From fasting with diabetes to “Veganadan”: How does one stay healthy during Ramadan?

04 Jun 2019 --- For nearly 1,500 years, Muslims have observed the holy month of Ramadan, and the spiritual period of reflection comes to an end today, marked by Eid al-Fitr. A core practice of this period is fasting, which is one of the five pillars of the Islamic Faith. Following the pre-dawn meal suhoor, those practicing Ramadan fast from sunrise to sunset, where the fast is broken with the rich and festive iftar meal. The overhaul of daily routines that is commonplace during the month of Ramadan has led proponents to consider the health implications of the religious observance, and knowledge has disseminated among the global Islamic community on how best to ensure optimal nutrition, energy and health during this holy time.

The significance of breaking the fast as a family, and with friends, means that food takes on a new level of significance during Ramadan. Some food items are also embedded in culture, and Muslims may choose to break their fast with these to follow the teachings of Muhammed.

“Dates have a significance during Ramadan as the Prophet Muhammad, peace be upon him, encouraged Muslims to break their fasts with dates. If dates are not available, then with water, milk, or yogurt. While not an absolute requirement, Muslims aspire to follow the teachings of Muhammad,” a spokesperson from the Islamic Food and Nutrition Council of America, tells NutritionInsight.

Dates have a significance during Ramadan as the Prophet Muhammad encouraged Muslims to break their fasts with dates.An increasingly globalized world means that what is on the iftar menu can vary hugely between geographical locations. “Muslims from around the world have different culinary traditions with which they break their fasts – soups, tea, fried pastries, etc. – but dates factor into almost all Muslim cultures during Ramadan. Wherever Muslims go, they may bring their traditional cuisines with them, but often there is a melding with local flavors – biryani or fufu are just as likely to be on the evening menu as pizza or hamburgers,” they add.

Despite the range of foods that may grace the table during iftar celebrations, long days and short nights mean that it can be difficult to eat balanced meals, the spokesperson notes. To combat this, the use of nutritional supplements may increase, as worshippers aim to achieve adequate nutrition while not over-eating. 

Meanwhile, Guardian contributor, Remona Aly, highlights that iftar meals are classically very meat-centric and that halal butchers often see a business boost during Ramadan. However, mirroring the general rise in plant-based eating globally, more and more Muslims are turning to vegan options. Looking toward Eid, Aly notes that vegan cakes, vegetable and bean curries and fresh fruits sprinkled with chopped dates may be popular options for vegan Muslims.

Staying healthy during the fast
Some have revered the act of fasting in the weight management space, however, many Muslims find that they gain weight during the Holy month, often due to overindulgence during iftar and lower levels of physical activity. However, the World Health Organization (WHO) notes in its dietary recommendations for the month of Ramadan that the Holy month is a time to practice “self-control, self-discipline, sacrifice and empathy for those less fortunate.” It encourages worshipers to try to maintain these practices even outside of fasting hours.

There are some “tips and tricks” afforded to those who are fasting, in a bid to ensure a health Holy month. Reaching adequate hydration levels, for example, can be a challenge – especially when Ramadan falls on long and hot days. 

The WHO recommends that water intake can be increased by eating hydrating foods. Adding watermelon, for example, to the suhoor meal, or green salad which cucumber and tomato in the iftar meal. Avoiding caffeinated drinks can also be a good idea to ensure ideal hydration. 

Could fasting hold benefits for diabetics?
According to Islamic teachings, the elderly, pregnant, or those with illnesses requiring regular medication – such as diabetes – can be exempted from fasting on medical grounds. People with Type 1 diabetes are generally advised not to fast, according to the WHO. People with Type 2 diabetes and hypertension who have their conditions under control, either through diet or medication, may be able to fast. However, they are advised to refer to their doctor or dietitian for the right advice based on their situation. Fasting is revered for its weight management benefits, as well as its spiritual significance.

However, a recent study has highlighted the potential health benefits that can come from fasting from dawn to sunset for 30 days, noting that it could even offer a potential new treatment approach for obesity-related conditions, including diabetes, metabolic syndrome and non-alcoholic fatty liver disease (NAFLD). Presented at Digestive Disease Week (DDW) 2019, the study found that the fasting model increased levels of proteins that play a crucial role in improving insulin resistance and protecting against the risks from a high-fat, high-sugar diet.

The pilot study included 14 healthy individuals who fasted (no food or drink) approximately 15 hours a day from dawn to sunset for 30 days during Ramadan. Researchers collected blood samples from the individuals before beginning the religious fast, again at the fourth week of fasting, and then one-week post-fasting. Resulting blood samples showed increased levels of tropomyosin (TPM) 1, 3 and 4, proteins that have a role in maintaining healthy cells and cell repairs important to the body’s response to insulin.

The findings follow a string of studies that have identified positive health outcomes associated with fasting. Earlier this year, a US study found that fasting intermittently (IF) may reprogram a variety of cellular responses and result in a range of health benefits in mice, while planned intermittent fasting could help to reverse Type 2 diabetes, doctors writing in the journal BMJ Case Reports found last year.

At a time where consumers are generally more health-aware, considerations around health and nutrition during Ramadan will likely continue to increase. Yet most importantly, “health benefits are an added benefit during this time [Ramadan], as the main focus of Muslims during Ramadan is their gratitude to God for all that has been provided for them – their food, health and family,” the spokesperson concludes. 

By Laxmi Haigh