This article discusses the numerous adverse effects of Islamic fasting ( Sawm ) that have been observed using scientific studies and news sources.

Some Muslims claim eating a small amount of food is the correct Islamic way however we cannot function for the whole day by eating only a small amount of food at the time of dawn. This would affect our performance even more during the day.

Medical fasting can have health benefits. As we will explain here, Islamic fasting, however, differs in many respects, and thus has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior. Health effects include heat stress, dehydration, migraines and, for lactating women, the nutritional make-up of their milk, among other harms.

In a recent study done on the Arab world, diseases linked to cholesterol and diabetes increased by 27.65% because of overeating.[3] Non-compliance with prescribed treatment regimens is common during Ramadan. [4] Other health effects include:

Dehydration

One study finds that incidences of dehydration increase during the month of Ramadan:

PHYSIOLOGICAL FUNCTIONS Evidence of hemoconcentration and dehydration has been found during Ramadan (El-Hazmi, Al-Faleh, & Al-Mofleh, 1987; Kayikcioglu et al., 1999; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). Restricted fluid intake, leading to disturbance in the fluid balance, is likely to cause these conditions. In the initial stages of dehydration, the clinical signs are tachycardia, tiredness and malaise, headaches and nausea. Middle-aged or more elderly persons are usually more prone to the effects of dehydration (Schmahl & Metzler). Dehydration is indicated by the increase of several serum biochemical parameters (El-Hazmi et al., 1987; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). The increase in uric acid, however, should especially be noted (El-Ati et al, 1995; El-Hazmi et al., 1987; Fedail et al., 1982; Schmahl & Metzler, 1991), because hyperuricemia is one of the known sequelae of prolonged fasting (Murphy & Shipman, 1963). Hyperuricemia is associated with reduction in glomerular filtration rate, decrease in uric acid clearance and alterations in the renal transport of uric acid (Murphy & Shipman). During Ramadan, however, reports show that the increase in uric acid does not excessively deviate from the normal range and studies have not reported clinical gout (El-Hazmi et al., 1987; Fedail et al., 1982). Increased uric acid is, therefore, unlikely to affect healthy individuals.[5]

Dehydration is indicated by the increase of several serum biochemical parameters (El-Hazmi et al., 1987; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). The increase in uric acid, however, should especially be noted (El-Ati et al, 1995; El-Hazmi et al., 1987; Fedail et al., 1982; Schmahl & Metzler, 1991), because hyperuricemia is one of the known sequelae of prolonged fasting (Murphy & Shipman, 1963). Hyperuricemia is associated with reduction in glomerular filtration rate, decrease in uric acid clearance and alterations in the renal transport of uric acid (Murphy & Shipman). During Ramadan, however, reports show that the increase in uric acid does not excessively deviate from the normal range and studies have not reported clinical gout (El-Hazmi et al., 1987; Fedail et al., 1982). Increased uric acid is, therefore, unlikely to affect healthy individuals.

Migraines

Migraines are three times more common during Ramadan, affecting an estimated 90 million Muslims:

An estimated 90 million of the world’s 1.57 billion Muslims are likely to suffer from migraine headaches during the dawn-to-dusk fasts during the month of Ramadan – which begins on Wednesday, at the height of summer heat. But Jewish researchers in the US and Israel have suggested how to help prevent the problem. Dr. Ibrahim Abu-Salameh, Israel’s only Beduin neurologist – who works at Soroka University Medical Center in Beersheba – headed a team that found migraine attacks are three times more common during the Muslim fast than in the rest of the year. Working with colleagues Dr. Igal Plecht and Dr. Gal Ifergan of the Beersheba hospital, Abu-Salameh studied 32 Beduin who suffered from migraine attacks during the Ramadan fast last year and compared the statistics to an ordinary month without the fast as a control. Migraines were much more common in women than men; three-quarters of the women complained of migraine while fasting, compared to a much lower figure among the men. The Soroka study was published recently in the Journal of Headache and Pain.

. . .

Abu-Salameh said that he has gotten migraine headaches during Ramadan, and has treated Beduin who came to his clinic complaining about severe headaches. He noted that the medical literature has almost ignored the phenomenon until now. Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.[6]

Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.

Tachycardia, Severe Headaches, Dizziness, Nausea, Vomiting and Circulatory Collapse

The following study was carried out on Turkish Muslims in Germany who were involved in heavy and manual work. 'Moderate to severe health disturbances' including severe dehydration were found in such laborers during Ramadan:

Abstract During Ramadan, Moslems are required strictly to avoid fluids and nourishment from dawn to sunset. Heat stress during such abstinence represents a substantial health hazard. In the Federal Republic of Germany (FRG) where numerous Moslems, particularly of Turkish origin, perform heat work and other heavy labour, we observed moderate to severe health disturbances in such labourers during Ramadan, e.g.: tachycardia, severe headaches, dizziness, nausea, vomiting and circulatory collapse. The severe dehydration of these workers was demonstrated by substantial increases in their hematocrit, serum protein, urea, creatinine, uric acid and electrolyte imbalance. Because of the evidence of the substantial health hazard to Islamic workers in such situations, we have strongly urged employers to refrain from assigning Islamic workers to heat work or heavy daytime work during Ramadan; we have therefore limited systematic studies of health problems during Ramadan to persons performing only moderate work. Even under these conditions signs of dehydration were found in the 32 labourers monitored. Some of these labourers also had to interrupt their observance of Ramadan due to health problems, e.g.: acute gout due to serum uric acid increase, or circulatory insufficiency. In light of the observed potentially harmful pathophysiological effects, the danger of dehydration of Islamic workers due to heat work during Ramadan should be taken very seriously.[7]

During Ramadan, Moslems are required strictly to avoid fluids and nourishment from dawn to sunset. Heat stress during such abstinence represents a substantial health hazard. In the Federal Republic of Germany (FRG) where numerous Moslems, particularly of Turkish origin, perform heat work and other heavy labour, we observed moderate to severe health disturbances in such labourers during Ramadan, e.g.:. Theof these workers was demonstrated by substantial increases in their hematocrit, serum protein, urea, creatinine, uric acid and electrolyte imbalance. Because of the evidence of the substantial health hazard to Islamic workers in such situations, we have strongly urged employers to refrain from assigning Islamic workers to heat work or heavy daytime work during Ramadan; we have therefore limited systematic studies of health problems during Ramadan to persons performing only moderate work. Even under these conditions signs of dehydration were found in the 32 labourers monitored. Some of these labourers also had to interrupt their observance of Ramadan due to health problems, e.g.: acute gout due to serum uric acid increase, or circulatory insufficiency. In light of the observed potentially harmful pathophysiological effects, the danger of dehydration of Islamic workers due to heat work during Ramadan should be taken very seriously.

Naturally we would expect that this would affect productivity, as is evidenced in a later section on Economical effects.

Weight Fluctuation

The following study takes a look at the significant fluctuations in the weight of individuals that occurs during the month of Ramadan, primarily as a result of the metabolic changes that occur in the body.

Numerous studies have reported significant weight loss during Ramadan (Adlouni, Ghalim, Benslimane, Lecerf, & Saile, 1997; Adlouni et al., 1998; Fedail, Murphy, Salih, Bolton, & Harvey, 1982; Kayikcioglu, Erkin, & Erakgun, 1999; Ramadan, Telahoun, Al-Zaid, & Barac-Nieto, 1999; Schmahl & Metzler, 1991; Sweileh, Schnitzler, Hunter, & Davis, 1992). The declines may result from water loss early in Ramadan and loss of body fat during the later period (Sweileh et al., 1992). In fact, we did find evidence of dehydration. Loss of body fat would indicate the use of fat for energy production during Ramadan (Husain, Duncan, Cheah, & Ch'ng, 1987; Ramadan et al., 1999; Sweileh et al., 1992). In addition, researchers have found decreased heart rate and oxygen consumption during Ramadan (Husain et al., 1987; Ramadan et al., 1999; Sweileh et al., 1992). These findings suggest a metabolic adaptation to fasting. It seems that during the Ramadan daylight hours - when no food or water is taken in - to conserve stored energy, the metabolism slows down (Sweileh et al., 1992). Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them.[5]

Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them.

Affect on Circadian Patterns and Sleep Disorders

The results of the following study can lead us to conclude that fasting negatively effects an individual's circadian rhythm. As a result, unfavorable side-effects such as lethargy and a lack of motivation, may contribute to a society's lack of productivity:

Changes of sleep habit in Ramadan affects autonomic activity and melatonin rhtyhmicity. The other negative effects may be that, during fasting patients with cardiovascular disease cannot consume medications, such as anti-ischemic, anti-platelet, anti-hypertensive drugs, and drugs of heart failure on time. Some patients may get admitted to the hospital with cardiovascular symptoms owing to failure of therapy.[8]

This change of meal schedule is accompanied with changes in sleep habits, such as delayed and shortened sleep periods, which may affect endocrine and neuroendocrine circadian patterns. Several cardiovascular parameters (i.e., heart rate, blood pressure, vascular tone, and coagulation-fibrinolysis) show circadian pattern. Several studies reported that autonomic activity and melatonin rhtyhmicity may be responsible for circadian patterns of cardiovascular parameters.. The other negative effects may be that, during fasting patients with cardiovascular disease cannot consume medications, such as anti-ischemic, anti-platelet, anti-hypertensive drugs, and drugs of heart failure on time. Some patients may get admitted to the hospital with cardiovascular symptoms owing to failure of therapy.

The following study was done in Saudi Arabia and it was observed that melatonin levels and REM sleep decreased during Ramadan:

Abstract: Fasting during Ramadan is distinct from regular voluntary or experimental fasting. This project was conducted to objectively assess the effect of Ramadan fasting on sleep architecture, daytime sleepiness and the circadian cycle of melatonin level. Eight healthy volunteers reported to the Sleep Disorders Center on four occasions for polysomnography and multiple sleep latency tests: 1) an initial visit for adaptation; 2) 2 weeks before Ramadan (BL); and 3,4) during the first and third weeks of Ramadan (R1, R3). Salivary melatonin level was measured using radioimmunoassay. Sleep latency at night was significantly shorter and the amount of rapid eye movement sleep was significantly less, at R3 compared to BL. There was no difference in multiple sleep latency test data between BL and Ramadan. Although melatonin level kept the same circadian pattern at BL, R1 and R3, it had a flatter slope and a significantly lower peak at midnight (00:00) at R1 and R3. This study showed a significant reduction in sleep latency and rapid eye movement sleep during the third week of Ramadan fasting. Otherwise, there was no significant effect of Ramadan on sleep architecture and assessment revealed no increase in daytime sleepiness. Although melatonin level had the same circadian pattern during Ramadan, the level of the hormone dropped significantly from baseline.[9]

Fasting during Ramadan is distinct from regular voluntary or experimental fasting. This project was conducted to objectively assess the effect of Ramadan fasting on sleep architecture, daytime sleepiness and the circadian cycle of melatonin level. Eight healthy volunteers reported to the Sleep Disorders Center on four occasions for polysomnography and multiple sleep latency tests: 1) an initial visit for adaptation; 2) 2 weeks before Ramadan (BL); and 3,4) during the first and third weeks of Ramadan (R1, R3). Salivary melatonin level was measured using radioimmunoassay. Sleep latency at night was significantly shorter and the amount of rapid eye movement sleep was significantly less, at R3 compared to BL. There was no difference in multiple sleep latency test data between BL and Ramadan. Although melatonin level kept the same circadian pattern at BL, R1 and R3,Otherwise, there was no significant effect of Ramadan on sleep architecture and assessment revealed no increase in daytime sleepiness. Although melatonin level had the same circadian pattern during Ramadan, the

Daytime Drowsiness, Alertness and Cognition

Naturally, a fast would indicate that individuals are ingesting less food. But the following two studies reveal that the decrease in the number of meals that are eaten directly disturbs normal sleep habits and thereby increases daytime drowsiness.

Abstract Few epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.[10]

Few epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.

The following study studies the effect that fasting has on the alertness of an individual. Evidently, the change in sleep patterns causes a decrease in oral temperature and alertness:

Abstract During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.[11]

During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.

Cognition

The physical fatigue associated with fasting results in impairment of cognitive function, as shown by performance in flicker fusion tests. [12]

Lactating women

In a certain study, the nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. The study said that it would seem prudent to excuse lactating women from fasting during Ramadan.[13]

Pregnancies

A new study by scientists in the United States has revealed that pregnant Muslim women who fast during Ramadan are likely to have smaller babies who will be more prone to learning disabilities in adulthood. The researchers also found that the women were 10 per cent less likely to give birth to a boy if they had fasted during Ramadan. The trend was clearest if the fasting was done early in the women’s pregnancy, and during the summer months, when long hours of daylight called for them to go longer without food.

. . .

The study, which used census data from the US, Iraq and Uganda, also discovered long-term effects on the adult’s health and his or her future economic success. "We generally find the largest effects on adults when Ramadan falls early in pregnancy," the Independent quoted Douglas Almond, of Columbia University, and Bhashkar Mazumder, of the Federal Research Bank of Chicago, the authors of the research, as saying. "Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects. Importantly, we detect no corresponding outcome differences when the same design is applied to non-Muslims," they added.[14]

"Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects. Importantly, we detect no corresponding outcome differences when the same design is applied to non-Muslims," they added.

Binge eating, headaches and increase in gastric acidity

fairly common habit during the Ramadan period, especially as the day is spent without eating or drinking,' says Anjali Dange, Dietitian at Welcare Hospital. 'Binge eating is aduring the Ramadan period, especially as the day is spent without eating or drinking,' says Anjali Dange, Dietitian at Welcare Hospital. "During the initial days of fasting, you may encounter slight dizziness as well as frequent headaches." Dr Phadke says that fasting can also increase levels of gastric acidity in the stomach which can cause burning and heaviness, and sometimes a sour taste in the mouth.[1]

Dr Phadke says that fasting can also increase levels of gastric acidity in the stomach which can cause burning and heaviness, and sometimes a sour taste in the mouth.

[15]

During Ramadan most of the population sleep during the day, with the iftar beginning at sundown: large feasts at which many end up eating so much they need to be taken to hospital casualty wards, with a record high almost 8,000 cases of indigestion recorded at the Hamad Medical Hospital emergency room solely in the first week of Ramadan 2011.

Dr. Muhammad Alabdooni, a Muslim and the chairman of the Dutch Moroccan Physicians Association, also maintains there is no scientific proof that Islamic fasting is physiologically beneficial.[16]

Increases the toxicity of commonly used medication

Fasting has been found to significantly change drug metabolism and deplete crucial chemicals in the liver needed to detoxify medication.

Paracetemol (also called acetaminophen) is one of the most commonly used drugs to treat day to day pain such as headaches or gastrointestinal pain, this is the very same pain that is likely to be encountered by a fasting individual. Therefore, a significant risk arises when someone who has been fasting takes this common medication (among many others).

As the Journal of Internal Medicine Reports: