A guide on healthy eating and hydration during Ramadan

By Nutritionist Golnar Khaleghi

Islam encourages Muslims to ensure that they are mindful of their health as this is key to happiness, and what we consume directly affects our health.

The blessed Prophet once said: “God has a right over you; your body has a right over you…” To strike a balance between the needs of the physical body and your spiritual needs, you must on the one hand consume the right type and amount of food and on the other hand develop excellent interpersonal skills. Fasting in the month of Ramadan is an opportunity to make significant changes in your lifestyle and develop healthy living choices. This is a great opportunity to focus on bringing back a balanced and through fasting you begin to learn how to manage your eating habits, how to improve self-control and discipline. 

To fast or not to fast- Ramadan and diabetes

When we fast, at about eight hours after our last meal, our bodies start to use energy stores to keep our blood glucose levels normal. For most people, this is not harmful, however if you have diabetes, especially if you take certain tablets or insulin, you’re at risk of of both hypo and hyper glycaemia (blood glucose being too low or too high), diabetic ketoacidosis (caused by high levels of ketones in the blood), dehydration and thrombosis.

With long fasts the risks of hypos and hyper and dehydration are high. A further problem that can occur, is the risk of high glucose levels following the larger meals that we eat before and after fasting at Suhoor (Sehri) and Iftar. People with Type 1 diabetes are generally advised not to fast as it is too dangerous. Those who have their diabetes under control, either by their diet or using tablets, may be able fast. However, their GP may require them to change their medication to help them take tablets outside fasting times. Those who need insulin to control their diabetes are generally advised not to fast. If you have complications associated with diabetes, such as poor vision or heart or kidney disease, the risk of aggravating these is very high and you should seriously consider not fasting.

How does fasting affect the body?

For many people, the key question regarding fasting is whether it is good or bad for your health. A quick overview of what happens inside the body during fasting: 

The changes that occur in the body in response to fasting depend on the length of the continuous fast. After eight hours of fasting and after the last meal the body enters into a fasting state. This is when the gut finishes absorption of nutrients from the food. In the normal state, body glucose, which is stored in the liver and muscles, is the body’s main source of energy. During a fast, this store of glucose is used up first to provide energy. Later in the fast, once the stores of glucose run out, fat becomes the next store source of energy for the body.

The kidney is very efficient at maintaining the body’s water and salts, such as sodium and potassium, therefore a balanced food and fluid intake is important between fasts. 

However, body fluids are lost through sweat. To prevent muscle breakdown, meals must contain adequate levels of carbohydrates and some fat. Hence, a balanced diet with adequate quantities of nutrients, salts and water is vital.

Results from studies on the health effects of Ramadan fasting are mixed. These are due to variable such as the length of the fast and the weather conditions experienced. Some studies have found that people lose weight during Ramadan although it was observed that they tended to put this weight back on after Ramadan. For overweight individuals who would like to lose weight and keep it off, ensuring that you maintain a healthy diet and get active when Ramadan is finished may help you sustain any weight lost due to fasting. Furthermore, 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. However, more research is needed to confirm health benefits of fasting on the body.

What to eat and drink at Iftar

With such an elaborate spread we usually eat like crazy once Iftar kicks in and ignore the idea of keeping our diets clean and healthy. overindulging can lead to physical discomfort and pretty much defeats the purpose of our fast. This can however be easily eased by making sure you intake small portions at a time and don’t over eat. 

When first breaking the fast go for plenty of fluids, low fat, fluid-rich foods. Below are some examples:

• Dates – traditionally eaten to break the fast since the time of the Prophet Muhammad (peace be upon him). Start by eating three dates, especially if you suffer from a headache or dizziness due to low blood sugar levels during the fasting period. Dates provide natural sugars for energy, provide minerals like potassium, copper and manganese and are a source of fiber. You could also try other dried fruits such as apricots, figs, raisins or prunes, which also provide fiber and nutrients.

• Have a bowl of soup traditional to Arab and Middle eastern countries. This is a crucial dish in the Ramadan meal and a light way to break the fast, since it prepares the stomach to receive the rest of the meal and helps replenish some of the body fluids lost during the day. Traditional soups are based on a meat broth and often contain pulses, like lentils and beans, and starchy foods like pasta or grains.

• Eat a salad, because it is rich in vitamins, minerals and fiber. The more colorful your salad, the more health benefits it holds. Remember to use healthy sources of fat such as avocados, nuts and seeds to make your salads more interesting. You could also add Quinoa or pulses like chickpea for more protein. 

• After breaking the fast meals vary between different cultures but try to make sure the foods you eat provide a balance of starchy foods, fruit and vegetables, dairy foods and protein-rich foods like meat, fish, eggs and beans. Complex carbohydrates are foods that will help release energy slowly during the long hours of fasting. Complex carbohydrates are found in grains and seeds, like barley, wheat, oats, millets, semolina, beans, lentils, wholemeal flour, basmati rice, etc. Fiber-rich foods are also digested slowly and include bran, cereals, whole wheat, grains and seeds, potatoes with the skin, vegetables such as green beans and almost all fruit, including apricots, prunes, figs, etc. 

• Make sure you drink sufficient 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. For some cultures usually breaking the fast by consuming a warm lemon and honey tea, or rose water is a custom.

• Chia seeds are super packed with Omega-3s, protein, calcium, iron, zinc and antioxidants. The tiny seed is an excellent source of fiber which will help prevent constipation due to the low fiber and water intake during Ramadan. Adding this to water is a great tip.Consume Fruit as it provides natural sugars for energy, fluid and some vitamins and minerals.You can also increase water intake with hydrating foods such aswatermelon, pears, cucumbers, lettuce and melons.

How to prevent getting thirsty 

• Drink at least eight glasses of water every day. Drinking beverages such as soft drinks will fill up your stomach and may delay your digestion process resulting in a lot of problems including gas, bloating, stomach pain, and weight gain, so water is absolutely the best drink for Ramadan. Try not to drink large quantities of water all at once. Instead drink water between your meal and throughout the evening.

• Adding too much salt to salads and other dishes as well as eating salty foods like salted fish and pickles will make you thirstier because they increase the body’s need for water as they cause water retention.

Healthy replacements

1. Instead of deep-fried foods like pakoras, samosas and fried dumplings replace these with whole grains, e.g. chickpeas (plain, or with potato in yogurt with different Indian spices), samosas baked instead of fried, and boiled dumplings.
2. High-sugar/high-fat foods, like sweets such as Ghulab Jamun, Rasgulla, Baklava, chocolates and biscuits, can be replace with milk-based sweets and puddings, like Rasmalai, Barfee or even protein balls made with dates and nuts.
3. Instead of frying foods try grilling or baking which is healthier and helps retain the taste of the food, especially chicken and fish.

What to eat and drink at 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 fiber or wholegrain varieties where possible as these tend to be digested more slowly. Below are some examples:

• Oats - these are whole grains and you could choose porridge, which will also provide fluids as it’s made with milk or water.
• Choose high fiber breakfast cereals as these provide plenty of fiber and are often fortified with vitamins and minerals, providing extra nutrients. As this is consumed with milk, you also get fluid and nutrients like calcium, iodine and b vitamins from the milk.
• Yogurt – this can be a good food to include as it provides nutrients like protein, calcium, iodine and b vitamins and also contains fluid. You could combine it with cereal or muesli and fruit as in the examples above.

• Breads – go for wholegrain options as these provide more fiber, for example wholemeal toast or chapattis. Avoid combining bread with salty foods like hard cheese, or preserved meats as these will make you feel thirsty.

This is a common problem and has many causes. Headaches during a fast could commonly be due to dehydration or hunger, inadequate rest, or the absence of addictive substances such as caffeine or nicotine. A moderate and balanced diet, especially not missing the pre-dawn meal and consuming adequate quantities of fluid are essential. Prevention is always better than a cure. However, if you do not adequately rehydrate before a fast, your risk of dehydration is increased and you may experience a general feeling of being unwell, lethargy, muscle cramps, dizziness and disorientation.