The holy month of Ramadan is the ninth month of the Islamic calendar and a time when many Muslims across the world fast during daylight hours for 29-30 days. The Islamic calendar is lunar and so Ramadan falls at a slightly earlier time in the year each year.
Muslims taking part in Ramadan do not eat or drink anything during daylight hours, eating one meal (the ‘suhoor’ or ‘sehri’) just before dawn and another (the ‘iftar’) after sunset. The end of Ramadan is marked by ‘Eid-ul-Fitr’, the Festival of the Breaking of the Fast. A special celebratory meal is eaten during the festival, the first daytime meal for a month.
The first day of Ramadan 2019 was May 6th and fasts will last over 18 hours on some days, making it all the more important to look after your health if you are fasting.
While fasting is obligatory for all healthy muslims (not children), there are exemptions for those who are ill or who's health could be affected by fasting, for example, pregnant or breastfeeding women and people with diabetes (see below).
1. How does fasting affect the body?
During fasting hours when no food or drink is consumed, the body uses its stores of carbohydrate (stored in the liver and muscles) and fat to provide energy once all the calories from the foods consumed during the night have been used up. The body cannot store water and so the kidneys conserve as much water as possible by reducing the amount lost in urine. However, the body cannot avoid losing some water when you go to the toilet, through your skin and when you breathe and when you sweat if it is warm.
Depending on the weather and the length of the fast, most people who fast during Ramadan will experience mild dehydration, which may cause headaches, tiredness and difficulty concentrating. However, studies have suggested that this is not harmful to health, provided that enough fluids are consumed after breaking the fast to replace those lost during the day. However, if you are unable to stand up due to dizziness, or you are disoriented, you should urgently drink regular, moderate quantities of water - ideally with sugar and salt - a sugary drink or rehydration solution. If you faint due to dehydration, your legs should be raised above your head by others, and when you awake, you should urgently rehydrate as outlined above.
For those who would normally consume caffeinated drinks such as tea and coffee during the day, the lack of caffeine during the fast may initially lead to headaches and tiredness. This may ease over the course of Ramadan as the body adjusts to going without caffeine during the day.
Once the fast is broken, the body can rehydrate and gain energy from the foods and drinks consumed. Having not eaten for a long period, you may find it helpful to eat slowly when breaking the fast and to start with plenty of fluids and low-fat, fluid-rich foods.
Drinking plenty of fluids, as well as consuming fluid-rich foods, such as fruit, vegetables, yogurt, soups and stews, is very important to replace fluids lost during the day and to start the next day of fasting well hydrated. Salt stimulates thirst and so it’s a good idea to avoid consuming a lot of salty foods. The pre-dawn meal, suhoor, provides fluids and energy for the day of fasting ahead, so making healthy choices can help you to cope better with the fast.
While iftar meals are often a time for celebration, with families and friends coming together to break their fasts, it’s important not to go overboard when eating during Ramadan. Consuming a lot of deep fried, creamy and sweet foods may actually cause you to gain weight during Ramadan. Ramadan can be a good time to make changes to improve the balance of your diet that you can sustain in the longer term.
The changes to eating habits and lack of fluids during the day may cause constipation for some people. When you can eat and drink, consuming plenty of high fibre foods, such as wholegrains, high fibre cereals, bran, fruit and vegetables, beans, lentils, dried fruit and nuts alongside plenty of fluids may help to ease constipation as well as doing some light physical activity, such as going for a walk after iftar.
2. Is fasting good for health?
Results from studies on the health effects of Ramadan fasting are mixed, probably because the length of the fast and the weather conditions experienced vary depending on the time of year and the country where the fast is being observed. Some studies have found that people who are overweight or obese lose weight and body fat during Ramadan (although they tended to put this weight back on after Ramadan). If you are overweight and would like to lose weight and keep it off, then making plans to maintain a healthy diet and get active when Ramadan is finished may help you sustain any weight lost due to fasting.
Some small studies have looked at the effect of Ramadan fasting on factors like blood cholesterol and triglycerides (fat in the blood) and found a short term improvement in some cases although some studies found no effect. There have also been some small studies that suggest that Ramadan fasting may have a short term beneficial effect on the immune system. In both cases, the results of studies have been mixed and so more research is needed to confirm these results.
3. What to eat and drink at iftar and suhoor
Iftar - when first breaking the fast go for plenty of fluids, low fat, fluid-rich foods and foods containing some natural sugars for energy (avoid consuming a lot of foods or drinks with added sugars). Below are some examples:
- Drinks: water, milk, fruit juices or smoothies - water provides hydration without any extra calories or added sugars. Drinks based on milk and fruit provide some natural sugars and nutrients - these are also good to break the fast but avoid drinking a lot of drinks with added sugars after breaking the fast as these can provide too much sugars and calories.
- Dates: traditionally eaten to break the fast since the time of the Prophet Muhammad, dates are a great way to break the fast as they provide natural sugars for energy, provide minerals like potassium, copper and manganese and are a source of fibre. You could also try other dried fruits such as apricots, figs, raisins or prunes, which also provide fibre and nutrients.
- Fruit: a traditional way to break the fast in South Asian cultures, fruit provides natural sugars for energy, fluid and some vitamins and minerals.
- Soup: traditional in many Arab countries, is a light way to break the fast and provides fluid. Traditional soups are based on a meat broth and often contain pulses, like lentils and beans, and starchy foods like pasta or grains, providing nutrients and energy.
After breaking the fast - meals vary between different cultures and traditions but try to make sure the foods you eat provide a balance of starchy foods, including wholegrains where you can, fruit and vegetables, dairy foods and protein-rich foods like meat, fish, eggs and beans, as shown by the Eatwell Guide. For example you could have a range of curries including fish, meat, vegetables and pulses, served with rice, chapattis and yogurt, and this would include all of the key food groups within the Eatwell Guide.
After a long fast it’s natural to want to treat yourself but try to keep the amount of fatty and sugary foods and sugary drinks you have to a small amount. Remember that you only have a relatively short time each day to eat and drink to provide your body with all the essential nutrients and fluids it needs to be healthy, so the quality of your diet is especially important during Ramadan.
If you can, once you have had a chance to digest your food, you could try doing some light exercise such as going for a walk. If you attend Taraweeh prayers (special night-time prayers for Ramadan) in the evening, perhaps you could walk all or part of the way there.
Suhoor - drink plenty of fluids, choose fluid-rich foods to make sure you are well hydrated for the day ahead and go for starchy foods for energy, choosing high fibre or wholegrain varieties where possible as these can help keep you feeling fuller and can aid digestion, helping to prevent constipation. Below are some examples:
- Oats: these are wholegrains and you could choose porridge, which will also provide fluids as it’s made with milk or water, muesli with milk or yogurt or overnight oats. You could experiment with fresh or dried fruit, nuts or seeds as toppings.
- High fibre breakfast cereals: these provide plenty of fibre and are often fortified with vitamins and minerals, providing extra nutrients. Because they are consumed with milk, you also get fluid and nutrients like calcium, iodine and b vitamins from the milk.
- Starchy foods like rice, or couscous: you could try rice pudding with fruit or experiment with couscous or other grains with dairy or fruit. If you go for savoury dishes at suhoor then it's a good idea make sure these are not too salty or they may make you very thirsty during the fast.
- Yogurt: this can be a good food to include at suhoor as it provides nutrients like protein, calcium, iodine and b vitamins and also contains fluid. You could combine it with cereal and fruit as in the examples above.
- Breads: go for wholegrain options as these provide more fibre, for example wholemeal toast or chapattis. Avoid combining bread with salty foods like hard cheese, or preserved meats. You could try nut butters (without added salt), soft cheese, or banana. As bread is fairly dry, make sure you drink plenty of water or other fluids alongside or you could have fluid-rich foods such as a lentil soup, which is a traditional food at suhoor in some countries.
4. Fasting with diabetes
Much research has been done on the health implications of fasting for people with both type 1 and type 2 diabetes. Type 2 diabetes tends to be particularly prevalent in people of south-Asian and black African descent, many of whom may be Muslim. There can be a risk of dehydration and hypoglycaemia, for those with diabetes who observe the fast, especially in the spring and summer when days are longer and warmer.
It is permissible in Islam for those with a health condition such as diabetes not to fast. However, Ramadan fasting has great spiritual significance for Muslims and many with diabetes do choose to fast. Whether to fast or not is a personal decision for each individual. If you are diabetic and are planning to fast it’s advisable to visit your doctor or healthcare team to talk about how to manage your condition while fasting.