Impact of Intermittent Fasting during Ramadan on diabetes patients

As the holy month of Ramadan is underway, Muslims across the world are observing fast everyday before dawn till sunset. Not eating or drinking anything for about 14-15 hours everyday is called intermittent fasting.

Well, this type of fasting is also widely popular among the people looking to lose weight. It, however, has its own pros and cons, which may vary in different people.

Diabetic people may be a little concerned about following this eating and fasting pattern as it may impact their blood glucose levels. Hence, here we will be discussing the impact of intermittent fasting on diabetic patients.

About Intermittent fasting and its functioning

Intermittent Fasting

Intermittent fasting (IF) refers to an eating regime in which the followers have a fixed period of eating and fasting on a daily basis. Some people also ensure very low calorie intake during the fasting period.

This practice, according to the experts, causes a metabolic switch in which the body starts using fat as the energy source instead of glucose. Moreover, IF also positively impacts the circadian rhythms of the gut and the release of insulin and growth hormone. Hence, it helps in weight management and energy metabolism.

IF can be of different methods, in which people may eat at different times. Here is a brief about the methods –

Time-restricted feeding

This is the most common form of intermittent fasting where the practitioner can allot a certain number of hours for eating and fasting each day. The most popular plan is the 16:8 method, which allows the follower to fast for 16 hours straight and eat during the 8-hour period.

Alternate day fasting

In this method, people fast on alternate days. On the fasting day, they can have no or minimal calories (maximum up to 500), and on the feasting day, they can eat as much as they want.

Periodic fasting

This type of IF is based on a 5:2 diet and Eat Stop Eat formula. In this method, the follower is allowed to eat for 5 days in a week, and has to limit their calorie intake up to 500 calories for two days, which shouldn’t be back to back.

In this pattern, people should eat responsibly on the non-fasting days and should not consider them as feast days.

Summary:

Intermittent fasting can be of various types, but a person should evaluate his/her needs before opting for any method. Diabetes patients must see their doctor before opting for any type of IF.

Does Intermittent Fasting improve your health?

Fasting During Ramadan

Most of the research done on intermittent fasting has been carried out on animals. However, there has been enough evidence to prove the impact of IF on humans also.

As per the studies, almost all types of IF methods result in some type of weight loss, starting from 2.5 percent to 9.9 percent. It also resulted in loss of fat mass among the followers. The studies, however, did not prove that IF is superior to the other ways of weight loss.

Moreover, IF has also shown positive effects in controlling the blood pressure level of the practitioners. In one of the studies, this fasting method showed decline in both systolic and diastolic BP of the followers.

Not only this, but another study proves that IF also improves the metabolic and cardiovascular health of the followers. It helps in decreasing total cholesterol and low-density lipoprotein (LDL) cholesterol.

The researchers already know that restricting calorie intake helps in improving insulin resistance. When a person fasts for a certain amount of time, his/her insulin sensitivity starts increasing, which results in decrease in insulin levels. These developments cause the blood sugar levels to improve during fasting and right after eating.

Summary:

Despite not having enough evidence, Intermittent Fasting can actually improve your health in a positive way. You just have to be extra cautious about what you are eating during the feasting time.

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How can intermittent fasting help a diabetes patient?

IF can cause a lot of benefits for the people suffering from diabetes. These benefits include

  • Aiding in weight loss
  • Enhancing insulin sensitivity
  • Reducing the need of insulin
  • Keeping fasting blood glucose levels under control
  • Decreasing hemoglobin A1c levels

It has been observed that people suffering from type 2 diabetes also generally have other issues too like hypertension, metabolic syndrome, hyperlipidemia and more. Intermittent fasting helps in improving these parameters also.

Possible side-effects of IF during Ramadan

Possible side-effects

If a patient associated with diabetes has poor vision or is suffering from kidney or heart disease, the risk of aggravation is high. Therefore, it is strictly recommended that such patients should restrict themselves from fasting during Ramadan.

Continuous fasting also carries a risk of hypoglycaemia. People with diabetes who are taking insulin or tablets must stop fasting in case they feel that they are having hypoglycemia. In such a case, a person must immediately consume some sugary fluids followed by starchy food.

Fasting might also elevate blood glucose levels sometimes. In such a situation, a patient must need to consume prescribed medicines, and if he does not take the medicine or is less active than normal, it could lead to diabetic ketoacidosis (DKA).

Fasting during Ramadan could have a high risk of complications if you suffer from one or more of the following:

  • Type 1 diabetes
  • Type 2 diabetes with poor blood sugar control
  • Recent history of low blood sugar
  • History of recurring low blood sugar
  • Unawareness of low blood sugar
  • Kidney disease or blood vessel complications
  • Pregnant women with diabetes

Intermittent fasting during Ramadan also poses a huge risk of dehydration among the diabetic patients. If a person does not drink enough fluids during the feasting hours, he/she may face dehydration. Dehydration can also cause hypotension.

Summary:

If you have diabetes, you must consult your physician to know how you should follow Intermittent Fasting during Ramadan. Keeping your blood glucose levels in check is also highly recommended.

Can you reverse type 2 diabetes through Intermittent Fasting?

There are a few studies available where diabetes reversal has been witnessed through IF. In a small case series, a total of three men could actually reverse their insulin resistance by following IF. Moreover, they also had weight loss, reduced waist size and hemoglobin A1c levels.

However, you can not rule out the possibility of diabetes relapse, hence, it would be better to say that those recovered individuals are in remission.

There is another study named Diabetes Remission Clinical Trial (DiRECT), which claims that they had divided the number of participants into two groups – weight management and pharmacological therapy. The results of the study showed that 46 percent of the participants in the weight management group had successfully achieved diabetes remission.

Well, the number of such studies is very limited and more research is required to trust this completely.

Summary:

There have been some studies which proved that it is possible to achieve diabetes remission through IF, but more studies are required to trust this completely.

Who shouldn’t follow Intermittent Fasting?

People who find it difficult to control blood glucose levels and those with brittle diabetes should not practice IF, as it may worsen the symptoms among them.

There are not enough studies available to understand the impact of IF on people who are pregnant or lactating.

People, who are more likely to suffer from hypotension, hypoglycemia and dehydration, should also avoid IF. Such individuals are old people, who have immunodeficiencies, and people with a history of brain injury or dementia.

Forcefully throwing yourself into IF can also worsen the situation if you are already suffering from eating disorders.

Summary:

People with hard to control blood sugar levels, pregnant and lactating women, older adults, people with brain injuries or dementia, and those with eating disorders should not follow intermittent fasting.

Handy tips for diabetes patients to follow IF

The most important thing for diabetes patients to do before starting with intermittent fasting is to consult their doctor, so that they can adjust the dosage and timings of their medications to rule out the possibility of hypoglycemia.

Here are a few more tips every diabetes patient must follow while on IF –

  • Keep checking blood sugar levels in every 2-4 hours (especially at the beginning)
  • People with hypoglycemia should break their fast immediately
  • They should treat their low blood sugar with 15 gms of carbs
  • They must consult their doctor before restarting the fast
  • Ensure being hydrated all the times
  • Dosage of medicines like diuretics and antihypertensives may be reduced
  • Have balanced diet
  • Avoid processed, fatty and sugary foods

Takeaway

Proper diabetes management is extremely important even during Ramadan as intermittent fasting may pose some threats to your health as well, apart from its benefits in your weight loss journey. Hence, it is highly recommended to do IF under the guidance of your doctor to ensure the healthiest results.

FAQ’s:

Can diabetic patients fast in Ramadan?

Generally, patients with type 1 diabetes or brittle or poorly managed diabetes can suffer from severe complications from fasting for long hours. Hence, they are advised not to fast during Ramadan. Patients of type 2 diabetes, however, can do intermittent fasting but only under the strict observance of a physician.

What is a normal blood sugar level after a 12 hour fast?

A normal fasting blood sugar level is less than 100 mg/dL. Blood glucose level between 100 to 125 mg/dL means the patient is prediabetic, and if it is 126 mg/dL or more on two different tests, it confirms diabetes.

Why is my glucose high when fasting?

In diabetes, your body doesn’t respond to insulin the same way it used to. Similarly, your fasting blood sugar level can also go up, even when you are following a strict diet. The raised level of sugar helps in making sure that your body has enough energy to execute your daily chores.

How does Ramadan affect blood sugar?

Monitoring the blood glucose levels while fasting is allowed. It helps in ensuring the safety of the patient all the time. Fasting can potentially impact your blood sugar levels, and may lead to hypoglycemia. Hence, keeping a close watch on the glucose levels in your blood is really important.

Does intermittent fasting affect blood sugar?

It is a well known fact that calorie restriction helps in improving insulin resistance. When a person fasts for a certain amount of time, his/her insulin sensitivity starts increasing, which results in decrease in insulin levels. These developments cause the blood sugar levels to improve during fasting and right after eating.

References

  1. https://www.hindawi.com/journals/bmri/2020/1281792/
  2. https://core.ac.uk/download/pdf/81636235.pdf

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