23 August 2010
This Ramadan, LIM WEY WEN speaks to two experts on staying active and healthy throughout the fasting season.
For many Muslims worldwide, the practise of refraining from food and drink for the holy month of Ramadan had started last Wednesday.
That said, fasting during Ramadan is not just about disciplining the body to restrain from food and water from dawn to dusk. On top of that, Muslims are also encouraged to refrain from unlawful desires and do good deeds.
However, as fasting may involve long periods of going without food and water, it can be challenging, especially to people who have medical conditions as they may be required to take their medications at regular intervals.
So, to find out more about how people can stay healthy and active during the month of Ramadan, Fit4Life speaks to Rokiah Don, director of the Ministry of Health’s public health department nutrition division, and Prof Dr Nor Azmi Kamaruddin, senior consultant endocrinologist and president of the Malaysian Endocrine and Metabolic Society for their insights.
From dawn to dusk
“The month of Ramadan, as revealed in the Qur’an, is a special occasion for Muslims. It is a period of restraint, reflection, devotion, generosity and sacrifice,” says Rokiah.
“Fasting during Ramadan teaches patience and self discipline, the ability to face hardship, and tolerate hunger and thirst. It is also an opportunity to train oneself to be aware of what one eats and practise healthy eating, and hopefully this training will last beyond Ramadan,” she adds.
A typical day for a person who is fasting during Ramadan would start with “sahur”, the first meal of the day that is taken before the call for morning prayers (Solat Subuh) before sunrise. He or she will then fast for the rest of the day and breaks the fast when the call for the evening prayers (Solat Maghrib) before sunset is pronounced.
After that, they may perform the Tarawih prayers – extra prayers performed by Muslims at night only during the month of Ramadan, which are encouraged, but not compulsory – before retiring for the day.
“Generally speaking, most people are able to fast, except those who are frail or sick,” says Prof Dr Nor Azmi.
People who are frail or sick, those travelling long distances, and women who are menstruating and breastfeeding can be exempted from fasting. The same goes for pregnant women, if there are concerns that fasting will harm the expectant mother or her baby. However, they are required to substitute the days missed after the month of Ramadan any time in the following year before the next Ramadan.
For people with chronic diseases, whose health or life can be threatened by fasting, and people who did not manage to replace the days missed, the replacement can be in the form of “fidyah” – contribution of a certain amount of staple food or the equivalent in money to feed the poor.
Good habits, health benefits
“Fasting during Ramadan confers many health benefits, such as the lowering of blood sugar, cholesterol, systolic blood pressure, as well as weight,” says Rokiah
There are two things that happen when someone fasts for a long period of time. There is a drop in fluid intake and there is a drop in calorie intake.
As the fasting period depends on the length of day time in a location or country, people who stay further away from the tropics may fast for shorter periods during winter and longer periods during summer compared to tropical countries like Malaysia. In Malaysia, people who fast during Ramadan need to go without food or water for about 14 hours every year.
“When you don’t drink for long periods, you may get dehydrated,” says Prof Dr Nor Azmi. A little dehydration may be tolerable for healthy people, but for the elderly and people who have kidney disease, dehydration may be dangerous as they are more likely to experience its complications (such as kidney failure and kidney stones).
In order to avoid dehydration, it is important for people who fast to drink enough water and to avoid being in the hot sun for prolonged periods.
“Imagine: your body is like a container of water. If you fill it up with enough water, any subsequent reduction in amount from sweating or urination will not be detrimental to the body,” says Dr Nor Azmi.
“The bladder will get rid of the extra water if you start off with a full container. However, if you don’t drink enough, you start off with half a container and you’ll end up with less water at the end of the day,” he elaborates.
Although there is a drop in calorie intake during the day, there is no need to eat excess food during sahur or when one breaks fast (iftar). This is because our body uses its energy stores (glycogen and fat stored in the liver) to maintain the body’s metabolism even without food or energy intake.
“Our diet during Ramadan should not differ very much from our normal daily diet following the serving sizes based on the Malaysian Food Pyramid.
“Our meals should be nutritious and kept as simple as possible and we should eat according to our needs. The diet should be such that we maintain our normal body weight. However, if one is overweight, Ramadan is a good opportunity to lose some weight,” says Rokiah.
“Furthermore, most people assume a more sedentary lifestyle during fasting. Hence a balanced diet which is less in quantity than normal will be sufficient to keep a person healthy and active during Ramadan,” she adds.
To remain healthy during Ramadan, Rokiah offers the following advice:
- Eat sahur just before dawn (half to one hour)
In view of the long hours of fasting, complex carbohydrates should be eaten, especially at sahur, as eating slow-digesting foods (like complex carbohydrates) will make you feel less hungry during the day. Wholemeal breads, brown rice, oats, beans and lentils are good sources of complex carbohydrate. You can also add one to two servings of fruits (eg one to two slices of papaya) to your sahur.
- Refined carbohydrates are better taken during iftar
Refined carbohydrates that are easily digested may be better taken when one breaks fast to restore blood glucose levels. This includes dates, which is an excellent source of sugar (refined carbohydrate), fibre, potassium and magnesium. Milk, fresh fruit juices and soups can also help to maintain water and mineral balance in the body.
- Select healthier food choices
Fried foods, very spicy foods and foods containing too much santan(coconut milk), sugar and salt should be limited and replaced with healthier options. For instance, choose roasted chicken instead of fried chicken, and mee soup or laksa instead of fried mee or curry mee.
- Choose healthier desserts
Sweet desserts should be prepared or served in smaller portions with less sugar. Alternatively, one can serve healthier choices like fresh fruits.
- Drink sufficient water between iftar and going to bed
This is to avoid dehydration and for detoxification of the digestive system. Aim for 8 glasses. The intake of too much coffee and tea should be avoided at sahur. Drinking too much tea will make one pass urine more and inevitably cause loss of mineral from the body.
One of the ways to avoid overeating when one breaks fast is to have a drink or eat some light snacks such as dates before taking a proper meal. This is to reduce the levels of ghrelin, an appetite hormone produced by the brain when one is hungry, and reduces dramatically when any food comes in contact with the lining of the stomach. As ghrelin increases one’s appetite, which stimulates further food intake, lower levels of it can reduce the urge to take in a lot of food after fasting.
“The moment you take in food and the food touches the lining of the stomach, the ghrelin levels in the blood drops … and when they come back for a proper meal, they won’t be eating a lot,” says Dr Nor Azmi.
Special care
Even when patients with chronic diseases can be exempted from fasting, many still decide to go ahead with the practice. However, patients with certain medical conditions require special attention and preparation for Ramadan.
For people with gastric pain due to peptic ulcer or increased gastric acid levels in the stomach, eating foods rich in fibre such as wholemeal bread, oats, vegetables, legumes and fruits in between iftar and sahur can help reduce the build up of acid in the stomach. Otherwise, doctors can also prescribe medications that can control the release of gastric acid in the stomach.
As Muslims are not allowed to take oral or tablet medications when they are fasting, people with diseases that require oral medications throughout the day may need to make prior arrangements with their doctors to change their medication regiments to suit the requirements of Ramadan.
For instance, people with hypertension who are taking blood pressure lowering medicines three times a day can opt for medications that they can take one or two times per day.
This is more important for people who have diabetes because generally, their medications must be accompanied by meals. As the medications are intended increase their insulin levels to reduce the hike in blood sugar levels brought about by meals, their blood sugar levels will go down if they do not take in any food.
With reduced caloric intake for such a long period of time, people (especially those with diabetes) can sometimes experience symptoms of low blood sugar levels (hypoglycaemia). Some of the common symptoms include shivering uncontrollably, having headaches and breaking out in cold sweat.
“We know that some patients, even after we have told them to break their fast when they think they are developing hypoglycaemia, remain stubborn,” says Dr Nor Azmi. “There are those who continue fasting even when they are already sweaty and shaking.”
Since hypoglycaemia can affect a person’s heart and brain, people who are fasting are advised to break their fast as soon as they experience symptoms as it is dangerous and potentially life threatening. (Low blood sugar can lead to inadequate blood supply to the heart and cause symptoms of angina or chest pain, and the brain depends on blood sugar as its only energy source.)
For Rokiah, it is important in the month of Ramadan, particularly to plan your schedule and meals ahead of time in order to make sure you get the nutrients, hydration, and rest that you need, taking into consideration the required prayers during day and night.
“A good schedule and the intake of a balanced diet is critical to maintain good health throughout Ramadan,” she says.
This article was published in www.thestar.com.my on 15 August 2010.