Patients with chronic illnesses, as well as pregnant women, require special care and caution, especially during Ramadan. They should consult their doctor to confirm whether fasting is safe for them and to receive recommendations regarding adjusting medication schedules, dietary choices, and adherence to preventative measures to ensure a safe and healthy fast during the holy month.

First: Heart Patients

Generally (after consulting a doctor, unless otherwise advised), individuals with stable heart conditions can fast safely. Fasting is beneficial because it helps reduce food intake and stress, thus mitigating the overall risks associated with heart disease and positively impacting the patients health. Doctors recommend paying attention to nutrition by consuming small amounts of food throughout the night, rather than two large meals (Iftar and Suhoor). Maintaining physical activity, such as walking, even for short periods, is also essential.

Categories of heart patients who are prohibited from fasting (after consulting their doctor and unless otherwise advised) include: *Those who suffer from recurrent chest pain; *Patients who have experienced a heart attack shortly before fasting; *Patients with congestive heart failure who suffer from severe fatigue and shortness of breath and require continuous diuretics; *Patients with severe stenosis or inflammation of the heart valves; *Patients taking blood-thinning medications; *Patients with malignant arrhythmias who are being treated with medication; *Heart patients whose condition requires hospitalization; *Shortness of breath and difficulty breathing; *Irregular heartbeat; *Severe dizziness or fainting; *Sudden swelling of the ankles or feet.

Taking Medication on Schedule During Ramadan : Heart patients treatment during Ramadan depends on the severity of their condition (after consulting their doctor and unless otherwise directed). Many people with heart and circulatory diseases are prescribed medications that must be taken regularly to protect their hearts and help them stay healthy. Since fasting involves abstaining from food and drink from sunrise to sunset, fasting during Ramadan may interfere with the treatment routine for heart patients (after consulting their doctor and unless otherwise directed). If your condition allows you to fast, you may be able to switch to taking your medication in the evening at Iftar (after consulting your doctor and unless otherwise directed).

Second: Kidney patients

Patients with advanced kidney failure, or those undergoing dialysis (hemodialysis or peritoneal), are often advised against fasting (after consulting their doctor and unless otherwise directed) due to their regular need for fluids and medication, and the high risk of dehydration, electrolyte imbalance, and prolonged fluid restriction. This can lead to serious complications, most notably: * coma, * sepsis. * Patients undergoing dialysis are also among those strictly prohibited from fasting. * Kidney patients with heart problems or diabetes are also prohibited from fasting. * Kidney transplant recipients are advised to exercise extreme caution, especially in the first few years after transplantation, as the decision depends on the stability of kidney function and the adherence of immunosuppressant medications.

Medical recommendations emphasize that the decision regarding the safe fasting of kidney patients during Ramadan is not uniform for all patients. It depends on the stage of the disease, the stability of the condition, and the type of treatment being followed. If a doctor permits kidney patients with mild kidney impairment or in the early stages of the disease, who have stable kidney function and do not suffer from serious complications, to fast (after consulting the doctor and unless otherwise advised) and after undergoing the necessary tests before Ramadan, they should follow a special diet. This diet involves avoiding plant and animal proteins to prevent straining the kidneys, abstaining from foods rich in sodium, potassium, and phosphorus, and avoiding salty beverages, while consuming large quantities of fluids.

The risks revolve around severe dehydration, toxin buildup, and electrolyte imbalances (potassium and sodium): * Changes in urination patterns: a significant decrease in urine output (retention), or a change in urine color to very dark (like tea). * Body swelling: facial swelling (especially around the eyes in the morning) or swelling of the hands and feet, indicating the kidneys inability to eliminate fluids. • Side pain: A sharp pain in the kidney area (sides or lower back). * Frequent nausea and vomiting: May indicate high levels of urea and toxins in the blood. * Muscle cramps: Resulting from an imbalance of salts and minerals in the blood.

Third: Liver patients

Key advice for liver patients during Ramadan (after consulting a doctor and unless otherwise advised): * Divide meals into smaller, more frequent portions throughout the non-fasting hours. * Avoid overeating and refrain from consuming fatty and fried foods. * At Iftar (breaking the fast), eat a complete and balanced meal containing complex carbohydrates, proteins, some unsaturated fats, vegetables, and fruits. * Avoid carbonated drinks and caffeinated beverages. * Drink plenty of water and fluids during the non-fasting hours. * Delay Suhoor (pre-dawn meal) and ensure it is rich in complex carbohydrates. * Avoid smoking and alcohol.

When is fasting unsafe for liver patients during Ramadan? In the following cases (after consulting a doctor and unless otherwise advised): * Acute viral hepatitis. * Esophageal varices. * Advanced liver cirrhosis. * Liver transplant patients. Patients are generally advised against fasting during the first year after surgery, but may be permitted to fast in the second year.

Fourth: Diabetic patients

Doctors generally advise diabetics against fasting, especially those who rely on insulin as their primary treatment. However, if the doctor permits fasting, the patient must follow instructions precisely. The most important of these is maintaining a healthy diet and not neglecting medication dosages and timing. Fasting helps lower blood glucose levels and enhances liver metabolism by increasing the consumption of stored glycogen and converting it into glucose.

Generally, patients who rely on insulin injections and require one or two doses daily can fast after consulting their doctor to adjust the dose times. Patients who require more than two doses daily should not fast, as this will lead to a drop in blood sugar levels.

A nutritionist can help prepare a list of permitted and prohibited foods and organize daily or weekly meals to protect diabetic patients from any setbacks during their fast

Fifth: Pregnant woman

Pregnant women should consult their doctor before fasting to ensure a healthy pregnancy. They should focus on drinking 2-3 liters of fluids between Iftar (breaking the fast) and Suhoor (pre-dawn meal), eat small, frequent meals (rich in fiber, protein, and complex carbohydrates), and avoid stress and heat. They should consult their doctor immediately if they experience dizziness, severe dehydration, or a decrease in fetal movement.

Key tips for pregnant women to fast safely during Ramadan (after consulting their doctor and unless otherwise advised): Nutrition and fluids (between Iftar and Suhoor): * Fluids: Drink plenty of water to avoid dehydration, and avoid caffeine and sugary drinks. * Small meals: Divide your food intake between Iftar and Suhoor to avoid indigestion and pressure on your stomach. * Suhoor meal: This is important and should include complex carbohydrates (whole wheat bread, oats) and potassium (bananas) to provide sustained energy. * Healthy foods: Focus on fiber-rich foods, lean proteins, and vegetables, and avoid fried and salty foods. * Consulting your doctor: This is essential to assess your condition and the babys condition during the fasting period. * Rest: Avoid strenuous activities and long walks, and take a rest or nap during the day. • Monitoring the fetus: Pay attention to fetal movement. If there are fewer than 10 movements in 12 hours, contact your doctor. * Vitamins: Dont neglect your supplements (folic acid and vitamin D)