Every Ramadan, heart patients ask their doctor "Can I fast?" asks the question. It is not correct to generalize that cardiovascular patients can or cannot fast. Because there are many different types of heart diseases. The best thing to do is to make a decision by evaluating heart patients individually. The type and severity of the disease, the fasting climate, the time between sahur and iftar, the type of foods eaten at iftar and sahur, the type and frequency of medications used should be taken into consideration when making the decision. Cardiology Department Specialist Prof. Dr. İbrahim Baran answered frequently asked questions on this subject:
What are the benefits of fasting for cardiovascular health?
Studies conducted on healthy individuals show the beneficial effects of fasting. Fasting increases good cholesterol (HDL) levels and reduces bad cholesterol (LDL) levels. Again, it reduces the development of diabetes and atherosclerosis by restricting calorie intake. Another positive aspect of fasting for heart patients is its psychological effect. In patients who fast, the depressive mood decreases and the patient feels relieved.
Can fasting trigger cardiovascular diseases?
Studies conducted on healthy people have linked heart diseases during Ramadan and the following months. showed that there was no increase in the hospitalization rate. However, fasting on hot and long summer days may cause problems for many patients. Excessive fluid and electrolyte loss can cause a drop in blood pressure, fainting, heart spasm, or heart failure. This situation is even more evident in elderly patients.
Is it harmful for cardiovascular patients to fast?
Heart patients who fast under the supervision of a doctor are more likely to fast during the month of Ramadan than heart patients who do not fast. It is known that the disease does not progress differently and there is no worsening. Even fasting in blood pressure patients, provided that they continue their medications; It leads to relief in blood pressure and weight loss. However, heart patients should make the decision to fast in consultation with the physician who monitors them and act in accordance with his recommendation. Because in many patients, drug therapy needs to be rearranged and dosage adjusted while fasting.
Which cardiovascular patients should definitely not fast?
It is especially dangerous for patients with active complaints such as chest pain and shortness of breath to fast. Patients with advanced heart failure should never fast. It may be harmful for patients taking high doses of diuretics to fast, especially during the summer. Fasting is not recommended for patients who have had a heart attack in the last 6 months, patients with chest problems, patients who have had stents placed or coronary bypass surgery in the last 6 months. Fasting is risky for patients with serious rhythm disorders. Patients with resistant hypertension should not fast until their blood pressure drops to normal. All cardiovascular patients, other than the above-mentioned conditions, should definitely consult their physicians whether they can fast.
How should the drug treatments of heart patients be regulated while fasting?
Not taking heart medications regularly. causes the disease to worsen. Necessary arrangements should be made for patients' drug treatments before the month of Ramadan. The treatment of patients who use a single dose of medication a day (such as hypertension and arrhythmia patients) can be regulated by shifting the medication dose to sahur or iftar. Care should be taken when using blood thinning medications. It may be considered to take the drugs taken in 2 doses a day at iftar and sahur. However, in the summer months, the average time between iftar and sahur is 16 hours, so the effectiveness of medications during the day may decrease. If possible, it may be beneficial to switch to 24-hour effective medications before Ramadan. In this case, if changing medication is not appropriate, fasting should not be allowed due to the risk of blood clot formation. It should not be forgotten that the risk of clots will increase with fluid loss, especially in elderly patients and in very hot environments. If the INR level of patients using Coumadin is variable, more frequent INR measurements may be considered during Ramadan.
Unfortunately, it is not possible to limit the treatment of patients with advanced heart failure between iftar and sahur. It is not possible to limit medication regimens to iftar or sahur due to the large number of medications these patients take and often accompanied by kidney failure or diabetes. is the province. For this reason, it is dangerous for patients with advanced heart failure to fast.
What should a heart patient who can fast pay attention to in nutrition? The long period of fasting increases the importance of nutrition in heart patients. Due to hot weather, adequate fluid intake should be ensured between iftar and sahur. Unless there is a suggestion to the contrary; Around 2 liters of fluid should be taken between iftar and sahur. Patients should be advised to stay away from hot environments while fasting and to avoid doing heavy work in the heat. A common problem we see in our patients fasting during Ramadan is that they eat heavy and large meals. While some patients eat heavily and excessively at iftar due to the effect of long-term hunger, others eat a lot at sahur in order to withstand hunger during fasting. However, a heavy meal triggers many heart diseases. Therefore, a balanced diet should be taken. Patients should eat three meals instead of two during Ramadan. These three meals should be in the form of iftar, 2-3 hours after iftar and sahur. In this way, the patient's cardiac burden will not increase since the meal amount is divided.
What should be eaten for iftar and sahur?
Foods that take a long time to digest should be chosen for these meals. Meals consisting of fiber, protein-rich vegetables and fruits undergo long-term digestion (about 8 hours); It also ensures a long-lasting feeling of satiety. On the contrary, sugary and floury foods containing processed carbohydrates will be digested in a short time (about 3 hours) and will cause you to feel hungry in a short time. Instead of processed carbohydrates (sugary foods, pastries, buns, baklava, pasta, cookies, jams, etc.), foods such as vegetable dishes, beans, peas, chickpeas, lentils should be preferred and acidic soft drinks should be avoided. One must definitely wake up for sahura.
As a result, fasting has positive effects on the heart and, in general, it does not cause worsening in the course of stable heart diseases. Many stable cardiac patients can fast without any problems, provided that their drug therapy is regulated and they are under the control of a physician. Cardiac patients must be consulted by a cardiologist before Ramadan. It should be decided individually whether the patient can fast or not, and when making this decision, the patient's general condition, medication, and climatic conditions should be taken into consideration. It should also be taken into consideration that cardiac diseases may coexist with diabetes and/or kidney diseases, and in such patients, the decision should be made together with a diabetes and kidney specialist.
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