Five years ago, a Muslim diabetes patient mentioned to Dr. Roli Dwivedi that she was fasting for the month of Ramadan — a practice that can be difficult for people trying to control their blood sugar.
“And here I was, sitting with my medical degree … and I’d never thought about it before,” said Dwivedi, chief clinical officer at Community-University Health Care Center in Minneapolis.
So she set about developing a curriculum for medical staff to learn how to work with patients during the holiest time of the year for Muslims, when prohibitions on eating, drinking and taking oral medications during the day sometimes run into conflict with managing health conditions.
Some health care providers are giving more consideration to the intersection of Ramadan and medicine in a state with an estimated 150,000 Muslims. In keeping with the belief that fasting teaches self-restraint and compassion for the less fortunate, many Muslims have been rising early to pray, fasting until sunset and gathering for celebratory feasts known as iftars with family, friends and neighbors late into the night for much of May.
Those who are ill or pregnant are exempt from fasting and can make up the time later or feed the needy instead. But some still want to fast, including patients who manage chronic health issues — such as diabetes, high blood pressure, depression and liver and cardiovascular disease — that require medication and monitoring but don’t preclude them from living normal lives.
Doctors are working with patients to adjust doses of medication, and they are offering advice about what to do if blood sugar levels get too high or low and how to break the fast in a way that is less likely to send their glucose levels skyrocketing.
While it’s traditional to break Ramadan fasts with dates, Dwivedi suggests to her diabetic patients that they have only one of the sugary fruits instead of five. And a variety of doctors have advised patients to be careful about eating too much of the fattening, carbohydrate-heavy foods that are common during iftars and can worsen a diabetic’s condition.
“I recommend, ‘Don’t eat a lot of sambusa’ because it contains a lot of fat,” said Dr. Osman Ahmed, a retired Somali-American doctor, referring to a fried pastry popular in Somali cuisine.
He is executive director of the East Africa Health Project, and educates members of the Somali community about taking care of their health during the holiday through TV, radio and seminars. Overall, he maintains that Ramadan is good for people’s health: He says it reduces obesity, cholesterol and cardiovascular disease.
‘No generic script’
Dr. Douglas Pryce has been treating Somali-Americans at a Hennepin Healthcare clinic since 1995. He said not everyone talks to the doctor about what to do with their medicine during Ramadan, so he tries to bring it up a month or two before the holiday. Given the variations in how people respond to medication and follow Ramadan, “there’s no generic script for any individual,” Pryce said.
Because people observing Ramadan eat heavier meals at night, he sees heartburn as a big problem for patients coming in. Those with high blood pressure also have a harder time controlling their condition because their sleep schedule is more disrupted from praying and eating. But in health care, it’s more important what people do in the long term than over a few days or weeks, he said.
“As food choices go, it’s tricky because a lot of people don’t prepare their own food [for iftar] and they look forward to this food,” said Pryce. He just cautions that they should not overeat, and he advises people not to drink too much tea, given that Somali tea has a lot of sugar.
He’s treated diabetes in Somali-American patients for many years and has seen increases in diabetes rates as they adapt to more Westernized diets and lifestyles.
Isaak Rooble helped organize “lunch and learn” forums for non-Muslim staff to learn about Ramadan at Allina Health, where he is the accountable health communities navigator. Medical staff check in with Muslim patients about whether they want to still come in for appointments during that month and talk to them about when to break fasts. Rooble said that during the first or second week of Ramadan, Allina sees Muslim patients with dehydration and high or low blood sugar come into the emergency department.
Yet Ramadan’s effect on health care in Minnesota is not limited to patients. A growing number of Muslims, including Rooble, are also working in the medical field and trying to meet the demands of their job while fasting.
At the Mayo Clinic, Dr. Syed Ahsan Rizvi, has been waking up before dawn for the morning prayer — and without a full night’s rest, coming in to work without his usual cup of coffee. He said he dealt with caffeine-withdrawal headaches for the first few days of Ramadan. His energy begins to flag in late afternoon, and sometimes Rizvi tells his team that he is going into his office for a 30-minute nap.
He wants to see more conversations about the needs of Muslim doctors, nurses and other health care staff during Ramadan — perhaps allowing them to have heavier workloads in the morning to offset a decline in energy later in the day. Ramadan in health care is as much about patient care as it is about considering the dynamics of the team of health care providers, he said.
Time to reset habits
In developing training for the Community-University Health Care Center, Dwivedi spoke with mosque leaders and Muslim patients. Since then, she has been refining the training to include people with other health issues, including those on blood thinners and who are pregnant or breast-feeding. They also looked at how to make adjustments for fasting patients who take antipsychotic drugs, which cause dryness of the mouth that can become worse when they don’t eat and drink all day.
Dwivedi takes Ramadan as an opportunity to introduce patients to healthier habits, such as quitting smoking. If they can quit for a month while fasting, she urges them to see if they can quit for a year — and for life. The period of self-discipline can inspire a desire for lasting change in habits.
“After Ramadan, [patients] are very much energized to live a good, healthy life the best they can,” said Pryce. “And that includes trying to do things like quit smoking and eat healthy and get good control of all their conditions.”