SHARES
Muslims around the globe observe the act of fasting during this holy month of Ramadan, in keeping with a divine commandment. However, can you fast if you suffer gastritis and peptic ulcer disease (PUD)? Will fasting lead to unwanted complications as increased acid levels in an empty stomach, thus aggravate gastritis and PUD? Find out more from our special interview with Dr Rizram Rahim from Columbia Asia Hospital, Petaling Jaya.
GetDoc: Can a person with gastric problem or Peptic Ulcer Disease (PUD) fast during Ramadan?
Dr Razrim: It should not be a problem for the majority of them. If you have mild gastritis it should not be a problem, you just need to adjust your meal time accordingly. In Malaysia, fasting is not that difficult as it is just like skipping your lunch. Patients can take several simple steps to reduce the risks of complications of gastritis/PUD while fasting.
But I would advise patients with severe symptoms not to fast. If you are a gastritis or PUD patient, you may check your condition with your doctor before fasting.
Dr Razrim Rahim, General Surgeon from Columbia Asia Hospital Petaling Jaya
GetDoc: What could possibly be the worse outcome of fasting in such patients?
Dr Razrim: Some people can get perforated ulcer but this is extremely rare. Most often it is intolerable pain which doesn’t permit you to carry out your work. That could probably be the most severe symptom.
For most people adjusting their time of meals should work in their favour.
There are two types of gastric pain- some get pain when they fast while some others get pain when they eat. The latter is not a problem especially if it is about certain foods, they can just avoid eating those foods.
GetDoc: What would your advice be for patients suffering from H.pylori?
Dr Razrim: H.pylori infection is not a long term problem, you can get yourself treated in about 2 weeks, with treatment of antibiotics and anti-acid. But it should not stop you from fasting. It is just an infection like any other. And although it can recur at later stage, it is not a chronic problem. It doesn’t have any bearing on whether or not you must fast.
GetDoc: What are the recommended food and beverages for patients with gastritis and PUD when fasting?
Dr Razrim: Most patients know which food or drinks trigger the gastric pain, they are able to tell by experience. So nothing specific, just avoid the food that triggers the gastric pain. For most people the trigger would be hot and spicy food and sometimes coffee, so it depends. The patient is the best judge for such things.
Image source from Hospotrade
GetDoc: Would you recommend more fruits and vegetable to be included in their diet?
Dr Razrim: A healthy diet is always helpful. Food that is fresh and organic is always recommended. Yes, many people cannot afford to eat organic food all the time, so choose food that is less processed. Processed food can cause the gastritis pain as it irritates the stomach lining.
So eating healthy is basically the answer for most conditions, be it preventing cancer or for gastritis.
GetDoc: What would be your advice to a gastritis patient who experiences pain when fasting? What should he or she do?
Dr Razrim: If the pain is bearable they can continue fasting. If the pain is unbearable, then I would advise them to take medication and break the fast. You just need to replace your fast later.
If the pain disturbs your work or if the pain is not bearable, there is a rule to break the fast. Antacids in liquid form provide immediate relief but on top of that, there are other medications that can prevent the acidity of the stomach from becoming too low. This can be consumed after breaking fast at night or once or twice a day before your morning meal and after you break your fast.
So you can adjust and take your medication according to your fasting times. The anti-acid (PPI) is the one that will be effective in the long term. It takes some time for the medication to help to relief the pain. So try not to miss your medication, be consistent, and take it whenever you are allowed to eat.
GetDoc: What should be the lifestyle changes you would suggest for gastritis and PUD patients during Ramadan?
Dr Razrim: The most important one is to modify your medication timing according to the breaking fast times. Another important thing is to trying not to eat everything at one go. Most would want to eat a lot when breaking fast. You need to contain the temptation to eat a lot, you can eat a frequent meals spaced with intervals rather than stuffing yourself with all the food just because you have paid for that buffet. It’s not worth it (laughs). Small regular meals is good for people with gastritis.
GetDoc: What about smoking and exercise?
Dr Razrim: Smoking is also proven to cause gastritis. It should be avoided altogether. Smoking is surely not beneficial in general. If a patient is serious enough to not have gastritis, he must be serious enough to stop smoking.
There is no reason to stop from exercising apart from the fact that they may be tired. What people can do is probably exercise during late afternoon or evenings so that they can immediately consume water after exercising. Adjust your exercise routine around the time of breaking fast so that you are not affected during the fasting period. Try not to exercise earlier during the fasting so that you don’t become dehydrated such that you cannot replace the fluids within a short time.
For example, you can go for a 45 minutes run at 6:30 p.m. and then it would almost be time to break fast by the time you finish. In Malaysia we are quite lucky our fasting period is only about 12 hours every day. In some countries like UK fasting in summer starts at about 3 a.m. in the morning and ends at about 10 at night, comparatively we are lucky. So it is all about planning and trying to continue whatever you are doing. Fasting shouldn’t change your regular schedule and productivity.
White rice or brown rice? (Image source from VegKitchen)
GetDoc: What are the recommended meals for Sahur?
Dr Razrim: The idea is to provide sustainable energy during period of fasting so wholesome food is better. For example you will feel full longer by eating the same quantity of food. It goes back to healthy eating so I recommend brown bread instead of white bread, brown rice instead of white rice. This ensures the fluctuations in glucose level in the body is less. When eating white rice or white bread the glucose level goes up and comes down very quickly, and then you start feeling hungry. However, this is not the case for brown rice or brown bread. Brown rice is slower to be digested and slower to raise blood sugar levels, thus you will feel full longer.
GetDoc: Would you recommend a carb based diet or a protein rich diet?
Dr Razrim: The food available at Pasar Malam is mainly processed food. It is unhealthy containing too much oil. You should get an equal amount of carbohydrates and proteins. Ramadan doesn’t mean that you must make drastic changes to your diet. If you are used to protein rich diet before Ramadan, you may continue to do so.
Image source from NDTV Food
GetDoc: Is dates a must to break fast?
Dr Razim: Dates is recommended food as it is high in nutrition and also recommended by religion, it is not a must. You can have some dates and light food before maghrib prayers, followed by the main meal after maghrib prayers.
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by Hridya Anand
A biochemist by education who could never put what she studied to good use, finally found GetDoc as a medium to do what she loved - bring information to people using a forum that is dedicated to all things medical. View all articles by Hridya Anand.
