SPECIAL SUPPLEMENT THURSDAY 30 APRIL 2020

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Public HealthSPONSORS

PHCC keen to provide services to all patients

ACTING MANAGING EDITORMohammed Salim Mohamed

EDITORIAL CONTRIBUTOR Fazeena Saleem

EDITOR-IN-CHIEFDr. Khalid Mubarak Al-Shafi

SUPPLEMENT COORDINATORAhmed Eltigani Idris

DESIGNAbraham Augusthy

Healthy diet and its importance during Ramadan

FAZEENA SALEEM THE PENINSULA

As the coronavirus pandemic rapidly sweeps across the world, it is inducing

a considerable degree of fear, worry and concern in the population at large.

Medical teams across Qatar’s healthcare system are working tirelessly to combat the spread of the virus and ensure anyone with COVID-19 receives the very best medical care to manage their physical symptoms.

However, it is impor-tant that people’s mental health is also prioritized at this time. Many people are understandably worried by the current situation and may feel frightened, con-fused, anxious, or low. The symptoms of conditions such as depression and anx-iety can often go unseen, but the impact they can have on an individual must not be underestimated.

Even in normal circum-stances, many of us will suffer some form of stress or psychological distress. But the emergence of COVID-19 and its impact on our lives can be a major cause of stress and anxiety. It is important to remember that these difficult times will pass, and life will return to normal.

As part of its public health response, the Min-istry of Public Health has worked with partners to develop a set of new mate-rials on the mental health

and psychosocial support aspects of COVID-19.

In collaboration with Ministry of Public Health and Primary Health Care Corporation, Mental Health Service in Hamad Medical Corporation have launched a new helpline to provide sup-port for people experiencing mental health problems as a result of the current COVID-19 pandemic.

The helpline is staffed by a team of mental health pro-fessionals who can provide assessment and support to callers through four main categories: Children and par-ents, adults, older people and frontline healthcare workers.

The helpline aims to pro-vide an easily-accessible support line for people in need of professional advice and care.

To access the helpline, which is available from 7am to 10pm every day, members of the public can telephone the toll free number, 16000.

Call 16000, Press 2 for English, Press 3 for HMC Medical Services and Press 1 for Medical Consultation.

Mental health staff man-ning the helpline speak a range of languages and every effort will be made to ena-ble callers to communicate in their language of choice, where possible.

Mental Health Helpline Service has managed more than 3,000 calls from the general public and frontline staff, since it was launched.

According to experts, everyone experience feel-ings of stress, anxiety, and

sadness, and most of the time these feelings pass quickly, but for some people, these feelings persist and nega-tively impact their quality of life.

Dr Abdul Hakeem Hamza, Senior Consultant, Family Medicine at Primary Health Care Corporation, has said that everyone has the potential to develop men-tal health issues regardless of age, gender or social status.

“The most common mental illnesses are anxi-ety and depression. People should seek professional help when they show symptoms like feeling sad for a longer period of time, inability to concentrate, extreme mood changes, drop from usual activities, low energy levels, lack of sleep and inability to cope with daily life,” he said.

Dr Hamza also advised people to take care of their body, take deep breaths, stretches, meditate, to eat healthy, well balanced meals, do exercise and get plenty of sleep.

“Hearing about the pan-demic repeatedly can be upsetting, take breaks from watching reading and listen-ing to news and social media. Connect with others, talk with people you trust about your concerns and about your feelings. Noticing early changes in the way we think, act or feel or recognizing those changes in people close to us is important to ensure all get the help and sup-port need to be healthy and happy,” he added.

Stay mentally healthy during COVID-19

Feeling irritable, stressed and tearyWanting to spend a lot of time alone and avoiding social situationsTiredness and exhaustionFinding it hard to relax or to concentrateFeeling sad or bad about ourselvesEating unhealthily and skipping meals Having poor sleep patterns or getting up later than usualFeeling hopeless and helpless Having thoughts of harming yourself Feeling worried, fearful, nervous or tense Physical symptoms suchas sweating, trembling,dizziness or rapid heartbeat

Some common early ‘warning’ signs that a person is struggling with their mental health may include:

Medical teams across Qatar’s healthcare system are working tirelessly to combat the spread of the

virus and ensure anyone with COVID-19 receives the very best medical care to

manage their physical symptoms.

P During this time of uncertainty it is especially important to take a proactive approach to your mental health and wellbeing and follow simple steps to maintain good mental health.

P Maintain a balanced diet and keep active. Try to exercise at home if possible or go for a walk outside, but avoid exercising in groups of people.

P Maintain strong relationships with family and friends. Use mobile phones and computers to

keep in contact with friends online to ensure you adhere to physical distancing guidelines.

P Practice good sleeping habits. Even if your normal routine has changed, try to go to bed and get up at set times.

P Learn ways to maintain a positive atti-tude. You may be unable to do many of your regular daily activities due to the current sit-uation, but try having a positive attitude to this and focusing on taking up new hobbies or

activities that you can do at home. P Talk about your feelings with someone

you trust. In this time of uncertainty it is understandable that you may feel worried, frightened, confused, anxious, or low. The best thing you can do is to speak to some-one about how you feel. Try talking to a family member or friend, or if you prefer you can call the Mental Health helpline on 16000 to speak to a healthcare professional.

Wellbeing tips and

advice

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The Primary Health Care Corporation (PHCC) con-firmed that all health centers affiliated with the corporation are keen to receive all patients

without delay.The Executive Director of the

Employment Department at PHCC, Dr. Samya Al Abdulla, indicated that under the current circumstances and in the framework of the preventive and pre-cautionary measures taken by the health care institution, the usual work mechanisms in health centers have been changed as the institution has taken many measures to reduce the number of patients present in health centers to avoid congestion and reduce the chances of spreading infection.

She added that among these mechanisms the transfer of appoint-ments registered in some specialties to telephone consulting service to pre-serve the public health and safety of patients, at the same time, the access to services was facilitated by launching other new services that contribute to empowering patients and facilitating quick access to services and medical consultations.

She explained that some important services continued for patients such as healthy child clinics and vaccinations, ultrasound radi-ology clinics, and pre-marital exam-ination clinics that are currently available in Leabaib Health Center, the Airport Health Center, Al Khor Health Center, the Al Rayyan Center, and the West Bay Center, as well as specialized clinics accepting urgent cases.

Al Abdulla said that all patients are invited to attend health centers only when necessary and in the event of an actual need for medical advice, and patients can obtain periodic health services through the electronic and virtual services provided by the institution remotely. She explained that the urgent care units in each of Muaither centers, Abu Bakr Center, Rawdat Al Khail Center, Al Shahaniya Center, Gharrafat Al Rayyan Center, Al Kaaban Health Center, and Al Ruwais Health Center are still oper-ating at full capacity as usual throughout the week and around the clock.

Dr. Samya Al Abdulla pointed out that all health centers receive patients without prior appointments and these cases are dealt with in all specialties.

She said that PHCC, and within the framework of the state plan to confront the spread of the pandemic, 4 health centers have been designated as health facilities dedicated to examining sus-pected cases of Coronavirus (COVID-19), along with providing them with all the necessary medical equipment and required human cadres, which are Muaither Health Center, Rawdat Al Khail Center, Gharrafat Al Rayyan Center, Umm Salal Health Center.

These centers operate seven days a week, 24 hours a day, except Umm Salal Health Center, as it works from 7 am to 11pm, and work in these centers is done in coordination with the Min-istry of Public Health where suspected cases are received, classified and dealt with according to the rules and the pro-cedures followed in this regard.

Dr. Samya Al Abdulla said that through telephone counseling services, health center doctors contact the patients according to their pre-determined appointments, where the doctor can see the patient's electronic file and diagnose the patient then put any orders for drugs or any necessary medical transfers in the electronic system. This service is provided during the weekdays from Sunday to Thursday from 7 am until 11 pm.

She revealed that since the inau-guration of the service on March 18 until April 20, doctors called high pri-ority patients, who had prior appoint-ments, as 49,341 calls were made, through which the necessary medical support and required consultations were provided.

Also, Dr. Samya Al Abdulla indi-cated that since April 15, the second phase has been inaugurated, where patients can now book an appointment for telephone consul-tations through the hotline 107 in most specialties, including dental consulting services.

The Community Call Center works seven days a week from 7 am until 11 pm. She said that the Com-munity Call Center provides distin-guished services for patients who need urgent medical advice without an appointment, where patients can call 16000 and be transferred to the institution's call center, which pro-vides virtual medical consulting service "call and videocall" where beneficiaries get medical consulta-tions required by specialists, diag-nosing their condition, and describing necessary medications if necessary.

She explained that since the service was launched on March 29 until April 20, over 13,703 calls were answered and 4,531 medical consul-tations were provided by phone through specialized doctors, as well as 377 consultations on video calling,

while the rate of waiting to answer the calls was a minute and a half.

Furthermore, the Community Call Center launched "Chatbot" for inter-active conversations, where it's available on MoPH website, PHCC website, and Hukoomi website. It provides a self-assessment service for the coronavirus through an inter-active conversation that guides the necessary guidance on social sepa-ration and preventive measures.

On the electronic medical certif-icates service, Dr. Samya Al Abdulla said the new service will allow patients to request a medical certif-icate online where the medical cer-tificate is issued electronically through the PHCC's website, using the health card number. She added that this service is available to all patients registered with PHCC who need a report on their health status for those with chronic diseases or pregnant women to provide them to employers during this period.

Moreover, she revealed PHCC launched the virtual diabetes clinic in cooperation with the MoPH and the Hamad Medical Corporation as a new and proactive step forward to communicate with diabetic patients and ensure their proactive treatment as part of a preventive strategy to reduce the risk of coronavirus infection in addition to receiving the regular care needed to manage their condition as the diabetics are more at risk due to their weak immune system.

On medicine delivery services to homes, she clarified that the service was launched on March 25 in coop-eration with Qatar Post to ensure the safety of all health center patients, especially patients suffering from chronic diseases and the elderly, where each health center set a WhatsApp number to communicate with patients on these numbers from Sunday to Thursday from 8am until 2pm and from 4pm to 10pm.

The pharmacist will request some patient data to dispense the medicines and deliver them via Qatar Post within two working days of receiving the request. The service is available for all cases and priority for patients with chronic diseases and the elderly who need to re-dispense drugs periodically.

Prime Minister and Minister of Interior, H E Sheikh Khalid bin Abdulaziz bin Khalifa Al Thani, recently inaugurated Ras Laffan Hospital and the Ruwais Health Center for Health and Recovery, which are dedicated to treating patients with the novel coronavirus (COVID-19), as part of the State of Qatar’s continuous efforts to secure the necessary requirements to provide care for patients infected with the virus. During his visit to the hospital and health center, His Excellency listened to a brief on the capabilities and medical equipment in the new facilities, which are equipped with the latest medical technologies in the field of care and diagnostic services and the capacity of Ras Laffan Hospital, which exceeds 400 beds, as well as the emergency service and the laboratory in Ruwais Health Center. H E the Prime Minister and Minister of Interior was accompanied by Minister of Public Health, H E Dr. Hanan Mohammed Al Kuwari, and a number of senior officials in the Ministry of Public Health, Hamad Medical Corporation, and the Primary Health Care Corporation.

Following the directive by the Min-istry of Public Health, Primary Health Care Corporation’s (PHCC) dental services has

restricted patient appointments to reduce the risk of spreading the COVID-19.

PHCC has limited it’s dental services to urgent services across health centres temporarily.

To be seen at the health centre, a patient must have one or more of the fol-lowing conditions:

� Severe toothache pain (not just a little pain),

� Infection or a substantial risk of it, � Trauma (such as a broken tooth). Patients requiring PHCC services

dental services can now dial 16000 and choose the PHCC option, they will then be routed to a PHCC Community Call Centre offering remote consultations for patients requiring both routine and urgent care dental services.

The Community Call Centre operates seven days a week from 7am to 11pm. Clients accessing this service can expect a video or telephone con-sultation with a dentist that will provide them with advice and offer appoint-ments if this is required. In addition, the service will assess those patients with routine conditions providing guidance.

If you feel sick before coming to see a dentist, for instance, if you have a fever, cough, shortness of breath and a sore throat — you must call the COVID-19 hotline #16000 first for advice on how to proceed.

These precautions are there for your safety and others — so please observe them.

� The best way to reduce your need to see a dentist is to keep good oral hygiene.

� Brush your teeth twice a day with toothpaste that contains fluoride

� Gargle frequently with an anti-septic mouthwash or simply rinse your mouth with salt water, which is a natural and cost effective way to keep your mouth clean.

Your dental care needs during COVID-19

PHCC keen to provide services to all patients

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It is important for people to create a proper meal plan in advance that will enable healthy eating and ensure their body gets its daily required nutrients

during the Holy Month of Ramadan.

Meals during Ramadan are divided into four parts – Iftar; after Taraweeh prayers; after midnight; and Suhoor (pre-dawn). It is common to have Iftar full of flavored dishes as it can include food choices from both lunch and dinner but it should still be a healthy meal and overeating should be avoided.

Afia’a Mohammed Al Masri,

Manager of Hemya Diet Centre at the Al-Ahli Hospital discussed about healthy diet and its impor-tance during Ramadan.

The ideal meal plan

MAIN RULES:

� Break your fast with drinking water and taking 3 pieces of dates. Dates contain simple sugars, fibers and essential minerals such as potassium and magnesium. This will help your glucose level and blood pressure return to normal and help you control your appetite during the main meal.

� We advise you to eat and drink slowly and chew your food well.

� Incorporate soups that are homemade, not creamy and loaded with vegetables and legumes.

� Salads can be also a good starter if it contains a variety of fresh watery vegetables such as tomatoes, cucumbers, beets, lettuce and other green leafy vegetables.

� Make time space between meals and try to divide your Iftar meal into three to four small meals.

� Stay away from fried and fatty food as much as possible

and substitute frying with baking, roasting, grilling or steaming. Fatty foods disturb digestion and cause undesirable weight gain.

� Avoid eating sweets every day during Ramadan and restrict them to few times only and not every day, substitute desserts which are fatty and loaded with sugar with fresh fruits or fruit juices .

Stay away from salty foods like pickles, processed meat, frozen foods, packaged or canned soups, preserved sauces, seasonings and salad dressings. Those items can increase your feeling of thirst a few hours after you start your fast.

� Drink as much water as possible between Iftar and sleeping time.

� Avoid caffeinated drinks such as coke, coffee or tea because they are diuretic and may cause dehydration. Also the amount of caffeine in these

beverages might cause insomnia, disturbed sleep and fatigue.

� Try to avoid refined car-bohydrates and sugar (e.g. white bread, white rice, sweets, and pastries) which can cause blood sugar surges leading to weight gain.

Do not skip Suhoor (pre-dawn meal) as this will increase the length of your fast, which is not advisable in this hot season and may result in dehydration and fatigue.

� For Suhoor meal, it is advisable to eat lean proteins and complex carbohydrates such as in beans, and drink a cup of fresh juice or eat a piece of fruit.

Iftar meal: Divided into 4 small meals

First: Eat three dates with one cup of water.

Second: Eat soup every day. This will help to overcome thirst and replenish your body with needed amount of water and

minerals. Avoid creamy and fatty soups and replace them with vegetables, legumes (such as lentils), grains( such as barley), or chicken soups (cream free).

Third: Appetizers such as stuffed vegetables or salads.

Eating appetizers after soup will prepare your stomach to begin the digestion process. Therefore, it is recommended to choose appetizers that are rich in vegetables such as stuffed vine leaves, marrow or cabbage, fat-toush, green salad or tabbouleh sprinkled with a hint of lemon or vinegar without any added salt. Use virgin olive oil, sesame oil ,and dried or fresh herbs to add richness and flavor to your salad.

Fourth: The main dishIt is preferable that Ramadan

tables feature one main dish, as food variety and indulgence gen-erally lead to overeating. Food for the Iftar meal should include a source of carbohydrates such as rice, pasta, or bread

Afia’a Mohammed Al Masri, Manager of Hemya Diet Centre at the Al-Ahli Hospital, speaks about the ideal meal plan and gives advice for pregnant women and breastfeeding mothers as well as people with chronic diseases

Healthy diet and its importance during Ramadan

preferable made from whole grains. And light protein source from trimmed red meat, skinless chicken or fish.

Here are a few examples: Thareed, meat kabsa, grilled skinless chicken with vegetable salona, pasta cooked with tomato sauce and vegetables (not creamy) , and hariss.

Suhoor meal:The best time to eat Suhoor

is half an hour before the Adhan. You can break your fast with something light such as:

� Whole grain bread with labneh/milk plus a piece of fruit/ fresh juice especially water melon , apple, or sweet melon juices.

� Cereals with fresh milk plus dried fruits

� Eggs or legumes such as Hummos and foul.

Advice for pregnant and breastfeeding women before fasting in Ramadan

Pregnant women who are willing to fast during Ramadan should seek their doctor’s advice throughout the month to make sure that fasting is not affecting their baby. It is important for pregnant women to follow up with their doctors before they decide to fast. While they are fasting, they should ensure to take rest frequently throughout the day and also ensure that they get the right nutrients and calories when they break their fast each evening. They should also ensure to consume up to three liters of water at Suhoor and Iftar. Pregnant women should also avoid sweets and other sugary snacks usually con-sumed after Iftar.

There are some concerns

that fasting may affect how well a baby grows in the uterus (womb), or that fasting may be linked to premature labor. Some studies suggest that more babies are born early if their mums fast during Ramadan. If Ramadan coincides with summer, this means hot weather and long days, which puts pregnant women at greater risk of dehy-dration due to low fluid intake and this could induce premature labor and subsequently lead to preterm births.

Fasting pregnant women should contact their doctor as soon as possible if:

They are not putting on enough weight or are losing weight.

They become very thirsty.Urinating less frequently or

if their urine becomes dark-colored and strong-smelling. This is a sign of dehydration, and it can make them more prone to urinary tract infections or other complications.

They develop a headache or other pains or a fever.

They become nauseous or start vomiting.

Fasting pregnant women should also contact their doctor straight away if:

There is a noticeable change in their baby’s movements, such as if their baby is not moving around or kicking as much.

They notice contraction-like pains. This could be a sign of premature labor.

They feel dizzy, faint, weak, confused or tired, even after they have had a good rest.

If any of the instances above occur, women should break their fast immediately and drink water. They should also contact their doctor immediately. There is usually an increase in the number of women visiting the emergency department during

Ramadan due to fasting and pregnancy.

Breastfeeding mothersBecause it is highly recom-

mended that women whose babies are aged 0-6 months breastfeed their babies exclu-sively (feeding babies only with

breast milk without supple-menting with water and other food) such women may not be able to fast. Mothers of older babies who are already taking supplementary food in addition to mother’s milk can fast, as scientific literature proved that fasting for 24 hours or less will

show very little changes in the amount of breast milk pro-duced and in its composition.

If women are exclusively breastfeeding their babies, they are not expected to fast during Ramadan. Mothers who wish to fast need to assess their general medical condition by consulting a physician and reporting the medications they might be using to boost their breast milk supply before making a decision to fast. This will help avoid any complica-tions that could cause harm to them and their baby while breastfeeding between Iftar and Suhoor.

People with chronic diseases

Patients should consult their physician before changing the timings of thier medications when fasting.

Not only would unsuper-vised change of medication timings render the medications useless, it could also cause serious complications to patients’ health. Therefore, patients that need to take med-icines constantly are advised to talk to their doctor, in advance, about the suitable timings for taking their medi-cations during Ramadan.

For example : Hypertensive medications are mostly taken once or twice daily, so patients with hypertension could fast and manage the timings and dosages of their medication without problems; however, they are advised to avoid salty foods and drink plenty of water during Iftar and at Suhoor.

Diabetic patients have to decide, together with their endocrinologists, whether they are able to fast or not. In most cases, diabetic patients of Type one diabetes are not able nor advised to fast because they take their medications on several intervals during the day and they have to maintain a certain level of blood sugar throughout the day that is com-patible with insulin mode and dosage, and having a stable

level of blood glucose is highly unattainable if the patient is fasting.

On the other hand, diabetic patients of type Two or gesta-tional diabetes can fast if they control their eating habits and timings of their meals in cor-respondence with their medi-cations if they taking any.

Diabetic patients should avoid changing their medi-cation timings arbitrarily in order to avoid complications such as hypoglycemia or hyperglycemia.

If diabetics experience symptoms of hypoglycemia, including extreme hunger, fatigue, dizziness, headache, severe sweating, trembling hand, increased heart rate and the tendency to lose con-sciousness, they should break their fast immediately and have some juice or any sweetened drink in addition to a carbohy-drate-rich meal in order to avoid a hypoglycemic coma.

Patients may also expe-rience hyperglycemia (elevated blood sugar) if they do not adhere to their medication timings and dosages or if they overindulge in consuming sweets and sugars or carbohy-drates during Iftar or Suhoor.

Symptoms of hypergly-cemia include extreme thirst, frequent urination, dry throat, vomiting, abdominal pain, fatigue and exhaustion. Like hypoglycemia, hyperglycemia can lead to a coma. Patients who experience symptoms of hyperglycemia are advised to drink water immediately and seek medical care before their c o n d i t i o n f u r t h e r deteriorates.

Some insulin-dependent patients are under the false impression that since they eat no food while fasting in Ramadan they would not need to adhere to their medication schedule. Failure to adhere to their medication regimen could lead to serious compli-cations such as ketoacidosis (ketones build up in the blood) that can, in turn, lead to dia-betic coma.

Meals during Ramadan are divided into four parts – Iftar; after Taraweeh prayers; after midnight; and Suhoor (pre-dawn). It is common to have Iftar full of flavored dishes as it can include food choices from both lunch and dinner but it should still be a healthy meal and overeating should be avoided.

Afia’a Mohammed Al Masri, Manager of Hemya Diet Centre at the Al-Ahli Hospital

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Dates considered a blessed fruit are especially consumed during the Holy Month of Ramadan. It is not only a custom to have

dates during this Holy month, but also a delightful and delicious fruit to eat. Dates, considered an essential item for breaking the fast, are being sold at almost all supermarkets.

Iftar is a time of replenishment for Muslims, but eating and having sweet beverages and foods can actually cause the blood sugar to decrease even further, causing more fatigue.

Dates might be one of the most ben-eficial fruits for humans. According to modern medicine, dates have 10 element which are crucial for humans to stay healthy and fit. The sugar in dates is fructose as opposed to glucose, and does not make people fat.

Vitamin B6 soothes the nerves and is abundant in dates. Physicians advise the elderly and those with stress to eat three dates in the morning, afternoon and evening. Dates also contain magnesium, which strengthens muscles and is good for pregnant women and to prevent cancer.

Dates are also highly nutritious. In 100 grams of dates, there are 1.5 grams of protein, 50 grams of carbohydrates and 225 calories. This is why they are beneficial for those who work in jobs

requiring either physical or mental effort or suffer from exhaustion or weakness due to illness. Dates are also good for anemia, tuberculosis and bone problems thanks to their levels of phosphorus, calcium and iron.

It is recommended to start Iftar by eating 2-3 dates, as it provides the body with sugar, helping restore low blood sugar after fasting all day.

One of the most common reasons for headaches or dizziness during Ramadan is low blood sugar, which is why eating dates is very beneficial at the start of Iftar.

W h a t a r e t h e benefits?

Provide vitality: Being rich in calories and sugar, as well as being easily digested and absorbed, they provide you with an imme-diate source of energy

Rich in essential nutrients: Dates contain 6 vitamins and 15 minerals and are especially rich in calcium, phosphorous, iron, mag-nesium and potassium.

Full of fibre: This facil-itates digestion and mod-erates bowl function, h e l p i n g p r e v e n t constipation

Heart healthy: They have only traces of fat, are cholesterol free and can be con-sumed by all members of your family

Did you know?You need to consume about 2-4

servings of fruits per day. 2-3 pieces of dates are considered as one fruit serving and contain about 70 calories!

Another way to add dates to your bal-anced diet is to incorporate them into your sweet recipes, this way you will replace some of the sugar as dates are naturally sweet and tasty.

Eat dates to stay healthy and fit

Quit smoking and live a healthier lifestyle

Hamad Medical Corporation’s (HMC) Smoking Ces-sation Clinic encourages tobacco smokers to use the fasting period during Ramadan as an opportunity to take the first steps towards quitting the habit and

living a healthier lifestyle.Fasting requires abstinence from smoking as well as eating

and drinking during the day. Ramadan provides an ideal oppor-tunity for smokers to quit. Activities during Ramadan such as prayers can help keep an individual occupied and assist him or her in quitting smoking.

Quitting smoking has various health benefits, especially for diabetics. It can result in improved blood sugar levels and blood circulation, increased insulin reception, decreased cho-lesterol levels, and decreased complications.

Acknowledging that it is difficult for many people to quit smoking, experts encourage smokers to seek professional help, such as through HMC’s Smoking Cessation Clinic, where patients can obtain advice, treatment and support from spe-cialists to help them to quit smoking permanently. The clinic provides patients with ways to replace their nicotine con-sumption and cope with withdrawal symptoms, and supports patients through the process of quitting.

Exercising, drinking plenty of water after Iftar and keeping away from other smokers are some steps that people can take to decrease the urge to smoke. Avoiding areas frequented by smokers will also help prevent inhalation of secondhand smoke, which is responsible for thousands of heart disease-related deaths every year.

Tar inhaled during smoking can cause lung cancer, heart disease, stroke and respiratory disease. Lung cancer is directly associated with smoking due to the presence of carbon mon-oxide and tar that are the leading causes of various types of cancers. Cigarette smoke contains more than 45 poisonous chem-icals that can cause cancer.

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Maintaining fluid levels plays an important role is staying healthy during the Holy Month of Ramadan. Water is one of the

most important components of the human body representing between 60 to 70 percent of the human body weight. Water plays an important role in the vital performance of many body systems and organs.

Water maintains the balance of elec-trolytes within the body and it is necessary for absorption of many nutrients as water also provides a suitable environment for a lot of chemical reactions within the body.

According to the new recommendations by the United States-based Institute of Med-icine, men and women should drink 3.7

liters and 2.7 liters of water respectively per day.

During the Holy Month of Ramadan, it is necessary to drink plenty of fluids, espe-cially water because of the long period of fasting and high temperatures. Water, juices and soups, as well as vegetables and fruits, are good sources of fluids for the body.

However, a fasting person should drink extra water because water contains no cal-ories and could compensate for the body’s fluids lost due to fasting.

Other calorie-rich drinks can cause weight gain and stimulant drinks such as coffee and tea can increase fluid loss because they are diuretics. Some vegetables such as watercress and fruits like

watermelon known for their high content of water are recommended as a rich source of liquids.

Eating meals high in salt and hot spices may increase thirst and the body's need for water, therefore eating such foods are not recommended at Suhoor as they may cause extreme thirst during fasting.

It is also preferred to drink lukewarm water instead of cold water especially at breakfast as this aids digestion. In order to encourage drinking more water, lemon slices or mint can be added to give water a sweet flavor and increase the desire to drink. Water is the dynamo of life and without it the body may not perform some vital functions efficiently.

Stay hydrated during Ramadan

Ramadan is the month of mercy and forgiveness. With the advent of the holy month, while we find joy in discussing

the spiritual, mental and physical ben-efits of fasting, we should also make health a priority and pay better attention to dietary recommendations during Ramadan. To start reaping the health benefits of fasting while rein-forcing our ability for obedience and work, here are a few general tips on health to be followed during Ramadan.

First tip: Break your fast with dates and eat after prayer

Eating dates has been recom-mended since the days of the Prophet Muhammad (PBUH). After long hours of fasting, the stomach is not yet ready to digest fatty meals that can over-burden the digestive system. Dates are quickly and easily absorbed through the stomach lining. They contain the simple sugars glucose and fructose that do not require a complicated process

to be digested as is the case with car-bohydrates and fats. Let your stomach rest during prayers, in preparation for food consumption.

Second tip: Make healthy choices and avoid overeating

Ramadan spreads offering a variety of delicacies from soups and appetizers to several entrees are the norm for many people. However, we should remember that a simple yet complete meal that contains all the nutrients a body needs will be sufficient to break a fast; otherwise the body will store excess calories as fat.

Be aware that serving several dishes at Iftar increases people’s appetite to indulge in more food. They might start with the main dishes and forget the wisdowm of our Prophet (PBUH) to break the fast with just a few dates, in preparation for a gentle reintroduction of food after many hours of fasting.

Third tip: Don’t skip Suhoor

Prophet Muhammad (PBUH) said: “Eat Suhoor, for in Suhoor there is blessing”.

Suhoor is the “energy-producing meal”. It fulfills the fasting person’s nutritional needs and helps him com-plete his fast. Many people overlook the merit and importance of this meal as recommended by our Prophet (PBUH) and indulge at night in fatty meals that have negative effects on health such as digestive disorders and weight gain due to excess calories stored by the body as fat.

Fourth tip: Follow the three-meal rule

The dietary rule is to eat three meals a day and it should not be dif-ferent during Ramadan. Suhoor refers to the breakfast meal consumed in the morning, Iftar is the equivalent of dinner and a light meal between the two will serve as supper. This helps regulate body functions and to fulfill its dietary needs with three meals that

balance carbohydrates, proteins, dairy products, fruit and vegetables. Do not forget to drink plenty of water.

Fifth tip: Consume plenty of vegetables and fruit Changes in dietary habits during

Ramadan cause many people to engage in the unhealthy behavior of consuming less fruit and vegetables. Fruit and vegetables are important and rank high on priority lists. Rich in vitamins, minerals and fiber, they provide the body with the required nutrients, contribute to a feeling of fullness, and aid bowel regulation. Whether raw or cooked, it is advisable to spread the recom-mended servings (at least five servings of fruit and vegetables per day) over the three meals.

Sixth tip: Reduce your intake of sweets

Sweets in general, and Ramadan desserts in particular, are high in fat, sugar and calories. Dry cakes (cream

free), rice pudding, and Mahallabiya can be consumed in moderation, but great restraint should be shown when eating Arabic sweets, such as Ktaev, Baklava, Kunafa and Luqaimat dump-lings, as they contain large amounts of syrup and ghee.

Seventh tip: Drink sufficient amounts of water

Water is the beverage of choice. Drinking water between Iftar and Suhoor reduces the risk of dehydration, especially when fasting during hot summer days. Therefore, each day drink between 2 - 3 liters (8 – 12 cups) of liquid, preferably water, from Iftar to Suhoor. Liquids include natural juices, milk, laban, soups and others. Reduce the consumption of caffeinated drinks such as coffee, tea and car-bonated drinks.

Prepared by Health Education ProgramsMinistry of Public Health www.hamad.qa

Reap the health benefits of fasting with these general tips

Fasting during Ramadan is an opportunity to rest the digestive system from its continued work throughout the year. Fasting has many benefits in the treatment of

numerous chronic diseases. It can reduce the risk of obesity, psychological pressure, high blood sugar, high cholesterol and triglyceride levels, blood pressure, kidney problems and heart disease.

While fasting is not possible for all patients with liver disease, there are

some patients who can benefit from fasting. For them, fasting can also be an important weight-loss tool.

Patients with liver disease who wish to reduce their weight during Ramadan are advised to avoid foods that contain fat and are also advised to limit the

use of corn and olive oils in the preparation of food.

There are two main types of liver disease – fatty liver disease and inflammatory fatty liver disease.

Patients with liver disease are gen-erally divided into three groups. The first group is patients who suffer from chronic inflammation of the liver because of Hep-atitis B, Hepatitis C or other chronic liver diseases.

This group of patients is normally able to fast, especially in cases where there is the existence of natural enzymes in the liver. However, fasting should be undertaken with proper treatment as defined by one’s physician.

The second group is patients with simple cirrhosis of the liver, with normal liver function. These patients are nor-mally able to fast, provided they do not experience any complications. The third group includes patients with advanced cirrhosis of the liver. These patients are generally not able to fast due to required therapies.

Patients with ascites, hepatic coma, blood vomiting and those with late stage fibrosis, as well as patients who are at high risk for low blood sugar, are also advised not to fast.

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Safer fasting practices for liver patients

Public Health

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Patients with kidney disease are advised to take pre-cautions if they choose to fast during the Holy Month of Ramadan.

Chronic kidney disease (CKD), a long-term condition involving the gradual loss of kidney function, can be categorized into five stages based on severity. CKD affects about 13 percent of Qatar’s population.

The category of severity of a patient’s kidney disease can indicate if he or she will be able to fast safely. For instance, patients with acute kidney failure should not fast until they fully recover.

However, CKD patients have dif-ferent stages of nephropathy (kidney disease), and patients diagnosed with stage three CKD or higher are advised not to fast as their kidneys fail to retain normal rates of body fluids, making them susceptible to further renal dys-function and renal damage.

Abstaining from food and water for long hours can lead to dehydration. CKD patients should consult their phy-sician to assess the severity of their condition and the potential risks asso-ciated with fasting.

Hemodialysis (a type of renal replacement therapy) patients typically undergo dialysis three times per week and cannot fast due to IV fluid intake during the procedure; however, these patients can fast during the rest of the week.

Kidney transplant patients are also advised to refrain from fasting due to their need to comply with their pre-scribed medication dosages and times. As many kidney transplant patients are diabetic, fasting may have a negative impact on their health. Therefore, it is imperative that these patients consult their physician before they decide to fast.

Patients with kidney disease must consult their dietitian in order to ensure adequate protection against potential complications while fasting. Kidney disease patients tend to overlook the importance of main-taining a healthy and balanced diet

while fasting.Kidney disease patients should not

skip Suhoor (pre-dawn meal) to avoid body weakness, bearing in mind that they need more calories than indi-viduals in good health.

Kidney disease patients should be on guard not to ingest high quantities of sodium, potassium and phosphorus, especially during Ramadan. Sodium is abundantly contained in table salt, as is potassium in some vegetables such as tomatoes, potatoes, okra and green leafy veggies as well as some fruits, including bananas, oranges, mangos, dates, apricots, peaches and canta-loupe. Phosphorus is found in beans,

carbonated drinks, nuts and dairy products. Patients who are on phos-phorus lowering medications should take their pills during meals, not before or after eating.

Each kidney disease has its own dietary requirement for Ramadan. If physicians approve fasting for pre-dialysis kidney patients, they should maintain a diet low in protein-rich foods to avoid imposing an extra burden on their kidneys that could lead to complete renal failure and increase urea in their system.

On the contrary, dialysis patients need to increase their protein intake, especially animal proteins, in order to

compensate for the protein lost during the dialysis process.

Pre-dialysis kidney patients should drink two to three liters of fluid per day if the volume of urine they pass is within the normal rate, otherwise, they should reduce their fluid intake to avoid water retention that could affect the heart and lungs.

Hemodialysis patients should be careful not to drink more than one liter of water/fluid daily after Iftar to prevent water retention that would otherwise affect their heart and lungs. Peritoneal dialysis patients can drink up to two liters of water daily, depending on the amount of fluid dis-

carded in the dialysis process.They should be aware of the

quantities of fluid they consume and reduce their intake of sweets and fatty foods as they are more prone to cardiovascular diseases. Kidney disease patients should avoid spending significant time outside in high temperatures when they are fasting, adding they should also avoid eating salty foods.

Meanwhile, HMC is urging patients with kidney disease who experience any difficulties while fasting to seek urgent professional advice or dial 999 for the Ambulance Service.

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Establishing and maintaining regular sleeping patterns during Ramadan is an important step to “re-adjusting” after the holy month. Due to the unique nature

of Ramadan, many people experience fre-quent and irregular sleeping times during the day because they stay awake during the night to perform acts of worship.

The problem is comparable to cir-cadian rhythm (a daily rhythmic activity cycle) sleep disorders usually experienced by those traveling eastwards or across several time zones where a passenger may suffer from circadian dysrhythmia, com-monly known as jet lag.

This is usually caused by the change in their bedtime and wake-up schedule, which can increase the risk of developing biological clock disorder such as delayed sleep phase syndrome (DSPS) or melatonin secretion rhythm disorder.

When people change their sleeping and waking up pattern, they may also suffer sleepiness, headache and mood swings.

Overeating, particularly eating high calorie sugary or fatty foods, weight gain, dyspepsia (indigestion), gastro-esophageal reflux or colon disorders can also increase the risk of developing sleep disorders during Ramadan.

Melatonin is a hormone secreted by the pineal gland (a small endocrine gland) in the brain. It helps regulate other hor-mones and maintains the body's circadian rhythm.

The circadian rhythm is an internal 24-hour ‘clock’ that plays a critical role when we fall asleep and wake up. When it is dark, the body produces more mela-tonin but its production drops when it is daylight. Being exposed to bright lights or watching TV in the evening can disrupt the body’s normal melatonin cycles and causes insomnia.

However, a person can strike a balance between sleeping and performing religious duties during Ramadan by adjusting their sleeping time schedule.

People who have a history of poor sleeping patterns may suffer insomnia and chronic biological clock disorders after Ramadan, in addition to difficulties in adjusting their reversed sleeping pattern, thus hindering their normal work or study time schedules.

People should gradually re-adjust their sleep and wake-up schedule over several days to help re-synchronize the body’s bio-logical clock.

Exposure to strong light for at least one hour after waking up is a helpful way of restoring a normal sleep schedule. Light is the most potent agent to synchronize the internal body clock that regulates circadian rhythms and helps in reducing the level of sleep hormone (melatonin) in the blood.

This does not necessarily require staying outdoors under the sun, but exposure to light coming through a window can be helpful as well.

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Establish regular sleeping patterns to boost health

Advice for kidney patients during Ramadan

Ramadan tips for people with high blood pressure

Hypertension is called the silent killer because patients with high blood pressure may have no symptoms for years. Although it is a prevailing and widespread disease, many people are

unaware that they have this condition unless they experience symptoms such as headaches or have had permanent damage to the heart, kidneys or arteries.

Most medical studies have shown that patients with hypertension can complete their fast if they have no complications or other medical problems. If you have high blood pressure and wish to fast, fasting will not have a negative impact on your blood pressure balance.

Here are some tips and advice to follow during Ramadan:

� Consult your physician to assess your health, determine whether or not you are allowed to fast, make any necessary adjustments to your medication dosages and determine the best time to take them between Iftar and Suhour. Your doctor can also determine if you need long-acting antihypertensive drugs that can be taken at night, once or twice a day, without affecting your fast.

� Drink plenty of fluids and unsweetened natural juices at Iftar to avoid thirst, dehydration and other associated complications.

� Make fruit and vegetables an essential part of your Ramadan meals as they are an important source of potassium that helps control high blood pressure.

� Avoid high-fat dishes and fluids.� Avoid stimulants such as coffee and caffeinated

soft drinks to reduce the intake of caffeine.� Stay away from high sodium foods such as

salted nuts and pickles which can lead to hyper-tension, and replace them with a fresh green salad.

� Eat grilled fish at least twice a week, as it con-tains a healthy fat called Omega-3 which helps

regulate blood pressure and prevent cardiovascular diseases. Good sources of Omega-3 include salmon and sardines.

� Consume red meat and poultry in moderation.

� Eat low-fat dairy products because calcium plays an important role in regulating blood pressure and improving bone health.

� Avoid processed meat and cheese such as sau-sages and mortadella as they contain high concen-trations of sodium.

� Be aware of hypertension warning signs such as dizziness and headaches. If you experience any of these symptoms, you should seek emergency medical services right away or consult your phy-sician immediately.

� Measure your blood pressure regularly.� Continue exercising during Ramadan as it

helps regulate blood pressure. Studies have shown that physical activity performed by Muslims during the Taraweeh prayers helps reduce high blood pressure.

Patients suffering from special medical problems should consult their physician before making the decision to increase their physical activity during Ramadan. Patients with hypertension should consider Ramadan a golden opportunity to quit smoking as it raises the systolic pressure by at least 20 mm Hg, and significantly increases the risk of heart attacks and strokes.

Ramadan is a good opportunity to gradually lose weight. Studies have shown that weight loss, even at just five percent of body weight, helps normalize blood pressure in Ramadan.

Mrs. Duaa Abu El Sheikh,Health Educator, Health Education ProgramsMinistry of Public Health www.hamad.qa

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Diabetics are advised to take necessary pre-cautions and consult their p h y s i c i a n

before deciding to fast during the Holy Month of Ramadan.

The decision to fast carries an assortment of potential risks and complications for individuals with diabetes. Individuals with diabetes who choose to fast during the Holy Month should obtain a medical assessment and specific advice on medication and dietary adjustments.

Diabetics who choose to fast need to be aware of the potential health risks. They must also be ready to adhere to the recom-mendations of their healthcare team in order to achieve a safer fasting experience.

A medical assessment and educational counseling on physical activity, meal planning, glucose monitoring and dosage and timing of medications must be part of the process of pre-paring for Ramadan.

Diabetes mellitus is a medical condition where the body fails to process blood sugar in a normal way. For individuals with dia-betes who choose to fast during Ramadan, several topics require special consideration and those with poorly controlled diabetes, elderly patients who require insulin, children, and the acutely ill or frail are generally advised not to fast. Fasting is also not recommended for pregnant women who need insulin and for breastfeeding mothers, whether they have Type 1 or

Type 2 diabetes. While most Type 2 diabetics are able to fast without complication, some dietary and medication adjust-ments are usually required.

Individuals with diabetes, both Type 1 and Type 2, who choose to fast should keep a watchful eye on their health and should monitor their blood glucose regularly and fre-quently. Diabetic patients have to decide, together with their

endocrinologists, whether they are able to fast or not. Diabetic patients should avoid changing their medication timings arbi-trarily in order to avoid com-plications such as hypoglycemia or hyperglycemia.

If diabetics experience symptoms of hypoglycemia, including extreme hunger, fatigue, dizziness, headache, severe sweating, trembling hand, increased heart rate and the

tendency to lose consciousness, they should break their fast imme-diately and have some juice or any sweetened drink in addition to a carbohydrate-rich meal in order to avoid a hypoglycemic coma.

Patients may also expe-rience hyperglycemia (elevated blood sugar) if they do not adhere to their medication timings and dosages or if they overindulge in consuming sweets and sugars or carbohy-

drates during Iftar or Suhoor. Symptoms of hypergly-

cemia include extreme thirst, frequent urination, dry throat, vomiting, abdominal pain, fatigue and exhaustion. Like hypoglycemia, hyperglycemia can lead to a coma. Patients who experience symptoms of hyperglycemia are advised to drink water immediately and seek medical care before their condition further deteriorates.

Some insulin-dependent patients are under the false impression that since they eat no food while fasting in Ramadan they would not need to adhere to their medication schedule. Failure to adhere to their medication regimen could lead to serious complications such as ketoacidosis (ketones build up in the blood) that can, in turn, lead to diabetic coma.

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Eating and sleeping routines change during the holy month of Ramadan unlike any other month. The 30-day period is the

perfect opportunity for anyone who is trying to lose weight through healthy diet and exercise. Some people may create an exercise planner in advance while fasting, as some prefer to work out before Iftar, and others after.

Research has shown that fasting for 30 consecutive days without performing any physical exercise or activity reduces strength and physical fitness. Muslims

have to remain active in the month of Ramadan to stay healthy.

This year, Ramadan occurs during summer. High temperatures should be taken into account when performing physical activity.

When is the best time for a fasting person to work out - before or after Iftar?

1. Before IftarPrecautions should be taken and

proper guidelines followed when working out before Iftar. Exercising just before Iftar should be limited and for no

longer than 60 minutes, preferably in an air-conditioned location. After you break the fast, drink sufficient amounts of fluids and water to replenish salts and minerals lost by the body, and have a good rest.

2. After IftarIt is advisable to perform physical

activity three hours after you break the fast as by then the body has completed the digestion process, and preferably in an air-conditioned location.

Tips and guidelines for exercising during Ramadan

� Perform physical activity for 30 minutes at least every day in an air-con-ditioned location.

� Avoid aggressive and high-intensity exercise during daytime and especially in hot weather. Hot days increase body fluid loss which could lead to dehydration.

� Choose a convenient time to work out during Ramadan, either just before Iftar or two to three hours after Iftar. Avoid physical activity immediately after you break your fast as all of the body’s energy will be directed towards digestion of food.

� Individuals should consult with their physician before starting any physical activity if they are unsure of their health.

� Reduce physical inactivity, such as sitting in front of the television for extended periods of time, and organize instead family activities such as going for a walk or performing household chores.

� Stop any physical activity imme-diately if you experience dizziness, nausea, difficulty breathing or chest pain.

� Drink sufficient quantities of water between Iftar and Suhour to avoid dehy-dration during fasting.

Hind Rustom Baqer, Health Counselling ExpertHealth Education ProgramsMinistry of Public Health www.hamad.qa

Advice for diabetics fasting during Ramadan

Heart patients should take care when fasting

People with heart problems should take extra precau-tions while fasting during Ramadan,

and consult their cardiologists, particularly in determining the proper timing and dosage of their medications, in order to avoid complications.

Patients should consult their cardiologists on how their medication should be adminis tered dur ing Ramadan. Patients and doctors may have to explore the possibility of substituting ordinary medication with long-lasting ones in order to compensate for the daily 15-hour fasting time.

Fasting has no negative impact on patients with stable heart conditions who have no recurrent symptoms, such as chest pain or shortness of breath. In fact, fasting could be beneficial for them. Lower food intake; abstaining from smoking, which will relieve the system of tobacco’s harmful effects; and the stress-reduced atmosphere

associated with the Holy Month of Ramadan; will reduce heart disease risk in general, and also have a pos-itive impact on people with heart conditions.

However, fasting could adversely affect patients with the following conditions:

� Heart patients who experience recurrent chest pain

� Patients with heart failure who experience fatigue or lack of energy and shortness of breath, as they need frequent dosages of diu-retic medications

� Patients who have suf-fered heart attacks should not fast within the six weeks fol-lowing the heart attack

� Open heart surgery patients should not fast within the six weeks following surgery

� Patients where the heart’s aortic valve is nar-rowed (stenosis) or inflamed

� Heart patients who are on blood thinners or anticoagulants

� Patients on malignant

arrhythmia medications� Patients with heart con-

ditions that require constant professional observation

People with heart problems are advised to eat in small por-tions, and to avoid fatty and salty foods, as well as large quantities of beverages (which could lead to shortness of breath).

Smaller food portions trigger favorable hormonal and metabolic changes which will increase the production of good cholesterol and decrease bad cholesterol. The outcome of these factors will be best if patients manage to reduce weight as a result.

It is also advisable for people to consume four

smaller meals instead of two large meals in Ramadan and to maintain physical exercise, even by taking a short walk.

People with heart condi-tions are advised to seek urgent professional medical advice or dial 999 for HMC’s Ambulance Service if they experience any difficulties or emergencies.

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An opportunity to lose weight through exercise

Fasting helps reduce stress & anxiety

Fasting in Ramadan is considered an important act of worship, imposed by

the Almighty God on Muslims. It is considered the season to conduct periodic maintenance of the bodies organs.

Fasting in the month of Ramadan has many advan-tages for individuals living with psychological disorders such as mild degrees of depression, anxiety, and insomnia. Fasting, and the spiritual and social practices that accompany it enable these individuals to with-stand and cope with life’s worries and woes and, as a result, reach a state of tranquility.

Fasting and associated acts of worship during the Holy Month of Ramadan is believed to result in the release of endorphins, these are the body’s naturally released ‘happiness’ hor-mones. Patients with mild to moderate degrees of depression participating in such activities tend to get removed out of their secluded lifestyle and, alternatively, become rather optimistic and start to think positively of themselves and others around them. Six percent of the world’s population suffers from depression, an estimate of about 350 million people of all ages according to the World Health Organization.

Research studies revealed that fasting helps self-restraint and better anger management in hot tempered individuals.

International research has revealed that fasting had a great positive impact on individuals undergoing ther-apeutic treatment for addiction and substance abuse, as this act of worship promotes positive behav-ioral change in these indi-viduals. In fact, there has been some research sug-gesting that spiritual prac-tices result in structural changes to the brain in areas associated with depression, thus having a protective factor.

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