Healthy Ramadan - islambradford.comislambradford.com/downloads/misc/HealthyRamadhan.pdfSpecial...

Healthy Ramadan

Name of Speaker

British Islamic Medical Association (BIMA) presents

Special thanks

Dr M Ali Karamat (Consultant Endocrinologist)

Dr Ateeq Syed (Consultant Endocrinologist)

Dr Ahmed Helmy (Consultant Endocrinologist)

Dr Naveed Yunis (Consultant Endocrinologist)

Dr Shahzad Amin (General Practitioner)

Resources:

Diabetes UK

International Diabetes Federation

Diabetes and Ramadan International AllianceSouth Asian Health Foundation

British Islamic Medical Association

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• Presence in all regions across the UK

• Strong Islamic values and community links

• Network of Health Care Professionals

We have over 1300 members who are Doctors, Pharmacists, Dentists, Optometrists, Nurses,

Paramedics, Students and more

Our Mission

Inspire our members to unite in the service of our patients and

profession

DISCLAIMER

This BIMA Health Promotion presentation is intended to provide general information to the public, and is not intended to address specific circumstances of any particular individual or entity and does not replace independent professional guidance and judgements.

BIMA has no conflicts of interest in this presentation and have independently compiled this presentation. We have received no sponsorship from pharmaceutical companies or Islamic organisations.

All reasonable measures have been taken to ensure the quality and accuracy of the information presented in this talk.

If you find any information regarding this talk that you believe may be inaccurate, please email BIMA at info@britishima.org or speak to the presenter.

IMPORTANT

• Please consult your GP for your specific medical issues

• Please consult a scholar with regards to any specific Islamic aspects of fasting

• There are differences of opinion within Islamic Jurisprudence and scholars and we respect these.

OBJECTIVES OF TODAY

• Learn about Potential health benefits and risks of fasting

• Diabetes and Ramadan

• Discuss a healthy diet plan

Why do you fast

Why do you fast?

• Fasting in Ramadan is a command from Allah swt and is compulsory for Muslims unless exempted.

• Health benefits are secondary.

• It`s recommended to fast in other months and on specific days as well.

• Muharram, Sha`ban, Shawwal, Dhul Hijjah

• 13th,14th,15th days of any Islamic month

• Mondays and Thursdays

• Every other day (Prophet Dawud as)

Health Benefits of Fasting

Health Benefits of Fasting?

Potential!

Health Benefits of Fasting?

Health Benefits of Fasting? (1)

• Potential health benefits are secondary.

• Evidence that short periods of fasting, if properly controlled, could achieve a number of health benefits, as well as potentially helping the overweight.

• Fasting diets have become one of the most popular health trends in recent years.

• Intermittent Fasting

Health Benefits of Fasting? (2)

• The power of Intermittent Fasting – 2012

• The so-called 5:2 diet made famous by Dr Michael Mosley.

• Eat normally 5 days a week, then two days a week you eat 500 calories if you are a woman, or 600 calories, if you are a man

• Sunnah/Prophetic tradition to fast on two days of the week Monday and Thursday

Health Benefits of Fasting? (3)

• Benefits of weight loss

• Improvement in Cholesterol

• Improvement in Blood Pressure Control

• Blood Glucose Control (in majority)

• Mental well being

• Control addictions e.g. like smoking

Health Benefits of Fasting? (4)

• Fasting during the month of Ramadan canbe good for your health if it's done correctly.

• Don`t eat in excess

• ‘Eat and drink, but not excessively’ Surah 7 v31

Health Risks of Fasting

Health Risks of Fasting?

Real and can be serious!

Health Risks of Fasting? (1)

• Dehydration/loss of water

• Stress

• Sleep disruption

• Headache

• Heartburn

• Constipation

Health Risks of Fasting? (2)

• More at risk groups:

– Pre-existing medical conditions

• Diabetes

• Asthma/COPD

• Heart Failure

– Chronic Kidney Disease

– Acute infections

– Pregnancy

Health Risks of Fasting? (3)

• Ramadan likely to start on May 15th 2018

• Long duration of fast >17 hrs

• Hot temperature

• Increased risk of dehydration

• Increased risk for certain patients.

• Change in diet puts certain patients at risk

ON THE BODY

Ramadan and Diabetes:

A guide for patients www.mcb.org.uk

IMPACT OF FASTING

Diabetes & Fasting

• Patient information leaflet

• Based on MCB and Diabetes Professional Advisory Group.

• Based on consensus of expert opinion.

Diabetes➢ In the UK Muslim population is estimated at 2.9 million

➢ Prevalence of diabetes is 22%, hence there are 750,000 patients with diabetes especially➢Pakistani, Indian and Bangladeshi➢ Middle eastern, South East Asian➢Black Population

➢ Fasting in Ramadan by Muslims is practiced by:▪ 43% Type 1 diabetic patients.▪ 79% Type 2 diabetic patients.

➢ Estimated number of Muslims world wide with diabetes who fast the month of Ramadan is 40-50 million.

Types of Diabetes

➢Type 1 diabetes: Need insulin (10%)

➢Type 2 diabetes (90%)

➢Diet

➢Tablets

➢Insulin +/- tablets

• Strongly linked to obesity/overweight

• Genetic (family history)

• Increases with age

Diabetic complications

Diabetes Complications

▪ Poor diabetic control linked to high blood pressure, eye diseases, kidney failure, heart disease, stroke, nerve damage and foot amputations.

▪ Good long term control can PREVENT these problems

WHO IS EXEMPT

WHO IS EXEMPT?

• children (under the age of puberty)

• elderly

• the sick: chronic and acute illnesses

• those with learning difficulties

• those who are travelling

• pregnant, breastfeeding and menstruating women.

However, should any one of you be sick or on a journey, then (he

should fast) a number of other days (equal to the missed ones);

And as for those who fast (with difficulty) they have a choice either

to fast or to feed a poor person for every day.

(Surah Baqarah: Ayah 184)

➢ Patients with certain conditions are exempt from fasting during Ramadan

■ High risk of complications if daily food and fluid intake are markedly altered

➢ More than a permission not to fast

■ “God likes His permission to be fulfilled, as He likes His will to be executed”

➢ ‘Fidyah’: compensation for not fasting

■ Fast at later date if possible

■ Feed the hungry and poor

Many Muslims with diabetes insist on fasting during Ramadan. This creates a medical challenges for both patients and physicians.

WHO IS EXEMPT?

POTENTIAL

RISKS WHEN

FASTING FOR

DIABETICS

POTENTIAL RISKS WHEN

FASTING FOR DIABETICS

1 Hypoglycaemia (when glucose levels are too low)

• Shaking, sweating

• Blurred vision

• Tingling of the lips

• Irritability/anxiety

• Fast pulse/palpitations.

Not all people with diabetes will be at risk of hypos

– only those with insulin or using certain medication.

POTENTIAL RISKS WHEN

FASTING FOR DIABETICS

The EPIDIAR study found that the change in eating patterns

during Ramadan increased the risk of severe hypoglycaemia

4.7 fold in type 1 diabetes and 7.5 fold in type 2 diabetes.

POTENTIAL RISKS WHEN

FASTING FOR DIABETICS

2 Hyperglycaemia (When glucose levels are too high)

• Thirst

• Going to the toilet more often

• Headaches

• Extreme tiredness

• Ketones – pear drop smell on breath (mainly for people

with Type 1 and occasionally for people with Type 2).

POTENTIAL RISKS WHEN

FASTING FOR DIABETICS

The EPIDIAR study found a fivefold increase in the incidence of

severe hyperglycaemia in patients with type 2 diabetes during

Ramadan.

POTENTIAL RISKS WHEN

FASTING FOR DIABETICS

3 Dehydration

• Feel more thirsty

• Not going to the toilet as often

• Dry mouth, lips and skin.

Remember testing your blood glucose levels doesn’t

break your fast so if you have the facility to test your

blood glucose levels regularly please do so.

BLOOD GLUCOSE CONTROL

• It’s very important to have good blood glucose control if you have been diagnosed with diabetes.

• If your blood glucose levels are too high for too long, you can get extremely ill.

• If you have a blood glucose meter it is important that you check your blood glucose levels more often during fasting.

• Good glucose control helps reduce your risk of developing future complications such as:

– Blindness

– Heart disease

– Stroke

– Nerve damage

– Kidney disease.

BLOOD GLUCOSE CONTROL

• If your blood glucose is less than 4.0mmol/l, end the fast immediately and treat the low blood sugar level.

• If your blood glucose level is higher than 16.7mmol/l, end the fast immediately.

• If you become dehydrated, end the fast immediately and have a drink of water.

• You should never stop your insulin, but you must speak to your doctor because you may need to change the dose and times of your insulin injections.

To fast or not to fast?

• The decision to fast during Ramadan is based on important considerations, including:

– The decision of the individual

– Religious practice

– Medical opinion

Religion Medicine

Person

Al-Arouj M, et al. Diabetes Care. 2010; 33(8):1895–1902.

Low Risk Patients

Well controlled Diabetes and otherwise healthy patients:

• Diet only

• Biguanide (Metformin)

• Thiazolidinedione (Pioglitazone)

• DPP-4 Inhibitors (Sitagliptin, Alogliptin)

• GLP-1 Agonists (Liraglutide)

• SGLT2 inhibitors (Dapagliflozin, Canagliflozin)

MAY HAVE TO CHANGE TIMING OF MEDICATION

Moderate Risk Patients

• Patients on Sulphonylurea (Gliclazide, Glimepiride)

• Poor control of diabetes

• Advanced complications e.g. Heart failure, stroke, foot problems

• Insulin treated (Type 2 Diabetes)

MUST DISCUSS PLAN AND AGREE WITH DIABETIC TEAM BEFORE COMMENCING FASTING

Very High Risk Patients

• Persistent poor control

• Type 1 Diabetes

• Poor awareness of hypoglycaemia

• Recent hospital admission with severe hypos or poor control

• Renal failure

SHOULD NOT FAST

WHAT ARE MY OPTIONS?

• Visit your doctor two months prior to Ramadan (Ideal)

• If you are advised by your doctor to not fast, then take that

advice.

• If you are unable to fast, speak to your local Imam.

• It may be a good idea to do a couple of days in the month

before Ramadan (Shabaan) to see if you are capable of

completing it without any complications.

• In certain areas there are education programes available to

help you manage your diabetes during Ramadan.

I never saw the Messenger of Allah (saws) fast for an entire

month except in Ramadan and I never saw him fast more

than he did in Shabaan.

(Bukhari and Muslim)

HOW SHOULD I MANAGE MY

DIABETES?

• It is important to take your medication with your food

• A suitable medication plan needs to be devised with your

doctor or diabetes team.

• Rigorous exercise is not recommended as the risk of hypos

may be increased.

Make not your own hands contribute to your destruction.

(Surah Baqarah, Ayah 195)

Eat of the good wholesome things.

(Surah Ta-Ha, Ayah 81)

Suhoor/Sehri/Pre-dawn meal (1)

• Anas ra related that the Prophet SAW said ‘Have Suhoor for there are blessings in it’ (Bukhari & Muslim)

• The Prophet pbuh said ‘Do not leave it, even if one of you were to drink a few sips of water, since Allah swt sends mercy and his angels seek forgiveness for those who take it’ (Ahmad)

Suhoor/Sehri/Pre-dawn meal (2)

Modern dieticians have recommended this meal

should be

Wholesome

high in fibre

moderate meal made up of

slow digesting foods giving enough energy for many hrs

with water and juices.

Suhoor/Sehri/Pre-dawn meal (3)

• Slow digesting and energy rich foods include porridge, muesli, bran, barley, wheat, semolina, beans, lentils (dahl), eggs, chicken, fish, broccoli, wholemeal bread/roti, brown rice. These help body to avoid feeling bloated and tired

• Aim adequate hydration as it aids digestion, reducesheadaches and dizziness

Suhoor/Sehri/Pre-dawn meal (4)

• Avoid sugary and fizzy drinks

• Avoid high caffeine drinks as they cause you to losemore fluids

• Take Suhoor as late as possible

Iftar/Iftari/Sunset meal (1)

• Anas RA reported that ‘The Prophet SAW used to break his fast before offering prayers with some fresh dates but if there were no fresh dates he would take a few dry dates and if there were no dry dates he would take a few drops of water’ (Tirmidhi)

Iftar/Iftari/Sunset meal (2)

• Healthy ways to break the fast include a handful of dates and some water. Dieticians recommend dates as they give refreshing boost of energy and juices.

• Healthy ways to open your fast would be slow-releasing food such as porridge, chapatti, lentils, beans, basmati rice or a handful of nuts.

• Drink as much water/juice as possible during the sunset hours to replace the dehydration from fasting.

Iftar/Iftari/Sunset meal (3)

• Cut down on deep fried foods and try grilled, baked, steamed or shallow fried foods instead

• Deep fried foods cause indigestion, heartburn, weight gain and make you feel bloated.

• Try to have light Iftar meal

Take home messages (Diabetics)

• Talk to your diabetes teams before you start fasting• Testing your blood glucose is important and does not

break the fast. Use a blood glucose meter regularly• Look for signs of hypoglycaemia, hyperglycaemia and

dehydration• Make sure someone you know is aware you are

fasting• Always carry some glucose tablets, glucose gel or a

sugary drink in case of hypo. This should be followed up with a snack.

• Finally if you are ill – it is important that you break your fast.

Take home messages (for all)

• There are potential benefits of fasting

• Weight loss

• Improvement in Cholesterol

• Improvement in Blood Pressure Control

• Control addictions e.g. like smoking

• Remember Don`t eat in excess

• ‘Eat and drink, but not excessively’ (Surah 7 v31)

• Have a clever Ramadan Diet Plan

Further Information

Diabetes UK

Muslim Council of Britain (MCB)

South Asian Health Foundation (SAHF)

THANK YOU

Any Questions?