Ramadan: How to Support Your Clients During Ramadan (Tips from Clinicians, for Clinicians)

“The Qur’an requires Muslims to fast during the month of Ramadan from sunrise to sunset. However, there are exceptions to this. One of them is that people who are ill or have medical conditions do not have to fast. This can include people living with diabetes.”

Diabetes UK

Clients fasting during Ramadan

Ramadan is the most holy month in the Islamic calendar, practiced by Muslims worldwide. Muslims believe it’s the month in which the Quran was revealed to the Prophet Muhammad through the angel Gabriel in A.D. 610. It’s a month in which Muslims are called upon to fast from dawn until sunset, meaning no food, drink, sexual activity (although some cultures may have a pre-dawn meal).

Rather than indulging in food and drink between dawn and sunset, Muslims are called upon to pray, release toxins, vanquish anger and ill feeling, and to draw closer to Allah. The mental and physical healing effects of fasting have been well known for centuries and the practice is also regularly adopted by other religions. Nevertheless, with Ramadan approaching, some Muslims might feel anxious about fasting if they have an eating disorder or are in early recovery from one. Food is such a deeply personal and essential component to the human experience that any adjustment to quantity, frequency, and how it’s cooked, are deliberations which cannot be taken lightly. These considerations will be pervasive during Ramadan for Muslims worldwide.

Seemingly conflicting messages from health experts, mental health clinicians, and from Islamic religious leaders, might cause some confusion and anxiety for those with an eating disorder or other serious health condition. The nutrition and integrative health fields are increasingly recognising the power of short and long-term fasting in protocols for health and disease. There’s also growing evidence that for women, cyclical hormonal patterns influence metabolism and fasting physiology and so it’s also important to consider other factors such as balancing hormones when embarking on periodic fasting. Renowned expert on Women’s Health, Dr Mindy Pelz advises that fasting should be customised taking into careful consideration factors such as the hormonal hierarchy of oxytocin, cortisol, insulin and lastly, sex hormones. This mountain of information can lead to some misunderstanding and confusion. Clinicians too, prepare themselves to answer difficult questions about fasting and how it relates to Ramadan and the Quaran, weighing up the health implications for those with a history of an eating disorder.

At Addcounsel, we know how sensitive it can be for our clients preparing for Ramadan, especially those living in more traditional Islamic cultures. In this article, we’ll cover some of the areas of misunderstanding and the questions most frequently addressed to clinicians during the period of Ramadan.

Is fasting safe for those with an eating disorder?

This question is one of the most asked to clinicians and health experts. At Addcounsel, we know that a ‘one size fits all’ approach to treatment doesn’t work, and so the answer to this question really depends on the current health of an individual. Some, who have experienced the worst of anorexia nervosa in the past may have had years of eating healthy and nutritious meals, occasionally treating themselves, and may have reintegrated back into society with minimal anxiety. Nevertheless, an individual with a history of anorexia will need to talk to a health professional and consider the risks involved in fasting for approximately twelve hours a day for almost a month. Anorexia nervosa never really goes away entirely; it has been known to be reactivated years after a seemingly good run of recovery.

Those with a binge eating disorder may have steadily refrained from bingeing, replaced by regular appropriately size portions, and have a different mindset altogether about their relationship to food. They may have concerns about fasting, fearing rekindling old patterns of behaviour associated with binge eating. Similar to a person in long-term recovery from anorexia nervosa, an individual with a binge eating disorder will need to discuss fasting/food planning with a health professional who has a clear understanding of their medical needs/history. Excellent health experts and clinicians have a responsibility to give advice and suggestions on how to preserve health, and so if there’s a health risk associated with fasting, most doctors will advise against doing anything to harm the body.

Diabetes and fasting

Following Ramadan for individuals living with diabetes could pose health risks, depending on the type of diabetes, medications used and current blood sugar levels.In an article titled Diabetes & Ramadan published by Diabetes UK, Professor Wasim Hanif, Professor of Diabetes and Endocrinology, Consultant Physician, and Clinical Director in Diabetes at University Hospital Birmingham advises: “I know that Ramadan is a very important time of year for Muslims around the world. It is important to ensure that people who are living with diabetes only fast after discussing it first with their diabetes team. Fasting can be dangerous if you have diabetes as it can cause health problems. I recommend taking a few minutes to read Diabetes UK’s information before you make a final decision. And if you know someone who can’t access this page, then please find a way to share this information with them.”

What are the fasting rules of Ramadan?

There are strict rules associated with fasting at Ramadan, which take into account that some individuals mustn’t fast. Let’s explore these rules, courtesy of Muslim Aid: “There are strict Ramadan fasting rules, largely around who can and must fast from food. Seeing as Sawm is one of the Five Pillars of Islam, it is expected that every Muslim should observe the fast, although it is not always possible. If a Muslim is an adult/post-puberty, healthy and fit, not on any medication, not travelling, they must observe the fast. This is because there is no feasible or valid reason that prevents them from fasting.”

The article continues: “Not every Muslim will fit into the above categories, and as such, they may be exempt. Those who are allowed to miss the food fast include pre-pubescent children, the elderly/frail, those on medication or under the care of a doctor, and people who are travelling. In addition to the groups listed above, there are separate rules that dictate what breaks a women’s fast. If a woman is menstruating, pregnant, or breastfeeding, they do not need to fast. If a woman begins to menstruate during the Ramadan fast, she should stop fasting immediately.”

The fasting rules of Ramadan clearly take into consideration the importance of health and vitality, along with the needs of the elderly and physically weak. Individuals who can’t fast for reasons stated above will be asked to practise Fidyah which asks of them to pay a small donation for every day they don’t fast. This is approximately £5 per day. However, if a person breaks their fast and doesn’t fit into the category of those who can’t fast, they are to pay Kaffatrah, meaning they must pay by either a monetary donation or by fasting. The aforementioned Muslim Aid reports: “Suppose a person is to pay Kaffatrah by fasting. In that case, they must fast for 60 continuous days per day that the fast is intentionally broken or pay 60 days’ worth of Fidyah per day that the fast is intentionally broken. This means if a person purposefully breaks their fast for one day, they should fast for a further 60 continuous days or pay 60 x £5. If the continuous fast is broken, it must be started again from the beginning.”

Contact us to learn more about Addcounsel

Addcounsel offers expert private and luxury rehab in London. We provide specialist treatment for drug addiction, alcohol addiction, mental health, and behavioural conditions. Our bespoke treatments are delivered with compassion and care by highly skilled mental wellbeing specialists, following our ‘one client at a time’ methodology. This involves dedicated, one-to-one therapy in an individual setting—no groups or other clients, ensuring an unrivalled level of care, and complete anonymity.

When you check in to our discreet central London rehabilitation facility, you’ll be embarking upon a personalised treatment programme tailored to your individual needs. We offer luxury private accommodation for the duration of your stay, with 24/7 access to a team of world-class experts headed by one of the UK’s leading psychiatrists.

Our multidisciplinary team boasts a wealth of mental wellbeing knowledge and expertise in every aspect of your recovery. Dedicated psychiatrists, nutritionists, therapists, and addiction specialists will create a comprehensive process designed specifically for you. Our focus isn’t just on your mind; we understand the important roles that genetics, nutrition and lifestyle can play in the development of a mental health condition and/or addiction, and in the process of recovery. 

Experts will assess the factors that led to your addiction or mental health condition, leverage the world’s most extensive menu of therapy services to help you recover, and create a robust aftercare programme to support re-integration into your family and lifestyle. 

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