Quit-smoking campaigns have been successful among Muslim communities that take advantage of the month of fasting in Ramadan to cut back, doctors say.
During Ramadan, which is ending now, Muslims abstain from eating, drinking and smoking from dawn to dusk. While pregnant women and people who are ill are exempted from the religious requirement, some choose to follow it anyway.
Dr. Juveria Zaheer of the Centre for Addiction and Mental Health in Toronto saw a gap in the information to guide clinicians in treating Muslim patients with mental illness during Ramadan. Previously, medical journals have published such information for fasting and physical health.
“It is important for clinicians not to undermine the significance of this spiritual practice,” Zaheer and her co-authors from the University of Toronto, Stanford University School of Medicine in California and the University of Manchester in the United Kingdom concluded in a commentary in May in the journal Lancet Psychiatry.
“A better understanding of the impact of fasting on health can allow for more nuanced decisions between clinicians and patients, so that informed decisions can be made about balancing faith-based practices and health.”
Take medication once a day or twice?
One of the studies Zaheer’s team looked at was how taking the smoking-cessation drugs varenicline or bupropion once a day was “as effective and tolerable” as the usual twice-a-day dosing.
Zaheer also pointed to a 2016 study from Malaysia published in the Qatar Medical Journal that found that, in the 21 days after Ramadan, levels of cotinine, a breakdown product of nicotine, remained lower in the saliva of male smokers who participated in a smoking-cessation program at work compared with those who didn’t.
As a family doctor in Staffordshire, U.K., Dr. Faraz Mughal said he often speaks with Muslim patients who smoke and want to fast.
“It’s an opportunity to advise and counsel them on how to improve their smoking habits,” said Mughal, who is also a researcher at Keele University. He wasn’t involved in Zaheer’s paper.
“If they’re not already engaged with smoking services, that they can use the month of fasting as a fantastic opportunity to quit smoking.”
Mughal advises people to slowly reduce their tobacco intake before Ramadan to reduce cravings, in combination with alternatives such as nicotine-replacement patches and gums.
After smokers break their fast at sunset, they can turn to the nicotine alternatives or reduce their use of tobacco in water pipes, also called hookahs, to gradually quit after the month ends. Hookah lounges are banned in several Canadian provinces and cities.
Coping with cravings
In the U.K., areas with dense Muslims communities often offer smoking-cessation services in combination with mosques and community centres to encourage people to improve their behaviour, he said.
“Fasting generally helps with impulse control and self-discipline,” to help deal with cravings, Mughal said.
As in the Malaysian research project, the key is maintaining the changes after Ramadan ends, he said.
Tobacco use remains the top cause of preventable death in Canada, killing 45,000 Canadians each year. Five million people, or 16 per cent of the population, smoke, according to the 2019 Tobacco Endgame report published by public health experts including the Canadian Medical Association and Heart and Stroke.
Aside from the impact of fasting on nicotine dependence, Zaheer’s paper suggested clinicians:
- Discuss the risk of fasting for patients with a history of eating disorders.
- Consider how the absorption of a medication is affected by food.
- Express concerns about lithium toxicity and dehydration if patients fast for long hours in summer.
- Increase monitoring of symptoms in patients with bipolar disorder who may be sensitive to disturbances from changing sleep patterns in Ramadan.
The last day of fasting is determined by the new moon. Eid-al-Fitr, the celebration marking the end of Ramadan, falls on either Tuesday or Wednesday this year.