Performing Fasting Healthily #HealthyPuasa

Some of you on Twitter might come to know me as (one of the many) @Twt_Malaysia curator that has shared tips about eating well, healthy, clean and exercising about a month ago. I thoroughly enjoyed my experience sharing what I am passionate about. Naturally, the request for opinions and advices trickles in.
Recently, a request came in for suggestion on a healthier way to fast. As the Muslim (in Malaysia particularly) will be fasting soon (about 2 weeks time), a few tweeps got together and shared a few tips on fasting - in a healthier way.
Why Fast?
Fasting are usually done as a religious obligation. Muslims practices 30-days of fasting during the Ramadan month. Catholics does it for a month 40days (thanks Adella!) during Lent. Hindus does it often, some on weekly (a day) basis. Buddishism teaches moderation and monks usually refrain from eating after lunch (usually eating one meal day only). Sikhs also does it for about 28 days.
Apart from fasting being religious-linked, the act actually has a lot of merits. The known benefits are:

• Allowing the digestive system to rest
• Detoxification as organs such as kidney and liver doesn't work hard
• Reduces and control blood sugar level and thus, reduces insulin resistance
• Encourage fats to be used as primary fuel and improve your lipid profile
• *Studies has shown it helps with cancer recovery and even cardiovascular diseases
• Known to reduce inflammatory responses such as allergy to food and possibly treatment of gout
• Help with blood pressure control with a steadier metabolic rates. Our BP increases after meals usually
• Helps with addiction to alcohol and nicotine. Fasting period is a good place to start giving up these vices
• encourage self-control over food and regulate eating habits.

*Footnote on cancer. Updated June 24, 2013. Brian mentioned that there is no strong clinical studies with regards to "fasting and cancer recovery". However, taking food rich in Omega-3 and anti-oxidants (think good oil rich in Vitamin E). Cancer patients recovering are also encourage to take in richer protien diet to compensate for "muscle-wasting" due to cancer treatment.

Fasting might not work for everyone. Some precautions to be taken would be:

• People with peptic ulcer or other gastrointestinal issues must approach fasting carefully. While the system rest, the secretion of digestive acid continues.
• Could dehydrate the body - reduce physical activities and give the body a break as well
• People with known cardiac problem, nursing, pregnant women, renal and liver problems are advised not to fast, or approach it with caution.

The pros of fasting out-numbered the cons. There is a good reason to fast. One can always practice intermittent fasting (IF) i.e. taking a day off from food or predetermined hours in a day of a week. Many ways to do it, and not just bounded by religion.
Doing It Healthily

Contributing credit to Brian Lian and GingkoBilobar. Both are practicing Nutritionist and Dietitian respectively

You can find the conversation and tips on Twitter using the hashtag #HealthyPuasa (not case sensitive). As promised, this is what the one day worth of sharing by Brian, Fauzee and Dr. Yoong.
Breaking Fast
Essentially, healthy fasting is no different from healthy eating. Consuming real food and eating in moderation. A body that is undergoing fast and has no food or limited liquid intake will reacts differently when food is introduced. When you break fast, one of the first to fire up is the insulin level as it anticipate blood sugar to increase when food are taken. For this matter it is wise to:

• avoid sweet things such as cordial drinks, soft drinks or anything sweet. Plain water is the best, though some electrolyte drinks can be acceptable
• avoid sweet food such as sweet or sugar dense food such as dates or kurma that has been soaked/preserved in sugar.
• avoid overeating. Moderation and stick to a serving of food. Your body would not be able to process more than 200kcal/hour and eating a normal meal of up to 700kcal allows the body to process it in 4hours - which is the typical digestion period.
• avoid signing up for buffet. Your stomach is only that big. Do not waste money on buffet.
• avoid forcing food down the throat just because you fast the whole day

One of the favorite during the fasting month is the Kurma or date. While this fruit is already sweet (naturally), the act of preserving it requires sugar and that is where the pitfall of the cheaper kurma having added sugar will spike the insulin level. 

Choose wisely and read the ingredients and label. The good/better kurma typically has lower sugar content (as carbohydrate and sugar) while the cheaper variants has higher energy value (calorie dense). For diabetics, it is NOT RECOMMENDED to break fast with kurma. It is high GI and a sudden glycaemic influx will raise high blood sugar level. If you must, go for the Kurma on stalks or those fresh kurma.

Eat in moderation and the intention of breaking fast (religion perspective) is just to provide some energy(at Breaking fast aka Mahgrib - Thanks Salina H for helping to make it clearer), for Terawih and before the main meal after Isyak. Do correct me if i am wrong. This is based on my own personal experience living in a boarding school and having a very good mixture of friends of all races.

The common mistakes many make when breaking fast is eating too fast and too much. Chew your food and eat slowly. It will send the signal to the brain that you are satiated and prevent overeating. If you can, do try t avoid the mega-breaking fast offered by every single eateries and fast food restaurant - it actually defeat the whole purpose of fasting. 

Another point to note is that the metabolic rate will be high during daytime and slow down at night. This is important as eating more at breaking fast will inevitably causes the body to store the extra unused calories as fat. Eating beyond your bedtime contributes to obesity. 

As much as possible eat food low in GI value. Low GI food are typically whole unprocessed or less processed food. Avoid fast food laden with oil and fats. Avoid overly starchy food. 

As dehydration could be an issue during the fasting month, it is suggested that an isotonic drink may be allowed to make up the loss electrolytes. Choose a good isotonic drink that has the balance electrolyte profile instead one that only has sodium chloride, or "table salt". 

Preparation for Fasting In The Morning

The breakfast, or Sahur, or the last meal before fasting commence is important to ensure sustained energy and nutrition throughout the day. Some people skip Sahur by justifying it with a very late meal past bedtime (extended supper?) so they could sleep a bit longer. Unless you have medical condition that does not allow you to have a "normal" sahur including throwing up food due to habit or known/unknown medical condition, do make sure your Sahur, or the last meal before fasting consist of:

• Complex carbohydrate. They are typically low in GI value and take longer to digest. In return it releases energy slowly and sustainably.
• With rice being staple diet for Malaysians, it is recommended that brown rice to be used to replace white rice. Other items worth your sahur would be rolled oats and multigrain bread.
• If you love milk, go for full cream or fresh milk. The fat in these milk is good for you and known to help lower GI value of the food you take. Make sense as milk fats takes time to be digested, thus helping to digest the food you eat slower.
• Take adequate fruits and vegetables. Load up on nuts and legumes. They are high in fiber and low in GI
• Choose lean cut meat instead of fat meat. 
• Protein help satiation, what it meant is it makes you full. 
• Avoid caffeine (read : Coffee or tea) as it's diuretic and will dehydrate you. If you must, compensate the liquid with the same amount of caffeinated drinks you took. 1 Cup of coffee with 1 cup of water. 
• Avoid processed cereals - they are high in GI and will digest fast, making you hungry faster.

Exercising During Fasting

It might be a wise choice to tone down the exercises regime during fasting. With the body deprived of energy by mid afternoon, it might not be a good choice to exercise too long of a duration. You can perform exercises in moderation such as a brisk walk or a jog. Heavier exercises such as at more intense effort could be demerital. 

Update June 24, 2013. For those observing religious fasting, a good time to exercise would be right before breaking fast (an hour before) and/or right after Ishak prayers. I've written about "Running On Empty" and it could be a good place to start training on no-food or minimal food.

If you must exercise :

• Limit to maximum of 45minutes of brisk walk or jog. This should cover the distance of about 3 to 4km.
• Consider stretching exercises such as Yoga. These movement helps to lengthen the muscles and aid in recovery or pain management
• If you must lift weight, practice common sense and do not over strain
• do not ever, ever use exercise during fasting month as an excuse to eat more at breaking fast
• or for that matter, never ever exercise to eat
• Swimming is a good option, provided the fasting you are undertaking allows you to ingest a bit of water. This is religion-centric

Fasting is actually a good opportunity to allow the body to rest, recover and rebuild. Most athletes over train and over strain their body without realising. If the fasting is done as part of a religious obligation, taking time off could be good for the body and soul.

Lastly, to quote the contributors, fasting by itself is not difficult. The most difficult part is actually making the healthy choices when it comes to food.

Happy fasting!