5 Healthy To-Do Things for a Fulfilling & Rewarding Fasting This Ramadan

WORDS DR DAVID TEO

Ramadan is a very significant and special observation that is shared by many Malaysians every year, which is why we created our top five tips to hopefully help make it easier for those observing the fast.

For many, the long hours of fasting can lead to dehydration, fatigue, low blood sugar, and headaches, especially if not enough water and nutritious food are consumed during the non-fasting hours. Therefore, it is essential for those fasting to ensure adequate hydration and a balanced diet during Sahur and Iftar.

Individuals suffering from chronic illnesses should consult their doctors on how to manage regular medication and to ensure it is safe for them to fast. People who are COVID-19 positive or have any symptoms of COVID-19 should consider staying at home and avoid contact with other people to prevent the risk of transmission. As COVID-19 continues to evolve around the world, it is important for Malaysians to be mindful when gathering and take measures to ensure a safe experience during Ramadan when with family, friends and co-workers.

We would also like to wish everyone a blessed and safe Ramadan month!

INTERNATIONAL SOS PRESENTS OUR TOP 5 TIPS FOR THOSE OBSERVING THE FAST THIS RAMADAN

Tip 1
DO NOT SKIMP ON REST AND SLEEP

Ramadan is a time of increased prayer. Though it may be tempting to stay up late for sahur and only sleep after imsak, you should still aim to get at least 8 hours of sleep daily even if this is accumulated over several separate periods of rest.

A well-rested body and mind will make it easier for you to concentrate at work and have more energy throughout the day.

Tip 2
STAGGER YOUR HYDRATION
Thirst can be one of the most challenging symptoms of fasting, leading us to drink plenty of water and liquids very fast as soon as we break our fast and then just before Imsak. However, rehydration should be a cumulative process.

The best way to rehydrate fasting bodies and maintain this hydration for longer is to pace your liquid intake by consuming at least 2 litres of water—1 or 2 glasses at a time—between iftar and imsak.

It also helps to cut down on caffeinated drinks at night, and to top up your liquid intake with soups, fruits and vegetables rich in water, such as cucumbers and watermelon.

Tip 3
EAT HEALTHY & NUTRITIOUS MEALS
Fasting will cause a change of habit in eating and your food intake frequency.

Hence, it is vital to fulfil your vitamin and mineral needs and to be mindful of your salt and sugar intake.

After a full day of fasting, avoid satisfying cravings with soda and energy drinks which are high in sugar. Instead, opt for unprocessed foods such as fruits, and consume complex carbohydrates such as rice, bread and wholegrains alongside vegetables, which will keep you fuller for longer.

As for salt intake, it is worth keeping in mind that having moderately savoury foods with water can help you retain some hydration for longer.

Avoid consuming too much salt as this can affect blood pressure and contribute to thirst and dehydration during the day.

Tip 4
DO MORE IN THE MORNING
Wherever possible, schedule more difficult tasks requiring greater concentration or physical effort in the morning.

Schedule important meetings during the first half of the day, when your energy levels will be higher and you are better able to retain new information.

Tip 5
DON’T STOP EXERCISING
Although you may feel more tired and, understandably, less active while fasting, skipping regular exercise for a full month is unhealthy, particularly as most of your food intake will be consumed at night.

Moderate exercise is advisable and will also help you feel less sluggish.

Just remember to wait a couple of hours after iftar before doing an activity.

Food for All: Modifying Food Texture for People With Dysphagia

WORDS AINUL SYAFIQAH MOHD AZAHARI & DR NURUL HUDA RAZALLI

DYSPHAGIA: IT MEANS DIFFICULTIES IN SWALLOWING FOODS & LIQUIDS
  • Dysphagia comes from  Greek word ‘dys’, which means difficulties, and ‘phagia’, which means swallowing.
  • Medically, dysphagia is a term for swallowing difficulties. Someone with dysphagia takes more time and effort to move food or liquid from their mouth down to their stomach.
  • Episodes of dysphagia can be intermittent or progressive.
IT IS A SYMPTOM FOR MANY MEDICAL CONDITIONS
  • In adults, dysphagia is very common in adult that has a history of stroke, dementia, Alzheimer’s disease, neck cancers, and gastroesophageal reflux disease (GERD).
  • It could also be present in children with attention deficit hyperactivity disorder (ADHD), autism, Down syndrome, and cerebral palsy.
  • Dysphagia can also be a sign that there are some issues with the many nerves and muscles that are involved in swallowing activities.
YOU MAY HAVE DYSPHAGIA IF YOU EXPERIENCE THE FOLLOWING
  • Persistent drooling of saliva
  • Coughing or choking when eating or drinking
  • Bringing food back up, sometimes through the nose
  • Feeling as though food is stuck in your throat or chest
  • Being unable to chew food properly
PEOPLE WITH DYSPHAGIA FACE ISSUES THAT CAN JEOPARDIZE THEIR HEALTH & WELL-BEING

Choking and lung infection

Individuals with dysphagia are susceptible to choking. Due to difficulties in swallowing normally, consumed foods or liquids can accidentally enter the airway into the lungs. This could result in aspiration pneumonia, often known as a lung infection and can be fatal.

Poor nutrition intake
  • The prevalence of malnutrition among people with dysphagia is reported to be anywhere between 3% and 29%, which is quite a high number.
  • Malnutrition leaves people with dysphagia more vulnerable to diseases, should they not receive enough essential nutrients for optimal body function.
  • Muscle wasting, underweight, and stunting could be other issues that arise. Hence, people with dysphagia needs to be aware of any weight loss, hair loss, feeling of coldness, and fatigue as these are the early symptoms of malnutrition.
Loss of appetite and fear of mealtimes
  • People with dysphagia often lose their appetite in conjunction with their reduced swallowing ability.
  • They might develop some degree of “laziness” when it comes to drinking more often, which may lead to dehydration.
  • Because their eating experiences can be difficult, uncomfortable, and unpleasant, they may develop anxiety during mealtimes.
Inability to talk fluently
  • Dysphagia can hinder one’s ability to talk fluently and, combined with difficulties in eating, may cause the affected person to experience low self-esteem and lead to self-isolation.
  • The decrease in social engagement will give a negative impact in the person’s quality of life.
  • Thus, social support from their carer, family members, and close friends are crucial. A little extra kindness and help will give a huge impact in their life and sometimes even touch their heart.
Proper nutrition management for people with dysphagia involves providing adequate nutrients through modification of food texture and fluid consistency.

We need to also keep an eye out for symptoms of dehydration such as dry mouth or tongue, thirst, headache, and lethargy. 

Also, be alert to any unexplained weight loss, hair loss, feeling of coldness and fatigue—these could be early symptoms of malnutrition.

IF YOU ARE WORRIED THAT YOU OR SOMEONE CLOSE TO YOU HAVE DYSPHAGIA

Consult a speech language pathologist, a healthcare professional trained to diagnose dysphagia, for a proper diagnosis.

People with dysphagia can consult with dietitians for their nutritional concerns or if they want to assess their nutritional adequacy.

TIPS FOR INDIVIDUALS WITH DYSPHAGIA TO ACHIEVE GOOD NUTRITION

Understand the extent of one’s dysphagia

Discuss with the speech language pathologist and other relevant healthcare professionals on the degree of swallowing ability in the person with dysphagia.

Refer to the International Dysphagia Diet Standardization Initiative (IDDSI) Framework

This guideline has seven levels. Flow test, spoon tilt, and fork drips are used as measurement methods to determine each level.

Click to view a larger and clearer image.

Further information can be obtained from the IDDSI website (link opens in a new tab).

Modify foods into certain textures 

For more detailed information on how to modify the textures of various foods, you can refer to this page on the IDDSI website (link opens in a new tab).

  • While modifying the textures of foods into appropriate textures, take into consideration the nutritional content (carbohydrates, protein, fat, as well as vitamin and minerals). Daily meals should provide all the nutrients to improve the person’s nutritional status.
  • Always choose softer food options if texture modification is not possible. For example, choose papaya instead of apple, and ‘soften’ a dish with gravy.
  • Add special thickening powder to watery liquids. This thickening allows for easier swallowing.
Useful tips for eating
  • Have the person with dysphagia sit upright to prevent choking.
  • Have them tilt their heads to prevent liquids from going into their air passage.
  • Encourage the person to take smaller bites, and give enough time to chew the food thoroughly.
  • If small pieces of food or liquid are stuck, have them cough a little.

Dysphagia is a journey of eating experience that may switch an individual’s life 360 degree. Hence support and motivation play an important role in the management of one’s dysphagia.


References:

  1. O’Rourke, F., Vickers, K., Upton, C., & Chan, D. (2014). Swallowing and oropharyngeal dysphagia. Clinical medicine (London, England), 14(2), 196–199. https://doi.org/10.7861/clinmedicine.14-2-196
  2. Shaheen, N. A., Alqahtani, A. A., Assiri, H., Alkhodair, R., & Hussein, M. A. (2018). Public knowledge of dehydration and fluid intake practices: Variation by participants’ characteristics. BMC public health, 18(1), 1346. https://doi.org/10.1186/s12889-018-6252-5
  3. Ueshima, J., Momosaki, R., Shimizu, A., Motokawa, K., Sonoi, M., Shirai, Y., Uno, C., Kokura, Y., Shimizu, M., Nishiyama, A., Moriyama, D., Yamamoto, K., & Sakai, K. (2021). Nutritional assessment in adult patients with dysphagia: A scoping review. Nutrients, 13(3), 778. https://doi.org/10.3390/nu13030778
  4. World Health Organization. (n.d.). Fact sheets – malnutrition. https://www.who.int/news-room/fact-sheets/detail/malnutrition