Ramadan Health Guide
Page 1 ForewordPage 2 IntroductionPage 4 The physiological changes that occur during a fastPage 5 Foods that benefit and foods that harmPage 6 Tips for the healthcare
FASTING is complete abstinence from food and drink between dawn and dusk. All those who are ill or frail, pregnant or menstruating women, breastfeeding mothers and travelers are exempted. They are required to make up the number of days missed at a later date or give a fixed sum to charity.
National Director, Equality and Human RightsDepartment of Health
Introduction
Health is the key to happiness, and what we consume directly affects our health. Islam encourages Muslims to ensure that they are mindful of their health. The blessed Prophet said: “Take advantage of the good health before illnesses afflict you”. He also encouraged Muslims to try their best to take up a healthy living lifestyle that includes a balanced diet, regular mental and physical exercise and a balance between material and spiritual needs. The Health Survey for England 2004 (Department of Health, 2005) has shown poor health and lifestyle choices of the Asian community in general and Muslim community in particular. Compared with the 24% of men in the general population who smoked cigarettes, higher levels of cigarette smoking were reported by Bangladeshi men (40%). South Asian men and women had the highest rates of diabetes. Pakistanis and Bangladeshis were up to five times more likely than the general population to have diabetes, and Indian men and women were up to three times as likely. Some 33% of Pakistani men and women eat the recommended five or more portions of fruit and vegetables a day, compared with 28% of Bangladeshi men and women. The month of Ramadan is a great opportunity to focus on bringing back a balanced and healthy lifestyle in your life. Through fasting you begin to learn how to manage your eating habits, how to improve self-control and discipline. This month requires you to give the stomach a break, and by doing so you are able to break down and expel the accumulated toxins from your body.This booklet is aimed at helping you understand the health issues related to fasting, so that you are able to make more informed choices, minimize complications and maximize the benefit of your fast. The booklet will: guide you through physiological changes that occur when you are fasting; give examples of beneficial and harmful foods during fasting; discuss potential medical problems and remedies; suggest a diet plan; and respond to the most frequently asked questions about fasting in general and medical issues in particular. The booklet also contains a section for doctors and medical professionals, to enable them to provide more informed services. The booklet has been put together by medical experts, Islamic scholars and researchers, who have stayed within the spirit of Islam, while ensuring the medical advice and suggestions are scientific and culturally sensitive. For many people, the key question regarding fasting is whether it is good or bad for your health. The answer to this requires a quick overview of what happens inside the body during fasting: the physiology of fasting. The changes that occur in the body in response to fasting depend on the length of the continuous fast. Technically the body enters into a fasting state eight hours or so after the last meal, 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. Small quantities of glucose are also ‘manufactured’ through other mechanisms in the liver. Only with a prolonged fast of many days to weeks does the body eventually turn to protein for energy. This is the technical description of what is commonly known as ‘starvation’, and it is clearly unhealthy. It involves protein being released from the breakdown of muscle, which is why people who starve look emaciated and become very weak.
As the Ramadan fast only extends from dawn till dusk, there is ample opportunity to replenish energy stores at pre-dawn and dusk meals. This provides a progressive, gentle transition from using glucose to fat as the main source of energy, and prevents the breakdown of muscle for protein. The use of fat for energy aids weight loss, preserving the muscles, and in the long run reduces your cholesterol levels. In addition, weight loss results in better control of diabetes and reduces blood pressure. A detoxification process also seems to occur, as any toxins stored in the body’s fat are dissolved and removed from the body. After a few days of the fast, higher levels of certain hormones appear in the blood (endorphins), resulting in a better level of alertness and an overall feeling of general mental well being.
Balanced food and fluid intake is important between fasts. The kidney is very efficient at maintaining the body’s water and salts, such as sodium and potassium. However, these can be lost through sweating. To prevent muscle breakdown, meals must contain adequate levels of ‘energy food’, such as carbohydrates and some fat. Hence, a balanced diet with adequate quantities of nutrients, salts and water is vital.
The physiological changes that occur during a fast6
The fasts of Ramadan can improve a person’s health, but – if the correct diet is not followed – can possibly worsen it! The deciding factor is not the fast itself, but rather what is consumed in the non-fasting hours. To fully benefit from fasting, a person should spare a great deal of thought to the type and quantity of food they will indulge in through the blessed month. As mentioned in the section on spirituality (see pages 12–13), overeating cannot only harm the body but it is thought also to interfere with a person’s spiritual growth during the month. A diet that has less than a normal amount of food but is sufficiently balanced will keep a person healthy and active during the month of Ramadan.The diet should be simple and not differ too much from one’s normal everyday diet. It should contain foods from all the major food groups, as shown below.
Fruit and vegetables Bread, other cereals and potatoes Milk and Meat, fish and dairy foods alternatives Foods containing fat Foods containing sugar 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. Fibre-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 Foods to avoid are the heavily-processed, fast-burning foods that contain refined carbohydrates in the form of sugar, white flour, etc., as well as, of course, too much fatty food (eg cakes, biscuits, chocolates and sweets, such as Indian Mithai). It may also be worth avoiding the caffeine content in drinks such as tea, coffee and cola. (Caffeine is a diuretic and stimulates faster water loss through urination.)
Foods to avoid Healthy /Alternative foods
Deep-fried foods, eg pakoras, samosas, fried dumplings. Whole grains, eg chickpeas (plain, or with potato in yogurt with different Indian spices), samosas baked instead of fried, and boiled dumplings
High-sugar/high-fat foods, eg Indian sweets such as Ghulab Jamun, Rasgulla, Balushahi, Baklawa Milk-based sweets and puddings, eg Rasmalai, Barfee
High-fat cooked foods, eg parathas, oily curries, greasy pastries Alternate with chapattis made without oil, and baked or grilled meat and chicken. Try to make pastry at home and use a single layer
Cooking methods to avoid / Alternative cooking methods
Deep frying Shallow frying – usually there is very little difference in taste
Frying Grilling or baking is healthier and helps retain the taste and original flavour of the food, especially chicken and fish
Curries with excessive oil Start with measuring the oil used in curry and try to bring the oil content down gradually, eg reducing five tablespoons to four. This is a good way of reducing oil without noticing much difference in the taste. A useful tip is to use more onions and tomatoes in the bulk of the curry 10Suhoor, the pre-dawn meal, should be a wholesome, moderate meal that is filling and provides enough energy for many hours. It is therefore particularly important to include slowly-digesting foods in the suhoor.
Iftar is the meal which breaks the day’s fast. This meal could include dates, following the Prophetic traditions.Dates will provide a refreshing burst of much-needed energy. Fruit juices will also have a similar, revitalizing effect. The meal should remain a meal and not become a feast! Try to minimise the rich, special dishes that traditionally celebrate the fast and keep to the advice included in the table opposite. Many of the foods which are mentioned and encouraged in this booklet are in the Holy Qur’an, and the Sunnah (the Prophetic traditions) also correspond to modern guidelines on a healthy diet and will help to maintain balanced, healthy meals in Ramadan. The most commonly consumed foods by Prophet Mohammed (peace be upon him) were milk, dates, lamb/mutton and oats. Healthy foods mentioned in the Holy Qur’an are fruit and vegetables, such as olives, onions, cucumber, figs, dates, grapes as well as pulses such as lentils. The encouragement of fish can be seen in the fact that Islamic law spares fish from any specific slaughter requirements, making it easy to incorporate fish in a meal.
Tips for healthcare professionals
Guidance notes on the Muslim fast during RamadanThe Muslim fast during the month of Ramadan provides an opportunity for health professionals to promote health improvement among Muslims by offering lifestyle advice on topics such as diet and smoking cessation.It is important to recognise that the Muslim community, like any other, is diverse. This results in differences of perception and practice among Muslim patients. The start of Ramadan advances 11 days every year as it is based on a lunar calendar and will sometimes fall in the summer months, resulting in a more onerous fast than when it is in the winter months. In 2007 Ramadan starts in mid-September. Fasting during Ramadan is intended as a discipline and requires abstinence from anything taken orally during the hours of daylight, each consecutive day for a month. This includes water and smoking. Bleeding will also preclude the fast for that day. Fasting is a requirement after puberty for all able-bodied Muslims of sound mind and good health, but there are concessions for those who are on a journey or who are ill, as well as for women during menstruation, pregnancy or breastfeeding. The concessions range from a complete exemption from fasting, for example for insulin-dependent diabetics, to a requirement to make up the fast at a later date in the case of those who are traveling or who have their periods. A charitable contribution as compensation can serve as an alternative to keeping the fast later. Since the month of Ramadan is an important time across the community, many patients will endeavor to keep their fasts during this time. With some conditions, this can clearly be harmful. The concessions exist specifically to ensure that people do not fast where it would be detrimental to their health, and this is very reasonable advice to give to patients. For people with acute illnesses, fasts can be broken and made up later.For people with many chronic conditions (eg ophthalmic, dermatological, neurological), fasting may have no impact and can continue as normal. If oral medication is required, fasting can be facilitated by reducing dosing to once or twice daily. Topical medication, including patches, is acceptable, but injections are not as they may draw blood. Fasting itself may have a physiological impact on diseases affecting the cardiovascular, renal and gastrointestinal systems, such as hypertension, renal impairment and peptic ulcers. Although fasting is possible in many of these circumstances, it may not be well tolerated physiologically, particularly in older patients – and these may be the very patients who are most adamant that they wish to perform their fasts. In some cases where a chronic illness has taken a long while to stabilise and maintain, adjusting medication around the hours of fasting may simply be impractical and potentially harmful. Nutrition and hydration are paramount and, while fasting is permissible, it is medically better for the mother to utilise the concession and compensate for or make up the missed fasts. Physical examinations, including rectal and vaginal examination do not invalidate the fast. Clinical investigations such as blood tests, or those requiring intravenous access or oral contrast, would preclude the fast during those particular days. Where these are elective outpatient investigations, many patients may prefer to reschedule them outside Ramadan. Urgent investigations should clearly not be delayed.
Each situation needs to be judged on its own merits, in the context of the patient’s observance of Ramadan. A comprehensive guide is not possible, but the examples above serve to illustrate that there is Islamic guidance to ensure that fasting is not prejudicial to a patient’s health.
