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Ramadan fasting and nutrition amidst current COVID-19 pandemic

Ramadan Kareem to all our Muslim brethren!

“Always take the positives out of a negative situation. Never overthink or stress. Every situation has a lesson to teach us”.( Dr. Bilal Philips)

As we enter the holy month of Ramadan, it is a different feeling and experience for all Muslims this year.


During this time, when people are into social distancing to avoid spreading the coronavirus, among the many challenges pious Muslims face during the COVID-19 pandemic is how to mark Ramadan. Fearing further deterioration and spread, governments and religious authorities across different countries, have sharply curtailed Ramadan services and communal feasts , including restrictions on public prayers and iftars ( the traditional communal breaking of the fast each evening during Ramadan). So this Ramadan will witness and uphold traditional ritualistic forms of worship in the quietness of every household.


Ramadan is the 9th lunar month in Islamic calendar year. It is the month when “Holy Quran” was handed over to the Prophet Mohammad (PBUH).The most important significance of Ramadan is that Muslims are required to observe fasting during daylight hours. Fasting is one of the five pillars of Islam and every adult is obligatory to fast. During this month foods and fluids are only allowed at night so fasting extends from dawn to sunset – the exact length of time dependent on geographical location and season. However, children(under the age of puberty) , people who are elderly, sick or have certain health conditions, who have learning difficulties ,who are travelling, women who are pregnant, breastfeeding or menstruating are exempted from fasting.


How does fasting effect our body?

Day long fasting for a month definitely has its impact on our body and health. And at this vulnerable times, the biggest confusion that arises in most minds is whether abstinence from food and liquids, including water, from sunrise to sunset each day during Ramadan would be a health risk? Should people with medical conditions or weakened immune systems go for fasting? Since,this is a time to be extra conscious about ones health and immunity, these questions do arise which is quite natural. But, contrary to what we fear, several research studies have shown that intermittent fasting, the kind practiced during Ramadan, has several health protective effects.


In recent years, researchers have discovered and studied the benefits of intermittent fasting, some form of which is common to many of the world’s religions. I have tried to put the findings in the pictorial representation here.


Reference:Mindikoglu et al.2020 ; Cabo R de and Mattson M P 2019; Rouhani MH and Azadbakht L 2014

In a study, reported in New England Journal of Medicines, Cabo and Mattson (2019) mentions that time shift in eating hours with intermittent fasting accelerates body’s metabolism and switch from glucose base to ketone based energy system, which will help in utilizing the stored body fats. In healthy individuals, during fasting state, the meals are skipped. This reduces the glucose level in the blood. The insulin production in the body also decreases accordingly as the blood glucose levels are low. The body is able to manage its normal function in the fasting state as it uses the stored glucose from the liver as well as the muscles in the form of glycogen with the help of some hormones known as counter regulatory hormones. This is because glucose is very essential for the normal functioning of the brain and red blood cells. The body also uses stored fats as fuel when glucose availability is reduced. The ketones produced from the breakdown of fats are used by the skeletal muscles, heart muscles etc. as fuel. Thus, it is a very complex metabolic activity.


Regular fasting in animals is associated not only with weight loss but also with lower blood pressure and heart rate, reduced insulin resistance, lower "bad" LDL cholesterol levels, higher "good" HDL cholesterol levels, and less inflammation. However these all have been done in medically supervised subjects and may vary according to individual conditions and the diet they consume. I say this because as reported , when pre-Ramadan lipid profile was compared to post-Ramadan values, studies showed decrease in weight for initial days but had an interesting finding that post Ramadan , total cholesterol and triglyceride decreased in men but not so incase of women.This, they attributed to the fact that men went on with their normal works and women reverted back to being sedentary lifestyle staying at home.


Diet during Ramadan

One of my young friend from Kashmir, Shabnam , once told me that the “Holy book has solution for every question that arise. We only have to learn to read and understand it that way”. Yes , indeed, I cannot differ from her. At times,I feel our ancestors were truly advanced and knowledgeable than us. Their learning had Science behind everything they did. See for instance ,since we are talking about Ramadan, there is this teaching of Prophet Mohammad, where he is quoted as saying “When one of you is fasting, he should break his fast with dates;but if he cannot get any, then with water, for water is purifying”. So it might have implied that, eating dates, which are high in sugars, helps the fasting body’s blood glucose levels to quickly return to normal. After that, one should drink water which will hydrate the dehydrated system . It is indeed essential to normalize the body metabolism before going on to a heavier meal. Breaking the fast with easily digestible foods is a healthy practice. After a long day of fasting one should avoid eating a heavy meal immediately. Instead after breaking one’s fast, one should try normalizing the body with soup, freshly squeezed fruit juice so that your body is hydrated enough. Then, go for the main course with a break of 15 or 20 minutes. This will also provide a feeling of satiety( fullness) , prevent over eating and this in turn will help the digestive system. Always remember to fill your iftar with quality and variety rather than quantity. Try to include coloured vegetables, greens and fruits; these are not only nutrient rich but also supply the much needed fibre, which is so important for avoiding constipation. A mixed platter of whole grains and legumes, seasonal vegetables, greens and spices, fruits, meat and poultry will also help maintain ones immunity. Eating whole fruit is definitely a better choice than its juice. Avoid too much fat (not more than 2 tablespoons/person/day), use preferably more than 2 varieties of oils, restrict salt consumption (not more than 1 teaspoon/person/day). Remember to keep sugar to bare minimum as it provides only calories with no other nutrients.


Some of my friends practice eating another heavy meal just before going to sleep ,skipping suhoor and fasting till the next iftar.This should be avoided because it can lead to very low sugar levels and dehydration.This will cause distraction, dizziness day long and hamper in carrying out the normal day to day routine life, which isn’t the way of Ramadan. One should always eat during suhoor,and it should be healthy but light and filling. Go for whole grain preparations which releases sugars slowly, dairy products ,boiled or steamed vegetables , cheese ,eggs and light salads. Dried fruits like almonds and walnuts can also be had which can give you a feeling of fullness for long hours. And remember to drink enough water or fresh fruit juice to keep you hydrated enough for the day.


Whatever I have written above is how to keep you nutritionally balanced, but the spiritual calmness or strength gain during this period of fasting goes a long way to make one’s life contended and healthy.


Is it safe to fast amidst Covid-19?

Observing fast during Ramadan is definitely a deep spiritual calling for followers of Islam and many will choose to abide. However, we must agree that some people are particularly vulnerable to COVID-19. Consider your existing health conditions to decide whether you should fast or not especially when immunity is so essential during this time of an existing contagious health disaster. People who are showing symptoms of Coronavirus infections or who have been in any sort of contact with carriers may refrain from fasting because it might poise a risk for their immune system. Though intermittent fasting shows promise, we don't have solid evidence about the benefits or how fasting might affect older adults. Human studies have looked mostly at small groups of young or middle-aged adults, for only short periods of time. In his statement, Dr Hans Henri P. Kluge, WHO Regional Director for Europe said that “Some of the reasons older people are greatly impacted by COVID-19 include the physiological changes associated with ageing, decreased immune function and multimorbidity which expose older adults to be more susceptible to the infection itself and make them more likely to suffer severely from COVID-19 disease and more serious complications”.


Although studies show that Ramadan fasting had no serious adverse effect on offspring, Rouhani and Azadbakht (2014) recommended pregnant women to refrain from fasting because of the limitations of studies and such cases depended on several other variables such as pregnancy duration, nutritional status before, during and after the Ramadan, maternal age, socioeconomic status and other potential covariates. With regards to diabetic patients, who want to fast during Ramadan,one should be aware that medical, nutritional and physical activity consultation is of prime importance .

As I cite Dr Hans Henri P. Kluge “Age is not the only risk for severe disease. The very notion that “COVID-19 only affects older people” is factually wrong. Severe cases of the disease have been seen in people in their teens or twenties, with many requiring intensive care and some unfortunately passing away.” People who are considered at high-risk with reference to COVID-19 include, those with underlying medical conditions (such as cardiovascular disease, diabetes, chronic respiratory disease, and cancer), people with chronic lung disease or moderate to severe asthma ,people who have received an organ transplant and remain on ongoing immune suppression medication, people who have serious heart conditions, people with severe obesity (body mass index [BMI] of 40 or higher), people with liver disease and who are immunocompromised including cancer treatment, smoking, bone marrow or organ transplantation, immune deficiencies, people with severe diseases of body systems, such as with chronic kidney disease undergoing dialysis.


To conclude, although studies showed that Ramadan fasting has health protective effects, individuals having any health complications should consult their medical team for fasting during Ramadan. If one is feeling well and don’t have an underlying health condition, it should still be safe to fast during Ramadan. The key messages are to stay at home, pray from home, be kind ,supportive to everyone and to break fast, share iftar at home or digitally in order to protect self as well as the people dear to us and in this way we fufill our obligations towards mankind and go closer to God.


This pandemic might be God’s way of reminding humans that there is a force in the higher up according to whose will the universe turns. It is a time to reflect and realize what we have done with this planet , how tiny we are and how humble we should be. It’s His mercy that we dwell upon. Let us all keep the thoughts of all deceased ones in our prayers-many who went off without having a glance of their dear ones.Let us also pray for those who are fighting this battle in isolation and all the warriors of essential services who are helping them win one.Let us pray for the humanity as a whole.May peace and unity prevail upon us.

References

Cabo R de and Mattson M P. Effects of Intermittent Fasting on Health, Aging, and Disease. N Engl J Med 381;26 nejm.org December 26, 2019.

Lind L. Circulating markers of inflammation and atherosclerosis. Atherosclerosis. 2003;169:203–14.

Mindikoglu AAL,Abdulsada MM,Jain A, MinChoi J ,Jalal PK ,Devaraj S ,Mezzari MP ,.Petrosino JF ,Opekun AR, YunJung S . Intermittent fasting from dawn to sunset for 30 consecutive days is associated with anticancer proteomic signature and upregulates key regulatory proteins of glucose and lipid metabolism, circadian clock, DNA repair, cytoskeleton remodeling, immune system and cognitive function in healthy subjects. J Proteomics 217 (2020) 103645.

Rouhani MH and Azadbakht L. Is Ramadan fasting related to health outcomes? A review on the related evidence.J Res Med Sci. 2014 Oct; 19(10): 987–992.

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hello@ohlifesbeautiful.com;London, England, UK