Fasting during the month of Ramadan is an obligatory practice for healthy adult Muslims. Ramadan diurnal intermittent fasting (RDIF) is regarded as a unique form of intermittent fasting involving consistent diurnal abstinence from food and drink for a fasting period that ranges, on average, between 8 and 18 hours (variation results from changes in season and altitude Islamic calendar follows the lunar system) over 29–30 days.
Fasting during Ramadan. Image Credit: Fevziie/Shutterstock.com
While religious fasts are religiously and spiritually motivated, they have the potential to profoundly affect physical health. Growing evidence supports the health benefits of intermittent fasting on health, disease, and aging. The benefits extend beyond weight loss and a reduction in free radical production which is linked to cancer and aging. Fasting can elicit adaptive, evolutionarily conserved, cellular responses that are integrated within and between organs to improve stress resistance, glucose regulation, and inflammation suppression.
Given that fasting during Ramadan is a form of IF and time-restricted feeding (TRF) pattern that occurs consistently throughout the world, contemporary interest in the impact on glucose homeostasis and glucoregulatory mechanisms has grown. When practiced healthily, fasting can increase metabolic health through measures such as decreasing weight, visceral fat, triglycerides, total plasma cholesterol, fasting insulin, and glucose levels. Other studies have also evidenced increases in brain-derived neurotrophic factor (BDNF), a protein associated with improved and mental health outcomes and cognitive capabilities. However, current evidence is too limited to draw this conclusion.
Alter your dietary patterns: the energy balance, macronutrients, and micronutrients
Due to the reliance on consistent, recurrent periods of feeding and hydration, fasting is not without risk. Potential risks of Ramadan, and indeed all types of intermittent fasting include weakness, tiredness, dizziness, hypoglycemia, insomnia, hypotension, nausea, headache/migraines, feeling faint or fainting, indigestion, malnutrition, and excessive hunger. There is also a risk for potential adverse effects on reproductive and bone health, particularly in women.
Moreover, compensatory overeating is a notable risk that may be pronounced in those with higher baseline disinhibition or emotional dysregulation which could fuel binge eating after the restriction period has ended. Paradoxically, this effect can worsen physiological and metabolic status, increasing visceral fat, and negatively impacting metabolic health. Mental health impacts are also a consideration; it can cause neurocognitive disorders and eating disorders.
It is important to apply the same fundamental nutrition principles to intermittent fasting as to other healthy eating plans. As individuals will undergo extended periods without food and liquid these principles may be even more critical. At the beginning and breaking of the fast, these approaches should be kept in mind:
- Consume minimally processed foods
- Eat a balance of lean protein, vegetables, fruits, complex carbs, and healthy fats
- Base meals on plant products (fresh vegetables, legumes, olives, fruits, seeds, and cereal (mainly whole grains) and moderate to low amounts of fish, meat and dairy products, added sugars i.e. based on the Mediterranean diet which has been linked to a major positive impact on the composition of gut microbiota, and overall health
- Eat the pre-dawn meal as well as the [ost-fast meal to minimize the risk of fatigue and dehydration during the day
- Avoid overeating during the post-fast meal
Adopting these behaviors will minimize the risk of hypoglycemia, hyperglycemia, and dehydration. Indeed, Ramadan is known as the month of generosity and socializing which may lead to excessive intake of food and drinks during the evening/night. Avoiding overconsumption of micronutrient-poor foods such as simple carbohydrates, high-fat and high-sugar foods e.g. deep-fried foods, desserts, sweetened carbonated beverages could increase the risk of developing hyperglycemia and subsequent metabolic effects such as diabetes and lipid disorders such as high cholesterol which can increase the risk of cardiovascular disease.
By contrast, underconsumption of food and water alongside, hard labor (particularly in the summer, where the heat exacerbates water loss through sweat), exercise, and poor sleep can lead to weight loss micronutrient and electrolyte loss. To fast healthily, it is important to eat a balanced meal when breaking and beginning the fast, to ensure the digestive process does not affect sleep as well as:
- Avoid the heat in the summer by staying indoors at peak sunlight hours/heat (if your occupation allows for this)
- Avoid excessive exercise; while an essential component of a healthy lifestyle, man observes chose to exercise close to the breaking of the fast or immediately after to avoid fatigue, muscle loss, and dehydration and improve performance, and muscle development
- Be mindful of the consumption of high fat, sugar, and salt foods and beverages, opting for slow-release carbohydrates, lean proteins, and polyunsaturated fats
- Eat slowly when breaking the fast and start with fluids and low-fat, water-rich foods e.g. yogurt, fruit, vegetables, soups, and stews
Since diabetes is a metabolic disorder involving the risks of hypo- and hyperglycemia, it is considered a risk state for people fasting during Ramadan, as are other metabolic conditions. For these individuals, fasting should not be attempted unless consulting doctors' advice.
Altering your habits: sleep, stress, and more
Ramadan is associated with several changes to behavior and general activity, sleep patterns, and mealtimes, and associated daytime drowsiness. Eating late at night, as is the case during fasting in the summertime in the Northern hemisphere, may result in circadian desynchronization. This is a disruption of the synchronization between sleep-wake rhythms and the circadian rhythms which consequently disrupts regular sleep patterns. This compounds the risk of worsened energy levels during daytime fasting due to the absence of food intake and altered metabolic responses.
As such, sleeping and eating schedule changes have been found to reduce cortisol levels in the morning increase levels in the evening. There are also reports of shifts in rhythms of body temperature and melatonin which suggest major chronobiological and behavioral changes during Ramadan.
To decrease the risk of these events it is important to maintain good sleep hygiene alongside mindful consumption of food before beginning, and when breaking the fast. To reduce the risk of stress, it is important to address any potential triggers; this can be through minimizing your non-obligatory commitments, avoiding strenuous exercise in the sun, and mindfulness. For those with underlying health conditions, it is important to consult the advice of healthcare professionals.
Fasting healthily in Ramadan is possible if the correct nutrition and lifestyle adjustments are made. These effects are beneficial outside of the religious period, with benefits including positive metabolic changes associated with the positive effects of incidence and prognosis of a range of metabolic diseases which. Indeed, the advantages of religious fasting have been explored in several studies including Buddhist, Christian, or Muslim populations. The outcomes of these studies indicate that religious fasting has beneficial effects on body weight and glycemia, cardiometabolic risk markers, and oxidative stress parameters.
References:
- Hassanein M, Al-Arouj M, Hamdy O, et al. Diabetes Res Clin Pract. 2017;126:303-316. doi: 10.1016/j.diabres.2017.03.003.
- Beshyah SA, Ali KF, Hafidh K, et al. Diabetes Res Clin Pract. 2021;172:108593. doi: 10.1016/j.diabres.2020.108593.
- Alabbood MH, Ho KW, Simons MR. Diabetes Metab Syndr. 2017;11(1):83-87. doi: 10.1016/j.dsx.2016.06.028.
- Persynaki A, Karras S, Pichard C. Nutrition. 2017;35:14-20. doi: 10.1016/j.nut.2016.10.005.
- Tahapary DL, Astrella C, Kristanti M, et al. Diabetes Metab Syndr. 2020;14(5):1559-1570. doi: 10.1016/j.dsx.2020.07.033.
Further Reading
Time-restricted eating shows promising weight and metabolic benefits, study reveals