Today was the first day that an estimated 1-1.5 billion Muslims around the world started a month long fast- it’s the first day of Ramadan, the holy month of Islam (in North America, Ramadan will start tomorrow, Sept 2nd). It is the duty of all healthy adult Muslims to abstain from eating, drinking, smoking, sexual activity and even gossiping during sunlight hours for the next 29-30 days- the Koran exempts the sick, the elderly, children below the age of puberty and pregnant women from this duty. The purpose of Ramadan is both physical and spiritual; through fasting and prayer, Muslims practice self-discipline and sacrifice that allows them not only be able to sympathise with the less fortunate, but to cleanse their souls and be relieved of past sins.
During Ramadan, most people will consume two meals a day: the Iftar or the meal at sunset that breaks the fast and the Suhur or the pre-dawn meal. Perhaps a little surprising is that, according to most studies, 50-60% of people who fast will maintain their weight during this month. The rest will either gain weight, as a result of compensatory eating during non-fasting hours, or lose weight- this is more common in overweight individuals.
In order to keep weight stable during Ramadan, it is recommended to avoid the common practice of eating foods rich in saturated fats and simple carbohydrates during non-fasting hours. Instead, the diet during Ramadan shouldn’t differ much from a normal healthy balanced diet rich in complex carbohydrates, vegetables, fruit, protein and healthy fats. It’s also recommended to eat the morning meal as late as possible to keep the time between meals as short as possible.
Dehydration is a very real risk, especially in this hot weather. It’s recommended to take in more fluids during non-fasting hours and to avoid strenuous exercise during fasting hours. Instead, exercise 2 hours after the iftar.
An estimated 40-50 million people with diabetes are expected to fast during Ramadan even though they would be exempt from fasting given that their medical condition may place them at high risk for complications. There is limited information on the consequences of fasting during Ramadan on people with diabetes- most of the findings are based on the 2001 population-based Epidemiology of Diabetes and Ramadan (EPIDIAR) study that looked at 12 243 people with diabetes from 13 Islamic countries. Basically, the study found that risks associated with fasting include low blood sugar, high blood sugar, diabetic ketoacidosis and dehydration.
People with diabetes should obtain a medical assessment 1-2 months prior to Ramadan and obtain proper education on symptoms of hypoglycemia and hyperglycemia, blood glucose monitoring, physical activity, meal planning and how to manage complications. They should also monitor their blood glucose frequently and break the fast if blood glucose falls below 3.9 mmol/L or goes above 16.7 mmol/L or if they become sick.
To avoid high blood sugar after their sunset meal, people with diabetes should spread out their meal, distributing calories over 2-3 smaller meals during the non-fasting interval. They should also exercise 2 hours after the sunset meal rather than during the day. Insulin and medication regimens most probably need to be changed and should be discussed with either their doctor or diabetes educator.
This said, people with Type 1 Diabetes should be advised not to take part in Ramadan since they are at high risk of developing complications, as are people with diabetes that cannot or are unwilling to monitor their blood glucose multiple times during the day. Nonetheless, fasting is a religious decision that is made by individuals, hopefully after receiving appropriate advise from their medical team as well as from their imams (religious leaders).
Muslims prepare for start of Ramadan. http://www.cbc.ca/world/story/2008/08/31/ramadan.html?ref=rss
The Trials of Ramadan Fasting. http://news.bbc.co.uk/2/hi/uk_news/magazine/6989742.stm
Recommendations for Management of Diabetes During Ramadan. http://care.diabetesjournals.org/cgi/reprint/28/9/2305.pdf