An Evaluation of Medico-Biological Benefits of Fasting in Ramadan (Prof. Naseem Ahmad Shah) At the onset of Ramadan Muslims all over the world start fasting from dawn to dusk daily for 30 days as ordained in Quran: “O you who believe! Fasting is prescribed to you, as it was prescribed for those before you (Jews and Christians) so that you may (learn) self-restrain” (2:183). But why do we need to fast? It is our experience that temptations and ways of the world tend to spoil our purity and austerity. Ramadan is a period of fasting, reflection, devotion, generosity self-regulation, self-training, and sacrifice observed by Muslims around the world. If the lessons learned during Ramadan, whether in terms of dietary intake or righteousness, are lived with, it is beneficial for one’s entire life. Like other religious obligations and rituals fasting too possesses a strong rationale planned with innumerable temporal and spiritual benefits for Muslims. Besides the fact that this obligation is most loved and cherished before Allah, its usefulness can be judged by the fact that it has been either permitted or ordained almost in all major world religions. Apart from many psychological, spiritual, economic and societal benefits that have been discussed and explained in the traditions of Prophet Muhammad (peace be upon him), that are widely known and recognized in Islamic culture, the modern scientific and medical research has discovered the amazing benefits of Islamic fasting. Spiritual Benefits: Ramadan is a period of fasting, reflection, devotion, generosity and sacrifice observed by Muslims around the world. While major holidays of other faiths have largely become commercialized events, Ramadan retains its intense spiritual meaning. Fasting, according to Islam, is primarily a spiritual discipline: On two occasions in Quran (9:112; 66:5), those who fast are called sa'ih (from saha meaning he travelled) or spiritual wayfarers; and according to one authority, when a person refrains, not only from food and drink but from all kinds of evil, he is called a sa'ih . While speaking of Ramadan, the month in which fasting is ordained, the Quran specially refers to nearness to God, as if its attainment were an aim in fasting, and then adds: "So they should hear My call (by fasting) and believe in Me, that they may walk in the right way" (2:186). The doors of Heaven are opened to a fasting person in the month of Ramadan. It is specially suited for spiritual advancement, for attaining nearness to God. Speaking of Ramadan, the Quran says: "And when My servants ask thee concerning Me, surely I am nigh; I answer the prayer of the suppliant when he calls on Me" (2: 186). The ways of attaining nearness to God are here spoken of as being specially opened in Ramadan and this nearness is to be sought through prayer. It is for this reason that the Prophet used to have special regard for Tahajjud prayers in the month of Ramadan. And he also recommended that his followers should, during this month, awake at night for prayers (Bu. 2: 27). In Tradition too, special stress is laid on the fact that the seeking of Divine pleasure should be the ultimate object in fasting: "Whoever fasts during Ramadan, having faith in Me and seeking My pleasure" (Bu. 2:28). No temptation is greater than the temptation of satisfying one's thirst and hunger when drink and food are in one's possession, yet this temptation is overcome not once or twice, as if it were by chance, but day after day regularly for a whole month, with a set purpose of drawing closer and closer to the Divine Being. A man can avail himself of the best diet, yet he prefers to remain hungry; he has the cool drink in his possession, yet he is parching with thirst; he touches neither food nor drink, simply because he thinks that it is the commandment of God that he should not do so. In the inner recesses, there is none to see him if he pours down his dry and burning throat a glass of delicious drink, yet there has developed in him the sense of the nearness to God to such an extent that he would not put a drop of it on his tongue. Whenever a new temptation comes before him, he overcomes it, because, just at the critical moment, there is an inner voice, "God is with me," "God sees me." Not the deepest devotion can of itself develop that sense of nearness to God and of His presence everywhere, which fasting day after day for a whole month does. The Divine presence, which may be a matter of faith to others, becomes a reality for him, and this is made possible by the spiritual discipline underlying fasting. Through increased devotion, he feels closer to his Creator, and recognizes that everything he has in this life is a blessing from God. A new consciousness of a higher life, a life above that which is maintained by eating and drinking, has been awakened in him, and this is the spiritual life. Ethical Benefits: There is also a moral discipline underlying fasting, for it is the training ground where man is taught the greatest moral lesson of his life – the lesson that he should be prepared to suffer the greatest privation and undergo the hardest trial rather than indulge in that which is not permitted to him. That lesson is repeated from day to day for a whole month, and just as physical exercise strengthens man physically, moral exercise through fasting, the exercise of abstaining from everything that is not allowed, strengthens the moral side of his life. The idea that everything unlawful must be eschewed and that evil must be hated is thus developed through fasting. Another aspect of the moral development of man by this means is that he is thus taught to conquer his physical desires. He takes his food at regular intervals and that is no doubt a desirable rule of life, but fasting for one month in the year teaches him the higher lesson that, instead of being the slave of his appetites and desires, he should be their master, being able to change the course of his life if he wills it. The man who is able to rule his desires, to make them work as he likes, in whom will-power is so developed that he can command himself, is the man who has attained to true moral greatness. Fasting is a special act of worship which is only between humans and God since no one else knows for sure if this person is actually fasting. Thus God says in a hadith qudsi that "Fasting is for Me and I only will reward it". The true essence of the fast is its moral value, and the Quran and Tradition have laid special stress on this. "Whoever does not give up," says one tradition "lying and acting falsely, Allah does not stand in need of his giving up food and drink" (Bu. 30: 8). This is true of all the Islamic injunctions. A man who says his prayers and does not keep in view their inner meaning, the object of prayer, is condemned in clear words: "Woe to the praying ones, who are unmindful of (the object of) their prayers" (107 : 4, 5). In another tradition, the ethical side of the fast is shown in the following words: "Fasting is a shield, so let the man who fasts not indulge in any foul speech or do any evil deed (la yajhal), and if any one fights or quarrels with him or abuses him, he should say, I am fasting. By Him who holds my soul in His hand, the breath of the faster is pleasanter with Allah than the scent of musk" (Bu. 30: 2). It is not refraining from food that makes the breath of the faster so sweet; it is refraining from foul speech and abuse and evil words and deeds of all kinds, so much so that he does not even utter an offensive word by way of retaliation. Thus a fasting person undergoes not only a physical discipline by curbing his carnal desires, the craving for food and drink, but he is actually required to undergo a direct moral discipline by avoiding all kinds of evil words and evil deeds. In the sight of God, as plainly stated in these traditions, the fast loses its value not only by taking food or drink but also by telling a lie, using foul language, acting unfaithfully, or doing an evil deed. The moral value of the fasting discipline is further enhanced by laying stress on the doing of good to humanity in the month of Ramadan. The example of the Prophet is quoted in this connection in a tradition. "The Prophet, peace and blessings of Allah be upon him, was the most bountiful of all people, and he exceeded his own bounty in the month of Ramadan" (Bu. 30: 7). Another tradition describes the month of Ramadan as "a month in which the sufferings of the poor and the hungry must be attended to" (MM. 7: I-iii). These injunctions make clear the significance of the tradition which says that when the month of Ramadan commences, "the doors of Heaven are opened and the doors of Hell are closed and the devils are put into chains" (Bu. 30: 5). This is true of the man who keeps the fast, both physically and morally. The devils are chained in his case because he curbs and conquers the lower passions, by exciting which the devil makes a man fall into evil. The doors of Hell are closed on him because he shuns all evil which is man's hell. The doors of Heaven are opened for him because he rises above physical desires and devotes himself to the service of humanity. In one tradition, fasting is described as bringing about a forgiveness of sins "for him who fasts having faith (in God) and to seek His pleasure and having an aim or purpose" (Bu. 2: 28; 30: 6). There is not the least doubt that fasting as qualified here, that is, when it is kept having true faith in God and when the person fasting resorts to it as a discipline for seeking the pleasure of God, is practical repentance of the highest value; and when a man sincerely repents of sins, his previous sins are forgiven, because the course of his life has been changed. Through fasting, a Muslim experiences hunger and thirst, and sympathizes with those in the world who have little to eat every day. Through self-control, a Muslim practices good manners, good speech, and good habits. Medical Benefits: Fasting in general has been used in medicine for medical reasons including weight management, providing rest to the digestive tract and for lowering lipids. But Islamic fasting is different from routine diet plans because in Ramadan fasting, there is no malnutrition or inadequate calorie intake. There is no restriction on the amount of food intake before beginning the fast or upon ending the fast at sunset. Moreover, the type of food taken during Ramadan does not have any selective criteria of crash diets such as those which are protein only or fruit only type diets. Everything that is permissible is taken in moderate quantities. In contrast to this there are many adverse effects of total fasting as well as so-called crash diets. The caloric intake of Muslims during Ramadan is at or slightly below the requirement guidelines. The process of decomposing and eliminating waste toxic materials by means of Islamic fasting can improve or even cure the diseases such as: cardiovascular and circulatory diseases, diseases of digestive system, diseases of the locomotive system including rheumatism, respiratory system diseases including asthma, and the early stage of malignant diseases like cancer. The physiological effect of fasting includes lowering of blood sugar, lowering of cholesterol and lowering of the systolic blood pressure. In fact, Ramadan fasting would be an ideal recommendation for the treatment of mild to moderate, stable, non-insulin diabetes, obesity, and essential hypertension. In 1994 the first International Congress on "Health and Ramadan", held in Casablanca, entered 50 extensive studies on the medical ethics of fasting. While improvement in many medical conditions was noted; however, in no way did fasting worsen any patients' health or their baseline medical condition. On the other hand, patients who are suffering from severe diseases, whether type I diabetes or coronary artery disease, kidney stones, etc., are exempt from fasting and should not be allowed to fast. Refraining from food during stated intervals does no physical harm to a healthy person. On the contrary, it does some good. But fasting has yet another and a more important, physical value. The man who cannot face the hardships of life, who is not able to live, at times, without his usual comforts, cannot be said to be even physically fit for life on this earth. The moment such a man is involved in difficulty or distress, as he must be every now and again, his strength is liable to give way. Fasting accustoms him to face the hardships of life, being in it a practical lesson to that end, and increases his powers of resistance. All mucus diseases such as colds, flu, asthma, hay fever, sinus and bronchial troubles are rapidly dissolved and eliminated from the body, leaving the user free from the varied allergies which cause difficult breathing and clogging of the sinus cavities. The types of diseases that are a result of calcium deposits in the joints, muscles, cells, and glands are readily dissolved and removed from the body. Fasting dissolves all unnecessary and unnatural fat deposits all over the body and Cholesterol deposits in the arteries and veins also respond to the cleansing power of fasting. When we fast for a few days, the stomach shrinks to its normal size and the hungry feeling gradually fades away. When we go back to the normal diet, we won’t have exaggerated hunger and won’t overeat (Bragg & Bragg, 1999). Ramadan fasting is not total fasting and believers take nutrients needed for the body, through the systematically planned early morning and evening food. Surprisingly enough, fasting programs can be used for underweight people who cannot gain weight even if they stuff themselves with many fattening foods. The cause of both overweight and underweight is a nutritionally unbalanced diet. Fasting is a natural way to normalize our body weight. “People are not nourished in proportion to amount of food they eat, but in proportion to how much they digest and assimilate” (Bragg & Bragg, 1999, p120). Thus what underweight people need is exactly what overweight people need revitalizing the digestive and assimilative systems to work efficiently. As metabolism is improved through fasting, the body recuperates the capability to assimilate proteins, fats, carbohydrates, starches, sugars, minerals, vitamins and all other essential nutrients necessary because all organs work properly after fasting. The stomach, intestines and colon are given a complete rest by the fast and are enabled to repair damaged structures. Piles, prostates, colitis, appendicitis, enteritis, enteric fever (typhoid), gastritis, etc., speedily recover under the fast. The alimentary tract becomes practically free of bacteria during a fast. The small intestines become sterile. Fasting also normalizes the digestive system of underweight persons, and equips body to digest and assimilate nutrients from the food they eat. Finally, fasting can help people to break addictions to harmful substances: tobacco, drugs, alcohol, tea, coffee, and other habit-forming beverages. Fasting leads our body to get rid of stored poisons, including addictive substances, and we lose our craving and tolerance for them. It is an effective detoxification therapy. Toxins accumulated in the body break down and pass out of the body. The human body uses the skin as a secondary eliminative organ. Because conditions such as boils, abscesses, carbuncles, and pimples are the body’s effort to eliminate poisons, skin problems also disappear as the rest of the body is cleansed (Burroughs, 1976). Psychological Benefits: The psychological effect of Ramadan fasting are also well observed by the description of people who fast. They describe a feeling of inner peace and tranquility. The prophet advised those fasting, "If one slanders you or aggresses against you, tell him 'I am fasting."' Thus personal hostility during the month is minimal. The crime rate in Muslim countries falls during this month. Every vice in society stems from a lack of self-control. Whether its violence, addiction, gambling or infidelity, they are all a result of succumbing to desires. When a person does not have the strength in their character to withstand the numerous temptations and tackle his nafs (lower self) to the ground, then he will most definitely become a slave to those desires. As a prisoner of desires, a person feels completely powerless, lacking any ability to help themselves. In the extreme cases, these individuals become depressed, suicidal, bankrupt, imprisoned or in a midst of a scandal. Since the root of all this evil is the inability to control oneself, then it would be of paramount importance to have training sessions for a whole society in order to strengthen their will power and avoid these destructive pitfalls that adversely affect everyone. Fortunately in the Muslim world there is such a training session during the blessed month of Ramadan. Every Muslim that fasts gets intensive exercise in withstanding many different kinds of temptations. The temptation to eat, drink, have relations or even get angry is overcome every day for a month which prepares us for the many arduous tests we face in life. Aside from gaining will power and the ability to control desires, fasting instills within us a deep feeling of gratitude along with patience. Deprivation leads to appreciation. After a long day of fasting our sense of taste and smell are heightened. Each sip of water is like releasing a gushing, cool river in a dry, barren land and each morsel of food that is consumed is like feeding a person who has been stranded on a desert island with very little to eat, the most exquisite, scrumptious meal. It is what Gestalt therapy defines as being focused upon the individual's experience in the present moment, being mindful and being in the here and now. In a world filled with immediate gratification, it is very healthy to learn how to delay the simple pleasures in life. Having the patience to withstand temptation and tolerating the delayed gratification are highly important elements in attaining personal maturity. We are trained patiently to wait for hundreds of things in life that take time and are delayed without a warning. Fasting is a method of helping an individual move toward self-realization and reach for super conscious energies. In this respect, a period of fasting can trigger exceptional human performances, paranormal abilities, and altered states of consciousness. This explains how we are able to accomplish such lofty, spiritual endeavors during Ramadan although we are sleep deprived and abstaining from food with such zeal and contentment. When we reflect on the psychological implications of fasting (saum), then we are even more empowered to embrace the blessed month of Ramadan and soar to new heights of spirituality in hopes of strengthening, purifying and enlightening the soul. According to medical scientists, the benefits of fasting to human health and the safety of the body are too many, some of which relate to the situation of mental fasting and its impacts on health. As fasting contributes effectively in the treatment of mental and emotional disorders and strengthens the will to fast, it also papers the feelings, love for good, and keeps one away from argumentative and aggressive orientation and sense of supremacy of spirit and ideas. Thus strengthening and consolidating the character and teaching the ways to bear problems and burdens, leaving no doubt in a person's health. Societal Benefits: In addition to its spiritual and moral values, fasting as prescribed in the Quran has also a social value, more effective than that which is realized through prayer. Rich and poor, great and small, residents of the same vicinity are brought together five times daily in the mosque on terms of perfect equality, and thus healthy social relations are established through prayer. But the commencement of the month of Ramadan is a signal for a mass movement towards equality which is not only limited to ones vicinity or even ones country but affects the whole Muslim world. The rich and the poor may stand shoulder to shoulder in one row in the mosque, but in their homes they live in different environments. The rich sit down on tables laden with dainties and with these they load their stomachs four, even six, times daily; while the poor cannot find sufficient food with which to satisfy their hunger even twice a day. The latter often feels the pangs of hunger to which the former are utter strangers; how can one feel for the other and sympathize with him? A great social barrier thus exists between the two classes in their homes, and this barrier is removed only when the rich are made to feel the pangs of hunger like their poorer brethren and go without food throughout the day, and this experience has to be gone through, not for a day or two, but for a whole month. The rich and the poor are thus, throughout the Muslim world, brought on the same level in which they are both allowed only two meals a day, and though these meals may not be exactly the same, the rich have perforce to shorten their menu and to adopt a simpler fare and thus come closer to their poorer brethren. This course undoubtedly awakens sympathy for the poor in the hearts of the rich, and it is for this reason that helping of the poor is specially enjoined in the month of Ramadan. People become kind and helping in Ramadan even though they are not like that in their usual lives. They like to care more about each other and avoid any issues or fiery talks in offices or at any place of work and even at homes. Through increased charity, Muslims develop feelings of generosity and good-will towards others. The Prophet Muhammad (peace be upon him) once said, "A man's wealth is never diminished by charity. Ramadan gives us a chance to correct our life styles and be practical in approach brings discipline in our lives which otherwise we cannot have and see in our lives. To spend a life with discipline is the most difficult thing. But a Muslim can make his life an example for others with respect to discipline. While we wake up at sahr time, we manage to do so because we care for fast. We offer Namaz of Fajr at proper time to close the fast properly, thus we give ourselves a chance to care for the things that need preference. Thus we learn to give preference to important matters and manage our lives in Ramadan by the rating of preferences. At iftar, all members of family gather on table to break the fast together. This might not be seen in many families during the common days but only Ramadan has this strange and beautiful bond that gathers the family members on one table again. No fights and talks happen on the table and everybody likes to offer each other the items present to eat. 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