the diverse Muslim population here in Utah continues to blossom, our health care workers are eager to learn more about their patients’ cultural practices. The arrival of Ramadan has raised many questions for our healthcare professionals who want to care for practicing patients, while also being sensitive to their religious requirements. 

Ramadan is a month-long period of spiritual, mental and physical cleansing. It’s a time for Muslims around the world to contemplate patience, giving, self-improvement, and positive life changes through fasting and prayer. Through Ramadan, Muslims re-dedicate themselves to caring for their body, mind, heart and soul.

General fasting practices

During the month of Ramadan, Muslim patients fast for approximately 15-16 hours every day. They typically eat a predawn meal, or Suhoor, as early as 4 am. They break their fast after sunset with another meal, Iftar. While fasting, patients must refrain from eating or drinking anything, including water, food, and most medications.

Impacts of fasting on health

Foregoing food, water and, in some cases, treatment for such an extended amount of time can cause many health concerns for our patients. Long periods of fasting can trigger symptoms like:

• Hypoglycemia
• Dehydration
• Urinary issues
• Headaches
• Dizziness

Fasting requirements also affect how and when patients can take their medications. During a fast, nothing can enter the stomach or digestive tract by mouth, nose or rectum. This includes swallowing anything, the use of nasal sprays, and the use of rectal suppositories.

In some cases, it may be necessary to adjust medications or treatments for higher risk patients. For instance, be aware of any patients on insulin or patients taking medications dosed 6-12 hours apart. Fasting can dramatically affect how their bodies tolerate treatment, so you may need to temporarily adjust the timing or dosage of their medications based on those needs.

What medications are allowed?

It’s important to understand that certain treatments won’t violate the conditions of fasting. A fast is broken when a substance reaches the digestive system through the natural openings of the body–like the mouth, nose, or rectum. Treatments given by injection or IV are typically permitted, if necessary.

Injections for B-12, testosterone, and insulin are allowed, as are intramuscular immunizations, like the Covid-19 vaccine. Some infusions, like iron transfusions and IV medicine infusions, are also generally acceptable.

Who is exempt from fasting?

Some Muslim patients may be excused or exempted from fasting during Ramadan. These individuals include:

• Children who have not yet reached puberty.
• Women who are pregnant or breast-feeding.
• Women who are menstruating, although they can complete their fast at the end of their cycle.
• People with conditions who could become significantly sicker through fasting. This includes insulin-dependent patients, or severely diabetic patients who would be unable to control their diabetes during a fast.
• The sickly elderly.

Talk with patients about their options

Ramadan reminds us to respect the cultural values and traditions of our patients. Our patient’s choice to persist in their beliefs is entirely their own. Our role is to support them by helping them navigate the potential difficulties or risks of fasting.

If you’re not sure your patient is practicing, or you don’t know to what degree your patient practices, you can:

• Refer to the patient’s documented spiritual preference. Go to: Chart-Review > Miscellaneous Reports > Learning assessment > SPIRITUAL/CULTURL: Any spiritual/cultural practices that affect your care?
• Simply ask your patient for clarification. Check to see if they’re practicing/fasting, and for what purpose. Open dialogue helps you build stronger connections with patients.