Chronic patients advised to seek doctor's advice before fasting

With the beginning of the holy month of Ramadan, people with chronic diseases such as diabetes, kidney failure and heart disease have questions about their ability to fast.Consultants from Hamad Medical Corporation (HMC) assert that determining the patient's suitability for fasting depends on the assessment of the patient's health by the attending physician.HMC Deputy Chief Medical Officer Prof Abdul Badi Abou Samra said that patients should consult the attending physician before they start fasting, in order to adjust the level of blood sugar and avoid any complications during the fasting period.The decision of the attending physician to fasting depends on the nature of the diabetes patient's condition.Prof Samra said that type 1 diabetes patients dependent on insulin treatment as well as pregnant women with diabetes are advised not to fast.However, type 2 diabetes patients who do not have heart and kidney complications can fast with some precautions, to be determined by the attending physician well before the beginning of Ramadan.It is also preferable to delay Suhoor meal as much as possible, and to drink more water between Suhoor and Iftar to avoid dehydration.Furthermore, for diabetes patients to fast safely, Prof Samra stresses the need to maintain sugar levels within the patient's safe rate of 80-180 mg/dl after breakfast, and to consistently eat Suhoor and Iftar meals, while delaying Suhoor as much as possible and drinking as much water between iftar and Suhoor to protect the kidneys.Stimulants such as tea, coffee and soft drinks must also be reduced as they contain diuretic caffeine, which exposes those fasting to the loss of large amounts of liquids.Post-Iftar exercise should be postponed to avoid seizures due to low blood sugar.Going to the mosque is part of the daily physical and sporting activity allowed for patients during Ramadan.It is necessary to ensure that blood sugar levels are checked several times a day, especially in the early days of fasting, as well as any time the patient feels the effects of having low blood sugar.For kidney patients, senior consultant and head of the HMC’s Nephrology Department Dr Hassan al-Malki classifies kidney patients who wish to fast during Ramadan into three categories, according to the degree of illness.He said that for acute renal deficiency patients, their health condition is critical and therefore they are prohibited from fasting until their kidney condition improves and returns to normal.Chronic kidney patients have different stages of nephropathy, and those with third-degree kidney disease and worse are advised not to fast.This is because the kidneys at this stage are unable to retain body fluids, which can cause severe deficiencies in their function, and may lead to significant kidney damage.Patients should refer to the attending physician to determine the extent of kidney damage and the likely impact of fasting.Patients who are undergoing haemodialysis to treat kidney failure will typically receive the treatment three times a week and cannot fast due to IV fluid intake during the procedure; however, patients can normally fast during days they are not undergoing hemodialysis.For peritoneal washing patients (abdominoplasty) performed by the patient himself at home, they cannot fast due to the presence of substances fed with washing fluid.Kidney transplant patients are advised not to fast due to the effect of low fluid on the transplanted kidneys and the need to take medication on a regular and timely basis.On the ability of cardiac patients to fast, senior consultant cardiologist and head of the Cardiology Department at Al Khor Hospital and associate professor at Qatar University’s College of Medicine, Dr Amar Salam, asserts that the incidence of various heart diseases such as cardiac crisis (clot), cardiac failure, irregular heart (atrial tremor) decrease during Ramadan.Incidences of cardiac failure and atrial trembling resulting from coronary artery failure are also lower.Ramadan fasting also increases beneficial cholesterol by 30-40%, which in turn protects heart arteries from LDL cholesterol deposits.Research has shown that fasting and its accompanying religious rites lead to self-tranquility and lowers excitement of the parasympathetic nervous system, resulting in lower blood pressure and heartbeat, which are good medical signals for most heart patients.Dr Salam said that the attending physician should be consulted several weeks before fasting begins, especially for patients with acute arterial deficiencies, to adjust the dates of taking the medication and receive the necessary instructions to avoid symptoms such as the sense of headache during fastingThe consumption of tea, coffee and other caffeinated drinks should be reduced five days before fasting, as well as foods containing high sugars and fatty substances should be avoided during Ramadan.For cardiac patients taking medication during Ramadan, Dr Salam said that the patient can take the medication at Iftar and again at Suhoor.For patients who take their medication three times a day, they have to see the competent doctor to replace it with a long-acting medication to be taken once or twice a day. – QNA