The month-long fast of Ramadan this year started on 23 March and will end on 22 April 2023.
Ramadan is a holy month to Muslims where they aim to grow spiritually. It is a month of fasting, introspection and prayers. However, observing the fast is not as straightforward for someone with a chronic condition such as hypertension or diabetes.
What happens to our bodies during fasting ?
Fasting promotes radical change in cellular physiology and metabolism. Among the many health benefits are weight loss, decreased inflammation, improved blood pressure and cholesterol levels.
However, unlike intermittent fasting where you can consume water during your fasting period, Muslims must abstain from both food and water during the fasting period.
Prolonged periods without water intake will naturally lead to dehydration. Persons with mild dehydration could experience symptoms such as headache that can be relatively easy to resolve. However, severe dehydration could lead to difficulty urinating, constipation and in extreme cases, cardiac arrhythmia.
A person with a weak heart may also experience water retention due to reduced kidney function. This is due to the activation of a complex system of compensatory mechanisms working on the kidneys, which are meant to protect us when the body senses an acute reduction of blood volume, here due to dehydration. Fluid retention could happen in a few parts of our body, with the most common being the lower limbs. It could also accumulate in the lungs, resulting in breathing difficulties.
Can a person with cardiovascular disease fast ?
Whether a person with cardiovascular disease can or cannot fast is highly dependent on the condition of his cardiovascular diseases. Persons with well-managed cardiovascular diseases should not face serious health issues should they decide to fast.
On the other hand, persons with acute cardiovascular diseases, or who have gone for recent heart surgery should consider the impact of fasting on their health during the fasting period.
For example, persons who have had a recent myocardial infarction, who have decompensated heart failure, or who have uncontrolled hypertension with multiple medications are advised not to fast.
How can a person with hypertension or cardiovascular disease fast safely ?
For a start, it is recommended to consult your doctor, or an internal medicine doctor, to assess your health condition before deciding if you can fast during Ramadan.
An internal medicine doctor who is trained to manage complex and multiple medical conditions would also review your medication dosages, and help you find the best time to take them before fasting or after breaking fast. This is extremely important for some patients who are on prescriptions that required three doses a day, as they may need to skip the dose within the fasting period.
Having a balanced diet rich in fresh fruits and vegetables is important, especially during this period. They are an important source of potassium that helps to control high blood pressure. Low fat dairy products have also shown to help regulate blood pressure and provide the calcium needed to improve bone health.
It is also advisable to avoid high fat dishes, stimulants such as coffee and processed meat.
These foods put extra load on your digestive system, which can mess with your blood pressure and water balance.
Many people also take the opportunity during Ramadan to quit smoking. Smoking has been known to be a a causative factor for high blood pressure. It increases the systolic pressure, and significantly increases the risk of heart attacks.
Lastly, it is important to be sensitive to your body reactions during the fasting period. Should you experience symptoms such as headaches, giddiness and breathing difficulties, it is important to get medical help immediately to alleviate the symptoms.
Ramadan fasting and diabetes
While Ramadan fasting means that neither food nor drink should be consumed from dawn to dusk, the nighttime traditionally holds the promise of festive meals, often particularly rich and sweet. The high sugar content may pose a significant challenge to managing diabetes mellitus well, as does the fasting during daytime. To complicate matters, the fasting state may stimulate the release of stored glucose, paradoxically leading to “fasting hyperglycaemia”
The American Diabetes Association (ADA) has published specific advice for diabetics during Ramadan. Diabetics who are at high risk for hypoglycemia and those with multiple diabetic complications (diabetic kidney disease, diabetic neuropathy and diabetic retinopathy) are advised to not fast during Ramadan, but rather maintain their usual nutritional routines. Children with type 1 diabetes should strongly be advised not to fast due to the high risk of acute complications such as hypoglycemia and probably diabetic ketoacidosis (DKA). Pregnant women with diabetes or gestational diabetes should be advised to avoid fasting because of possible negative maternal and fetal outcomes.
As adverse side effects may occur even in lower risk groups, the ADA recommends doing a thorough check of diabetic control in the weeks leading up to Ramadan. This should be followed up by patient education on the symptoms of both too high and too low blood sugar levels, so that patients will recognize danger early on and will be able to act on this. Education should also cover important aspects like glycemic targets, self-monitoring of blood glucose, diet, physical activity including Taraweeh prayers, medication and dose adjustment, side effects and when to break the fast.
Patients medicating with oral agents such as metformin, thiazolidinediones and dipeptidyl peptidase-4 inhibitors appear to be safe and do not need dose adjustment. By contrast, most sulfonylureas may not be used safely during Ramadan except with extreme caution; besides, older agents, such as chlorpropamide or glyburide, should not be used. Reduction of the dosage of sulfonylurea is needed depending on the degree of control prior to fasting.
Patients who require insulin treatment should ideally seek customized treatment plans from their regular physicians. Insulin therapy should be individually adjusted depending on usual glycaemic control at the beginning of Ramadan, after a few short days of adjustment, at the end of Ramadan and then again be reassessed a few short days later.
About Dr Adrian Mondry
Dr Adrian Mondry is a Hypertension Specialist accredited by the German Hypertension League in Singapore. He was previously a senior consultant in the department of medicine at the National University Hospital and Ng Teng Fong General Hospital (NTFGH), Dr Mondry has more than 30 years of experience in the field of internal medicine.
Dr Adrian Mondry is recognised for his leadership and contributions in establishing the dedicated hypertension clinic within the National University Health System and fast-track deep vein thrombosis service at NTFGH.
Dr Adrian Mondry is fluent in English, German and French.
About Kaizen Medical
Kaizen Medical is located at Mount Elizabeth Novena Specialist Centre, Suite 11-57.
At Kaizen, we provide in depth health care to patients with multi-organs diseases; tackling undifferentiated presentations that cannot be easily assigned to a single organ.