Islamic Fasting and Health: Difference between revisions

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<metadesc>Islamic fasting has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior.</metadesc>
<metadesc>Islamic fasting has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior.</metadesc>
This article discusses the numerous adverse effects of [[Islam|Islamic]] [[fasting]] (''[[Sawm]]'') that have been observed using [[Islam and Science|scientific]] studies and [[news]] sources.
This article discusses the numerous adverse effects of [[Islam|Islamic]] [[fasting]] (''[[Sawm]]'') that have been observed using [[Islam and Science|scientific]] studies and news sources.


==Introduction==
==Introduction==


Medical fasting can have [[health]] benefits. However, Medical fasting differs from Islamic fasting, and contrary to popular Muslim beliefs, Islamic fasting, unlike Medical fasting, has numerous adverse effects. As we will explain here, Islamic fasting has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior. Health effects include heat stress, dehydration, migraines and, for lactating women, the nutritional make-up of their milk, amongst others.  
Medical fasting can have [[health]] benefits. As we will explain here, Islamic fasting, however, differs in many respects, and thus has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior. Health effects include heat stress, dehydration, migraines and, for lactating women, the nutritional make-up of their milk, among other harms.  


===What is Islamic fasting?===
===What is Islamic Fasting?===
{{Main|Sawm‎}}


The salient features of Islamic fasting are:
The salient features of Islamic fasting are:
* For 30 days every [[Islamic Lunar Calendar|lunar year]] (during the month of Ramadan), waking up before dawn and eating and [[Drinks|drinking]] to prepare for the fast (binge eating is a common habit).<ref name="Anjali Dange"></ref><ref>Abdel-Moneim Said - [{{Reference archive|1=http://weekly.ahram.org.eg/2009/963/op11.htm|2=2011-08-28}} Wasting Ramadan] - Al-Ahram Weekly, September 3, 2009</ref>
 
* Refraining from consuming any food or water from dawn to sunset
*For 30 days every [[Islamic Lunar Calendar|lunar year]] (during the month of Ramadan), waking up before dawn and eating and drinking to prepare for the fast (binge eating is a common habit).<ref name="Anjali Dange"></ref><ref>Abdel-Moneim Said - [{{Reference archive|1=http://weekly.ahram.org.eg/2009/963/op11.htm|2=2011-08-28}} Wasting Ramadan] - Al-Ahram Weekly, September 3, 2009</ref>
* Breaking the fast at sunset and again eating and drinking to prepare for the day ahead.  
*Refraining from consuming any food or water from dawn to sunset
*Breaking the fast at sunset and again eating and drinking to prepare for the day ahead.


Some Muslims claim eating a small amount of food is the correct Islamic way however we cannot function for the whole day by eating only a small amount of food at the time of dawn. This would affect our performance even more during the day.
Some Muslims claim eating a small amount of food is the correct Islamic way however we cannot function for the whole day by eating only a small amount of food at the time of dawn. This would affect our performance even more during the day.
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==Effects on Health==
==Effects on Health==


In a recent study done on the Arab world, diseases linked to cholesterol and diabetes increased by 27.65% because of overeating.<ref name="ANSA"/> Non-compliance with prescribed treatment regimens is common during Ramadan. <ref>Aslam M, Healey MA. Drug regimens and fasting Moslem patients [Letter]. Lancet 1985;290:1746</ref> Other health effects include:
In a recent study done on the Arab world, diseases linked to cholesterol and diabetes increased by 27.65% because of overeating.<ref name="ANSA" /> Non-compliance with prescribed treatment regimens is common during Ramadan. <ref>Aslam M, Healey MA. Drug regimens and fasting Moslem patients [Letter]. Lancet 1985;290:1746</ref> Other health effects include:


===Dehydration===
===Dehydration===
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{{Quote|| '''PHYSIOLOGICAL FUNCTIONS'''  
{{Quote|| '''PHYSIOLOGICAL FUNCTIONS'''  
Evidence of hemoconcentration and dehydration has been found during Ramadan (El-Hazmi, Al-Faleh, & Al-Mofleh, 1987; Kayikcioglu et al., 1999; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). Restricted fluid intake, leading to disturbance in the fluid balance, is likely to cause these conditions. In the initial stages of dehydration, the clinical signs are tachycardia, tiredness and malaise, headaches and nausea. Middle-aged or more elderly persons are usually more prone to the effects of dehydration (Schmahl & Metzler).  
Evidence of hemoconcentration and dehydration has been found during Ramadan (El-Hazmi, Al-Faleh, & Al-Mofleh, 1987; Kayikcioglu et al., 1999; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). Restricted fluid intake, leading to disturbance in the fluid balance, is likely to cause these conditions. In the initial stages of dehydration, the clinical signs are tachycardia, tiredness and malaise, headaches and nausea. Middle-aged or more elderly persons are usually more prone to the effects of dehydration (Schmahl & Metzler).  
Dehydration is indicated by the increase of several serum biochemical parameters (El-Hazmi et al., 1987; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). The increase in uric acid, however, should especially be noted (El-Ati et al, 1995; El-Hazmi et al., 1987; Fedail et al., 1982; Schmahl & Metzler, 1991), because hyperuricemia is one of the known sequelae of prolonged fasting (Murphy & Shipman, 1963). Hyperuricemia is associated with reduction in glomerular filtration rate, decrease in uric acid clearance and alterations in the renal transport of uric acid (Murphy & Shipman). During Ramadan, however, reports show that the increase in uric acid does not excessively deviate from the normal range and studies have not reported clinical gout (El-Hazmi et al., 1987; Fedail et al., 1982). Increased uric acid is, therefore, unlikely to affect healthy individuals.<ref name="Morimoto">Toda, Masahiro, Morimoto, Kanehisa - [http://findarticles.com/p/articles/mi_qa3852/is_200401/ai_n9352292/ Ramadan Fasting - Effect on Healthy Muslims] - Social Behavior and Personality, 2004</ref>}}
Dehydration is indicated by the increase of several serum biochemical parameters (El-Hazmi et al., 1987; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). The increase in uric acid, however, should especially be noted (El-Ati et al, 1995; El-Hazmi et al., 1987; Fedail et al., 1982; Schmahl & Metzler, 1991), because hyperuricemia is one of the known sequelae of prolonged fasting (Murphy & Shipman, 1963). Hyperuricemia is associated with reduction in glomerular filtration rate, decrease in uric acid clearance and alterations in the renal transport of uric acid (Murphy & Shipman). During Ramadan, however, reports show that the increase in uric acid does not excessively deviate from the normal range and studies have not reported clinical gout (El-Hazmi et al., 1987; Fedail et al., 1982). Increased uric acid is, therefore, unlikely to affect healthy individuals.<ref name="Morimoto">Toda, Masahiro, Morimoto, Kanehisa, "[http://findarticles.com/p/articles/mi_qa3852/is_200401/ai_n9352292/ Ramadan Fasting - Effect on Healthy Muslims]", Social Behavior and Personality: an international journal, 2004</ref>}}


===Migraines===
===Migraines===
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Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.<ref>Judy Siegel-Itzkovich - [{{Reference archive|1=http://www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=184112|2=2011-04-04}} Beduin doctor: Migraines common during Ramadan fast] - The Jerusalem Post, August 9, 2010</ref>}}
Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.<ref>Judy Siegel-Itzkovich - [{{Reference archive|1=http://www.jpost.com/HealthAndSci-Tech/Health/Article.aspx?id=184112|2=2011-04-04}} Beduin doctor: Migraines common during Ramadan fast] - The Jerusalem Post, August 9, 2010</ref>}}


===Other Moderate and Severe Disturbances===
===Tachycardia, Severe Headaches, Dizziness, Nausea, Vomiting and Circulatory Collapse===


The following study studied [[Turkey|Turkish]] Muslims in [[Germany]] who were involved in heavy and manual work. 'Moderate to severe health disturbances' including severe dehydration were found in such laborers during Ramadan:
The following study was carried out on Turkish Muslims in Germany who were involved in heavy and manual work. 'Moderate to severe health disturbances' including severe dehydration were found in such laborers during Ramadan:
 
{{Quote||''The health risks of occupational stress in Islamic industrial workers during the Ramadan fasting period.
Schmahl FW, Metzler B''


{{Quote||
'''Abstract'''  
'''Abstract'''  
During Ramadan, Moslems are required strictly to avoid fluids and nourishment from dawn to sunset. Heat stress during such abstinence represents a substantial health hazard. In the Federal Republic of Germany (FRG) where numerous Moslems, particularly of Turkish origin, perform heat work and other heavy labour, we observed moderate to severe health disturbances in such labourers during Ramadan, e.g.: '''tachycardia, severe headaches, dizziness, nausea, vomiting and circulatory collapse'''. The '''severe dehydration''' of these workers was demonstrated by substantial increases in their hematocrit, serum protein, urea, creatinine, uric acid and electrolyte imbalance. Because of the evidence of the substantial health hazard to Islamic workers in such situations, we have strongly urged employers to refrain from assigning Islamic workers to heat work or heavy daytime work during Ramadan; we have therefore limited systematic studies of health problems during Ramadan to persons performing only moderate work. Even under these conditions signs of dehydration were found in the 32 labourers monitored. Some of these labourers also had to interrupt their observance of Ramadan due to health problems, e.g.: acute gout due to serum uric acid increase, or circulatory insufficiency. In light of the observed potentially harmful pathophysiological effects, the danger of dehydration of Islamic workers due to heat work during Ramadan should be taken very seriously.<ref>Polish Journal of Occupational Medicine 1991 4:3 219-28</ref>}}
During Ramadan, Moslems are required strictly to avoid fluids and nourishment from dawn to sunset. Heat stress during such abstinence represents a substantial health hazard. In the Federal Republic of Germany (FRG) where numerous Moslems, particularly of Turkish origin, perform heat work and other heavy labour, we observed moderate to severe health disturbances in such labourers during Ramadan, e.g.: '''tachycardia, severe headaches, dizziness, nausea, vomiting and circulatory collapse'''. The '''severe dehydration''' of these workers was demonstrated by substantial increases in their hematocrit, serum protein, urea, creatinine, uric acid and electrolyte imbalance. Because of the evidence of the substantial health hazard to Islamic workers in such situations, we have strongly urged employers to refrain from assigning Islamic workers to heat work or heavy daytime work during Ramadan; we have therefore limited systematic studies of health problems during Ramadan to persons performing only moderate work. Even under these conditions signs of dehydration were found in the 32 labourers monitored. Some of these labourers also had to interrupt their observance of Ramadan due to health problems, e.g.: acute gout due to serum uric acid increase, or circulatory insufficiency. In light of the observed potentially harmful pathophysiological effects, the danger of dehydration of Islamic workers due to heat work during Ramadan should be taken very seriously.<ref>Schmahl FW, Metzler B, "The health risks of occupational stress in Islamic industrial workers during the Ramadan fasting period", Polish Journal of Occupational Medicine 1991 4:3 219-28</ref>}}


Naturally we would expect that this would affect productivity, as is evidenced in a later section on Economical effects.
Naturally we would expect that this would affect productivity, as is evidenced in a later section on Economical effects.
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Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them.<ref name="Morimoto"></ref>}}
Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them.<ref name="Morimoto"></ref>}}


===Sleep disorders, Daytime Drowsiness, Alertness and Cognition===
===Affect on Circadian Patterns and Sleep Disorders===


Effects of fasting on sleep architecture, daytime sleepiness and sleep patterns:
The results of the following study can lead us to conclude that fasting negatively effects an individual's circadian rhythm. As a result, unfavorable side-effects such as lethargy and a lack of motivation, may contribute to a society's lack of productivity:
 
{{Quote||This change of meal schedule is accompanied with changes in sleep habits, such as delayed and shortened sleep periods, which may affect endocrine and neuroendocrine circadian patterns. Several cardiovascular parameters (i.e., heart rate, blood pressure, vascular tone, and coagulation-fibrinolysis) show circadian pattern. Several studies reported that autonomic activity and melatonin rhtyhmicity may be responsible for circadian patterns of cardiovascular parameters. '''Changes of sleep habit in Ramadan affects autonomic activity and melatonin rhtyhmicity'''. The other negative effects may be that, during fasting patients with cardiovascular disease cannot consume medications, such as anti-ischemic, anti-platelet, anti-hypertensive drugs, and drugs of heart failure on time. Some patients may get admitted to the hospital with cardiovascular symptoms owing to failure of therapy.<ref>"Does Ramadan modify the Circadian Patterns?", Journal of Postgraduate Medicine, March 2006, Vol. 52 Issue 1 [https://tspace.library.utoronto.ca/bitstream/1807/6924/1/jp06011.pdf pdf]</ref>}}
 
The following study was done in Saudi Arabia and it was observed that melatonin levels and REM sleep decreased during Ramadan:


{{Quote||'''Abstract:'''  
{{Quote||'''Abstract:'''  
Fasting during Ramadan is distinct from regular voluntary or experimental fasting. This project was conducted to objectively assess the effect of Ramadan fasting on sleep architecture, daytime sleepiness and the circadian cycle of melatonin level. Eight healthy volunteers reported to the Sleep Disorders Center on four occasions for polysomnography and multiple sleep latency tests: 1) an initial visit for adaptation; 2) 2 weeks before Ramadan (BL); and 3,4) during the first and third weeks of Ramadan (R1, R3). Salivary melatonin level was measured using radioimmunoassay. Sleep latency at night was significantly shorter and the amount of rapid eye movement sleep was significantly less, at R3 compared to BL. There was no difference in multiple sleep latency test data between BL and Ramadan. Although melatonin level kept the same circadian pattern at BL, R1 and R3, it had a flatter slope and a significantly lower peak at midnight (00:00) at R1 and R3. This study showed a significant reduction in sleep latency and rapid eye movement sleep during the third week of Ramadan fasting. Otherwise, there was no significant effect of Ramadan on sleep architecture and assessment revealed no increase in daytime sleepiness. Although melatonin level had the same circadian pattern during Ramadan, the level of the hormone dropped significantly from baseline. The results of the scientific studies can lead us to conclude that fasting severely alters an individual's circadian rhythm.  As a result, the unfavorable side-effects such as lethargy and a lack of motivation, will unfortunately contribute to a society's lack of productivity.<ref>Ahmed BAHAMMAM/Sleep Disorders Center, Respiratory Unit, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia</ref>}}
Fasting during Ramadan is distinct from regular voluntary or experimental fasting. This project was conducted to objectively assess the effect of Ramadan fasting on sleep architecture, daytime sleepiness and the circadian cycle of melatonin level. Eight healthy volunteers reported to the Sleep Disorders Center on four occasions for polysomnography and multiple sleep latency tests: 1) an initial visit for adaptation; 2) 2 weeks before Ramadan (BL); and 3,4) during the first and third weeks of Ramadan (R1, R3). Salivary melatonin level was measured using radioimmunoassay. Sleep latency at night was significantly shorter and the amount of rapid eye movement sleep was significantly less, at R3 compared to BL. There was no difference in multiple sleep latency test data between BL and Ramadan. Although melatonin level kept the same circadian pattern at BL, R1 and R3, '''it had a flatter slope and a significantly lower peak at midnight (00:00) at R1 and R3.''' '''This study showed a significant reduction in sleep latency and rapid eye movement sleep during the third week of Ramadan fasting.''' Otherwise, there was no significant effect of Ramadan on sleep architecture and assessment revealed no increase in daytime sleepiness. Although melatonin level had the same circadian pattern during Ramadan, the '''level of the hormone dropped significantly from baseline.'''<ref>Ahmed S. BaHammam, "[http://onlinelibrary.wiley.com/doi/10.1111/j.1479-8425.2004.00135.x/abstract Effect of fasting during Ramadan on sleep architecture, daytime sleepiness and sleep pattern]", Sleep and Biological Rhythms, Volume 2, Issue 2, pages 135–143, June 2004</ref>}}
 
===Daytime Drowsiness, Alertness and Cognition===


Naturally, a fast would indicate that individuals are ingesting less food. But the following two studies reveal that the decrease in the number of meals that are eaten directly disturbs normal sleep habits and thereby increases daytime drowsiness.
Naturally, a fast would indicate that individuals are ingesting less food. But the following two studies reveal that the decrease in the number of meals that are eaten directly disturbs normal sleep habits and thereby increases daytime drowsiness.


{{Quote|| ''Epidemiological study: chronotype and daytime sleepiness before and during Ramadan.
{{Quote||
Taoudi Benchekroun M, Roky R, Toufiq J, Benaji B, Hakkou F''
'''Abstract'''  
'''Abstract'''  
Few epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.<ref>Therapie 54:567-72</ref>}}
Few epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.<ref>Taoudi Benchekroun M, Roky R, Toufiq J, Benaji B, Hakkou F, "Epidemiological study: chronotype and daytime sleepiness before and during Ramadan.", Therapie 54:567-72</ref>}}


The following study studies the effect that fasting has on the alertness of an individual. Evidently, the change in sleep patterns causes a decrease in oral temperature and alertness:
The following study studies the effect that fasting has on the alertness of an individual. Evidently, the change in sleep patterns causes a decrease in oral temperature and alertness:


{{Quote||''Daytime alertness, mood, psychomotor performances, and oral temperature during Ramadan intermittent fasting. Roky R, Iraki L, HajKhlifa R, Lakhdar Ghazal N, Hakkou F''
{{Quote||
 
'''Abstract'''  
'''Abstract'''  
During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.<ref>Annals of Nutrition and Metabolism 2000 44:101-7</ref>}}
During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.<ref>Roky R, Iraki L, HajKhlifa R, Lakhdar Ghazal N, Hakkou F, "Daytime alertness, mood, psychomotor performances, and oral temperature during Ramadan intermittent fasting.", Annals of Nutrition and Metabolism 2000 44:101-7</ref>}}


===Cognition===
===Cognition===
The physical fatigue associated with fasting results in impairment of cognitive function, as shown by performance in flicker fusion tests. <ref>Ali MR, Amir T. Effects of fasting on visual flicker fusion.
The physical fatigue associated with fasting results in impairment of cognitive function, as shown by performance in flicker fusion tests. <ref>Ali MR, Amir T. Effects of fasting on visual flicker fusion.
Percept Mot Skills 1989;69:627-31</ref>
Percept Mot Skills 1989;69:627-31</ref>
===Affect on Circadian Patterns===
{{Quote||This change of meal schedule is accompanied with changes in sleep habits, such as delayed and shortened sleep periods, which may affect endocrine and neuroendocrine circadian patterns. Several cardiovascular parameters (i.e., heart rate, blood pressure, vascular tone, and coagulation-fibrinolysis) show circadian pattern. Several studies reported that autonomic activity and melatonin rhtyhmicity may be responsible for circadian patterns of cardiovascular parameters. '''Changes of sleep habit in Ramadan affects autonomic activity and melatonin rhtyhmicity'''. The other negative effects may be that, during fasting patients with cardiovascular disease cannot consume medications, such as anti-ischemic, anti-platelet, anti-hypertensive drugs, and drugs of heart failure on time. Some patients may get admitted to the hospital with cardiovascular symptoms owing to failure of therapy.<ref>"Does Ramadan modify the Circadian Patterns?" - Journal of Postgraduate Medicine, March 2006, Vol. 52 Issue 1 [https://tspace.library.utoronto.ca/bitstream/1807/6924/1/jp06011.pdf pdf]</ref>}}


===Lactating women===
===Lactating women===
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Dr. Muhammad Alabdooni, a Muslim and the chairman of the Dutch Moroccan Physicians Association, also maintains there is no scientific proof that Islamic fasting is physiologically beneficial.<ref>[http://www.rnw.nl/africa/article/fasting-during-ramadan-good-your-health Is fasting during Ramadan good for your health?] - Radio Netherlands Worldwide</ref>
Dr. Muhammad Alabdooni, a Muslim and the chairman of the Dutch Moroccan Physicians Association, also maintains there is no scientific proof that Islamic fasting is physiologically beneficial.<ref>[http://www.rnw.nl/africa/article/fasting-during-ramadan-good-your-health Is fasting during Ramadan good for your health?] - Radio Netherlands Worldwide</ref>


==Accident and Emergency Attendances==
===Increases the toxicity of commonly used medication===
In 1994, the Accident and Emergency Department of St Mary's Hospital in London conducted a study to examine if accident and emergency attendances increased during Ramadan for Muslim patients. At the time, the department was treating 55,000 new patients every year:
Fasting has been found to significantly change drug metabolism and deplete crucial chemicals in the liver needed to detoxify medication.
 
Paracetemol (also called acetaminophen) is one of the most commonly used drugs to treat day to day pain such as headaches or gastrointestinal pain, this is the very same pain that is likely to be encountered by a fasting individual. Therefore, a significant risk arises when someone who has been fasting takes this common medication (among many others).
 
As the Journal of Internal Medicine Reports:
 
{{Quote||Paracetamol-related hepatotoxicity is now the most common cause of the potentially devastating clinical syndrome of acute liver failure in many western countries. In patients who develop liver damage following moderate paracetamol overdose in the order of 5–10 g daily, recent fasting and nutritional impairment have been identified as key precipitants.


{{Quote||2=The results are shown in Table 1. This demonstrates a '''significant rise in the number of Muslims attending during Ramadan''' compared to non-Muslims, with the proportion of Muslims rising from 3.63% of total attendances in the periods before and after Ramadan to 5.11% during Ramadan (P=0.0024). '''The rise in non accident-related attendances among Muslims was also significant''' when compared to non-Muslims (P=0.027) [...]<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294766/ The effect of the fast of Ramadan on accident and emergency attendances] (J R Soc Med. 1994 September; 87(9): 517–518.)</ref>}}
In keeping with experience in the modest paracetamol overdose setting [6], it is likely that fasting occurring on a background of longstanding diminished caloric intake and severe malnutrition played an important role in the development of paracetamol-induced liver damage at recommended dosage of 4 g daily in this patient. Fasting and malnutrition result in reduction of hepatic levels of glutathione, required for inactivation of N-acetyl-p-benzoquinonimine, the toxic metabolite of paracetamol [6]. A 16-h period of fasting is sufficient to substantially deplete hepatic glutathione stores in mice [11]. <ref name=ParaODFast">[http://onlinelibrary.wiley.com/doi/10.1046/j.1365-2796.2003.01097.x/full Paracetamol-induced hepatotoxicity at recommended dosage] - The Journal of Internal Medicine, Janurary 24, 2003</ref>}}


==Social Effects==
==Social Effects==
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===Irritability===
===Irritability===


The following study in [[Morocco]] found that irritability increased during Ramadan:
The following study in Morocco found that irritability increased during Ramadan:
 
{{Quote|| ''Kadri N, Tilane A, El Batal M, Taltit Y, Tahiri SM, Moussaoui D''


{{Quote||
'''Abstract'''   
'''Abstract'''   


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METHODS AND SUBJECTS: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32+/-5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale.  
METHODS AND SUBJECTS: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32+/-5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale.  


RESULTS: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. '''Irritability increased continuously during Ramadan and reached its peak at the end of the month.''' Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.<ref>Psychosomatic Medicine 2000 Mar-Apr 62:2 280-5 ([{{Reference archive|1=http://www.psychosomaticmedicine.org/cgi/reprint/62/2/280.pdf|2=2011-04-04}} pdf])</ref>}}
RESULTS: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. '''Irritability increased continuously during Ramadan and reached its peak at the end of the month.''' Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.<ref>Kadri N, Tilane A, El Batal M, Taltit Y, Tahiri SM, Moussaoui D, "[{{Reference archive|1=http://www.psychosomaticmedicine.org/cgi/reprint/62/2/280.pdf|2=2011-04-04}} Irritability During the Month of Ramadan]", Psychosomatic Medicine 2000 Mar-Apr 62:2 280-5</ref>}}


{{Quote||Wael Bakor, 29, marketing manager at a major company in Jeddah, expressed regret at the attitude of employees. “Unfortunately, people become more tense and irritated during Ramadan. One can easily notice the bad moods, the tension and the inability to put up with anyone or anything,” he said.<ref name="arabnews">Hassna’a Mokhtar - [http://www.webcitation.org/61GqHsLOo <!-- Original URL http://www.arabnews.com/?page=1&section=0&article=101889&d=30&m=9&y=2007 -->Productivity and Self-Discipline in Ramadan] - ArabNews, September 30, 2007</ref>}}
{{Quote||Wael Bakor, 29, marketing manager at a major company in Jeddah, expressed regret at the attitude of employees. “Unfortunately, people become more tense and irritated during Ramadan. One can easily notice the bad moods, the tension and the inability to put up with anyone or anything,” he said.<ref name="arabnews">Hassna’a Mokhtar - [http://www.webcitation.org/61GqHsLOo <!-- Original URL http://www.arabnews.com/?page=1&section=0&article=101889&d=30&m=9&y=2007 -->Productivity and Self-Discipline in Ramadan] - ArabNews, September 30, 2007</ref>}}
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===Crime Rate===
===Crime Rate===


In a study done on the Arab world,<ref name="ANSA"/> experts claimed that increases in blood crimes (+1.5%) and theft (+3.5%) were observed during Ramadan.
In a study done on the Arab world,<ref name="ANSA" /> experts claimed that increases in blood crimes (+1.5%) and theft (+3.5%) were observed during Ramadan.


{{Quote||[Egypt] In the past few years, Ramadan — a month usually reserved for pious contemplation and reverence — has been marred by an alarming rise in violent crime, experts have said.<ref>Yasmine Saleh - [{{Reference archive|1=http://www.dailystaregypt.com/article.aspx?ArticleID=3746|2=2011-07-12}} Ramadan saw rise in violent domestic crimes] - Daily News Egypt, November 2, 2006</ref>}}
{{Quote||[Egypt] In the past few years, Ramadan — a month usually reserved for pious contemplation and reverence — has been marred by an alarming rise in violent crime, experts have said.<ref>Yasmine Saleh - [{{Reference archive|1=http://www.dailystaregypt.com/article.aspx?ArticleID=3746|2=2011-07-12}} Ramadan saw rise in violent domestic crimes] - Daily News Egypt, November 2, 2006</ref>}}
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{{Quote||The Passports Department in Makkah arrested over 1,800 persons suspected of pickpocketing and stealing from pilgrims and visitors during the [2011] Umrah and Ramadan seasons ... Hussein stated that the advancement in technology, particularly facial recognition, reduced crimes tremendously in previous years.<ref>[http://arabnews.com/saudiarabia/article499367.ece 1,800 nabbed for thefts in Ramadan] - Arab News, September 9, 2011</ref>}}
{{Quote||The Passports Department in Makkah arrested over 1,800 persons suspected of pickpocketing and stealing from pilgrims and visitors during the [2011] Umrah and Ramadan seasons ... Hussein stated that the advancement in technology, particularly facial recognition, reduced crimes tremendously in previous years.<ref>[http://arabnews.com/saudiarabia/article499367.ece 1,800 nabbed for thefts in Ramadan] - Arab News, September 9, 2011</ref>}}


===Child Trafficking===
====Child Trafficking====


{{Quote||With the advent of Ramadan in just a few days, child trafficking, a trade that sometimes goes unpunished in Yemen, is expected to increase as food prices rise and parents struggle to provide for their children.
{{Quote||With the advent of Ramadan in just a few days, child trafficking, a trade that sometimes goes unpunished in Yemen, is expected to increase as food prices rise and parents struggle to provide for their children.
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While there are no statistics that determine how many children are trafficked on an annual basis, authorities do know that during the month of Ramadan the numbers rise. "One of the main problems is that there is a lack of reliable data," Ur-Rahman said.<ref>Salma Ismail - [http://www.webcitation.org/query?url=http%3A%2F%2Fwww.yementimes.com%2FDefaultDET.aspx%3Fi%3D1287%26p%3Dlocal%26a%3D1&date=2011-04-04 <!-- http://www.yementimes.com/DefaultDET.aspx?i=1287&p=local&a=1 -->Yemen child trafficking to increase in Ramadan] - Yemen Times, August 20, 2009</ref>}}
While there are no statistics that determine how many children are trafficked on an annual basis, authorities do know that during the month of Ramadan the numbers rise. "One of the main problems is that there is a lack of reliable data," Ur-Rahman said.<ref>Salma Ismail - [http://www.webcitation.org/query?url=http%3A%2F%2Fwww.yementimes.com%2FDefaultDET.aspx%3Fi%3D1287%26p%3Dlocal%26a%3D1&date=2011-04-04 <!-- http://www.yementimes.com/DefaultDET.aspx?i=1287&p=local&a=1 -->Yemen child trafficking to increase in Ramadan] - Yemen Times, August 20, 2009</ref>}}


===Disruption of Emergency Services===
===Emergency Services===
 
====Increase in Accidents====
 
In 1994, the Accident and Emergency Department of St Mary's Hospital in London conducted a study to examine if accident and emergency attendances increased during Ramadan for Muslim patients. At the time, the department was treating 55,000 new patients every year:


An increase in road traffic accidents in the [[United Arab Emirates]] during Ramadan was reported.<ref>Bener, A., Absood, G. H., Achan, N. V., & Sankaran-Kutty, M. (1992). Road traffic injuries in Al-Ain City, United Arab Emirates. The Journal of the Royal Society of Health, 112, 273-276.</ref> Taking this into consideration, you would expect Emergency Services in Muslim majority nations to work twice as hard during this period. Unfortunately, this is not the case.
{{Quote||2=The results are shown in Table 1. This demonstrates a '''significant rise in the number of Muslims attending during Ramadan''' compared to non-Muslims, with the proportion of Muslims rising from 3.63% of total attendances in the periods before and after Ramadan to 5.11% during Ramadan (P=0.0024). '''The rise in non accident-related attendances among Muslims was also significant''' when compared to non-Muslims (P=0.027) [...]<ref>[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1294766/ The effect of the fast of Ramadan on accident and emergency attendances] (J R Soc Med. 1994 September; 87(9): 517–518.)</ref>}}
 
An increase in road traffic accidents in the United Arab Emirates during Ramadan was reported.<ref>Bener, A., Absood, G. H., Achan, N. V., & Sankaran-Kutty, M. (1992). Road traffic injuries in Al-Ain City, United Arab Emirates. The Journal of the Royal Society of Health, 112, 273-276.</ref> Taking this into consideration, you would expect Emergency Services in Muslim majority nations to work twice as hard during this period. Unfortunately, this is not the case.
 
====Disruption of Services====


In August, 2010, Mustafa Mor, who was involved in a road accident in Turkey, was left waiting on a stretcher due to the X-ray service being closed for fast-breaking.
In August, 2010, Mustafa Mor, who was involved in a road accident in Turkey, was left waiting on a stretcher due to the X-ray service being closed for fast-breaking.
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Another study takes a look at fasting Muslims who were stricken with lethargy and fatigue due to the behavioral changes that accompany the month long celebration.  
Another study takes a look at fasting Muslims who were stricken with lethargy and fatigue due to the behavioral changes that accompany the month long celebration.  


{{Quote||''Some behavioural Changes observed among fasting subjects, their nutritional habits and energy expenditure in Ramadan. Karaaðaoðlu N, Yücecan S''
{{Quote||
 
'''Abstract'''  
'''Abstract'''  
This study was conducted in five provinces and food consumption, physical activity types and duration for 3 consecutive days were recorded in the questionnaire together with some general characteristics of 750 (320 males, 430 females) adults who were on fast during Ramadan at time of interview. One hundred and eighty-seven subjects had some type of health problems, among whom 60.4% were using drugs, and 31.6% were on diets; however, during Ramadan 9.7 and 18.8% of the subjects dropped taking drugs and did not regularly keep on diets, respectively. During the fasting time, from dawn to sunset, 34.3% of the subjects developed some behavioural disturbances, such as feeling tired and being unwilling to work. Although the meal consumed at dawn consisted of foods that were usually eaten at breakfast, the meal consumed at sunset consisted of a great variety of foods. Calcium intake was the most insufficiently consumed nutrient. It was observed that the daily energy intakes were less than the expenditures both in males and females. Further research should be done on the effects of fasting in health and disease.<ref>International Journal of Food Science and Nutrition 2000 Mar 51:125-34</ref>}}
This study was conducted in five provinces and food consumption, physical activity types and duration for 3 consecutive days were recorded in the questionnaire together with some general characteristics of 750 (320 males, 430 females) adults who were on fast during Ramadan at time of interview. One hundred and eighty-seven subjects had some type of health problems, among whom 60.4% were using drugs, and 31.6% were on diets; however, during Ramadan 9.7 and 18.8% of the subjects dropped taking drugs and did not regularly keep on diets, respectively. During the fasting time, from dawn to sunset, 34.3% of the subjects developed some behavioural disturbances, such as feeling tired and being unwilling to work. Although the meal consumed at dawn consisted of foods that were usually eaten at breakfast, the meal consumed at sunset consisted of a great variety of foods. Calcium intake was the most insufficiently consumed nutrient. It was observed that the daily energy intakes were less than the expenditures both in males and females. Further research should be done on the effects of fasting in health and disease.<ref>Karaaðaoðlu N, Yücecan S, "Some behavioural Changes observed among fasting subjects, their nutritional habits and energy expenditure in Ramadan", International Journal of Food Science and Nutrition 2000 Mar 51:125-34</ref>}}


In September 2009, Stephen Constantine, Head coach of Sudan partly blamed his side’s loss to the Black Stars to the fasting of most of his players. <ref>[http://sports.peacefmonline.com/soccer/200909/26144.php "Fasting affected my players" – Sudan coach] - Peace FM, September 6, 2009</ref> In Italy, both a prominent coach and a team owner in the top Serie A league linked the rigors of Ramadan's sunrise-to-sunset fasting to Muslim players' poor performance on the pitch. <ref>Jeff Israely - [http://www.time.com/time/world/article/0,8599,1919106,00.html Soccer Star Benched for Fasting During Ramadan] - TIME, August 27, 2009</ref>
In September 2009, Stephen Constantine, Head coach of Sudan partly blamed his side’s loss to the Black Stars to the fasting of most of his players. <ref>[http://sports.peacefmonline.com/soccer/200909/26144.php "Fasting affected my players" – Sudan coach] - Peace FM, September 6, 2009</ref> In Italy, both a prominent coach and a team owner in the top Serie A league linked the rigors of Ramadan's sunrise-to-sunset fasting to Muslim players' poor performance on the pitch. <ref>Jeff Israely - [http://www.time.com/time/world/article/0,8599,1919106,00.html Soccer Star Benched for Fasting During Ramadan] - TIME, August 27, 2009</ref>
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===Violence and Anti-Social Behavior Towards Non-Muslims===
===Violence and Anti-Social Behavior Towards Non-Muslims===


The month of Ramadan often sees an increase in violence and anti-social behavior towards religious minorities living among a large Muslim population.<ref name="MNN"></ref> In some Muslim majority countries like [[Algeria]],<ref name="Algeria">[http://www.abc.net.au/news/stories/2010/09/22/3018315.htm?section=justin Christians tried for breaking Ramadan fast] - ABC News, September 22, 2010</ref> Morocco,<ref>Doug Bandow - [http://www.cato.org/pub_display.php?pub_id=11966 Morocco: The Limits of Islamic Religious Tolerance] - KATO Insitute, July 8, 2010</ref> [[Pakistan]],<ref>[{{Reference archive|1=http://www.deccanherald.com/content/181534/25-jailed-pak-eating-public.html|2=2011-08-06}} 25 jailed in Pak for eating in public during Ramadan] - PTI, August 5, 2011</ref> [[Saudi Arabia]],<ref>[{{Reference archive|1=http://www.bikyamasr.com/73404/saudi-warns-non-muslims-with-expulsion-if-eating-drinking-in-public-during-ramadan/|2=2012-07-22}} Saudi warns non-Muslims with expulsion if eating, drinking in public during Ramadan] - Bikya Masr, July 21, 2012</ref> and in parts of the United Arab Emirates,<ref>Anissa Haddadi - [{{Reference archive|1=http://uk.ibtimes.com/articles/190323/20110801/non-muslim-holidaying-in-dubai-warned-to-respect-ramadan-rules.htm|2=2011-08-02}} Non-Muslim Holidaying in Dubai Warned to Respect 'Ramadan Rules'] - International Business Times, August 1, 2011</ref> it is against the law to eat or drink in public during fasting hours, and violating these laws can involve jail-time or expulsion.
The month of Ramadan often sees an increase in violence and anti-social behavior towards religious minorities living among a large Muslim population.<ref name="MNN"></ref> In some Muslim majority countries like Algeria,<ref name="Algeria">[http://www.abc.net.au/news/stories/2010/09/22/3018315.htm?section=justin Christians tried for breaking Ramadan fast] - ABC News, September 22, 2010</ref> Morocco,<ref>Doug Bandow - [http://www.cato.org/pub_display.php?pub_id=11966 Morocco: The Limits of Islamic Religious Tolerance] - KATO Insitute, July 8, 2010</ref> Pakistan,<ref>[{{Reference archive|1=http://www.deccanherald.com/content/181534/25-jailed-pak-eating-public.html|2=2011-08-06}} 25 jailed in Pak for eating in public during Ramadan] - PTI, August 5, 2011</ref> Saudi Arabia,<ref>[{{Reference archive|1=http://www.bikyamasr.com/73404/saudi-warns-non-muslims-with-expulsion-if-eating-drinking-in-public-during-ramadan/|2=2012-07-22}} Saudi warns non-Muslims with expulsion if eating, drinking in public during Ramadan] - Bikya Masr, July 21, 2012</ref> and in parts of the United Arab Emirates,<ref>Anissa Haddadi - [{{Reference archive|1=http://uk.ibtimes.com/articles/190323/20110801/non-muslim-holidaying-in-dubai-warned-to-respect-ramadan-rules.htm|2=2011-08-02}} Non-Muslim Holidaying in Dubai Warned to Respect 'Ramadan Rules'] - International Business Times, August 1, 2011</ref> it is against the law to eat or drink in public during fasting hours, and violating these laws can involve jail-time or expulsion.


{{Quote||Last year [2009] during Ramadan, there was an upsurge against Christians in the Muslim world," says Jerry Dykstra of Open Doors, USA. Dykstra says that although persecution did not increase in every Muslim nation, it did increase significantly in many of them, Egypt being one of the worst.  
{{Quote||Last year [2009] during Ramadan, there was an upsurge against Christians in the Muslim world," says Jerry Dykstra of Open Doors, USA. Dykstra says that although persecution did not increase in every Muslim nation, it did increase significantly in many of them, Egypt being one of the worst.  
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ICC's Jonathan Racho said: "Forcing Christians to fast during the Islamic fasting month is both outrageous and a clear violation of freedom of religion. We call upon Pakistani officials to immediately release Gull and Ashir and take appropriate legal measures against police officers who detained them."<ref>[http://www.christiantelegraph.com/issue6747.html Christians arrested in Pakistan for eating during Ramadan] - The Christian Telegraph, September 2, 2009</ref>}}
ICC's Jonathan Racho said: "Forcing Christians to fast during the Islamic fasting month is both outrageous and a clear violation of freedom of religion. We call upon Pakistani officials to immediately release Gull and Ashir and take appropriate legal measures against police officers who detained them."<ref>[http://www.christiantelegraph.com/issue6747.html Christians arrested in Pakistan for eating during Ramadan] - The Christian Telegraph, September 2, 2009</ref>}}


Ramadan-inspired violence against non-Muslims and non-observant Muslims is worryingly on the increase in the West. Notable incidents include; a Jewish women in Toulouse, [[France]], being called a "dirty Jew" and struck on the head by two Muslim teenagers for buying food during fasting hours; a Muslim man in a central Lyon Restaurant struck in the head with a glass bottle and hit with a chair by three youths for not respecting Ramadan;<ref>[http://vladtepesblog.com/?p=25211 Two people assaulted in France for eating during Ramadam. One was not even Muslim] - Vlad Tepes, August 24, 2010</ref> an 11-year-old in Sydney, [[Australia]], chased and later beaten by Muslim students because he ate a salami sandwich during Ramadan;<ref>[http://www.news.com.au/national/parents-say-son-was-tormented-for-eating-salami-sandwich-during-ramadan/story-e6frfkvr-1225797140592 Parents say son was tormented for eating salami sandwich during Ramadan] - The Daily Telegraph, November 13, 2009</ref> a Turkish MP in Berlin, [[Germany]], beaten by restaurant staff for ordering pork sausages;<ref>[{{Reference archive|1=http://news.am/eng/news/70698.html|2=2011-08-12}} Turkish MP was beaten for ordering pork sausage in Germany] - NEWS.am, August 11, 2011</ref> and the following report is of an atheist living in the [[United Kingdom]]:
Ramadan-inspired violence against non-Muslims and non-observant Muslims is on the increase in secular societies. Notable incidents include; a Jewish women in Toulouse, France, being called a "dirty Jew" and struck on the head by two Muslim teenagers for buying food during fasting hours; a Muslim man in a central Lyon Restaurant struck in the head with a glass bottle and hit with a chair by three youths for not respecting Ramadan;<ref>[http://vladtepesblog.com/?p=25211 Two people assaulted in France for eating during Ramadam. One was not even Muslim] - Vlad Tepes, August 24, 2010</ref> an 11-year-old in Sydney, Australia, chased and later beaten by Muslim students because he ate a salami sandwich during Ramadan;<ref>[http://www.news.com.au/national/parents-say-son-was-tormented-for-eating-salami-sandwich-during-ramadan/story-e6frfkvr-1225797140592 Parents say son was tormented for eating salami sandwich during Ramadan] - The Daily Telegraph, November 13, 2009</ref> a Turkish MP in Berlin, Germany, beaten by restaurant staff for ordering pork sausages;<ref>[{{Reference archive|1=http://news.am/eng/news/70698.html|2=2011-08-12}} Turkish MP was beaten for ordering pork sausage in Germany] - NEWS.am, August 11, 2011</ref> and the following report is of an atheist living in the United Kingdom:


{{Quote||Monzur Rahman was left with a broken arm, damaged eye and lying unconscious in the street after the violent attack earlier this month. The 39-year-old atheist claims he was brutally set upon by a pack of youths for failing to observe Ramadan.
{{Quote||Monzur Rahman was left with a broken arm, damaged eye and lying unconscious in the street after the violent attack earlier this month. The 39-year-old atheist claims he was brutally set upon by a pack of youths for failing to observe Ramadan.
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{{Quote||'''Low productivity during Ramadan affects Dubai employees'''<BR><BR>Performance in most companies, institutions and government departments around the Arab world is usually at a low during the month of Ramadan, with poor productivity and constant reported absences.<ref>[http://www.kuwaittimes.net/read_news.php?newsid=NjkyOTQ3NTM0 Low productivity during Ramadan affects Dubai employees] - Kuwait Times, September 24, 2007</ref>}}  
{{Quote||'''Low productivity during Ramadan affects Dubai employees'''<BR><BR>Performance in most companies, institutions and government departments around the Arab world is usually at a low during the month of Ramadan, with poor productivity and constant reported absences.<ref>[http://www.kuwaittimes.net/read_news.php?newsid=NjkyOTQ3NTM0 Low productivity during Ramadan affects Dubai employees] - Kuwait Times, September 24, 2007</ref>}}  


In [[Bahrain]], the work day is reduced to six-hours instead of the normal eight hours:<ref name="arabnews"/>
In Bahrain, the work day is reduced to six-hours instead of the normal eight hours:<ref name="arabnews" />


{{Quote||Alaa Al-Mohammadi, 27, works as a teaching assistant at King Abdul Aziz University, which, during Ramadan, opens between 10 a.m. and 3 p.m. Al-Mohammadi noticed the low level of productivity during the month of Ramadan, especially among students. “On account of the nature of the month when people stay up all night, absenteeism increases among students,” she said.<ref name="arabnews"/>}}
{{Quote||Alaa Al-Mohammadi, 27, works as a teaching assistant at King Abdul Aziz University, which, during Ramadan, opens between 10 a.m. and 3 p.m. Al-Mohammadi noticed the low level of productivity during the month of Ramadan, especially among students. “On account of the nature of the month when people stay up all night, absenteeism increases among students,” she said.<ref name="arabnews"/>}}
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==Conclusion==
==Conclusion==


Intermittent and prolonged fasting is generally not conducive to a healthy lifestyle. Depriving the body of water and essential nutrients by dividing and postponing meals to irregular intervals does nothing to limit consumption. In-fact it causes a host of health, performance and mood disorders. Fasting is not normally prescribed for the well being of human beings. Instead, it is commonly understood that eating healthy, smaller-portioned meals, interspersed throughout the day is far better in maintaining a well-balanced diet and far more forgiving on a person's metabolism.  Any claims that prolonged and intermittent fasting contributes to the well-being of an individual's health are misleading, based on the scientific studies that prove otherwise. If the Islamic argument in favor of fasting is that “we fast because Allah commanded us to do so," then it is obvious that [[Allah]] is not a nutritionist or a dietitian because the negatives definitely outweigh the positives.
Intermittent and prolonged fasting is generally not conducive to a healthy lifestyle. Depriving the body of water and essential nutrients by dividing and postponing meals to irregular intervals does nothing to limit consumption. In-fact it causes a host of health, performance and mood disorders. Fasting is not normally prescribed for the well being of human beings. Instead, it is commonly understood that eating healthy, smaller-portioned meals, interspersed throughout the day is far better in maintaining a well-balanced diet and far more forgiving on a person's metabolism.  Any claims that prolonged and intermittent fasting contributes to the well-being of an individual's health are misleading, based on the scientific studies that prove otherwise. The only benefit of fasting that can be claimed, then, must be metaphysical. However, what is clear is that the practice has concrete and definite physical, social, and economic harms.
 
==Responses to Apologetics==


So the question to the Muslim world is: keeping in mind the above adverse affects of fasting observed in studies, what benefit does the Muslim world get for 1 billion people staying hungry throughout the day for one full month every year? Did Allah actually want Muslims to suffer physically, socially and economically for one month every year? Also, if fasting is beneficial as Muslims claim, why do Muslims not fast the entire year instead of just one month?
#'''''"Most of the evidence provided is from newspaper articles. Not very scientific is it?"'''''<br>The claim that "most of the evidence provided is from news paper articles" is false. The majority of this page references and quotes directly from the conclusions of scientific studies.  It also quotes medical experts and statistics provided by Medical facilities. As for the news articles quoted here, they are reliable sources that reference and describe the conclusions of scientific studies. For an indepth section by section response, see the '[[Talk:Adverse Effects of Islamic Fasting|talk]]' page, or simply view the references provided below.
#'''''"Muslims do not fast in Ramadan so they can be healthy. They fast because Allah commanded them to."'''''<br>This is true. But many Muslims attempt to justify this unhealthy practice by claiming it is healthy. Besides, if Allah is all-knowing and merciful, he would not endanger his followers' health by making a hazardous activity become compulsory. However, it would make complete sense if we were to accept he is ignorant of [[Islam and Science|science]] or a [[Jahannam (Hell)#Why_It_Makes_Allah_a_Sadist|sadist]]. But then why would anyone want to worship such a deity?
#'''''"Islam is just one of numerous religions (Hinduism, Christianity, Catholicism etc.) that prescribe fasting for its people."'''''<br>This claim is true, but also very disingenuous. Rules vary but fasting in Christianity is not compulsory, nor is it expected to be a complete fast. Meaning Christians generally reduce (not stop) their intake of food, and also drink freely during fasts. This is perfectly healthy and not comparable to the Islamic sawm. Similarly in Hinduism, fasting is a part of the religion, but individuals observe different kinds of fasts based on their personal beliefs and local customs.<ref>[{{Reference archive|1=http://en.wikipedia.org/wiki/Fasting|2=2013-03-14}} Fasting] - Wikipedia, accessed March 14, 2013</ref> This argument is also a logical fallacy known as ad hominem tu quoque. Meaning it is not a valid defense of Islam, but a diversion that some may construe as an indirect admission of Islam's flaws.


{{Core Science}}
==See Also==
==See Also==


*[[Fasting]] ''- A hub page that leads to other articles related to Fasting''
{{Hub4|Fasting|Fasting}}


==External Links==
==External Links==


* [http://www.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20080914093305299C824902 Ramadan diet poses health risk - experts]
*[http://www.iol.co.za/index.php?set_id=1&click_id=13&art_id=vn20080914093305299C824902 Ramadan diet poses health risk - experts]


===Scientific Studies===
===Scientific Studies===


* [http://www.ncbi.nlm.nih.gov/pubmed/9100605 Ramadan diet restrictions modify the circadian time structure in humans. A study on plasma gastrin, insulin, glucose, and calcium and on gastric pH] ''(extract)''
*[http://www.ncbi.nlm.nih.gov/pubmed/9100605 Ramadan diet restrictions modify the circadian time structure in humans. A study on plasma gastrin, insulin, glucose, and calcium and on gastric pH] ''(extract)''


* [http://www.unboundmedicine.com/medline/ebm/related/9198696/%5BRamadan__A_month_of_fasting_with_risk_for_both_nocturnal_overeating_dehydration_and_starving%5D Medical Search Engine Result]'' - more studies on fasting''
*[http://www.unboundmedicine.com/medline/ebm/related/9198696/%5BRamadan__A_month_of_fasting_with_risk_for_both_nocturnal_overeating_dehydration_and_starving%5D Medical Search Engine Result]'' - more studies on fasting''


==References==
==References==
{{Reflist|2|refs=}}
{{Reflist|30em}}
[[Category:Islam and Science]]
[[Category:Islam and Science]]
[[Category:Health]]
[[Category:Fasting]]
[[Category:Criticism of Islam]]
[[Category:Ritual]]

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This article discusses the numerous adverse effects of Islamic fasting (Sawm) that have been observed using scientific studies and news sources.

Introduction

Medical fasting can have health benefits. As we will explain here, Islamic fasting, however, differs in many respects, and thus has significant harmful effects on health, national economy and productivity, crime rate, public safety and social behavior. Health effects include heat stress, dehydration, migraines and, for lactating women, the nutritional make-up of their milk, among other harms.

What is Islamic Fasting?

The salient features of Islamic fasting are:

  • For 30 days every lunar year (during the month of Ramadan), waking up before dawn and eating and drinking to prepare for the fast (binge eating is a common habit).[1][2]
  • Refraining from consuming any food or water from dawn to sunset
  • Breaking the fast at sunset and again eating and drinking to prepare for the day ahead.

Some Muslims claim eating a small amount of food is the correct Islamic way however we cannot function for the whole day by eating only a small amount of food at the time of dawn. This would affect our performance even more during the day.

Effects on Health

In a recent study done on the Arab world, diseases linked to cholesterol and diabetes increased by 27.65% because of overeating.[3] Non-compliance with prescribed treatment regimens is common during Ramadan. [4] Other health effects include:

Dehydration

One study finds that incidences of dehydration increase during the month of Ramadan:

PHYSIOLOGICAL FUNCTIONS

Evidence of hemoconcentration and dehydration has been found during Ramadan (El-Hazmi, Al-Faleh, & Al-Mofleh, 1987; Kayikcioglu et al., 1999; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). Restricted fluid intake, leading to disturbance in the fluid balance, is likely to cause these conditions. In the initial stages of dehydration, the clinical signs are tachycardia, tiredness and malaise, headaches and nausea. Middle-aged or more elderly persons are usually more prone to the effects of dehydration (Schmahl & Metzler).

Dehydration is indicated by the increase of several serum biochemical parameters (El-Hazmi et al., 1987; Ramadan et al., 1999; Schmahl & Metzler, 1991; Sweileh et al., 1992). The increase in uric acid, however, should especially be noted (El-Ati et al, 1995; El-Hazmi et al., 1987; Fedail et al., 1982; Schmahl & Metzler, 1991), because hyperuricemia is one of the known sequelae of prolonged fasting (Murphy & Shipman, 1963). Hyperuricemia is associated with reduction in glomerular filtration rate, decrease in uric acid clearance and alterations in the renal transport of uric acid (Murphy & Shipman). During Ramadan, however, reports show that the increase in uric acid does not excessively deviate from the normal range and studies have not reported clinical gout (El-Hazmi et al., 1987; Fedail et al., 1982). Increased uric acid is, therefore, unlikely to affect healthy individuals.[5]

Migraines

Migraines are three times more common during Ramadan, affecting an estimated 90 million Muslims:

An estimated 90 million of the world’s 1.57 billion Muslims are likely to suffer from migraine headaches during the dawn-to-dusk fasts during the month of Ramadan – which begins on Wednesday, at the height of summer heat. But Jewish researchers in the US and Israel have suggested how to help prevent the problem.

Dr. Ibrahim Abu-Salameh, Israel’s only Beduin neurologist – who works at Soroka University Medical Center in Beersheba – headed a team that found migraine attacks are three times more common during the Muslim fast than in the rest of the year.

Working with colleagues Dr. Igal Plecht and Dr. Gal Ifergan of the Beersheba hospital, Abu-Salameh studied 32 Beduin who suffered from migraine attacks during the Ramadan fast last year and compared the statistics to an ordinary month without the fast as a control.

Migraines were much more common in women than men; three-quarters of the women complained of migraine while fasting, compared to a much lower figure among the men. The Soroka study was published recently in the Journal of Headache and Pain.
. . .

Abu-Salameh said that he has gotten migraine headaches during Ramadan, and has treated Beduin who came to his clinic complaining about severe headaches. He noted that the medical literature has almost ignored the phenomenon until now.

Meanwhile, Dr. Michael J. Drescher of Hartford Hospital in Connecticut and colleagues at Sheba and Shaare Zedek Medical Centers in Israel recently suggested that otherwise-healthy Muslims suffering from migraine attacks during the Ramadan fast ask their doctors for a prescription for etoricoxib (commercial name Arcoxia) to prevent the headaches that come with fasting.[6]

Tachycardia, Severe Headaches, Dizziness, Nausea, Vomiting and Circulatory Collapse

The following study was carried out on Turkish Muslims in Germany who were involved in heavy and manual work. 'Moderate to severe health disturbances' including severe dehydration were found in such laborers during Ramadan:

Abstract

During Ramadan, Moslems are required strictly to avoid fluids and nourishment from dawn to sunset. Heat stress during such abstinence represents a substantial health hazard. In the Federal Republic of Germany (FRG) where numerous Moslems, particularly of Turkish origin, perform heat work and other heavy labour, we observed moderate to severe health disturbances in such labourers during Ramadan, e.g.: tachycardia, severe headaches, dizziness, nausea, vomiting and circulatory collapse. The severe dehydration of these workers was demonstrated by substantial increases in their hematocrit, serum protein, urea, creatinine, uric acid and electrolyte imbalance. Because of the evidence of the substantial health hazard to Islamic workers in such situations, we have strongly urged employers to refrain from assigning Islamic workers to heat work or heavy daytime work during Ramadan; we have therefore limited systematic studies of health problems during Ramadan to persons performing only moderate work. Even under these conditions signs of dehydration were found in the 32 labourers monitored. Some of these labourers also had to interrupt their observance of Ramadan due to health problems, e.g.: acute gout due to serum uric acid increase, or circulatory insufficiency. In light of the observed potentially harmful pathophysiological effects, the danger of dehydration of Islamic workers due to heat work during Ramadan should be taken very seriously.[7]

Naturally we would expect that this would affect productivity, as is evidenced in a later section on Economical effects.

Weight Fluctuation

The following study takes a look at the significant fluctuations in the weight of individuals that occurs during the month of Ramadan, primarily as a result of the metabolic changes that occur in the body.

Numerous studies have reported significant weight loss during Ramadan (Adlouni, Ghalim, Benslimane, Lecerf, & Saile, 1997; Adlouni et al., 1998; Fedail, Murphy, Salih, Bolton, & Harvey, 1982; Kayikcioglu, Erkin, & Erakgun, 1999; Ramadan, Telahoun, Al-Zaid, & Barac-Nieto, 1999; Schmahl & Metzler, 1991; Sweileh, Schnitzler, Hunter, & Davis, 1992). The declines may result from water loss early in Ramadan and loss of body fat during the later period (Sweileh et al., 1992). In fact, we did find evidence of dehydration.

Loss of body fat would indicate the use of fat for energy production during Ramadan (Husain, Duncan, Cheah, & Ch'ng, 1987; Ramadan et al., 1999; Sweileh et al., 1992). In addition, researchers have found decreased heart rate and oxygen consumption during Ramadan (Husain et al., 1987; Ramadan et al., 1999; Sweileh et al., 1992). These findings suggest a metabolic adaptation to fasting. It seems that during the Ramadan daylight hours - when no food or water is taken in - to conserve stored energy, the metabolism slows down (Sweileh et al., 1992).

Other studies, however, have reported no change in body weight during Ramadan (El-Ati, Beji, & Danguir, 1995; Finch, Day, Razak, Welch, & Rogers 1998; Maislos et al., 1993; Maislos, Abou-Rabiah, Zuili, Iordash, & Shany, 1998). In fact, one study carried out in Saudi Arabia reported a significant increase in body weight during Ramadan (Frost & Pirani, 1987). Such variations may be attributable to local custom and food quality. In short, in Islamic communities - as elsewhere - food habits vary according to geography, culture, and socioeconomic factors (Musaiger, 1993; Rashed, 1992). Ramadan is a special month and the variety of foods generally increases (Karaagaoglu & Yucecan, 2000) so, during this period, richer meals and special treats are not uncommon in households that can afford them.[5]

Affect on Circadian Patterns and Sleep Disorders

The results of the following study can lead us to conclude that fasting negatively effects an individual's circadian rhythm. As a result, unfavorable side-effects such as lethargy and a lack of motivation, may contribute to a society's lack of productivity:

This change of meal schedule is accompanied with changes in sleep habits, such as delayed and shortened sleep periods, which may affect endocrine and neuroendocrine circadian patterns. Several cardiovascular parameters (i.e., heart rate, blood pressure, vascular tone, and coagulation-fibrinolysis) show circadian pattern. Several studies reported that autonomic activity and melatonin rhtyhmicity may be responsible for circadian patterns of cardiovascular parameters. Changes of sleep habit in Ramadan affects autonomic activity and melatonin rhtyhmicity. The other negative effects may be that, during fasting patients with cardiovascular disease cannot consume medications, such as anti-ischemic, anti-platelet, anti-hypertensive drugs, and drugs of heart failure on time. Some patients may get admitted to the hospital with cardiovascular symptoms owing to failure of therapy.[8]

The following study was done in Saudi Arabia and it was observed that melatonin levels and REM sleep decreased during Ramadan:

Abstract: Fasting during Ramadan is distinct from regular voluntary or experimental fasting. This project was conducted to objectively assess the effect of Ramadan fasting on sleep architecture, daytime sleepiness and the circadian cycle of melatonin level. Eight healthy volunteers reported to the Sleep Disorders Center on four occasions for polysomnography and multiple sleep latency tests: 1) an initial visit for adaptation; 2) 2 weeks before Ramadan (BL); and 3,4) during the first and third weeks of Ramadan (R1, R3). Salivary melatonin level was measured using radioimmunoassay. Sleep latency at night was significantly shorter and the amount of rapid eye movement sleep was significantly less, at R3 compared to BL. There was no difference in multiple sleep latency test data between BL and Ramadan. Although melatonin level kept the same circadian pattern at BL, R1 and R3, it had a flatter slope and a significantly lower peak at midnight (00:00) at R1 and R3. This study showed a significant reduction in sleep latency and rapid eye movement sleep during the third week of Ramadan fasting. Otherwise, there was no significant effect of Ramadan on sleep architecture and assessment revealed no increase in daytime sleepiness. Although melatonin level had the same circadian pattern during Ramadan, the level of the hormone dropped significantly from baseline.[9]

Daytime Drowsiness, Alertness and Cognition

Naturally, a fast would indicate that individuals are ingesting less food. But the following two studies reveal that the decrease in the number of meals that are eaten directly disturbs normal sleep habits and thereby increases daytime drowsiness.

Abstract

Few epidemiological data have been reported on the relation between Ramadan fasting, life habits (meal frequency, sleep habits) and daytime sleepiness during Ramadan. This paper presents the results of a detailed study of the chronotype and daytime sleepiness before and during Ramadan. It was conducted on a sample of 264 subjects aged between 20 and 30 years. Results have revealed a significant decrease in the meal frequency during Ramadan compared with the control period. Before Ramadan, the majority of subjects woke up between 6 and 7 a.m. and went to sleep between 10 and 11 p.m. however, during Ramadan fasting, they woke up after 8 a.m. and preferred to go to sleep later (after midnight). Chronotype as evaluated by the Horne and Ostberg scale was changed significantly during Ramadan: an increase of the evening type and a decrease in the morning type of subjects was observed. Daytime sleepiness as evaluated by the Epworth Sleepiness Scale was significantly increased.[10]

The following study studies the effect that fasting has on the alertness of an individual. Evidently, the change in sleep patterns causes a decrease in oral temperature and alertness:

Abstract

During the month of Ramadan, Moslems abstain from drinking and eating daily between sunrise and sunset. This change of meals schedule is accompanied with changes in sleep habit, which may affect diurnal alertness. This study examined the effect of Ramadan intermittent fasting on the diurnal alertness and oral temperature in 10 healthy young subjects. The cognitive task battery including movement reaction time (MRT), critical flicker fusion (CFF) and visual analogue scale, was administered at 6 different times of the day: 09.00, 11.00, 13.00, 16.00, 20.00 and 23.00 h on the 6th, 15th, and 28th days of Ramadan. The baseline day was scheduled one week before Ramadan, and the recovery day 18 days after this month. Oral temperature was measured prior to each test session and at 00.00 h. During Ramadan oral temperature decreased at 09.00, 11.00, 13.00, 16.00 and 20.00 h and increased at 23.00 and 00.00 h. Subjective alertness decreased at 09.00 and 16.00 h and increased at 23.00 h. Mood decreased at 16.00 h. MRT was increased at the beginning of Ramadan (R6) and CFF was not changed. These results showed that daytime oral temperature, subjective alertness and mood were decreased during Ramadan intermittent fasting.[11]

Cognition

The physical fatigue associated with fasting results in impairment of cognitive function, as shown by performance in flicker fusion tests. [12]

Lactating women

In a certain study, the nutritional status of lactating women was affected by Ramadan fasting. All of the nutrient intakes (except vitamins A, E and C) decreased during Ramadan. The study said that it would seem prudent to excuse lactating women from fasting during Ramadan.[13]

Pregnancies

A new study by scientists in the United States has revealed that pregnant Muslim women who fast during Ramadan are likely to have smaller babies who will be more prone to learning disabilities in adulthood.

The researchers also found that the women were 10 per cent less likely to give birth to a boy if they had fasted during Ramadan. The trend was clearest if the fasting was done early in the women’s pregnancy, and during the summer months, when long hours of daylight called for them to go longer without food.
. . .

The study, which used census data from the US, Iraq and Uganda, also discovered long-term effects on the adult’s health and his or her future economic success.

"We generally find the largest effects on adults when Ramadan falls early in pregnancy," the Independent quoted Douglas Almond, of Columbia University, and Bhashkar Mazumder, of the Federal Research Bank of Chicago, the authors of the research, as saying.

"Rates of adult disability are roughly 20 per cent higher, with specific mental disabilities showing substantially larger effects. Importantly, we detect no corresponding outcome differences when the same design is applied to non-Muslims," they added.[14]

Binge eating, headaches and increase in gastric acidity

'Binge eating is a fairly common habit during the Ramadan period, especially as the day is spent without eating or drinking,' says Anjali Dange, Dietitian at Welcare Hospital.

"During the initial days of fasting, you may encounter slight dizziness as well as frequent headaches."

Dr Phadke says that fasting can also increase levels of gastric acidity in the stomach which can cause burning and heaviness, and sometimes a sour taste in the mouth.[1]
During Ramadan most of the population sleep during the day, with the iftar beginning at sundown: large feasts at which many end up eating so much they need to be taken to hospital casualty wards, with a record high almost 8,000 cases of indigestion recorded at the Hamad Medical Hospital emergency room solely in the first week of Ramadan 2011.[15]

Dr. Muhammad Alabdooni, a Muslim and the chairman of the Dutch Moroccan Physicians Association, also maintains there is no scientific proof that Islamic fasting is physiologically beneficial.[16]

Increases the toxicity of commonly used medication

Fasting has been found to significantly change drug metabolism and deplete crucial chemicals in the liver needed to detoxify medication.

Paracetemol (also called acetaminophen) is one of the most commonly used drugs to treat day to day pain such as headaches or gastrointestinal pain, this is the very same pain that is likely to be encountered by a fasting individual. Therefore, a significant risk arises when someone who has been fasting takes this common medication (among many others).

As the Journal of Internal Medicine Reports:

Paracetamol-related hepatotoxicity is now the most common cause of the potentially devastating clinical syndrome of acute liver failure in many western countries. In patients who develop liver damage following moderate paracetamol overdose in the order of 5–10 g daily, recent fasting and nutritional impairment have been identified as key precipitants. In keeping with experience in the modest paracetamol overdose setting [6], it is likely that fasting occurring on a background of longstanding diminished caloric intake and severe malnutrition played an important role in the development of paracetamol-induced liver damage at recommended dosage of 4 g daily in this patient. Fasting and malnutrition result in reduction of hepatic levels of glutathione, required for inactivation of N-acetyl-p-benzoquinonimine, the toxic metabolite of paracetamol [6]. A 16-h period of fasting is sufficient to substantially deplete hepatic glutathione stores in mice [11]. [17]

Social Effects

Irritability

The following study in Morocco found that irritability increased during Ramadan:

Abstract

OBJECTIVES: We hypothesized that people in Morocco are more irritable during the month of Ramadan than during the rest of the year. Our objectives were to measure irritability in fasting Muslims during the month of Ramadan, to describe its various modes of expression, and to examine risk factors for this irritability.

METHODS AND SUBJECTS: We studied 100 healthy volunteers during the month of Ramadan for two successive years (1994 and 1995). All subjects were male (mean age, 32+/-5.8 years), and 51% of them were smokers. Irritability was assessed over a 6-week period (before, four times during, and after the end of Ramadan). We assessed both subjective (visual analog scale) and objective irritability. We also recorded the consumption of psychostimulants, duration of sleep, and anxiety level as measured by the Hamilton Anxiety Scale.

RESULTS: Irritability was significantly higher in smokers than in nonsmokers before the beginning of Ramadan. It was higher in both groups during the Ramadan month. Irritability increased continuously during Ramadan and reached its peak at the end of the month. Consumption of psychostimulants (coffee and tea) and anxiety level followed the same pattern. Smokers and nonsmokers had a similar pattern of irritability over time, but irritability increased more in smokers than in nonsmokers.[18]
Wael Bakor, 29, marketing manager at a major company in Jeddah, expressed regret at the attitude of employees. “Unfortunately, people become more tense and irritated during Ramadan. One can easily notice the bad moods, the tension and the inability to put up with anyone or anything,” he said.[19]

Crime Rate

In a study done on the Arab world,[3] experts claimed that increases in blood crimes (+1.5%) and theft (+3.5%) were observed during Ramadan.

[Egypt] In the past few years, Ramadan — a month usually reserved for pious contemplation and reverence — has been marred by an alarming rise in violent crime, experts have said.[20]
Director of Jakarta Police’s General Crime Unit, Sr. Comr. Muhammad Iriawan called on Jakarta residents to be alert as crimes tended to increase during the fasting month of Ramadan.

...

Iriawan said crimes such as house break-ins and robberies tend to increase during Ramadan, when the need for extra money was high because of the festivities.[21]
official of the Jakarta city administration, A Sjarief Mustafa, says that the number of prostitutes caught by his office had increased from 94, before Ramadan, to 264 during it. He also said that the numbers of beggars had increased. He claimed that the incidence of social ills such as begging and prostitution always increased during the "holy month", and said that people from the provinces often used the "momentum" of Ramadan to come to Jakarta and seek money from the Jakarta's residents.[22]
The Passports Department in Makkah arrested over 1,800 persons suspected of pickpocketing and stealing from pilgrims and visitors during the [2011] Umrah and Ramadan seasons ... Hussein stated that the advancement in technology, particularly facial recognition, reduced crimes tremendously in previous years.[23]

Child Trafficking

With the advent of Ramadan in just a few days, child trafficking, a trade that sometimes goes unpunished in Yemen, is expected to increase as food prices rise and parents struggle to provide for their children.

"I think during Ramadan prices rise and there is a lapse of security along the borders," Coordinator of Child Parliament Om Khalthoum said.

Almost 1,500 Yemeni children were saved by child protection centers from exploitation, abuse and deprivation that come at the hands of their traffickers or smugglers, according to Naseem Ur-Rahman of UNICEF. Yemeni children, primarily boys, are trafficked into Saudi Arabia for exploitation as beggars, street vendors and unskilled laborers.

While there are no statistics that determine how many children are trafficked on an annual basis, authorities do know that during the month of Ramadan the numbers rise. "One of the main problems is that there is a lack of reliable data," Ur-Rahman said.[24]

Emergency Services

Increase in Accidents

In 1994, the Accident and Emergency Department of St Mary's Hospital in London conducted a study to examine if accident and emergency attendances increased during Ramadan for Muslim patients. At the time, the department was treating 55,000 new patients every year:

The results are shown in Table 1. This demonstrates a significant rise in the number of Muslims attending during Ramadan compared to non-Muslims, with the proportion of Muslims rising from 3.63% of total attendances in the periods before and after Ramadan to 5.11% during Ramadan (P=0.0024). The rise in non accident-related attendances among Muslims was also significant when compared to non-Muslims (P=0.027) [...][25]

An increase in road traffic accidents in the United Arab Emirates during Ramadan was reported.[26] Taking this into consideration, you would expect Emergency Services in Muslim majority nations to work twice as hard during this period. Unfortunately, this is not the case.

Disruption of Services

In August, 2010, Mustafa Mor, who was involved in a road accident in Turkey, was left waiting on a stretcher due to the X-ray service being closed for fast-breaking.

investigation after a patient waited at the door of an X-ray service in a hospital, which was closed for half an hour at the time for fast-breaking.

Mustafa Mor’s car went off the road and crashed into a tree in the Nizip district of the southern province of Gaziantep. Bekir Karabacak, a passerby, took him and his cousin, who has the same name and was a passenger in the vehicle, to the Nizip Public Hospital. The doctors thought that the passenger Mor might have had a broken leg and sent him to the X-ray service.

The health care personnel took Mor on a stretcher to the X-ray service, where they found a note that said, “I am having dinner, I am about to return,” hanging on the door. Karabacak, who had taken him to the hospital, said: “We are also fasting. Should this place be closed? There is an injured man here, and this is a hospital.” After Mor waited half an hour, the staff returned from dinner.

Cengiz Öztop, the chief physician of Nizip Public Hospital, claimed that there was no neglect in the situation.[27]

Search and rescue teams in Kocaeli, Turkey, had also stopped working due to Ramadan.

Search and rescue teams including 200 people who were working on the beaches of the western province of Kocaeli have stopped working due to Ramadan. Vacationers have criticized the decision and said that people swam in the area unperturbedly thanks to the rescue teams. According to the vacationers, the shores will be full of people until the schools start. Kocaeli Metropolitan Municipality officers said that they would review the decision once again.[27]

Reduced Blood Donation

Blood Transfusion Organization announced that blood donations have dropped by 35 percent since the beginning of the Muslim fasting month of Ramadan (Sept. 25).[28]

The same news source said that "each blood unit can save three lives". This implies that Ramadan also results in loss of life since life-saving blood donations drop by one-third.

Physical Exhaustion and Incapacitation

Another study takes a look at fasting Muslims who were stricken with lethargy and fatigue due to the behavioral changes that accompany the month long celebration.

Abstract

This study was conducted in five provinces and food consumption, physical activity types and duration for 3 consecutive days were recorded in the questionnaire together with some general characteristics of 750 (320 males, 430 females) adults who were on fast during Ramadan at time of interview. One hundred and eighty-seven subjects had some type of health problems, among whom 60.4% were using drugs, and 31.6% were on diets; however, during Ramadan 9.7 and 18.8% of the subjects dropped taking drugs and did not regularly keep on diets, respectively. During the fasting time, from dawn to sunset, 34.3% of the subjects developed some behavioural disturbances, such as feeling tired and being unwilling to work. Although the meal consumed at dawn consisted of foods that were usually eaten at breakfast, the meal consumed at sunset consisted of a great variety of foods. Calcium intake was the most insufficiently consumed nutrient. It was observed that the daily energy intakes were less than the expenditures both in males and females. Further research should be done on the effects of fasting in health and disease.[29]

In September 2009, Stephen Constantine, Head coach of Sudan partly blamed his side’s loss to the Black Stars to the fasting of most of his players. [30] In Italy, both a prominent coach and a team owner in the top Serie A league linked the rigors of Ramadan's sunrise-to-sunset fasting to Muslim players' poor performance on the pitch. [31]

Violence and Anti-Social Behavior Towards Non-Muslims

The month of Ramadan often sees an increase in violence and anti-social behavior towards religious minorities living among a large Muslim population.[32] In some Muslim majority countries like Algeria,[33] Morocco,[34] Pakistan,[35] Saudi Arabia,[36] and in parts of the United Arab Emirates,[37] it is against the law to eat or drink in public during fasting hours, and violating these laws can involve jail-time or expulsion.

Last year [2009] during Ramadan, there was an upsurge against Christians in the Muslim world," says Jerry Dykstra of Open Doors, USA. Dykstra says that although persecution did not increase in every Muslim nation, it did increase significantly in many of them, Egypt being one of the worst.

During Ramadan last year in Egypt, a church was burned to the ground. At least 155 Egyptian Christians were arrested for not participating in Ramadan. Last September, Rody Rodeheaver with I.N. Network explained that Ramadan "is a time when Muslims who are moderate often become much more aggressive about their faith, and they [see it] as a time to be aggressive as they deal with Christians." Rodeheaver also noted that many people are somewhat psychologically distraught by a lack of food since Muslims are required to fast during Ramadan.

This year, with tension rising after Muslim attacks on Christians in Afghanistan, Somalia, Pakistan and other nations just before Ramadan, prospects don't look much better. The potential for a swell in persecution in the next 28 days is high.

Ramadan--August 11 to September--is especially daunting for Muslim converts to Christianity.[32]
Hocine Hocini, 44, and Salem Fellak, 34, were arrested on August 13 [2010] on the building site where they worked in the northern region of Kabylie [Algeria] after they were spotted eating lunch. The pair admit to eating but insist it happened in a discreet place. Muslims are not allowed to eat during daylight hours during the Ramadan holy month. In Algeria breaking the fast can be punished with three months in jail.

"I am optimistic," Hocini, a Protestant with a one-month-old daughter, said as he left the courtroom in Ain el Hammam after the hearing. "I have no regrets, I'm Christian and assume my responsibilities. We are innocent, and we haven't done any harm to anyone...We are Christians and we have not eaten in a public place."

The verdict is due on October 5. The prosecutor called for the full three months in prison for both men.[33]
Police in Pakistan arrested two Christians for eating during the Islamic fasting season of Ramadan in the city of Silanwali on Aug. 25 [2009], reports Michael Ireland, chief correspondent, ASSIST News Service.
. . .

In a media release, ICC says that after the waiter served them tea and a snack, several policemen started to question them as to why they were desecrating Ramadan by eating during the Islamic fasting season. The two Christians told the police that since they are Christians, they are not supposed to fast during Ramadan.
. . .

Azzaq Bhatti, the father of Gull Masih and paternal uncle of Ashir Sohail, in an interview with ICC said that, "during Lent, all Muslims eat, drink and smoke publicly and neither police nor government authorities take notice of it. And none of the Muslims are arrested for desecrating Christians' Lent season."

ICC's Jonathan Racho said: "Forcing Christians to fast during the Islamic fasting month is both outrageous and a clear violation of freedom of religion. We call upon Pakistani officials to immediately release Gull and Ashir and take appropriate legal measures against police officers who detained them."[38]

Ramadan-inspired violence against non-Muslims and non-observant Muslims is on the increase in secular societies. Notable incidents include; a Jewish women in Toulouse, France, being called a "dirty Jew" and struck on the head by two Muslim teenagers for buying food during fasting hours; a Muslim man in a central Lyon Restaurant struck in the head with a glass bottle and hit with a chair by three youths for not respecting Ramadan;[39] an 11-year-old in Sydney, Australia, chased and later beaten by Muslim students because he ate a salami sandwich during Ramadan;[40] a Turkish MP in Berlin, Germany, beaten by restaurant staff for ordering pork sausages;[41] and the following report is of an atheist living in the United Kingdom:

Monzur Rahman was left with a broken arm, damaged eye and lying unconscious in the street after the violent attack earlier this month. The 39-year-old atheist claims he was brutally set upon by a pack of youths for failing to observe Ramadan.

Arif Raham, a friend of Monzur (who speaks little English), relayed to the Advertiser his terrifying story. He said Monzur had been chatting with a friend who was drinking during Ramadan.

He claims he was then approached by a group of around ten young men who asked him why he wasn’t observing Ramadan. When he replied that he was an atheist they are believed to have chased him to nearby Walburgh Street, attacking him outside his home.

Monzur was reportedly battered until unconscious and later taken to the Royal London Hospital. His left arm was broken and metal bolts later put in. Tower Hamlets police have made no arrests and enquiries are ongoing.[42]

Economical Effects

As some of the above studies established, fasting can cause dehydration, sleep disorders and other harmful affects. Naturally all of this would affect productivity and the national economy. Those living in Muslim majority nations can readily feel the effects of stagnation that accompanies the month of Ramadan. In such places, it is a month that is marked by very low productivity. When the entire population of a country observes fasting during the time they are at work, it is inevitable that they will suffer a significant loss in general productivity. In a survey carried out by Cairo’s Institute of Social Sciences of the Arab World it is found that the productivity of Arab businesses during the month of Ramadan dropped by a staggering 78%:

During Ramadan, the productivity of Arab businesses drops by 78%. The essential factors? Fewer work hours, absenteeism, and sick leave. (...) The figures are included in a survey carried out by Cairòs Institute of Social Sciences of the Arab World which was printed today by 'Leaders', a Tunisian website. (ANSAmed)[3]

Production in almost all businesses in Morocco drops during the month of Ramadan, analysts say, although consumption increases significantly:

Work hours are shorter during Ramadan, with employees working seven-hour days compared to the regular 8.5-hour days. Some businesses don't open until 10 am, and school timetables change to accommodate the Ramadan calendar.

"The drop in productivity could be due to the disruption of the body clock," said A. Hamdi, who works in an industrial unit. "It is difficult to get used to the work day.

In addition to the women who race home to make iftar, others are sneaking out earlier to avoid traffic jams, which usually start at 4 pm with the end of the normal working day."[43]
Low productivity during Ramadan affects Dubai employees

Performance in most companies, institutions and government departments around the Arab world is usually at a low during the month of Ramadan, with poor productivity and constant reported absences.[44]

In Bahrain, the work day is reduced to six-hours instead of the normal eight hours:[19]

Alaa Al-Mohammadi, 27, works as a teaching assistant at King Abdul Aziz University, which, during Ramadan, opens between 10 a.m. and 3 p.m. Al-Mohammadi noticed the low level of productivity during the month of Ramadan, especially among students. “On account of the nature of the month when people stay up all night, absenteeism increases among students,” she said.[19]
"Jordanian workers in general are not hard working and in Ramadan, employees frequently are absent or ask for leave, a notable phenomenon that negatively affects the overall economic performance," economist Salameh Darawi told The Jordan Times over the phone Wednesday. Economic analyst Hussam Ayesh said productivity drops by about 50 per cent in the public and private sectors during Ramadan.[45]

Comments from Muslims and former Muslims

An employee at a construction material company, who preferred anonymity, said: "Everything is slow in Ramadan and I myself tend to delay work. The only fast thing I see in Ramadan is lunatic drivers speeding to get home for iftar."[45]
In Ramzan the working hours are nine to one. That’s it. And in these four hours work is the last thing on the workers’ mind. Go to any government office during these four hours and you will encounter a grouchy, lazy and sick-of-life person with bad breath (apparently even brushing your teeth in the morning is not kosher if you are fasting). No matter how urgent your work, leave the place and come back after two and a half months in the third week of Muharram. This man is in no mood to do anything. He’d rather go home and watch an Indian movie till he breaks fast.[46]
I couldn't concentrate in school. I had nasty heart burn all morning, because we'd wake up at an ungodly hour to gorge! [...] There are many women in my life and some of them are extremely old with various medical conditions. They all feel compelled to fast. It drives me insane![47]

Conclusion

Intermittent and prolonged fasting is generally not conducive to a healthy lifestyle. Depriving the body of water and essential nutrients by dividing and postponing meals to irregular intervals does nothing to limit consumption. In-fact it causes a host of health, performance and mood disorders. Fasting is not normally prescribed for the well being of human beings. Instead, it is commonly understood that eating healthy, smaller-portioned meals, interspersed throughout the day is far better in maintaining a well-balanced diet and far more forgiving on a person's metabolism. Any claims that prolonged and intermittent fasting contributes to the well-being of an individual's health are misleading, based on the scientific studies that prove otherwise. The only benefit of fasting that can be claimed, then, must be metaphysical. However, what is clear is that the practice has concrete and definite physical, social, and economic harms.

Responses to Apologetics

  1. "Most of the evidence provided is from newspaper articles. Not very scientific is it?"
    The claim that "most of the evidence provided is from news paper articles" is false. The majority of this page references and quotes directly from the conclusions of scientific studies. It also quotes medical experts and statistics provided by Medical facilities. As for the news articles quoted here, they are reliable sources that reference and describe the conclusions of scientific studies. For an indepth section by section response, see the 'talk' page, or simply view the references provided below.
  2. "Muslims do not fast in Ramadan so they can be healthy. They fast because Allah commanded them to."
    This is true. But many Muslims attempt to justify this unhealthy practice by claiming it is healthy. Besides, if Allah is all-knowing and merciful, he would not endanger his followers' health by making a hazardous activity become compulsory. However, it would make complete sense if we were to accept he is ignorant of science or a sadist. But then why would anyone want to worship such a deity?
  3. "Islam is just one of numerous religions (Hinduism, Christianity, Catholicism etc.) that prescribe fasting for its people."
    This claim is true, but also very disingenuous. Rules vary but fasting in Christianity is not compulsory, nor is it expected to be a complete fast. Meaning Christians generally reduce (not stop) their intake of food, and also drink freely during fasts. This is perfectly healthy and not comparable to the Islamic sawm. Similarly in Hinduism, fasting is a part of the religion, but individuals observe different kinds of fasts based on their personal beliefs and local customs.[48] This argument is also a logical fallacy known as ad hominem tu quoque. Meaning it is not a valid defense of Islam, but a diversion that some may construe as an indirect admission of Islam's flaws.

See Also

  • Fasting - A hub page that leads to other articles related to Fasting

External Links

Scientific Studies

References

  1. ↑ 1.0 1.1 Dietitian Advises Selective Eating Habits During Ramadan - Khaleej Times Online, September 7, 2008
  2. ↑ Abdel-Moneim Said - Wasting Ramadan - Al-Ahram Weekly, September 3, 2009
  3. ↑ 3.0 3.1 3.2 Ramadan: Productivity of Arab Businesses Drops by 78% - ANSAmed, September 3, 2009 (original URL)
  4. ↑ Aslam M, Healey MA. Drug regimens and fasting Moslem patients [Letter]. Lancet 1985;290:1746
  5. ↑ 5.0 5.1 Toda, Masahiro, Morimoto, Kanehisa, "Ramadan Fasting - Effect on Healthy Muslims", Social Behavior and Personality: an international journal, 2004
  6. ↑ Judy Siegel-Itzkovich - Beduin doctor: Migraines common during Ramadan fast - The Jerusalem Post, August 9, 2010
  7. ↑ Schmahl FW, Metzler B, "The health risks of occupational stress in Islamic industrial workers during the Ramadan fasting period", Polish Journal of Occupational Medicine 1991 4:3 219-28
  8. ↑ "Does Ramadan modify the Circadian Patterns?", Journal of Postgraduate Medicine, March 2006, Vol. 52 Issue 1 pdf
  9. ↑ Ahmed S. BaHammam, "Effect of fasting during Ramadan on sleep architecture, daytime sleepiness and sleep pattern", Sleep and Biological Rhythms, Volume 2, Issue 2, pages 135–143, June 2004
  10. ↑ Taoudi Benchekroun M, Roky R, Toufiq J, Benaji B, Hakkou F, "Epidemiological study: chronotype and daytime sleepiness before and during Ramadan.", Therapie 54:567-72
  11. ↑ Roky R, Iraki L, HajKhlifa R, Lakhdar Ghazal N, Hakkou F, "Daytime alertness, mood, psychomotor performances, and oral temperature during Ramadan intermittent fasting.", Annals of Nutrition and Metabolism 2000 44:101-7
  12. ↑ Ali MR, Amir T. Effects of fasting on visual flicker fusion. Percept Mot Skills 1989;69:627-31
  13. ↑ "The effect of Ramadan on maternal nutrition and composition of breast milk." Pg. 278-283, vol. 48 - Nutrition and Dietetics; Food Engineering, Hacettepe University, Ankara, Turkey
  14. ↑ Ramadan fast not recommended during pregnancy - The Times of India, Jun 25, 2010
  15. ↑ Qatar: surge in diabetes/obesity, unhealthy Arab habits - ANSAmed, March 13, 2012
  16. ↑ Is fasting during Ramadan good for your health? - Radio Netherlands Worldwide
  17. ↑ Paracetamol-induced hepatotoxicity at recommended dosage - The Journal of Internal Medicine, Janurary 24, 2003
  18. ↑ Kadri N, Tilane A, El Batal M, Taltit Y, Tahiri SM, Moussaoui D, "Irritability During the Month of Ramadan", Psychosomatic Medicine 2000 Mar-Apr 62:2 280-5
  19. ↑ 19.0 19.1 19.2 Hassna’a Mokhtar - Productivity and Self-Discipline in Ramadan - ArabNews, September 30, 2007
  20. ↑ Yasmine Saleh - Ramadan saw rise in violent domestic crimes - Daily News Egypt, November 2, 2006
  21. ↑ Bati Kartini & Samuel L - 4 Gold Shop Robbers Killed, 2 Caught During Police Raids Across the City - The Jakarta Globe, August 28, 2009
  22. ↑ David - Ramadan Crime - Indonesia Matters, October 20, 2006
  23. ↑ 1,800 nabbed for thefts in Ramadan - Arab News, September 9, 2011
  24. ↑ Salma Ismail - Yemen child trafficking to increase in Ramadan - Yemen Times, August 20, 2009
  25. ↑ The effect of the fast of Ramadan on accident and emergency attendances (J R Soc Med. 1994 September; 87(9): 517–518.)
  26. ↑ Bener, A., Absood, G. H., Achan, N. V., & Sankaran-Kutty, M. (1992). Road traffic injuries in Al-Ain City, United Arab Emirates. The Journal of the Royal Society of Health, 112, 273-276.
  27. ↑ 27.0 27.1 Man gets delayed health care due to Ramadan in Turkey - Hurriyet Daily News, August 15, 2010
  28. ↑ Iran-Daily.com (pdf) - October 1, 2006
  29. ↑ Karaaðaoðlu N, Yücecan S, "Some behavioural Changes observed among fasting subjects, their nutritional habits and energy expenditure in Ramadan", International Journal of Food Science and Nutrition 2000 Mar 51:125-34
  30. ↑ "Fasting affected my players" – Sudan coach - Peace FM, September 6, 2009
  31. ↑ Jeff Israely - Soccer Star Benched for Fasting During Ramadan - TIME, August 27, 2009
  32. ↑ 32.0 32.1 Ramadan a time of fasting and...persecution? - Mission Network News, August 13, 2010
  33. ↑ 33.0 33.1 Christians tried for breaking Ramadan fast - ABC News, September 22, 2010
  34. ↑ Doug Bandow - Morocco: The Limits of Islamic Religious Tolerance - KATO Insitute, July 8, 2010
  35. ↑ 25 jailed in Pak for eating in public during Ramadan - PTI, August 5, 2011
  36. ↑ Saudi warns non-Muslims with expulsion if eating, drinking in public during Ramadan - Bikya Masr, July 21, 2012
  37. ↑ Anissa Haddadi - Non-Muslim Holidaying in Dubai Warned to Respect 'Ramadan Rules' - International Business Times, August 1, 2011
  38. ↑ Christians arrested in Pakistan for eating during Ramadan - The Christian Telegraph, September 2, 2009
  39. ↑ Two people assaulted in France for eating during Ramadam. One was not even Muslim - Vlad Tepes, August 24, 2010
  40. ↑ Parents say son was tormented for eating salami sandwich during Ramadan - The Daily Telegraph, November 13, 2009
  41. ↑ Turkish MP was beaten for ordering pork sausage in Germany - NEWS.am, August 11, 2011
  42. ↑ Sheena McKenzie - Battered Stepney man in recovery - East London Advertiser, September 23, 2010
  43. ↑ Hassan Benmehdi - Productivity drops during Ramadan in Morocco - Magharebia (Casablanca), September 19, 2008
  44. ↑ Low productivity during Ramadan affects Dubai employees - Kuwait Times, September 24, 2007
  45. ↑ 45.0 45.1 Mohammad Ghazal - Productivity suffers during holy month - The Jordan Times, September 10, 2009
  46. ↑ Nasir Abbas Mirza - OPINION: Rejoice! The season to shun work is here - Daily Times, August 23, 2009
  47. ↑ It’s a strange Ramadan - Blog from Nimbu, a former Muslim, September 14, 2007
  48. ↑ Fasting - Wikipedia, accessed March 14, 2013
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