Heartburn (indigestion)
The stomach is an acidic environment, designed to digest food and kill bacteria. The stomach and esophagus (gullet) are normally protected from this acid by the body’s own special juices and ‘valves’ between these two organs. If either too much acid is produced or the valve at the bottom of the esophagus is ‘faulty’, you may experience heartburn. Fasting usually reduces the amount of acid produced, but thoughts of food or the smell of it make the brain order the stomach to produce more acid. Hence if there is a net increase in acid, heartburn could be a problem during the fast.
Those who are on regular medication for indigestion, such as antacids (eg. Gaviscon), antihistamines (eg. Zantac) or proton pump inhibitors (eg Losec, Zoton or Nexium) are advised to continue taking them, at the pre-dawn meal for instance. The control of heartburn or belching can be aided by eating in moderation and avoiding oily, deep-fried or very spicy food. Reducing your caffeine intake and/or stopping smoking can also be of benefit, if relevant. Preparations such as peppermint oil may help reduce belching or colic. Sleeping with your head raised on a few pillows and long-term weight loss may also help prevent heartburn.
Poor control of diabetes
Those injecting insulin are advised not to fast, as the potential risk to health, both in the short and long term, of not taking insulin is too great. People who have their diabetes under control using tablets should ensure that they visit their GP prior to Ramadan, in order to discuss any possible changes to their drug regime which would facilitate a safe fast. If not, such patients are at risk of poor control of their diabetes during and outside the fasting times. Regular self-monitoring of your blood glucose is strongly advised. Low blood sugar levels (a ‘hypo’) are dangerous, and if untreated may lead to fainting or fits, and hence must be strictly avoided. Feeling dizzy, sweaty and disorientated may all suggest a hypo. If this is suspected, you should immediately have a sugary drink, or place sugar or a sugar-rich sweet below the tongue.
Long-acting tablets, such as Glibenclamide, increase the risk of having a hypo, and should be changed to a shorter-acting variety before you embark on a fast. Diabetics with further complications, such as angina or heart failure, stroke, retinopathy (eye disease), nephropathy (kidney disease) or neuropathy (nerve disease of feet/hands with numbness/loss of feeling) should seek careful advice from their doctor before starting a fast
Headache
This is a common problem and has many causes. Headaches during a fast could commonly be due to dehydration or hunger, inadequate rest, or the absence of addictive substances such as caffeine or nicotine. A moderate and balanced diet, especially not missing the pre-dawn meal, consuming adequate quantities of fluid and if necessary taking a dose of painkillers such as paracetamol, may all go a long way towards either preventing or reducing the risk of developing a disabling headache. Headaches can also be prevented by sensible measures such as not exposing oneself to direct sunlight, wearing a hat when out, using sunglasses to reduce the effect of glare from the sun and relieving any tense muscles with a short, gentle massage.
Those with a history of frequent and/or disabling migraines should aim to gain adequate control with lifestyle and/or medical treatment if required, prior to starting a fast.
Despite the above measures, if you have a persistent, disabling headache, you should see a doctor.
Dehydration
Dehydration is a common occurrence during a fast. The body continues to lose water and salts through breathing, sweat and urine; the quantity of water loss will vary depending on the weather, how much you had to drink before your fast, the degree of physical exertion and the ability of the kidneys to retain water and salts.
Prevention is always better than cure. However, if you do not adequately rehydrate before a fast, your risk of dehydration is increased. This risk is higher in the elderly and in those taking tablets such as diuretics. Depending on the severity of the dehydration, you may experience a general feeling of being unwell, lethargy, muscle cramps, dizziness, disorientation and even collapse or fainting. If you are unable to stand up due to dizziness, or you are disorientated, you should urgently rehydrate with regular, moderate quantities of water, ideally with sugar and salt, or Dioralyte or Lucozade.
If you faint due to dehydration, your legs should be raised above your head by others, and when you awake, you should urgently rehydrate as outlined above.
Complications of any common chronic diseases
Diabetes has been discussed above.
Other common diseases such as high blood pressure and asthma are controlled using medication that needs to be taken regularly every day of the year. This is necessary in order to avoid possible complications from the inadequate control of disease, such as a stroke or an asthma attack. A consultation with your doctor should provide an opportunity to discuss any potential options for completing a fast safely, while continuing to control your disease.
Constipation
Constipation could be a very irritating problem for someone undertaking a fast. Maintaining good hydration outside the fast, eating healthily, with lots of fruit and vegetables in your diet, increasing the fibre content of your food using bran, and being active all help to keep your bowel motions as regular as would otherwise be expected. If the problem persists, a short course of bulk laxatives may help.
Stress
Lack of food and water, changes of routine and shorter periods of sleep can all collude to increase stress levels. Hence it is important to address any potential sources of stress in order to minimise harmful effects. This can be helped by not taking on more than you can reasonably handle, not playing sports in the hot sun, controlling your anger in advance and abstaining from smoking.
Obesity
Strange, but true! For the unwary, or those lacking in caution, food consumed during the pre-dawn and dusk meals may lead to some unintended weight gain. Obesity is an epidemic in the making, and has numerous complications in its own right. It is ironic that you are able to become overweight or obese while you are fasting. But if you do not approach the fast with discipline and will, the opportunity to lose weight and become healthier is wasted
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