Muslim Doctors Association (MDA)

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LOCKDOWN RAMADAN 2.0

So here we are again, facing another Ramadan in semi- lockdown circumstances.

It won’t be as bad, but it won’t be the big iftars, the packed taraweeh prayers, the busy streets around the masjids that we’re used to seeing.

The UK Government is easing restrictions slightly from April he 12th, but it extends only to outdoor meetings in groups of up to six, or two households- an iftar picnic in the dark perhaps? Probably in the rain too…

Ramadan has always been a time for family, friends, connecting with relatives, and reaching out to those less fortunate than ourselves. This extraordinary year however, has hit us all in ways we could never have imagined. Alhamdulillah the vaccination programme has largely been a success, so if you are invited to have a vaccine please have it! If you have any concerns please discuss these with your GP. If your appointment is during Ramadan there is no problem with this, having a vaccination does not break your fast as has been confirmed by multiple Islamic scholars and Muslim organisations.

This year most of us will be breaking our fasts at home, some of us lucky enough to still be around our immediate families or friends, many not so lucky. Some mosques are opening up for congregational prayers – although many only for the men.

With COVID still about, it is paramount that we look after ourselves and our loved ones. Fasting has immeasurable health benefits, including those on immunity. Cycles of fasting and re-feeding have been shown to promote hematopoietic stem cell activation and regeneration of immune cells (Cheng et al 2014(https://pubmed.ncbi.nlm.nih.gov/24905167/) and also to rest gut microbiota, and promote the T-cell mediated killing of cancer cells. (Buono2019 (https://pubmed.ncbi.nlm.nih.gov/31442398/ ) So just by partaking in the fast, we’re doing ourselves a favour – SubhanAllah.

Some people of course won’t be able to fast – for medical reasons, age, pregnancy, or just out of choice. It’s important to respect each other’s decisions, whilst remembering that Ramadan can still be observed even if we are unable to fast. We can maximise on other forms of ibadah and help others as much as we can. If you’re unsure as to whether fasting is right for you because you suffer with a medical problem please contact your GP.

Have a Healthy Ramadan!

STEP 1: SLEEP

First step! Get enough sleep– one of my favourites! It can be difficult with the long night prayers, and then waking up again pre-dawn to really feel rested in Ramadan, particularly those of us with full time jobs, household chores and responsibilities for families and loved ones. This year in the UK sunset will be around 8, so thankfully we have a little bit of a longer night.

I’ll be trying to get my prayers done by 11pm and get a few hours sleep before waking up for suhoor. I’m lucky enough to also get some sleep after Fajr prayers- but if you can’t- due to work, kids, or your circadian rhythm (!) try and schedule a nap in at some point in the day. That could be in your lunch hour – you won’t be eating! – so maybe a 40-minute nap could be on the cards? Or later in the afternoon, before sunset. Power naps work wonders, and we know that sleep is when our bodies and brains regenerate. Enough rest lets us work at optimum performance, so I always remind myself that it’s not laziness or a waste of time, actually it’s preparation to be my best.

STEP 2: FOOD

The good part… FOOD!

Unfortunately Ramadan sometimes becomes a bit of fry-fest, particularly in South Asian communities, and all then washed down with some sugar-laden treats…

COVID has shown us that the ethnic minority communities are high risk for complications (https://cutt.ly/VvL8swz) . They are also at high risk of medical problems like diabetes and heart disease (https://www.bhf.org.uk/informationsupport/risk-factors/ethnicity )… not a combination we should be aiming for!

For good optimal health and fuelling, try and limit fried and sugary snack intake. We have strong evidence that sugar leads to inflammation, and inflammation can lead to poorer immune responses. Refined oils are also culprits for inflammation, and so we should try to use olive oil, avocado oil, or other minimally processed fats if we are frying, or to add to foods.

There are lots of great food bloggers online who will give you hints and tips for healthy eating, but in general stick to a balanced a diet similar to what is shown in Figure 1. Traditionally, as is the Sunnah, we break our fast with dates and water or milk.

After this, some fruits for hydration are a good choice.

Plan a balanced meal to include starchy foods including whole grains, which will nourish you and provide you with fuel for your days, dairy products– an important source of calcium – perhaps yogurt for suhour, or milk with oats. (Chia seeds are also an excellent source of calcium – so maybe throw some on your porridge! And protein-rich foods, protein is essential to life, it provides the building blocks for muscle, and helps promote brain functioning. Fish, meat, chicken, eggs and cheese are all great sources of protein. Tofu, lentils, nuts, chia seeds and chickpeas are great vegetarian protein sources.

It is also worth considering taking a vitamin D supplement. There is evidence to suggest that vitamin D is an important factor in immunity, a large percentage of people who have become seriously ill with COVID have had low vitamin d levels.

Most other vitamins people will usually be able to get from their diets, however if you feel you can’t eat enough in Ramadan, a multi vitamin may also be helpful. Vitamin C is also important for immunity, and can be found in fresh fruits such as oranges, lemons and kiwi fruit, as well as in tablet form.

Figure 1: Balanced eating plate in Ramadan

STEP 3: HYDRATION

WATER! DRINK IT! We have slightly longer nights now, so more time to drink. Try to get in at least 1.5l of water a day. For me it’s the ever-lasting struggle – drink water, pee, can’t sleep… but it’s only a month! Water is vital for every process in the body. It keeps our skin and hair healthy, produces lubrication for our joints, and keeps our kidneys healthy. Herbal teas and sugar free drinks all count as fluid intake. Try to limit caffeine to 1-2 cups a day, as it can be a little dehydrating.

Dehydration and caffeine withdrawal are the hardest things to contend with at the start of Ramadan, so do your body a favour and DRINK!

Also the perfect opportunity for smokers to give up! Get in touch with your GP if you want some support… we’re here to help.

STEP 4: EXERCISE

EXERCISE?! EXERCISE??!!

In Ramadan?!

To be honest in years gone by I haven’t been great at sticking to a workout regime in Ramadan…

This year feels different though. The gyms have been closed for most of the year, we’ve been stuck on our sofas most of the time, and the sluggishness and lethargy is real.

Gentle exercise is so important for physical and mental health. My aim is going to be to go for a half an hour walk at least five times a week, and maybe a little bit of gentle weight training at home the other two days. There are lots of Instagram and YouTube videos to give you tips on workouts at home.

The gyms are due to reopen on the 12th so some of us I’m sure will be itching to get back! Remember to drink extra fluids if you’re working out, and use hydration support drinks if you really work up a sweat!

But … what else?

STEP 5: CONNECT

Ramadan isn’t really about food, and drink and sleep…

There’s a spirit, holiness about the month. A peace, which descends on us. This is the bit we all look forward to.

After the year we have all had, Ramadan couldn’t be more welcome. Those of us in the healthcare profession have no doubt had one of the worst years of our lives, and indeed the community at large have been affected in many ways.

Ramadan is the perfect time to reflect.

What have we done with our year? Have we been making lockdown banana bread? Have we used lockdown to increase in our ibadah, connect with the Quran, and grow closer to our creator?

Last year in March I was suddenly faced with the reality of death.

There was something in the air (COVID!) that was killing people – people my age, people I love, my patients.

The reality of how brief life is hit me again. When is it my time to meet my Lord? What will I do when I meet Him? Will He be pleased with me?

I decided to start wearing hijab, prayed a bit more than I had done before, became more aware of my daily actions and how I treated others.

I then started working in A+E and a COVID hot hub, seeing really sick patients, 10 hours plus a day, run off my feet. I was reminded of life, and death, and the powers of Allah, but in my exhaustion my practise became lax. Bare minimum fard prayers, less Quran, coming home and collapsing in a heap before repeating the next day.

For Ramadan this year I’ve been lucky enough to choose my own shifts, I’m working a lot less, and sometimes from home. For me COVID, and this last year has been a reminder as to how short life is, and how whilst we enjoy our time here, we must also prepare for the next.

I’m looking forward to spending time with my immediate family – making the most of now, and also feeling grateful that they are all still here and in good health. I will also be reflecting on the lives of those who didn’t make it this far, and will try to hold the humility that not all of us will make it to next Ramadan- be that because of COVID or otherwise.

Such is the temporary nature of this world.

A special mention is also needed for Muslims who are fasting alone this month. Many Muslims, reverted and by birth, find themselves alone, and this can be particularly hard during Ramadan- a time we usually spend together in families and communities. Loneliness is a huge problem in the UK, and the impact of loneliness on our mental health has been highlighted more so by COVID and lockdown. Not having free access to mosques and community centres will no doubt compound these matters even further.

For those Muslims who find themselves in this position, remember you are not alone. Try things like reaching out to friends or family, and maybe break your fasts together over video call. Keep in touch with others by text and phone and try to meet someone out doors once or twice a week if you can, a short walk and a chat can be great for the mood.

There are some of us who won’t be able to do these things for one reason or another, and to those people, firstly I hold you in my sincere duas, may your days and nights be full of peace and mercy, and may your hearts be filled with Allah. Secondly I would encourage you to reach out; there are community organisations and groups available for support and chats. If you are feeling low in mood, tearful, lonely or depressed please reach out to your GP for professional advice.

Finally, if you or anyone you know is struggling with food for Ramadan please let me know and we will do our best to find them support.

I pray we all have a blessed Ramadan, one filled with peace and mercy, and that we maximise it’s benefits- physical, mental and spiritual.

You can read our previous blogs on building the 5 pillars of health this Ramadan (https://muslimdoctors.org/build-the-five-pillars-of-health-this-ramadan/), eating healthy during Ramadan (https://muslimdoctors.org/feast-and-famine/), visit our mental health COVID hub (https://muslimdoctors.org/mental-health/), as well as read our practical guides on looking after your mental health (https://muslimdoctors.org/covid-hub/), list of mental health support for healthcare professionals https://muslimdoctors.org/covid-mental-health-resources-for-healthcare-professionals/ and tips on how to have conversations with someone who maybe struggling with their mental health (https://muslimdoctors.org/time-to-talk-time-to-change/). If you are an NHS worker, you can get free Islamic counselling through the Lateef Project (https://www.lateefproject.org/)

See you all for Eid!
Ramadan Mubarak!
Naeema
Dr Rashid is a locum GP working in Berkshire and West London.
She has a special interest in mental health and urgent care.
Naeema.rashid@doctors.org.uk

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