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Can people who have undergone bariatric surgery fast during Ramadan?

The requirement to observe a total fast (abstain from all forms of nourishment including liquids) during daylight hours in the month of Ramadan poses a greater challenge in the management of people who have undergone bariatric surgery.

Bariatric surgery is increasingly performed for the correction of morbid obesity, particularly in people with co-morbid conditions such as diabetes. As most bariatric procedures limit the amount of food or drink that can be consumed in one sitting, patients are advised to sip fluids frequently through the day. A total fast during long summer days would put these patients at risk of dehydration. Fasting for long periods could lead to the desire to eat larger amounts at a faster pace on breaking the fast.

This could result in vomiting, compounding dehydration and poor nutritional intake. Foods that are frequently eaten at the sunset meal such as sweets and deep-fried pastries would also put some patients at risk of dumping syndrome and/or steatorrhoea.

The small stomach volume may also pose a further difficulty with fitting in nutritional supplements and medications around meal times. Research in this area is virtually non-existent. Based on clinical experience we recommend that:
Patients should avoid total fasts in the first 12 – 18 months after bariatric surgery when new eating and drinking habits are being established
Beyond this period the risk of postprandial vomiting is reduced and patients who are otherwise in good health may observe religious fasts if fluids can be taken through the day (e.g. fasting Ramadan)
Patients should be advised to base their meals on complex carbohydrates and high quality proteins to optimise their nutritional status
Patients who have had malabsorptive procedures such as gastric bypass should be advised of the importance of continuing with their nutrient supplements such as iron, calcium and vitamin D, and multivitamins.

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