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Healthy fasting for children

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Bubur lambuk is a popular dish during Ramadan. It’s also a good dish to give your kids who have just started to fast.

Are you about to get your children started on fasting? Don’t worry, there’s a safe and healthy way to get your child to fast.

GENERALLY, children who have not yet hit puberty do not have to fast. However, as they get older, you may want to start preparing your child for this ritual. You can start encouraging your child to begin fasting at the age of seven by getting him to fast for a few hours a day and gradually introduce him/her to all-day fasting.

It is important to teach your child the correct way to fast in order to get him mentally and physically accustomed to the discipline. Since our weather tends to be hot, it is crucial that you take your child’s age into account so as to avoid illness and fatigue.

Given that your child is growing – developing bones and muscles – and needs more nutritious foods in proportion to his size, you must assess your child’s ability to fast.

Start with the basics. Before Ramadan, you can:

– Get your child to eat smaller meals throughout the day to help control the temptation to eat large meals.

– As Ramadan draws nearer, cut down your child’s number of meals a day so that his mind, body and appetite are all in tune for the coming fasting period.

– Gradually cut down your child’s consumption of salt and sugar as these increase thirst and cravings.

During Ramadan, you can:

– Gradually initiate your child into the fasting month. In the beginning, encourage him to fast until 10am.

This can be gradually extended to the noon prayer time (zuhur), and then until the time of the evening prayer (asar).

– Give your child a proper meal during sahur that will last him throughout the fasting period every day. Slow-digesting, fibre-rich foods such as wholegrain cereals, fruits and vegetables are an essential part of the meal.

– Don’t allow your child to overeat (this can cause bloating and indigestion) or eat spicy foods, which can increase gastric acidity.

The best way for your child to get all the energy and protein he needs is to include a variety of protein sources (e.g. milk, cheese and yogurt in meals and snacks). Carbohydrates like rice and potatoes are also an important source of energy.

Don’t forget to pack more colour into your child’s meals as these contain a variety of vitamins and minerals. Even white foods like garlic, onions, mushrooms and cauliflower contain allicin and quercetin – substances that may defend the body against inflammation.

To help you in your child’s meal planning during Ramadan, here are some suggestions for sahurbuka puasa, and moreh(a form of “supper” held either during the breaking of fast or after tarawih prayer and witr prayer).

Sahur

Food: Breakfast cereals, e.g. oats, wholemeal breads, pancakes (lempeng), rice with mixed vegetables, chicken porridge, tuna/egg/sardine sandwiches.

Drink: Milk, malted drink, plain water, fruit juice, tea.

Fruit: Bananas, papaya, watermelon.

Buka puasa

Food: Rice with kurma or chicken curry, laksa, mi goreng,rendangpulutlemang, traditional Malay cakes, roti jalanasi kukus with fried chicken.

Drink: Plain water, fruit juice, tea.

Fruit: Mango, watermelon, papaya.

Moreh

Food: Bubur lambuk, traditional Malay cakes – kuih lapis,dodolondeh-ondeh, curry puff, mi rebus.

Drink: Plain water, fruit juice, syrup juice, grass jelly drink.

Fruit: Watermelon, orange, banana.

Avoid carbonated drinks during iftar (time of breaking fast) as they can produce gas and cause discomfort.

It is good to inculcate fasting in your child from young. Just remember to ensure that your child meets his nutrition requirements at the same time.

Although it’s easier to allow your child to eat the same meals you eat during buka puasa, it is better to do some meal planning before or during Ramadan to ensure that your child will eat healthy and nutritious foods.

via Healthy fasting for children – Health | The Star Online.

Life in the fasting lane

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Beware of overeating while breaking your fast, especially after a trip to the Ramadan bazaar. Overeating can lead to a spike in blood sugar, which can lead to hyperglycaemia. – GARY CHEN / The Star

Many Muslims with medical conditions such as diabetes observe a fasting period during Ramadan despite being religiously exempted from doing so. We break down the health risks, as well as preventive measures, to ensure a safe and healthy fasting season.

MILLIONS of Muslims in Malaysia are now celebrating the holy month of Ramadan, including those with medical conditions like diabetes.

In Islam, Ramadan is considered to be the most blessed and spiritually-beneficial month of the year.

For this reason, many observe a fast from dawn to dusk throughout the month, during which they must abstain from eating, drinking and smoking, amongst other practices.

There are however, no restrictions on the amount of food or drink they can consume at night.

According to religious tenets, fasting is intended to teach a person patience, humility and self-control.

This practice is also thought to be good for health, and provides a yearly routine of spiritual cleansing for Muslims.

Many Muslims with legitimate health concerns also fast despite being religiously exempted from doing so – some even going against their doctor’s advice.

Hence, it is imperative for medical professionals, and even more so for those who are fasting, to be aware of the potential risks associated with fasting, and take steps to fast in a safe and healthy manner.

Rising numbers

Diabetes is a condition that causes a person’s blood sugar level to rise too high.

It occurs when the body does not produce enough insulin to function properly, or when the body’s cells do not react to insulin. This is known as insulin resistance.

Type 2 diabetes is the most common type of diabetes and affects up to 90% of diabetic patients around the world.

It usually affects those over the age of 40, although increasingly younger people are also being affected.

Its growing prevalence is associated with rapid cultural and social changes, and is often attributed to unhealthy lifestyle and behavioural patterns such as a poor diet coupled with physical inactivity.

 

Professor Dr Nor Azmi Kamaruddin explains that factors such as taking too much insulin or other diabetes medications, skipping a meal, or strenuous exercise can cause a dive in blood sugar in diabetic patients.

Prof Nor Azmi explains that factors such as taking too much insulin or other diabetes medications, skipping a meal, or strenuous exercise, can cause a dive in blood sugar in diabetic patients. –Filepic

In 2010, the National Health and Morbidity Survey revealed that an estimated 3.4 million Malaysians suffer from diabetes.

The survey showed an increase in diabetic cases among Malaysians aged 30 and above, from 8.3% in 1996, to 14.9% in 2006. This marks an 80% increase over a period of just 10 years.

The same survey revealed an even more dramatic increase in diabetic cases among the nation’s youth. Between 1996 and 2006, the number of diabetic cases in Malaysians aged 18 years and above rose from 4.4% to 14%, a 200% increase in just a decade.

More alarmingly, it is believed that an estimated one-third (or 36%) of the diabetic population remains undiagnosed.

Fasting is not meant to create excessive hardship on the individual, but Muslims who are diabetic may face significant challenges in managing their condition, as fasting requires abstinence from all foods, fluids, oral medications, as well as IV fluids, which may be required to keep their blood sugar level in check.

Among the problems to look out for include:

Hypoglycaemia (low blood sugar)

Low blood sugar is a well-known risk associated with daytime fasting, especially for diabetic patients. It occurs when there is too much insulin and not enough sugar (glucose) in your blood.

If left untreated, low blood sugar can lead to serious medical problems, including loss of consciousness, and convulsions or seizures that require emergency treatment.

Professor Dr Nor Azmi Kamaruddin, head of the diabetes and endocrine unit at Universiti Kebangsaan Malaysia (UKM), explains that factors such as taking too much insulin or other diabetes medications, skipping a meal, or exercising harder than usual can cause low blood sugar in diabetics.

Not eating enough during sahur, the meal consumed before dawn, can increase the risk of hypoglycaemia, he explains.

The logic behind this is simple. Most diabetic patients are required to take insulin or other diabetic medications to decrease their blood sugar levels. However, consuming less calories than what your body needs naturally will lower your sugar levels. This, compounded with the use of insulin or diabetic medications, could cause blood sugar to plummet to dangerous levels.

“Most people do not eat enough during sahur, because they are not used to eating at that hour. Hence, appetite tends to be poor,” says Prof Azmi.

“Diabetics, in particular, need to consume the same amount of food they usually consume, to maintain a healthy blood sugar level.”

He stresses that reduction of insulin or medication is not recommended because if you do not have enough insulin to cover the extra sugar in your blood, ketoacidosis can occur.

Ketoacidosis itself is a severe, life-threatening condition that requires immediate treatment. Symptoms include nausea, vomiting, abdominal pain, rapid breathing, and in some cases, unconsciousness.

Hyperglycaemia (high blood sugar)

Conversely, high blood sugar also affects people with diabetes. Contributing factors include excessive food intake, illness, and not taking enough glucose-lowering medication.

High blood sugar can become severe and result in serious complications such as diabetic coma, which requires emergency care. In the long term, persistent hyperglycaemia, even if not severe, can lead to complications affecting the eyes, kidneys, nerves and heart.

During Ramadan, most people usually consume two meals per day – one before sunrise and one after sunset.

“However, some people have the tendency to binge-eat when they break fast. That’s when the problem arises,” says Prof Azmi.

“When you starve yourself for some 14 hours, and then consume a significant amount of food, your blood sugar levels will shoot up if you’re diabetic.”

“This occurs especially when people go to bazaars hungry. They tend to overbuy, and subsequently overeat.”

Dehydration

When you have diabetes, excess glucose builds up in your blood. As a result, your kidneys have to work harder to filter and absorb the excess sugar.

If your kidneys can’t keep up, the excess sugar is excreted through your urine, along with fluids drawn from your tissues. This causes frequent urination, which may leave a diabetic dehydrated and constantly thirsty. As they drink more fluids to quench their thirst, they will urinate even more.

This is where the problem arises. Says Prof Azmi: “During Ramadan, diabetic patients tend to suffer from dehydration because they don’t drink enough water to replenish the fluids that have been lost.

“To make things worse, Malaysia is situated in the tropics. On average, we lose up to half a litre of sweat everyday due to the heat.

“Those who work outdoors could lose over a litre every day.”

 

Mobile applications such as Ramadan, Diabetes and Me (as shown in the picture) allow diabetic patients to keep track of their blood sugar levels throughout the day. .

Mobile applications such as Ramadan, Diabetes and Me (as shown in the picture) allow diabetic patients to keep track of their blood sugar levels throughout the day.

Fasting tips for diabetics

During Ramadan, your regular day-to-day dietary habits get thrown out the window. Health problems can arise from an insufficient diet or as a consequence of overeating.

To avoid this, it is essential for diabetic patients to maintain a healthy and balanced diet throughout the holy month. The aim should be to maintain a consistent body mass.

Nutrition

At the predawn meal, consuming foods rich in “complex” carbohydrates (slow-digesting foods) is advisable because of the delay in digestion and absorption, which keeps you feeling fuller for longer.

In addition, increase your fluid intake during non-fasting hours to avoid dehydration.

When breaking fast, Prof Azmi advises diabetic Muslims to start off with a glass of water, before moving on to dishes, starting from vegetables, protein, and finally to carbohydrates, to avoid overeating.

Ingesting large amounts of foods rich in carbohydrates and fats should be avoided, he says. “About 70-80% of the Asian diet consists of rice. However, the high glycaemic index (GI) in rice could cause blood sugars to spike.

“Also, try to avoid sweetened or carbonated drinks. You might also want to go for whole fruit options instead of fruit juices.

“Ingestion of fruit juices leads to a rapid absorption of glucose in the bloodstream, resulting in a sudden spike in blood sugar.

“In comparison, eating whole fruits involves processes such as chewing and digestion. This will result in a more gradual and stable increase in blood sugar.”

Frequent monitoring of sugar levels and medication

It is important for diabetic patients to monitor their blood sugar levels multiple times a day.

This is especially critical for type 2 diabetes patients who require insulin.

Mobile applications such as Ramadan, Diabetes and Me allow diabetic patients to keep track of their blood sugar levels throughout the day.

Developed by MSD, the app (which is currently only available on IOS devices) feature a blood sugar tracker that offers an easy and convenient way to monitor your daily blood sugar levels.

Meanwhile, those who are on oral medication may have to adjust the dosage or switch to short-acting medication, which can be taken along with their main meal of the day.

Similarly, patients who are on insulin will need to switch to a twice-a-day regime of short-acting insulin, with the larger dose timed before the main evening meal.

Exercise

Normal levels of physical activity may be maintained. However, Prof Azmi advises against strenuous exercise, as it may lead to a higher risk of hypoglycaemia.

“If a diabetic patient has already been exercising regularly, he should continue, but stick to mild or moderate-intensity exercises,” he says.

“I would suggest exercising just before the break of fast, rather than in the morning, so they will be able to recover from their workouts by replenishing their bodies with food.”

He also points out that diabetic patients should try to avoid sun exposure to avoid further fluid loss.

Pre-Ramadan medical assessment

Ideally, all diabetic patients who wish to fast during Ramadan should undergo a medical assessment and engage in an education programme to undertake the obligation as safely as possible.

The American Diabetes Association recommends that people with type 2 diabetes undergo a medical assessment at least two months prior to fasting.

South-east Asian guidelines for management of endocrine disorders during Ramadan advise planning for the period at least three months in advance.

During this assessment, individual patients need to understand the potential risks they may face if they decide to fast.

Specific changes in diet or medication regimens should be tailored to a patient’s needs, so they can fast on a stable and effective programme.

Such assessments should also extend to those who do not wish to fast due to the heightened risk of hypo- and hyperglycaemia.

via Life in the fasting lane – Health | The Star Online.

App on fasting for diabetics

PHARMACEUTICAL firm MSD has launched a mobile app called Ramadhan, Diabetes And Me to help diabetics manage their blood sugar levels while fasting.

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Ewe (left) with diabetic patient Mohd Kamal Muda and Dr Nor Azmi showing the app and booklets

Its managing director, Ewe Kheng Huat, says the app is part of its Ramadan Hypoglycaemia campaign 2012. The company has also launched a booklet, Fact About Fasting, to create greater awareness about possible complications while fasting for diabetics.

The app offers tips and information about fasting and helps diabetics track their sugar level. The data stored is only available to the user who can later share it with doctors during consultations or save the information as a PDF file to be emailed.

The app also provides a Qiblat compass and times for prayers and breaking fast.

Both the app and booklet are available for free on AppStore and at Persatuan Diabetes Malaysia, clinics and hospitals.

For the video on a special interview with UKM Medical Centre head of endocrinology department Professor Dr Nor Azmi Kamaruddin on diabetes and how to use the Ramadhan, Diabetes And Me app, click on NST e-paper.

Read more: NST

Managing illnesses when fasting

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

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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:

GASTRITIS

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.”

MIGRAINE

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.

DIABETES

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.

KIDNEY DISEASE

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.

FOR DIALYSIS PATIENTS

MEAL TIME MENU

Iftar or buka puasa
1 apple or 2 pieces of dates
+ 1 kuih (e.g. apam, kuih sago, kuih lapis, popia)
+ minimal fluid
Note:
– 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

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

FOR DIABETICS

MEAL TIME MENU

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

Sahur
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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