Tips for diabetic patients in Ramadan

A major change in the dietary pattern happens during Ramadan compared with other times of the year. Fasting Muslims are required to refrain from consuming water and food from sunrise to sunset, which is a relatively a long period. Diabetes occurs when blood sugar rises in the blood because of a lack in the hormone insulin or the resistance of body cells, which leads to the accumulation of glucose in the blood.Diet during Ramadan for people with diabetes should not differ significantly from a healthy and balanced diet. The nutritional advice should be tailored to their special needs and medical problems. It should aim at maintaining a constant body mass.

Commenting on this topic, Dr. Wafaa Helmi Ayesh, Director of the Clinical Nutrition Department at DHA and a past speaker in the International Medicine Conference & Exhibition, said: “The decision of fasting or not is dependent on the case of each diabetic patient and the advice of the physician. Some diabetic patients can fast in the holy month of Ramadan if they follow a designed diet by their physician that matches their medical diet in order to ensure that they are safe and healthy even while fasting. The diet is designed to propose a healthy food program and to modify the medicine timings and the blood glucose level.”

Dr. Waffa added: “When it comes to diabetic patients, no ‘one diet’ can be used by all similarly. Each case of diabetes is different from the other, and the way the body responds differs too. However, most importantly is that is for people with diabetes to eat enough to keep nourished, but taking in mind that the kind of food is healthy.”

Carbohydrates provide a lot of energy, but they affect sugar level particularly for people with type 2 diabetes.

Carbohydrates with a low glycaemic index such as brown rice, full grain bread and vegetables are better options than white rice, non-full grain bread or potatoes.

Healthy Iftar options in Ramadan should include:

• Whole grain cereal, low-fat milk, cottage cheese with sliced peaches topped with toasted almonds

• Plain Greek Yogurt flavored with blueberries and cinnamon, whole wheat toast with nut butter.

• Foul (a hearty Middle Eastern breakfast dish made of lentils or fava beans), small serving of sliced fruit

• Whole wheat roti (unleavened bread) and egg khagina (a Southeast Asian dish)

Studies had showed that 50–60% of individuals who fast maintain their body-weight during the month of Ramadan, while 20–25% either gain or lose weight. From her side, Dr. Waffa stressed that: “The common practice of ingesting large amounts of foods rich in carbohydrates and fats, especially at the sunset meal, should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing “complex” carbohydrates (slow digesting foods) may be advisable at the predawn meal, which should be eaten as late as possible before the start of the daily fast. It is also recommended that fluid intake be increased during non-fasting hours.”

Traditionally the fast is broken (Iftar) after sunset and begins with the eating of dates and drinking water. Nutritionists advise to limit number of dates eaten to 1-2 each evening and to drink plenty of water and sugar free beverages throughout the evening, but avoid caffeine beverages as they can be dehydrating.

As a nutritionist herself, Dr.Ayesh advices diabetic patients to refrain from food that is high on sugar and sweets during Suhoor. They must depend on fruits, fresh vegetable salads without oily dressings, lentils, yoghurt, whole serial, steam cooked or boiled vegetables with no or less of oils/fats, non-vegetarian items grilled or steamed.

Dr. Ayesh urges diabetic patients to delay their Suhoor meal to the maximum time limit permitted, and hasten to break their fast at the beginning of the stipulated time.At Iftar and after it, diabetic people are encouraged to drink sugar free drinks, fruit juices and water to quench thirst and to compensate for any water and electrolyte deficit that would have occurred in the daytime.

“Sweets may be popular dishes in Ramadan, but they aren’t advised as they can cause an increase in blood sugar levels. If you wish to consume sweets or ‘white carbohydrates’, it may be best to stick to much smaller portions of these.If your blood sugar levels become considerably raised as a result of these meals, it may be best not to continue with the fasting. The Suhoor meal should contain a balance of whole grain sources of starchy carbohydrates as well as some protein and fat to help slow the digestion and help the feeling of fullness last as long as possible into the day.” added Dr.Ayesh.

Most health problems are likely to arise from inappropriate diet or because of over-eating and insufficient sleep.Thus, moderation in eating is the key to good health. Discuss a plan with your dietitian. Keep sensible portions in mind and follow the same guidelines for healthy eating that you do the rest of the year with an emphasis on whole grains, lean sources of meat, fish and poultry, small amounts of heart healthy fats and limit added sugars.