By Dr. Manal Ghazzawi
Ramadan is a sacred month eagerly anticipated by Muslims around the world. It brings immense joy and peace into human beings when observed, promoting overall well-being for both minds and bodies. Research has shown numerous health benefits associated with fasting:
- Improving verbal memory
- Improves heart health by reducing blood pressure, resting heart rates and other heart-related measurements
- Exercising when fasting enhances physical performance, more fat loss and maintenance of muscle mass
- Fasting can help people that are obese to lose weight and people with diabetes (with strict supervision) to control their sugar level- helping to get off insulin therapy.
While fasting can be beneficial for individuals with diabetes, it is important to be aware of the associated risks and complications. It is crucial to approach the holy month with caution to avoid hypoglycemia (low blood sugar levels) or hyperglycemia (high blood sugar levels), dehydration, or diabetic ketoacidosis (liver breaks down fat for fuel).
Prior to beginning fasting, it is essential to engage in advanced planning with your healthcare team.
Individuals with well-controlled type- 2 diabetes who effectively manage their condition through a healthy lifestyle and medication regimen can fast by adjusting their medication and regularly monitoring their glucose levels with their healthcare team. However, those with diabetes who are fasting and taking high doses of medication, as well as engaging in physical activity, should exercise extreme caution to prevent hypoglycemia.
People who may be at high risk of complications when fast during Ramadan include the following:
- Type 1 diabetes
- Type 2 diabetes with poor blood sugar control or taking certain types of insulin
- Recent history of severe low blood sugar or diabetic ketoacidosis
- History of recurring low blood sugar or unawareness of low blood sugar
- Conditions such as severe kidney disease or blood vessel complications
- Diabetic and
- Diabetic and pregnant
The expected values for normal fasting blood glucose concentration in a diabetic patient are 4-7 mmol/L (72mg/dL- 126mg/dL) and below 8.5 mmol/L (153mg/dL) at least 90 mins after eating.
It is crucial to understand that individuals may react differently to varying levels of low blood sugar. Therefore, it is essential to closely monitor your glucose levels and educate your family members on recognizing signs of low blood sugar, which may include, irregular or fast heartbeat, fatigue, pale skin, shakiness, anxiety, wearing, hunger, irritability, tingling or numbness of the lips, tongue, or cheek
As low blood sugar progresses, symptoms can worsen and may include confusion, abnormal behaviour, or both. These symptoms may manifest as the inability to complete routine tasks, visual disturbances like blurred vision, seizures, or loss of consciousness.
If you experience any of the aforementioned symptoms, immediate treatment is necessary.
- Eat or drink 15 to 20 grams of fast-acting carbohydrates. These are sugary foods or drinks without protein or fat that are easily converted to sugar in the body. Try glucose powder, fruit juice, regular (not diet) soda, honey, or sugary candy.
- Recheck blood sugar levels 15 minutes after treatment. If blood sugar levels are still under 70 mg/dL (3.9 mmol/L), eat or drink another 15 to 20 grams of fast-acting carbohydrate, and recheck your blood sugar level again in 15 minutes. Repeat these steps until the blood sugar is above 70 mg/dL (3.9 mmol/L).
- Have a snack or meal. Once your blood sugar is back in the standard range, eating a healthy snack or meal can help prevent another drop in blood sugar and replenish your body’s glycogen stores.
Additionally, to prevent hyperglycemia, it is important to be prepared to adjust medication doses, regulate food intake, and be willing to break your fast if needed.
What is best to eat during Iftar?
- Eat few dates- they are high in fiber, calcium, iron – rich in potassium
- Complex carbohydrates such as whole grains like lentils, quinoa, bulgar wheat, brown rice, millet, wheat etc
- Protein-rich sources such as lean meat, skinless chicken, fish, eggs, legumes and low-fat dairy products.
- Avoid deep fried foods and those with refined carbs like white bread, pastries, biscuits etc. Instead, break your fast with like salads and vegetable soups, then later citrus fruits after your main meal.
- Reduce the intake of salt and salted food, such as dressing, sauces, salted nuts and crisps. Dehydration is a risk due to limited fluid intake during the day, and high salt foods can further increase this risk.
- Drink plenty of water at Suhoor and Iftar. It is recommended that you drink at least 8 cups of water between Iftar and Suhoor so that your body may adjust fluid levels in time for the next day.
Avoid drinks that contain caffeine such as tea and coffee as these can make you lose more water by going to the toilet more. Avoid sugary drinks such as orange, apple, tropical fruit juice and fizzy drinks. Diet drinks and non-sweetened drinks are preferred options.
In conclusion, it is important to remember that while the Qur’an mandates fasting for Muslims during the month of Ramadan from dawn to dusk, it also emphasizes the importance of not harming one’s body. Individuals living with diabetes and other health conditions may be exempt from fasting due to the increased health risks involved.
I extend my warm wishes to all in advance for a blessed Ramadan and Eid al-Fitr.
Manal Ghazzzawi- is a Doctor of Pharmacy, a public health specialist and a consultant clinical pharmacist. She is a health entrepreneur, CEO of Citiglobe Pharmacies Ltd, and a laureate for women in Africa Entrepreneurs 2020 and has won many awards as the most outstanding pharmacist in Sierra Leone. Dr. Ghazzawi is a foundation fellow of the newly established Postgraduate College of Health Specialists in Sierra Leone.
