Advising patients with existing conditions about fasting during Ramadan
BMJ 2022; 376 doi: https://doi.org/10.1136/bmj-2020-063613 (Published 31 January 2022) Cite this as: BMJ 2022;376:e063613
- Ammad Mahmood, clinical research fellow in stroke and neurology registrar1,
- Sahira Dar, general practitioner2,
- Ammarah Dabhad, clinical pharmacist3,
- Bilal Aksi, patient4,
- Tahseen A Chowdhury, consultant physician and diabetologist5
- 1Institute of Neurosciences and Psychology, University of Glasgow, Imaging Centre of Excellence, Queen Elizabeth University Hospital, Glasgow
- 2NHS Greater Glasgow and Clyde Primary Care Division, Glasgow
- 3Royal Wolverhampton NHS Trust, Wolverhampton, UK
- 4Glasgow
- 5Royal London Hospital, London, UK
- Corresponding: A Mahmood ammad.mahmood{at}glasgow.ac.uk
What you need to know
Identify potential harms (such as from medication incompatibility or expected metabolic changes) that may occur with Ramadan fasting and consider mitigating measures (such as changes to medication or fasting in winter months instead of summer) or abstention from fasting
Seek specialist input for patients:
Taking specialist prescribed medications
With reduced life expectancy
Undergoing oncological treatment
When there is any uncertainty
Make shared decisions about whether to fast, safe options for administration of medicines, reduction of dehydration risk, and what constitutes adequate nutrition
If deterioration, disease exacerbation, or delayed recovery occurs during fasting, advise patients to break their fast, take a break from fasting, and seek medical help
Managing chronic conditions during the Islamic month of Ramadan can be challenging, especially as many patients may prioritise fasting over health concerns.123 For example, one epidemiological study of 13 countries with large Muslim populations in Asia, northern Africa, and the Middle East showed increased hypoglycaemic episodes in people with diabetes (types 1 and 2).1 Also challenging is when Ramadan occurs close to the summer solstice in regions at extremes of latitude (when daylight hours are longer), in both hemispheres.
Pre-Ramadan consultations with patients wishing to fast who have existing conditions—ideally held one to four months before the start of Ramadan—are advocated by the British Islamic Medical Association, the International Diabetes Federation, and the Diabetes and Ramadan Alliance, among others.234567
Healthcare professional opinion is pivotal—with it, Islamic authorities (such as imams and scholars) can offer further advice or assurance to patients about religious exemption from fasting.
What will this article cover?
This article describes which patients might benefit from pre-Ramadan consultations (box 1), what to ask and review during consultations, and suggestions for risk stratification and joint decision making. It is aimed at healthcare professionals including GPs, specialist doctors, …
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