Thursday, March 13, 2025

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.


Monday, March 10, 2025

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

"The Messenger of Allah () 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 (), and the Prophet () 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.