British Islamic Medical Association (BIMA) presents. Healthy Ramadan. Name of Speaker

Transcription

1 British Islamic Medical Association (BIMA) presents Healthy Ramadan Name of Speaker

2 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 Alliance South Asian Health Foundation

3 British Islamic Medical Association Volunteer led and delivered 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

4 Our Mission Inspire our members to unite in the service of our patients and profession

5 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 BIMA at or speak to the presenter.

6 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.

7 OBJECTIVES OF TODAY Learn about Potential health benefits and risks of fasting Diabetes and Ramadan Discuss a healthy diet plan

8 Why do you fast

9 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 13 th,14 th,15 th days of any Islamic month Mondays and Thursdays Every other day (Prophet Dawud as)

10 Health Benefits of Fasting

11 Health Benefits of Fasting? Potential!

12 Health Benefits of Fasting?

13 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

14 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

15 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

16 Health Benefits of Fasting? (4) Fasting during the month of Ramadan can be good for your health if it's done correctly. Don`t eat in excess Eat and drink, but not excessively Surah 7 v31

17 Health Risks of Fasting

18 Health Risks of Fasting? Real and can be serious!

19 Health Risks of Fasting? (1) Dehydration/loss of water Stress Sleep disruption Headache Heartburn Constipation

20 Health Risks of Fasting? (2) More at risk groups: Pre-existing medical conditions Diabetes Asthma/COPD Heart Failure Chronic Kidney Disease Acute infections Pregnancy

21 Health Risks of Fasting? (3) Ramadan likely to start on May 15 th 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

22 IMPACT OF FASTING ON THE BODY Ramadan and Diabetes: A guide for patients

23 Diabetes & Fasting Patient information leaflet Based on MCB and Diabetes Professional Advisory Group. Based on consensus of expert opinion.

24 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 million.

25 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

26 Diabetic complications

27 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

28 WHO IS EXEMPT

29 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)

30 WHO IS EXEMPT? 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.

31 POTENTIAL RISKS WHEN FASTING FOR DIABETICS

32 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.

33 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.

34 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).

35 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.

36 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.

37 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.

38 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.

39 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 Person Religion Medicine Al-Arouj M, et al. Diabetes Care. 2010; 33(8):

40 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

41 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

42 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

43 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)

44 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)

45 Eat of the good wholesome things. (Surah Ta-Ha, Ayah 81)

46 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)

47 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.

48 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, reduces headaches and dizziness

49 Suhoor/Sehri/Pre-dawn meal (4) Avoid sugary and fizzy drinks Avoid high caffeine drinks as they cause you to lose more fluids Take Suhoor as late as possible

50 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)

51 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.

52 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

53 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.

54 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

55 Further Information Diabetes UK Muslim Council of Britain (MCB) South Asian Health Foundation (SAHF)

56 THANK YOU Any Questions?