Fasting for chronic patients: How and when [Archives:2006/988/Health]

October 9 2006

Dr. Bahaa Lotfy
“Doctor, I have a cardiac problem, but I want to fast during Ramadan. How can I do it properly?” This is a very common question asked not only by cardiac patients, but by many other chronic patients. However, the answer is sophisticated.

Ramadan fasting is one of the Islamic faith's basic pillars. One first should look at the positive and negative effects of fasting upon the human body. The body needs food to provide energy for immediate use by burning carbohydrates; that is, sugar. Excess carbohydrates that can't be used immediately are stored for future use as fat tissue in muscles and as glycogen in the liver. Insulin, a hormone secreted from the pancreas, lowers blood sugar and diverts it to other forms of energy storage; that is, glycogen.

When one fasts (or drastically decreases carbohydrate intake), blood glucose and insulin levels are lowered, which causes breakdown of glycogen in the liver to provide glucose for energy, as well as breakdown of fat in adipose tissue also for energy.

Total fasting reduces or eliminates hunger and causes rapid weight loss. In his book “Fasting as a Way of Life,” Allan Cott noted, “Fasting brings a wholesome physiological rest to the digestive tract and central nervous system and normalizes metabolism.”

A study conducted in the Cardiology and Cardiovascular Surgery Department at Hamad General Hospital part of Hamad Medical Corporation in Qatar investigated whether Ramadan fasting has any effect on patients with heart disease. Studying 465 outpatients with various heart diseases who fasted during Ramadan from Oct. 24 to Nov. 24, 2003, they concluded that the effects of fasting during Ramadan upon stable cardiac disease patients are minimal; thus, most patients with stable cardiac disease can fast.

Suggested fasting guidelines for medical patients

Diabetic patients: Diabetics who control their condition by diet alone can fast and hopefully, with weight reduction, their disease may even be cured or at least improve.

However, those diabetics who supplement their diet with oral hypoglycemia agents should exercise extreme caution if they decide to fast. These patients should reduce their dosage to one-third and not take the medication in the morning, but rather with the evening iftar meal. Also, if they develop low blood sugar symptoms during the day, they should break the fast immediately.

Diabetic patients who take insulin shouldn't fast. However, if they do so at their own risk, they should be closely supervised and drastically change their insulin dosage. For example, such patients should eliminate short-acting insulin altogether and take only NPH or Lantus after the iftar meal or before the sahoor meal.

If diabetic patients fast, they still should observe a diabetic diet during iftar, sahoor and dinner, checking their blood sugar both before breakfast and after ending their fast. Also, sweet snacks common during Ramadan aren't good for their disease.

Hypertensive and cardiac patients: Those who are overweight with mild to moderate high blood pressure should be encouraged to fast, since it may help lower blood pressure. They also should see their physician to adjust their medications. For example, the water pill (diuretic) dosage should be reduced for fear of dehydration and long-acting agents can be taken once a day before sahoor. Such patients also should avoid pickles and salty foods at iftar. However, those with severe hypertension or heart disease shouldn't fast at all.

Coronary heart disease patients with heartbeat irregularities (arrhythmia) should be careful and consult their cardiologist before making any medication changes. Also, it's strongly advised to avoid iftar foods containing lipids (fat) and, needless to say, they should stop smoking and avoid chewing qat.

Dr. Bahaa Lotfy is a cardiology specialist at Saudi-German Hospital, Sana'a.