Dr. Khadija Musyar
Ramadan may be safe for some healthy elderly people, but for many of them, this practice carries risks, the main ones being: dehydration, hypoglycaemia, and malaise that could lead to falls and fractures.
Absolute contraindications for the elderly
Ramadan fasting poses a danger to the elderly who suffer from a chronic disease such as diabetes, especially if it is being treated with insulin or if it is not yet controlled. This applies to patients with kidney failure or heart disease, and patients who have had a recent heart attack, unstable angina, or recent heart failure, or when taking high doses of diuretics. In all these cases, fasting during Ramadan exposes you to dehydration, hypoglycemia, and malaise that may lead to falls and fractures.
Fasting is also prohibited in the event of a deterioration in the function of the adrenal glands (adrenal insufficiency) because the replacement therapy used in this disease requires taking it regularly during the first part of the day, which is not compatible with fasting.
Risks of fasting in the elderly
Fasting can endanger people’s health in the presence of contraindications. Very serious complications can occur despite the stable condition of the disease, such as: stroke, myocardial infarction, or kidney failure. In the case of diabetes, there is an increased risk of hypoglycemia or dangerously high blood glucose levels and ketoacidosis.
There is a special problem for this period is the mismanagement of medicines due to the short duration of breakfast, especially since the elderly are highly vulnerable to the dangers of medicines due to their slower elimination through the kidneys, their accumulation in body fat, and their more violent passage through the brain. Thus, the drugs remain in larger quantities and for a longer period in the body.
The situation also gets more complicated when several doses of medication need to be taken at regular intervals; In addition to the need to take some medicines on an empty stomach, taking them before suhoor may be inappropriate during Ramadan, as the stomach is not entirely empty when waking up for the suhoor meal.
In addition, there are some drugs whose intake is not compatible with fasting: diuretics, sulfonamides that lower blood sugar.
The Ramadan diet: Malnutrition in the elderly, a risk that cannot be ruled out
A balanced diet is required during the month of Ramadan, because the nutritional balance of elderly people is very fragile, due to poor appetite and low reserves. When breaking the fast, it is preferable that the meal be light, and it is especially important to avoid sugars that cause a strong secretion of insulin followed by a feeling of hunger. It is also recommended to eat plenty of suhoor. During this meal, you should avoid drinks that contain stimuli such as coffee, tea, mint, chocolate, as well as energy drinks and cola, because they disturb sleep and some of them cause increased urination, a factor that increases thirst during the day.
Elderly people should not restrict their food consumption during Ramadan because, contrary to popular belief, their energy needs are almost identical to those of young people. Even the requirements for water, protein and calcium are higher than in young adults. To avoid aggravating muscle aging, the recommended daily dietary intake of proteins, especially during Ramadan, should be higher than that recommended for adults: 1 to 1.2 versus 0.8 to 1 g/kg/day in adults.
Fasting and physical activity during Ramadan
Getting 15 to 30 minutes of daily physical activity is essential to combat the age-related decline in muscle mass, which can be exacerbated by fasting. In fact, muscle mass decreases with age, and muscle makes up only 17% of body weight at 70 years old versus 30% at 30 years old. Called sarcopenia, this phenomenon has huge ramifications for the elderly because of the vulnerabilities it causes: risks of infection due to reduced protein reserves needed for immune defenses, and possible falls and fractures that threaten the independence of elderly people.
In addition, physical activity, especially outdoors, has a positive effect on sleep and morale. In fact, by being exposed to natural light during the day, it allows the latter to penetrate the eyes and stimulate the secretion of the sleep hormone, melatonin.
However, the elderly should not exceed the physiological capabilities of their bodies and know that their physiological “norms”, which are very different from those of younger people, force them to be more vigilant.
The main recommendations for elderly people to fast safely:
It is highly recommended that the elderly person do the following:
Consult your doctor before deciding whether or not to fast during Ramadan and how to take your medications. Do not administer medications on your own;
– do not reduce the usual food intake;
– Make sure to consume good portions of proteins, because your need is greater;
Drink well at least 1.7 liters per day;
Do exercise for at least 15 minutes a day and adopt, as far as possible, regular hours of sleep;
Eat a good suhoor before sunrise, have a snack at breakfast and dinner 3 hours later.
Dr. MOUSSAYER KHADIJA Dr. Khadija Musyar
Specialist in internal medicine and geriatrics
Specialist in internal medicine and Geriatrics in private practice, Ex – intern at the Hospitals of Paris (Charles Foy geriatric hospital)
Présidente de l’Alliance Maladies Rares Maroc, Chair of the Rare Diseases Coalition, Morocco
President of the Moroccan Association of Autoimmune and Systemic Diseases (AMMAIS)
President of the Moroccan Society of Autoimmune and Systemic Diseases