Ramadan intermittent fasting can pose challenges and risks for some groups of patients. Based on a narrative literature review and our clinical expertise, we provide practical guidance for clinicians managing patients with gastrointestinal and hepatobiliary conditions who wish to fast during Ramadan. Following the established International Diabetes Federation and Diabetes and Ramadan International Alliance risk stratification framework, we categorised patients’ risk as low or moderate, high, or very high. We advise all patients at very high risk and most patients at high risk to not observe fasting due to potential harm. For others, we offer nuanced recommendations on medication rescheduling, lifestyle changes, and tailored fasting advice to minimise adverse effects. Shared decision making that respects patients’ religious motivations is essential, with risks and benefits carefully weighed on an individual basis.
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Clinical Resources Categories
Liver
Venesection treatment in haemochromatosis – current best practice from the BSG/BASL Special Interest Group
clinical-resource/Venesection-treatment-in-haemochromatosis

Guidelines
Inflammatory Bowel Disease
British Society of Gastroenterology guidelines on inflammatory bowel disease in adults: 2025
clinical-resource/BSG-guidelines-on-IBD-in-adults-2025
Published June 2025