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Muslims who have chronic diseases should take measures to ensure they fast without aggravating their conditions, write Kasmiah Mustapha and Nadia Badarudin


THOSE suffering from chronic illnesses, including diabetes, kidney disease and gastric, will face more challenges during Ramadan. They have to change their medication timetable to suit fasting hours, which also means adjusting their eating habits and diet.

While some may need doctors’ advice on whether they can fast, here are several measures patients can take to ensure a smooth fasting month:


Pantai Hospital Kuala Lumpur consultant physician and gastroenterologist Datuk Dr S.Mahendra Raj says patients may find managing their gastric a challenge during the fasting month.
Gastric usually involves a few conditions such as gastroesophageal reflux disease, functional dyspepsia, peptic ulcer disease and stomach ulcer.

Those who have contracted Helicobacter pylori, a bacteria in the stomach wall, will also suffer from the same symptoms, including heartburn, indigestion, nagging pain in the upper abdomen area, nausea, and a gnawing or burning pain in the stomach.

“Without proper management, fasting can aggravate the symptoms. Patients need to change their eating habits. When breaking fast, start with drinking water. Avoid drinking too much coffee or tea or eating oily, spicy food. If you want to eat something sweet, take a small quantity only.

“Then, have small meals over the course of the period. Many tend to break fast with a big meal which is a bad idea. They should split up their meals. Maybe they can have a snack in between the Tarawih prayer and then have a small, well-balanced meal.

“They should avoid eating one hour or 1½ hours before sleep. People with gastritis should not lie down immediately after a meal as it can make their condition worse.”

Patients are usually on medication to reduce the acidity in the stomach. During Ramadan, they have to adjust their medication schedule. Usually, they need to take the medication before food. They may need to take it half-an-hour before breaking fast and half-an-hour before they eat sahur (predawn meal).

They can take a simple antacid before going to bed and immediately after sahur, which will reduce stomach acidity during the day. Those with mild symptoms and who are not on medication may need to take some form of medication during Ramadan.

“Because they are fasting, they need medication to cope with acid reflux, like acid reduction medication. They may need to take one dose during sahur to control acidity in the stomach when they are fasting.

“If the pain is too severe, they don’t have any option but to stop fasting. This is especially for people suffering from stomach ulcers since it can lead to more complications. Fortunately, the majority of people with acid reflux and functional dyspepsia should be able to fast with some adjustments.”


People who suffer from migraine are likely to experience it more often during the fasting month due to dehydration and a low blood sugar level.

When we eat a meal with high sugar content during sahur, this causes blood sugar levels to rise rapidly, followed by a fast drop that may trigger a headache.

Dehydration is also a trigger because the tissues surrounding the brain are largely made up of water. When they lose water, they shrink and this extra pressure can cause headache.

If patients receive the green light from their doctors to fast, there are a few steps they need to take to ensure they won’t suffer from dehydration or low blood sugar level.

“They need to drink a lot of fluid after breaking fast and during sahur. If you don’t drink enough water, the depleting water content in the body when you fast will cause headache. When you drink enough fluid, it provides some balance when you are fasting. Avoid coffee, tea and carbonated drinks. These are diuretic drinks which cause you to urinate more and so leave you dehydrated.”

It does not matter if you don’t drink eight glasses of water as the rule is not set in stone. Even during non-fasting months, people should drink when they are thirsty. “There is this idea that we need to drink eight glasses of water every day. There is no certain rule. Your body has this beautiful mechanism called thirst. It tells your body if it needs fluid. You should drink whenever you feel thirsty. Even if it is less than eight glasses, it does not matter.”

Another step to reduce migraine during fasting is to avoid eating refined carbohydrates. Eat complex carbohydrates such as brown rice or food with high fibre. This should apply to everyone, not only those suffering from migraines.”
Dr Mahendra says usually cheese and chocolate are said to be the triggers for migraine. Those who suffer from migraine should know the triggers and take steps to avoid them. They should also discuss with their doctors on any changes to their medication schedule as well as the dosage.


For diabetes patients, the important thing is to break fast on time and for sahur, they should try to eat as near  to imsak as possible, says Syaidatun.

“Patients are advised to limit food with high sugar content as well as fried food during sahur. Taking one or two dates to break fast is allowed as part of the carbohydrate exchange. Avoid salty food to reduce the risk of dehydration. Diabetics should also try to drink adequate amounts of water, or choose sugar-free drinks.”

The dosage and time of oral medication or insulin may need to be adjusted according to the patient’s blood glucose reading or occurrence of hypoglycaemia. Those on oral medication can take it during breaking fast and sahur. Patients who are on insulin need to adjust time for injections based on their needs.

Besides monitoring diet, it is crucial to self-monitor blood sugar levels throughout the day as these can be erratic when fasting. “If they notice that their blood sugar level drops below 3.0 millimoles per litre or they experience symptoms of hypoglycaemia, they should break fast and manage the condition.

Symptoms include feeling weak and tired, shaking and sweating, headache, nervousness or anxiety, feeling irritable or uneasy, unclear thinking, double or blurry vision and fast, pounding heartbeats.


National Kidney Foundation Malaysia dietitian Syaidatun Noorhusna Yahya says fasting is safe for patients with kidney disease as long as they do not have any medical complications but they are advised to consult their doctors or dietitians to manage their medication and diet.

“A dialysis patient, for instance, can try to fast on non-dialysis and dialysis days before Ramadan to observe the impact of fasting on health. Besides monitoring blood glucose level, a diabetic may need to be well-versed to recognise warning signs of dehydration, low blood sugar and other possible complications.”

Syaidatun says for patients on dialysis, their diet during fasting month should not differ much from non-fasting months. They must consume foods that contain adequate protein, low potassium, low phosphate, low sodium and restricted amount of fluids which should be between 500ml and 750ml per day.

However, they should take note of any unusual symptom such as tiredness, giddiness, cramps or low blood pressure after dialysis. These symptoms may indicate dehydration so the patient should break fast and drink some fluid.
“The diet for those not on dialysis depends on the stage of their disease, but mostly they need to limit their protein intake, just like they do during non-fasting months. Most kidney patients have diabetes and hypertension, so following a diet similar to those patients should be fine.”

Medication should also be adjusted accordingly. As patients tend to eat more when breaking fast, they should take a higher dosage at this time, while the lower dosage should be taken during sahur.

*Cover — AP Picture

Eat right

HERE are sample menus for those on dialysis and for diabetics.



Iftar or buka puasa
1 apple or 2 pieces of dates
+ 1 kuih (e.g. apam, kuih sago, kuih lapis, popia)
+ minimal fluid
– Total fluid intake should be between 500ml and 750ml per day.
– Fluids include the drink that patient takes with medicine, soup as well as food that become liquid at room temperature like ice-cream.
– Excessive fluid can make a patient feel uncomfortable or experience breathing difficulty during dialysis.
– Dates have high potassium content and should be eaten sparingly. Eating one or two dates is enough.
After Maghrib prayer
150g or 1 medium Chinese bowl of rice
+ 80g of fish, fried, coated with corn flour
+ 1/2 cup of fried ridge gourd (petola)
+ 1 slice watermelon
After Tarawih prayer
Tea or coffee + 1 tbsp sugar
+ 1 or 2 pieces of plain biscuit or kuih

1 ½ cups of rice/mee/vermicelli
+ 80g of chicken
+ ½ cup of stir fried bean sprouts
+ 1 Chinese pear or li
+ minimal fluid



Iftar or buka puasa
1 apple or 2 dates
+ 1 kuih (e.g. popia, steamed apam etc)
+ plain water

After Maghrib prayer
1½ cups of rice or noodles or rice vermicelli
+ 1 piece of chicken (1 drumstick or 1 chicken wing) or fish (example: 1 small mackerel)
+ 1 cup of cooked vegetables
+ 1 orange
+ plain water
After Tarawih prayer/moreh
1 savoury kuih or 3 pieces of plain cream crackers or 1 slice of bread
+ 1 glass of milk

1½ cups of rice or noodles or rice vermicelli
+ 1 piece of chicken (1 drumstick or 1 chicken wing) or fish (1 small mackerel)
+ 1 cup of cooked vegetables
+ 1 slice of papaya
+ Plain water

Read more: NST

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