Medical aspects of the religious fast

Many religions throughout the world include fasting as an important and integral part of the religious observance. One consequence of this is often the fasting headache, which is usually diffuse or located in the frontal region. The pain is non-pulsating and of moderate intensity usually starting after 16 hours of fasting and resolves within 72 hours after resumption of food intake.

The likelihood of developing a fasting headache increases directly with the duration of the fast. People who often get headaches throughout the year have a higher risk of developing headache during fasting than people who do not usually suffer from headache. Low blood sugar and the sudden withdrawal of caffeine and/or smoking (nicotine) have been especially implicated as causative factors, but much remains to be understood about this topic. A medication, Etoricoxib (Arcoxia) 120 mg, if taken just before the fast can effectively prevent or lessen the severity of the fasting headache in most people.

However, here in the USA, there is a problem. Although this drug was approved and is used in 70 countries, it has not been approved for use in the USA by the FDA because of safety concerns. The FDA has continued to study the data supplied by Merck, the manufacturer of Arcoxia seeking to determine if the benefits of the drug can be demonstrated to outweigh its risks.

Adverse effects of fasting other than headache include, voice changes, hoarseness, vocal fatigue, and deepening of the voice with a decrease in pitch. It’s a good idea to discontinue caffeine and nicotine and to keep well hydrated for 48 hours prior to the fast.

Dr. Philip Schmidt, a board-certified internist and endocrinologist, also advised that diabetics intending to fast should be prepared to check their blood sugars four times during the fast. Diabetics, especially type 1 diabetics are advised never to fast as that would place their lives at risk; those type 2 diabetics, who are using insulin, are also advised not to fast.

Type 2 diabetics, who take oral hypoglycemic agents should discuss with their own doctors, the importance of discontinuing these medications during the fast and also always having some candy containing sugar on hand in case they became hypoglycemic (low blood sugar). Many doctors may also advise stopping any diuretics and/or anti-hypertensive medication during the fast but not to stop cardiac drugs such as those use to treat cardiac arrhythmias.

Pregnant women are also well advised not to fast as fasting may result in dehydration and the unanticipated onset of labor in the third trimester. Lactating women should also not fast as the resultant dehydration causes a marked disturbance of milk synthesis. If you are under the care of a physician, who has prescribed medication for you and are considering fasting, you must consult with your doctor and follow his/her advice regarding the advisability of fasting.

Have a Question? Call Dr. Okun at 718-241-6767

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