UHS Medical Times
HEALTH DURING RAMADAN Ramadan is an excellent time to start your physical fitness journey while you are on a spiritual journey. Fasting has numerous physiological benefits and supports weight loss by giving you a chance to re-assess your meals and improve your eating patterns. Fasting during Ramadan can improve one's health, but only if done in the proper manner. Of course, moderation is key to health. Starting your Iftar meal with a warm soup comforts the stomach after a long day of fasting, replenishes your body with fluids and helps prepare the digestive system for this blessed meal. When the body is starved of food, it starts to burn fat so that it can make energy. This can lead to weight loss. However, if you fast for too long your body will eventually start breaking down muscle protein for energy, which is unhealthy.
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THE SCIENTIFIC BENEFITS OF RAMADAN FASTING The difference between Ramadan and total fasting is the timing of the food; during Ramadan, we basically miss lunch and take an early breakfast and do not eat until dusk. Abstinence from water for 12 or so hours is not necessarily bad for health and in fact, it causes concentration of all fluids within the body, producing slight dehydration. The body has its own water conservation mechanism; in fact, it has been shown that slight dehydration and water conservation, at least in plant life, improve their longevity. Moreover fasting during Ramadan does not exceed 14 hours or so, the normal steady state of the body is maintained as a result of coordinated physiological mechanisms. Hence, nearly all the biochemical results in the laboratory are normal. The physiological effect of fasting includes:
Lowering of blood sugar, Lowering of cholesterol Lowering of the systolic blood pressure
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In fact, Ramadan fasting would be an ideal recommendation for the treatment of mild to moderate, stable, non-insulin diabetes, obesity, and essential hypertension. However patients who are suffering from severe diseases, whether type I diabetes or coronary artery disease, kidney stones, etc., are exempted from fasting and should not be allowed to fast. The original meaning of 'sawm' is to be at rest. We give rest to the gastro-intestinal tract, the tongue, the eyes and ears, etc. The transit time for a bolus of food from the mouth to the end of the large intestine, called colon, is about 12 to 14 hours. In fact, fasting is an additional safety device for the regenerative processes of the body. The repair processes of the body and the brain, including the memory molecules take place when the body is at rest, especially during the stage of deep sleep. Sleeping during Ramadan is much deeper than in other times. Two hours of sleep during Ramadan are more satisfying and refreshing than more hours of sleep otherwise. Fasting significantly increases deep sleep and reduces the dreaming time, which takes place during the Rapid Eye Movement (REM) sleep. Therefore, it is more beneficial for the elderly to fast because their normal hours of deep sleep in the non-fasting state are much less.
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SOURCE OF ENERGY DURING A FAST The changes that happen in the body during a fast depend on the length of the continuous fast. The body enters into a fasting state eight hours or so after the last meal, when the gut finishes absorbing 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 glucose runs out, fat becomes the next source of energy for the body. With a prolonged fast of many days or weeks, the body starts using protein for energy. This is the technical description of what is commonly known as "starvation". It is clearly unhealthy and involves protein being released by the breakdown of muscle, which is why people who starve look very thin and become extremely weak. However, you are unlikely to reach the starvation stage during Ramadan, because the fast is broken daily.
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GENTLE TRANSITION FROM GLUCOSE TO FAT As the Ramadan fast only lasts from dawn till dusk, the body's energy can be replaced in the pre-dawn and dusk meals. This provides a gentle transition from using glucose as the main source of energy, to using fat, and prevents the breakdown of muscle for protein. The use of fat for energy helps weight loss. It preserves the muscles and eventually reduces your cholesterol level. In addition, weight loss results in better control of diabetes and reduces blood pressure. After a few days of the fast, higher levels of endorphins appear in the blood, making you more alert and giving an overall feeling of general mental wellbeing. A balanced food and fluid intake is important between fasts. The kidneys are very efficient at maintaining the body’s water and salts, such as sodium and potassium. However, these can be lost through perspiration. To prevent muscle breakdown, meals must contain enough energy food, such as carbohydrates and some fat.
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HOW TO FAST SAFELY DURING RAMADAN By following simple guidelines, it may help you lose weight and decrease blood pressure and cholesterol. Alternatively, over-indulging at Iftar and Suhoor can cause weight gain. The Holy month is often seen as a time to practice self-control, self-discipline, sacrifice and empathy for those less fortunate. It is encouraged to try to maintain these practices even outside of fasting hours.
Never skip ‘Suhour'
Just as breakfast is the most important meal of the day, ‘Suhour' (the meal eaten before dawn) is equally important during Ramadan. The pre-dawn meal helps your body stay hydrated and fuelled up on energy and nutrients until your next meal at iftar. It also helps you avoid overeating when you break your fast at sunset. A well-balanced meal at ‘suhour' contains: • Complex carbohydrates: Oats, wheat, lentils, grains and other complex carbohydrates (like fava beans) are slow-releasing carbs, helping keep your blood sugar steady and giving you a feeling of fullness for the greater part of the day. • High-fibre foods: Fibre-rich foods are digested slowly and include cereals, dates, figs, bran, whole wheat, grains, seeds, potatoes, vegetables and almost all fruit especially apricots and prunes. Bananas are a good source of potassium and other essential nutrients that help keep your body hydrated. • Protein-rich foods: High protein foods like eggs, cheese, yoghurt or meat are also recommended as they can help replenish your energy throughout the day.
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Aim to Eat At Least 7 Servings of Fruit and Vegetables Every Day Fruits and vegetables are a great snack between meals, and a healthy alternative to pastries and sweets usually consumed during Ramadan. Some fruits and vegetables naturally contain high water content, especially cucumbers, watermelons, melons, squash and pumpkins. Eating those after fasting hours can help keep you hydrated. One serving of fruits and vegetable can be quantified as: • ½ cup (125 ml) of fresh, frozen mixed vegetables/fruits or 100% real fruit juice or vegetable juice •
1 cup (250 ml) of leafy raw vegetables or mixed salad
•
1 fruit (average size)
Try to Cut Down on Sugary and Processed Foods Avoid heavily processed, fastburning foods that contain refined carbohydrates such as sugar and white flour, as well as fatty foods like Ramadan desserts. They are high in fat and low in nutrients.
Break your Fast Slowly and Don't Overindulge While it is tempting to overindulge at Iftar after a day of food deprivation, remember that you should slow down. Start with a few dates and water and then wait before starting your main meal. Dates are a great source of energy for the body, helping it to secrete digestive enzymes in preparation for the upcoming meal. Afterwards, you may get started on some warm soup. Avoid heavy oils and fats in your meal. Make sure you consume plenty of vegetables and a good portion of protein and enough carbohydrates, with a little fat. Remember you should eat slowly and give time for your body to digest the food. 7 Newsletter | June 2018
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Make soups a regular item on your Iftar meals Soups are warm, soothing on the stomach and easy to make. They provide the body with fluids, vitamins and minerals while offering a great way to incorporate vegetables. Try making soups from colorful vegetables available in season such as carrots, tomatoes, pumpkins, bell peppers, spinach, zucchini and eggplants. Remember to limit the amount of salt and oil you use while preparing them. Add flavour with fresh herbs.
Stay Hydrated Drink at least 8-12 cups of water a day. Drink plenty of fluids for hydration from the period of Iftar to the time of suhour. Beware of consuming a lot of popular sugary Ramadan drinks such as Tamarind and Hibiscus. Although juices, milk and soup are sources of fluids, water is the best choice, so try to consume other drinks in moderation.
Avoid Caffeinated Drinks Caffeine is a diuretic that stimulates faster water loss, leading to dehydration. It is best to avoid caffeinated drinks such as strong tea, coffee and colas, or drink them in moderation.
Avoid Deep Frying Try to avoid fried foods or those prepared with large quantities of oil. If frying cannot be avoided, one tip would be to reduce the quantity of oil used. Instead of using one cup of oil you can cut down the amount to half or quarter of a cup. It is best to avoid frying with animal fat such as ghee. Alternatively, recommended oils to use are monounsaturated fats such as sunflower, canola and corn oil. Olive oil is not recommended for frying foods.
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Avoid Working Fasting Hours
Out
During
To avoid dehydration, it's best to postpone working out until after fasting hours. We suggest you work out at a time when energy levels are at their best and rehydration is possible, such as after Iftar. Allow at least 2-3 hours after eating to begin your exercise routine, to give your body enough time to digest properly. Maintain hydration throughout your workout and don't forget to drink plenty of water after, to replenish the water and mineral losses due to sweating. Water regulates your body temperature, lubricates your joints and transports nutrients throughout your body. Staying hydrated is particularly important during exercise.
Adapt Fasting to Your Physical Condition Prior to Ramadan, Muslims, particularly seniors, should consult a doctor, as should pregnant women, children and people with diabetes taking medication to control their insulin levels. 9 Newsletter | June 2018
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MEDICATIONS DURING RAMADAN 1. Diabetes General Information
Muslims with diabetes need to take special precautions during Ramadan to manage blood glucose levels and aim at avoiding hypoglycemia during the day and hyperglycemia at night. People with diabetes wishing to fast should first consult their doctor. Certain diabetes medication may increase your risk of hypoglycemia while fasting. Therefore your treatment regimen may need to be altered to ensure your blood sugar levels are effectively managed during Ramadan. Speak to your healthcare professional about your current treatment / dosage and discuss any adaptations required.
Healthy eating and diet tips:
Your diet during Ramadan should be healthy and balanced. Try to eat food such as wheat, semolina and beans at Suhoor before beginning the fast, because this food releases sugar slowly. This will stabilize your blood sugar levels and help to reduce your cravings and appetite through fasting hours. At Iftar it is advisable to first eat food that release sugars quickly, such as fruits, which will rapidly increase your blood sugar levels, followed by slow-acting carbohydrates. You should avoid food high in saturated fats and try to increase your fluid intake during non- fasting hours.
Your treating doctor will decide if it is possible for you to fast safely during Ramadan or not. Please consult your doctor if you wish to fast.
Patients who advised to fast:
are
NOT
Patients with type-1 diabetes, with some exceptions. Women with gestational diabetes, especially those who are on insulin. Diabetic patients who are unaware of hypoglycemic episodes because their disease is advanced, they are used to low glucose level 10 Newsletter | June 2018
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2. Hypoglycemia - Low Blood Sugar General Information
Your blood sugar (glucose) is considered low when it is less than 70 milligram / deciliter (equivalent to 4 mmol / litter) in the blood, with or without the presence of symptoms.
What is the treatment of low blood sugar? When having symptoms of low blood sugar, please follow these instructions: Step 1: Check your blood sugar. Step 2: Take 15 gram of easily absorbed sugar (example: a half cup of juice, half cup of sweetened soda, table spoon of honey or Sugar). Step 3: Wait for 15 minutes and then check your blood sugar again to make sure that your blood sugar is not going lower. Step 4: If the sugar is still below normal level, repeat steps 1,2 and 3. Step 5: To maintain a normal blood sugar level after correcting the low blood sugar; take 15 gram of slowly absorbed sugar (example: fruit, 1 cup of milk, or 1 slice of whole bread).
3. High Blood Pressure General Information
High blood pressure is one of the most common diseases in the world. There are many medical studies that have been conducted to evaluate the effect of fasting on the disease. It has been reliably concluded that there is nothing that prevents Muslims with this illness from fasting during Ramadan especially if there are no associated complications. Here are some helpful hints and cautions to be aware of during the month of Ramadan if you have this disease.
When to take your Medications for Hypertension during Ramadan?
Many of the medications used in the treatment of hypertension are slow release medications with long-term effects. Most are used once or maximum twice during the day, and can be taken during the evening at Iftar and at Suhoor. If a patient takes a beta blocker medicine such as “Atenolol� once a day; it may be taken at Iftar. If the patient is taking diuretics, it is preferable to be taken either with Iftar or about two hours following Iftar.
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4. Asthma General Information Asthma is a disease affecting the airways to and from your lungs. The typical symptoms are wheezing, cough, chest tightness, and shortness of breath. Most people with asthma are treated with inhalers and some types of oral medication. Drugs delivered by inhalers can be grouped into relievers and preventers; a reliever inhaler like Salbutamol and Terbutaline relaxes the muscle in the airways so they are taken as needed for rapid, short-term symptomatic relief during an asthma attack; a preventer inhaler is taken one to two times every day to prevent symptoms from developing.
When to take your medication for Asthma in Ramadan? In most cases, fasting during Ramadan does not pose any problem for the majority of asthma patients. If using the preventer inhaler (usually brown, orange or yellow) do so at Suhoor and at breakfast. However, if a patient is using the reliever spray (usually blue in color) patient should administer the medication whenever a need to use it arises, even if it is during the daylight hours of Ramadan. (Patients so affected should seek the advice from DAR El EFTAA to review fasting rules.). For patients who are taking the medication like the Singulair or loratidine , they will take these at bed time. This also applies to patients with allergic sinusitis.
When to seek for a medical advice for Asthma in Ramadan? Some patients independently rearrange their medication routines during Ramadan. This can lead to the exacerbation of asthma. An attack of asthma may be more severe in some patients. If so, the patient may need to use the reliever inhaler more than twice a day, require the addition of cortisone to their therapy regimen or require the use of evaporators. For these groups of patients, it is recommended not to vary their medication schedule until they seek the advice from a qualified physician.
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5. Gastrointestinal Disorders What lifestyle changes do I need to adopt during Ramadan? In addition to the spiritual benefits, Ramadan fasting can improve person’s health. But if an incorrect or poor diet is followed, fasting may have negative impact on your health. Balanced food and fluid intake is important. Your diet should be simple and not too much different from your normal every day diet.
How should I take my medications during Ramadan? • If you are on regular medications and planning to fast during the Holy month of Ramadan, please consult with your physician or pharmacist to discuss whether you require any specific changes to your therapy. • You may refer to the document suggested time for taking medication.
6. Epilepsy General Information Epilepsy is a disorder that results from surges in electrical signals inside the brain, causing recurring seizures. Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others have full-fledged convulsions.
What medication schedule should an epileptic patient follow in Ramadan? • If it is a once daily medication like Phenytoin, the patient can continue to take it once in the evening after Iftar. • If the medication is a twice daily dose like Tegretol ®- carbamazepine, then the patient can continue taking the medication at Iftar and at Suhoor (Imsak time). • If the medication is to be taken three or four times daily, then it is hard to fit in Ramadan schedule. It is recommended that the patient consult his neurologist to prescribe a longer acting formulation. 13 Newsletter | June 2018
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7. Pregnant or breast feeding women General Information The holy month of Ramadan can be a difficult time for pregnant and breastfeeding women. Fasting between dawn and sunset (Maghreb) is obligatory, but mums-to-be still need to get the essential nutrients to help their baby grow healthily.
Is it safe for me to fast? If you are healthy and have not had any complications so far, you can continue your daily routine as normal. Just make sure you slow down, allow time to rest, and stay away from stress and anxiety triggers as far as possible. And remember to get the right nutrients and enough calories when you break your fast. For breastfeeding women, the decision to fast or postpone the fast depends on a number of things, but probably the age of your baby is the main one. The decision is more difficult if your baby is tiny and gets all its nutrition only from nursing, compared with a healthy 1-year-old who is consuming other foods and only breastfeeding at night.
Will I make enough milk? Breastfeeding women are still able to keep up milk production while fasting, but the amount of fat in the breast milk may decrease. This is not a problem in itself, but it could mean your baby gets hungry more quickly and goes to the breast more often. Preparing for fasting will help you avoid potential problems. Talk to your doctor if you are worried about your baby.
When should I break my fast?
During the day if you felt any dizziness, palpitation, headache, blurred vision or decrease fetal movement (especially during third trimester) break your fast and contact your doctor immediately. Be aware of the signs of dehydration and if you have any breastfeeding problems talk to the breast feeding consultant. 14 Newsletter | June 2018
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8. What is dehydration? General Information
Dehydration occurs when you lose more fluid than you take in, and your body doesn't have enough water and other fluids to carry out its normal functions. If the holy month falls during high summer, if you don't replace lost fluids, nutrients and minerals after breaking your Iftar you may get dehydrated.
How to Avoid Dehydration during Ramadan? Stay away from the sun: During the day stay away from the sun and excessive heat. Remain in a cool and shaded area, wear a cap or a hat and do less strenuous activities. Drink water and fluids after Iftar: Normal dehydration post-fast is easily remedied by drinking six to eight glasses of water after Iftar. Try to avoid tea, coffee and sodas, as they contain high levels of caffeine and sugar, which may cause further dehydration. Drink traditional Ramadan drinks: The traditional Iftar drink Kamardeen (apricot) helps in the reduction of discomfort from stomach acid build-up, brought about by the lack of water. Replace lost nutrients and minerals: Drink other fluids besides water, such as fruit juices, to replace lost nutrients and minerals. Getting your five portions of fruits and vegetables, particularly watery citrus fruits. Take care of your health: don't over-exert yourself while fasting and remember that you are allowed to break your fast if you absolutely must. You can simply make it up at a later time.
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9. Thyroid Gland Disturbance General Information Thyroid gland is gland that lies in our neck. It makes thyroid hormone. This hormone controls how the body uses and stores energy.
Hyperthyroidism:
Hyperthyroidism is the medical term for when a person makes too much thyroid hormone. Hyperthyroidism can cause the thyroid gland to enlarge. This causes a swelling in the neck called a "goiter". Hyperthyroidism caused by Grave's disease can also make the eyes bulge. Untreated hyperthyroidism can cause a heart rhythm disorder called “atrial fibrillation,� chest pain, and rarely, heart failure.
During Fasting in Ramadan Carbimazole: take your medicine (full dose/total tablets) before or after Iftar or at suhoor with glass of water/juice one time only.
Hypothyroidism:
Hypothyroidism is when a person does not make enough thyroid hormone & is a condition that makes you feel tired.
During Fasting in Ramadan Levothyroxine: take your medicine 30 minutes before Iftar or 30 minutes before suhoor with glass of water/juice one time only.
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10. Patients on Anticoagulation Therapy General Information Anticoagulants are medications that reduce the ability of the blood to form clot. These medications are used to prevent serious medical conditions related to blood clot. Warfarin, Dabigatran and Rivaroxaban are names of oral anticoagulant medications.
When to take anticoagulation medication during Ramadan? Check with your physician or pharmacist what may be a suitable time to take your medication. They may provide you with a Ramadan dose administration time chart to guide you about administration time. If you are on Warfarin or Rivaroxaban and your dose is once daily, be consistent with the time of administration each day either before start fasting or after breaking your fast. If you are on Dabigatran and the frequency is two times daily, take 1 dose before start fasting and the other dose after you break your fast.
Don’t Forget To Check June Edition of
ARISE Nursing Newsletter Edition of ARISE Nursing Newsletter focusses on the importance of Therapeutic Communication for patients. June
This edition contains techniques of Therapeutic communication and how a nurse can use this to help patients heal faster through higher level of caring. It guides Nurses to contribute to the emotional, mental and physical well being of the patients.
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