Ahmed Tholal

Medical benefits, fasting & Diabetes Mellitus

Ahmed Tholal — Fri, 21 Aug 2009 18:30:27 +0000

Most Muslims do not fast because of medical benefits but because it has been ordained to them in the Quran. The medical benefits of fasting are as a result of fasting. Fasting in general has been used in medicine for medical reasons including weight management, for rest of the digestive tract and for lowering lipids. There are many adverse effects of total fasting as well as so-called crash diets. Islamic fasting is different from such diet plans because in Ramadan fasting, there is no malnutrition or inadequate calorie intake. The caloric intake of Muslims during Ramadan is at or slightly below the national requirement guidelines. In addition, the fasting in Ramadan is voluntarily taken and is not a prescribed imposition from the physician.

Ramadan is a month of self-regulation and self-training, with the hope that this training will last beyond the end of Ramadan. If the lessons learned during Ramadan, whether in terms of dietary intake or righteousness, are carried on after Ramadan, it is beneficial for one’s entire life. Moreover, the type of food taken during Ramadan does not have any selective criteria of crash diets such as those which are protein only or fruit only type diets. Everything that is permissible is taken in moderate quantities.

The only difference between Ramadan and total fasting is the timing of the food; during Ramadan, we basically miss lunch and take an early breakfast and do not eat until dusk. 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.

The physiological effect of fasting includes lower of blood sugar, lowering of cholesterol and lowering of the systolic blood pressure. In fact, Ramadan fasting would be an ideal recommendation for treatment of mild to moderate, stable, non-insulin diabetes, obesity and essential hypertension. In 1994 the first International Congress on “Health and Ramadan”, held in Casablanca, entered 50 research papers from all over the world, from Muslim and non-Muslim researchers who have done extensive studies on the medical ethics of fasting. While improvement in many medical conditions was noted; however, in no way did fasting worsen any patients’ health or baseline medical condition. On the other hand, patients who are suffering from severe diseases, whether diabetes or coronary artery disease, kidney stones, etc., are exempt from fasting and should not try to fast.

There are psychological effects of fasting as well. There is a peace and tranquility for those who fast during the month of Ramadan. Personal hostility is at a minimum, and the crime rate decreases. This psychological improvement could be related to better stabilization of blood glucose during fasting as hypoglycemia after eating, aggravates behavior changes.

Recitation of the Quran not only produces a tranquility of heart and mind, but improves the memory. Therefore, I encourage my Muslim patients to fast in the month of Ramadan, but they must do it under medical supervision. Healthy adult Muslims should not fear becoming weak by fasting, but instead it should improve their health and stamina.

DIABETES MELLITUS AND RAMADAN FASTING

Diabetes mellitus affects people of all faiths. Muslims are no exception. Many diabetic Muslims have a desire to fast during the month of Ramadan, although if they cannot for health reasons, they have a valid exemption. The dilemma for physicians and Muslim scholars is whether or not Muslim diabetic patients (1) should be allowed to fast if they decide to; (2) can fast safely; (3) can be helped to fast if they decide to; (4 ) can have their disease monitored at home; and (5) are going to derive any benefit or harm to their health. Fasting during Ramadan by a Muslim diabetic patient is neither his right nor Islamic obligation, but only a privilege to be allowed by his physician, at the patient’s request, knowing all the dangers and assuming full responsibility in dietary compliance and glucose monitoring, with good communication between the physician and the patient .

PSYCHOLOGICAL STATE OF DIABETES DURING RAMADAN

Diabetes mellitus itself adversely affects patients’ psychological states by changes in glucose metabolism, blood and CSF osmolality, needs for discipline and compliance, fear of long term complications and threat of hypoglycemic attacks and the possibility of dehydration and coma.

On the other hand, fasting during Ramadan has a tranquilizing effect on the mind, producing inner peace and decrease in anger and hostility. Fasting Muslims realize that manifestations of anger may take away the blessings of fasting or even nullify them.

Diabetics know that stress increases the blood glucose by increasing the catecholamine level and any tool to lower the stress ; ie., biofeedback or relaxation improves diabetic control. Thus, Islamic fasting during Ramadan should have a potentially beneficial effect with regard to diabetic control.

EDUCATIONAL PROGRAM FOR DIABETICS DURING RAMADAN

It should be directed toward (a) diabetic home management; (b) preparing them for Ramadan; (c) recognizing warning symptoms of dehydration, hypoglycemia and other possible complications.

Patients should be taught home glucose monitoring, checking urine for acetone, doing daily weights, calorie-controlled diabetic diet, need for sleep and normal exercise. They should be able to take pulse, temperature, look for skin infection and notice changes in the sensorium ( mental alertness ) . They should be on special alert for any colicky pain, a sign for renal colic, or hyperventilation, a sign of dehydration, and to be able to seek medical help quickly rather than wait for the next day.

CRITERIA ALLOWING DIABETICS TO FAST DURING RAMADAN

a. All male diabetics over age 20. Please see editor’s note (1).
b. All female diabetics over age 20 if not pregnant or nursing. Please see editor’s note (2).
c. Body weight normal or above ideal body weight. Please see editor’s note (3).
d . Absence of infection, co-existing unstable medical conditions, ie, coronary artery disease, severe hypertension (B/P 200/120), kidney stones, COPD or emphysema. Please see editor’s note (4).
TABLE 1
1500 CALORIE AND DIET MENU FOR RAMADAN
FOOD EXCHANGES
PRE-DAWN BREAKFAST

American Pakistani Middle Eastern
Fruit 1 1/2 c Orange Juice 1/2 Grapefruit 1/2 Grapefruit
Starch 3 1/2 c Oatmeal1
English Muffin 1 Pit Bread
1/2 Potato Bhujia a 1 Pita Bread
1/3 c Fool Midammis
Meat 2 1 Boiled Egg
1/4 c Cottage Cheese 2 egg Omelet
1 oz Feta Cheese 1 Boiled Egg
Fat 1 1 tsp Margarine
1 tsp Olive Oil
1 tsp. Olive Oil
And 2 Black Olives
Skim Milk 1 1c Skim Milk 1 c Skim Milk 1 c Laban
Free Foods 2 tsp Sugar Free Jam
Coffee Tea Tea
POST-SUNSET ENDING THE FAST

Fruit 1 2 large Dates 2 large Dates 2 large Dates
Starch 1 6 sm Vanilla Wafers 1/3 c Chana Chaat 1/3 c Salatet Hummus
Skim Milk 1 1 c Skim Milk 1 c Lassi 1 c Rabat
DINNER

Meat 3 3 oz Roast Beef 3 oz Bhuna Gosht 3 oz Tikka Kebab
Starch 2 1 sm Baked Potato
1 Dinner Roll 1/3 c Daal
1 Chapati 1/3 c Lentil Soup
1 Pita Bread
Vegetable 2 1 c Tossed Salad
(carrot, cucumber,
tomato, radish) 1/2 c Steamed 1 c Sliced Raw Vegetables
(tomato, cucumber, onion)
1/2 c Bhindi Bhujia
Cauliflower in Tomato
Broccoli Sauce 1/2 c Tomato and Onion
(cooked with Tikka Kebab)
1/2 c Cooked
Fat 1 2 tsp Sour Cream 1 tsp Oil used in cooking 1 tsp Oil (used in cooking)
Fruit 1 1 Fresh Apple 15 sm Grapes 1 Fresh Apple
Free Foods
Lettuce (for salad) -as desired
2 Thl Reduced Calorie Dressing
C coffee Tea Tea
BEDTIME SNACK

Fruit/Starch 3 Graham Cracker 1/2 Mango 2 Tangerines
Skim Milk 1 1 c Skim Milk 1 c Skim Milk 1 c Laban
Editor’s Notes

(1) The age limit of 20 has no Quranic basis. The actual physical development and tolerance which can precede the physiological age is the criteria here, not the age. If a male diabetic has the physical built and ability of fasting, he should be instructed to fast if he can do it without difficulty or compromising his heatlh as explained in the rest of the article.
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(2) Again the age limit of 20 has no Quranic basis. See note (1). Also the ban on fasting of pregnant females or nursing mothers is not Quranic or called for. Pregnant and or nursing mothers have to assess their own tolearance and ability of fasting. Those who are healthy enough, having mild Dibetes should be able to fast.
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(3) Again. These are general suggestions, not Quranic rules. We should not use the scale to decide when to fast or not. A healthy slightly under weight person has no excuse not to fast, if he/she can. He/she can check with his/her physician if he/she is questioning his/her ability to fast.
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(4) Again. these are generalization that is not necessarily correct. Some COPD or emphysema patients, mild infections, mild coronary artery disease….etc. may be able to fast withut diffclulty or compromising their well being. If in any doubt ask your good submitter (Muslim) doctor.

Night Prayer in Ramazan

Ahmed Tholal — Fri, 21 Aug 2009 18:23:30 +0000

It was narrated from Abu Hurayrah that the Messenger of Allah (peace and blessings of Allah be upon him) said: “Whoever prays at night in Ramadan out of faith and in the hope of reward, his previous sins will be forgiven.”1

This hadith is indicative of the virtue of praying qiyam in Ramadan, and shows that this is one of the means of forgiveness of sin. Whoever prays Taraweeh as it should be prayed has prayed at night (qiyam al-layl) in Ramadan.

Forgiveness is conditional upon “faith and hope of reward,” as stated here. What is meant by “faith” is that when the person stands to pray qiyam, he believes in Allah, may He be exalted, and believes in His promise and in the virtue of praying qiyam, and in the greatness of its reward with Allah. “Hope of reward” means that he is seeking the reward from Allah and is not doing it for any other purpose such as showing off, etc.

It was narrated that Abu Hurayrah (may Allah be pleased with him) said: The Messenger of Allah (peace and blessings of Allah be upon him) used to encourage them to pray qiyam during Ramadan, without commanding them to do it. Then he said: “Whoever prays at night in Ramadan out of faith and in the hope of reward, his previous sins will be forgiven.”

So the Muslim should be keen to pray Taraweeh, and should be patient in completing the prayer with his imam. He should not neglect any part of it, or leave before his imam, even if his imam does more than eleven or thirteen rak’ahs, because the Prophet (peace and blessings of Allah be upon him) said: “Whoever prays qiyam with the imam until he finishes, it will be recorded that he spent the night in qiyam.” It is only a few nights, which the wise man makes the most of before they are gone.

Abu Dawud said: It was said to [Imam] Ahmad while I was listening: “Can qiyam – i.e., Taraweeh – be delayed until the end of the night?” He said: “The way of the Muslims is dearer to me.”

If a person is keen to pray whatever rak’ahs he wants to at the time of the pre-dawn (suhoor time), then he should not pray witr again at the end of his prayer, rather it is sufficient for him to pray witr with his imam in Taraweeh, because of the hadith of Talq ibn ‘Ali (may Allah be pleased with him) who said: The Messenger of Allah (peace and blessings of Allah be upon him) said: “There cannot be two witrs in one night.”

With regard to the hadith of Ibn ‘Umar (may Allah be pleased with him) – according to which the Prophet (peace and blessings of Allah be upon him) said: “Make the last of your prayers at night witr” – this is to be understood as referring to one who prays at the end of the night and did not pray witr at the beginning of the night.

The command here is to be understood as a recommendation, not an obligation. It is not essential to conclude the prayer at the end of the night with witr, based on the fact that the Prophet (peace and blessings of Allah be upon him) prayed at the end of the night, after his witr.

Abu Dawud said: I said to Ahmad: “Does praying after witr invalidate witr?” He said: “No.” Abu Dawud said: I heard Ahmad say concerning one who prayed witr at the beginning of the night then got up to pray qiyam: “He should pray two rak’ahs.”
It was said: “Does he not have to pray witr?”
He said: “No.”
He said: I heard someone ask him about someone who wanted to pray after witr: “should he pray two by two?”
He said: “Yes, but after witr he should lie down.”

The imam should take care to pray properly in Taraweeh. He should pray with proper focus and humility, reciting in a proper manner and being at ease in ruku’ and sujud. He should beware of rushing lest he fails to attain the proper level of khushu’ (focus and humility) and lest he make the weak, elderly and sick among the people behind him get too tired.

Al-Sa’ib ibn Yazeed said: ‘Umar ibn al-Khattab commanded Ubayy ibn Ka’b and Tameem al-Dari to lead the people in praying eleven rak’ahs of qiyam. He said: The reciter used to recite the surahs that contain more than a hundred verses, until we would lean on sticks because of having to stand for so long, but we did not leave until dawn was approaching.

When the worshipper has said the tasleem at the end of witr, he should say: Subhan al-Malik al-Quddus (Glory be to the Sovereign, the Most Holy) three times, elongating the vowels and raising his voice the third time, because it is proven that the Prophet (peace and blessings of Allah be upon him) did that.

O Allah, accept this (worship) from us, for You are the All-Hearing, All-Knowing, and accept our repentance, for You are the Acceptor of Repentance, the Most Merciful

Ramadan-and-eid-al-fitr

Ahmed Tholal — Mon, 09 Mar 2009 08:03:54 +0000

Ramadan is the ninth month of the Islamic calendar. Islam uses a lunar calendar-that is, each month begins with the sighting of the new moon. Because the lunar calendar is about 11 days shorter than the solar calendar used elsewhere, Islamic holidays “move” each year. In 2010 Ramadan begins at sundown on August 11.
For more than a billion Muslims around the world-including some 8 million in North America-Ramadan is a “month of blessing” marked by prayer, fasting, and charity. This year Ramadan precedes Christmas and Hanukkah. But while in many places these holidays have become widely commercialized, Ramadan retains its focus on self-sacrifice and devotion to Allah (God).
Why this Month?
Muslims believe that during the month of Ramadan, Allah revealed the first verses of the Qur’an, the holy book of Islam. Around 610 A.D., a caravan trader named Muhammad took to wandering the desert near Mecca (in today’s Saudi Arabia) while thinking about his faith. One night a voice called to him from the night sky. It was the angel Gabriel, who told Muhammad he had been chosen to receive the word of Allah. In the days that followed, Muhammad found himself speaking the verses that would be transcribed as the Qur’an.
At many mosques during Ramadan, about one thirtieth of the Qur’an is recited each night in prayers known as tarawih. In this way, by the end of the month the complete scripture will have been recited.
Fasting
Muslims practice sawm, or fasting, for the entire month of Ramadan. This means that they may eat or drink nothing, including water, while the sun shines. Fasting is one of the Five Pillars (duties) of Islam. As with other Islamic duties, all able Muslims take part in sawm from about age twelve.
During Ramadan in the Muslim world, most restaurants are closed during the daylight hours. Families get up early for suhoor, a meal eaten before the sun rises. After the sun sets, the fast is broken with a meal known as iftar. Iftar usually begins with dates and sweet drinks that provide a quick energy boost.
Fasting serves many purposes. While they are hungry and thirsty, Muslims are reminded of the suffering of the poor. Fasting is also an opportunity to practice self-control and to cleanse the body and mind. And in this most sacred month, fasting helps Muslims feel the peace that comes from spiritual devotion as well as kinship with fellow believers.
Eid al-Fitr
Ramadan ends with the festival of Eid al-Fitr, which in 2009 occurs on September 21. Literally the “Festival of Breaking the Fast,” Eid al-Fitr is one of the two most important Islamic celebrations (the other occurs after the Hajj, or pilgrimage to Mecca). At Eid al-Fitr people dress in their finest clothes, adorn their homes with lights and decorations, give treats to children, and enjoy visits with friends and family.
A sense of generosity and gratitude colors these festivities. Although charity and good deeds are always important in Islam, they have special significance at the end of Ramadan. As the month draws to a close, Muslims are obligated to share their blessings by feeding the poor and making contributions to mosques.

Poll

Ahmed Tholal — Thu, 05 Mar 2009 09:42:34 +0000