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Ramadan Fasting And Our Digestive System
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BY Dr MUHAMMAD KARIM BEEBANI, JEDDAH
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I feel pity for the stomach. I really feel pity for the stomach, intestines and in fact the whole gastrointestinal system and this is because the whole year we never let this system take rest.

Apart from the three main meals every few minutes we pour something in the stomach, be it snacks, drinks, fruits or other eatables. None of us thinks that the food which we had already sent in before is being digested by the stomach and right when it has reached half way we dump some more boluses only to disrupt the digestive work up previously completed. This of course makes the food to stay a longer time in the stomach, which may result in dyspepsia, gastritis, irritable bowel syndrome etc.

In contrast, Ramadan is the only period in which our gastrointestinal system takes good rest as the Muslims observe fasting for the whole month. Digestion is not just the name of churning movements of the stomach and absorption by the intestines, but it is a huge integrated system involving the nervous system (e.g. vagus nerve) as well as hormone secreting glands etc.

So the whole gastrointestinal system takes good rest for the first time in the whole year. As digestion begins in the mouth where the salivary glands secrete excessive saliva, which carries hormones to act upon the food, the burden on the salivary glands and the teeth is reduced in the month of Ramadan. The esophagus takes rest during fasting, as there is no food to require it's propelling movements, which push the food to the stomach.

Similarly the stomach and the intestines also take good rest, as after completing the digestion and absorption of the food consumed in the morning they have nothing to do till Iftar time. Not only the stomach and intestines take rest but along with them the glands like pancreas and gall bladder which secrete hormones also reduce their secretions as their is no food to demand their hormones. Hence, there is substantial reduction in the gastrointestinal hormones like gastric juice, gastrin, CCK-PZ, gastric inhibitory peptide (GIP), motilin, vasoactive intestinal peptide (VIP), neurotensin, enteroglucagon, neuropeptide Y, gallium, substance P etc.

Lastly the colon and the liver are also at ease during fasting. In short Ramadan lifts the heavy burden and strain, which we have put on our gastrointestinal system and gives it what can be said to be a refreshing annual vacation of thirty days.

Now come to the diagnostic possibilities of Ramadan fasting. A good number of patients, who consult physicians with abdominal pain, suffer from peptic ulcers. The peptic ulcer can be gastric or duodenal in type. The presentation of abdominal pain in both gastric and duodenal ulcers is different in relation to food intake. Duodenal ulcer pain, though variable, usually occurs when the stomach is empty and the gastric ulcer presents pain after the food intake. In normal days the differentiation of the two entities is difficult to make as people eat frequently, but in Ramadan an individual undergoes two stages. One, during the fasting when his stomach is empty and the other after evening breakfast when the stomach is full. If the patient complains of abdominal pain while fasting, it will point to the possibility of duodenal ulcer and if the pain occurs after Iftar the gastric ulcer will be the suspected diagnosis.

It is worth mentioning that the peptic ulcer pain is variable and it may not occur in some patients. Similarly in most of the duodenal ulcer cases as soon as mild pain starts patient eats something due to which the pain disappears and the disease remains undiagnosed. This undiagnosed ulcer may later on present with perforation of the ulcer, haematemesis (vomiting of blood) that has a high mortality. In the Ramadan type of severe fasting the duodenal ulcer is more likely to surface and as there is no provision to relieve the pain with food, the patient may be forced to consult a physician who with the help of endoscopy can easily clinch the diagnosis. While examining the abdomen of a patient who is already fasting, a physician can easily palpate the tenderness as well as feel the edema around the peptic ulcer region. A generalized mild tenderness in the abdomen of a patient who is fasting can be due to irritable bowel syndrome, inflammatory bowel disease or colitis etc. Ramadan fasting has a healing effect on peptic ulcers as it curbs smoking and alcohol intake, which are two recognized precipitating factors for the peptic ulcer. It also has beneficial effects on inflammatory bowel disease, irritable bowel syndrome, dyspepsia, gastritis etc.

Last but not the least, imagine a person who has fasted for more or less 14-15 hours and is now ready to break his fast. His taste buds have taken good rest, so at Iftar the food is going to taste more pleasant than ever before. This is yet another bounty of Ramadan. Allah's apostle (PBUH) says :" There are two pleasures for the fasting person, one at the time of breaking his fast and the other at the time when he will meet his Lord, then he will be pleased because of his fasting."

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