Fasting, Festivals and Older Adults: Staying Safe

Respect, then plan

Many traditions accept that fasting is not required of those who are old, ill or on essential medicines, and offer alternatives such as charity, prayer or a partial fast. A gentle conversation, "we want you to keep your health so that you can keep your faith", works better than argument, and a doctor's note can help.

Who should not fast, or only with medical supervision

Ask the doctor before any fast, and be especially cautious or avoid fasting if the person:

• Has diabetes on insulin or tablets that lower blood sugar (sulfonylureas, insulin) or has had low blood sugar episodes, kidney complications or unstable sugar; see low blood sugar in older adults: recognising and treating it.
• Has heart failure, recent heart attack, unstable angina or arrhythmia, or is on diuretics.
• Has kidney disease or is on dialysis, or has had kidney stones; see eating with chronic kidney disease: a family guide.
• Has uncontrolled high or low blood pressure or takes several blood pressure medicines.
• Is on blood thinners, where food consistency matters, or medicines that must be taken with food (many painkillers, steroids, metformin, iron, some antibiotics).
• Has a stomach ulcer, gastritis or severe reflux; see acidity and reflux in older adults.
• Is underweight, frail, malnourished, losing weight or has a poor appetite; see malnutrition in older adults: signs and prevention.
• Has dementia and may not recognise thirst or hunger or the need to stop.
• Is recovering from illness or surgery.
• Has cancer, is on chemotherapy or has swallowing difficulty.
• Takes many medicines; see polypharmacy and deprescribing.
• Is in very hot weather without good access to cool places.

Talk to the doctor beforehand

Plan two to four weeks ahead where possible. Bring the medicine list and ask:

• Is it safe for my parent to fast, and in what way (full fast, partial, fruit-and-milk fast, no-water fast)?
• Do any medicines need a change in timing or dose? Doctors may shift doses or switch formulations to suit fasting hours, but this must be done by the doctor, not by the family.
• How often should we check sugar, blood pressure and weight? See how to test blood sugar at home step by step and how to measure blood pressure at home accurately.
• At what readings or symptoms should the fast be broken?
• How to adjust fluids and salt in heart or kidney disease.
• What food and drink may be taken within the fast.
• A written plan to keep with the medicines.

Common fasting patterns and their risks

Nirjala (no food and no water) fasts such as Karva Chauth, Nirjala Ekadashi: dehydration, low blood pressure, dizziness, falls, kidney injury, confusion, low blood sugar, heat illness, especially in summer. Not advisable for most older adults; consider fluids or a modified fast.

Fruit-and-milk fasts (phalahar): safer, but may be low in protein and high in sugar; diabetics should watch fruit portions and sago.

Single-meal fasts or fasting until evening: risk of overeating at the break, spiking sugar and bloating.

Navratri and other multi-day vrat diets: foods allowed (sabudana, kuttu atta, singhara atta, rajgira, potatoes, sweet potato, peanuts, makhana, dairy, fruit, sendha namak) are often high in starch, fried, salty, low in protein, fibre and some vitamins; may cause constipation, acidity, weight loss and sugar swings.

Ramadan (roza): fasting from dawn to sunset with no food or drink; pre-dawn (sehri) and sunset (iftar) meals; extended hours in summer; risk of dehydration and medicine timing issues. Islamic teaching exempts those who are sick or elderly and cannot fast without harm, with alternatives such as feeding the needy; a doctor's advice and a religious scholar's guidance can both be sought.

Staying safe while fasting (if the doctor agrees)

### Medicines

• Do not stop, skip or double any medicine without the doctor's instructions.
• Follow the doctor's revised schedule for insulin, diabetes tablets, blood pressure, heart and other medicines; use a written chart and a pill organiser; see pill organiser guide and giving medicines safely at home.
• Medicines that need food (metformin, iron, many painkillers, steroids) must be timed with the permitted meals.
• Diuretics (water tablets) increase the risk of dehydration and low blood pressure.
• Never use medicine "tonics" or herbal products to cope with fasting without advice; see supplements and medicine interactions: a safety guide.

### Hydration

• Drink enough during the permitted hours: aim for the usual fluid target spread through the non-fasting period (for example, water, buttermilk, lassi, coconut water if allowed, nimbu pani, soups, fruit); see hydration for older adults: how much and how to remember.
• Limit tea and coffee, which increase fluid loss, and avoid very sweet or salty drinks.
• Stay cool, avoid direct sun and heat; use fans and light cotton clothes; see summer heat and bedridden care.
• Heart and kidney patients must follow the doctor's fluid limits.

### Food choices

• Break the fast gently: begin with water or a glass of buttermilk, a date or a fruit, then a light meal, rather than heavy fried food and sweets.
• Protein and fibre: add curd, paneer, milk, nuts, makhana, dals if allowed (for example in some fasts, sama rice khichdi with curd and peanuts), eggs, fish and chicken if the tradition allows (after Ramadan sunset, or in non-vegetarian fasting patterns), sprouts, vegetables and fruit; see how much protein do older adults need.
• Choose slow-digesting options: buckwheat (kuttu), amaranth (rajgira), water chestnut flour (singhara) rotis with vegetables and curd rather than deep-fried puris; sabudana khichdi with plenty of peanuts and vegetables and less ghee, in moderate portions; baked or roasted makhana; vegetable soups; fruit chaat with a few nuts.
• Limit deep-fried items (pakoras, puris), sugary sweets, large amounts of potato, salty snacks and too much rock salt; see eating for heart health after 60.
• Diabetes: keep portions of sabudana, potato, sweet potato, kuttu, fruit and sweets small, include protein and fibre, avoid long gaps, and check sugar more often; see eating for diabetes after 60.
• Constipation prevention: fibre from fruit and vegetables, fluids and gentle movement; see constipation in older adults: fibre, fluids and movement.
• Acidity: avoid prolonged gaps, spicy and fried foods, strong tea, and lying down right after meals.
• Pre-dawn meal (Ramadan sehri): protein and complex carbohydrate, plenty of fluid, avoid salty food; see high-protein Indian meals for seniors.

### Monitoring

• Check blood sugar several times a day if diabetic, including before breaking the fast and when feeling unwell; break the fast if sugar falls below the level the doctor set (often about 70 mg/dL) or if symptoms of low sugar occur, and treat as advised; see diabetes and low-sugar emergencies: a family plan.
• Check blood pressure and pulse if on blood pressure medicines.
• Weigh if advised.
• Rest, avoid heavy exertion and heat, and reduce long ceremonies in the sun.
• Keep someone nearby, especially for those living alone; keep a phone within reach.

When to break the fast: warning signs

Stop fasting, drink and eat, and call the doctor, for:

• Dizziness, light-headedness, blurred vision, fainting or near fainting.
• Heart racing, palpitations, chest discomfort.
• Severe headache, confusion, unusual drowsiness or irritability.
• Shakiness, sweating, hunger, pallor (possible low sugar).
• Very dark or scanty urine, severe thirst, dry mouth.
• Vomiting, severe nausea or stomach pain.
• Breathlessness.
• Muscle cramps or weakness.
• Very high or very low blood pressure or sugar.

Call 112 for chest pain, collapse, severe confusion, seizures, severe breathlessness or a sugar reading with drowsiness that does not improve with sugar. Breaking a fast for health reasons is accepted in most traditions.

Festival feasts

Festivals bring sweets, fried snacks, rich meals, late nights, travel and visitors.

• Plan portions: take a small plate, start with salad and vegetables, choose one or two favourites, eat slowly, and avoid second helpings.
• Sweets: one small piece after a meal rather than several snacks through the day; sugar-free sweets are not automatically healthy; see 10 sugar-free sweets to enjoy a guilt-free Diwali.
• Fried foods and salt: limit; they affect blood pressure, heart failure and acidity.
• Alcohol: best avoided; it interacts with medicines and increases fall risk.
• Keep to medicine and meal timings, even on busy days.
• Hydrate, particularly in warm weather.
• Keep walking and resting.
• Safe food handling: avoid food left out in the heat for hours; see monsoon infections and older adults.

When to ask a professional

Ask the doctor well before the fast about safety, medicine timing and monitoring; ask a dietician for fast-friendly menus that meet protein, fibre and energy needs; ask a pharmacist about medicine timing and interactions. Seek help promptly if warning signs occur. Call 112 for chest pain, collapse, severe confusion or breathlessness.