Counselling the Patients who Cannot Fast in Ramadan:

Dr. Habeeb Haris

Proper counselling of Muslim patients for whom fasting is contraindicated is important to ensure compliance.
Doctors / family members should console the patients for whom Ramadan fasting is contraindicated that they should not feel guilty about it as they are not doing anything sinful by not fasting. They can tell the patients that Allah has excused them and they will be rewarded inshaAllah for accepting His will with Sabr. 

The Prophet (SAWS) said: “When a slave falls ill or travels, he gets a reward similar to that which he gets for the good deeds he usually performs when at home [not travelling] and in good health." (Bukhari)

Imam Ibn Hajar writes in Fath Al-Bari, the authoritative commentary of Sahih Bukhari: “This applies to the one who is used to performing acts of obedience, but he was prevented from it, while his intention was to do it had he not been prevented.”
And the rewards of the missed Ramadan fasts can be acquired by observing the Qadha Fasts after they recover, or by offering the Fidya if they are terminally sick patients. Moreover, these patients can do all other acts of worship in Ramadan to compensate for the spiritual gains they think they are missing out by not fasting. 

Ultimately, Allah sees our intentions and rewards accordingly.

Dates in Ramadan - The Diabetic Dilemma

- by Dr Habeeb Haris

Dates in Suhoor and Iftar:

It is sunnah to eat dates in Suhoor and Iftar.
“The most excellent pre-fasting meal of the believer is dates.” (Sunan Abī Dāwūd 1399, Grade: Sahih)

The prophetic wisdom of eating dates at Iftar and Suhoor is the ideal biological decision, as fructose (the sugar in dates) maximizes rates of liver glycogen restoration. 

[Conlee RK, Lawler RM, Ross PE. Effects of glucose or fructose feeding on glycogen repletion in muscle and liver after exercise or fasting. Ann Nutr Metab. 1987;31(2):126-32. doi: 10.1159/000177259. PMID: 3592616.]

But the Prophet (ﷺ) would break the fast with water if dates were not available.

Anas bin Malik (RA) narrated:

"The Messenger of Allah would break the fast with fresh dates before performing Salah. If there were no fresh dates then (he would break the fast) with dried dates, and if there were no dried dates then he would take a few sips of water." (Tirmidhi: 696)

The Prophet (ﷺ) even stopped his companions from taking dates when they were sick.

"The Messenger of Allah (ﷺ) entered upon us, and with him was Ali bin Abu Talib, who had recently recovered from an illness. We had bunches of unripe dates hanging up, and the Prophet (saw) was eating from them. Ali reached out to eat some, and the Prophet (saws) said to Ali: 'Stop, O Ali! You have just recovered from an illness.' I made some greens and barley for the Prophet (ﷺ), and the Prophet (ﷺ) said to Ali: 'O Ali, eat some of this, for it is better for you.' [Sunan Ibn Majah, The Chapters on Medicine, Hadith No: 3442]

So, there is no problem if Physicians ask their patients to cut down dates intake in Ramadan to limit the calories. The sunnah can be achieved by taking a single date or even a small part of it. Diabetics can choose dates that are lower in sugar content like the Ajwa or the Deglet Nour or the Barhi (semi-dry). 

If it is proven that a patient will more likely get harmed due to eating dates, it is perfectly fine from a shariah perspective to advice him against taking it. 

But any such advice should be done based on a proper scientific analysis by taking the following thinks into consideration:

-The glycemic index (GI) of dates varies according to the variety of dates and the stage of their ripening. 

-Generally people do not eat only dates at Iftar. The effect on blood glucose will vary if other foods are taken with dates. Proteins, fats and fiber intake will all alter and decrease the glycemic effect.

-Brisk walk after Iftar to the masjid for Maghrib Salah will also decrease the blood glucose spike. That's what most people do.

-Also the extent of diabetes control of the person will affect his body response to dates intake.

Any good study has to take all these things into consideration before giving any blanket recommendations.

Moreover there are many studies which actually say that dates may not be that harmful for diabetics after all.

For example:

'Effect of dates on blood glucose and other metabolic variables: A narrative review'

by Sachdev Meenakshi and Anoop Misra says:

"The glycemic index (GI) of date varieties ranges from 42.8 to 74.6, and glycemic load (GL) 8.5–24. 

The glycemic indices of various stages of dates are; Rutab (semi-ripe), 47.2; Tamer (fully ripe, traditionally sun-dried), 45.3, and Tamer (commercial), 35.5. 

Glucose tolerance-based studies and cross-sectional studies show no significant changes in glycemic indices or association with glycemic worsening with intake of dates. Few randomized controlled trials (RCT) also showed no change in glycemia and weight in the intervention groups consuming dates."

Glycemic indices of five varieties of dates in healthy and diabetic subjects

By Juma M Alkaabi (Nutr J. 2011 May 28;10:59. doi: 10.1186/1475-2891-10-59)
“The results show low glycemic indices for the five types of dates included in the study and that their consumption by diabetic individuals does not result in significant postprandial glucose excursions.”

‘Glycemic indices of dates “Ramadan Symbolic Food” in patients with type 2 diabetes using continuous glucose monitoring system’

By Samir Assaad Khalil (Diabetes Research and Clinical Practice, Volume 172, February 2021)

Can People with Diabetes Eat Dates?
by Lisa Wartenberg, MFA, RD, LD  (https://www.healthline.com/nutrition/dates-for-diabetes)
“If you have diabetes, consider eating dates alongside a source of protein, such as a handful of nuts, which supports your body digesting the carbs a bit more slowly, further helping prevent blood sugar spikes.”

“dates generally have a low GI, between 44 and 53, which may differ slightly depending on the type of date”
 “they have a low GI and medium GL, those living with diabetes can enjoy dates in moderation.”. 

There are many other such studies and articles from different countries. What is needed is more RCTs (randomized controlled trials) pertaining to the glycemic index of different date varieties in different amounts and in combination with different traditionally taken Iftar meals in our homes and different levels of patient physical activity post Iftar. This will enable the Physicians to give proper evidence based and personalised advise to each patient.

Meanwhile it's ok to caution the patients to limit calorie intake through dates and other fruits in a nuanced way to avoid both dates-overindulgence and dates-phobia.

Human Intelligence V.S. Artificial Intelligence in Islamic Paradigm

Human knowledge is divided into necessary and speculative or deductive. Necessary knowledge is knowledge that cannot be doubted and speculative knowledge is ‘acquired’ by deduction from necessary knowledge and sense perception. The Islamic theologian ‘Adud al-Din al- ‘Iji (d. 756/1355) stated that humans are gifted with innate reason, necessary knowledge and the capacity for speculation and deductive reasoning. The purpose of these faculties is to reflect on revelation and creation to come to the realisation of the existence of God and they extend beyond the realm of sense perception to the metaphysical or spiritual realm, as well as the microcosmic and macrocosmic, as mentioned in Qur’an 41:53, which states: “We shall show them Our portents on the horizons and within themselves.”

Reason and rationality thus have a cosmological dimension and are related to the very nature of the universe, which was created with an intrinsic order and intelligibility. This view of reason and rationality stands in contrast to the reductive logic of means–ends forms of rationality that instrumentalise means in the pursuit of narrow utilitarian ends and is the type of rationality that is embodied by computers, and especially AI systems, which are trained to optimise their parameters based on ‘reward functions’ given by their designers.

It is important to note that a bifurcation between discursive and intuitive modes of thinking never occurred in Islamic thought as it did in Western metaphysics. Instead, the intellect comprises both functions of logical analysis and intuitive knowledge. Empirical, rational, conceptual, moral and spiritual modes of thought are all united in Islamic thought.

There is, therefore, a correspondence between reality and the intellect in terms of the intelligibility of reality and the registration of signs in the intellect and their signification. Hence, rather than meaning being superimposed by the mind, as in the case of a Kantian agent, the function of the intellect is to discover the universal principles and intrinsic intelligibility of the cosmos, and to participate in this intelligible order itself by doing so.

This opens the question of whether the multidimensional nature of the human mind and intelligence in Islamic thought implies a limit to what can be achieved in the quest for artificial general intelligence (AGI). From an Islamic perspective, AI research takes place in a context that is twice removed from reality as it is. The first veil is materialism or physicalism, which circumscribe what can be known about reality to what can be described quantitatively in mathematical terms. The second is that AI agents exist in a digital realm that is a further abstraction of the material world into a digital format. AI research works from behind this second veil and problems such as common sense and abstraction with limited data remain insurmountable challenges.

There are various attempts to provide a formal definition of intelligence in mathematical terms. In contrast to the interrelation between intelligence, consciousness and life in Islamic thought, a significant and often unstated presupposition held by AI researchers is that intelligence can be decoupled from consciousness, and indeed the phenomenon of life. In Islamic thought, on the other hand, intelligence, consciousness and life are unified through the existence of the soul.

The modern word ‘algorithm’ is derived from the Latinisation of al-Khwarizmi (c. 780–850 ce) whose work on algebra in the early ninth century influenced the development of European algebra. Al-Khwarizmi produced his mathematical works with the aim of aiding legal scholars in issues such as property relations, trade, calculating inheritance and wills according to Islamic law. It is an ironic turn of history that today’s algorithms are more often associated with surveillance, discrimination and dispossession in the logic of surveillance capitalism.

The vast Islamic intellectual tradition, which remains relatively unexplored in relation to AI, can be the source of crucial insights to resist the dehumanising tendencies of a mechanistic, materialistic and techno-scientific study of the mind and intelligence.

- Taken from Dr. Yaqoub Chaudhary’s article entitled "Islam and Artificial Intelligence" published in ‘The Cambridge Companion to Religion and Artificial Intelligence’