RAMADAN is the ninth month of the Islamic calendar and it's a time for spiritual reflection and self-improvement. During this period of heightened devotion and worship, Muslims fast from dawn to sunset.
However, it is also a time when there is a rise in digestive problems due to increased acid levels in an empty stomach. In addition, those with pre-existing digestive issues such as gastritis will need to be mindful of the way they fast so as not to exacerbate their condition.
The common issues I treat during Ramadan are gastritis, gastroesophageal reflux disease (GERD), gastric ulcers, and acute gastroenteritis. The symptoms are usually abdominal pain, discomfort after meals, indigestion, bloating, burping, diarrhea and flatulence.
Those with gastritis will often feel a sharp and prickling pain in the stomach, which can worsen when they eat. Meanwhile, those with GERD will feel discomfort in their abdominal area or experience heartburn with a sour taste at the back of their throat.
I once treated an elderly patient who had blood in his stools. Despite battling abdominal pain, the patient insisted on fasting, which worsened his condition and led to bleeding gastric ulcers. He had to cease fasting for several weeks.
Therefore, it is important to make the necessary adjustments to the way you fast to ensure that you can do it healthily and safely.
FASTING ADJUSTMENTS
First and foremost – drinking at least two litres of water a day is a must. This is especially crucial as some people may experience diarrhea while fasting, which can lead to severe dehydration and result in kidney failure.
However, slow down and take smaller sips. Gulping down large amounts of water can actually trigger distension in the stomach (bloating) and cause heartburn.
Increased cases of diarrhea may also be caused by the poor hygiene of some food stalls – which is why people need to be more discerning of stalls they patronise, especially at bazaars.
Shorten the period of your fast by eating later during sahur and breaking fast as early as possible during iftar. Also, avoid overeating and pace yourself. During iftar, begin with a small portion of food. Filling an empty stomach suddenly may sometimes trigger acid reflux.
Chew your food longer and slower to make it easily digestible. It is also best to avoid lying down for three hours after a heavy meal as this can easily lead to heartburn and nausea – which means no sleeping after sahur.
If one must lie down, prop your head up on an elevated surface as this can deter acid reflux. In addition, steer clear of wearing tight belts as the pressure on your abdomen may force food and acid up your esophagus.
PRIORITISE HEALTH
Those with pre-existing digestive issues would have learnt from past experiences and usually take the gastric medication beforehand as a preventive measure. The effect of most of these medications can often last the entire day.
It becomes a little trickier though for those who encounter heartburn in the middle of the day. Should they choose to only take medication when they break their fast, then they should drink and take their medicine and pray first. After half an hour, they may then eat.
While gastric medication is more effective when taken before food, you may also opt to first break your fast then wait for three hours before taking your medication.
However, if the pain becomes unbearable, it is advised to break your fast to take antacids for pain relief. If medical care is needed and a gastroscopy or colonoscopy is required, the procedure will nullify fasting.
More importantly, those with other medical conditions such as diabetes and
hypertension will need to consult their doctors when it comes to their medication schedule as those with diabetes may risk becoming hypoglycemic.
Do also bear in mind that you need to seek immediate medical attention if there is significant weight loss, a pale complexion and blackish stools as this means blood in your stools.
It is permissible if a person is unable to fast due to medical or religious reasons and therefore, should not force themselves to do so.
You should always protect your health and wellbeing.
SUITABLE FOOD AND DRINKS
For sahur:
*A glass of milk
*Carbohydrates (rice, noodles, and bread)
*Whole grains (barley, brown rice, and buckwheat)
*Legumes
*Fruits and vegetables (these are high in fibre and will leave you feeling fuller throughout the day)
For iftar:
*Foods with fast-release sugar such as dates (for diabetic patients, please consult your doctor).
*Fruits and vegetables
*Carbohydrates
*Proteins (red and white meat)
Avoid:
*Very spicy food
*Curry
*Deep fried food
*Foods high in acidity (processed foods, cheese, seafood, and more)
*Caffeinated beverages (coffee, tea, and chocolate)
*Carbonated drinks
*Drinks that contain citric acid (lemon juice, lime juice, and more)
THE OTHER FACTORS
Besides fasting, other factors can also put you at risk for digestive problems.
These include:
*Your diet and dietary habits
*Certain medications and painkillers (most commonly used to treat joint pain or headaches)
*Smoking
*Alcohol consumption
*Steroids (this can sometimes lead to gastric ulcers)
*The presence of helicobacter pylori bacteria as it increases stomach acid production.
*Underlying medical conditions (diabetes, hypertension, heart disease, and kidney disease)
*Stress (this is when the brain sends indirect signals to the stomach to increase acid production)
*The writer is consultant internal medicine and gastroenterologist at Prince Court Medical Centre.