Healthy eating during the month of Ramadan

Dr Shireen Kassam

FastingRamadan is the ninth month of the Islamic calendar and is a time when most muslims around the world will fast. No food or drink is consumed during the hours between sunrise and sunset. The length of the fast will therefore vary based on geographical location and time of year. Most people will eat a meal just before sunrise (the ‘suhoor’ or ‘sehri’) and then break the fast with a second meal after sunset (the ‘iftar’)

When you fast, the body will first utilise stored carbohydrates in the form of glycogen for energy. How long it takes to deplete these stores will depend on your level of physical activity. Your body can rely on the glycogen stores for most of the duration of fast for everyday activities. However, if undertaking physical activity as well, the stores can be depleted much faster. The body will then also need to use fat stores for energy. Even though the kidneys will try and conserve water, some continues to be lost through urination, sweating and breathing. This can lead to symptoms of dehydration, essentially for those in hotter climates.

Are there any health benefits to fasting?

Reasons for fasting during Ramadan are mainly religious and spiritual and it is a time for reflection, self-improvement and increased devotion and worship. However, fasting in general is thought to have a number of benefits for health, although there remains some uncertainty about the extent and duration of these benefits. On a basic level, fasting usually results in a reduction in the number of calories you are consuming in a day and so for some people it can be easier to lose excess body weight when fasting is incorporated into a weight loss regimen. Many people do experience weight loss for this reason during the month of Ramadan, but this weight can easily be put back on again unless significant changes to a person’s way of eating is continued. There does need to be some caution for those that are already of lower body weight or underweight as losing too much weight may not be healthy.

There is also some evidence to suggest periods of fasting may lead to better immune health, lower levels of inflammation and growth factors, and improve blood lipid levels, blood pressure and insulin resistance. Fasting results in beneficial changes to the types of bacteria residing in the gut, and this is thought to be one of the reasons for the wide range of short-term benefits seen. However, if outside of the periods of fasting you are not consuming a fibre-rich, gut healthy diet, it is unlikely that there will be any long-term benefits to health. Whether fasting results in a lower risk of certain chronic conditions, such as cardiovascular disease, cancer and type 2 diabetes, in the longer term is a question that has not yet been answered. It certainly cannot make up for unhealthy habits in general and there will be more benefits to concentrating on eating a healthy plant-based diet, regular physical activity, avoiding smoking and drinking alcohol and getting good quality sleep regardless of whether you decide to fast or not.

How to maintain a healthy diet whilst fasting

Before the fast starts, be sure to drink plenty of fluid to avoid dehydration during the day. Choose carbohydrate-rich foods that are also high in fibre for suhoor – the morning meal. This will ensure a slow release of energy during the day while supporting gut health and preventing constipation. You can’t go wrong with a bowl of oats with a plant-based milk such as soya milk, topped with nuts, ground flaxseed and some fruit. Try adding nut butters or a handful of walnuts to your morning oats for extra protein and healthy fats.

When breaking the fast, it may be difficult to start with a large meal. It is traditional to break the fast with dried dates (my favourite are Zaytoun Medjoul dates). This is a great choice as they are high in natural sugars and will provide energy fast. Make sure to hydrate well with plenty of water or non-caffeinated teas.

The main meal should focus on healthy foods that are rich in fibre and nutrients. This includes vegetables, whole grains and plant-based sources of protein such as tofu, tempeh, lentils, beans, chickpeas, seitan and mycoprotein (Quorn®). Easy meals could be as follows:

  • dahl/tofu curry and brown rice with a side salad or steamed vegetables
  • pilaf rice with lentils, potatoes and vegetables
  • bean soup with lots of vegetables and whole grain bread or chapatti
  • homemade baked falafel with hummus and salad

It is best to avoid fried foods and foods high in refined sugar as these will not contain healthy nutrients and do not benefit overall health. Fresh fruit makes a great dessert and can be eaten with soya yogurt and topped with a small amount of dark chocolate.

Focusing on a healthy plant-based diet will support gut health, avoid constipation, keep you fuller for longer, reduce inflammation and set you up for healthy eating beyond the month of Ramadan.

After the evening meal, try and incorporate some form of physical activity like a short walk or some stretching exercises like yoga. This will help regulate blood sugar and make up for times during the day when you do not feel like moving.

Fasting in older adults

Fasting can become increasingly challenging as we get older. If you are already of lower body weight, then you may lose too much weight, which can have a negative impact on bone health and the immune system. Older adults tend to have lower muscle mass and weight loss from fasting can lead to further muscle loss. Incorporating some simple muscle strengthening exercises can be useful. The Eight to 10 exercises from the image below can be selected so that each major muscle group is exercised. Exercises can be completed using machines, free weights, elastic bands, or body weight.

Exercises while fasting Circulation. 2024 Jan 16;149(3):e217-e231. doi: 10.1161/CIR.0000000000001189

Use of prescription medications is also more common as we age, and some need to be taken with food or may exacerbate the risk of dehydration and other electrolyte imbalances in the blood. If you have diabetes, regulating blood sugar can be problematic, with risks of low blood sugar. Although people with medical conditions are not required to fast, some may still want to try. This should ideally be done after consultation with your healthcare provider. Further useful information about fasting with diabetes can be found here.

Fasting in children

According to the muslim faith, children should start fasting during Ramadan once they have reached puberty. If a child wants to fast then this should be planned with their parents and it is sensible to make the school aware. Children may be more prone to some of the side-effects of fasting such as dehydration, low energy and fatigue and difficulty concentrating. Focusing on healthy foods, including prioritising plant sources of protein and including plenty of healthy fats, such as nut butters, olive oil and avocado, is a sensible approach.

Pregnancy, lactation and menstruation

Fasting during these phases of a woman’s life can be challenging and it is permissible not to fast. Many women still continue to fast during their monthly period. Focussing on nourishing and iron-rich foods such as dates, beans, tofu and dark leafy greens is useful. If pregnant, eat as much as you can at suhoor, because this is the meal which will keep you going during the day. If you are pregnant and feel very hungry, or extremely thirsty, weak, dizzy, or are worried about your baby, it’s best to break your fast rather than risk your and baby’s life.

Healthy food swaps

It is best to concentrate on foods that promote health and contain high levels of essential nutrients. Sensible swaps would be choosing beans, lentils or tofu rather than meat. Using whole grains rather than refined grains. These can include barley, bulgur, farro, millet, quinoa, black, red or brown rice, wholemeal breads and pasta. Swap out candy and traditional sweets for whole fresh or dried fruit. Snack on unsalted nuts, seeds and popcorn rather than crisps and crackers. Drink mainly water and non-caffeinated teas rather than sodas. Avoid alcohol.