* As the Ramadan fast extends from dawn until dusk, there is ample opportunity to replenish energy stores at pre-dawn and dusk meals.

Fasting teaches you to manage your eating habits and improve

self-discipline. Here’s how to make more informed choices,  

minimise complications and maximise the benefit of fasting

during the holy month of Ramadan

By Dr Antony Joseph George

 

The month of Ramadan is a great opportunity to focus on bringing back a balanced and healthy lifestyle. Through fasting you learn how to manage your eating habits and improve self-discipline.

This article aims to help you understand the health issues related to fasting, so that you are able to make more informed choices, to minimise complications and maximize the benefit of your fast.

The body enters into a fasting state eight hours or so after the last meal, when the gut finishes absorption of nutrients from the food. In the normal state, body glucose, which is stored in the liver and muscles, is the body’s main source of energy.

During a fast, this store of glucose is used up first to provide energy. Later in the fast, once the stores of glucose run out, fat becomes the next store source of energy for the body. Only with a prolonged fast of many days to weeks does the body eventually turn to protein for energy. This is the technical description of what is commonly known as ‘starvation’, and it is clearly unhealthy.

As the Ramadan fast only extends from dawn until dusk, there is ample opportunity to replenish energy stores at pre-dawn and dusk meals. This provides a progressive and gentle transition from glucose to fat as the main source of energy, thereby preventing the breakdown of muscle for protein.

Balanced food and fluid intake is important between fasts. The kidney is very efficient at maintaining the body’s water and salts, such as sodium and potassium. However, these can be lost through sweating. To prevent muscle breakdown, meals must contain adequate levels of ‘energy food’, such as carbohydrates and some fat. Hence, a balanced diet with adequate quantities of nutrients, salts and water is vital.

 

Don’t skip Suhour

Even though the thought of sleep may be far more appealing than waking up to force down some food, don’t skip breakfast. Breakfast is the most important meal of the day and during Ramadan – it’s the meal that will sustain you for the next few hours.

 

Good and bad foods

During Ramadan you need to put extra effort into including foods from all five food groups to ensure variety and a well-balanced diet. These foods include:

l Breads, cereals and other grain products

l Fruit and vegetables

l Meat, fish and poultry

l Milk, cheese and yoghurt

Fats and sugars (these contain very little nutrients and are high in calories and therefore their intake should be limited).

The most commonly consumed foods during this period are milk, dates, lamb/mutton and oats. Healthy foods mentioned in the Holy Qur’an are fruit and vegetables, such as olives, onions, cucumber, figs, dates, grapes as well as pulses such as lentils.

Complex carbohydrates are foods that will help release energy slowly during the long hours of fasting and are found in grains and seeds like barley, wheat, oats, millets, semolina, beans, lentils, whole meal flour and basmati rice. Look out for foods labelled Low G.I.

Fibre-rich foods are also digested slowly and include bran, cereals, whole wheat grains, vegetables such as green beans and seeds, potatoes with skin, and almost all fruit, including apricots, prunes and figs.

Foods to avoid are the heavily processed and fast-burning foods that contain refined carbohydrates such as sugar and white flour or fatty food like cakes, biscuits, chocolates and sweets. It may also be worth avoiding the caffeine content in drinks such as tea, coffee and cola (caffeine is a diuretic and stimulates faster water loss through urination).

 

What if I’m unwell during Ramadan?

Ramadan fasting is obligatory for the healthy adult but when fasting may significantly affect the health of the fasting individual or when one is genuinely sick, Islam exempts them from fasting. “God intends every facility for you; he does not want to put you into difficulties” (Qur’an 2:185).

Because taking pills and medications can be seen as breaking the fast, people on regular medicines should discuss this with their doctor or pharmacist. If necessary, it is possible to make up missed fasting days at a later date. Fasting isn’t recommended for pregnant women in their 2nd or 3rd Trimester or children under the age of nine.

 

Should I exercise?

When we fast, our bodies naturally become less active because of the reduced energy that we are getting from food. Therefore, it is advisable to reduce the level of high impact exercise you perform during Ramadan.

Rather than lifting weights at the gym, consider something like yoga which will place less stress on your body and also allows you to relax and meditate during your exercise – important things during the month of Ramadan. If you need to work out or train at the gym, consider exercising after you have broken the fast.

 

Can I smoke?

Smoking is considered to void a fast because you take something into your body through your mouth. A principle of Ramadan is purification of the body and tobacco is the greatest contributor to death and disease in the developed world.

This makes Ramadan a great time to consider quitting smoking or at least cutting back.

Speak to a doctor or pharmacist for more advice. Nicotine patches will help you cut down or quit and won’t void the fast.

 

Quick tips

l Eat normal sized, nutritious meals at Suhour and Iftar.

l Avoid foods high in fat, salt and sugar.

l Choose a diet rich in fruit, vegetable, beans, lentils rice and grains.

l Drink plenty of fluids and avoid caffeinated beverages like coffee, tea, energy drinks or cola.

l Break the fast with a healthy snack like dates – a nutritious burst of natural sugar.

l Speak to a health professional before changing medication regimes for Ramadan.

l Avoid excessive exercise during fasting times — if you want to go to the gym, consider doing so after Iftar.

 

Eating habits

What foods should I eat at Suhour and Iftar?

 

Suhour

The pre-dawn meal should be a wholesome, moderate meal that is filling and provides enough energy for many hours. It is therefore particularly important to include slowly-digesting foods like complex carbohydrates. Drink fluids to keep you hydrated during the day and assist with digestion.

 

Iftar

The meal that breaks the day’s fast could include dates, following the tradition. Dates will provide a refreshing burst of much-needed energy. Fruit juices will also have a similar, revitalising effect. The meal should remain a meal and not become a feast!

 

Diabetes and fasting

It is a time for spiritual reflection, prayers and purification of body, mind and soul. It is better for persons with diabetes to visit their caregiver to take advice before fasting.

Anyone who would be putting their health at serious risk is exempted from fasting. For example, people with uncontrolled diabetes, people with complications of diabetes like damage to eyes and kidneys.

During fasting, body uses glucose for activities from the previous meal. After 8 hours body depends on stored glucose as a source of energy. Later to maintain blood sugar, body will break down fat as a source of energy.

Persons with diabetes who are controlled on diet, metformin or DDP4 Inhibitors (januvia , Galvus, onglyza) can undertake fasting as any other person as the risk of hypoglycemia is least with these drugs. Those who are on sulfonylureas (daonil, glimipride, glyclazide) and insulin have the risk of hypoglycemia on fasting. They should consult their physicians regarding adjustment of dosages before fasting. They should at least in the initial days self monitor blood sugar levels to see the trend with change in food intake.

They need to break fast in case of low blood sugar level. (Blood sugar testing will not break a fast.)

At dawn, they should have a balanced diet. Meals should contain complex starchy food like chappathi, whole grain bread, lentils oats. These will release glucose slowly and maintain blood sugar level for a long time. They also make you less hungry. Coffee and sugary drinks may promote urination and dehydration, so it may be avoided.

 

Ending fast

Dates are good source of energy and fibre. Limiting to 1 or 2 dates will prevent high sugar surge. You must eat fruits, plenty of vegetables and drink plenty of water to prevent constipation.

It is a good time to stop smoking and to take a decision to stop it for the rest of your life.

 

lDr Antony Joseph George is a specialist-internist at Aster Medical Centre in Al Hilal.