For patients with heart disease, they must have concerns about whether they can fast safely because it is related to the routine of taking medicines, what foods are good to eat while fasting, and of course their exercise routine. In fact, heart disease patients can safely and comfortably follow these tips.
The benefits of fasting for heart health
Fasting has many benefits and can reduce risk factors for heart disease. This is because people who fast regularly will be able to control themselves over what they want to eat and drink. Here are the benefits of fasting:
- Cholesterol levels decrease
Coronary heart disease is caused by atherosclerosis, which is a narrowing or blockage of the coronary arteries due to fat infiltrating the lining of the blood vessels.
A study states that there are changes in the fat profile and the ratio of good fats and bad fats during fasting in the month of Ramadan, where total cholesterol levels decrease from 193.4 ± 51 mg/dl to 184.3 ± 42 mg/dl after Ramadan, as well as triglyceride levels decrease. from 4.5±1 mg/dl to 3.9±1 mg/dl and also decreased LDL. In contrast, there was an increase in good fat, namely HDL after Ramadan fasting, by 30-40% in people with heart disease.
- Lowers blood pressure
In conditions of high blood pressure, the heart has to work harder to pump blood than normal people. This can cause heart fatigue, enlargement and thickening of the heart muscle can occur, which eventually results in heart failure. In a study during the month of Ramadan, there was a decrease in systolic blood pressure from 132.9 ± 16 mmHg to 129.9 ± 17 mmHg.
- Lowering blood homocysteine levels
Homocysteine is one of the natural amino acids where if high levels in the blood can increase the risk of atherosclerosis, so you can get heart and blood vessel disease. Although not significant, there is a decrease in blood homocysteine levels when a person is fasting.
- Avoiding the Body Experiencing Insulin Resistance
Another benefit of fasting is that it makes the body wiser in using sugar, so this can prevent the body from experiencing insulin resistance which leads to diabetes mellitus. If the conditions of sugar metabolism are well controlled, then the body will be far from the risk of heart disease.
In addition, a study shows that changing eating patterns to twice a day during Ramadan can improve the condition of insulin resistance in diabetics.
- Control weight
Obesity is a factor in the occurrence of metabolic syndrome, which can increase the risk of heart and blood vessel disease and diabetes mellitus. Fasting can hold food so that body weight can be controlled properly, thus the possibility of heart disease is even smaller.
When can people with heart disease fast?
A study in Qatar which was conducted for 10 years, as many as 2,160 patients with heart failure were observed for their physical condition during fasting. The results of this study state that fasting does not have a negative impact on heart function or the health of other organs.
Rami et al conducted a prospective observational study of the effects of Ramadan fasting in patients with chronic heart failure with an ejection fraction of less than 40 percent. The ejection fraction is a measurement of the blood pumped out of the ventricles, normally more than 50 percent. There were 249 patients with symptoms of heart failure who underwent outpatient care at three clinics. Of the 249 patients, 227 patients underwent fasting during Ramadan. Researchers observed participants' adherence to limiting fluids and salt and taking medication before, during, and after Ramadan. As a result, 209 patients (92%) experienced no change or symptoms of heart failure improved, while 18 patients (8%) their condition worsened, caused by indiscipline following fluid and salt restriction rules, as well as lack of adherence to taking medication.
Although fasting does not cause bad side effects in people with heart disease, there are several things that these patients should not fast, including frequent recurring chest pain in the near future, frequent fatigue, shortness of breath, or the need to take diuretic drugs more than 3 times a day, have just had a heart attack or heart surgery, or have a heart rhythm disorder that causes the patient to take regular anti-arrhythmic drugs. However, for people with heart problems who wish to fast, it is advisable to consult with a heart and blood vessel specialist first. Patients with high blood pressure can participate in fasting, as long as they don't have serious complications, of course they still take medication regularly.
Setting heart medications during fasting
Heart medicines must be taken regularly during the fasting month to reduce the risk of complications from heart disease. There are some medicines that need adjustment, of course you have to consult with your doctor first.
- Blood thinning medication
Antiplatelets or blood thinners such as acetyl salicylic acid (ASA) can be given after eating sahur or breaking the fast. However, for patients with ulcer disease it should be given after breaking the fast, and enteric coated tablets are chosen which can pass through the stomach. If you need to give ulcer medicine.
- Anti-cholesterol drug
Statins must still be consumed, especially in patients with coronary heart disease. Not only do they function to reduce bad cholesterol, but also to stabilize plaque so as to avoid clogged arteries and heart attacks. Statins should be given at night because the enzymes that make cholesterol are more active at night.
- diuretic
When fasting, diuretic drugs such as furosemide can be reduced in dosage during fasting, of course you have to consult with a heart and blood vessel doctor who knows his history first. Furosemide should be taken when breaking the fast to avoid dehydration and weakness if taken in the morning. Fluid restrictions in people with heart failure are also important according to doctor's recommendations.
- Anti-hypertensive drugs
The European Heart Journal (2018) states that taking high blood pressure medication at night is better than in the morning. The expert from Spain examined 19,000 hypertensive patients who regularly took anti-high blood pressure medication from 2008 to 2018. As a result, patients who took medication before going to bed, the risk of heart attack decreased by 44%, the chance of heart failure fell by 42%, the risk of stroke fell by 49% , and the risk of death from cardiovascular disease decreased by 45%. With a record of regular sleep rhythms, such as waking up in the morning and sleeping at night is not disturbed. But again, giving antihypertensive drugs is sometimes also individual, you can also take it in the morning and choose a mono drug or once a day at the same time.
For administration of bisoprolol absorption is better in the morning, so it is given at dawn. Medication adjustments during fasting should be consulted with a doctor.
Foods that should be consumed at breaking the fast and dawn
When sahur and breaking the fast, you should eat vegetables and fruits, because they contain potassium which can reduce the effect of sodium or salt on blood pressure. Some types of foods that contain lots of potassium are bananas, oranges, melons, cantaloupe, eggplants, cucumbers, and green vegetables. However, foods high in potassium should also be watched out for in patients with chronic kidney failure.
In patients with hypertension, it is not recommended to consume foods with a high salt content, both at dawn and breaking the fast because salt can trigger a rapid rise in blood pressure. Limiting salt intake in food to at least 2 grams per day, or about one teaspoon.
Whole grains or whole grains are an excellent source of fiber, which plays a role in regulating blood pressure and heart health. So that it can be a choice of food menu at dawn and breaking the fast.
Reducing the consumption of saturated fat and trans fat when breaking the fast and dawn is very important to help reduce cholesterol in the body. High cholesterol levels can cause plaque in blood vessels which can increase the risk of heart disease or stroke. We recommend consuming sources of fat that can increase HDL (good cholesterol) such as avocados, almonds, olive oil, canola oil.
Low-fat protein sources such as skinless or fat meat, fish, eggs, soybeans, tofu, tempeh, skimmed or low-fat milk can be selected to prevent increased cholesterol.
Patients with hypertension should limit their consumption of caffeinated drinks, such as coffee, tea and soft drinks.
Exercise while fasting
When fasting, exercise should be done with light to moderate intensity, 30 minutes 3-5 times a week. Determination of this intensity can be done by measuring the pulse with the formula 70% x Maximal HR ( heart rate = pulse). The formula of the maximum HR is 220-age. For example, in a patient aged 50 years, the maximum HR is 220-age (50 years) = 170. If the intensity is moderate, the maximum recommended pulse rate is 70% x 170 = 119 times per minute. Another way is to do a speech test, which is said to be of moderate intensity if you can maintain a conversation or say a sentence without panting while exercising, but you can't sing anymore.
Morning exercise may be done as long as the intensity is light such as walking, it can be done in the afternoon, but be careful because blood sugar is lowest just before breaking the fast. Exercise can also be done at night 2 hours after eating.
Tips for safe fasting in heart sufferers
During the fasting month, it is best to consume enough food, small portions, and not take "revenge" when breaking the fast. Reduce fatty foods and lots of salt, such as fried or fast food. Expand vegetables and fruits, fibrous foods such as wheat or whole grains. Take time to rest and get enough sleep, drink at least 8 glasses of water a day, unless your doctor recommends limiting fluids in heart failure. And the most important thing is to consult a doctor if there are complaints or consultations about routine medicines that are consumed. May fasting in the holy month of Ramadan bring blessings and benefits, make the body healthier and avoid diseases that we don't want.
Article written by dr. Rony M. Santoso, SpJP(K), FIHA, FSCAI, FESC, FAPSC (Cardiologist & Vascular Specialist Interventional Cardiology Consultant at EMC Alam Sutera Hospital).