For many that struggle with eating disorders, fasting during Ramadan presents as an unspoken challenge, both mentally and physically. As this month may present as an opportunity to conceal an eating disorder with the mask of dedication to faith, fasting will also put a strain on any improvements made during treatment.
Fasting during the holy month of Ramadan is a pillar in Islam. Around one quarter of the world’s population observes this month, looking forward to it to spiritually strengthen their relationship with God and better themselves. Between sunrise and sunset, Muslims abstain from things such as eating, drinking and smoking. The main meals in Ramadan are considered futoor and suhoor – much different than the typical breakfast, lunch and dinner that we are accustomed to. As a result of the change in meal types, timings and amounts, the challenge in Ramadan arises as the body must readjust to new eating habits. Furthermore, as Ramadan comes to end, the body must gradually return to its normal state. For many, this is something to look forward to. For people with eating disorders, this may be detrimental to any progress made during treatment.
The Middle East Eating Disorders Association is medical and psychological association that deals with eating disorders. The main concern MEEDA has with fasting individuals that have previously been diagnosed with an eating disorder are the high-risk food restrictions placed on individuals during this month. While fasting during Ramadan is considered a religious duty, it is important to recognize that it could present as a trigger for people that currently have eating disorders or have been treated for eating disorders. Bulimics may feel uneasy with the sudden feeling of fullness after breaking fast, compelling them to rid it. On the other hand, individuals that are more prone to starvation, such as anorexics, may eat very little and very selectively when breaking fast. These habits can easily be overlooked by everyone during the slurry of pre-iftar and post-iftar traditions.
Individuals who are struggling with restrictive eating disorders (e.g. anorexia nervosa), are at a higher risk of dehydration, low glucose levels, low blood pressure, osteoporosis, electrolyte imbalances, cardiac arrhythmias, fainting and cardiac arrest. Nibbling on light snacks during the day will help reduce hunger and the chances of any serious complications that may arise from prolonged starvation. Along with the serious medical risks that may develop from fasting, the environment during Ramadan may drive an eating disorder patient into a serious psychological battle with anxiety and depression.
On the other hand, among binge type eating disorders (e.g. bulimia nervosa and binge eating disorder), individuals are likely to experience a hyperglycemic flux – possibly causing insulin resistance and increasing the risk of early onset Type II Diabetes. As these patients are likely to alternate between complete restriction and binge eating, people that are on the path of recovery may be triggered by fasting, especially followed by a large fast break.
Typically, the medical treatment of eating disorders is based on regular small meals and snacks throughout the day. Serious cases of eating disorders may require inpatient treatment. During the treatment phase, fasting for long hours is completely contraindicated and may negatively affect the recovery process and induce relapse.
There is a certain taboo in the Muslim community about not fasting; many ill patients end up in a battle that is torn between the need to maintain their body’s physical and mental needs and fulfill their religious duties. When deciding if individuals that are struggling with an eating disorder are permitted from fasting, it is important to give equal importance to the fundamentals of both mental and physical health, and religion. Surah Al-Baqara 2:184 of the Qur’an states that while the number of fasting days has been ordained, an individual that is ill may be allowed actions that are different and easier during Ramadan. As the type of illness is not specified, we must use our judgement to define the illness and its severity.
MEEDA has contacted “Dar el Efta’a”, explaining the health issues of eating disorder patients and inquired as to how it would be possible to alleviate fasting during Ramadan. This high religious authority assured us that because of their medical condition, patients are permitted to break fast during Ramadan and may engage in other religious actions as compensation. We advise patients to the seek the advice of their religious authorities.