Fasting and your health: How to stay well during Ramadan | Doctor’s Note

The Muslim holy month of Ramadan is upon us and people across the world are fasting as well as spending much of their time contemplating and praying. For many, it will be the first Ramadan since the pandemic began when they can bring family and friends into their homes to share in the breaking of the fast. But there will also be an air of sadness for those whose homes have experienced the loss of loved ones to COVID-19; for them, prayers will be even more important.

During Ramadan, adult Muslims who observe the fast are not to eat or drink from sunrise to sunset. Of course, the length of time a person fasts for varies depending on where in the world they live as day length is governed by the time of year and the distance one is from the equator. Some people are also exempt from fasting, like children, the elderly, those whose health is likely to be compromised by abstaining from food and drink, and menstruating and pregnant women; they have the option of donating money to charitable organisations as an alternative.

Fasting, in general, has been shown to have health benefits, with intermittent fasting becoming a popular way to lose weight. Rather than focus on what to eat, intermittent fasting tells you when to eat. It involves fasting for a certain number of hours each day (usually between eight and 16, any longer than this can be dangerous), reflecting the way humans likely ate during their hunter/gatherer years before they learned to farm.

The idea is that once your body has used up its sugar stores, it begins to burn fat, and weight loss occurs – a process known as metabolic switching. Studies have shown that the health benefits that can be incurred through intermittent fasting include lower blood pressure and cholesterol, overall reduced inflammation, better responses to insulin and reduced risk of type 2 diabetes. There is also evidence that intermittent fasting can help improve our long-term memory, reduce the risk of certain cancers and slow down the signs of ageing.

But for Muslims, the health benefits are secondary, and the purpose of the fast, which is one of the five pillars of Islam, is to bring them closer to God, give thanks and reflect on the teachings of the Quran. Some people may find fasting easy but for others, it can be a challenge and hunger can get in the way of work and other daily activities. So, are there ways to stave off some of those hunger pangs?

The answer is, yes; certain foods eaten before commencing a fast can help reduce your hunger while maintaining your health – it is just a case of knowing what to eat.

Suhoor: Fibre, protein, carbs

If you are fasting, do not skip suhoor, the morning meal before the fast begins. Eating the right food at this point is key in helping to reduce cravings later in the day.

Breakfasts tend to include carbohydrate-rich toast or sugary cereals, but these will only cause a glucose spike in your blood, followed by a dip as the sugar is broken down. This will activate the cravings centre in your brain telling you that more food is needed. So instead, opt for a fibre and protein-rich suhoor meal.

Fibre is key in slowing down digestion and keeping you feeling full. It is thought to increase the amount of short-chain fatty acids in your gut. These help promote a feeling of fullness with some studies showing fibre from sources such as beans, peas and chickpeas can increase your feelings of fullness by 31 percent. For breakfast, think about cooking up some mushrooms, avocados, vegetables, pulses or nuts to help keep those hunger pangs at bay.

Protein should also be an important component of your suhoor meal. It may feel odd but going for food high in protein such as lean meats like baked fish or chicken is a good way to keep from being hungry later in the day; alternatively, you could try boiled or poached eggs or vegan protein sources including lentils or chickpeas. Studies have shown that protein-rich meals keep you fuller for longer and reduce hunger hormones compared with sugary or carbohydrate-rich breakfasts. So, alongside your fibre, have a good chunk of protein to keep you less hungry as your fast progresses.

Carbohydrates are a key component of most meals, but they do cause sugar spikes and insulin levels to increase which can make you hungry later on. You do not have to avoid them completely, however. Instead, look at when you eat carbohydrates during your meal. Studies show that eating carbohydrates after your fibre and protein can reduce glucose and insulin spikes in your blood. The fibre will coat your intestines and combine with the protein. Food will then move more slowly through the gut and less glucose from the rest of the meal will be absorbed. This means feeling fuller for longer, curbed cravings and better hormonal balance.

So the best way to enjoy a suhoor meal is to get your fibre first, followed by proteins and fats, then save your carbohydrates such as toast or paratha until the end. You may be tempted to eat them all together but the order in which you eat your food has been shown to be important in balancing your hunger later in the day – give it a go.

Hydration: Benefits of plain water

Do not forget to hydrate.

There is some research to show that drinking water can help us from feeling hungry. One small study found that people who drank two glasses of water immediately before a meal ate 22 percent less than those who did not. It showed that drinking water before eating can stretch the stomach and send fullness signals to the brain.

Try drinking a glass of water before and after your meal. There is still a lot to be understood about how water might curb hunger cravings, but dehydration during the fasting periods in Ramadan is a real concern and the neurones that govern thirst and hunger are closely related.

Remember that although tea and coffee contain water, the caffeine content in them can act as a diuretic and make you pass more urine, which can add to the dehydration effects of fasting, so it is best to go for the good stuff: plain water.

Iftar: What to eat when breaking your fast

The food we break the fast with is equally important.

Traditionally, Muslims break the fast at sunset with the consumption of a date; these are sugar-rich and are absorbed quickly by the body, giving it an almost instant boost. Following this, try to split the iftar meal into two, rather than eating one large meal. This will help manage a large blood glucose spike, as well as reduce the risk of indigestion.

Think about a broth or soup starter, taking a break for prayers and then coming back to a more substantial meal made up of complex carbohydrates, proteins and fibre-rich vegetables. Balancing meals in this way will mean you will feel less bloated and reduced glucose/insulin spikes mean you will have more energy overall. Plus the protein and fibre in your meal will keep you fuller for longer and you will not find yourself drifting back to the kitchen for snacks later.

Ramadan can play havoc with our sleep routines. Waking up early for suhoor and then praying tarawih late into the night can mean we have less time for sleep. Many of us have to work during Ramadan too, so cannot have a lie-in. Try to prioritise sleep on your days off from work, getting enough good quality sleep can reduce feelings of hunger by decreasing levels of our hunger hormone, ghrelin, and increasing levels of the appetite-regulating hormone, leptin.

On the days that it is possible to do so, aim to go back to sleep after the fajr prayer and get a total of eight to 10 hours of sleep per night; it will not only help with your levels of hunger but also your general wellbeing.

COVID-19 and fasting

It is important to remember that we are still in a pandemic and levels of COVID-19 remain high in many countries, driven by the BA.2 subvariant of Omicron which is proving to be highly contagious. Although it is thought to have milder symptoms than Delta, a person’s response to the virus is unpredictable and the sheer number of people becoming infected means we are again seeing a rise in hospitalisations because of COVID.

Crowded mosques are an ideal breeding ground for the virus, as people are in close proximity to one another and many buildings are often poorly ventilated, meaning an airborne virus such as SARS-CoV-2 can pass between people easily. Remember, if you have any symptoms of COVID, then you should do a test and not go to the mosque to pray while you are awaiting the results or if it is positive.

The symptoms of Omicron overlap with those of the common cold, so sore throats, headaches and runny noses should be treated as suspected COVID until proven otherwise through a test.

Those in charge of mosques need to adapt and look at ventilating their buildings properly, this might mean investing in approved air filters or ensuring windows and doors remain open so that air moves through the building efficiently. Consider wearing a mask to the mosque. Most of us are used to wearing masks in public indoor spaces and the mosque should be no different. Bringing your own prayer mat and performing the ablution at home will further help reduce your risk of contracting COVID.

If you are clinically extremely vulnerable, consider praying at home, rather than risk mixing with large groups of strangers who may be carrying the virus. And of course, be up to date with the vaccines, they are the best and safest way to reduce your risk of getting seriously ill from the virus. In order to fast for the entirety of Ramadan, you have to remain well – and these simple measures will help you do so.

Fasting and other health issues

For those who have long-term health conditions, you are exempt from fasting but in my experience treating patients, I know some may still choose to attempt to fast. Remember to discuss this with your physician first; you must not suddenly stop your medication and even changing the timings of your medication can have adverse effects on your health. People with type 2 diabetes who are on glucose-lowering drugs may suffer from dangerously low blood sugar levels if they fast, so it is vital that they discuss this with their doctor.

Although exempt, many pregnant Muslim women also partake in the daily fast during Ramadan. As a doctor, I would advise against this. More studies are needed to investigate the effects of fasting on pregnancy outcomes, but one large systematic review found that although it had no significant effect on birth weight or stillbirths, there was evidence the placenta – the vital organ that transports food and oxygen to the developing baby – was lighter in weight in fasting mothers than those who were not fasting. Pregnancy exempts women from fasting for good reason, and it is best to stick to the rules put down by Islam when it comes to this.

Exercising during Ramadan can be done safely, providing you do not push yourself. This is not the time to build muscle or endurance, the focus should be on maintaining fitness levels. It is likely you will fatigue easily during a fast and there is an increased risk of dehydration. Make sure you drink plenty of water at suhoor and iftar and eat fruit and vegetables that have a lot of water locked within them.

Avoid caffeine or salt-rich foods and drinks during your eating hours as these will only serve to dehydrate you later on. If you can, exercise after the fast has been broken so you can drink while you work out. If that is not possible, exercising just before the breaking of the fast is the next best thing as you can drink and rehydrate soon after. It is best to avoid exercising in high temperatures or in the sun for too long. Remember, you are fasting and scaling back on exercise or taking more rest days is not a bad thing during Ramadan.

While fasting has been shown to have some health benefits, what you do on either side of your fast is equally important to maintaining good health. Ramadan is about reflection and discipline as well as breaking bad habits, and if we can all eat a bit more healthily and more mindfully and carry this throughout the year, this can only be a good thing.