This week Muslims begin an important annual ritual prescribed by the Koran. For the next 29 or 30 days, healthy Muslims will fast during daylight hours, refraining from consuming food, drink and even oral medication from dawn until sunset.
Muslims fast during the month of Ramadan, which, because Islam uses a lunar calendar, does not fall at exactly the same time every year. The fact that in recent years Ramadan has fallen during the longest and hottest days of the year in the Northern Hemisphere adds to the challenge of observing the fast in a healthy manner, experts admit.
"We can always accommodate if we need to but it is going to be difficult this year for many people, at least in this part of the world," says Dr. Aasim Padela, a practising Muslim and an emergency-room physician at the University of Chicago Medical Center.
Observing the Ramadan fast is easier when the month falls in the winter, at a time when the span from dawn till sunset may be as short as eight hours and the risk of dehydration is lower. This year, though, Ramadan begins shortly after the summer solstice, when days are at their longest. Depending on the location and how they interpret the Koran, Muslims may have started the month of fasting as of Monday or will start Tuesday or Wednesday.
A religious leader with the Islamic Foundation of Toronto says for people who follow the guidance of the Crescent Committee – which believes the new moon that signifies the start of Ramadan should be spotted, not scientifically calculated – the first day of fasting is likely to be Wednesday, July 10.
Imam (the term is the equivalent of pastor or rabbi in other faiths) Yusef Badat explains that in the Koran, Muslims are exhorted to fast during daylight hours to remind themselves of the plight of the poor and to develop self-discipline.
"The idea or the principle is very simple, that if a person can control and curb their hunger and their thirst for a certain amount of hours … then this is a sign that they can also curb and abstain from all sorts of sin such as lying, cheating, harming someone, etc.," Badat says.
"When I feel the pain of hunger, I remember those who don't have food. And that motivates me. That's a trigger for me to help those who are suffering wherever they may be across the globe."
Using a day late last week to show how long the fast will last in the early days of this year's Ramadan, Badat notes that dawn was at 3:20 a.m. and sunset was at 9:02 p.m. – almost 18 hours during which no food, drink or oral medication could be consumed by those who fast.
Not all Muslims will fast. The Koran exempts pregnant women and nursing mothers and people who are sick. As well, children who haven't reached puberty don't fast, though Badat says some families will encourage children approaching puberty to fast for part of the day to get into the habit. Adults who have temporary health problems can make up days by fasting later, when their health permits.
And those who are too frail or too unwell to fast at all can compensate by paying what's called "fidah" or compensation, Badat says – about $10 a day to help feed the poor.
Because the fast includes anything consumed orally, even medication, people with health conditions should consult with their doctors and religious leaders to decide whether they can safely fast, says Padela, who himself will observe Ramadan.
Lots of studies have been done to look at whether fasting is safe for people with different conditions, he says, pointing to diabetes as one where concerns have been raised.
"There are some people who have good diabetic control who are on some medicines that can be taken during that time period," Padela says. Others, in whom the disease is not well controlled, might not be abSle to fast.
"There's a very granular-level discussion that needs to occur at the level of what the patient's circumstances are, what their illness is, what their comorbidities [existing conditions] are and what their body, their physiology can tolerate and not tolerate," he says.
Those who are fasting adjust their days to consume calories and imbibe fluids when they can. Brunch may take place at 2:30 a.m., Badat says. And people may nap after work as they wait for the sun to go down.
In Muslim countries, society may adjust to a different schedule during Ramadan. Even in North America, Muslims plan ahead, Badat says.
Some will talk with their employers about working reduced hours or re-arranging their work hours. If no accommodation can be made and a person cannot safely fast during a hot day – say a construction worker toiling under a beating summer sun – that day or those days can be made up later. The Koran makes it clear people are not to make themselves ill by fasting, Badat says.
"When we're living in a part of the world where we're considered a minority, it can be challenging, but it's not impossible."
Dr. Michael Finkelstein of Toronto Public Health says people who are observing the Ramadan fast need to make sure they drink enough fluids during the hours when the sun is down.
"July is a pretty hot month here. So they need to be aware of the early signs and symptoms of dehydration," says Finkelstein, who is an associate medical officer of health for Toronto. "Things like dizziness, lightheadedness, headaches, intense tiredness, dry mouths and obviously the colour of their urine can get quite dark – those are indications that their fluid balance is in trouble."
He also suggest deferring outdoor tasks, if possible. "So if there are things that need to be done that don't have to be done during the middle of the day, try to move those to times during the day when it's cooler – early evening or early in the day so that you can avoid stressing your body at the height of the heat of the day, basically."