Dr.Ajaz Ahmad Suhaff
Fasting in the holy month of Ramadan represents one of the five pillars of Islam. Ramadan is a treasured month. It is a spiritually intense period of reflection and devotion, whose purpose is to seek guidance and ask for forgiveness, quietly focusing on getting closer to Allah. We all believe that the month of Ramadan is a blessing but can be a challenge even for the healthy individual. Fasting improves both spiritual and physical aspects of health.
In 1994, the first International Congress on “Health and Ramadan”, held in Casablanca, it was suggested that Ramadan fasting would be an ideal recommendation for the treatment of mild to moderate diseases such as Non-insulin dependent diabetes, essential hypertension, weight management, and for rest of the digestive tract includes lowering blood sugar levels, lowering of cholesterol and lowering of the lipid profile.
How does fasting in Ramadan affect psychological health?
Psychological effects of Ramadan fasting are also well observed by the description of people who fast. Fasting strengthens control of impulses and helps develop good behavior and gives strengthens and self control. Research studies have revealed that fasting helps self-restraint and better anger management in hot tempered individuals. ‘Qiyam al-Layl’ (late evening) voluntary prayer in Ramadan also leads to peace of mind and helps curb frustration associated with the burdens and pressures of life.
During Ramadan, families sit down to break their fast each night together. They visit relatives’ and friends’ homes for the nightly ritual, known as iftar. Engaging in fasting can bring families and social groups closer together and helps people suffering from depression and loneliness by reassuring them that they are not alone. When a person is fasting , the body releases chemicals to help protect the brains from the negative effects. These chemicals can put us in a good mood. The body begins to adapt to starvation by releasing massive amounts of catecholamines including epinephrine (adrenaline), norepinephrine, and dopamine as well as gluco-corticoids, steroid hormones involved in regulating the immune response and glucose metabolism. These chemicals help our body responds to stress through a boost of feel-good.
A study in 2009 showed that therapeutic fasting alleviates depression symptoms and improves anxiety scores in 80% of chronic pain patients after just a few days. Researchers have found that fasting boosts the levels of available serotonin in the brain and this could be one mechanism of fasting as an antidepressant during Ramadan. Sleep changes which occurs during this month also has beneficial effects on many depressive patients as sleep deprivation has been used as a therapy for severe depressive disorders. During manic episodes, the need for sleep is known to be reduced.
International research has revealed that fasting had a great positive impact on individuals undergoing therapeutic treatment for addiction and substance abuse, as this act of worship promotes positive behavioral change in these individuals. Fasting for a whole month in Ramadan helps breaking addictions to harmful substances like tobacco, drugs, alcohol, tea, coffee and other habit-forming beverages. It requires abstinence from smoking as well as eating and drinking during the day. Ramadan provides an ideal opportunity for smokers to quit. Activities during Ramadan such as family visits and prayers can help keep an individual occupied and assist him or her in quitting smoking.
In older people, the decline of mental functioning and the increased risk for neurodegenerative disorders such as Alzheimer’s and Parkinson’s become a larger concern. Recent research suggests that fasting may mitigate the development of these situations. Intermittent fasting increases the chemical known as BDNF (brain-derived neurotrophic factor), which is associated with increased hippocampal neurogenesis. That means, the more BDNF you make the more likely it is that your brain is building new neurons.
The Challenge of fasting in Ramadan
With the arrival of Ramadan we have instances of public cases of irritability within our community that emerge even in persons without mental illnesses. But fasting can also exacerbate symptoms in some patients suffering from mental illnesses. Some studies have found that there is possibility of recurrence in patients with bipolar disorder during fasting. Fasting poses the challenge of the inability to take medications during the day, dehydration and other somatic changes that necessitate dosing modification changes. Some medications have to be maintained at a specific therapeutic index, namely lithium, a common mood stabilizer used to treat bipolar disorder as lithium is quite sensitive to the level of hydration or excessive sweating.
Making a unilateral decision to fast without a doctor’s approval is irresponsible. Doctors must be consulted and informed of the commencement date of Ramadan and they are best placed in deciding whether one is capable of the fast or not. Psychiatrists and physicians should work together in educating patients on triggers and signs of a worsening mental state. We must review the level of functioning and stability of our patients prior to Ramadan. Practitioners should collaborate with imams and community heads for our patients’ comfort. We should empower and equip them with information they can use during this blessed month. In short, Ramadan fasting is safe in most conditions and disorders, but caution is required in subjects with schizophrenia and bipolar disorder.
— The author, a Senior Resident Department of Psychiatry, at SKIMS Medical College, Bemina, can be reached at: