Professor Fatai Fehintola, a consultant physician and clinical pharmacologist, speaks with SADE OGUNTOLA about what individuals need to know about fasting, situations under which they can take their medications, and the need to prioritise their health during the Ramadan fast and at all times.
FASTING may provide some health benefits, including weight loss, blood sugar control, and protection against medical conditions like cancer and neurodegenerative disorders. Is this also applicable to the Ramadan fast?
While it is apt to say that fasting has many benefits for adherents, some of the acclaimed benefits are not necessarily correct. Yes, fasting will help reduce weight; the problem with weight is not unconnected to the need to reduce the amount of food you eat. The food becomes usable energy. If it is not used, then it becomes stored up either as fat or in building up of the body muscles. That is essentially why people who engage in fasting would benefit from this exercise. But it is also important to note that fasting is not without some challenging issues, especially if it is done involuntarily. That is akin to starvation. That is not the type of fast we are talking about. We’re talking about voluntary fasting, one that is done either for spiritual reasons or to shed body weight.
Under what conditions can individuals tap into the health benefits of fasting?
No doubt, in fasting there is a need for moderation. We are close to Ramadan fasting, so using that as an example. Muslims are expected to abstain from food for a certain part of the day. In Nigeria, this is rarely up to 16 hours in the day, spanning usually 30 or 29 days. No doubt, some people would have challenges from fasting. For instance, individuals with medical conditions that burn their energy or make them loose water uncontrollably. There are also circumstances when fasting by a healthy person, if it is not done in moderation, done for a prolonged consecutive period, might cause some problems, including some metabolic derangements.
Can people with chronic conditions like asthma, diabetes, and heart conditions fast given that some may need to take their medicines after their meals?
For the Ramadan fast, which I am much more familiar with, once the individual has time to break the fast, depending on the type of medications the person is using, he can have his medication during the ‘non-fasting’ period. Take, for example, a hypertensive individual who takes hypertension medication once a day; he can shift it to the time to break his fast.
Of course, such hypertension medicine shouldn’t cause the individual to urinate too much such that it severely affects the person’s level of hydration. Where the hypertension medicine severely affects the person’s level of hydration or result on marked metabolic dysfunction such an individual may ‘suspend’ Ramadan fasting and ‘repay’ the missed days later if and once the ill-health abates.
Even people who have diabetes, depending on the medication regime that they have and depending on how well controlled that individual is, can do their fasting and at the same time take their medication during the period that is allowed for them to take any medication vis-a-vis very early in the morning before maybe 5 am and then in the evening after 7 pm till the following morning.
Also, where an individual is required to take medication mandatorily for maybe three to four times a day, for instance, some infectious diseases, such an individual, medically and as far as my understanding of Islam is concerned, is advised to abstain from fasting during that period. A person’s health comes first before the benefits to gain from fasting, whether spiritual or otherwise.
Medications like paracetamol suppositories, intramuscular long-acting antipsychotic injections, inhalers, and oxygen to aid breathing; can these be used during a Ramadan fast?
My understanding of the ‘protocol’ for Ramadan fast is that an individual who is fasting is not supposed to allow anything to pass through his mouth into the stomach during the stipulated period. Therefore in that circumstance, the use of any medication through the mouth does not even arise. By extension, if the individual has a condition that warrants that he should take such medication to preserve his or her health, I believe, that person in Islam is permitted to not fast, and after that period is over, the person can “repay” the missed fasting. That extends to individuals who may require medications like paracetamol suppositories, intramuscular injections and oxygen to aid breathing.
In circumstances where these medicines, particularly Oxygen, are used, it would suggest a moderate-severe, even critical level of illness.
Of course, such critically ill individuals are already exempted from fasting. I want to believe that suppository may be used once the use of the same was dictated by illness that impacts the person’s health critically because it’s not passing through the mouth.
The use of an inhaler in the case of an asthmatic attack may be complex! It is my considered opinion that in case of an asthmatic attack that is not severe enough, it can be permitted since the person is not admitted into the hospital, and that person may continue with that fast insofar as the person’s health is not going to be jeopardised for whatever reason.
But any condition in an individual that is critical enough to warrant serious intervention, including taking some oral medication and drinking water with, it will warrant discontinuing the fast. Insofar as the person’s health is going to be jeopardised for whatever reason; Ramadan fasting is allowed to be sidelined and then “repaid” at a later time.
What are the things that you preach against during any fast?
As medical practitioner, emphasis first and foremost is that individuals must look after their health. For individuals who need to take any medication during certain periods, if the medication can be adjusted in such a way that it can be taken early in the morning and then later in the evening during Ramadan fast, that is well and good. But if there is no such opportunity to vary the timing for the medication for a particular illness, then the fasting has to wait until such a condition is properly taken care of.
Usually, we take every case individually, but the general principle is health first. We need to do everything possible to ensure that the person’s health is not jeopardised for any reason, including fasting.
It is noteworthy that Islam permits “skipping” fasting for travellers, infirm persons, pregnant women, and women who are menstruating; they are expected to “pay back” the fast they missed once.
We should always be mindful of our health, and people who go fasting for weeks on end could end up being emanciated. It could also result in a metabolic derangement. So, moderation is key. Fasting must be done with moderation and with utmost care, whether it is in search of a higher spiritual endowment or even to improve one’s physique. Some people simply starve themselves because they want to look skinny; they want to lose weight. Losing weight should be done responsibly. These are issues that one needs to interrogate.
But as far as my experience with such unwholesome practices or health-jeopardising attitudes is concerned, I cannot immediately pinpoint anything now. But I know that there are quite a number of people who do certain things not necessarily because it is for some spiritual development or for their health when advised to reduce their food intake so as to control their weight or as part of the management of obese diabetes.
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The economic situation of the country is linked to increasing numbers of people who are malnourished. Even as the Ramadan fast is around the corner, what will you want to call their attention to to ensure that they stay healthy?
I will reiterate over and over again that whatever we do, let’s do it with moderation. This should be uppermost in our minds. Yes, there are some benefits to fasting, both spiritual and physical, but it could affect our health. Particularly as Muslims, we know that we have to approach it with a lot of caution. No doubt, people without a good diet could become malnourished when they cannot afford a balanced diet. However, during Ramadan, individuals shouldn’t worry that their malnourished state will worsen because they don’t have food to eat before the fast and to break their fast.
In the extreme circumstances, fasting may have to be suspended by individuals who are unable to get food at all. But I hasten to add that situation maybe purely hypothetical there are usually sufficient numbers of individuals or organisations/centres that would provide the requisite two meals per day for such vulnerable individuals during Ramadan. For example, the UCH Muslim Students’ Society of Nigeria are already preparing and will, as usual, to provide meals for such persons during this Ramadan.
So in most cases, such an assumption that an individual who is a Muslim who is required to embark on a fast, who truly wants to fast, will not get food to eat in the morning and/or in the evening will rarely occur. Indeed, some philanthropist primarily look for such opportunities to feed people. So, in a way, some people who did not even have food to eat when it was not a fasting period; they may be able to access better, more nutritious meals during the Ramadan fasting period!
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