Ramadan during COVID-19? Healthy meal plans, high fiber and freezing are key, say nutrition experts

23 Apr 2020 --- Muslims around the world are entering the holy month of Ramadan, prompting fasting during daylight hours. While Ramadan usually sees communities come together to break fast and pray together, this year will look quite different, with COVID-19 presenting new challenges. Nonetheless, nutritionists are providing useful tips to help fasters remain healthy, with wholegrains emerging as a key focus area. Meanwhile, new research from Nestlé Health Science (NHSc) details how Type 2 diabetes patients can manage blood sugar levels while fasting.

“For many Muslims, observing Ramadan is going to be very different this year. The usual gatherings of family and friends from outside your household to break the fast in the evening, as well as the traditional night time prayers at the mosque, will unfortunately not be possible. The UK lockdown will mean several changes to how we shop for and eat foods and drinks throughout the month, but, as always, it's important to eat and drink well during Ramadan, fueling your body with all the key nutrients it needs – without overindulging,” says Bridget Benelam, Nutrition Communications Manager of the British Nutrition Foundation (BNF), who will be observing the fast.

As part of quarantine measures to curb the coronavirus spread, UK consumers are also being encouraged to shop for food as infrequently as possible, underscoring the importance of planning what ingredients are needed for early morning suhoor and evening iftar. BNF notes that planning ahead can also help reduce food waste, which is heavily discouraged in Islam. 

“With smaller numbers of people likely to be eating together this year, it may be easy to overcook or overbuy, but having a meal plan will help you to only buy what you need. If you are used to cooking for larger groups, you could always freeze extra portions, or take the opportunity to offer any extra food you make to friends or neighbors while following social distancing advice,” advises BNF. 

Making the most of the eating window
With many Muslims expecting to fast for up to 20 hours a day, it is critical that the food eaten during the nighttime hours packs a nutritional punch. “How you eat during the non-fasting window significantly impacts how you feel throughout your fast. Ensuring you are eating nutritionally balanced foods at suhoor, iftar and post-iftar will help you feel more energized throughout your fast,” Nazima Qureshi, Registered Dietitian at The Healthy Muslims, tells NutritionInsight.

Dates are a traditional food to break the fast, and contain fiber and natural sugars, as well as minerals including potassium, copper and manganese. Meanwhile, BNF notes that in many South Asian cultures, fresh fruit is a traditional way to break the fast. This provides fiber, natural sugars, fluids and some vitamins and minerals. BNF also proposes dried fruit, such as apricots, figs, raisins or prunes, as another alternative to dates.

After breaking fast, BFN recommends opting for starchy foods for energy, choosing high fiber or wholegrain varieties where possible, as these can help keep people feeling fuller. This is echoed by Qureshi, who notes that focusing on protein, healthy fats and wholegrain carbohydrates will help provide the body with energy throughout the day. She adds that supplements should be recommended on a personal basis rather than a requirement for everyone.

People with diabetes will be facing heightened challenges over Ramadan.Parallels with intermittent fasting
Some elements of Ramadan eating patterns are similar to intermittent fasting (IF), which has gained increasing interest in recent years. “There is limited research on religious fasting, but research has been conducted for IF, which is a bit different as water and supplements are allowed. Based on this, there are some health benefits such as weight loss, improvement in cardiovascular health markers, improvement in inflammatory markers, cognitive benefits, and improved blood sugar levels. I would love to see more high-quality research done on religious fasting in the coming years,” states Qureshi.

Anne de la Hunty, Senior Nutrition Scientist at BFN, adds that IF can be an effective way to lose weight if it results in an overall reduction in the number of calories consumed each day. “Although some animal studies have suggested that restricting eating to a narrower time frame without reducing overall calorie intake can lead to weight loss, this has not yet been shown in human studies.”

Managing diabetes
NHSc is highlighting that people with diabetes will be facing heightened challenges over Ramadan as they must manage blood sugar levels. During fasting hours, metabolism adapts to the lack of food and reacts to maintain the constant energy and glucose levels in the body by using energy stored in the liver and fat tissue. Eventually, this can affect glucose levels in people with diabetes. Some people’s bodies may respond with hypo- or hyperglycemia, with blood sugar levels dropping or spiking too high.

However, a recent study in Malaysia found that NHSc’s diabetes-specific nutritional formula can aid blood sugar levels during Ramadan. Called Nutren Untuk Diabetik in Malaysia, it is a diabetes-specific formula of 30 essential vitamins and minerals, with low glycemic index and made with whey and casein protein. 

The researchers examined a group of 38 participants with diabetes who were following a structured nutritional program, which included Nutren Untuk Diabetik being taken as part of suhoor and/or as a pre-bedtime snack. In comparison to the 25 fasting patients who did not follow any advice on meal composition during Ramadan, the Nutren Untuk Diabetik group had lower pre-dawn and pre-bedtime blood sugar levels and meaningfully better fasting blood glucose.

By Katherine Durrell