Healthy habits for Ramadan
By Lina Breik, Accredited Practicing Dietitian (APD)
Ramadan is the ninth month of the Islamic calendar. Muslims around the world spend the daylight hours in a complete fast (from sunrise to sunset) abstaining from all foods and fluids (yes, even water!) everyday for this month.
For Muslims, Ramadan is a time to practice self-restraint; a time to cleanse the body and soul from impurities and re-focus one’s self on the worship of God. Ramadan is a ‘must’ for all Muslims except: the elderly, children until the age of puberty, the sick, people with intellectual disabilities, travellers and pregnant, breastfeeding and menstruating women.
Lina Breik, a Muslim Accredited Practicing Dietitian from Melbourne, has put together a list of handy hints you could advise your Muslim patients with to stay healthy during Ramadan.
1. Consider dividing your food into two main meals with snacks in between and after
a.Suhoor (aka Sehar) – the pre-dawn meal
•Include complex carbohydrates, which are rich in fiber to help give you sustainable energy throughout the long hours of fasting and keep your bowels healthy.
•Some examples of complex carbohydrates: multigrain and wholemeal breads and cereals, all bran, basmati rice, lentils, oats, semolina, wholemeal flour and beans.
•Don’t forget to also include a good protein serve at this mealtime to sustain you that little bit longer while your fasting.
•Some examples of protein rich foods: 65g cooked lean meat, 1-2 eggs, a handful of nuts and seeds or a cup of lentils/chickpeas.
•Try and make this meal your largest one
b.Iftar – the sunset snack (the first thing you eat when the fast is broken)
•It is Prophetic tradition to break your fast with some dates and a cup of water.
•It is also tradition to follow this with a bowl of soup to continue providing adequate hydration and helps settle the hunger to prevent yourself from overeating at the main meal.
c.Dinner – the main meal
•Remember that this meal should not be considered a ‘feast’.
•Give yourself at least 10 minutes after Iftar to begin your dinner meal
oNote: It is Prophetic tradition for Muslims to perform prayer (which takes 5-10 minutes) straight after Iftar and then approach the dinner meal.
•The healthy plate model guidelines apply during Ramadan – ½ the plate to be vegetables/salad, ¼ carbohydrates (e.g. rice, pasta, potato) and ¼ protein rich foods (e.g. beef, lamb, chicken, fish, lentils).
•Eat slowly and chew very well to help pace yourself. It is quite common to want to eat a large amount after a ~12 hour fast, but remember it takes a good 20 minutes for your stomach to tell your brain it is full. Serve small portions initially, the food is not going to run away!
d.Supper – Two hours after the dinner meal, it is likely you will feel hungry. This is normal and it is important you make healthy choices. Some examples of great choices could be 1-2 of the following:
•A 100-200g of low fat yoghurt
•A wholegrain salad/cheese/tuna sandwich
•1-2 pieces of fresh fruit
•A cup of low fat milk
•A handful of nuts
•Popcorn (unsalted and unbuttered)
•Fresh fruit juice
•Vita-brit biscuits with low fat cheese
•Hummus dip with vegetable sticks
2.Make sure you drink as much fluid (preferably water) as possible. A good technique to help you remember your fluids is to “drink 2 by the hour” – meaning 2 cups of water (250 mls = 1 cup). From sunset (~ 5 pm) to 10 pm, you would have consumed 2.5 L of fluid keeping you very well hydrated.
3.Due to the festive nature of Ramadan where lots of family and friends often gather at sunset to eat together, high sugar/fatty sweets are usually a regular after dinner. Try to initially fulfill your sugar craving with one of the healthy snacks listed above and then have a small amount of the traditional sweets.
4.Avoid as much as possible:
•Fried foods which can make you feel sluggish and fatigued
•Salt and high salt foods
•Large amounts of foods high in refined sugars, which will not provide you with sustainable energy.
5.Potential obstacles that you may encounter and some solutions:
•Don’t miss Suhoor to avoid low blood glucose levels during the day that can worsen/create headaches
•Consume adequate fluids
•Include fiber rich foods (such as fruit, vegetables and wholegrain breads and cereals)
•Include at least 30 minutes of planned activity such as walking
•Avoid lying flat straight after breaking your fast.
* Consult your doctor if any of these issues persist.
If you have a chronic disease and/or regularly take medication it is very important you discuss your Ramadan plans 1-2 months before with your doctor and seek advice from an Accredited Practicing Dietitian to tailor specific dietary requirements to your needs.
Recommended readings for Dietitians:
1.Sheikh A, Gatrad A. Caring for Muslim patients. Radcliffe Publishing Ltd; 2nd Revised edition, Oxon, UK 2007.
2.Queensland Health and Islamic Council of Queensland. Health Care Providers’ Handbook on Muslim Patients Second Edition 2010. Division of the Chief Health Officer, Queensland Health, Brisbane 2010.
3.Bawadi H, Al-Shwaiyat N, Tayyem R, Mekary R, Tuuri G. Developing a food exchange list for Middle Eastern appetisers and desserts commonly consumed in Jordan. Nutrition and Dietetics. 2009; 66:20-26.
4. Salti I, Benard E, Detournay B, Bianchi-Ciscay M, La Brigand C, Voinet C, et al. A Population-Base study of Diabetes and Its Characteristics During the Fasting Month of Ramadan in 13 Countries. Diabetes Care. 2004; 27(10):2306-11
5. Norouzy A., Salehi M., Philippou H., Arabi H., Shiva F., Mehrnoosh S, et al. (2013)Effect of fasting in Ramadan on body composition and nutritional intake: a prospective study. J Hum Nutr and Diet. 26 (Suppl. 1) 97-104.