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17 May, 2019 05:49:21 PM / LAST MODIFIED: 17 May, 2019 05:55:14 PM

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Health and faith

Understanding people’s different cultural backgrounds, lifestyles, and religious practices play an important role in their health care
Mohammed Abul Kalam, Ph.D
Health and faith

The holy month of Ramadan, which sees Muslims all over the world fast during daylight hours, begunlast week. Doe shaving type 2 diabetes exclude a person from fasting? Not necessarily.

The decision belongs to the person, but getting some advice from health professionals can help.Type 2 diabetes, which constitutes the majority of diabetes cases, occurs when the body becomes to the actions of insulin, or loses the capacity to produce sufficient insulin from the pancreas. Insulin keeps the body’s blood glucose levels within a healthy range.People with type 2 diabetes can manage the condition by maintaining a healthy lifestyle, including doing exercise and keeping a healthy diet. In more serious cases, people with type 2 diabetes may need to take medications such as metformin, sulfonylureas, or other glucose-lowering tablets, or self-administer insulin injections.
The month of Ramadan:Dietary practices such as fasting, feasting, and consumption of special foods are an essential component of many religious and cultural celebrations. For Muslims, fasting during the month of Ramadan is obligatory for all healthy adults, who must refrain from eating, drinking and taking oral medications between dawn and sunset.During Ramadan, most people have two meals per day, at sunset and before sunrise. This can be risky for people with type 2 diabetes – particularly those who use insulin or certain oral diabetes medications – for a couple of reasons.

First, fasting during the day can increase the risk of low blood glucose levels in people who usually take insulin or other blood glucose-lowering medications.And conversely, the evening meal to break the fast, called “Iftar,” often involves eating large amounts of calorie-rich foods in a relatively short space of time. This can put people with diabetes at risk of high blood glucose levels overnight.Omission or changes in the timing of medications may also contribute to the instability of blood glucose levels.

Low blood glucose levels can cause symptoms of sweating, shakiness, and confusion. If severe, they can lead to seizures, coma, or even death. High blood glucose levels make people feeltired and generally unwell and can lead to dehydration and poor concentration. Extremely high levels are a medical emergency.

Diabetes’ symptoms are subtle and can include tiredness, minor wounds that won’t heal, and thirst that often occurs for a long time before diagnosis. When someone finally goes to their doctor with these symptoms, they can be shocked to find they have the illness.

Still, if the disease is well controlled, by keeping blood pressure, cholesterol, and blood glucose levels low, people with diabetes can live relatively free of its complications (heart disease, stroke, eye disease, kidney disease, circulatory problems, and nerve damage, among others). But controlling it is a demanding, all-day-every-day kind of task.

But it’s not quite that simple: The month of Ramadan is a special time for Muslim people, where fasting and feasting are integral to religious life, social interaction and communal celebration.Because fasting is one of the five pillars of Islam, there is a strong desire to participate, even among those who could be exempt for medical reasons. Those who cannot fast for medical reasons may feel alienated by their diabetes and develop negative attitudes towards it, possibly resulting in impaired self-management of their condition.

Intermittent fasting diets involve periods of fasting cycled with periods of feeding. Fasting involves a zero or reduced calorie intake from foods and drinks. Feeding can involve food and drink consumption under strict rules – or not – and can be ad libitum (eating based on your hunger and fullness) – or not.

The term intermittent refers to the fact that the fasting periods are not continuous. Continuous “fasting” diets also exist and, conversely to intermittent fasting diets, involve energy restriction to below-“normal” requirements for continuous, prolongedperiods: weeks, months, or more. Of course, we couldn’t fast continuously on zerocalories, because we would starve to death.

Intermittent fasting has been part of some health and religious practices, such as Islamic Ramadan, for thousands of years. It has been – and currently is – linked to living a longer Ramadan. More recently, intermittent fasting has gained popularity in weight-loss circles, partly due to both obesity and society’s “thin ideal”.

Culturally sensitive discussion allows people with diabetes to make informed choices: The month of Ramadan is determined according to the Islamic lunar year and varies annually in the Western calendar. Professionals caring for people who observe Ramadan should be aware of its timing and start the conversation in advance. Muslims with diabetes wanting to observe Ramadan should be counseled on the risks of fasting. Drawing on the guidelines, health providers can reassure their patients that those who do not fast for medical reasons also receive spiritual rewards and should not feel guilty.

Health-care professionals may suggest donations of food or money to the poor could be considered as an alternative if it’s within the person’s means.A person with diabetes may need to check their blood sugar more often if they’re fasting. Discussion about Ramadan must occur in a culturally sensitive and non-judgmental way, appreciating a person’s right to evaluate the risks and benefits of fasting – both spiritual and physical – for themselves, and determine from an individual perspective whether fasting is the right decision. Doctors might also advise their patient to discuss any concerns with their local religious leader.For those who choose to fast despite their exemption, discussions about glucose monitoring, nutrition, exercise, and potential medication changes can ensure they fast as safely as possible.

Many religions under one name: It is foolish to deny that there is a violent edge to Islam, as there is to Christianity and Judaism. In all these traditions, there is the tension between the idea of a God whose will is always good and a God whose will is always right. And where God is seen as a being whose willcan transcend the good (as he is in Islam, Christianity, and Judaism), evil acts committed in his name can abound. Both peace and violence can equally find their justification in the Muslim, Christian and Jewish idea of God.

 “Islam” and “the West” are no longer helpful banners behind which any of us should enthusiastically rally. There really is no clash of civilizations here, not least because the notion of “civilization”, Islamic or Western, really doesn’t have any purchase in a globalized world.The fault line in modern religion doesn’t go to a clash between civilizations or even to a clash between religions so much as to a struggle within religions and within cultures, between theologies, ethics, political ideologies, ethnicities, exclusivism, and inclusivism.

It is a struggle between liberals and conservatives, fundamentalists and moderates, reason and revelation. It is a battle within theologies between a God who is thought to be knowable through nature, man and history and a God who is thought to be only knowable through the revelations contained in the inerrant pages of the Torah, the New Testament or the Quran.

It is a struggle within all religions between those who believe there are “many paths to Heaven”, endorse freedom of religion, encourage tolerance and support mutual respect against those who believe there is only “one way to Paradise” and desire to impose this on everyone else, whatever it takes.

Understanding people’s different cultural backgrounds, lifestyles, and religious practices play an important role in their health care. A lack of understanding might lead to poorer health outcomes and disengagement with health services, while research shows culturally appropriate diabetes education and prevention programs improve outcomes for people from different backgrounds. Health-care professionals should educate themselves about their cultural setting and local patient population to maintain effective therapeutic relationships and achieve the best patient-focused outcomes.

The writer is Former Head, Department of Medical Sociology,

Institute of Epidemiology, Disease Control & Research (IEDCR)

Dhaka, Bangladesh

E-mail: med_sociology_iedcr@yahoo.com

 

SR

 

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Editor : M. Shamsur Rahman
Published by the Editor on behalf of Independent Publications Limited at Media Printers, 446/H, Tejgaon I/A, Dhaka-1215.
Editorial, News & Commercial Offices : Beximco Media Complex, 149-150 Tejgaon I/A, Dhaka-1208, Bangladesh. GPO Box No. 934, Dhaka-1000.

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