Disclaimer: I am not suggesting that anyone impulsively abstain from Ramadan fasting because of the information in the following text.Since Ramadan is an obligation in our religion,any such decision needs to be made in consultation with a judicious Muslim physician who understands well both the benefits and the risks of this noble practice.

Asalamu aleykum, brothers and sisters,aunties and uncles lol.I have spent a long time thinking about why Ramadan can be so difficult at times for many individuals.It didn’t make sense to me that Allah would ordain such an ordeal as part of our religious obligations.So I began investigating.The good new is that I believe I am finally getting to an understanding of what is really happening here-even if I am not sure how to manage it.

Let me be very clear from the outset.The problem during Ramadan is not with hunger and thirst as some of the original texts- Quranic and hadith- would imply.Most people can deal quite easily with hunger and thirst and this preoccupation often more or less disappears within the first couple of days if not the first hours of the fast.So, that is not the issue.The issue is much more with symptoms like headaches and nausea and incapacitating fatigue and difficulty concentrating .Those are the issues that can prevent people from functioning during Ramadan and make them feel that it is more like an illness than the process of abstinence- which it is supposed to be.

So what is happening here? Well,when I first started examining the issue ,I looked into the two most obvious variables-dehydration, from not drinking,and hypoglycemia from not taking in calories,But neither added up.The studies I was able to find indicated that males could maintain their glycemic levels for 72 hours during continuous fasting and females for about 24 hours.No problem there.None of us are fasting continuously for that long! As to dehydration, it takes about two weeks to die from water deprivation! So being deprived for 12-17 hours should be no big deal.Those two variables-the most obvious ones-should not really be part of the problem.

Then there are the scientific types looking into this matter including two well-done studies about fasting in Saudi Arabia.(Plos One,2014;9(5):e96500 and PLos One 2017,12(4):e0174342).These studies investigate some of the standard physiological variables done in routine blood monitoring.Their findings are interesting and I will attempt to summarize here what they indicated.

1)Mean levels of GGT(one of the most sensitive liver enzyme tests) as well as total protein and albumin decreased during Ramadan.That is probably all good,indicating that the liver is under less stress because of the reduced eating

2) Morning leptin was increased and morning adiponectin was decreased.Both of these are hormones released from fat cells indicating changes probably due to the on and off eating patterns of Ramadan.Unfortunately both of these changes are indicative of insulin resistance,something at the root of problems with adult-onset diabetes,i.e. not good.

3)CRP levels and IL-1a( indicators of inflammation in the body)  were lower(a good sign) but their diurnal variation was abolished(probably not good)

4)Blood glucose concentration remained within normal limits(as expected)

5) LDL(bad cholesterol)increased significantly(not good)

6) increased glucocorticoids,the stress hormone was increased(not good)

So what we see here is a mixed picture- some variables improving others worsening.The troubling, but not unexpected feature, however, that the studies indicate is that there is an increased incidence of cardiometabolic disorders and type -2 diabetes.Not unexpected as I have witnessed several crises of a medical and psychiatric nature as a doctor-from migraines to kidney stones to intractable depression.Each of these was manageable although sometimes the only way to manage them was to stop fasting-which we are permitted to do for medical reasons.

As I have said,none of this was surprising and none of it was troubling-at least to me.There may be a small but relatively predictable worsening of certain medical conditions during Ramadan.Some of them require sound medical advice.But overall,this increased risk is a small price to pay for obedience to our Lord and all the benefits pursuant to that.Let us remember that doing hajj also involves a low level of risk as does breaking our sleep cycle to pray tahhajjud.All well-worth the effort in terms of our relationship with our Creator.,no doubt.

As usual,whenever I consult with the official scientific publications,I still felt that my questions  were not really answered and I remained unsatisfied.Then came the’tajalli’! the ‘ilham’! -the insight if you wish..The real problem is none of the above-mentioned! The real problem is that we are all toxic in the modern world-to various degrees.You see, the people at the time of the Prophetsaws and right up to early in the twentieth century had no mercury in their mouths from amalgam fillings.they had no lead in their system from lead pipes and additives to petroleum and lead in paints.They had no aluminum from vaccines and Teflon,non-stick cookware.They had no exposure to pesticides and herbicides and fungicides in their food.They were not surrounded by formaldehyde-(in glues and fillers) laden construction materials and on and on.But all of us in the modern world have these exposures.These substances are found in umbilical cord blood and breast milk.

So we are all toxic!And fasting becomes a detoxification process! And that is where most of the symptoms come from.

This may all sound discouraging at this point.And it is troubling.And it definitely has to be managed appropriately.But there is an upside to all of this.If Ramadan is really a detox program, there may well be benefits to it.I am hoping to test out this hypothesis in the next few years inshallah.If it turns out to be the case, I will have attained the Holy Grail of Islamic Medical Research lol-proving that Ramadan is beneficial to our health .Anyone interested in participating in this research is more than welcome to contact me.I,myself intend to do a pre- and post-Ramadan hair analysis for heavy metals to see if there are any changes to be found.I am also looking for a lab that can do Urinary Glyphosate(a marker for all pesticide exposures)in a cheap and simple way. To be continued…Salaams,Ibrahim