Mini-symposium: Ramadan fasting and the medical patient: An overview for clinicians
Authors: Beshyah Salem , Fathalla Waseem , Saleh Abdulkarim , Al Kaddour Abdulrazzak , Noshi Mohamed , Al Hateethi Husni , Al-Saadawi Nameer , Elsiesi Hussein , Amir Numan , Almarzouqi Mohamed , Khalil Ali , Benbarka Mahmoud , Ahmed Urooj , Mustafa Huda , Al-Mahmeed Wael 
Published: July 2017

The daytime fasting of Ramadan is observed annually by millions of adult Muslims all over the world. Some may have mild, moderate or severe medical conditions. They may seek advice on feasibility and safety of fasting and/or their management. Physicians ought to have a working knowledge about the religious rules of Ramadan fast and their medical implications. In this article we present a concise summary of the proceedings of a series of symposia. Their objectives were to review the effects of Ramadan fasting on the health of Muslim patients with various chronic medical conditions and to propose practical management strategies. An initial introductory Islamic perspective on fasting to set the scene for the following presentations. The religious rulings excluding patients with acute and chronic medical conditions from fasting were highlighted. The roles of the medical professional in guiding patients on best ways to make informed decisions to fast and feast safely were stressed. Available evidence from published literature and clinical practice was reviewed and practical guidance covering the major body systems was given. Generally speaking, fasting in Ramadan is possible for most stable chronically ill patients under medical supervision. The effect of fasting on health issues should be explained to patients well ahead of starting the holy month. Counseling patients about their use of medications as well as their suitability to undertake the fast is a major step in health care for Muslim patients. Available observations cover a spectrum of chronic medical conditions affecting various body systems. These include renal, hematological cardiac, neurological, rheumatologic, gastroenterological, endocrine conditions and drug therapy during Ramadan. Changes in the parameters of clinical functions in healthy people and in non-renal patients were minimal, insignificant and remained within the normal range. Patients on hemodialysis could fast safely on nondialysis days. Stable renal transplant recipients do not seem to sustain any risk from fasting after the first year. No evidence of increased risk of renal stones and colic was found during Ramadan. No consistent rise in cardiac events was observed during Ramadan. Hypertension needs special treatment manipulations. Headache and risk of seizures are two neurological conditions with relevance to fasting. These can be managed by simple medical measures. Peptic acid disease complications may increase by the long fasting, however treatment with peptic disease medications reduces the risks. Hematological conditions influenced by dehydration such as sickle disease are better managed by adequate hydration particularly under stressful circumstances. Rheumatological conditions can be managed by usual therapies during Ramadan. Diabetes received most attention from the medical profession for obvious reasons. Several expert statements were published. Where the risk of hypoglycemia or hyperglycemia is increased many would advise against fasting. Patients controlled by simple regimens with low risk of hypoglycemia may be able to fast safely. Changes in medication aim at adjusting the amount and timing of the drug administration to match calorie intake thus preventing hypoglycemia in the daytime and hyperglycemia after sunset. In conclusion, management of the medical patients during Ramadan represents a special challenge to patients alike. Taking on this challenge is an opportunity to test the cultural-competence of health services.