Revisiting an old article
by Dr Suriyakhatun Osman
I wrote this lecture years ago after reading a book on fasting written by an American, Dr Alan Cott, the book was titled Fasting, the Ultimate diet. What I wrote was in Bahasa and, it was in the form of a presentation. Now I m trying to rewrite it in English adding to it what I learned from my many years of experience fasting as well as treating fasting related problems in my clinic. This writer was talking not about the Muslim fast but the fasting that some people undertake, while not taking any solid food, they would take water, or some would take juices.
The Muslim fast on the other hand is a semi fast but also a complete fast. One goes without food and drink and, more that this, one goes without negative thoughts, if that is possible. The fasting one undertakes is to fast from all negative things, including negative thoughts. It is also a withdrawal from fulfilling some of our bodily needs that are related to our desires and urges. While these are not forbidden in themselves, they are to be abstained from while in the state of fasting. This includes all actions pertaining to the sex act. However it is only abstained from while observing the sun up to sundown fast and is permitted in the night-time while not fasting even in the fasting month of Ramadan.
It is not my intention to discuss the merits and demerits of fasting but it is my intention to address some of the benefits, problems and mechanics of fasting to help the individual who wants to undertake the fast. It is also not my intention to go into great technical details nor is it my intention to write a scholarly treatise with references since there is a time constraint to my writing. Having said that, most of what I am writing have been verified and data on it can be easily found on the internet and in books.
The fast begins with a pre fast preparation. The pre fast preparation for the average Muslim faster is to get up before dawn to eat a meal! Of course those who are afraid of going hungry will eat a big meal if they have the appetite to eat at this hour! But, in actual fact, the bigger the meal you eat, the faster you'll get hungry. It would therefore be wise to eat a small meal that is packed with the nutrients one needs for the day. A complex carbohydrate meal with a lot of essential fatty acids and a helping of vegetable protein would be good. If you take a cup of muesli with yoghurt and honey adding some flax seeds, it would make a good pre fast meal. A liquid meal made from a complete food powder may be a good choice for those who have no time to waste preparing a meal, a light wholesome meal may be another option. Milk with dates is also a good pre fast meal, adding a whole food vitamin and mineral preparation would not be a bad idea. If you are allergic to milk, substitute the milk with soya milk. Taking refined carbohydrates like white flour and white rice is not such a good idea because these foods digest pretty fast and you get very hungry very soon, as well as your blood sugar will rise very fast and then drop very fast. A complex carbohydrate on the other hand, will digest much more slowly keeping the blood sugar steady.
Examples of complex carbohydrates are brown rice, whole meal cereals including wheat and all vegetables and fruits except for the very starchy ones which have much less fibre and a lot of carbohydrates. Fruits are very good for breaking the fast because they have a lot of easily utilised sugars but they are not likely to cause the sudden rise and then fall of the blood sugar. It is eating simple sugars (white sugar) that sometimes make people dizzy after breaking the fast, because the blood sugar shoots up suddenly releasing insulin which then works to bring down the blood sugar again super fast as well. The fibre in the meal slows down digestion, hence the blood sugar rise is gradual when we eat complex carbohydrates.
For those who are usually constipated while not fasting, the bad news is that it is going to get worse when fasting and it is also going to negate any beneficial detox effect of the fast! For these people, I would suggest that a few days before beginning the fast, eat light foods, avoid animal proteins, drink lots of water and take a preparation that would cleanse the bowels. Depending on the type and manner of constipation, these are the suggestions : Take a fibre preparation before bedtime with a large glass of water, ones that can be bought at a pharmacy are psyllium seed preparations or asperghula husk. You can make your own preparation using local ingredients (getah anggur, kembang semangkok, selasih). Take a tablespoonful of Lactulose (available over the counter at the Pharmacy) or if this is too mild, add two senokot tablets or granules prepared according to instructions on the pack you bought. Senokot may cause some griping pain while being a good bowel cleanser and each person has got to find their own suitable dose! Start taking more fibre with your meals but, if you have been used to eating low fibre meals, you may find that suddenly increasing fibre intake will cause bloating! Adding a suitable amount of chlorella and spirulina may help with the detox but having said that, please make sure the brands you use are from pollution free sources and, also there are some people allergic to chlorella and spirulina so please start with a small quantity, way below the recommended dose! You may want to know why I suggest a detox to begin the fast. Most Muslims do not do any kind of detox and simply plunge into the fast. Many will have been fasting for a few days in the week the previous month and this will be a detox in itself. Those who plunge into the fast may have a tough time the first week of the fast if their bodies are having a lot of waste matter that has not found its way out of the body in the normal course of its metabolism. How is this possible you may ask?
In an experiment done in a lab, some cells from a chicken were grown in a Ringer's solution. The Ringer's solution was changed daily. The cells lived for more that 20 years. The reason the cells died finally is because the solution was not changed during a long public holiday when the lab was closed. This experiment showed that the cells survived when their metabolites were efficiently dealt with. The Ringer's solution that was contaminated with the metabolites from the cells still contained enough cell nutrients, which means that what killed the cells were their own toxic products! Our bodies have their metabolites eliminated via our stools, by being processed by the liver, and through our kidneys as urine, also through our skin as sweat and through our lungs in the vapour that comes out with our breaths. If for any reason there is an inefficient elimination due to the sluggishness of the liver or the kidneys or the skin and lungs, our body will be storing waste matter meant to be eliminated. The waste products are the metabolites from the food we eat and also from pollution that we are exposed to via breathing and our drinking water as well as food. When we are not fasting, our cells are busy processing the food we keep ingesting and this may make the cells fall back on the clearing out of the waste matter which then gets retained in the cells but when we stop eating the cells will then have the time they need to deal with the waste matter. For this reason I have always advised people to stop eating at about 6 pm and have the next meal at about 8 am, even if they do not do any fasting! In other words, it is possible to eat ourselves to death if we do not pay attention to the detox and elimination functions of our bodies.
So now we go to the actual fast itself. Basically the fast is to stop eating and drinking from sun up to sun down! The time of the fast varies from country to country and season to season and year to year. For some it may be 14 hours, for some much more and for some much less! But somehow since the Muslim calendar moves because it is a non-adjusted lunar calendar, it keeps shifting until those who have fasted in the winter will find themselves some years later fasting in the summer!
So what actually happens during a fast? A long enough fast will result in ketosis. The body will run out of its glycogen, the constant energy supply that the body produces from foods eaten and, the body starts dipping into its reserve supply stored in the fat. The body however, no matter how fat a person is, is very reluctant to dip into the stored fat, some long ago mechanism for survival of the human I suppose and will let the blood sugar level really drop, as well as let the body metabolism slow down before it actually starts to dip into the stored energy reserves. Does a person who totally fasts for about 14-18 hours in a day go into a ketosis state? This is an individual thing and, can only be determined by doing a ketone test on the urine or the breath.
Some of the experiences of the faster come from reflex actions by the body. Do we feel hungry because the body does not have enough food? More often that not, the hunger pangs we get are reflex, because we eat at a certain time, so we regularly feel hungry even though our body may not need the food! When the blood sugar goes down, we may feel dizzy, and, we will not be able to stand the cold as much as when we are not fasting.
Many people get a headache when they fast, even a few hours into the fast.. The headache comes on for many reasons, some of it may have to do with a gastric reflex action, and, some of it may be due to toxins that start to get released into the blood stream because of being released from the cells. The waste matter that has been trapped in the cells and in our fat cells, start to find its way into the blood because we have given the cells time to process the metabolites in the cells by not eating. The cells start to deal with the accumulated waste products and throw them back into the blood so that they can go to the liver and the kidneys, and the skin and lungs to be released from the body. This gives rise to the smelly breath, smelly sweat, pungent urine and smelly stools the faster may experience. It may also make the faster experience diarrhoea a few days into the fast and these increased toxins in the blood, on their way out, also gives rise to the lethargy, body ache and weakness, besides the headache and dizziness that the faster experiences. It sounds bad, but leaving the toxins in the cells is much worse because there they cause the cells to degenerate and age faster. A person who has done some detox before the fast will experience much less problems from these annoying symptoms besides being simply tired and hungry.
Anyone who has actually undertaken the fast will tell you they start to feel better in the second week of the fast! By this time the body's reflex actions will have adjusted to the new time table of eating, and also the accumulated waste in the cells will have had a sufficient time to have been removed, thus the overload of metabolites from the cells and the fat cells will have reduced.
Some problems however may start to become apparent during this time! What I notice is an increase in cases of renal colic and gouty arthritis, and, gastritis. I also find many cases of acute gastroenteritis, quite apart from the diarrhoea that I mentioned earlier as possibly due to a detox reaction. Most of these medical problems of the faster is not directly related to the fasting but, more because of how they break the fast each day! My favourite phrase that I say to my patients is "This is not because of the fasting, but this is because of how you break your fast!" (Ini bukan salah puasa, ini salah buka puasa) Most people are not aware and do not think it necessary to change the way they eat after not eating for 14-18 hours! They break their fast by eating as they usually eat and if that consists of really hot chili padi and curried chicken, roast beef and a heaping plate of rice, then that is what they’ll eat when they break their fast!
The problem is that the gastrointestinal tract, having rested for an unusual length of time, and being really empty of food, is not ready to digest irritating foods in large quantities engulfed in record time! My advice would be to eat lightly and certainly cut down on the animal proteins as much as possible and substitute mixed vegetables and beans for it. This would counter the tendency for uric acid stones and deposits, the main reason for the increased incidence of gouty arthritis and renal colic during the fasting month. By the way, some beans may also be a problem for some people with a raised uric acid level to start with. Taking a lot of fruit juices would help alkaliniaze urine and this would also be a great help in preventing stones. Drinking a lot of water whenever possible throughout the night would also be a good practise. If there is a strong tendency for uric acid stones, perhaps a commercially sold alkalinizer may be a good preventive measure.
The other reason for the gastrointestinal problems besides indiscreet breaking of the fast, is eating food that has been in the refrigerator, or worse still, kept on the table for long periods of time. Asians for example would cook rice and leave it in the pot for long hours in the hot weather and not realize that germs would have been breeding in the rice. Or they would eat leftovers from the break fast meal for the pre dawn sahur again paving the road for ingesting germs! My advice here would be to cook enough for one meal, and to quickly refrigerate leftovers if they are to be eaten again and, to throw away the bacterial cultures and fungal cultures that you may discover in the refrigerator after a week of fasting and accumulating left over foods, lest a hapless member of the family raids the refrigerator at night and ends up sick!
There is another problem that I have come across during the fasting month and that is, many people who were allergic to certain foods had flare ups when they ingested the food during the breaking of the fast! The explanation for this is that, in actual fact the person may be very sensitive to the food, but the effect is masked when the person eats regular meals because of the other digestive functions. Abstaining from food therefore augments the sensitivity reactions. This is actually helpful because it identifies the food we are sensitive to and we can thus avoid these foods. Although we may think that we have become more allergic to these foods, in actual fact we are already very allergic to these foods, except that the allergies would manifest in less dramatic but more chronic ways. For example, if we are allergic to shrimp and usually, on non fasting days, taking shrimp makes us wake up with a runny nose the
next morning, we may find that taking shrimp for the break fast meal may cause an immediate itch in the mouth! The most sensible thing to do with food we are allergic to is to avoid these foods but I know of very many people who would rather have the allergy than go without the food! In this case, then I would suggest make sure you do not take foods you are allergic to in the break fast meal, take it later in the night.
The best thing to take for the break fast meal is bland nutritious foods and most Muslims know that the Prophet (pbuh) used to take dates and milk. The prophet (pbuh) used to have a very meagre meal for breakfast and the same for sahur, which would make the fast a ketotic one, that is the body goes into ketosis, there is a break down of fat and, there is a detoxification process that goes on, and research has shown that in this kind of fasting, it is quite possible that tumours will be resorbed and shrink, even disappear from the body. This kind of fast, eating far less than the caloric needs of the day will have a lot of added benefits but, is not to be undertaken by those who are having other serious metabolic disease except under close medical supervision and monitoring! It is also possible to cure disease related to the guts, including colitis and constipation, if one is prepared to go on a strictly bland diet, completely avoiding the foods that aggravate the conditions. This is different in different people, many people are gluten intolerant, quite a number are pretty allergic to spices and chilli although they will say they cannot do without it. Some cannot take certain vegetables and certain meats so what to avoid is quite individual! The month long fast, if undertaken with the avoidance of the foods one cannot tolerate well will improve digestion and heal many minor functional digestive problems and possibly even more serious ones.
About spices, many Asian styles of cooking are very spicy. Spices have a lot of essential oils and stuff that need to be processed by the liver and by the kidneys. So, in the fasting month when water intake is nil in the daytime for 14-18 hours, it is very wise to cut down on spices or to avoid spices entirely.
I have read about a lot of research done on the Ramadan fast on blood lipid levels and, it has been shown that fasting reduced serum cholesterol while raising the good cholesterol. This result was obtained in many of the studies conducted and, one that I am quoting is titled:
Effect of Ramadan Fasting on Lipid Peroxidation, Serum Lipoproteins and Fasting Blood Sugar done in the Isfahan Universirty of Medical Sciences on 50 healthy subjects.
One of the things frequently pointed out to be negative is the dehydration that is caused by not taking any fluids from sun up to sundown, but in actual fact this also has been proven to be of possible benefit:
Quoting from a magazine article: at this URL
http://www.saisamachar.com/saipranaam/nov02/health.htm
Abstinence from water during this period is not bad at all and in fact, it causes concentration of all fluids within the body, producing slight dehydration. The body has its own water conservation mechanism; in fact, it has been shown that slight dehydration and water conservation, at least in plant life, improve their longevity.
For the effects of fasting on the blood sugar, again a lot of research has been done on this, and the results may differ with different research but a consensus may be reached that it is generally beneficial. In my clinic though I do not see it to be so, most probably because we find that during Ramadan, many people will take to drinking sweetened water and syrups! When I was studying in another Muslim country which I will not mention, I was shocked to find out that my landlord, a family of 4 adults, actually consumed one kilogram of sugar in 2 days during Ramadan because of extra sweetmeats they prepared! There were many other things I found rather weird and among them, day became night, night became day, people stayed up to eat and talk the whole night and in the day time they mostly slept! I think in some places schools were closed and work was cut to a minimum. I am of the opinion that all these practices actually negate the beneficial effects of fasting and am happy to say it is not the custom here in Malaysia where people would spend the earlier part of the night in group prayers and then sleep, waking early for the pre dawn meal, more prayers and Quran reading while in the day time it is work as usual.
Another common problem is gastritis! I have mentioned about taking hot chili and spices and said that it is not a very wise choice of food for breaking the fast! Neither are caffeine drinks, especially if one is sensitive to caffeine. I find that a cup of coffee or tea an hour or so after breaking the fast is not too harmful for the average person but for the sensitive person it is enough to cause a digestive upset as well as insomnia or, in the case of tea, the tannin content in the tea may cause constipation to a bowel that is already sluggish from the reduced peristalsis caused by the fast! A very good drink for breaking the fast would be a tea made from fresh ginger! What I do is take fresh young ginger and crush it, and add hot water and honey and a little limejuice, or lemon juice. It helps digestion and is a very soothing drink to take after a fast. I know fresh young ginger may not be too easy to find in the West though and ginger powder may have to do but won' t taste as good! This drink is one my grandmother used to make and I remember drinking it every fasting month when I was a child. I have revived the tradition in my own home, and have also found out that ginger heals many minor digestive complaints!
Other simple solutions to hyperacidity may be Magnesium Trisilicate, which can be bought at the pharmacy. It has the added advantage of being mildly laxative which helps in the fasting month! Read labels and do not buy anything that contains aluminium. We get enough from aluminium foils and aluminium cans and do not need an extra dose of it! Aluminium has been implicated in Alzheimer's disease and one should avoid any antacid that contains aluminium and mind you, many actually do.
There is an effect of experiencing a high from eating even from 2 days of fasting the Muslim way. I think this would be difficult to explain to people who have not experienced this high! When we are eating every day and eating very regularly, I think we sometimes get to the point that the eating does not seem to be contributing to our energy. I have often felt tired and even sluggish especially when there had been too many dinner invitations, and the food was so delicious that one tended to overindulge. I have found my own cure for this and that is to fast, and to break my fast with light foods for at least 2 days! What we will experience is that the first day of the fast is very difficult, I would feel very tired and my whole body would ache, my head would ache and I would not be in a very good mood! On the second day, I would feel less tired, and my body would start to feel better, I would be mild mannered and sweet, even though I would feel tired! And then when I have a normal day on the third day starting with breakfast in the morning, what would happen is that I would feel great! I would have a lot of energy, I would be vivacious and full of life. My digestion would have improved, food would taste great but a little bit would be enough and after a meal there would be a surge of energy and a sense of well being that would have been absent before the fast.
For a month long fast, it is the same but, on an extended scale! There are several differences in routine that happens when we fast and that is that we have to sleep less, because of the pre dawn meal and prayers. It would help to sleep early but usually what happens is that after breaking the fast in the evening, there is so much energy that one does not feel like sleeping early and would use the time for reading and prayers or talking or doing a hundred and one things that one did not feel like doing in the day time while fasting! This does not always happen though, if one has taken too much food when breaking the fast, what happens is an extreme lethargy and sleepiness and you may find yourself sleeping right after breaking the fast so if you do not want to go to sleep after breaking the fast, make sure you do not fill your stomach to the brim! It is also not a commendable thing to do!
The Prophet's instructions on eating are very simple, "Eat when hungry and do not eat until you feel full. There should be one third of your stomach with food, one third with liquid and, one-third with air!" The wonderful thing though that you will find is, that after some time, you will not need so much sleep and can make do with less sleep. This seems to be a result of eating less!
As I have said previously, when fasting the stomach and intestines become somewhat more sensitive than they are when we are eating all the time. What this means is that foods we react to will have a greater amplitude of the same reaction we have while not fasting. A far as supplements are concerned, the more concentrated ones may not agree very much with the digestion while fasting so for most people, it would be best to cut down supplements to the minimum.
As for those on medications, here are the adjustments that may be needed:
Diabetics on hypoglycaemics or insulin: When fasting the blood glucose level will go down so if you take a dose during the pre dawn meal, you may go into hypoglycaemia in the day time. Symptoms would include vertigo, cold sweating and feeling faint. I usually advise my patients to take their daily dose during the evening meal. Those who take 2 dose a day will need adjustment of the predawn dose. A reduced dose may also be needed. Monitoring blood glucose levels while fasting would help in the adjustments, involve your doctor in the adjustments. As for antihypertensives, it is probably ok to stick to the medication as before, those taking medication 3 times a day may need to change to longer acting versions of the drugs they are taking. Again talking to your doctor is going to help make the adjustments.
Antibiotics: Anybody who needs antibiotics while fasting should request for the antibiotics with a daily or twice daily dose. It would be a bit problematic to try to take 3 daily doses at night and not possible to adjust the dosing! Some antibiotics can cause crystals in the urine and cause pain when urinating because of the no intake of water in the daytime. As such, please inform your doctor you are fasting and ask the doctor not to give such antibiotics. Those who are prone to urine infections may take urine alkalinizers, which are sold over the counter in pharmacies. Cornsilk and barley drinks would also be helpful to take.
I have mentioned about constipation: Vegetables and other complex carbohydrate foods are essential. Mild constipation can be dealt with by taking fibre preparations like psyllium husks, and there are some fruits like prunes and tamarind juice that can also help. Other than this there are some mild preparations like Forlax that are very
safe to take when absolutely necessary. The other alternative is to go for enemas. Constipation should not be allowed to continue, as it will reduce the detox effect of the fast. The liver cannot unload its accumulated waste products if the person is constipated. Avoid tea because it contains tannin, which is astringent and tends to cause constipation if you are constipated. Those taking NSAID, ie painkillers may have much more gastric irritation on these and, if they have sensitive stomachs should change to less irritating drugs which your doctor will tell you about. It may cost more than the usual NSAID s that you are taking. Eg, you may change from diclofenac sodium a non-steroidal anti-inflammatory to a cox 2 inhibitor like meloxicam.
You may however want to try alternative treatment and now may be a good time to make the switch! The fasting time is also the best time to deal with your drug and food addictions! Since smokers and caffeine drinkers have to abstain while fasting, they will find that it gets much easier to keep delaying the coffee or cigarettes until they don' t drink it or smoke it and it is time to fast again! Those who are really heavy smokers may need a little bit more help from the doctor by going on a nicotine patch or some other aids to stopping smoking. Many have asked me about taking injections. In general, injections according to the clerics I have consulted are allowed while fasting, and there should not be a problem with this. Having said this, painkillers are still excreted to the stomach and taking such an injection on an empty stomach may cause a gastric irritation.
Other issues I have seen raised about fasting is physical activities and sports. Naturally these activities will cause the person to sweat and become dehydrated so what happens when you sweat and cannot drink any fluids? I have done exercise and aerobic dancing while fasting and am none the worse for it. What I do is to have these activities in the late afternoon, about an hour or so before the time for breaking the fast. In this way there is not much of a delay in replenishing the water in the body. There is a possibility of feeling a bit dizzy while exercising, this is not harmful and is due to the lower blood pressure of the faster.
As for bathing, many fasters avoid bathing after 12 noon when fasting because they say it is makruh, ie not recommended and will reduce the rewards of the fasting since it refreshes the tired body and therefore makes the suffering less! But practically speaking, bathing every day and scrubbing with a sponge will very much help the body to detox since all the fasting is going to move toxins into the organs of elimination which are the large intestine including the liver, the kidneys, the lungs and the skin via the sweat glands and the skin cells! By removing the dead skin cells, which contain the toxin, we allow the skin to send more of the stuff it wants to remove via the skin! So one of the benefits of the fast will be a lovely clear complexion! Not to worry if in the beginning the skin throws out pimples and other eruptions, this does sometimes happen before the skin clears! But the skin will not clear unless you do not eat that foods that aggravate eruptions, like nuts and chocolates!
Another tip I would like to share is to carry a drinking bottle, make sure it is one that is not easy to spill, when you go for the tarawih prayers. This way you can drink in between the prayers and rehydrate yourself better. You will notice your throat get very dry while saying the tarawih, if you have neglected to bring your drinking water along!
There is a little bit I would like to address about the emotional and mental effects of fasting. There are my own observations and bits and pieces I have heard or read somewhere and cannot make references to ..this is the reason I cannot write scholarly papers, a lot of what I say is mere heresay and anecdotal! A talk I attended just before the fast made a point about the fast. Now this advise is by some holy person and as usual I cannot remember who but, something clicked when I heard the advise. The advise is, stop what you do as a routine in your life, forget about that extra ironing that you do, vacuum the house less, spend less time on the computer, CHANGE your routine in whatever way you can and, do beneficial things you never had the time for! Read that motivational book that you have bought a few months ago and never had the time for, read the Quran and make sure you ponder over the meanings. MAKE ROOM in your life for new things by removing from it the stuff that is keeping away the new things that are needed in your life. Your mind is clear when you fast, because the energy spent on digesting food, is now not being expended and is available to your brain. The emotional support you get from the sense of togetherness, the breaking of the fast with the family, the increased consciousness about keeping away the negative, makes this an ideal time to reflect, to think and to grow in our realisations besides the extra prayers that we do. I always need my inward looking time and it is quite easy to be caught in group activities and forget to look inwards at this time, but it would be a waste not to use this time for that inner spring cleaning!
I have had some questions asked to me and will address them now before ending this series on the Muslim fast and our body.
One person asked me what to do if one is underweight and will lose a lot of needed weight when fasting! Some people have very high body metabolism and tend to lose weight even when eating well. The ones I know who are like this are very healthy in other ways except that they look like they have not eaten for weeks! I would suggest to take extra high calorie meal replacements after the usual meals as a drink in between the 2 main meals and to take another supper snack an hour before sleeping. Take more fat, nuts are a good source of fat and snack on dried fruits and nuts at night. Please make sure you know your cholesterol levels before undertaking to eat more fat. There are some pretty thin individuals who may have raised cholesterol levels and raised ldl cholesterol (bad cholesterol) and low hdl (good cholesterol).
Another person asked me what I think of the traditional way some people take extra large meals with lots of goodies during the fasting month, much more than they usually eat and this person said he actually gained weight in the fasting month! I think this is a very unhealthy way to fast and would be harmful in the long run as well as it negates many of the benefits, both physical, emotional and spiritual.
Ramadan Mubarak! May you have the best fast possible and emerge from the fasting month renewed and victorious over your nafs, healthier in mind body and soul!
Suriya Osman
