As Ramadan fast approaches, which will see millions of Muslims around the world fast from sunrise to sunset, it is important to understand the relationship between fasting and diabetes.
The Qur’an requires Muslims to fast during the month of Ramadan. However, there are exceptions to this. One of them is that people who are ill or have medical conditions do not have to fast, including people with diabetes.
Diabetes, particularly type 2 diabetes, is a growing health problem for people from the South Asian community, with the likelihood of developing type 2 diabetes is reported to be as much as six times higher than in white Europeans.
However, for the vast majority of Muslims, fasting is an important aspect when practising their faith, which is why Asian Standard has sat down with registered dietician Fareeha Jay, who specialises in diabetes dietetics to talk about how to fast with diabetes safely.
Fareeha Jay graduated in 2000 with a Masters in Anthropology from Quaid-I-Azam University in Pakistan, before moving to the UK in 2004 where she started working as a community development officer.
It was in this role where she worked alongside dieticians that inspired a career change, where she is now a registered dietician with the Health and Care Professions Council.
This advice does not replace that of a GP or diabetic nurse or doctor, and it is important to always consult with them before deciding to fast.
Ms Jay said: “The most important thing for anyone with diabetes is to engage with their diabetes team or GP. In many cases, the diabetes team or GP may want to change the medication or dose or timing of administering the medication.
“There is often a cultural pressure to engage in fasting, so the first thing is we need to encourage people to engage with health professionals. Nevertheless, it is their decision, and it is up to the induvial whether they want to fast.”
If your blood sugar is below 4mmol/l or over 16.6 mmol/l, then it is important to break the fast to consume food or water to reduce the risk of getting seriously ill or a trip to the hospital. If you feel unwell or disorientated, contact your GP.
Here are eight helpful tips to remember when fasting whilst living with diabetes.
- Staying hydrated
One mistake people often make when thinking about is fasting and diabetes is that it is all about the food. However, keeping hydrated is equally as important as it keeps blood sugar levels down.
Ms Jay explains: “We need to think about fluids. Hydration is very important. People with diabetes can get hypoglycaemia or hyperglycaemia, and dehydration which can lead to thrombosis.
“Around six to eight glasses of fluid are recommended. This amount of fluid can seem like a lot, so it may be beneficial to initially aim for two or three glasses and get the rest from meals or fruit.”
Milk, soup, fruit and vegetables, all count as hydration. Fruit tea and sugar-free drinks also count in increasing fluid levels. Drinks with caffeine such as tea and coffee, also count, but they can contribute to feeling dehydrated, a faster heart rate, and restlessness.
- Do not skip Suhoor
People with diabetes should not skip Suhoor. Instead of eating one big meal at Iftar, people should remember to eat at Suhoor.
The dietician said: “People often feel tired and so they skip Suhoor. It is important that they have two meals during the fast break.
“A balanced meal at Suhoor is important so people will be energised and not feel hungry throughout the day”, Ms Jay said.
She added: “Suhoor doesn’t need to be elaborate. Suhoor should start with some fluids, water is the best, but milk is also good a choice, followed by a balanced meal.
- Eating balanced meals
Ms Jay recommends people eat a portion of complex carbs – 80-160g of basmati rice or brown rice, oatmeal, barley, buckwheat, or quinoa. These types of carbs are extremely high in fibre and are a slow release of energy, which helps to regulate blood sugar levels.
Healthy fats, such as nuts, olives, nut butter, and olives, are needed in the diet as they can slow down the release of energy when combined with complex carbs, meaning that blood sugar is stabilised, and you feel fuller for longer.
Alongside this, a portion of protein is recommended, either from lean meat, dairy, or a plant-based alternative, which is needed to build and repair bones and muscles in the body.
Good meat proteins include 60-90g of chicken, lamb, beef, or fish per person, with dairy including 200ml of milk, 125ml of yoghurt, or a matchbox-size portion of cheese. Plant-based sources of protein come from lentils, chickpeas, tofu, and nuts such as almonds and tofu.
Vegetables and fruit, if possible, is also needed at Suhoor and Iftar, as they are a good source of vitamins and minerals, and a great source of fibre, which can help maintain a healthy gut, the registered dietician said. Vegetables can include starchy vegetables, such as potato, sweet potato, and corn as they are a source of slow-releasing energy.
- Reduce salt intake
The NHS recommends consuming no more than 6g of salt per day, which sounds like a lot, but salt is in everything. Food rich in salt can make you feel thirsty, which can lead to dehydration and thrombosis.
Cheese, fatty foods, and processed food all contain excess salt which is why Ms Jay advises minimising consuming them during Ramadan and throughout the rest of the year.
It is also good to watch out for caffeine and spicy foods, as they can also make you feel more dehydrated.
- Portion control and moderation
Portion control is necessary for every meal, but it is especially important when fasting during Ramadan.
People with diabetes do not need to cut out fruit or snacks completely out of their diet completely, but instead, eat them in smaller quantities.
Ms Jay recommends eating three portions of fruit a day. One portion at Suhoor and the rest at Iftar. A portion is what you can fit in the palm of your hands.
“When we talk about diabetes, we always think about moderation. We do not talk about stopping eating certain things, instead of about eating them in moderation.
“People tend to eat more at Iftar, so rather than having a big portion of dessert, have half of what you would normally eat.”, the dietician said.
- Splitting the Iftar meal
“It is important that people do not eat a large meal immediately after breaking the fast”, the dietician said. Instead, it should be broken into two halves.
When people break the fast with some dates or a glass of milk, Ms Jay recommends eating a small bowl of soup or having a small starter before the main meal. This is because eating a big meal at once can cause blood pressure and glucose levels to spike and can lead to indigestion.
Like with Suhoor, people need to plan an Iftar meal that includes complex carbohydrates, coupling it with protein, healthy fats and some fruit and vegetables, if possible.
Ms Jay said: “The important thing to remember is to limit refined carbs and eat in moderation. Refined carbs include white bread, naan, and cereal. As soon as you eat these, your body breaks them down and you get a sugar spike – which you do not want.”
- Exercise but only in moderation
Exercising during Ramadan is healthy, but it is important to not push your body to the limit. Exercising after Taraweeh prayers is often a good time to work out after a meal and water are consumed, and before Suhoor.
The dietician said: “Exercise is great, but it is important to not overdo it. This is not the time to build muscles, do not be afraid to scale back the intensity. Exercise is good for people who have hyperglycaemia.
“Listen to your body and what it requires. A walk or a stroll can be beneficial.”
- Changing cooking methods
Ms Jay said, there is often a focus on fried foods – pakoras, samosas, and chips. “If you fancy having them, maybe bake them instead of frying them”, the dietitian said.
She added: “They often do not taste the same, but it is a small compromise that you have to make. You don’t have to stop eating these foods, but changing the preparation often makes a big difference.”
Other ways of making easy swaps, is by limiting the amount of oil you use by brushing it on instead of pouring it on, use low-fat milk or yoghurt, and boil, steam, or bake vegetables.