Working with your patients for a healthy Ramadan

Ramadan, the month of fasting observed by the majority of Muslims across the world, begins this year in the evening of 10 March 2024. It is a highly social time which many communities look forward to. The month is marked by abstinence of food and drink, amongst other pleasures, during daylight hours. In the UK, this will range from 14 to 16 hours as the sunshine begins to fill our days in the spring.

GPs will be well aware that for patients with chronic illnesses Ramadan can present a challenge - fasting is invalidated by any oral intake, including medication. Routines are also radically altered to accommodate the change in meal times which centres around the pre-dawn and sunset meals. Sleep may also suffer from attendance at nightly devotions and late social gatherings during non-fasting hours.

The decision to fast is an individualised choice and has several religious exemptions (e.g. frailty, travel, menstruation, pregnancy/breastfeeding) that need to be contextualised to each person. Nonetheless, the desire to fast is strong amongst many. Patients often make risker choices out of an eagerness to take part in Ramadan which could be better managed with the right advice.

Ramadan guidelines

The British Islamic Medical Association (BIMA) have produced a Ramadan Compendium. This is a series of evidence-based shared decision guidelines for clinicians to use with patients around fasting in Ramadan with chronic health issues. These guidelines were initially developed in response to anxieties around COVID-19 and fasting. They have since been expanded to cover a range of illnesses and published in peer-reviewed literature.

In summary, patients should be individually assessed on their suitability to undertake Ramadan fasting. This is not a binary choice; patients may be able to undertake intermittent fasts throughout the month and make up the rest during the shorter winter months for example. The Compendium has risk-stratified matrices and medicine optimisation tables for once daily alternatives. It also includes monitoring recommendations where suitable. These conversations are best held during routine reviews ahead of Ramadan. Some patients may develop interval conditions during Ramadan or become more responsive when engaged through the prism of enabling a safer Ramadan.

Healthy Ramadan

Many UK Muslim communities experience significant health and social inequalities. Ramadan is also an opportunity to positively engage with patients' beliefs for health promotion through behaviour activation. There should always be a strong emphasis on meal planning leading into and during Ramadan. Strategies to encourage low salt and carbohydrate meals, for instance, can yield significant improvements in BP and weight. Furthermore, smoking invalidates Ramadan fasting, but transdermal nicotine replacement patches are permissible to use and should be encouraged. This can be alongside goal setting during Ramadan to be smoke-free. Physical activity is also possible during Ramadan. This is true even during hotter days, with evening walks and late-night training regimes.

BIMA held a series of outreach days through February last year, visiting mosques to offer quick health checks. There were conversations around healthier lifestyle choices tailored to the community and advice on fasting with common conditions such as:

• diabetes,
• menopause,
• mental health,
• respiratory disease.

Conclusion

GPs stand to not only improve clinical outcomes for their Muslim patients by being curious around Ramadan. We are also well placed to derive significant benefits for their patients’ physical and mental wellbeing by facilitating a safer Ramadan for them.

About the writer

Dr Salman Waqar is President of the British Islamic Medical Association and Honorary Secretary of Thames Valley Faculty.

For queries and questions BIMA can be contacted at info@britishima.org.