if you have diabetic complications, such as eye disease, kidney or heart problems. If you still wish to fast with Type 1 diabetes or Type 2 insulin-dependent diabetes, you should discuss this with your diabetic team – your consultant or specialist nurse – so they can keep you safe. You may have to check your blood sugar levels much more often and adjust your insulin doses. Additionally, you need to be careful with any sugar surge when you break your fast after sunset, as this can also put your health at immediate risk with diabetic ketoacidosis. For diabetes controlled with diet alone, it’s safe to fast without the risk of hypoglycaemia. You can even use it as a chance to kick-start a healthy eating schedule or lose weight if that’s one of your goals – your doctor can discuss how best to go about this. If you are either elderly or very young, this can have implications for your health. Especially in hotter countries, you will put yourself at risk of dehydration, which can make you very unwell and put you at risk of urine infections and kidney problems. Children up to the age of puberty and the elderly or frail are not obligated to fast. Similarly, those with learning difficulties or mental health problems are exempt, and those who are pregnant.
Anyone who becomes sick during Ramadan should seek medical attention as usual, and your faith supports the view that your health needs come before maintaining your fast. It’s also accepted in the UK that cancer treatment such as chemotherapy or radiotherapy should continue during Ramadan. Sometimes people are invited for a screening test during the month of Ramadan – again, the accepted view is that this is important in looking after your health, even if you have no symptoms of cancer. So you should attend these appointments and follow any medical recommendations, such as taking medications for certain imaging tests or procedures. Appointments for non-urgent medical matters may be rearranged so as not to impose on prayer-time – discuss this with your healthcare provider or doctor to see what’s possible.
Diabetes UK suggests that if you’re showing any symptoms of COVID-19, you should not fast and you should focus on getting yourself better. The Muslim Council of Britain has added frontline healthcare staff to the list of those exempt from fasting, if they’re providing care and at real risk of dehydration or making clinical errors due to wearing Personal Protective Equipment (PPE) and long shifts. The current pandemic brings new challenges to Ramadan, as this is traditionally a time for families to come together and invite those isolated in their communities to pray together and break fast together after sunset. Obviously, during these times, this risks spreading the virus and is discouraged. The Muslim Council of Britain has useful guidance about how to navigate current circumstances safely while working or studying from home, and while most prayers will be held at home rather than in your mosque.
Many people are left in a dilemma as the call to join your family and community in the rituals of Ramadan, but you worry that fasting may put your health in peril. If you are pregnant, breastfeeding or menstruating, or you need to travel a significant distance, there are other options available to you: you can delay your fast for a time that’s more suitable, or wait for the winter months. You can also give food contributions or charitable donations to those in greater need in place of your fast. You can also join in self-reflection and prayer, along with your community.