II. Definitions

  1. Ramadan
    1. Muslim holiday that occurs in the 9th month of the Islamic lunar calendar
    2. Extends for one month in March, April and/or May, varying by the lunar calendar
    3. Post-pubertal muslims abstain from food, drink, medications, smoking and sex during daylight hours

III. Evaluation: Risk Stratification for Fasting During Ramadan

  1. Indications
    1. Diabetes Mellitus
    2. Chronic medical conditions impacted by Fasting or delayed medication doses
  2. Low to moderate Risk
    1. See Diabetes Sick Day Management
    2. Ensure adequate oral intake during non-Fasting hours
  3. High Risk
    1. Avoid continuous Fasting
    2. Trials of Fasting and intermittent Fasting may be tolerated

IV. Precautions

  1. Cardiovascular Disease
    1. Diuretics and antihypertensives may predispose to Electrolyte disturbance, Dehydration, Hypotension
    2. Optimize medication schedule to once to twice daily
    3. Exercise caution with Anticoagulants and antiplatelet agents
    4. Avoid Fasting within 6 weeks of Acute Coronary Syndrome or other unstable cardiovascular condition
  2. Seizure Disorder
    1. Optimize Seizure Prophylaxis management well before intended Fasting during Ramadan
    2. Optimize Sleep Hygiene
    3. Impaired sleep and altered medication schedule increase the risk of breakthrough Seizures
  3. Mental Illness
    1. Ramadan social activities may have a positive or negative impact on mood
    2. High risk medications (e.g. Lithium) may have altered levels and toxicity due to Fasting and Dehydration
    3. Those without decision making capacity (e.g. Delirium, Dementia, Psychosis) are exempt from Fasting
    4. Eating Disorders may be exacerbated by cycles of Fasting and non-daylight meals

V. Management: Alternatives to Continuous Ramadan Fasting

  1. Nonconsecutive Ramadan Fasting
    1. High risk patients may choose to intermittently fast as a trial to optimize diet and medication schedule
    2. Intermittent fasts allow for recovery and may start before Ramadan and include make-up fasts after Ramadan
    3. Fasting may need to be interrupted for acute illness, travel or Menstruation (with Make-Up Fasting as below)
  2. Post-Ramadan Make-Up Fasts
    1. Typically Make-Up Fasting is scheduled immediately following Ramadan
    2. However, in acute or chronic illness, Fasting may be delayed until health stabilizes
  3. Winter Fasting
    1. Patients may choose to shift their Ramadan fast to the shorter, cooler days of Winter (depending on geographic location)
  4. Charitable Giving
    1. Persistent illness may contraindicate Fasting without possible make-up fasts
    2. In these cases, fidyah (charity) may be given for each missed day of Fasting

VI. Prevention

  1. Tobacco Cessation
    1. Ramadan is an excellent time to initiate Tobacco Cessation (smoking breaks the fast)
    2. Offer Nicotine Replacement and other Tobacco Cessation strategies
  2. Obesity
    1. Weight loss strategies (e.g. intermittent Fasting) may coincide with Ramadan-related Fasting
  3. Exercise
    1. Maintain adequate hydration and Caloric Intake to support Exercise program
    2. Plan Exercise at the end of the day's fast or during non-Fasting hours
    3. Athletes may require additional guidance and strategies

VII. Resources

  1. Ramadan Compendium (British Islamic Medical Association)
    1. https://britishima.org/guide/ramadan-compendium/
  2. Diabetes and Ramadan (International Diabetes Federation)
    1. https://idf.org/our-activities/education/diabetes-and-ramadan.html

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