Perspectives on physical and mental health during Ramadaan

WITH the month of Ramadaan almost upon us, DR ZIYAAD WILLIAMS and DR TASLEEM RAS consider some important health-related aspects of fasting, especially for those of us who may have chronic diseases.

This article was provided by the Cape Town Branch of Islamic Medical Association of South Africa (IMASA). For further information telephone +27 21 762 1414 or email: imasa.wcape@gmail.com

While understanding that the primary objective of fasting in the holy month is an act of worship and geared towards spiritual development, we know that it also has an impact on our physical and mental wellbeing. This article will introduce some principles relating to three key domains of health as it pertains to fasting: physical wellbeing, mental health and oral health.

Physical health

Research around the world has shown that intermittent fasting, such as is undertaken in Ramadaan, has a positive effect on blood pressure and sugar control.

However, this good effect is limited to those who also follow a healthy eating plan during this time, and who do not over-indulge lovely Ramadaan treats. However, this does not mean that medication can be discarded, especially in the following patients.

People who have ‘brittle’ disease, that is, those whose blood pressure or blood sugars are not well controlled before Ramadaan should seek urgent medical attention to make an informed decision about the safety of fasting. Ignoring the reality of these risks could result in serious, disabling and permanent, yet preventable damage to certain organs, like the kidneys or heart.

Another group of patients who must take special caution are those diabetics who are on insulin. The dangers of falling into a low blood sugar coma or kidney damage is very real in this group of patients.

Because the kidneys are extraordinarily sensitive to changes in the body’s water balance, and given the fact that we inevitably become dehydrated to some degree, patients with kidney problems should not be fasting at all. A simple blood test at your GP can inform you about this risk.

Some of the common problems that patients complain about, especially in the early days of Ramadaan, are headaches, nausea and vomiting, and in the later days, kidney stones, muscle cramps and fatigue.

All of these can be prevented or lessened by paying particular attention to maintaining hydration in the morning and evenings, cutting down on fatty and spicy foods, increasing the intake of fruit, yoghurt and nuts, and decreasing caffeine consumption well before Ramadaan.

Mental health

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Ramadaan being a month of introspection and spiritual strengthening, we must also pay attention to our emotional and psychological wellbeing.

In our society, mental health issues, such as depression, anxiety, bipolar mood disorder, eating disorders and substance abuse, are hopelessly under-recognised. During Ramadaan, these are frequently unmasked as people try to improve the quality of their lives.

In people who do not have any mental health issues, fasting actually improves mental health by improving our sense of wellbeing, enhancing memory and other cognitive functions. Intermittent fasting has been shown to have positive effects in patients suffering from clinical depression, and works alongside medication and counselling.

However, in research emanating from the Islamic world, patients diagnosed with schizophrenia or bipolar mood disorder should not fast as this leads to higher levels of relapse in both these conditions.

Ramadaan also presents an ideal opportunity for the rehabilitation of drug addicts, with the proviso that these patients will need lots of psychological, emotional and social support during this time.

Oral health

Saliva is an essential element of oral health. During fasting, the quality and quantity of saliva is changed, resulting in an abnormal oral environment. The mouth becomes dry and acidic, which predisposes to the growth of bacteria and tooth decay, and an unpleasant odour.

Oral hygiene has an important role to play, and here we need to stick to basic facts that hold true for any situation: brush twice daily, for at least one minute per session (the average person brushes for 20 seconds or less), floss twice daily to remove debris from hard to reach spaces, and use a fluoride containing toothpaste. Additionally, the use of the miswaak has been shown to assist anti-bacterial processes and it improves saliva flow.

Conclusion

We have provided some principles that impact physical, mental and oral health in Ramadaan. The recurring theme is to drink enough water, stay away from unhealthy foods, especially sugary food and drink, be proactive in empowering yourself about the health decisions you make, and use your health professionals as a resource to assist you in making these decisions.

Dr Williams is a graduate of UWC dental school, and is in private practice in Walmer Estate, Cape Town.
Dr Ras is a family physician, and works in academic practice at the University of Cape Town.

This article was first published in the March 2022 print edition of Muslim Views.