Islamic Fasting and Health
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Medical fasting can have health benefits. As we will explain here, Islamic fasting, however, differs in many respects, and thus has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior. Health effects include heat stress, dehydration, migraines and, for lactating women, the nutritional make-up of their milk, among other harms.
What is Islamic Fasting?
The salient features of Islamic fasting are:
- For 30 days every lunar year (during the month of Ramadan), waking up before dawn and eating and drinking to prepare for the fast (binge eating is a common habit).
- Refraining from consuming any food or water from dawn to sunset
- Breaking the fast at sunset and again eating and drinking to prepare for the day ahead.
Some Muslims claim eating a small amount of food is the correct Islamic way however we cannot function for the whole day by eating only a small amount of food at the time of dawn. This would affect our performance even more during the day.
Effects on Health
In a recent study done on the Arab world, diseases linked to cholesterol and diabetes increased by 27.65% because of overeating. Non-compliance with prescribed treatment regimens is common during Ramadan.  Other health effects include:
One study finds that incidences of dehydration increase during the month of Ramadan:
Evidence of hemoconcentration and dehydration has been found during Ramadan (El-Hazmi, Al-Faleh, & Al-Mofleh, 1987; Kayikcioglu et al., 1999; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). Restricted fluid intake, leading to disturbance in the fluid balance, is likely to cause these conditions. In the initial stages of dehydration, the clinical signs are tachycardia, tiredness and malaise, headaches and nausea. Middle-aged or more elderly persons are usually more prone to the effects of dehydration (Schmahl & Metzler).Dehydration is indicated by the increase of several serum biochemical parameters (El-Hazmi et al., 1987; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). The increase in uric acid, however, should especially be noted (El-Ati et al, 1995; El-Hazmi et al., 1987; Fedail et al., 1982; Schmahl & Metzler, 1991), because hyperuricemia is one of the known sequelae of prolonged fasting (Murphy & Shipman, 1963). Hyperuricemia is associated with reduction in glomerular filtration rate, decrease in uric acid clearance and alterations in the renal transport of uric acid (Murphy & Shipman). During Ramadan, however, reports show that the increase in uric acid does not excessively deviate from the normal range and studies have not reported clinical gout (El-Hazmi et al., 1987; Fedail et al., 1982). Increased uric acid is, therefore, unlikely to affect healthy individuals.
Migraines are three times more common during Ramadan, affecting an estimated 90 million Muslims:
Dr. Ibrahim Abu-Salameh, Israel’s only Beduin neurologist – who works at Soroka University Medical Center in Beersheba – headed a team that found migraine attacks are three times more common during the Muslim fast than in the rest of the year.
Working with colleagues Dr. Igal Plecht and Dr. Gal Ifergan of the Beersheba hospital, Abu-Salameh studied 32 Beduin who suffered from migraine attacks during the Ramadan fast last year and compared the statistics to an ordinary month without the fast as a control.
Migraines were much more common in women than men; three-quarters of the women complained of migraine while fasting, compared to a much lower figure among the men. The Soroka study was published recently in the Journal of Headache and Pain.
. . .
Abu-Salameh said that he has gotten migraine headaches during Ramadan, and has treated Beduin who came to his clinic complaining about severe headaches. He noted that the medical literature has almost ignored the phenomenon until now.Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.
Tachycardia, Severe Headaches, Dizziness, Nausea, Vomiting and Circulatory Collapse
The following study was carried out on Turkish Muslims in Germany who were involved in heavy and manual work. 'Moderate to severe health disturbances' including severe dehydration were found in such laborers during Ramadan:
AbstractDuring Ramadan, Moslems are required strictly to avoid fluids and nourishment from dawn to sunset. Heat stress during such abstinence represents a substantial health hazard. In the Federal Republic of Germany (FRG) where numerous Moslems, particularly of Turkish origin, perform heat work and other heavy labour, we observed moderate to severe health disturbances in such labourers during Ramadan, e.g.: tachycardia, severe headaches, dizziness, nausea, vomiting and circulatory collapse. The severe dehydration of these workers was demonstrated by substantial increases in their hematocrit, serum protein, urea, creatinine, uric acid and electrolyte imbalance. Because of the evidence of the substantial health hazard to Islamic workers in such situations, we have strongly urged employers to refrain from assigning Islamic workers to heat work or heavy daytime work during Ramadan; we have therefore limited systematic studies of health problems during Ramadan to persons performing only moderate work. Even under these conditions signs of dehydration were found in the 32 labourers monitored. Some of these labourers also had to interrupt their observance of Ramadan due to health problems, e.g.: acute gout due to serum uric acid increase, or circulatory insufficiency. In light of the observed potentially harmful pathophysiological effects, the danger of dehydration of Islamic workers due to heat work during Ramadan should be taken very seriously.
Naturally we would expect that this would affect productivity, as is evidenced in a later section on Economical effects.
The following study takes a look at the significant fluctuations in the weight of individuals that occurs during the month of Ramadan, primarily as a result of the metabolic changes that occur in the body.
Loss of body fat would indicate the use of fat for energy production during Ramadan (Husain, Duncan, Cheah, & Ch'ng, 1987; Ramadan et al., 1999; Sweileh et al., 1992). In addition, researchers have found decreased heart rate and oxygen consumption during Ramadan (Husain et al., 1987; Ramadan et al., 1999; Sweileh et al., 1992). These findings suggest a metabolic adaptation to fasting. It seems that during the Ramadan daylight hours - when no food or water is taken in - to conserve stored energy, the metabolism slows down (Sweileh et al., 1992).Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them.
Affect on Circadian Patterns and Sleep Disorders
The results of the following study can lead us to conclude that fasting negatively effects an individual's circadian rhythm. As a result, unfavorable side-effects such as lethargy and a lack of motivation, may contribute to a society's lack of productivity:
The following study was done in Saudi Arabia and it was observed that melatonin levels and REM sleep decreased during Ramadan:
Daytime Drowsiness, Alertness and Cognition
Naturally, a fast would indicate that individuals are ingesting less food. But the following two studies reveal that the decrease in the number of meals that are eaten directly disturbs normal sleep habits and thereby increases daytime drowsiness.
AbstractFew epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.
The following study studies the effect that fasting has on the alertness of an individual. Evidently, the change in sleep patterns causes a decrease in oral temperature and alertness:
AbstractDuring the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.
The physical fatigue associated with fasting results in impairment of cognitive function, as shown by performance in flicker fusion tests. 
In a certain study, the nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. The study said that it would seem prudent to excuse lactating women from fasting during Ramadan.
The researchers also found that the women were 10 per cent less likely to give birth to a boy if they had fasted during Ramadan. The trend was clearest if the fasting was done early in the women’s pregnancy, and during the summer months, when long hours of daylight called for them to go longer without food.
. . .
The study, which used census data from the US, Iraq and Uganda, also discovered long-term effects on the adult’s health and his or her future economic success.
"We generally find the largest effects on adults when Ramadan falls early in pregnancy," the Independent quoted Douglas Almond, of Columbia University, and Bhashkar Mazumder, of the Federal Research Bank of Chicago, the authors of the research, as saying."Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects. Importantly, we detect no corresponding outcome differences when the same design is applied to non-Muslims," they added.
Binge eating, headaches and increase in gastric acidity
"During the initial days of fasting, you may encounter slight dizziness as well as frequent headaches."Dr Phadke says that fasting can also increase levels of gastric acidity in the stomach which can cause burning and heaviness, and sometimes a sour taste in the mouth.
Dr. Muhammad Alabdooni, a Muslim and the chairman of the Dutch Moroccan Physicians Association, also maintains there is no scientific proof that Islamic fasting is physiologically beneficial.
Increases the toxicity of commonly used medication
Fasting has been found to significantly change drug metabolism and deplete crucial chemicals in the liver needed to detoxify medication.
Paracetemol (also called acetaminophen) is one of the most commonly used drugs to treat day to day pain such as headaches or gastrointestinal pain, this is the very same pain that is likely to be encountered by a fasting individual. Therefore, a significant risk arises when someone who has been fasting takes this common medication (among many others).
As the Journal of Internal Medicine Reports:
The following study in Morocco found that irritability increased during Ramadan:
OBJECTIVES: We hypothesized that people in Morocco are more irritable during the month of Ramadan than during the rest of the year. Our objectives were to measure irritability in fasting Muslims during the month of Ramadan, to describe its various modes of expression, and to examine risk factors for this irritability.
METHODS AND SUBJECTS: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32+/-5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale.RESULTS: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. Irritability increased continuously during Ramadan and reached its peak at the end of the month. Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.
In a study done on the Arab world, experts claimed that increases in blood crimes (+1.5%) and theft (+3.5%) were observed during Ramadan.
...Iriawan said crimes such as house break-ins and robberies tend to increase during Ramadan, when the need for extra money was high because of the festivities.
"I think during Ramadan prices rise and there is a lapse of security along the borders," Coordinator of Child Parliament Om Khalthoum said.
Almost 1,500 Yemeni children were saved by child protection centers from exploitation, abuse and deprivation that come at the hands of their traffickers or smugglers, according to Naseem Ur-Rahman of UNICEF. Yemeni children, primarily boys, are trafficked into Saudi Arabia for exploitation as beggars, street vendors and unskilled laborers.While there are no statistics that determine how many children are trafficked on an annual basis, authorities do know that during the month of Ramadan the numbers rise. "One of the main problems is that there is a lack of reliable data," Ur-Rahman said.
Increase in Accidents
In 1994, the Accident and Emergency Department of St Mary's Hospital in London conducted a study to examine if accident and emergency attendances increased during Ramadan for Muslim patients. At the time, the department was treating 55,000 new patients every year:
An increase in road traffic accidents in the United Arab Emirates during Ramadan was reported. Taking this into consideration, you would expect Emergency Services in Muslim majority nations to work twice as hard during this period. Unfortunately, this is not the case.
Disruption of Services
In August, 2010, Mustafa Mor, who was involved in a road accident in Turkey, was left waiting on a stretcher due to the X-ray service being closed for fast-breaking.
Mustafa Mor’s car went off the road and crashed into a tree in the Nizip district of the southern province of Gaziantep. Bekir Karabacak, a passerby, took him and his cousin, who has the same name and was a passenger in the vehicle, to the Nizip Public Hospital. The doctors thought that the passenger Mor might have had a broken leg and sent him to the X-ray service.
The health care personnel took Mor on a stretcher to the X-ray service, where they found a note that said, “I am having dinner, I am about to return,” hanging on the door. Karabacak, who had taken him to the hospital, said: “We are also fasting. Should this place be closed? There is an injured man here, and this is a hospital.” After Mor waited half an hour, the staff returned from dinner.Cengiz Öztop, the chief physician of Nizip Public Hospital, claimed that there was no neglect in the situation.
Search and rescue teams in Kocaeli, Turkey, had also stopped working due to Ramadan.
Reduced Blood Donation
The same news source said that "each blood unit can save three lives". This implies that Ramadan also results in loss of life since life-saving blood donations drop by one-third.
Physical Exhaustion and Incapacitation
Another study takes a look at fasting Muslims who were stricken with lethargy and fatigue due to the behavioral changes that accompany the month long celebration.
AbstractThis study was conducted in five provinces and food consumption, physical activity types and duration for 3 consecutive days were recorded in the questionnaire together with some general characteristics of 750 (320 males, 430 females) adults who were on fast during Ramadan at time of interview. One hundred and eighty-seven subjects had some type of health problems, among whom 60.4% were using drugs, and 31.6% were on diets; however, during Ramadan 9.7 and 18.8% of the subjects dropped taking drugs and did not regularly keep on diets, respectively. During the fasting time, from dawn to sunset, 34.3% of the subjects developed some behavioural disturbances, such as feeling tired and being unwilling to work. Although the meal consumed at dawn consisted of foods that were usually eaten at breakfast, the meal consumed at sunset consisted of a great variety of foods. Calcium intake was the most insufficiently consumed nutrient. It was observed that the daily energy intakes were less than the expenditures both in males and females. Further research should be done on the effects of fasting in health and disease.
In September 2009, Stephen Constantine, Head coach of Sudan partly blamed his side’s loss to the Black Stars to the fasting of most of his players.  In Italy, both a prominent coach and a team owner in the top Serie A league linked the rigors of Ramadan's sunrise-to-sunset fasting to Muslim players' poor performance on the pitch. 
Violence and Anti-Social Behavior Towards Non-Muslims
The month of Ramadan often sees an increase in violence and anti-social behavior towards religious minorities living among a large Muslim population. In some Muslim majority countries like Algeria, Morocco, Pakistan, Saudi Arabia, and in parts of the United Arab Emirates, it is against the law to eat or drink in public during fasting hours, and violating these laws can involve jail-time or expulsion.
During Ramadan last year in Egypt, a church was burned to the ground. At least 155 Egyptian Christians were arrested for not participating in Ramadan. Last September, Rody Rodeheaver with I.N. Network explained that Ramadan "is a time when Muslims who are moderate often become much more aggressive about their faith, and they [see it] as a time to be aggressive as they deal with Christians." Rodeheaver also noted that many people are somewhat psychologically distraught by a lack of food since Muslims are required to fast during Ramadan.
This year, with tension rising after Muslim attacks on Christians in Afghanistan, Somalia, Pakistan and other nations just before Ramadan, prospects don't look much better. The potential for a swell in persecution in the next 28 days is high.Ramadan--August 11 to September--is especially daunting for Muslim converts to Christianity.
"I am optimistic," Hocini, a Protestant with a one-month-old daughter, said as he left the courtroom in Ain el Hammam after the hearing. "I have no regrets, I'm Christian and assume my responsibilities. We are innocent, and we haven't done any harm to anyone...We are Christians and we have not eaten in a public place."The verdict is due on October 5. The prosecutor called for the full three months in prison for both men.
. . .
In a media release, ICC says that after the waiter served them tea and a snack, several policemen started to question them as to why they were desecrating Ramadan by eating during the Islamic fasting season. The two Christians told the police that since they are Christians, they are not supposed to fast during Ramadan.
. . .
Azzaq Bhatti, the father of Gull Masih and paternal uncle of Ashir Sohail, in an interview with ICC said that, "during Lent, all Muslims eat, drink and smoke publicly and neither police nor government authorities take notice of it. And none of the Muslims are arrested for desecrating Christians' Lent season."ICC's Jonathan Racho said: "Forcing Christians to fast during the Islamic fasting month is both outrageous and a clear violation of freedom of religion. We call upon Pakistani officials to immediately release Gull and Ashir and take appropriate legal measures against police officers who detained them."
Ramadan-inspired violence against non-Muslims and non-observant Muslims is on the increase in secular societies. Notable incidents include; a Jewish women in Toulouse, France, being called a "dirty Jew" and struck on the head by two Muslim teenagers for buying food during fasting hours; a Muslim man in a central Lyon Restaurant struck in the head with a glass bottle and hit with a chair by three youths for not respecting Ramadan; an 11-year-old in Sydney, Australia, chased and later beaten by Muslim students because he ate a salami sandwich during Ramadan; a Turkish MP in Berlin, Germany, beaten by restaurant staff for ordering pork sausages; and the following report is of an atheist living in the United Kingdom:
Arif Raham, a friend of Monzur (who speaks little English), relayed to the Advertiser his terrifying story. He said Monzur had been chatting with a friend who was drinking during Ramadan.
He claims he was then approached by a group of around ten young men who asked him why he wasn’t observing Ramadan. When he replied that he was an atheist they are believed to have chased him to nearby Walburgh Street, attacking him outside his home.Monzur was reportedly battered until unconscious and later taken to the Royal London Hospital. His left arm was broken and metal bolts later put in. Tower Hamlets police have made no arrests and enquiries are ongoing.
As some of the above studies established, fasting can cause dehydration, sleep disorders and other harmful affects. Naturally all of this would affect productivity and the national economy. Those living in Muslim majority nations can readily feel the effects of stagnation that accompanies the month of Ramadan. In such places, it is a month that is marked by very low productivity. When the entire population of a country observes fasting during the time they are at work, it is inevitable that they will suffer a significant loss in general productivity. In a survey carried out by Cairo’s Institute of Social Sciences of the Arab World it is found that the productivity of Arab businesses during the month of Ramadan dropped by a staggering 78%:
Production in almost all businesses in Morocco drops during the month of Ramadan, analysts say, although consumption increases significantly:
"The drop in productivity could be due to the disruption of the body clock," said A. Hamdi, who works in an industrial unit. "It is difficult to get used to the work day.In addition to the women who race home to make iftar, others are sneaking out earlier to avoid traffic jams, which usually start at 4 pm with the end of the normal working day."
Performance in most companies, institutions and government departments around the Arab world is usually at a low during the month of Ramadan, with poor productivity and constant reported absences.
Comments from Muslims and former Muslims
Intermittent and prolonged fasting is generally not conducive to a healthy lifestyle. Depriving the body of water and essential nutrients by dividing and postponing meals to irregular intervals does nothing to limit consumption. In-fact it causes a host of health, performance and mood disorders. Fasting is not normally prescribed for the well being of human beings. Instead, it is commonly understood that eating healthy, smaller-portioned meals, interspersed throughout the day is far better in maintaining a well-balanced diet and far more forgiving on a person's metabolism. Any claims that prolonged and intermittent fasting contributes to the well-being of an individual's health are misleading, based on the scientific studies that prove otherwise. The only benefit of fasting that can be claimed, then, must be metaphysical. However, what is clear is that the practice has concrete and definite physical, social, and economic harms.
Responses to Apologetics
- "Most of the evidence provided is from newspaper articles. Not very scientific is it?"
The claim that "most of the evidence provided is from news paper articles" is false. The majority of this page references and quotes directly from the conclusions of scientific studies. It also quotes medical experts and statistics provided by Medical facilities. As for the news articles quoted here, they are reliable sources that reference and describe the conclusions of scientific studies. For an indepth section by section response, see the 'talk' page, or simply view the references provided below.
- "Muslims do not fast in Ramadan so they can be healthy. They fast because Allah commanded them to."
This is true. But many Muslims attempt to justify this unhealthy practice by claiming it is healthy. Besides, if Allah is all-knowing and merciful, he would not endanger his followers' health by making a hazardous activity become compulsory. However, it would make complete sense if we were to accept he is ignorant of science or a sadist. But then why would anyone want to worship such a deity?
- "Islam is just one of numerous religions (Hinduism, Christianity, Catholicism etc.) that prescribe fasting for its people."
This claim is true, but also very disingenuous. Rules vary but fasting in Christianity is not compulsory, nor is it expected to be a complete fast. Meaning Christians generally reduce (not stop) their intake of food, and also drink freely during fasts. This is perfectly healthy and not comparable to the Islamic sawm. Similarly in Hinduism, fasting is a part of the religion, but individuals observe different kinds of fasts based on their personal beliefs and local customs. This argument is also a logical fallacy known as ad hominem tu quoque. Meaning it is not a valid defense of Islam, but a diversion that some may construe as an indirect admission of Islam's flaws.
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