More than one billion Muslims worldwide abstain from food, drink, and oral medications from dawn to sunset during the holy month of Ramadan. Patients with chronic illnesses are exempt but most elect to fast. The fasting period typically lasts 15 to 16 hours, and two meals are eaten during the night. People with heart problems should take extra precautions while fasting during Ramadan, and consult their cardiologists, particularly in determining the proper timing and dosage of their medications, in order to avoid complications.
Patients should consult their cardiologists on how their medication should be administered during Ramadan. Patients and doctors may have to explore the possibility of substituting shorter-acting medication with long-lasting ones in order to compensate for the daily 15-hour fasting time.
Fasting has no negative impact on patients with stable heart conditions who have no recurrent symptoms, such as chest pain or shortness of breath. In fact, fasting could be beneficial for them. Lower food intake; abstaining from smoking, which will relieve the system of tobacco’s harmful effects; and the stress-reduced atmosphere associated with the Holy Month of Ramadan; will reduce heart disease risk in general, and also have a positive impact on people with heart conditions.
Q1. Should a person with diabetes fast?
People who have their diabetes under control, either by diet or using tablets, may fast. However, their Doctor may require them to make changes to their medication in order to help them take tablets outside the times of fasting. Those injecting insulin are advised to take single dose of long acting insulin (Lente) after Iftaar as compared to short acting insulin (Rapid).
Q2. Should a person with high or low blood pressure fast?
Those with well-controlled high blood pressure may fast with lifestyle
alterations and/or medication.
Their Doctor may require a change to their medication in order to help them take tablets outside the times of fasting.
A person with so-called ‘low blood pressure’ who is otherwise well and healthy may fast. An adequate intake of ﬂuid and salts in the diet is advised.
Q3 Is it safe to fast for Ramadan after recent heart surgery?
If you have undergone recent heart surgery or have had a heart attack, you should avoid fasting or going on a restrictive diet for at least 6 weeks. To give your body the best chance of healing, fasting may not always be possible.
Q4 Should a person who taking his blood thinners (anticoagulants), or any medications for an irregular heartbeat, fast?
He can continue fasting , only change your blood thinner, Short acting blood thinner Apixaban and dabigatran )to long acting ( rivoroxaban to be taken once a day for irregular heartbeat instead of using a Pill in the pocket approach –
Metaprolol to Metolar XR
Diltiazem to Dilzem SR which has sustained action throughout the day
Other heart-related reasons to avoid fasting include:
Q5. Will I need to take my medication during fasting hours?
If you’re on heart medication and want to avoid taking oral tablets between dawn and sunset, your doctor may be able to give you versions with longer- lasting effects for the duration of Ramadan, depending on your prescription. Speak to your doctor in advance to find out if this is possible. Bear in mind that if there are no other alternatives, you may not be able to avoid taking medication during fasting hours.
If you’ve had a stent implanted, you will likely be on dual antiplatelet therapy for atleast a year to prevent blood clotting (which means you’ll be taking 2 types of medications, clopidogrel and aspirin). You should be able to fit these around your fast by taking clopidogrel before sehari or after iftar, and your aspirin after iftar.
Always speak to your doctor before beginning your fast so you can explore the best options for you.
Q6. What should I do if I start feeling dizzy or unwell during my fast?
Light-headedness can be brought on by dehydration, so you should try to
avoid this by drinking plenty of water when breaking your fast.
If you do feel dizzy or unwell, and this feeling doesn’t subside after 20 minutes, notify your doctor. Seek medical attention immediately if you feel feverish, short of breath, or faint.
If you’ve concerns about your heart health, always speak to a specialist.
Q7. What should I eat when I keep fast (Sehri)?
The fasts of Ramadan can improve a person’s health, but if the correct diet is not followed, it can possibly worsen it! The deciding factor is not the fast itself, but rather what is consumed in the non-fasting hours.
Overeating can harm the body. A diet that has less than a normal amount of food but is sufﬁciently balanced will keep a person healthy and active during the month of Ramadan.
You try to eat little and often, switching 2 big meals for 4 smaller portions. The diet should be simple and not differ too much from one’s normal everyday diet. It should contain foods from all the major food groups, as shown below.
This must always be accompanied by some complex carbohydrates and proteins. A meal comprising carbohydrates and proteins and some hydration works brilliantly to kick start your day.
These meals will help you get through the fasted state as they are rich in complex carbohydrates which will provide fuel through the day, proteins and healthy fats from nuts will bring satiety and energy at the same time.
paneer or eggs with multigrain bread or chapati’s to name a few.
Q8. What should I eat as break fast (Iftaar)?
Desserts are the most looked forward part of the day
Carrot or ghia burfi, makhana or fox nuts kheer, coconut laddoo, mung daal burfi, mung daal halwa, flaxseed laddoo are some healthy options.
Try apple slices with date syrup, grilled pineapples, cottage cheese with a hone. Swap refined sugar with jaggery, coconut sugar, date syrups and date paste. Adding these sweeteners will add minerals like phosphorous to your diet which helps in ease cough..
We should not focus on restricting calories, instead, we should focus on the right kind of foods which can be sustained. Implementing some of the above ideas in your Ramadan menu will help you find even a better version of you during the fasting month.
|Foods to avoid||Healthy/alternative foods|
Deep-fried foods, eg pakoras, samosas, fried dumplings
|Whole grains, eg chickpeas (plain, or with potato in yogurt with different|
|Indian spices), samosas baked instead of fried, and boiled dumplings|
|High-sugar/high-fat foods, eg Indian sweets such as Ghulab Jamun, Rasgulla, Balushahi, Baklawa||Milk-based sweets and puddings, eg Rasmalai, Barfee|
High-fat cooked foods, eg parathas, oily curries, greasy pastries
|Alternate with chapattis made without oil, and baked or grilled meat and chicken. Try to make pastry at home and use a single layer|
|Cooking methods to avoid||Alternative cooking methods|
|Deep frying||Shallow frying – usually there is very little
difference in taste
|Grilling or baking is healthier and helps retain the taste and original ﬂavour of the food, especially chicken and ﬁsh|
Curries with excessive oil
|Start with measuring the oil used in curry and try to bring the oil content down gradually, eg
reducing ﬁve tablespoons to four. This is a good way of reducing oil without noticing much difference in the taste. A useful tip is to use more
onions and tomatoes in the bulk of the curry