(RNS) — Ozempic, Wegovy, Mounjaro and Zepbound — all part of a class of drugs called GLP-1 medications — have been a gamechanger for people struggling with diabetes and obesity, and, as celebrities from Oprah Winfrey to Khloé Kardashian to Kelly Clarkson have disclosed, a revolutionary weight-loss aid. The public interest in GLP-1s was further fueled by a commercial that ran during this year’s Super Bowl for a tele-health service that offers an off-brand version of the drug.
There are growing concerns that adopting GLP-1 as a lifestyle drug is not ideal for everyone. Last year Saturday Night Live, with Ramy Youssef hosting, featured a faux-commercial for “Ozempic for Ramadan,” showing Muslims “shooting up” Ozempic when fasting bogged them down. But Muslims who are taking a GLP-1 caution that it has affected their experience of the holy month in unexpected ways.
During Ramadan, observant Muslims abstain from food and beverages from sunrise to sunset. The fast begins after an early morning meal called suhoor and is broken each day with a celebratory meal called iftar. Initially it may seem that Ramadan would be easier to manage on a GLP-1 because the drugs suppress appetite. But a number of Muslims on GLP-1-have expressed apprehension about nutrition, hydration and exercise while fasting on the drug. Some Muslim patients complain that it is actually harder, because the appetite suppression is so efficient that they are too nauseated to break the fast at the end of the day.
For this reason, it also turns weight loss from a desirable side-effect into a concern. Mustafa Nakawa, a board-certified obesity and family medicine specialist and the founder of Way Less Weight Loss Clinic in Oak Brook, Illinois, said he decreases the dose of his patients’ drugs if they tended to lose weight in previous Ramadans. He also asks them to inject the medication just before the iftar, so their effect won’t be felt until after they’ve eaten. He also recommends patients eat smaller, nutrient-packed meals, and in extreme cases, when nausea might prevent adequate intake of food despite being on the lowest dose of the medication, he stops it altogether.
Given that GLP-1 patients are normally told to drink a lot of water, the doctor advises those who fast to tank up early in the morning and break their fast with water as well. “Avoid coffee and tea in the early morning, and in the evening, make sure to drink plenty of water and maintain the water intake throughout the waking period at night,” he said.
He also recommends caution when it comes to dates, which are traditionally eaten to break the daily fast. “Just choose high-fiber, less-sweet dates and eat three at most,” said Nakawa. “Think of the three dates as a substitute for the dessert later.”
Those who are taking the drug for diabetes may choose not to fast, as the Quran stipulates that those suffering from illness are exempt from fasting if it could jeopardize their health. (According to Islamic law, a Muslim who doesn’t fast should compensate by feeding a poor person during the month instead.) But a 2023 narrative review of studies on GLP-1 treatment during Ramadan, published in the Journal of Obesity, suggests it is generally safe for people with diabetes to fast while taking the drug, but Nakawa stresses that medical supervision of the patient is necessary.
Nakawa said he tells his patients with type-2 diabetes who take both a GLP-1 drug and another diabetes-specific medication, such as metformin or glipizide, to stop the latter if the patient wishes to fast, in order to prevent hypoglycemia. “But it is all individual, and that is why being under medical supervision while fasting is so important,” he said.
It’s reasonable to ask questions, too, about how GLP-1s affect the goal of fasting during Ramadan, which includes attaining piety, seeking forgiveness for past sins and understanding the pain of hunger that others may experience.
So, is taking GLP-1s during the Ramadan fast cheating, as SNL suggested?
It isn’t, according to Sheikh Hassan Aly, imam and director of Humanitarian Faith Initiative at Med Global, a Muslim-led group that improves health care for vulnerable people, as long as the medications are taken as part of obesity or weight loss treatment. “It would only decrease the spiritual meaning of the fast if the individual concerned were healthy and only took the medications in order to suppress hunger during the fast,” he said.
Aly added that injecting the medications themselves during the day should not be considered breaking the fast.
Zohair Abdul-Rahman, a physician who is a senior research fellow for Yaqeen Institute’s Department of Systematic Theology, said, “The purpose of the fast, as Allah says in the Quran, is that you can have taqwa (God consciousness); Allah wants ease for you, not hardship. So this idea that if you’re not suffering as much and you’re not as hungry as the other person, then you’re not getting the full spiritual value is simplistic.”
Like Aly, Abdul-Rahman also stresses that GLP-1 medications are a treatment for diabetes and obesity, and as such, they do not interfere with the spiritual functions of Ramadan. He strongly warned against connecting the fasts (i.e. skipping the intervening meals) and emphasized the importance of a healthy diet during iftar and suhoor.
Sawsan Abubaker was diagnosed last year with diabetes and started taking Ozempic in November. After four months on the medication, her blood sugar has dropped to a normal range; she has also lost 25 pounds. This year, during her first Ramadan on Ozempic, she is not experiencing much difference, other than some reduction in nausea. Taking Nakawa’s advice, she has stuck to a protein-rich diet and has increased her water intake by taking small sips during the night. She has also changed the timing of her injections from morning to evening to coincide with her iftar.
“My hunger levels are normal, similar to previous years; I have just learned to avoid sugar,” she said.
Modern scientific developments are often thought to clash with ancient spiritual practices such as Ramadan fasting. In fact, after a return to the Scriptures and an active re-examination of the ancient edicts to see how they apply to today’s dilemmas, they can more often than not be successfully adapted to modern circumstances without diminishing their spiritual meaning.
(Anna Piela, an American Baptist Churches USA minister, is a visiting scholar of religious studies and gender at Northwestern University and the author of “Wearing the Niqab: Muslim Women in the UK and the US.” The views expressed in this commentary do not necessarily reflect those of Religion News Service.)