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Tips for chronic disease management during Ramadan: PHCC

The Primary Health Care Corporation (PHCC) has offered important health tips for fasting people in the Holy Month of Ramadan.

“A scientific fact based on findings of studies shows that every person needs a certain number of fasting hours to cleanse the body of toxins, if that person does not suffer from any illnesses. We, as doctors, believe that fasting is a patients’ personal right, and our mission is to help them take the right decision and fast safely,” said Dr. Naela Darwish Saad, Manager of PHCC’s Umm Slal Health Center & Consultant Family Medicine.

One of the most important risks that older persons are exposed to while fasting is dehydration as well as complications of chronic diseases, added Dr. Saad. These include heart disease, diabetes, high blood pressure, and kidney failure. Add to that medication nonadherence—when patients do not take their medications as prescribed—, as well as malnutrition and deficiency of some vitamins, minerals, and calcium.

Dr. Saad advised older persons with chronic diseases to see a doctor early enough before Ramadan to check if it is safe to fast, and to manage their medications and determine the proper timings for taking them. Further, she advised to hasten to break their fast and avoid high-fat foods such as fried foods and red meat.

As for people who suffer from chronic diseases, Dr. Saad said that they should consult their doctor before fasting to check if it is safe to fast and develop a treatment plan for them.

Dr. Naela Darwish Saad, Manager of PHCC’s Umm Slal Health Center & Consultant Family Medicine.

For diabetic patients, fasting depends on the type of diabetes and its complications. People with type 1 diabetes who are on insulin or people with type 2 diabetes on several doses of insulin a day are not advised to fast. In general, however, if a patient takes one injection of insulin, it should be before Iftar. If taken twice a day morning and evening, the main dose should be before Iftar and the lowest dose before Suhoor, according to their doctor’s instructions.

For diabetics who take a tablet once a day, it can be taken before Iftar. For tablets taken twice a day, a dose can be taken before Iftar and the other before Suhoor. For some types of tablets, the patient may need to reduce the dose taken at Suhoor, according to their doctor’s instructions.

Dr. Saad noted that all fasting diabetics need to measure their blood sugar levels at home, whether while fasting or at night, to ensure that they control their sugar levels properly. Home tests should be done before Iftar and Suhoor meals and two hours after the two meals to compare the measured blood sugar levels with the desired ones as instructed by the doctor.

Patients with acute hepatitis and decompensated liver failure cannot fast as they desperately need sugars and they develop ascites—the buildup of an abnormal amount of fluid inside the abdomen (belly).

Patients with chronic hepatitis and hepatic steatosis can fast, keeping in mind that they should avoid fatty foods that contain preservatives, pickles, and sweets, and go for vegetable soup and green salad. They should also quit smoking and reduce animal protein to 50 to 80 grams.

Fasting is not required for some patients with cardiovascular disease such as those who experienced a recent stroke during the first six weeks, unstable angina, acute heart failure, heart arrhythmias, some cases of valve stenosis, and some cases of uncontrolled high blood pressure.

Patients with kidney failure should not fast. If a patient is undergoing dialysis, they can fast on the day when they are not undergoing dialysis. It is also advisable not to fast for patients with kidney stones, especially on extremely hot days, but if they do so, they should drink enough fluids at evening and at Suhoor before fasting.

For asthma patients, fasting have benefits such as improving the lungs capacity and asthma. Patients can use bronchodilators while fasting, according to religious scholars’ fatwas as well as the doctor’s instructions. A patient with severe asthma who needs an emergency checkup should break his fast in case he needs intravenous fluids and medicines.

Further, Dr. Saad stated that fasting for pregnant women does not negatively affect the growth of the fetus if she follows a healthy lifestyle and diet. However, she has to consult her doctor to avoid any risks she or her unborn baby may be exposed to or any pain she may feel.

Some pregnant women are not advised to fast such as mothers with low blood pressure, severe vomiting in the early months of pregnancy, and some chronic diseases that require a specific medication. They also should not fast if there is a decrease in fetal movement or weight, if they suffer from preterm labor pain, if they are taking medication to prevent preterm labor, or if they develop preeclampsia.

Dr. Saad advised pregnant women to break their fast with a cup of milk and dates, then have some high-protein foods.

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