August 2009 /
Introduction to this Issue
"Medicine in Ramadan"
Asalamu alaykum dear friends & colleagues,
Muslims around the world welcome the start of the holy month of Ramadhan for
2009, we at MMAC extend our best wishes to our Muslim brothers and sisters for
a month full of blessings, peace, and good health, and we take this opportunity
to present our third MMAC e-newsletter issue.
every practicing Muslim recognizes the distinctiveness of Ramadhan in
Islam. It is the month of fasting, of
course, but even more importantly it is the month of moral and spiritual
development, a crucial annual shakeup of our usual routines so that we may
consider how to improve ourselves, in our relationship with God and with our
communities. Though often overlooked,
this imperative for self-improvement (physically, spiritually, and on the
community level) is a far more significant aspect of Ramadhan than the mere act
of abstaining from food and drink between dawn and dusk.
The mission of MMAC is in line with this
mandate for better self-awareness and community service. Our aim as an organization is to provide a
platform for Canadian Muslim physicians (and trainees in the field) to achieve
excellence, solidify their role as leaders in their communities, and advocate
on behalf of their patients as well as for the health of their community as a
whole. Of course, any organization is
only as strong and as successful as the activity of its members. In order for MMAC to grow and achieve its
stated goals, an active interest and involvement from its target community is
We invite and encourage all Canadian
Muslim physicians, residents, and medical students to participate in developing
MMAC, by taking on the leadership and/or joining others in projects that are
important to them. The purpose of MMAC
is to meet the unique professional and health-related needs of Canadian Muslim
medical practitioners and the Canadian
Muslim community; please help us identify and address these needs.
To date, we are proud of the efforts of
our members in organizing the University Representatives Board (URB), which
includes medical school representatives for eight universities across Canada,
and which has produced the largely circulated Medical School Admissions Guide
as well as organizing local events to educate fellow medical students about
issues pertaining to care of Muslim patients.
Read about recent and upcoming URB events in this e-newsletter, and we
hope that medical students who have yet to join will be inspired to do so.
Also in this issue of the e-newsletter,
read about the impact of fasting on cardiovascular risk factors by Dr. Adnan
Hameed, FRCP (cardiology), and we providelinks to some published papers and
reviews addressing several health issues in the context of Ramadhan fasting,
including diabetes, kidney function in transplant patients, seizures,
maternal/fetal health in pregnancy, and sleep.
We leave critical appraisal of these papers up to our readers, and hope
they inspire more research into the healthcare of fasting Muslims during
Happy fasting and have a productive and
MMAC Boad of Directors
|Feature Article: Fasting & Impact on Health
| Adnan Hameed, MD, FRCP(C)
Internal Medicine; Cardiology Fellow
cultures and across the ages, fasting (abstinence from food) has been used to
assist the body to relieve itself from discomfort, pain or disease. Regulatory and reparative processes are
allowed unimpeded progress by the temporary omission of food, which often helps
restore balance in physiologic function.
Thus, fasting affects overall well-being and can even positively impact
certain diseases.(1) Indeed, as
a conservative approach to managing diseases such as hypertension and
dyslipidemia, fasting has been shown to be an effective treatment for
addressing major cardiovascular risk factors.Hypertension places excess stress on the
walls of the blood vessels and thereby damages the inner lining of arteries and
veins. An elevated blood pressure
increases the risk of heart attacks, strokes, peripheral vascular disease and
renal failure. Fasting, a natural
intervention has been studied in various forms throughout the world as a method
of lowering blood pressure. In Russia,
Murav'ev et al., demonstrated that a two week fasting period resulted in a
statistically significant reduction of weight, a decrease in average daily
systolic and diastolic ambulatory blood pressure readings and improved
hemodynamic parameters of the left sided chambers of the heart.(2) Goldhamer et al., showed that a water only fasting diet dropped blood pressure
by an average of 37/13 mmHg with the greatest reduction being observed in those
with the most severe hypertension.(1)
Caloric restriction has also been shown to
decrease elevated lipid profiles with remarkable success. At Washington University, researchers
conducted a study over a six- year period which concluded that a regimen of
fasting decreased atherosclerosis as compared to age matched controls consuming
a typical American diet.(3) Several variables, including serum lipids,
lipoproteins, fasting plasma glucose and insulin, blood pressure, body
composition and carotid artery intima-media thickness were assessed. Participants in the fasting arm showed an
improvement in all variables at the end of the study. Higher HDL levels and less atherosclerotic
disease were found in the study arm by the end of the trial. Similarly, the Journal of Nutrition,
Metabolism and Cardiovascular disease, which focuses on the interplay between
nutritional and metabolic alterations and cardiovascular disorders, published
an article analyzing the connection between diet, obesity and dyslipidemia
earlier this year.(4) It
revealed a statistically significant reduction in total cholesterol and LDL
levels with a coincident rise in HDL in persons consuming a lower calorie
diet. In the American Journal of
Cardiology, scientists from the University of Utah published an article showing
that people who performed intermittent fasting benefited from a 40% reduction
in heart disease risk.(5) By
lowering cholesterol levels, fasting ultimately reduces the burden of disease
on the human body.
Various pathophysiologic mechanisms have
been postulated to explain the positive impact of fasting on hypertension and
dyslipidemia. Some theories suggest that
the reduced oxidative stress and increased cellular resistance which occurs in
the fasting state account for the health benefits. Low calorie consumption results in less
cellular damage as the byproducts of digestion, which are toxic to the body,
are decreased.(6) A slower
metabolic rate, more efficient protein production, an improved immune system
and increased production of hormones are also postulated to explain the health
benefits of fasting.
Some opponents of fasting argue that
fasting is a form of starvation which harms the body; however, many studies
dispute this. With more than 1 billion
Muslims participating in the obligatory fasting during Ramadan, research has
been preformed to assess the effects of no dietary intake from dawn to dusk for
30 consecutive days. The results show
that this particular mode of fasting is not detrimental to the body, at least
not in the short term. Moreover, investigators
have found no negative impact of fasting on acute coronary syndromes, stroke or
admissions to hospital for heart failure.(7,8,9) Of course, it should be recognized that
fasting during Ramadhan does cause unique metabolic changes in most individuals(10),
and the potential for harm exists if the fast is practiced inappropriately,
such as through inadequate hydration or indulgence in greasy or sweet foods
during the non-fast hours. Furthermore,
fasting patients should be counseled about the importance of adhering to
prescribed medications, with any change in schedule being carefully monitored
and approved by their physicians and pharmacists. Some chronic diseases, such as diabetes, may
still be safely managed during fasting if the appropriate care and monitoring
Improvements in many medical conditions
have been associated with fasting, while few if any detrimental effects to
health or medical conditions have been conclusively attributed to abstaining
from food for fixed periods of time.
Beyond the medical benefits, fasting has many immeasurable rewards, not
least of which is strengthening of will-power and spiritual wellbeing, both of
which can ultimately help improve physical health as well. Therefore, it behooves the medical community
to continue studying the impact of fasting on health so that physicians may
offer their Muslim patients the best advice on optimizing their health during
1) Goldhamer A,
Lisle D, Parpia B et al.
supervised water-only fasting in the treatment of hypertension. J Manipulative Physiol Ther. 2001
Jun;24(5):335-9. Center for Conservative
Therapy, Penngrove, Calif, USA.
SA, Malishevskii MV, Makarova GA, et al.
and peripheral hemodynamics in patients with essential hypertension on a
Med (Mosk). 2003;81(9):35-9.
3) Fontana L, Meyer TE, Klein S, et al. Long-term calorie restriction is highly effective in
reducing the risk for atherosclerosis in humans. Proc Natl Acad Sci U S A.
2004 Apr 27;101(17):6659-63.
4) Tapsell L, Batterham M, Huang XF, et al.
Short term effects of
energy restriction and dietary fat sub-type on weight loss and disease risk
factors. [EPUB ahead of print]
5) Horne BD, May HT, Anderson JL, et al. Usefulness of Routine
Periodic Fasting to Lower Risk of Coronary Artery Disease in Patients
Undergoing Coronary Angiography.
American Journal of Cardiology.
6) Mattson MP, Wan R. Beneficial effects of intermittent fasting and
caloric restriction on the cardiovascular and cerebrovascular systems. J Nutr Biochem. 2005
Mar;16(3):129-37. Laboratory of
Neurosciences, National Institute on Aging Intramural Research Program,
7) Al Suwaidi J,
Bener A, Suliman A, et al. A population based study of Ramadan fasting and acute coronary
syndromes. Heart. 2004;90:695-696.
8) Bener A, Hamad A, Fares A, et al. Is there any effect of Ramadan fasting on stroke incidence?. Singapore
Med J. 2006;47:404-408.
9) Al Suwaidi J,
Bener A, Hajar HA, et al. Does hospitalization for congestive heart failure occur more
frequently in Ramadan? (A population-based study (1991-2001)). Int J Cardiol. 2004;96:217-221.
10) Leiper JB, et al. Effects
on health of fluid restriction during fasting in Ramadan. European Journal of Clinical Nutrition
11) Kobeissy A, et al.
Suggested insulin regimens for patients with type 1 diabetes mellitus
who wish to fast during the month of Ramadan.
Clinical Therapeutics 2008;30(8):1408-1415.
|Medical Literature on Health & Fasting
Over the last several years, there has been an increase in the body of medical literature pertaining to fasting in Ramadan and its relation to one's health or varying medical conditions. Below is a list of a few articles which try to address the issue of Ramadan and Medicine.
MMAC does not necessarily endorse the articles below, and as with all medical literature, requests its readership to review them critically prior to adopting them into your clinical practice.
Below are a few articles we thought would be worth sharing. Click on the article to see it in pdf.
Al-Arouj M, et al. Recommendations for management of diabetes during Ramadan. Diabetes Care 2005;28(9):2305-2311.
Benaji B, et al. Diabetes and Ramadan: Review of the Literature. Diabetes Research and Clinical Practice 2006;73:117-125
Dikensoy E, et al. The effect of Ramadan fasting on maternal serum lipids, cortisol levels, and fetal development. Archives of Gynecology and Obstetrics 2009;279:119-123.
Aadil N, et al. Drug intake during Ramadan. BMJ 2004;329:778-782.
Ghalib M, et al. Does repeated Ramadan fasting adversely affect kidney function in renal transplant patients? Transplantation 2008;85:141-144.
Gomceli YB, et al. Does the seizure frequency increase in Ramadan? Seizure 2008;17:671-676.
University Representative Body
University Repre-sentative Body (URB) has been growing at a rapid pace since
its inception in 2007. For the current academic year (2009-2010), we have representatives at the each of the following
Recent activities by MMAC
student members have included:
- University of Ottawa
University of Western Ontario
(Schulich School of Medicine & Dentistry)
McMaster University (Michael
G. DeGroote School of Medicine)
University of Toronto
University of Alberta (*NEW)
University of Calgary (*NEW)
University of British Columbia (*NEW)
Organizing interview help
sessions for medical school applicants
Fast-a-thons (proceeds to the
food bank) and Eid dinner during Ramadhan
Hosting guest speakers to
discuss issues related to treating Muslim patients
- 2009-2010 MMAC Application Guide (see below)
Meet and Greet for MMAC
members (see below)
Several projects are being planned for the
upcoming academic year, including a career fair, a lecture series on the
contribution of Islam to medicine, and an orphan sponsorship dinner.
To become involved or if you have
questions, contact a university representative (please see the contact email
addresses list in the sidebar of this e-newsletter). If you are a medical student or resident at a
medical school not yet represented in MMAC, please contact the MMAC Board of
Directors at email@example.com
MMAC Application Guide 2009-2010
The MMAC URB is proud to annouce the release of the 2009-2010 MMAC
Medical School Admission Guide - complete with new additions and fresh advice from current medical students across the country!
For a copy, click on the picture above or download it here
| URB Inaugural Meet & Greet
The MMAC inaugural Meet and Greet on August
8 2009 was a great success with a variety of undergraduate students, medical
students, residents and physicians in attendance. We had members from Ottawa to London make the
trip to support the MMAC's vision of unity and cooperation.
Br Saif Al-Mousawy, a third-year medical
student from the University of Ottawa and former MMAC chapter representative,
coordinated the event and was the Master of Ceremonies.
Following recitation of
the Holy Quran, Dr. Raza Naqvi, MMAC VP Education and resident at U of T spent some time discussing MMAC's
mission, vision, and accomplishments over the past two years. A copy of his presentation can be viewed here.
Br Saif then outlined the steps required for individual chapter building for the various medical
students and representatives from around Ontario. He expanded on his own personal
experiences in establishing a Chapter at the University of Ottawa in the past
This was followed by a very unique
discussion from MMAC's McMaster representative, Br Hisham Ali, about his
medical elective in East Africa through CanAID Africa. The elective was a
fantastic opportunity both personally and professionally. Dr. Shiraz Datoo, the
Secretary General of CanAID Africa, was also in attendance and answered questions regarding medical electives overseas. Should anyone wish to inquire further regarding elective opportunities
in Tanzania, kindly email Dr. Shiraz Datoo at firstname.lastname@example.org.
The event was very
well received and a great opportunity for brothers and sisters in the medical
field to finally meet one another in person. The event helped put faces to
names and foster a further sense of brotherhood and sisterhood amongst various
MMAC members. It was a pleasure to see people bonding, making connections and
strengthening their position within our Muslim community. We look forward to
hosting the event again next year.
Click the links below for pictures of the event:Picture 1
, Picture 2
, Picture 3