Health Advice for Ramadan

We have brought together in this article the views and recommendations of doctors and expert dieticians regarding healthy nutrition during Ramadan. It is our hope that the entire Islamic world will spend this blessed month in health, peace, security, abundance, and solidarity.

Beware of Poor Nutritional Habits!

In order to fulfill the fasting obligation without suffering any health problems, a number of unwise dietary habits need to be avoided.

For those fasting during Ramadan, it is of great importance to pay close attention to what they eat during the two main meals; before sunrise (sahur) and after sunset (iftar). They need to be carefully aware of changes that take place in their bodies when fasting throughout the day. Since eating nothing for long hours increases one's appetite and satiation threshold, the typical result is the quicker consumption of more food than normal. Therefore, the believers should avoid sudden and excessive food consumption, especially during the evening meal.

Increased consumption of such foodstuffs as meat, bread, rice, pasta, baked goods, desserts, and pastries is common during Ramadan, while the consumption of fruit and vegetables decreases. However, the levels of protein, vitamins, and minerals that the body requires for a healthy, energetic life do not alter during this month. In addition, behaviors such as overeating, eating too wide a range of foods too quickly, failure to get up for sahur meal, and eating too much before sunrise, may lead to ulcers and other disorders, even abdominal bleeding. For these and other similar reasons, the following basic points need to be borne in mind in order for you to fast in a healthy manner and not to tire your bodies:

1. What Health Issues Need to be Considered When Fasting?

Those who fast during Ramadan need to be careful to drink enough water and must pay attention to their sleep patterns. Insufficient sleep can lead to headaches and low blood pressure.

- Since metabolism falls rapidly during Ramadan's daylong fasting, it is easy to gain weight. Therefore, high-calorie, rich foods should be avoided.

- In the evening, sudden consumption of large quantities of food may lead to indigestion.

- Be keen to have the sahur meal, since fasting without eating a predawn meal prolongs the length of time one goes without food, and this results in a quick fall in metabolism and a possible occurrence of fatigue and headache.

- Whether or not you get up early for the sahur meal, eat slowly, chew your food well, and drink enough water. In the evening, avoiding eating to complete fullness will improve the quality of your sleep. Avoid rich, fatty and spicy foods at both meals.

- Since the body of a fasting person will be deprived of water for a long period, it is important to drink often between evening and dawn.

- In order not to become very thirsty while fasting, be careful to avoid salty foods such as pickles and peanuts at your sahur meal.

- Blood sugar levels drop during fasting. However, they rise very fast when food is consumed suddenly in the evening. If you do not get up before dawn to eat, your blood sugar levels begin to fall in the very early hours of the day and soon reach even lower levels. After the evening meal, therefore, you should follow the principle of eating little and often.

- During Ramadan, be careful to avoid inactivity. You can have a walk two hours after the evening meal, as long as it is not too strenuous.

- On an empty stomach, however, you should avoid walking, jogging, or putting in excessive effort in the gym as a means whereby to burn off excess food intake.

2. What Should We Eat When Breaking the Fast?

- The ideal recommended evening meal is to begin eating slowly and moderately at sunset, followed by a main course a few hours later.

- Begin with dates, water, soup and light foods.

- Do not eat too much or too quickly.

- The main course should be eaten a few hours after sunset. Give priority to fruit and vegetables, and take care to consume yoghurt, buttermilk (diluted yoghurt) or milk.

- Preference should be given to vegetables such as fresh green beans, spinach, aborigines, purslane, Brussels sprouts, white cabbage, lupus, and broccoli, as well as small quantities of fat-free fish, low-fat chicken, and dried beans and seeds.

- Traditional desserts at the evening meal should be eaten two hours afterwards. Prefer milky puddings to syrupy desserts.

- In the sahur meal, avoid eating spicy, fatty, or salty foods that will make you feel thirsty during the day.

3. What Foods Should We Consume in Limited Quantities?

- Instead of gorging yourself before sunrise, choose light foods, such as whole-wheat cereal products, vegetables and salads that get absorbed slowly into the bloodstream.

- During Ramadan, especially before dawn, consume high-fiber products and avoid heavy, spicy foods and all kinds of fried and fatty foods, such as fried chickens and kebabs.

- Do not neglect to consume at least two portions of fruit as snacks between your evening and sahur meals.

- Consume nourishing liquids and foods such as fruit juice and buttermilk during the night between evening and dawn. Avoid acidic drinks.

- Also avoid refined carbohydrates, too much table sugar, jam, honey, treacle, and products made from white flour, heavy desserts, carbonated drinks and ones containing caffeine.

Additionally, experts recommend consuming limited quantities of flour-based desserts, and they say that milky puddings are preferable. Dried fruit in syrup made from normal sugar is very popular, but it raises insulin levels and, for this reason, dieticians say that dried fruit in syrup should be cooked with very little sugar. They also recommend vegetable-based pastries in sahur meal, instead of ones containing meat or cheese.

Be careful not to consume too many of ready-to-eat meals, flour-based foodstuffs, and fried foods during Ramadan. Unfortunately, Ramadan pita bread is one of the hardest foods to digest, and experts recommend whole wheat bread instead.

4. What Foods are the Healthiest to Eat During Ramadan?

After fasting and going without food all day long, instead of overeating, it is best to choose low-glycemic foods that are digested and absorbed slowly into the bloodstream, such as dark cereal products, vegetables, and salads. The following are some of the healthiest foods that you can choose:

- High-fiber foods (apples, pears, and grapes with the skin on; dried apricots, prunes, and dates; cereal products and dried cereals; green beans, peas, and spinach).

- Foods rich in Omega 3 and folic acid (products made from whole-wheat flour and breakfast cereals such as meusli; asparagus, spinach, peas, and tomato juice; salmon, tuna fish, sardines, and mackerel; linseed, purslane, lentils, walnuts, and almonds).

- Foods made with non-saturated oils, especially filtered olive oil.

- Fruits like oranges rich in Vitamin C.

5. How Can One Avoid Gaining Weight During Ramadan?

Foods high in carbohydrates —that are consumed in the evening— trigger the release of the insulin hormone, which plays an important role in stimulating the appetite. Therefore, people who overeat in the evening can easily put on weight and also risk increased blood fats and blood pressure that in turn can lead to many diseases, such as heart and circulatory disorders.

Delicatessen products, baked goods, pita bread, and desserts are all high-calorie foods that can lead to weight gain. Dietary experts, therefore, recommend that the ideal early-evening meal should be eaten slowly and moderately, followed by the main course a few hours later. Another way to avoid putting on weight during Ramadan is to drink plenty of water.


This article has been taken with modifications and with kind permission from the author’s website.

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Diet during Ramadan

By: M. Z. A. Nomani, Ph. D.

To be healthy, one must consume food from the major food groups: bread and cereal, milk and dairy product, meat and bean, vegetable and fruit. During the month long fast of Ramadan the metabolic rate of a fasting person slows down and other regulatory mechanisms start functioning. Body and dietary fat is efficiently utilized. Consuming total food intake that is less than the total food intake during normal days is sufficient to maintain a person's health. Intake of fruits after a meal is strongly suggested. A balanced diet improves blood cholesterol profile, reduces gastric acidity, prevents constipation and other digestive problems, and contributes to an active and healthy life style. (Int. J. Ramadan Fasting Research, 3:1-6, 1999)

INTRODUCTION

Fasting during the Islamic month of Ramadan can be good for one's health and personal development. Ramadan fasting is not just about disciplining the body to restrain from eating food and drinking water from predawn until sunset. The eyes, the ears, the tongue, and even the private parts are equally obligated to be restrained if a Muslim wants to gain the total rewards of fasting. Ramadan is also about restraining anger, doing good deeds, exercising personal discipline, and preparing oneself to serve as a good Muslim and a good person during and after Ramadan.

This is why the Messenger of Allah (Peace be upon him, Pbuh) has been attributed, by Hazrat Abu Hurairah in hadith, to say: "He who does not desist from obscene language and acting obscenely (during the period of fasting), Allah has no need that he didn't eat or drink." (Bukhari, Muslim). In another hadith by Hazrat Abu Harairah, the Prophet (Pbuh) said: "Fasting is not only from food and drink, fasting is to refrain from obscene (acts). If someone verbally abuses you or acts ignorantly toward you, say (to them) 'I am fasting; I am fasting." (Ibn Khuzaoinah). Restraint from food, water, and undesirable behavior makes a person more mentally disciplined and less prone to unhealthy behavior. In an investigation in Jordan (1), a significant reduction of parasuicidal cases was noted during the month of Ramadan. In the United Kingdom, the Ramadan model has been used by various health departments and organizations to reduce cigarette smoking among the masses, especially among Africans and Asians (2).

Ramadan fasting has spiritual, physical, psychological, and social benefits; however, manmade problems may occur, if fasting is not properly practiced. First of all, there is no need to consume excess food at iftar (the food eaten immediately after sunset to break fast), dinner or sahur ( the light meal generally eaten about half an hour to one hour before dawn). The body has regulatory mechanisms that activate during fasting. There is efficient utilization of body fat, El Ati et al. (3) . Basal metabolism slows down during Ramadan fasting, Husain et al. (4). A diet that is less than a normal amount of food intake but balanced is sufficient enough to keep a person healthy and active during the month of Ramadan.

Health problems can emerge as a result of excess food intake, foods that make the diet unbalanced, and insufficient sleep (5, 6). Ultimately also, such a lifestyle contradicts the essential requirements and spirit of Ramadan.

DIET DURING RAMADAN

According to Sunna (the practices of Prophet Muhammad, Pbuh) and research findings referred in this report, a dietary plan is given:

1. Bread/Cereal/Rice, Pasta, Biscuits and Cracker Group: 6-11 servings/day; 2. Meat/Beans/ Nut Group: 2-3 servings/day. 3. Milk and Milk Product Group: 2-3 servings/day. 4. Vegetable Group: 3-5 servings/day; 5. Fruit Group: 2-4 servings/day. 6. Added sugar (table sugar, sucrose): sparingly. 7. Added fat, polyunsaturated oil 4-7 table spoons.

Breakfast, iftar

Dates, three

Juice, 1 serving (4 oz.)

Vegetable soup with some pasta or graham crackers, 1 cup

The body's immediate need at the time of iftar is to get an easily available energy source in the form of glucose for every living cell, particularly the brain and nerve cells. Dates and juices are good sources of sugars. Dates and juice in the above quantity are sufficient to bring low blood glucose levels to normal levels. Juice and soup help maintain water and mineral balance in the body. An unbalanced diet and too many servings of sherbets and sweets with added sugar have been found to be unhealthy, Gumma et al. (7).

Consume foods from all the following food groups:

Meat/Bean Group: Chicken, beef, lamb, goat, fish, 1-2 servings (serving size = a slice =1 oz); green pea, chickpea (garbanzo, chana, humus), green gram, black gram, lentil, lima bean and other beans, 1 serving (half cup). Meat and beans are a good source of protein, minerals, and certain vitamins. Beans are a good source of dietary fiber, as well.

Bread/Cereal Group: Whole wheat bread, 2 servings (serving size = 1 oz) or cooked rice, one cup or combination. This group is a good source of complex carbohydrates, which are a good source of energy and provide some protein, minerals, and dietary fiber.

Milk Group: milk or butter-milk (lassi without sugar), yogurt or cottage cheese (one cup). Those who can not tolerate whole milk must try fermented products such as butter-milk and yogurt. Milk and dairy products are good sources of protein and calcium, which are essential for body tissue maintenance and several physiological functions.

Vegetable Group: Mixed vegetable salad, 1 serving (one cup), (lettuce, carrot, parsley, cucumber, broccoli, coriander leaves, cauliflower or other vegetables as desired.) Add 2 teaspoons of olive oil or any polyunsaturated oil and 2 spoons of vinegar. Polyunsaturated fat provides the body with essential fatty acids and keto acids. Cooked vegetables such as guar beans, French beans, okra (bhindi), eggplant (baigan), bottle gourd (loki), cabbage, spinach, 1 serving (4 oz). Vegetables are a good source of dietary fiber, vitamin A, carotene, lycopenes, and other phytochemicals, which are antioxidants. These are helpful in the prevention of cancer, cardiovascular diseases, and many other health problems.

Fruits Group: 1-2 servings of citrus and/or other fruits. Eat fruits as the last item of the dinner or soon after dinner, to facilitate digestion and prevent many gastrointestinal problems. Citrus fruits provide vitamin C. Fruits are a good source of dietary fiber.

Fruits and mixed nuts may be eaten as a snack after dinner or tarawiaha or before sleep.

Pre-dawn Meal (sahur):

Consume a light sahur. Eat whole wheat or oat cereal or whole wheat bread, 1-2 serving with a cup of milk. Add 2-3 teaspoons of olive oil or any other monounsaturated or polyunsaturated fats in a salad or the cereal. Eat 1-2 servings of fruits, as a last item.

DISCUSSION

Blood cholesterol and uric acid levels are sometimes elevated during the month of Ramadan (. Contrary to popular thinking, it was found that intake of a moderately high-fat diet, around 36% of the total energy (calories), improved blood cholesterol profile, Nomani, et al. (9) and Nomani (10). It also prevents the elevation of blood uric acid level (8-10). The normal recommended guideline for fat is 30% or less energy. On weight basis, suggested fat intake during Ramadan is almost the same as at normal days. Fat is required for the absorption of fat-soluble vitamins (A, D, E, K) and carotenoids. Essential fatty acids are an important component of the cell membrane. They also are required for the synthesis of the hormone prostaglandin. Keto-acids from fat are especially beneficial during Ramadan to meet the energy requirement of brain and nerve cells. Keto-acids also are useful in the synthesis of glucose through the metabolic pathway of gluconeogenesis. This reduces the breakdown of body proteins for glucose synthesis. Therefore, the energy equivalent of 1-2 bread/cereal servings may be replaced with polyunsaturated fat.

During Ramadan increased gastric acidity is often noticed, Iraki, et al. (5), exhibiting itself with symptoms such as a burning feeling in the stomach, a heaviness in the stomach, and a sour mouth. Whole wheat bread, vegetables, humus, beans, and fruits -- excellent sources of dietary fiber -- trigger muscular action, churning and mixing food, breaking food into small particles, binding bile acids, opening the area between the stomach and the deudenum-jejunum and moving digesta in the small intestine, Kay (11). Thus, dietary fiber helps reduce gastric acidity and excess bile acids, Rydning et al. (12). In view of dietary fiber's role in moving digesta, it prevents constipation. It's strongly suggested that peptic ulcer patients avoid spicy foods and consult a doctor for appropriate medicine and diet. Diabetic subjects, particularly severe type I (insulin dependent) or type II (non-insulin dependent), must consult their doctor for the type and dosage of medicine, and diet and precautions to be taken during the month. Generally diabetes mellitus, type II, is manageable through proper diet during Ramadan, Azizi and Siahkolah (13).

Pregnant and lactating women's needs for energy and nutrients are more critical than the needs of men (14). There is a possibility of health complications to the pregnant woman and the fetus or the lactating mother and the breastfed child, if energy and nutrient requirements are not met during the month of Ramadan (15-19). Governments, communities, and heads of the family must give highest priority to meet women's dietary needs. In African countries, Bangladesh, India, Pakistan and many other places malnutrition is a major problem, especially among women from low-income groups. Further more, it is common among these women to perform strenuous work on farms or in factories, and other places. Malnutrition and strenuous conditions may lead to medical problems and danger to life. Under these conditions one must consult a medical doctor for treatment and maulana or shiekh for postponement or other suggestions regarding fasting. Quran Al-Hakeem and Hadith allow pregnant women and lactating mothers flexibility during the month of Ramadan.

For practical purposes and estimation of nutrients a diet was formulated, given below:

Iftar: 3 dates, 1/2 cup of orange juice, 1 cup of vegetable soup, 2 plain graham crackers; dinner: 1 cup of vegetable salad with two teaspoons of corn oil and two teaspoon of vinegar, 2 oz. of chicken, 1/2 cup of okra, 4 oz. of cooked whole chana (garbanzo), 3 tea spoon of oil while cooking main dishes, 2 slices of whole wheat bread, 1 cup of cooked rice, 3/4 cup of plain yogurt, one orange, 1/2 cup grapes, 1 oz of nuts-mixed roasted-without salt; sahur: 2 slices of whole wheat bread, 1 cup of milk, 1/4 cup of vegetable salad with two teaspoons of corn oil and two teaspoons of vinegar, 1 skinned apple, 2 teaspoons of sugar with tea or coffee.

Nutritionist IV (20) was used to estimate energy and nutrient content in the above diet, which was as follows: energy, 2136 kilocalories; protein, 70g; carbohydrate , 286g; fat, 87g, 35 % of energy of the total intake, (saturated fat 16.9g; mono saturated, 28.4g; poly unsaturated, 34g; other 7.3g; - oleic, 25.6g; linoleic, 29.5; linolenic, 0.6g; EPA-Omega-3, 0.006g; DHA-omega-3, 0.023g; dietary fiber 34g; calcium, 1013mg; sodium, 3252 mg; potassium, 2963mg; iron 13.3mg; zinc, 10mg. When the nutrients were compared with the Recommended Dietary Allowance (RDA), for an adult non-pregnant and non-lactating female (14), the diet met 100% or more of the RDA for protein, calcium, sodium, potassium, and vitamin A, K, B1, B2, B3, B6, B12, folate, and C. The energy was close to the RDA, (97%). The dietary fiber level also was met as per the recommendation (11). Consuming food in the above amount by pregnant or lactating female may not meet the RDA for all of the nutrients. They may need supplementation of some minerals and vitamins such as, iron vitamin D, and more energy through bread or rice.

Further suggestions:

Drink sufficient water between Iftar and sleep to avoid dehydration.

Consume sufficient vegetables at meal s. Eat fruits at the end of the meal.

Avoid intake of high sugar (table sugar, sucrose) foods through sweets or other forms.

Avoid spicy foods.

Avoid caffeine drinks such as coke, coffee or tea. Caffeine is a diuretic. Three days to five days before Ramadan gradually reduce the intake of these drinks. A sudden decrease in caffeine prompts headaches, mood swings and irritability.

Smoking is a health risk factor. Avoid smoking cigarettes. If you cannot give up smoking, cut down gradually starting a few weeks before Ramadan. Smoking negatively affects utilization of various vitamins, metabolites and enzyme systems in the body.

Do not forget to brush or Miswak (tender neem tree branch, Azhardicta indica or other appropriate plant in a country, about 1/4-1/2 inch diameter and 6-8 inches length, tip partially chewed and made brush like). Brush your teeth before sleep and after sahur. Brush more than two times or as many times as practicable.

Normal or overweight people should not gain weight. For overweight people Ramadan is an excellent opportunity to lose weight. Underweight or marginally normal weight people are discouraged from losing weight. Analyzing a diet's energy and nutritional component, using food composition tables or computer software, will be useful in planning an appropriate diet.

It is recommended that everyone engage in some kind of light exercise, such as stretching or walking. It's important to follow good time management practices for Ibada (prayer and other religious activities), sleep, studies, job, and physical activities or exercise.

In summary, intake of a balanced diet is critical to maintain good health, sustain an active lifestyle and attain the full benefits of Ramadan.

Dr. Mohammad Zafar A. Nomani, is Professor Emeritus, West Virginia University; and recipient of the first King Hassan II award for outstanding research contributions on Ramadan fasting, honored by Hassan II Foundation for Scientific and Medical Research on Ramadan, Casablanca, Morocco, at the First World Congress on Health and Ramadan.

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(. Hallak, M.H. and M.Z.A. Nomani. Body weight loss and changes in blood lipid levels in men on hypocaloric diets during Ramadan fasting. American Journal of Clinical Nutrition. 48:1197-1210, 1988.

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[Source: International Journal of Ramadan Fasting Research]