The Essentials of Fasting: Diabetes and Hypertension.

What is fasting?

Fasting is stopping ourselves from food and drink for a certain period. During the month of Ramadan for adult Muslims intermittently observe fasting including restricting food intake for a specific period and is correlated with many health benefits. So let’s discuss the essentials of fasting: diabetes and hypertension.

Advantages of Fasting for Diabetes and Hypertension:

Scientifically, fasting has some proven health benefits for diabetes and hypertension. For example, intermittent fasting improves insulin resistance and blood sugar levels in diabetics and helps with hypertension.

Fasting also improves insulin sensitivity, which can help people with type 2 diabetes manage their condition more effectively.

In addition, fasting optimizes blood pressure in hypertension. Research has shown that fasting one day per week for eight weeks significantly reduces blood pressure.

Risks of fasting for diabetes and hypertension

Despite the potential benefits of fasting, some risks are also to consider in people with diabetes and hypertension. Fluctuations and inconsistent blood sugar and blood pressure levels are common in these patients during fasting. In addition to all these low blood sugar levels, and hypoglycemia, are also known to cause shakiness, dizziness, confusion, and even death.

Increased risk of dehydration can be hazardous in hypertension and cause a drop in blood pressure, leading to fainting. In addition, fasting can be challenging for people with diabetes and hypertension who are on strict medication regimens.

Furthermore, you may also find it helpful to talk to your healthcare provider before observing the fasting regimen. As it may prove to be very fruitful and it may ensure the safety of these patients also.

Diabetes and Fasting:

For individuals with type 1 diabetes, it’s not recommended to fast during Ramadan. If fast, they should be supervised closely. However, type 2 diabetics are generally safe to fast, but medication adjustment is needed. Daily monitoring of blood sugar to ensure safety and be prepared to break the fast if blood glucose levels of <60 mg/dl or symptomatic hypoglycemia, and patients should avoid fasting on “sick days.

Diabetics on metformin, GLP-1 receptor agonists, insulin secretagogues, or SGLT2 inhibitors should break their fast and seek immediate medical attention if they develop; vomiting, diarrhea, and a drop in blood pressure. In fact, dose adjustment is required before starting fasting. Similarly insulin users should monitor their blood sugar more often to monitor hypoglycemia and need to reduce 10% the dose of basal insulin, which should be done by their healthcare provider.

What about meals?

Regarding meals, avoid ingesting large amounts of carbohydrates and fats, especially at iftar, and take complex carbohydrates which digest slowly are advisable at suhoor, which should be eaten as late as possible before the start of the daily fast. Fluid intake be increased during non-fasting hours.

Complex carbohydrates include beans, oatmeal, whole-wheat bread, quinoa, barley, skinned potatoes, sweet potatoes, and other plant foods.

Patients who are considered high-risk and should avoid fasting are:

Poorly controlled T1DM (pre-Ramadan A1C >9%
Severe hypoglycemia or DKA within 3 months,
recurrent hypoglycemia, and/or unawareness of hypoglycemia
Acute illness and advanced macrovascular complications, renal disease
Pregnancy in diabetes or GDM – treated with insulin
Type 1 diabetes on regular insulin

Hypertension and Fasting:

Always choose healthy foods for breakfast and focus primarily on salads and proteins. Reduce fatty or high-fat food and salt consumption, and beware of hidden salt in pickles, salty nuts, olives, and dough. Stay physically active with light exercise or medium-intensity walking, bike riding, ball sports, or swimming.

The critical factor is never skipping your blood pressure medications and staying well-hydrated between Iftar and Suhoor. Blood pressure-lowering drugs must be taken in Suhoor and/or Iftar depending on whether it is prescribed for once or twice daily use Consult with your physician to adjust your regimen; take medications three times daily or water pills. Immediately contact your physician if you feel dizzy or notice BP readings are too high or too low.

Suggestions for Patients Taking Medicines twice or more per day

Since patients taking their medications more than twice in 24 hours and cannot reduce to twice a day regimen, therefore they are always advised by physicians not to observe fasts. Where as other patients may take their drugs at Iftar or Suhoor (or both). additionally some some physicians may advice long-acting or slow-release drugs once or twice at night, that allow the patient to observe fasting more comfortably and safely. Elderly patients and those with renal disease who take non-steroidal anti-inflammatory drugs should regularly monitor renal function since fasting may increase serum urea and sodium levels in such individuals.

Some Suhoor And Ifatr Meal Ideas:

People with diabetes need also to avoid fried items instead they need to include food prepared either through grilling, steaming, or air frying. I recommend reading my previous blog on fasting and health, published recently, for more meal ideas.

For additional reading on Ramadan, fasting and Iftar read our article below:

https://remediesforum.com/2023/03/20/healthy-ramadan-how-to-improve-your-well-being

Fresh fruits and vegetables:
green salad, variety off fresh fruits
Whole grains: sources include whole grain cereal, bread, brown rice, and oatmeal.
Protein: sources include milk, yogurt, eggs, and nuts.
Healthy fat: sources are nuts and olives.

The essentials of fasting: diabetes and hypertension must include one of the following:

Oatmeal that may include milk with nuts and fruits sprinkled on the top.
A bowl of whole-grain cereal with milk, topped with nuts and fruits.
You can also include a piece of whole-grain toast, a boiled egg, and a selection of fruit esspecially oranges or grape fruit.
whole grain bread’s such as peanut butter sandwich on and a glass of milk.
A banana or an apple with peanut butter and a glass of skimmed milk.
A bowl of vegetable soup, a piece of whole grain garlic toast, and a glass of milk.
Whole-wheat couscous salad with mixed vegetables, olive oil, and canned tuna or grilled chicken.
SEHRI:
- 2-3 glasses of water, 1 fruit or nut; almonds, walnuts
Main meal:
- roti/ bread with
  - eggs, veggies or oatmeal and yogurt
  - couscous
  - Iftar:
  - fresh fruit/ yogurt/ smoothie/soup
  - Post Maghreb:
  - Roti/ bread with
    - Chicken, fish, meat, lentils
    - Rice
    - Drink milk, water, nuts, and chia seeds between iftar and sehri

Conclusion:

Since fasting offers many health benefits for people with diabetes and hypertension. therefore, it is vital to approach fasting cautiously and seek medical advice before starting a fasting regimen. Regularly monitor blood sugar and blood pressure levels while fasting, how ever be mindful of breaking the fast when absolutely necessary. In other words, fasting can prove to be a helpful way of managing diabetes and hypertension. Hope you enjoyed reading the essentials of fasting: diabetes and hypertension.