Maggie McKay (Host): Welcome to the Health Podcast, presented by Pullman Regional Hospital. I'm your host, Maggie McKay. Joining us today is Dr. Mohammed Younes, lead resident of the Family Medicine Residency Center, to discuss health maintenance for fasting during the Ramadan season. Thank you so much for being here today, Dr. Younes.

Mohammed Younes, MD: My pleasure. Thank you for having me.

Host: So, why is it important to consider your health while fasting during Ramadan?

Mohammed Younes, MD: Well, I mean, fasting for the month of Ramadan is definitely a physically demanding task that all Muslims of age are required to complete as long as they're mentally, physically, and financially able to do so. The reason why taking care of health is so important is because, depending on the part of the world that you're in, you're sometimes going without food or water for 19, 20 plus hours a day, and you're doing that for 29 to 30 consecutive days, which over time can definitely have its toll.

Host: Wow. No water either. I didn't know that.

Mohammed Younes, MD: Yeah, it's a dry fast. So, that's one of the common questions that I get as a Muslim. I say, no water, and there's no food, no water that can enter our system while we're fasting.

Host: Wow. How does fasting affect the body?

Mohammed Younes, MD: Yeah, I mean, there's tons of health benefits if it's done the right way, and I'm sure we'll get into that a little bit later. But in terms of just general overall benefits, I mean, if you do it right, you can lose fat, you can lose some of that visceral fat, the fact that kind of is attached to your inner organs, like the liver and all. It's generally if you do it right, people sleep better because they're not getting as much of the glucose spikes, people have more mental clarity and, in terms of just mental health, a way to kind of detach from some of our vices and all. It can have a lot of positive benefits there. But again, you have to prepare for it properly.

Host: And can fasting affect your medication schedule?

Mohammed Younes, MD: Absolutely. Yeah. So, depending on what kind of medication you're on and why, and the dosing, right? So, some people take a medication just once a day. And if you're taking a once-a-day medication, almost always it's not going to really impact your scheduling. It may just make you take it a little bit earlier in the morning, or maybe later in the day. For the twice-a-day dosing, depending on where you are in the world and how long the fasting is for that day, because some parts of the world you're fasting for maybe 12 to 14 hours in a day. And for twice a day dosing, you can make that work. If you're fasting, you know, 19, 20 plus hours, the twice a day dosing can be a little bit more complicated. Three times a day gets very complicated at that point. So, there's some things to keep in mind for sure.

Host: And for people with diabetes, what special considerations should be taken while fasting?

Mohammed Younes, MD: Yeah. There's a lot. We're going to start with the medication, I guess, right? So, first of all, what medication is the person on and why, right? So if they're on a seizure medication that has to be taken two or three times a day and the patient has a history of poorly controlled seizures, if they're not on this medication, well, it may not be compatible with fasting, and they would have a valid excuse from a religious perspective to not fast for their medical concern. If it's a matter of blood pressure and they're usually taking them twice a day, but with modifications, they can manage their blood pressure just fine with once-a-day dosing or maybe changing the medication if it's appropriate for that patient, then fasting would be compatible. And most people, when they're fasting, they're not eating a lot of the foods or doing a lot of the things like smoking, for example, that would impact their blood pressure as much. So even though you're not eating when you're smoking, it's still not allowed during your fasting hours. So, that's another thing to keep in mind.

I guess the biggest impact it would have would be on the insulin on like diabetic patients. And that's where there's going to be some significant things to consider with mealtime insulin, long-acting insulin, and other diabetic medications.

Host: So for the hours that you are allowed to eat, what foods are recommended to stay satiated throughout the day?

Mohammed Younes, MD: Yeah. So, the best thing to do after you break your fast-- so, the name for that meal is called the Iftar-- the best thing to do would be to have a minimally processed whole foods diet. So, trying to cut out any processed foods, trying to limit deep fried foods and really focusing on healthy proteins-- fish, chicken are great choices. Beef is also great. But you want to kind of maybe focus less on the red meats and more on some of the healthier meats. You want to get your fruits and your vegetables. Making sure you're getting enough fiber during the day. But really, you're focusing on healthy foods, whole foods, and things that are going to induce satiety and give you adequate nutrition throughout the day.

Host: So, you kind of answered this already, but the iftar is the time that you're allowed to eat. And what's sahur? And what foods are recommended to eat and drink at those times?

Mohammed Younes, MD: Yeah. So, iftar is when we break our fast, that's the opening of our eating window. Sahur is the closing of our eating window, and that's basically the morning breakfast that we have before we initiate our fast. Just real quick on the topic of iftar. And so, iftar starts at sunset no matter where you are in the world, so whenever the sunsets, there are some minor exceptions if you live in a part of the world where the sun doesn't set, and there's a different rules for that. But sahur comes in, not necessarily at sunrise, it's actually a little bit before sunrise. But for people that don't know their religions, we just kind of say maybe 30 minutes to an hour before sunrise. And the foods that would be recommended for sahur would be, again, whole foods minimally processed. The prophet, who we follow as our guide when it comes to practicing the religion, the prophet Mohammed, he would have dates, a date fruit. Those are very nutritious, calorie dense, lots of fiber, healthy sugars. So, a lot of us would have dates. We'd make sure we get a lot of water and hydration during the day. Milk is another good thing to be having in the morning. Oatmeal is a good one for some good, healthy carbs. And then, for people that are coffee drinkers, it'd be a great time to get your caffeine in for the day to make sure that you're not struggling throughout the day without your coffee.

Host: You mentioned drinking water. I thought you're not allowed to drink water during the fast.

Mohammed Younes, MD: Not during the fast. So, you can do so between iftar and sahur. So during your eating and drinking window, you are highly encouraged to drink water and make sure you're hydrating for the day. Once the sahur hits, and the sahur is lined up with the morning prayer. It's called the Fajr prayer, once the call to that morning prayer is made, then all water, all medication, all food would have to stop until the sunset.

Host: So, do people get dehydrated? Because I imagine there's only so much water you can load up on in those few hours that you are allowed to drink.

Mohammed Younes, MD: Yeah. Some people definitely gulp fluid down. I'm not sure if the average healthy person would get clinically dehydrated with their regular Ramadan fasting. A lot of it has to do with how they handle their water, right? So if you're going to try just chugging two liters in the last 30 minutes, before your eating window closes, well, you're going to feel pretty sick and you're probably not going to do a good job of absorbing all that water. We recommend eight ounces every 30 minutes to an hour. I mean, it doesn't have to be like clockwork, but you want to get regular bits of water in your body for that six- to eight-hour period where you can eat and drink.

Host: Dr. Younes, what types of patients should be asking their doctor if they are able to fast, if they're fit enough?

Mohammed Younes, MD: Yeah, that's a great question. So, we already kind of touched on this a little bit earlier, but any diabetic patient on insulin, definitely talk to your doctor about it first. Any patient with chronic kidney disease and especially end-stage kidney disease, where hydration is so key, you really want to make sure your doctors know if you're planning on fasting, and make sure you talk to them and see if they think it's a good idea.

Other patient populations that should have these conversations with their doctors are patients who are pregnant. So during pregnancy, we as Muslims, we are excused from fasting during this time. And if you want to discuss with your OB-GYN or family medicine provider first, you can have that conversation. And it is okay to break your fast while you're pregnant. People that are sick dealing with an acute illness or not feeling well; if you, for whatever reason, get lightheaded or dizzy, these are all good reasons to break your fast, and there's no penalty or sin upon the Muslim that chooses to break. In fact, God has told us to break our fast if we are not feeling well. And then, the last group, I guess, is anyone that's traveling. So if you have a road trip coming along or you're flying or something like that, you are excused from fasting for that day and you can make it up at a later time. We don't want anyone to be dehydrated or lightheaded while they're on a long road trip.

Host: All good information to have. Is there anything else you'd like people to know or that you would like to add that we didn't cover?

Mohammed Younes, MD: So, I'm a physician. I see patients regularly and I have Muslim and non-Muslim patients. And a lot of the Muslim patients, they're very passionate about their fasting. And I know here in Pullman, we have a very strong Muslim population with the college. And a lot of non-Muslim physicians and nurse practitioners, primary care providers, specialists are dealing with Muslim patients on a regular basis.

It's important for me, I think, to share from a Muslim perspective how important the fasting is. We take it very seriously. It is a very special time of the year for us. It is a very spiritual time of the year. And although there are some health benefits that can be associated, most of the benefits are actually more spiritual and mental. There are unfortunate times where patients can't fast. But just being mindful as a physician or primary care provider that there are times where we have to have these conversations with our patients, making sure we know, "Are you planning on fasting this year? Are you not planning on fasting and why?" And if you, as a primary care provider, think that they can't handle a full 18 hours of no food or water, having that conversation with them and explaining to them why, and that is okay to have that conversation.

Host: Yeah. That's good to know. Well, thank you so much for sharing your expertise. This has been very educational and interesting. We appreciate you.

Mohammed Younes, MD: Thank you very much. It's been great.

Host: Absolutely. Again, that's Dr. Mohammed Younes. Learn more about this subject, providers and services at Pullman Regional Hospital online at pullmanregional.org. It's important to have a primary care provider who understands your individual needs and who can support you along the way. Visit our Family Medicine Residency Center webpage to learn more about our residency programs and to find a provider who's right for you at, again, pullmanregional.org/residency-center. I'm Maggie McKay. Thank you for listening to the Health Podcast from Pullman Regional Hospital.