10 Tips for Healthy and Safe Ramadan Fasting

Sunday, May 5 marked the beginning of this year’s Ramadan and the start of Ramadan fasting from dawn to dusk! Ramadan fasting has been associated with many health benefits, including weight loss and lowered stress and inflammation. However, the daily fasting schedule of Ramadan does run counter to daily circadian rhythms and has been associated with delayed bedtime and lower quality sleep. To help you maintain your health during this time if you are participating in Ramadan fasting, we’ve interviewed experts and collected some healthy tips for daytime fasting.

More than a billion people will likely participate in Ramadan fasting this month. Those who join in this daily fasting from dawn to sunset may enjoy deeper groundedness and social connectedness as families and friends break daily fasts together in celebration of their faith. It may be because of both this social nature of Ramadan fasting as well as the inherent health benefits of metabolic switching that Ramadan fasting helps many people lose weight and lower stress and inflammation in their bodies.

“The month of Ramadan generally lasts 28–30 days. Most Muslims eat two meals, before sunrise (known as Sehar) and after sunset (known as Iftar). Fasting is said to cultivate the spirit of sacrifice and teaches Muslims moral and self-discipline and sympathy for the poor.” – Review of diabetes management and guidelines during Ramadan

There are a greater number of research studies investigating the health impacts of Ramadan fasting than for any other form of religious fasting, says Richard Bloomer, Dean of the School of Health Studies at the University of Memphis. Most of these studies show that the benefits of Ramadan fasting intersect with the observed benefits of intermittent fasting more broadly. Bloomer’s research interests include exercise physiology, metabolism and intermittent fasting.

“These studies reveal health benefits for most individuals,” Bloomer said. “Ramadan fasting is a form of intermittent fasting. It just so happens that people practicing this form of fasting eat in the morning before sunrise and again 12 to 15 hours later with one or two meals before bedtime.”

In one 2012 study published in Nutrition Research investigating the impacts of Ramadan fasting for 21 healthy men and 29 healthy women, researchers found a significant lowering of proinflammatory cytokines including IL-6 and tumor necrosis factor alpha, leukocytes (immune cells), blood pressure, body weight and body fat percentage during Ramadan. In small scale studies, Ramadan fasting has also been associated with lowered fasting blood glucose and insulin levels as well as improvements in insulin sensitivity connected to weight loss. These benefits are more likely to occur in overweight individuals. On the other hand, studies have reported mixed results or no changes in glycemic control among healthy/lean men and women practicing Ramadan fasting.

In summary, the health impacts of Ramadan fasting generally align with the beneficial metabolic changes that come with abstaining from nutrients for an extended period of time each day. But daytime fasting can change circadian rhythms and sleep patterns in a less positive and even detrimental way. Many people who participate in Ramadan fasting report increased daytime sleepiness and decreased performance.

Disrupted sleep patterns, daytime sleepiness and avoidance of daytime physical activity may lead to negative health outcomes including reduced glycemic control, sugar cravings and loss of lean or fat-free mass. People who lose weight during Ramadan fasting (where significant weight loss is reported more often for men than for women) often regain this weight shortly after Ramadan. A rebound in body fat percentage after Ramadan has also been observed, which could be attributed to loss of lean or fat-free mass during Ramadan.

Luckily, there are things you can do to minimize the circadian rhythm disruptions and maximize the health benefits associated with Ramadan fasting. For example, keep moving and exercising during the day over Ramadan to preserve your lean muscle mass and to improve your sleep. Learn more with our daytime fasting tips below!

Tips for Healthy and Safe Ramadan Daytime Fasting

1. Hydrate.

Most people practice Ramadan fasting without water or other liquids during the fasting window. While fasting without water can be dangerous, you can prepare for a healthy daytime fast by drinking as much or more water than you feel you need before dawn and after sunset.

Try to hydrate as much as possible before dawn and at sunset. Trying to “make up” your daily water intake by drinking lots of water before bedtime might make you wake up throughout the night to go to the bathroom, disrupting your sleep.

If possible, avoid dehydrating drinks including coffee in the evenings and sugary drinks.

2. Get enough sleep!

Compared to individuals not fasting, people practicing Ramadan fasting have reported greater alertness in the early afternoons (when most of us start to feel groggy after lunch!), but also in the late evenings and after midnight. Ramadan fasting appears to significantly reduce levels of melatonin, the “sleep hormone”, in the late evenings.

Circadian disruptions that happen during Ramadan may be attributable to nighttime eating and lowered physical activity levels or napping during the day. Late-night social interaction may be an enjoyable part of Ramadan for many people. But late-night events, media consumption and snacking may be something you should minimize at least most nights of the week during Ramadan. These behaviors don’t help you get the healthy sleep that will make Ramadan fasting a healthy, more physically and mentally enjoyable experience.

To improve your sleep during Ramadan:

• Move during the day. Try to get at least 30 minutes of light to moderate physical activity, for example.
• Get sunlight early in the day.
• Minimize caffeine and simple carbohydrates in the evenings.

3. Eat like a king at Suhoor, a prince at Iftar and a pauper before bed.

You should absolutely enjoy community meals and social time eating and drinking together during Ramadan. However, try to stop eating within two hours of when you plan to go to sleep. This will help you sleep better but also conserve better glycemic (blood sugar) control. Getting enough sleep helps with blood sugar control, while sleep loss and shift-work are associated with more low and high blood sugar events, diabetes and other metabolic dysfunctions.

High fat meals close to bedtime in particular can disturb sleep as fat takes longer to digest and can cause gastric upset. Simple carbohydrate intake and consumption of sugar-sweetened beverages are also associated with poor sleep quality.

Resource: Effect of Diet on Sleep Quality

4. Keep moving during the day.

It’s healthy and generally considered to be safe to exercise daily during Ramadan, as long as you don’t feel dehydrated. Based on a report in Diabetes Care on recommendations for management of diabetes during Ramadan, even people with type 2 diabetes or prediabetes are encouraged to maintain normal levels of physical activity while watching for signs of hypoglycemia*. Getting physical activity, even exercise “snacking” throughout the day, can help you preserve muscle mass if you lose weight during Ramadan. Daytime exercise can also help improve your sleep quality. You may want to exercise before Iftar so that you can drink water shortly afterwards.

*Talk to your physician if you have diabetes or prediabetes, as you may be at higher risk of hypoglycemia or low blood sugar during or after fasted exercise. Diabetics taking medications to control their blood sugar should not participate in Ramadan fasting without consulting a physician.

“We know that if you are eating less, losing weight and not exercising, you are going to lose more lean mass or muscle mass than you have to,” said Amanda Salis, a research fellow at the University of Sydney’s Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders. Salis has participated in Ramadan fasting herself with her husband who is from Turkey. While she was initially nervous about her energy levels during the fast, she found that she actually felt great and had plenty of energy to engage in exercise during the day.

“Fasted exercise feels great to me – it gives you a little burst of energy as it releases your muscle and liver energy stores,” Salis said. “I convinced my husband to keep exercising during Ramadan, as well!”

In previous experimental studies of intermittent fasting, people practicing alternate day fasting chose to exercise on fasted days as often as on feeding days. Many athletes also participate in Ramadan fasting while engaging in high-level performance and competition.

“As long as people are eating enough during the allowed daily feeding period [of Ramadan], they shouldn’t have any concerns about whether they will have enough fuel in the tank, so to speak, to engage in physical activity,” Bloomer said. “If they are eating adequate carbohydrate, they are going to have adequate glycogen* stores for normal performance. It’s just a matter of dealing with issues of hunger. But these typically go away within a few hours [of fasting], and then people actually tend to feel better during the day.”

*Glycogen is stored sugar in your muscles and liver.

However, if you live in a region of the world where it is getting very hot during the day during Ramadan, you may want to stick to light to moderate physical activity and perform this activity indoors to avoid heat exhaustion and dehydration. Bloomer also suggests exercising in the evenings before Iftar so that you can rehydrate shortly afterwards.  

5. Try not to overeat.

As long as you aren’t underweight or at risk of falling underweight, avoid trying to “make up” calories or eating as if you were needing to compensate for your fasting window. Eating normal meal sizes will help you feel more comfortable, get better sleep and even lose weight during Ramadan. For example, you probably shouldn’t be eating twice as much as you normally would at dinner or after dinner. This can cause indigestion and heartburn, particularly in the evenings.

“I suggest that people don’t deviate too much from their normal eating patterns,” Bloomer said. “People often have the idea that they have to dump in loads of food during their eating window to achieve their calorie allotment for the day. However, eating a bolus of 1,000 or more calories in the late evenings, especially from a meal or snack rich in dietary fat, can majorly disrupt your sleep. I recommend eating normal sized meals [in the morning and evenings], perhaps in combination with a meal replacement beverage or protein shake if you are an athlete and you want to get in extra calories to avoid muscle mass loss.”

Eat mindfully and pause during and after Iftar to tune into your hunger and satiety levels. You might find that your eyes are actually bigger than your stomach during this daily break-fast. Eating smaller meals will also help prevent overly elevated blood sugar levels after Iftar.

6. Track your blood sugar.

Test your blood glucose using a blood glucose meter such as Keto-Mojo during your fasting and after eating, and tell your doctor if your levels fall outside of a healthy range.

“During Ramadan fasting, glucose [blood sugar] homeostasis is maintained by meals taken during night time before dawn and by liver glycogen stores. Changes in serum lipids are variable and depend on the quality and quantity of food intake, physical activity and exercise, and changes in body weight. Compliant, well-controlled type II diabetics may observe Ramadan fasting, but fasting is not recommended for type I, noncompliant, poorly controlled and pregnant diabetics. There are no adverse effects of Ramadan fasting on respiratory and cardiovascular systems, haematologic profile, endocrine, and neuropsychiatric functions.” – Alkandari et al., 2012, The implications of Ramadan fasting for human health and well-being

7. Eat more veggies, fruit and protein.

Try to eat a variety of foods in the early morning and evening, going first for as many fruits, vegetables, fat from plants such as olive oils and nuts, and whole grains as you can. These foods, along with protein, keep you fuller during your fasting window and can also help with blood sugar control while you are fasting.

For example, at your pre-sunrise meal you might enjoy water was well as oatmeal with fruit and nuts and some eggs or avocado toast, or a bowl of vegetable soup with a piece of whole grain toast with butter or olive oil, a glass of milk and some dates or a fruit smoothie.

Try to break your daily fast with lower glycemic index foods – choose veggies, fruit, protein, fats and legumes over bread and other carbs. This will help prevent harmful blood sugar spikes that can happen after a fast, especially when breaking a fast in the evenings. We are naturally more insulin resistant, or our tissues are slower to take up glucose, in the evenings.

8. Know when to break your fast early.

If you have diabetes or another health condition for which fasting is normally contraindicated, you are excused from the practice of Ramadan fasting. If you do choose to fast, you should consult your physician and be prepared to break your daily fast if you feel ill or if your blood glucose (blood sugar) levels drop too low, for example. For many people with diabetes, that means a level of 70 mg/dL or less. The risk of severe hypoglycemia increases in subjects with type 1 and type 2 diabetes who undertake fasting during Ramadan.

Ramadan fasting can also cause harmful hyperglycemia or high blood sugar levels. This has been attributed to overeating during non-fasting hours as well as diabetes medication dosing that doesn’t take fasting into account.

“The risk of hypoglycemia is increased significantly among diabetic individuals during Ramadan. Hyperglycemia usually occurred due to overeating during nonfasting hours of Ramadan and change in dosage of antidiabetic drugs to prevent hypoglycemia. Fasting during brightening to sunset results in remarkable changes in eating pattern and daily physical activity. Studies reported that insulin delivery should be rescheduled during Ramadan in which need to insulin reduction in daytime and increase in nighttime. Therefore, it is recommended that diabetic patients use the insulin pump for regulating their insulin requirement during Ramadan.” – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274578/

Resources:

• Recommendations for Management of Diabetes During Ramadan
• Review of diabetes management and guidelines during Ramadan

9. Eat fiber in the morning, reduce your simple carbohydrates at night.

In a report on recommendations for the management of diabetes during Ramadan published in Diabetes Care in 2010, physicians and researchers from multiple institutions advised that people practicing Ramadan fasting minimize the carbohydrate and fat content of their sunset meals. They also advised that people should consume more complex carbohydrate and plant fibers during their early morning or pre-fast Ramadan meals. Consumption of high fiber whole grain cereals at Suhoor has been found to promote better satiety, improved bowel function and improved blood lipid levels during Ramadan.

“The common practice of ingesting large amounts of foods rich in carbohydrates and fats, especially at the sunset meal, should be avoided. Because of the delay in digestion and absorption, ingestion of foods containing “complex” carbohydrates (slow digesting foods) may be advisable at the predawn meal, which should be eaten as late as possible before the start of the daily fast. It is also recommended that fluid intake be increased during nonfasting hours.” – Recommendations for Management of Diabetes During Ramadan

10. Know when not to fast

Individuals who should not fast and who are exempt from Ramadan fasting include pregnant women, children under the age of puberty, elderly and frail individuals, the acutely unwell and those with chronic illnesses in whom fasting may be detrimental to health.

Ramadan Mubarak!

In summary, with Ramadan fasting you are likely to enjoy health benefits as long as you pay attention to what your body needs and do what works best for you. You can further improve your health, focus and energy levels during Ramadan fasting by maintaining a moderate amount of daily physical activity and a high level of vegetable and fruit intake.

Amanda Salis at the University of Sydney’s Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders recommends that people consider continuing some form of daily fasting even after Ramadan, to conserve its weight loss and other health benefits. In her own research of Ramadan fasting, she has found that this fasting schedule systematically produces weight loss even in the absence of other dietary changes, without any decrease in resting metabolic rate.

“I used to think that people must dread the Ramadan fast all year long, but I realized after studying it that people love the fasting! Individuals in Muslim communities are often sad when the Ramadan fast is over,” Salis said. “We also know that people tend to regain weight and fat after the Ramadan fast. Most people will lose 1-2 kilograms during Ramadan, which leads to improvements in metabolic health, glucose regulation and fat loss, even if they regain the weight later. So I think the main health message here is to continue some form of intermittent fasting after Ramadan to help prolong its benefits.”

Try practicing your Ramadan fasting and other year-round daily fasting with the added benefits of fasting with friends and receiving up-to-date educational resources on fasting and nutrition with the LIFE Fasting Tracker app. Check out our “Ramadan” LIFE Circles in the app! Ramadan Mubarak!