|Year : 2013 | Volume
| Issue : 2 | Page : 84-85
Nutritional recommendations for type 2 diabetes during Buddhist Lent (War Dwin)
Tint Swe Latt1, Manash P Baruah2, Rakesh Sahay3
1 Department of Rector, University of Medicine-2, Yangon, Myanmar, India
2 Department of Endocrinology, Exceli Hospitals, Guwahati, Assam, India
3 Department of Endocrinology, Osmania Medical College, Hyderabad, Andhra Pradesh, India
|Date of Web Publication||6-Jul-2013|
Manash P Baruah
Department of Endocrinology, Exceli Hospitals, Guwahati, Assam
Source of Support: None, Conflict of Interest: None
The Buddhist Lent is an annual three lunar month long fast observed by devout Buddhists. This involves fasting daily from noon to midnight, abstaining from all solid foods. Only liquids and jaggery are allowed during this period. This paper discusses the unique nutritional challenges posed by this fast for people with diabetes, and suggests practical recommendations to ensure healthy nutrition and successful fasting for them.
Keywords: Buddhism, calorie, diabetes, exercise, hyperglycemia, hypoglycemia, Myanmar, nutritional supplements
|How to cite this article:|
Latt TS, Baruah MP, Sahay R. Nutritional recommendations for type 2 diabetes during Buddhist Lent (War Dwin). J Med Nutr Nutraceut 2013;2:84-5
|How to cite this URL:|
Latt TS, Baruah MP, Sahay R. Nutritional recommendations for type 2 diabetes during Buddhist Lent (War Dwin). J Med Nutr Nutraceut [serial online] 2013 [cited 2020 Dec 1];2:84-5. Available from: https://www.jmnn.org/text.asp?2013/2/2/84/114733
| Introduction|| |
The Buddhist Lent (known in Myanmar as War Dwin) is an annual three month lunar long fast observed by devout Buddhists during the monsoon.  This fast places strict dietary demands, which may pose a challenge to diabetes management in people wishing to observe the fast. These dietary restrictions are somewhat similar to (but not exactly the same as) meal patterns followed by venerable Buddhist monks and adherents of the Jain religion.
Surprisingly, scanty references are available in the English medical literature related to the need for nutritional advice to people with diabetes who wish to observe the Buddhist Lent. 
| Nutritional Restrictions During Buddhist Lent|| |
Days of the Buddhist Lent are marked by two 12-hour long cycles: Keeping the fast (uboke saunt in Myanmarese) from noon to midnight and breaking the fast (uboke htwet) from midnight to noon. During the fast, devout can take only liquids and jaggery. Some less conservative people consume fruit, ginger, and onion during this time. Liquids commonly consumed include water, green tea, lemonade, soft drinks, soybean milk, and fruit juice. Coffee and alcohol are avoided. During the feasting period, people often take a small snack after midnight a breakfast of normal proportions, and a heavy lunch before noon.
| Impact of Buddhist Lent on Diabetes|| |
The dietary pattern followed during Lent imposes significant metabolic stress upon the person with diabetes. This is similar to the effects that have been observed during Ramadan.  During the fasting period, the individual with diabetes is predisposed to hypoglycemia. Some people at times indulge in "defensive liquid snacking", consuming large amounts of soft drinks, or other calorie rich beverages. This causes hyperglycemia.
The tendency to take heavier meals during the pre-noon period also worsens glycemic control.
| Recommendations|| |
People with diabetes wishing to keep the Buddhist Lent should follow the general advise given as part of medical nutrition therapy.  However, it is not possible for them to adhere to a 3 + 3 meal pattern. Certain modifications are required in this regime.
Patients should be explained about the need to take low and medium calorie liquids at frequent intervals. These include water, green tea, lemonade, buttermilk, milk, fresh soybean milk, and freshly squeezed fruit juice without added sugar. They should be trained to identify the symptoms of hypoglycemia, including subtle complaints such as inability to concentrate, inability to mediate, or poor quality of meditation. Such history should be elicited with sensitivity and respect.
High calorie drinks such as soft drinks, sweetened soy milk and concentrated fruit juices, as well as jaggery should be avoided, except to manage hypoglycemia. Easily available, commercial "diabetic" food supplements can be used.
Patients should also be trained to read and understand food labels, to know the calorie content, and nature of various food products.
During the feasting period, people with diabetes should be encouraged to eat small, frequent meals, in moderation. Practical suggestions to cut down on unwanted calories should be given. For example, one should prefer boiled noodles (khat swae pyote) to fried noodles (khat swae chow). The quantity of oil used in frying noodles may be decreased. If postprandial hyperglycemia is a therapeutic challenge, one may shift from rice-based meals such as mohingya to wheat-based food stuffs, which have a lower glycemic index. 
It must be noted, different varieties of rice and wheat have varying glycemic indices. In Myanmar, for example, Ngasein rice (62.05%) has a lower glycemic index than Pawsun (66.8%), which in turn is healthier than Emata (71.14%).
Diabetes care professionals and patients should be aware of this nutritional fact on glycemic control.
Nutritional recommendations are often prescribed as part of lifestyle modification (LSM). LSM is incomplete if it does not include physical activity and stress management. During the Buddhist Lent, the devout may be requested to practice walking meditation (ta yar myat) instead of sitting meditation (ta yar thein), especially after heavy meal.
| Conclusion|| |
Observing the Buddhist Lent is an important part of every devout Buddhist's life and is a personal decision. As healthcare providers, our duty is to offer practical, acceptable, appropriate advice regarding healthy nutrition advice to people with diabetes who wish to keep the fast. This paper covers some of the useful dietary recommendations that are specific to Buddhist Lent.
Though written from a Myanmarese, and a Buddhist, perspective, it will be useful for adherents of Jain and Hindu religions who keep similar fasts. It is also useful for venerable Buddhist clergy, and for Buddhist laity of all countries.
| References|| |
|1.||Latt TS, Kalra S. Managing diabetes during fasting-A focus on Buddhist Lent. Diabetes Voice 2012;57:42-5. |
|2.||Jaleel MA, Raza SA, Fathima FN, Jaleel BN. Ramadan and diabetes: As-Saum (The fasting). Indian J Endocrinol Metab 2011;15:268-73. |
|3.||Kalra S, Joshi S, Baruah M. Medical nutrition therapy for diabetes: The challenge in India. J Med Nutr Nutraceut 2012;1:3-4. |