We are halfway into the month of Ramadan, the month of fasting. People with ongoing medical conditions or the ones that usually don’t fast get a bit nervous to fast as they think it may cause their medical condition to get worse or it may make them sick. Looking at the experiences of people who have medical conditions and also to an overall experience of public at large it has seen that the fasting results in better health and improves the overall condition of the person. Although the fasting is a stress to the body and may be looked as unhealthy but it is the stress that does actually enhance the performance of the body, provided it is done with a better knowledge and guidance.
People who fast and eat in responsible way and in moderation develop more healthy habits because of the control it provides to the person. It has been seen that they loose stored fat from their body. Loosing fat and the weight leads to improved sugar control as well as improved blood pressure control. This decreases overall risk for the stroke , kidney damage, blindness and heart attack. At the same time it also improves body’s immunity thus making it hard to develop infections.
As we know that the fasting is a stress and can if not managed properly can result in effects usually not intended. Most of the these effects are the result of problems with our behavior as opposed to the fasting itself. So we need to be careful in how we act in Ramadan especially at the fasting and breakfast times. I will highlight some of the possible issues that we all need to keep in mind.
1. Water Balance
People drink excessive water at the start of the fast as well as at the breakfast time. At the start of fast it is in the anticipation of becoming thirsty soon. Although it is otherwise quite ok but not for the people with kidney and heart issues. A weak or damaged kidney and weaker heart will not be able to handle this much water at one time and result in fluid overload state. In our emergency department we do see people on dialysis presenting with fluid overload making it harder for them to breath. So people who have these conditions need to seek help from their physicians prior to making the decision regarding fasting. Their medications need to adjusted and the food intake planned before they can safely fast.
2. Sugar Balance
Similar to water balance eating at the start and finish of fasting this can lead to high swings of glucose in patients with diabetes and also who are pre-diabetics. Most of the young diabetics and well controlled disease can fast without any fear of worsening of their condition. The elderly need to be careful regarding their fast so to avoid any episodes of low blood sugar or abnormally high blood sugar after breaking their fast. Patients need to adjust their medicines and also plan their meals to avoid such catastrophes. They also need to control their habits and adjust the eating at the time of breakfast. Their physicians play a vital role in planning the fast and adjusting their medicines. This way their experience can be a healthy one.
3. Salt Balance
Although we don’t pay much mind to the salt intake but it play a very vital role especially in patients with heart problems and blood pressure issues as well as for patients on dialysis. This pertains to both sodium and potassium salts. People with high blood pressure are sensitive to sodium intake and their blood pressure gets out of control and results in more harm. And for those patients who have kidney issues cannot get rid of potassium so if taken more than required it may cause life threatening bad heart rhythms. The patients need to discuss their food intake and the harmful and safe food should be known by them, so they can avoid these situations.
Although there are other situations also, but these are more commonly encountered. We know by experience that if fasting is done in a moderate way it would result in better health outcomes. So while we care about our spiritual life and cleansing of heart and mind, we should also be careful about our medical conditions that are ongoing. The physician community has a significant role to play. They are the ones that can guide the patients regarding their safety during this important month. They need to guide their patients regarding food, adjust their medications and have appropriate follow up to catch issues before they get out of hand. It then result in better patient doctor relationship and as a result better health outcome.
Happy Ramadan
I can be reached at erdoc@shifa.com.pk.