Come Ramazan and household kitchens go into overdrive. Samosas and pakoras are downed by the dozens and ghee-soaked parathas are consumed to last us the day. The cravings from the day-long abstinence from food are satisfied with the juiciest, fattiest and most calorie-laden fare our cuisine can offer.
But much of what we traditionally eat is counter-productive to our health. In fact, the benefits derived from month-long fasting, such as detoxification of our bodies and regulation of our metabolism, could easily be reversed by binge eating or an unbalanced diet.
To strike a balance between feasting and fasting, T-Magazine gives you the lowdown on how to maintain health and fitness during Ramazan.
Nutrition during Ramazan
This year, the fasts would last anywhere between 16 hours to 18 hours, depending on where in the world you are, and the trend will continue for the next 10 years to 15 years till the time Ramazan coincides with the summers. Taxing weather and dietary excesses could take a toll on your body if a healthy eating and hydration plan is not followed.
To ensure that, your diet should include foods which are low in carbohydrates and rich in proteins, good fats and fibre. Plain water and fruit juices are recommended over artificial sweeteners and soft drinks. Observational studies show a massive correlation between artificial sweeteners and obesity, even though they are calorie-free. But if you insist on satisfying your sweet tooth without having actual sugar, choose the healthier option, stevia.
Dr Mozamila Mughal, clinical dietician at the Aga Khan University Hospital (AKUH), Karachi, advises careful planning of sehr and iftar menus, minimising the intake of fried and spicy food items. Sehri should include foods, such as eggs, porridge and wheat, which sustain the body throughout the day. The fast should be broken with a date and a beverage to restore glucose level in the blood, followed by fruit chat and white or black beans, along with one fried item. One samosa or a couple of pakoras in a day are enough, she says, as three tablespoons of oil is how much a person should consume in a day. “Fat and high-calorie food takes time to digest, causes acidity and increases weight and cholesterol. The stomach gets heavy and causes discomfort and sleeplessness,” Dr Mughal says, adding that people should eat less at iftar and have a full meal at dinner an hour later.
For children who are fasting, healthier meals such as homemade soups, fresh fruit juices, vegetable salads, noodles and milk shakes should be prepared advises Dr Saima Rashid, lecturer at the Dow University of Medical Sciences, Karachi.
Hydration during Ramazan
Doctors recommend drinking eight to ten tall glasses of water a day, which roughly amounts to two litres. If you fail to consume the required quantity of water during the non-fasting hours of Ramazan, you may show signs of dehydration. “Your urine should be pale like straw,” says Dr Rashid. “Any darker [colour] means you need to slowly increase your fluid intake. Your body will quickly adapt and your trips to the bathroom will lessen.” Insufficient fluid intake can lead to kidney stones or lethargy due of fall in blood pressure.
Water intake during Ramazan has to be planned well: drink up to three glasses of water during sehri, while two litres of fluids in the form of water, lassi, milk shakes and fruit juices should be consumed after iftar. If you are already meeting the day’s water intake, you may drink an additional two to four glasses of water to counter the dehydrating effects of air conditioning and extreme outside temperatures, says Dr Rashid.
Fruit and vegetables can be particularly hydrating, and during Ramazan people should try to consume more than five portions of fruit a day — especially watermelon, grapefruit, apples, tomatoes, cucumber, squash, courgettes and lettuce.
Ramazan and diabetes
Long fasts during hot and humid weather can be taxing for the healthy body, and you would assume that patients with diabetes should not fast. But a 2004 study of 12,243 people with diabetes from 13 Islamic countries showed that approximately 43% of the patients with type 1 diabetes and 79% of patients with type 2 diabetes fast during Ramazan.
With adequate care and monitoring of blood sugar, a diabetic patient may fast. “It depends on your own situation,” says Dr Jaweed Akhter, head of endocrinology at the AKUH. “If blood sugars leading up to Ramazan are regulated, then they may fast.”
Ideally, the patient should undergo a medical exam at least one or two months prior to Ramazan to ascertain his condition. On the basis of the results, the physician should be able to recommend the appropriate diet and adjustment in medications for Ramazan.
Dr Akhter recommends taking a small dose of diabetes medication at the time of sehri, while a larger dose during iftari, but of course with the doctor’s advice. “It depends on which medicines they are taking. Usually people take a larger dose during the mornings, which is wrong. On a routine day, the morning dose covers breakfast, snack and lunch, while the evening dose covers dinner. In Ramazan, this is reversed, where in the morning a small dose of medicine is enough for sehri, while the larger evening dose covers iftari, dinner and a possible midnight snack.”
Blood glucose levels must be monitored during the fast, once before iftari and then two hours after it, and in times of weakness or hunger. The fast is not broken by the prick of a needle checking for blood sugar or injecting insulin, according to a fatwa issued by the Islamic Fiqh Assembly of the Organization of the Islamic Conference.
The best way for a diabetic patient to break his fast is by exercising discipline. Dr Akhter suggests breaking the fast with one or two dates, taking an insulin shot if required, offering prayers (which would give the desired 15 minute break between the shot and the meal) and then having dinner, as opposed to snacks.
Risks of fasting for diabetic patients
If a patient has fluctuating levels of blood sugar, is pregnant with diabetes, or suffers from associated kidney problems, then fasting should be avoided. In fact, if blood sugar levels fall below 60mg/dl or surpass 300mg/dl, the fast should immediately be broken.
The risks arising from fasting with uncontrolled diabetes can vary from moderate to severe. The patient may suffer from hypoglycemia — low blood sugar (less than 60 mg/dl) resulting from high insulin, a hormone that allows your body to absorb sugar from food to make energy or store it for later use. The symptoms are weakness, fatigue, palpitations, sweating and hunger pangs. In severe cases, with blood glucose levels of less than 30mg/dl, the patient may suffer from blurred vision, poor responsiveness and even coma and death.
Hyperglycemia occurs when blood sugar rises to more than 300 mg/dl due to low insulin. This could be a result of inappropriate diet or non-adjustment of medication. It could lead to dehydration as the body loses fluids to dilute the sugar concentration in the blood, putting pressure on the kidneys, or leading to clots from increased blood viscosity.
Diabetic ketoacidosis usually results from the excessive reduction of insulin dosages based on the assumption that food intake is reduced during the month. The body switches to burning fat instead of glucose for energy, resulting in high blood sugar.
Recommended diet for diabetes patients:
Foods to take: Foods rich in fibre and complex sugars (which digest slowly and do not lead to instant blood sugar spikes), such as whole grains, fruits, chickpeas, lentils, salads, cereals, meat, lemonade, lassi and dates (maximum two in a day).
Foods to avoid: Foods involving simple sugars such as mangoes (only one small or half of a large mango allowed), fruit juices, refined grains such as white rice (limit to three times a week) and white bread, and fried items.
Ramazan and heart patients
Heart patients suffering from high cholesterol or hypertension, whose condition remains controlled with medication, are encouraged to fast, with small modifications to the dosage and timings of the medicines. “It increases compliance to therapy,” says Dr Aamir Hameed Khan, cardiologist at AKUH. Age is no inhibition for fasting, unless your condition is frail. A blood pressure medicine can be taken without sehri as well, but should not be missed. There are certain medicines, however, which are diuretics, meaning they make the body produce more urine. Such medicines can be taken at the time of iftar to minimise bathroom trips during fasting.
The good news is that diet affects the heart in the long term. “As long as weight is not gained or the waistline is not increased, a month of indulgent eating doesn’t make a difference,” says Dr Khan. “A jalebi would not hurt.” But that doesn’t give you the excuse to eat recklessly. In fact, Dr Khan says that, “The patient should not change his routine or diet, but the whole family should, because they are all at risk of heart ailments due to genetics.”
His recommended method of breaking the fast: take two dates and milk, pray and then have routine dinner for iftar. “Make dinner and iftar one event,” he says. This prevents binge eating, ensures adequate nutrition for the body and leaves the stomach empty before sleeping.
Risks of fasting for heart patients
“Only patients in an unstable condition are asked to refrain from fasting,” says Dr Khan. This includes people who suffer from heart failure and irregular heartbeat, and those who have angina pains during walking, bathing or eating.
Recommended diet for heart patients:
Foods to take: Fruits, salads, vegetables, whole grains, fish, chicken, beans and lentils and beef and mutton in moderation.
Foods to avoid: Fried food items, too much chutney and pickle (they are high in salt and spice) refined and processed carbohydrates (have less fibre and instantly dissolve in blood) such as white bread, white rice and tea and coffee (because they are diuretics and dehydrate the body).
Weight gain and exercise during Ramazan
The long hours of fasting may not be enough to burn out those few extra pakoras from the previous iftar, and your body may start showing signs of a bulging belly and tightening pants. The increase in the consumption of fried food items during Ramazan often leads to weight gain. Some doctors assert that physical training during Ramazan is not necessary as prayers, five times a day, and taraweeh are enough exercise.
But the fitness team at one of Lahore’s popular gyms, Shapes, states that a month-long gap in fitness training for people who regularly work out, sets them back a great deal.
The trick is to maintain your existing exercise programme, but not intensify the routine by increasing weights, sets, repetitions, speed or distance. According to the Shapes team, the ideal time for exercise is 90 minutes before iftar or, as Dr Khan recommends, two hours after it. Thirty minutes of exercise is enough on a fasting day, says Dr Mughal.
There are, of course, exceptions for people who suffer from injury or chronic diseases. The Shapes team does not allow patients with Type 1 diabetes to exercise at all since physical activity may lead to insulin suppression in the body. Type 2 diabetics, however, can do aerobic exercises and low-intensity strength training for a maximum of 30 minutes. For heart patients, Dr Khan insists that the exercise regimen must not change. Ideally, they should do aerobic exercises five times a week for 30 minutes, either before iftar or two hours after it.
The diet effect
Controlling one’s diet is equally important for maintaining a healthy weight. Do not mistake a loss in weight during Ramazan as necessarily a result of eating less; fasting could lead to dehydration and hence the change in weight, warns the Shapes fitness team. Eat foods that digest slowly, such as fibrous foods or those rich in complex carbohydrates, as these keep the stomach full for a long time. Eating too much will not last us the whole day because we cannot store food like camels. Instead, go for a protein breakfast, because calories from it are broken down slower than from carbohydrates. Have sweets only after eating your meal and drinking water, and when your stomach tells your brain that you still have space. Avoid late night snacking as it is more likely to be stored as fat.
Mifrah Haq is a sub-editor for The Express Tribune Magazine.
Ishrat Ansari works at The Express Tribune Karachi desk. She tweets @Ishrat_ansari
Published in The Express Tribune, Sunday Magazine, July 6th, 2014.