Medically speaking, not having any food or water from before sunup to after sundown every day for a month is perfectly safe for healthy adults. Healthy, of course, means the absence of any disease, especially conditions that require ‘strong’ medicines that must be taken regularly every day, and if these medicines are not taken properly, that can cause serious problems.

Around this time, every year, there appear articles written by Muslims extolling the virtues of fasting. Fasting is periodic starvation combined with dehydration or lack of fluids. The only problem is that starvation for less than a day, every day, for a month carries no long-term benefits. If fasting in the religious context is accepted as a ‘lesson’ and as such avoiding all sorts of excess consumption, including food, becomes a guiding life principle then fasting will have long-term benefits of many different sorts, medical as well as social.

It is an interesting fact but of all attempts at prolonging life, only decreased intake of food/calories on a regular basis actually has shown to be of some benefit. Besides an overall decrease in food intake, moderation in what we eat is by itself beneficial in the prevention of many important medical conditions. Unfortunately overeating often done at the start and the end of the fast might actually be harmful. I personally know of many people that at the end of the month of fasting are heavier than they were when they started.

Not eating for the entire day is not dangerous for most people except for those that suffer from diabetes (high blood sugar) and take medicine for it. If the medicine is not properly managed the fasting person can develop extremely low blood sugar and even faint from it. This extreme low blood sugar is dangerous, and, therefore, all diabetics should consult with their doctors on how to manage their medicine during the month of fasting. Most medicines can be adjusted around a day-night cycle.

For patients that take medicines for other problems, often the medicine schedule can be adjusted during the fasting period. In this category are people that take medicine for high blood pressure. One type of medicine often used to treat high blood pressure is the diuretic’ or water pill. This type of medicine increases the amount of water removed from the body and that can be dangerous during fasting, and so should be taken only at the end of the fasting period. Patients taking cancer medicines should in my opinion avoid fasting. Not because of the medicines but because of the basic disease. Cancer weakens the body tremendously.

During fasting, more important than hunger is thirst that comes from the inability to drink fluids. Interestingly Christian fast during Lent but are allowed to drink fluids. Some of us might remember that many people died during a previous month of fasting in Karachi that fell during summer. Besides heatstroke the other primary reason for these deaths was from dehydration or loss of water. Whether drinking water should be available in public places to people during the fasting period is an important question.

In a previous article on this issue I had suggested that mosques should make such arrangements for the sick, the old, children and non-fasting public.

When it comes healthy people, as I have said above, fasting is not harmful, especially during the winter months. There are some exceptions. People that perform strenuous physical work in the open under a hot sun should think about fasting in an objective way. Also with the current state of loadshedding during the day in the hottest summer months as we are going through now, even people, especially women working at home and in the kitchen should be extra careful. Insidious water loss during a hot afternoon can be really debilitating.

The question of breastfeeding a child during the month of fasting is one that I will leave to the religious divines to consider and answer.

The other category of healthy people that might think twice about fasting are those that are involved in competitive sports, especially in the open during the sunlit hours. A professional tennis player can lose up to four or five litres during three or five sets of tennis. Even in less strenuous sports like cricket, dehydration can significantly affect a player’s ability. During the recent India-Pakistan match I kept wondering whether players of our team were listless possibly due to the fact that many of them were fasting.

Now some basic dietary advice about what to eat when starting and ending the period of fasting. The media is full of sage advice about moderation and stuff but at the same time recipes for delicious fatty and sweet stuff are pushed energetically. About fatty stuff, fat is good at the start of a fast because it hangs around longer in the stomach. The paratha (fried flat bread) and omelette combination has been a long time staple for those that fast for good reason. For many, a regular meal of leftovers is also quite appropriate.

However when it is time to break the fast, too much fatty food should be avoided. Breaking up the end of the fast into the initial stage followed later by a proper meal a bit later is a great idea. The reason is simply that fasting leading to hunger often ends in binge eating. This is a well-known medical fact and people who diet to lose weight are advised to have multiple small meals in a day. Also a heavy fatty meal at night is not conducive to a sound and restful sleep. Going to sleep with a full stomach has other medical disadvantages but more about that some other time.

It is important to remember that hunger is essentially a habit. When our stomach becomes empty, all sorts of biological signals start floating around the body including the rumbling stomach asking for food. In most normal people there is enough stored ‘energy’ to last for many weeks. It is for this reason that ‘crash’ diets help in losing weight by burning up the energy stored in the body as fat. I have known many people that eat only one major meal in a day and do quite well.

Unlike hunger, thirst is a real warning signal telling us that the body has lost up to five per cent of the water stored in it. That can start a cascade of events that could lead to all sorts of problems ending eventually in unconsciousness. For this reason getting hydrated properly at the start of a fast is vital. Water is not the best drink. Milk or diluted milk or diluted yogurt are much better because they get absorbed relatively slowly in the stomach and stick around longer than plain water.

Finally, fasting and the very old. Care-givers should keep an eye on them especially on hot days. There are many stories about the elderly who were thought to be fast asleep but could not be woken up when it came time to break the fast. Sadly whether we like it or not, old age is also a dangerous medical condition.