II. Definitions
- Ramadan
- Muslim holiday that occurs in the 9th month of the Islamic lunar calendar
- Extends for one month in March, April and/or May, varying by the lunar calendar
- Post-pubertal muslims abstain from food, drink, medications, smoking and sex during daylight hours
- Purpose is to purify the soul, practice self-Discipline and empathize with the less fortunate
III. Epidemiology
- Ramadan is observed by 1.8 Billion muslims worldwide
IV. Evaluation: Risk Stratification for Fasting During Ramadan
- Indications
- Diabetes Mellitus
- Chronic medical conditions impacted by Fasting or delayed medication doses
- Elderly or frail
- Menstruating women (or postpartum lochia)
- Pregnancy or Breast Feeding (exempted if Fasting endangers the child)
- Prepubertal children (exempted from Fasting)
- Low to moderate Risk
- See Diabetes Sick Day Management
- Ensure adequate oral intake during non-Fasting hours
- High Risk
V. Precautions
- Chronic disease planning for Ramadan
- Plan chronic condition care (e.g. Diabetes Mellitus) to reduce Fasting-related complications
- Adjust medication timing to coincide with non-daylight fluid and meal timing
- Cardiovascular Disease
- Diuretics and Antihypertensives may predispose to Electrolyte disturbance, Dehydration, Hypotension
- Optimize medication schedule to once to twice daily
- Exercise caution with Anticoagulants and antiplatelet agents
- Avoid Fasting within 6 weeks of Acute Coronary Syndrome or other unstable cardiovascular condition
-
Seizure Disorder
- Optimize Seizure Prophylaxis management well before intended Fasting during Ramadan
- Optimize Sleep Hygiene
- Impaired sleep and altered medication schedule increase the risk of breakthrough Seizures
- Mental Illness
- Ramadan social activities may have a positive or negative impact on mood
- High risk medications (e.g. Lithium) may have altered levels and toxicity due to Fasting and Dehydration
- Those without decision making capacity (e.g. Delirium, Dementia, Psychosis) are exempt from Fasting
- Eating Disorders may be exacerbated by cycles of Fasting and non-daylight meals
-
Critical Illness
- Enlist religious leaders (e.g. Imams) and family members to help guide patients in Fasting decisions
- Life saving measures take precedence over Fasting per Islamic teaching
- Examples: Severe Anemia requiring transfusion, Hypoglycemia
- To quote muslim source, "Your body is a gift and taking care of it is part of your religious duty"
- Medications
- Intravenous Fluids including IV dextrose
- Coinsidered to be breaking the fast, but exempted in Critical Illness
- Non-nutrient and non-oral medications
- Generally allowed during Fasting period
- Includes subcutaneous Insulin, Metered Dose Inhalers and topical drops (eye, ear)
- Intravenous Fluids including IV dextrose
VI. Management: Alternatives to Continuous Ramadan Fasting
- Nonconsecutive Ramadan Fasting
- High risk patients may choose to intermittently fast as a trial to optimize diet and medication schedule
- Intermittent fasts allow for recovery and may start before Ramadan and include make-up fasts after Ramadan
- Fasting may need to be interrupted for acute illness, travel or Menstruation (with Make-Up Fasting as below)
- Post-Ramadan Make-Up Fasts
- Winter Fasting
- Patients may choose to shift their Ramadan fast to the shorter, cooler days of Winter (depending on geographic location)
- Charitable Giving
VII. Prevention
-
Tobacco Cessation
- Ramadan is an excellent time to initiate Tobacco Cessation (smoking breaks the fast)
- Offer Nicotine Replacement and other Tobacco Cessation strategies
- Obesity
-
Exercise
- Maintain adequate hydration and Caloric Intake to support Exercise program
- Plan Exercise at the end of the day's fast or during non-Fasting hours
- Athletes may require additional guidance and strategies
VIII. Resources
- Ramadan Compendium (British Islamic Medical Association)
- Diabetes and Ramadan (International Diabetes Federation)
IX. References
- Swaminathan and Hagahmed (2025) Caring for the Fasting Patient in the ED, EM:Rap, 2/24/2025
- Waqar (2023) Am Fam Physician 107(2): 125-6 [PubMed]