With Ramadan around the corner, we are once again holding a debate whether fasting may be dangerous for Muslims observing one of the five pillars of Islam and in particular for those who have diabetes, heart-related conditions and renal impairment.

You will be surprised to know for example that Ramadan fasting (RF) is not associated with any change in the incidence of acute cardiac illness and the majority of cardiac patients can fast without any difficulty. Besides, improvement in lipid profile, especially 30% to 40% increment in high-density lipoprotein, as reported in some studies, appear promising.

Nevertheless, patients with unstable angina, recent myocardial infarction, uncontrolled hypertension, decompensated heart failure, recent cardiac intervention or cardiac surgery or any debilitating diseases should avoid fasting.

Ramadan fasting is feasible for an insulin-dependent diabetic patient who wishes to fast. Clinicians should advise their patients about the importance of adequate glycemic control before Ramadan and frequent glucose monitoring during fasting. Certain types of Insulin seem to be more beneficial than others.

Turning to my urological patients, I assure them that RF does not increase the risk for developing urinary tract stones compared to non-fasting months. However, fasting in Ramadan during the summer may increase the risk of developing ureter stones compared to fasting in Ramadan during the winter. This can be justified by the fact that a hot climate can increase the chances of dehydration and decreased urine volume in patients, predisposing them for urinary stone formation. Finally, urinary tract stones are more likely to form in the ureter during Ramadan than in other locations of the urinary tract.