THE fasting month can be a challenge to those with chronic illnesses. As Muslims, they are obligated to fast but at the same time, doing so may result in serious health issues. Find out how you can fast without complications.
1 DIABETES
To ensure good blood glucose control, diabetics must ensure that they follow these steps.
Do not skip sahur
Sahur, the meal eaten just before dawn, should be taken as late as possible just before imsak to avoid unnecessary prolonged fasting.
Sahur should have a balance of carbohydrates, wholegrains and wholegrain products, lean protein, fruit and vegetables. It will provide satiety and longlasting energy to maintain blood sugar levels throughout fasting.
Limit foods high in salt, such as processed foods and fast food to reduce risk of dehydration.
Also, drink plenty of water during sahur to stay hydrated
Never delay buka puasa
Start with one or two dates or one serving of fresh fruit with plain water to restore energy. Dates or fresh fruit which are rich in fibre, vitamins and minerals is a good carbohydrate source that provides instant energy after fasting for long hours.
After maghrib prayers, the main meal should comprise complex carbohydrates from rice, noodles or bread with low fat protein sources such as fish and lean meat with fruit and vegetables
Ensure consistency in carbohydrate intake
Be mindful of carbohydrate sources and portion size at each meal.
Excessive carbohydrate intake may lead to hyperglycemia (high blood sugar level) while too little may cause hypoglycemia (low blood sugar level).
Choose complex carbohydrates such as brown rice, wholegrain bread and biscuits.
Avoid refined carbohydrates such as white rice, white bread and sugary food such as carbonated drinks, fruit drinks and juices, sweetened kuih and dessert.
Supper after terawih can be taken as replacement for pre bedtime snacks
Have a glass of an oat drink or low fat milk, one to two slices of wholemeal bread or three to four pieces of wholegrain crackers.
Adjust time for medication
Discuss with your doctor on the adjustment on timing and dosage of oral medication or insulin regime to minimise the risk of high hypoglycemia. Frequent blood glucose monitoring is encouraged before meals and two hours after a meal to determine changes in blood glucose level.
— The above are guidelines from Pantai Hospital Kuala Lumpur dietitian Hin See Ling.
2 HYPERTENSION
Consult your doctor before you start fasting. You may need to adjust your medication accordingly to ensure your blood pressure is under control.
Continue to control sodium intake during fasting month. You are advised to omit/limit foods high in salt/sodium such as processed meats (sausage, nugget, fishball and burger patty), canned products, pickles and salted food (salted egg, cencaluk) and limit the consumption of condiments and flavouring agents which are oftenly high in sodium.
Eat food from all major food groups to get a wholesome and nutritious meal which is low in sodium and high fibre during buka puasa and sahur which include complex carbohydrates, fruit and vegetables, meat or a meat substitute.
Limit intake of sodium especially during sahur to control blood pressure and limit your thirst.
— PHKL dietitian Ong Min Ying
3 GASTROESOPHAEGAL REFLUX DISEASE (GERD)
It is not uncommon for people to “reward” themselves with large portions of fatty, fried and sugary dishes during buka puasa. This further aggravates symptoms of Gerd, which include burning sensation in the chest and throat.
While you should not skip sahur, it is not advisable either to eat large meals during this time.
Eat a well balanced meal for sahur and buka puasa. Avoid high fat foods such as fried food, or foods with excessive amount of coconut milk.
Avoid beverages that contain caffeine (coffee/tea) which may trigger gastric reflux and cause dehydration due to the diuretic effect. — PHKL dietitian Ong Min Ying
4 HEART DISEASE
Ramadan is an opportunity to change your eating habits and improve selfdiscipline in dietary control, especially for those with heart disease.
For buka puasa, eat a healthy and balanced meal that’s low in fat such as grilled or baked foods. If you are having chicken, remember to remove the skin.
Instead of eating cookies and pastries as snacks, take fruit as these help to boost your fibre and vitamin intake.
Don’t skip sahur as it is important to ensure you have sufficient energy to last through the fasting hours. A simple yet healthy food choice for sahur is oats with low fat milk taken with fresh fruit. This provides soluble fibre that reduces cholesterol and provides a slow release of energy. — PHKL dietitian Ong Min Ying
5 KIDNEY DISEASE
Kidney disease patients who are on haemodialysis need higher protein intake to compensate for protein loss during dialysis. They should avoid foods high in phosphorus and potassium.
Limit intake of vegetables and fruit which are high in potassium such as banana, jackfruit and dates.
Avoid drinking excessive fruit juices when breaking fast. Do not over consume water or other beverages after breaking fast. Stick to your usual fluid allowance. A glass of water or lemon juice and a serving of low potassium fruit such as guava, orange, apple, papaya is a good option to minimise potassium intake. Limit dates to two to three a day.
Limit foods high in phosphate such as nasi lemak, coconut milk based dishes and soft boned fish (anchovies, sardines), lentils, beans and egg yolks and items such as kuih lapis, French toast and kaya.
Avoid foods high in sodium such as salted egg and fish, pickles, processed meat, instant noodles and soup dishes cooked with bouillon cubes. Excessive sodium intake can cause fluid retention in the body which can be dangerous for people on haemodialysis.
— PHKL dietitian Hin See Ling.
6 STOMACH ULCER
Stomach ulcers are painful sores that happen when the thick layer of mucus which protects the stomach from digestive juices is reduced.
To ensure healthy fasting, spread food intake into smaller and frequent meals which includes sahur, a light snack for breaking of fast, evening meal after Maghrib prayer and prebed snack after tarawih.
Never skip sahur. Try to eat as late as possible, just before imsak. Having a good and balanced meal with complex carbohydrates from whole grains cereals, lean protein, fruit and vegetables will provide sustainable energy and make you feel less hungry throughout the day.
Do not delay buka puasa. Have a glass of non acidic fresh fruit juice or a portion of non acidic fresh fruit or three dates with plain water. This offers instant energy and rehydrates your body after long hours of fasting.
When you eat after maghrib, watch the food portion. Have a healthy and balanced meal comprising complex carbohydrate, fruit and vegetables.
A light snack which is low in fat and high in fibre (such as oatmeal drink with low fat milk) may be taken after Tarawih. Avoid deep - fried pastries and those made with coconut milk.
Avoid caffeinated drinks such as coffee and tea. These are natural diuretics and can cause your body to excrete more water and make you feel thirsty and dehydrate.
— PHKL dietitian Hin See Ling
7 ANAEMIA
Anaemia occurs when a person has an abnormally low amount of red blood cells. The most common type is iron deficiency anaemia.
They should still follow their normal diet during the fasting month. Include iron rich food during sahur and the evening meal after breaking fast. Examples are red meat, boiled egg, fish and chicken.
Vegetarians can obtain iron from fortified cereals, tofu, chickpeas as well as from vegetables such as kangkung and fern shoots.
Include vitamin C rich fruit and vegetables to enhance the absorption of iron. Consume a glass of fresh orange juice for better iron absorption
Avoid taking iron rich food with coffee or tea as caffeine inhibits iron absorption.
Maintain adequate hydration by drinking enough water during non fasting hours.
Minimise sweet pastries. Opt for food rich in iron such as stuffed tofu or sweet beancurd as snacks. — PHKL dietitian Hin See Ling
8 GOUT
Gout is caused by hyperuricemia (excessive uric acid in the blood). This occurs when the body produces too much, or does not excrete enough, uric acid.
Ensure you take your meals for buka puasa, a light snack after terawih and don’t skip sahur. Eating regular meals will help you obtain enough energy and nutrients during the fasting month.
Avoid high energy foods (fried, rich, greasy and sugary food) which are usually served during fasting month.
Limit servings of protein to two to three a day. One serving equals one palm sized (80g) meat/fish/poultry or two eggs. High intake of protein is a known risk factor for elevated uric acid level.
Be aware of the hidden protein in food. It can be found in foods such as murtabak, satay and kuah kacang, nasi lemak with added dishes such as beef rendang.
— PHKL Head of Dietetic, Wong Wen Yin