Journal of Isfahan Medical School

Journal of Isfahan Medical School

Recommendations for Ramadan Fasting in Patients with Diabetes Mellitus Based on Integrative Medicine and According to the Persian Culture- A Review Study

Document Type : Review Article

Authors
Mansour Siavash 1
Zahra Aghanouri 2
1 Professor, Endocrine and Metabolism Research Center of Isfahan. Isfahan University of Medical Sciences, Isfahan, Iran
2 Iranian Medicine Specialist, Endocrine and Metabolism Research Center of Isfahan. Isfahan University of Medical Sciences, Isfahan, Iran
10.48305/jims.v41.i706.0042
Abstract
A lot of the adult Muslim population will fast during Ramadan while many of those suffering from diabetes mellitus (DM). Risks of fasting for people with DM include hypoglycemia, hyperglycemia, ketoacidosis, and dehydration. Physicians should assess the likelihood of these risks in each patient and recommend him/her accordingly. With the right management and correct intervention, many people with diabetes can fast safely during Ramadan, but some of them need to be closely monitored and educated for the appropriate action. By quantifying multiple risk factors, a risk score is calculated that plays an important role in the decision/permission to fast for each patient. The new risk stratifying system defines three risk groups.  People, who fast against the advice of their physician/health care provider, should carefully follow the instructions of the expert to prevent serious complications. In this article, first, we discuss the risks of fasting in patients with diabetes mellitus, based on recent international guidelines and scientific pieces of evidence. Then we present dietary and lifestyle instructions for patients with diabetes mellitus during Ramadan, based on traditional Iranian medicine and also according to the latest pieces of evidence.
Keywords
Fasting
Diabetes mellitus
Integrative medicine
Life style
Persian medicine
Subjects
  1. Pippitt K, Li M, Gurgle HE. Diabetes mellitus: screening and diagnosis. Am Fam Physician 2016. 93(2): 103-9.
  2. Raiesi O, Siavash M, Mohammadi F, Chabavizadeh J, Mahaki B, Maherolnaghsh M, et al. Frequency of cutaneous fungal infections and azole resistance of the isolates in patients with diabetes mellitus. Adv Biomed Res 2017; 6: 71.
  3. Saadatnia M, Siavash M, Keyhanian K, Hamid A, Amini A, Davoudi V. Cognitive impairment in type 2 diabetic patients treated with metformin in comparison with those taking glibenclamide. J Neurol Stroke 2014; 1(4): 19.
  4. Siavash M, Najjarnezhad A, Mohseni N, Abtahi SM, Karimy A, Sabzevari MH. Efficacy of maggot debridement therapy on refractory atypical diabetic foot ulcers: an open-label study. Int J Low Extrem Wounds 2021; 20(4): 315-20.
  5. Siavash M, Shokri S, Haghighi S, Shahtalebi MA, Farajzadehgan Z. The efficacy of topical royal jelly on healing of diabetic foot ulcers: a double‐blind placebo‐controlled clinical trial. Int Wound J 2015; 12(2): 137-42.
  6. Siavash, M, Tabbakhian M, Sabzghabaee AM, Razav N. Severity of gastrointestinal side effects of metformin tablet compared to metformin capsule in type 2 diabetes mellitus patients. J Res Pharm Pract 2017; 6(2): 73-6.
  7. Akbar A, Saeb R. Report of the second conference on Diabetes and Ramadan, Iran, Mashhad, 2017. Journal of Nutrition, Fasting and Health 2017; 5(2): 83-4.
  8. Athar S. A report on the first international congress on health and Ramadan. J Islamic Med Assoc N Am 1996; 28(1): 43-4.
  9. Al-Arouj M, Abu Al Magd M, Annabi FA, Assaad-Khalil S, Ba-Essa EM, Fahdil I, et al. Recommendations for management of diabetes during Ramadan: update. BMJ 2010; 33(8): 1895-902.
  10. Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan. Diabetes Care 2005; 33(8): 1895–902.
  11. Ibrahim M, Abu Al Magd M, Annabi FA, Assaad-Khalil S, Ba-Essa EM, Fahdil I, et al. Recommendations for management of diabetes during Ramadan: update 2015. BMJ Open Diabetes Res Care 2015; 3(1): e000108.
  12. Beshyah SA. IDF-DAR practical guidelines for management of diabetes during ramadan. Ibnosina J Med BS 2016; 8(3): 58-60.
  13. International Diabetes Federation and DAR International Alliance. Diabetes and Ramadan: Practical Guidelines 2021. Diabetes Res Clin Pract 2022; 185:109185.
  14. Lessan N, Zainudin SB, Ahmedani Y, Mohamed NA, Shaltout I, Al Awadi F. Diabetes and Ramadan–practical guidance to ensure a safer fast. [Online] [March 2021]. Available from: URL: https://www.denovomedica.com/cpd-online/wp-content/uploads/Diabetes-and-Ramadan-practical-guidance-to-ensure-a-safer-fast-_-Online.pdf.
  15. Avicenna AAH, Al-Qanun fi al-Tibb [in Arabic]. 1st Beirut-Lebanon: Dar al-kotob al- elmiyah; 1999. p. 368-9.
  16. Ilkhani R, Aghanouri Z, Mojahedi M, Montazeri A, Siavash M, Tabatabaei F. Comparing Mizaj (temperament) in type 1 diabetes mellitus and healthy controls: A case–control study. J Res Med Sci 2019; 24: 58.
  17. Moghimi M, Kord Afshari G, Mohammadi Konari H, Shams Ardekani M. Fasting in diabetic patients; the viewpoint of traditional Iranian medicine.[in Persian]. Jornal of Islamic and Iranian Traditional Medicine 2012; 3(1): 125-30.
  18. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Pharmacologic approaches to glycemic treatment: standards of care in diabetes-2023. Diabetes Care 2023; 46(Suppl 1): S140-S157.
  19. Tefera MM, Masresha Altaye B, Yimer EM, Fikadu Berhe D, Tadesse Bekele S. Antidiabetic effect of germinated Lens culinaris medik seed extract in streptozotocin-induced diabetic mice. J Exp Pharmacol 2020; 12: 39-45.
  20. Aisa HA, Gao Y, Yili A, Ma Q, Cheng Z. Beneficial role of chickpea (Cicer arietinum L.) functional factors in the intervention of metabolic syndrome and diabetes mellitus. Bioactive Food as Dietary Interventions for Diabetes 2019; 615-27.
  21. Bhagyawant SS, Narvekar DT, Gupta N, Bhadkaria A, Gautam AK, Srivastava N. Chickpea (Cicer arietinum L.) Lectin Exhibit Inhibition of ACE-I, α-amylase and α-glucosidase Activity. Protein Pept Lett 2019; 26(7): 494-501.
  22. Jukanti AK, Gaur P, Gowda C, Chibbar R. Nutritional quality and health benefits of chickpea (Cicer arietinum L.): a review. Br J Nutr 2012; 108(S1): S11-S26.
  23. Aghili M. Makhzan Al-adwiyeh [in Persian]. Tehran, Iran: Sabz Arang Publications; 2009.
  24. Adnan M, Gu S, Batool S, Fatima B, Rehman A, Yaqoob S, et al. A review on the ethnobotany, phytochemistry, pharmacology and nutritional composition of Cucurbita pepo L. J Pharmacol 2017; 6(2): 133-9.
  25. Thanh TTT, Quach TTM, Yuguchi Y, Nguyen TN, van Ngo Q, van Bui N, et al. Molecular structure and anti-diabetic activity of a polysaccharide extracted from pumpkin Cucurbita pepo. J Mol Struct 2021; 1239: 130507.
  26. Nayudu ST, Sowjanya K. Anti-diabetic activity of methanolic extract of prunus domestica. Int J Recent Innov Trends Comput Commun 2017; 5(4): 213-20.
  27. Islam O, Azad AK, Rahman MM, Alam AK, Khairuzzaman M, Ferdous J, et al. Phytochemical profiling and evaluation of antioxidant and antidiabetic activity of methanol extract of spinach (Spinacia oleracea L.) leaves. Int J Pharm Sci Scient Res 2017; 2: 24-7.
  28. Hedayati N, Naeini MB, Arash Mohammadinejad A, Mohajeri SA. Beneficial effects of celery (Apium graveolens) on metabolic syndrome: A review of the existing evidences. Phytother Res 2019; 33(12): 3040-53.
  29. Esmaeilzadeh D, Razavi BM, Hosseinzadeh H. Effect of Abelmoschus esculentus (okra) on metabolic syndrome: A review. Phytother Res 2020; 34(9): 2192-202.
  30. Forino M, Stiuso P, Lama S, Ciminiello P, Tenore GC, Novellino E, et al. Bioassay-guided identification of the antihyperglycaemic constituents of walnut (Juglans regia) leaves. Journal of Functional Foods 2016; 26: 731-8.
  31. Das AK, Mandal SC, Banerjee SK, Sinha S, Saha BP, Pal M. Studies on the hypoglycaemic activity of Punica granatum seed in streptozotocin induced diabetic rats. Phytotherapy Research 2001; 15(7): 628-9.
  32. Katz SR, Newman RA, Lansky EP. Punica granatum: heuristic treatment for diabetes mellitus. J Med Food 2007; 10(2): 213-7.
  33. Azam A, Itrat N, Ahmed U. Hypoglycemic Effect of Barley (Hordeum vulgare) in Diabetics. Int J Innov Sci Res Tech 2019; 37(5): 515-9.
  34. Nejatbakhsh F. The rules of nutrition in diseases based on the basics of Iranian traditional medicine. [in Persian]. Tehran, Iran: Choogan Publications; 2014.
  35. Beatrice IO, Olakunle AT, Olakunle AA, Abiodun RO, Folake MH, Aluko AF. Antidiabetic Principle in Cucumis sativus L. In: Wang H, Editor. Cucumber economic values and its cultivation and breeding. Norderstedt, Germany: BoD – Books on Demand; 2021.
  36. Manzano M, Giron MD, Vilchez JD, Sevillano N, El-Azem N, Rueda R, et al. Apple polyphenol extract improves insulin sensitivity in vitro and in vivo in animal models of insulin resistance. Nutr Metab (Lond) 2016; 13: 32.
  37. Mohebbi S, Naserkheil M, Kamalinejad M, Hosseini SH, Noubarani M, Mirmohammadlu M, et al. Antihyperglycemic activity of quince (Cydonia oblonga Mill.) fruit extract and its fractions in the rat model of diabetes. International Pharmacy Acta 2019; 2(1): 2e7: 1-8.
  38. Mahmoud KB, Hanen W, Mansour RB, Jemai N. Antidiabetic, antioxidant and chemical functionalities of Ziziphus jujuba (Mill.) and Moringa oleifera (Lam.) plants using multivariate data treatment. Afr J Bot 2022; 144: 219-28.
  39. Wolever TMS, Vuksan V, Relle LK, Jenkins AL, Josse RG, Gerald S, et al. Glycaemic index of fruits and fruit products in patients with diabetes. Int J Food Sci Nutr 1993; 43(4): 205-12.
  40. Kumar V, Sachan R, Rahman M, Sharma K, Al-Abbasi FA, Anwar F. Prunus amygdalus extract exert antidiabetic effect via inhibition of DPP-IV: In-silico and in-vivo approaches. J Biomol Struct Dyn 2021; 39(11): 4160-74.
  41. Gholamhoseinian A, Fallah H, Sharififar F. Inhibitory effect of methanol extract of Rosa damascena Mill. flowers on α-glucosidase activity and postprandial hyperglycemia in normal and diabetic rats. Phytomedicine 2009; 16(10): 935-41.
  42. El-Sayed MIK. Effects of Portulaca oleracea L. seeds in treatment of type-2 diabetes mellitus patients as adjunctive and alternative therapy. J Ethnopharmacol 2011; 137(1): 643-51.
  43. Rossol S. Constipation in patients with diabetes mellitus. MMW Fortschritte der Medizin 2007; 149(44): 39-42.
  44. Gorji N, Moini R. Maintaining health with Iranian medicine [in Persian]. 7th Tehran, Iran: Choogan Publications; 2016.
  45. Mopuri R, Ganjayi M, Meriga B, Koorbanally NA, Shahidul Islam M. The effects of Ficus carica on the activity of enzymes related to meta bolic syndrome.
    J Food Drug Anal 2018; 26(1): 201-10.
  46. Bento C, Gonçalves AC, Silva B, Silva LR. Peach (Prunus persica): Phytochemicals and health benefits. Food Rev Int 2020; 38(2): 1-32.
  47. Suksomboon N, Poolsup N, Lin W. Effect of kiwifruit on metabolic health in patients with cardiovascular risk factors: A systematic review and meta-analysis. Diabetes
    Metab Syndr Obes 2019; 12: 171.
  48. Monro JA. Kiwifruit, carbohydrate availability, and the glycemic response. Adv Food Nutr Res 2013; 68: 257-71.
  49. Zarei MA, Sadeghi M. α-glucosidase inhibition by hexane extract from aerial parts of Descurainia sophia L. schuar and Fumaria vaillantii Loisel. Journal of Plant Research (Iranian Journal of Biology) 2020; 33(4): 787-802.
  50. Soltanian N, Janghorbani M, Adibi P. Effects of psyllium vs. placebo on constipation, weight, glycemia, and lipids: A randomized trial in patients with type 2 diabetes and chronic constipation. Complement Ther Med 2018; 40: 1-7.
  51. Chaudhary S, Semwal A, Kumar H, Chandra Verma H, Kumar A. In-vivo study for anti-hyperglycemic potential of aqueous extract of Basil seeds (Ocimum basilicum Linn) and its influence on biochemical parameters, serum electrolytes and haematological indices. Biomed Pharmacother 2016; 84: 2008-13.
Journal of Isfahan Medical School
Volume 41, Issue 706
2nd Week, April
March and April 2023
Pages 42-53

  • Receive Date 01 April 2022
  • Revise Date 10 March 2023
  • Accept Date 10 March 2023