Can fasting during Ramadan really help lower your sugar levels
For a lot of individuals, Ramadan fasting can lead to a decline in glucose levels but will vary based on your current health condition, medications, and how the fast is completed (in addition to major aspects of Ramadan fasting). This article provides an unbiased, peer-reviewed overview of Ramadan fasting from a scientific perspective.
Different people (and cultures) have their own method of Ramadan fasting – fasting between sunrise and sunset has created a time-restricted eating pattern (with meals scheduled at set times of day), therefore changing when food is consumed, how much food is consumed, and how much sleep is obtained – resulting in changes in the way the human body metabolises glucose. Research has applied the concept of intermittent time-restricted eating, using Ramadan fasting as an example of this type of eating, to determine the variance in outcome of those studies.
What the research shows (big-picture)
- Those with no diabetes typically see some improvements in fasting glucose levels and weight if they follow Ramadan or other forms of Time Restricted Eating. Intermittent fasting has been studied in Randomised controlled trials and has shown modest decreases in fasting glucose and improved insulin sensitivityfor several groups.
- People with type 2 diabetes have mixed results from fasting during Ramadan. There is sufficient evidence from systematic reviews and meta-analyses that many people will not experience a large worsening of HbA1c or will even see improved control if they have pre-Ramadan medical evaluations and medication counseling. However, there is a risk of low glucose (hypoglycemic episodes) and high glucose (spikes after large meals) in the evening after fasting.
Who tends to benefit
Individuals who are metabolically flexible being overweight and insulin resistant without the use of high, risk glucose, lowering therapies can frequently realise a small benefit to be gained from the time window and less snacking. Research on structured intermittent fasting (like 5:2, 16:8) have shown better weight and sometimes better glucose control than regular care. However, the majority of advantages are derived from reduced calorie intake and better meal timing rather than some mysterious “fasting magic”.
Important risks and caveats
People with Type 1 diabetes do not all experience the same Ramadan. The risks for fasting for type 1s who suffer from brittle control, people who have had a recent history of severe hypoglycemia (low blood sugar), or who take insulin/secretagogue are increased. All of these individuals require individualised fasting plans, and some of these individuals should not be fasting. Research around the world shows that more individuals experience both low and high blood sugar levels during this month of fasting, and a minority of them require hospitalisation as a result. Education and adjustments made to medication prior to Ramadan can significantly lower the risk to these individuals.
Practical tips (if you plan to fast)
1. It is important to consult with your physician before Ramadan in order to plan for your diabetes with a medical workup and a prediction of how well you will do while fasting. The IDF-DAR is a good reference source if you need help on how to fast or what kind of medication changes may be needed accordingly.
2. To avoid a high at Iftar, it is best to have a variety of complex carbohydrates, proteins and fibre at Suhoor.
3. Use a Continuous Glucose Monitor (CGM) or a finger prick to monitor your blood glucose levels frequently to know when to break your fast (for example if you have very low blood glucose; or have developed high or very high BG levels, you should see a doctor).
4. Fluids are very important! It is essential to consume sufficient fluids between breaking the fast and when eating Suhoor. Also avoid eating large amounts of added sugars at the time of sundown or within the hour after.
(The writer is a lead consultant – Endocrinology & Diabetology, Aster Whitefield)
