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An illuminated crescent moon which signifies the beginning and end of fasting in Ramadan

Fasting is not an unusual practice in any culture or religious, nor indeed in new-age health and dieting regimes. The month of Ramadan for Muslims is an incredibly spiritual and important one and its significance must be understood if anyone is to work therapeutically and inclusively with Muslim clients and families.

For a helpful backdrop, Muslims are required to fast from sunrise to sunset. It is often not viewed as a choice, rather an obligation. We rise early for prayers and to consume a last meal before sunrise; at sunset we consume large meals to replenish energy and fluid levels. We might perform prayers after their meal in the mosque (men usually) which extends our evenings. All these routines lead to alterations in feeding habits, sleep patterns and energy levels.

When does Ramadan start?

At the time of writing, Ramadan in 2022 starts on the evening of 2 April and will last 29 or 30 days depending on the sighting of the moon. At the start of the month this year, sunrise will be at approximately 630am and at the end of the month, it will be at approximately 550am. Sunset will start at approximately 730pm at the start of the month and will end at approximately 830pm. For the current year’s timings, please see: www.islamic-relief.org.uk/about-us/what-we-do/ramadan/ramadan-timetable/

In the Western world, Ramadan can be perceived often as a concerning ritual – that it can be harmful and unhelpful to those who practice it, especially if someone is less able or has health vulnerabilities. However, these concerns overall are usually unfounded and can be perpetuated by a lack of understanding or inquiry.

So what does research say about short-term fasting in general? Is it really unhealthy or dangerous? Here are some findings with neurological contexts:

  • Evolutionary theory supports the idea that short-term fasting heightens cognitive awareness and perception because food was never in abundance like it is now. In fact, overconsumption results in cognitive impairment (Mattson, 2019).
  • For decades, researchers have found that cognition is not necessarily negatively affected by short-term fasting (eg Liebermeister & Schroeder, 1983; Green, Elliman & Rogers, 1995).
  • Fasting can improve neuroprotection, maintain cognitive function, and improve mitochondrial function after moderate TBI (eg Davis et al, 2008).
  • In a review by Gudden, Vasquez & Bloemendaal (2021), clinical studies were reported to show benefits of intermittent fasting in conditions such as epilepsy, Alzheimer’s disease, and multiple sclerosis on symptoms and progress. They also reported that animal studies show conditions like Parkinson’s disease, ischemic stroke, autism spectrum disorder, and mood and anxiety disorders could benefit from fasting.

With this in mind, what if you are a non-Muslim professional who has to interact with Muslim clients and their families during Ramadan? What does it mean for them… What does it mean for you? Here are some tips:

1. Research and talk about Ramadan

Be aware of the dates for Ramadan (it comes forward by approximately 10 days each year). Ask your client what Ramadan means to them and how they would like it to look this month in terms of the role you have with them. How would they like to receive support in that time? This includes care, therapies and expert meetings. Due to historical oversights of Ramadan, it might be hard for a client/family to know that they can ask for a timetable that accommodates Ramadan. Advocating for them at this time might be helpful.

2. Know your fasting etiquette

Eating or drinking in front of a fasting Muslim is not going to be viewed as a covert taunt, but it speaks volumes about how a different way of life is responded to. It would be advisable to eat and drink outside of any meeting or arrangement with a fasting Muslim as a gesture of respect rather than because a Muslim would be offended. It’s an opportunity to reflect on why one is doing what they are doing and why it cannot be done differently during this time possibly as a one-off.

3. Check in with your Muslim clients during Ramadan

The above research indicates there might be little founded concerns about cognitive functions, but there might be a need to respectfully undertake a risk assessment for other health needs. Knowing the risks according to research rather than popular comments and explaining the risks to your clients is important in achieving a mutual understanding of clinical/professional and personal obligations. Indeed, Ramadan is not required by those who will medically deteriorate as a result of it.

4. Recognise that fasting is difficult in the UK for most Muslims

The sunrise-sunset length can be quite long (up to 18 hours in the height of summer) and this impacts on fatigue and mood. Appreciating that anyone can have an off day and a fasting Muslim is no exception, express patience and compassion in your approach. While it might not be valued in the moment, it will be later on.

5. Be inquisitive and open-minded with open questions

In the pursuit of understanding what Ramadan is about or might feel like, sometimes insensitive comments are unwittingly communicated. When someone is undertaking a difficult task that is perceived as an obligation, comments about how much weight can be lost, how dangerous it seems, questioning whether they should observe Ramadan without any specific rationale or showing pity can be highly offensive and appear close-minded. Open up the conversation instead with questions about how Ramadan is experienced, what the Ramadan-specific terms are, what is helpful during this month, what is enjoyable about the month, what the significance is for them specifically. Perhaps, if it feels appropriate to the relationship, asking to join in one day to see what is feels like in your client/family’s shoes would be a welcome gesture. You may well be invited to the iftar meal at sunset which will be a unique window into a new cultural experience.

6. Know when Eid is

Eid, the celebration after Ramadan, is often viewed as a sign of care and respect. Appreciate that Eid is a space to acknowledge and share the spiritual bounty of the month’s hardships with friends and loved ones. Again, this time should be protected from external intrusions until the client/family is ready to return to the pre-Ramadan routines. Supporting this with the team around the client is an important role to play.

Respect for Ramadan benefits the therapeutic relationship

Ramadan is a significant and deeply-held need for most Muslims in a way that is hard to describe to non-Muslims especially as it is often responded to negatively and critically.

Knowing that the professionals working closely with them are able to recognise, appreciate and respectfully work around one of the most sacred months in the Islamic calendar will benefit the therapeutic relationship immeasurably. It is also arguably the right way to respond to difference of any kind.

Ramadan Kareem (tr: Ramadan generosity) to you.


Written by Dr Shabnam Berry-Khan, Managing Director of PsychWorks Associates

This article was produced by Dr Shabnam Berry-Khan, Managing Director of PsychWorks Associates, a Case Management and Treating Psychology service for people with serious and catastrophic injuries, including those from diverse backgrounds.

About PsychWorks Associates

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References

Liebermeister H, Schroter K. (1983) Absence of detrimental changes of cognitive parameters during fasting. International Journal of Obesity, 7, 45–51.

Green MW, Elliman NA, Rogers PJ. (1995) Lack of effect of short-term fasting on cognitive function. Journal of Psychiatric Research, 29, 245–53.

Mattson, MP (2019) An Evolutionary Perspective on Why Food Overconsumption Impairs Cognition. Trends in Cognitive Sciences, 20(3), 200-212

Davis, LM, Pauly, JR, Readower, RD, Rho. jM, Sullivan, PG (2008) Fasting is neuroprotective following traumatic brain injury. Journal of Neuroscience Research 86(8), 1812-22

Gudden, J.; Arias Vasquez, A.; Bloemendaal, M. (2921) The Effects of Intermittent Fasting on Brain and Cognitive Function. Nutrients, 13, 3166.

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