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Olivia Olarte-Ulherr / 18 July 2014
Number of patients complaining of digestive problems increases every Ramadan, comprising about 40 to 50 per cent of patients who visit the emergency department.
Ramadan is the time for cleansing, not only the soul but also the body. However, wrong dietary practices during this period can lead to more harm than good.
According to doctors in the Capital, every year during Ramadan, more people visit the emergency rooms with digestive problems — heartburn, indigestion, stomach upset, acute gastritis, constipation — and renal colic, kidney stone, headaches, muscle and throat pains. Those with diabetes, high blood pressure, asthma and other chronic diseases complain of complications. With Ramadan falling at the peak of summer this year, patients are also seen suffering from gastroenteritis (stomach flu) as a result of consuming contaminated food.
“We see an increased number of patients complaining of digestive problems every Ramadan, comprising about 40 to 50 per cent of patients who visit the emergency department,” said Dr Magdi Mohammed, emergency medicine specialist at Burjeel Hospital.
At the NMC Specialty Hospital, the emergency section sees about five cases a day from the start of the holy month. Dr Ravi Arora, head of emergency at the hospital noted that indigestion and stomach upsets happen due to overeating.
“In the first few days of fasting, the body is not used to fasting and this results in indigestion. People also end up eating a lot more, especially fried food. My advice is not to eat anything in large quantities as it takes time for the tummy to get used to fasting.”
Headaches are also very common and are mostly caused by dehydration or hunger. “Sometimes, people sleep late and this leads to activation of migraine or headache due to over-exhaustion. This is also due to caffeine and nicotine withdrawal,” Dr Mohammed noted.
According to Dr Indira Gouthaman, senior emergency doctor at LLH Hospital, gastritis or acidity is also a problem. “For a long period of time the stomach remains empty, so we should be careful about the diet. Start with food that is gentle on the stomach, so acidity doesn’t flare up. Don’t overeat and avoid heavy and deep-fried food.”
Dehydration causes muscle pains especially among people who work outdoors. This can aggravate kidney stones and renal colic.
“A number of patients have complications due to fasting, like those with kidney stones and renal colic. We do have a lot of cases because fluid intake is reduced,” Dr Gouthaman said. “Also, lower fluid intake leads to high uric acid levels. For them the complication becomes greater because part of the treatment for uric acid is taking plenty of fluids,” she added.
Fasting also affects those with chronic illnesses.
“You find that people with chronic illness insist on fasting although they are exempted, especially the elderly who come with complications of diabetes like hypoglycaemia (low blood glucose),” remarked Dr Mohammed.
Dr Arora, who is also a specialist internist and diabetologist, said he generally sees diabetic patients with very high and very low sugar levels. This is because patients taking insulin or tablets “get confused and they take either too much or too less.”
He said that prior to Ramadan every year he advises his patients on how to modify their medication. “Those taking insulin injections and tablets should lower the dose to be taken at Suhoor and increase the dose at the time of Iftar. We reduce the dose of medication depending on the type of diabetes, the patient’s capacity to deal with fasting and the type of medication. The treatment should be individualised.”
Hypertensive patients should also monitor their blood pressure and may need to change their medication dosage.
“Most medications prescribed for people with high blood pressure need to be taken once or twice a day. Typically these medications will have a 12-to-16 hour effect. The tablets can be taken at Suhoor, and during Iftar. Patients who have tablets prescribed three times daily are likely to have short-acting drugs. For these patients, it would be prudent to ask physicians about the afternoon dose and if it can be adjusted for the fasting month,” advised Dr Georgie Thomas, cardiologist at Burjeel.
“For patients with routine medical problem such as diabetes, high blood pressure and asthma and other chronic diseases, it’s good to have a dry run of two to three days before Ramadan to give them time to adjust,” Dr Arora suggested.
At NMC in the past two weeks, Dr Arora has attended to a number of people suffering from gastroenteritis (vomiting and diarrhoea) as a result of food-borne illnesses.
“This is due to contaminated food. The large volume of food prepared (in advance) to avoid the big rush increases the level of contamination and decreases the level of hygiene,” he said, adding that the weather is also a contributing factor.
“Not just from the cook, it can happen from people delivering the food, as well. We’ve seen Iftar meals packed in newspapers and plastic bags, and some are even kept two hours in outside temperature.”
He recommends that food should not be kept out in the heat, should be relatively fresh and warm before serving or distributing.
Remain hydrated, eat healthy, move and don’t forget Suhoor.
“The main issue during Ramadan is dehydration due to fasting for long hours. We need to bring our fluid and blood sugar levels up again, but gradually,” Dr Mohammed said.
“After breaking the fast take two litres of water, divide this in portions from breaking the fast till Suhoor, take it during this period.”
For those working outdoors, he advised consumption of fluids up to three to four litres as they lose fluids during the day. But reduce or avoid consumption of colas, tea coffee and energy drinks as these can cause dehydration.
Cold drinks at Iftar should be avoided as they can cause throat problems.
Start the fast by taking complex carbohydrates (oatmeal, brown rice, porridge) as they are digested and absorbed slowly into the blood, maintaining blood sugar levels for a longer period of time.
“People are neglecting Suhoor meal but this is the most important food for the day,” Dr Mohammed pointed out.
While breaking the fast, it is recommended to take dates because they are packed with easily digestible sugar, giving sugar immediately to the body when it is in a sugar-depleted state.
After prayer, continue the meal with some warm liquid like soup. Simple carbohydrates which are absorbed fast into the blood stream are best for Iftar. Avoid foods that are deep fried, high in fat and high in sugar as they can upset the stomach. Have a good serving of vegetables and fruits and do not overeat. Avoid the sun during the day, stay in cool areas and limit physical activities as much as possible. In the evening, it is encouraged to take up some activities like walking for at least 15 minutes.
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