Ramadan and food when living with diabetesMonday, 23 March 2020
Ramadan is the ninth month of the Islamic lunar calendar. It is a sacred time to commune with God while abstaining from eating, drinking and smoking. Muslims fast for an entire month from sunrise to sunset. It is a time to learn how to manage eating habits, improve self-control and discipline, and sympathise with the poor. The end of Ramadan is marked by Eid ul Fitr, the festival of breaking the fast.
According to religious tenets, fasting is not meant to create excessive hardship on an individual. The sick, elderly, pregnant or breastfeeding are exempt from fasting. Fasting is a commendable spiritual practice but it’s one that can come with major health risks for people living with diabetes. However, most people living with type 2 diabetes who are treated with metformin, thiazolinediones or diet alone, and who have blood glucose well managed, are at low risk of complications with fasting.
Hypoglycaemia (low blood glucose levels below 4mmol/L) and hyperglycaemia (high blood glucose levels over 15mmol/L) are common risk factors for people who are fasting. Hypoglycaemia occurs more frequently during the fasting hours and if you experience it you must break your fast immediately. If not, your blood glucose levels will continue to drop further. Hyperglycaemia occurs as a result of overeating or eating too many carbohydrates when the fast is broken. People living with diabetes can also experience dehydration when fasting due to decreased fluid consumption and excessive perspiration.
Strategies for safe fasting
- Monitor blood glucose levels
- Check your blood glucose levels more frequently, particularly if you take insulin or are on any sulfonylureas.
- Exercise. Normal physical activity can be maintained, however, too much physical activity especially while fasting can lead to hypoglycaemia and dehydration.
Eating during Ramadan should not be significantly different from healthy eating during the rest of the year. Good nutrition is particularly important as longer gaps between meals and feasting after iftar can lead to greater swings in blood glucose levels. Healthy eating will help you avoid the overeating of carbohydrates and fatty foods in the sunset meal.
Suggested meal plan
- Let your predawn meal (suhoor) be the largest one.
- Include complex carbohydrates such as multigrain/wholegrain, sourdough breads, porridge, oats, bran, barley, semolina and buckwheat to give you sustainable energy throughout the day
- Include protein rich foods such as lean meat, poultry, fish, eggs, dairy products, seeds, nuts, beans, legumes and tofu
- Drink plenty of fluids, and choose fluid-rich foods to make sure you are well hydrated for the day
When breaking your fast (iftar)
- Break your fast with a date, a cup of water and / or a bowl of soup. Three dates are equal to one exchange (15g of carbohydrates). This will provide an instant energy boost and help settle your hunger and prevent overeating at the start of your meal. Give yourself 10-15 minutes to pray.
- Eat slowly and chew food well to help develop mindfulness around eating
- Use the healthy plate model as a reminder: a quarter of your plate should be complex low GI carbohydrates such as low GI rice, legumes and sweet potato, a further quarter of your plate should be lean meat, skinless chicken, egg, fish or tofu; the final half of your plate should be vegetables or salad
- Make sure you drink plenty of fluids – try to drink two cups every hour to remain hydrated
Snacking after iftar
Snack two to three hours after iftar to avoid overeating when you break your fast and to prevent overindulging in traditional sweets. Avoid sugary foods as they don’t provide you with sustainable energy. Fried foods may also make you feel sluggish.
Some healthy choices include:
- One or two pieces of fresh fruit
- Canned fruit in natural juice (drained)
- Vegetable sticks with a tablespoon of hummus, tomato salsa or yoghurt dip
- 100-200g of low fat yoghurt
- A cup of low fat milk or soy milk (calcium fortified)
- Unbuttered and unsalted popcorn
- A handful of plain raw unsalted nuts
- A slice of grainy bread with a thin spread of avocado, low-fat ricotta, cottage cheese or hummus, with sliced vegetables
It is recommended to have a pre-Ramadan medical assessment to check your health and discuss what changes you will need to make to your medications or insulin regimen if you choose to observe fasting. When you fast your calorie intake is restricted which makes you are more sensitive to insulin. It is important to work with your health care professional to ensure you avoid any complications.