This year, the Olympic Games has spotlighted Islam in for several reasons, most of all because of the arrival of Muslim women from every country including Saudi Arabia as well as the coincidence of the Games with Ramadan, the Holy month of Ramadan, a month when healthy Muslims must fast from dawn until dusk posing for many Muslim athletes either a personal dilemma or a significant challenge to their athletic routine.
Islam is very much an orthopraxy -- defined more by practices based on belief rather than by belief alone. There are five pillars, or essential practices, central to Islamic belief. The third pillar is sawm, or fasting, during the holy month of Ramadan, when Muslims refrain from eating or drinking and sexual activity from before dawn until after dusk.
Of all the pillars of Islam, Ramadan is the one best observed by Muslims who self-report adhering to this tenet above all others. It carries deep meaning for Muslims around the world and Ramadan ushers in a renewed observation of Islamic practices by many Muslims who may be otherwise lax in their actions in the remainder of the year. In a recent survey, 77 percent of American Muslims reported adhering to Ramadan irrespective of their other observations of Islamic pillars. In sum, observing Ramadan is more important to Muslims than any other action defining Islamic belief. Olympians are likely to be no different in this regard.
The spiritual aims of Ramadan are rooted in physical and mental regeneration combined with intensified praying during each day of the month. He or she becomes acutely aware of the bounty from God the Muslim receives each time he breaks his fast. Because the timings of Ramadan depend on the lunar Islamic calendar it advances relative to the Gregorian calendar by approximately 10 days each year. Ramadan therefore falls in every season and at every latitude, resulting in widely divergent durations of fasts and prevailing climatic conditions. This year in London the month falls during some of the longest days of the British summer with more than 17 hours of daylight and peak summer temperatures compounding the challenges of competing while fasting.
Muslims universally understand Ramadan is a mandatory requirement for healthy Muslims, excused only in the event of infirmity or illness. Unsurprisingly, athletes at every level who are committed self-identifying Muslims may feel they cannot compromise either their desire to fast or their need to compete.
The interest in the fasting athlete is rising for several reasons. More and more Muslim countries now participate in the Olympics. Many competing Olympians are now Muslims (though exact numbers of Muslim Olympians at London 2012 are unknown some estimates place the figure at almost 3,500 athletes, not including their Muslim coaches and Muslim officials who may have traveled with them to London). This is against a backdrop of the rising participation in sport globally across the Muslim world, and the impending first FIFA World Cup in 2022 to be held in Muslim Qatar, driving more than $100 Billion in infrastructural development and national sporting programs compelling researchers to examine the impact of Ramadan on athletic performance. Put simply, sport is becoming increasingly important to both the observant Muslim and the countries where they train and plan to compete.
While no Muslim nation has ever hosted the Olympics, more and more Muslim countries have begun hosting major athletic competitions. Because of the predicted growth of the global Muslim population reaching 25 percent of global population by 2022 (according to the Pew Research Center's Forum), when Qatar becomes the first Muslim nation to host the FIFA World Cup tournament, challenges to being an elite athlete and an observant Muslim committed to observing Ramadan will become more common.
Even so, it is only recently that scientific studies have become to examine the effects of Ramadan on athletic performance. The most intense study of the fasting athlete has been performed by FIFA and F-MARC (FIFA's medical research body) through international physician and scientist investigators assessing the fasting Muslim footballers.
Spearheaded by FIFA's dynamic and visionary Chief Medical Officer, Dr. Jiri Dvorak, FIFA and F-MARC have issued consensus recommendations which have just been published in July 2012 in the Journal of Sports Sciences. These findings present the best available recommendations for both the fasting athlete and those managing them.
FIFA and F-MARC have been instrumental in correcting this deficit of scientific knowledge. More than 300 million people in 208 countries are involved in the world's favorite game, including 42 million women, but more importantly, football is the fastest growing sport in the Muslim world, a trend set to continue particularly considering the Pew Forum's predictions on the future growth of an increasingly young Muslim population.
Even casual travel through the Muslim World reveals football is enjoyed by Muslims both as a popular leisure activity in many Muslim countries, and at the highest competitive level with many Muslim players, both male and female, reaching elite international status. Iran and Yemen have their own women's football teams, among many other Muslim nations. In Saudi Arabia football is the most popular sport, with its own federation and more than 36 soccer teams. Even Saudi women play football, though in unofficial teams on private facilities.
Reports of Muslim athletes arriving at the Olympics with clear intentions not to fast for fear of compromising match performance were noted early in the Olympics press coverage. Their decisions (for instance in the Egyptian teams) had been supported by coaches who advised the athletes couldn't possibly calorie load in the restrictions imposed on their schedule by the Ramadan time table. Sometimes their decisions were further supported by religious edicts. The Washington Post has reported the High Egyptian Islamic Council issued a fatwa, excusing their athletes from fasting during coaching or competition. While this is reasonable, these decisions are made out of lack of awareness of the scientific knowledge FIFA has begun to carefully amass.
As part of an all-Muslim team (often with Muslim officials and coaches who themselves understand Ramadan and may be observing it too) the Muslim athlete may be more supported than otherwise. However, many Muslim athletes are welcomed by their non-Muslim colleagues with similar support when the community becomes aware of Ramadan in the best spirits of sportsmanship. London 2012 arranged special meals to be available at the fasting time of suhoor and ensured the food is acceptable (halal) for the Muslim competitors.
The first studies looking at the Fasting Player were the initiative of Dr. Yacine Zerguini, a sports medicine orthopedist, and FIFA Medical Committee member conducted in Algeria, a Muslim majority country, in 2004. Later, Zerguini led efforts to combine research Tunisia, also a Muslim Majority country with the Tunisian Football Association in 2006.
Based on these early data, FIFA concluded the changes in the timing of food intake and sleep patterns during Ramadan had little effect on physical performance in this sample of youth football players observing Ramadan during a residential training camp setting though it is worth noting that match performance was not assessed in this investigation and the players studied were junior players, not elite players at the peak of football performance. FIFA was convinced that further investigation was needed and with the award of the bid for the FIFA World Cup at 2022 their focus on the Muslim footballer intensified.
I was invited to speak at the world's first consensus conference on Ramadan and Football on Nov. 25-26, 2011 in Doha at Aspetar, Qatar's FIFA Accredited Sports Medicine Center. The meeting brought together scientists, physicians and football players to exchange our knowledge and experiences.
Before we even began the scientific sessions, FIFA leadership made clear what every coach and player already knows: the decision to fast is purely personal. Many of us at the meeting were also observant Muslims, but Muslim or not, we all agreed and FIFA's official position is that the autonomy in expression of personal belief is paramount for the Muslim and particularly the Muslim footballer and no official position could be held to obstruct this choice.
In the course of the symposium, I met with preeminent elite Muslim footballers who are competing at the highest international level. It quickly became clear that personal experience of individual players did not always match research findings. (The scientific findings of FIFA's symposium on Ramadan and football can be downloaded here.)
Madjid Bougherra, an Algerian national team player, described how he always tried to avoid loss of sleep when fasting caused by long meals at night and therefore elected to eat pasta as a means to quickly replete his carbohydrate stores. High carbohydrate intake complies with current nutritionists' recommendations for players during Ramadan. Bougherra mentioned that he felt the challenges in observing Ramadan were less marked for players in Muslim teams than for those playing in teams where only a minority of players in a team will be Muslim. His made a heartfelt appeal:
"We would indeed be grateful for advice on what to eat and drink and when, also how to best sleep. We need your help, help from scientists and physicians."
Nadir Belhadj, another Algerian professional player, speculated about the impact on match performance and injuries and expressed a need for advice on how he could train long and hard despite the fasting.
"I feel there are for sure more injuries during fasting," he said.
A recent Tunisian study over two seasons did indeed confirm Belhadj's suspicion showing higher injury rates recorded during Ramadan as compared to the pre- and post-Ramadan likely because injuries peak with suboptimal physical preparation, tiredness, sleep loss or lack of training, all situations that might occur with fasting players.
As the final week of the Olympics unfolds in the penultimate week of Ramadan we can be assured that there are more Muslim athletes competing at the apex of their sport than ever before. The most extensive data on how to manage an athlete who wishes to compete and fast has been amassed by FIFA, which is deeply committed to advancing soccer globally, including throughout the Muslim world. Experts and observant Muslims alike agree on one conclusion: that there is no single coping strategy, and in fact a "one size fits all" approach is unlikely to be the solution, even within the same sport.
The Games' coincidence with Ramadan invites us to view a new and refreshing expression of the Modern Muslim as he or she participates in the world's most universal celebration of humanity. As a Muslim I find even more gratifying than the Olympic spirit is the community spirit engendered in the cultural sensitivity and hospitality extended by the global community to the Muslim athletes at London 2012 in particular. More than anything, it is the flexibility inherent to Islam which permits the Muslim to compete even during Ramadan and to make that decision entirely for himself or herself.
Triumphant images of the modern Muslim athlete, whether or not he or she becomes a medalist, not only inspire us here in the West but much more in the Muslim majority world, where the practice and experience of Islam may for many be far from so flexible or rich with opportunity. The 2012 Olympics present for Muslims a rare moment to look in a global mirror and see a self image that fills us with awe and pride and deep humility at the accommodations the non Muslim world makes for each of us.
Algerian national football player Nadir Belhadj, now representing Qatar, explained his suspicion that rates of injury could be higher during Ramadan for the fasting player.
Dr. Michel D'hooghe is a Belgian member of the FIFA Executive Committee and attended the Doha symposium on Ramadan and Symposium underlining FIFA's executive support for developing the best science for the fasting Muslim football player. He reminded us that the actual decision of fasting must remain an individual one for each player.
Algerian national football player Madjid Bougherra, now recruited to play for Qatar, appealed to all of the scientists gathered to pursue research in how best to advise the fasting soccer player.
Dr. Jiri Dvorak, the Chief Medical Officer who has spearheaded developments in football and medicine for the last 15 years and is now driving efforts to protect football players as they pursue their sport and faith during Ramadan.
The Research team who have studied and authored the consensus guidelines for the fasting football player who must compete and observe Ramadan. Dr. Jiri Dvorak, FIFA's chief medical officer, is seen in the center of the photograph. Dr. Qanta Ahmed is standing immediately behind him.
Qatar has committed more than $100 Billion USD investment in infrastructure and programs centered on readying the tiny sovreignty for the FIFA World Cup 2022. The stadium pictures is next to Aspetar, Qatar's FIFA accredited center for Sports Medicine which hosted the first symposium on Ramadan and Football. The stadium has an entirely retractable roof. Many of the stadia to be built for the World Cup will be dismantled after the tournament and shipped and donated to countries in need of infrastructure as part of Qatar's post World Cup legacy.
Follow Qanta Ahmed, MD on Twitter: www.twitter.com/MissDiagnosis