---- Diet during Ramadan ----

INTRODUCTION

Fasting during the Islamic month of Ramadan can be good for one's health and personal development. Ramadan fasting is not just about disciplining the body to restrain from eating food and drinking water from predawn until sunset. The eyes, the ears, the tongue, and even the private parts are equally obligated to be restrained if a Muslim wants to gain the total rewards of fasting. Ramadan is also about restraining anger, doing good deeds, exercising personal discipline, and preparing oneself to serve as a good Muslim and a good person during and after Ramadan.

This is why the Messenger of Allah (Peace be upon him, Pbuh) has been attributed, by Hazrat Abu Hurairah in hadith, to say: "He who does not desist from obscene language and acting obscenely (during the period of fasting), Allah has no need that he didn't eat or drink." (Bukhari, Muslim). In another hadith by Hazrat Abu Harairah, the Prophet (Pbuh) said: "Fasting is not only from food and drink, fasting is to refrain from obscene (acts). If someone verbally abuses you or acts ignorantly toward you, say (to them) 'I am fasting; I am fasting." (Ibn Khuzaoinah). Restraint from food, water, and undesirable behavior makes a person more mentally disciplined and less prone to unhealthy behavior. In an investigation in Jordan (1), a significant reduction of parasuicidal cases was noted during the month of Ramadan. In the United Kingdom, the Ramadan model has been used by various health departments and organizations to reduce cigarette smoking among the masses, especially among Africans and Asians (2).

Ramadan fasting has spiritual, physical, psychological, and social benefits; however, manmade problems may occur, if fasting is not properly practiced. First of all, there is no need to consume excess food at iftar (the food eaten immediately after sunset to break fast), dinner or sahur ( the light meal generally eaten about half an hour to one hour before dawn). The body has regulatory mechanisms that activate during fasting. There is efficient utilization of body fat, El Ati et al. (3) . Basal metabolism slows down during Ramadan fasting, Husain et al. (4). A diet that is less than a normal amount of food intake but balanced is sufficient enough to keep a person healthy and active during the month of Ramadan.

Health problems can emerge as a result of excess food intake, foods that make the diet unbalanced, and insufficient sleep (5, 6). Ultimately also, such a lifestyle contradicts the essential requirements and spirit of Ramadan.

DIET DURING RAMADAN

According to Sunna (the practices of Prophet Muhammad, Pbuh) and research findings referred in this report, a dietary plan is given:

1. Bread/Cereal/Rice, Pasta, Biscuits and Cracker Group: 6-11 servings/day; 2. Meat/Beans/ Nut Group: 2-3 servings/day. 3. Milk and Milk Product Group: 2-3 servings/day. 4. Vegetable Group: 3-5 servings/day; 5. Fruit Group: 2-4 servings/day. 6. Added sugar (table sugar, sucrose): sparingly. 7. Added fat, polyunsaturated oil 4-7 table spoons.

Breakfast, iftar:

Dates, three
Juice, 1 serving (4 oz.)
Vegetable soup with some pasta or graham crackers, 1 cup

The body's immediate need at the time of iftar is to get an easily available energy source in the form of glucose for every living cell, particularly the brain and nerve cells. Dates and juices are good sources of sugars. Dates and juice in the above quantity are sufficient to bring low blood glucose levels to normal levels. Juice and soup help maintain water and mineral balance in the body. An unbalanced diet and too many servings of sherbets and sweets with added sugar have been found to be unhealthy, Gumma et al. (7).

Dinner:

Consume foods from all the following food groups:
Meat/Bean Group

Bread/Cereal Group
Milk Group

Vegetable Group

Fruits Group

Fruits and mixed nuts may be eaten as a snack after dinner or tarawiaha or before sleep.

Pre-dawn Meal (sahur):

Consume a light sahur. Eat whole wheat or oat cereal or whole wheat bread, 1-2 serving with a cup of milk. Add 2-3 teaspoons of olive oil or any other monounsaturated or polyunsaturated fats in a salad or the cereal. Eat 1-2 servings of fruits, as a last item.

Blood cholesterol and uric acid levels are sometimes elevated during the month of Ramadan (8). Contrary to popular thinking, it was found that intake of a moderately high-fat diet, around 36% of the total energy (calories), improved blood cholesterol profile, Nomani, et al. (9) and Nomani (10). It also prevents the elevation of blood uric acid level (8-10). The normal recommended guideline for fat is 30% or less energy. On weight basis, suggested fat intake during Ramadan is almost the same as at normal days. Fat is required for the absorption of fat-soluble vitamins (A, D, E, K) and carotenoids. Essential fatty acids are an important component of the cell membrane. They also are required for the synthesis of the hormone prostaglandin. Keto-acids from fat are especially beneficial during Ramadan to meet the energy requirement of brain and nerve cells. Keto-acids also are useful in the synthesis of glucose through the metabolic pathway of gluconeogenesis. This reduces the breakdown of body proteins for glucose synthesis. Therefore, the energy equivalent of 1-2 bread/cereal servings may be replaced with polyunsaturated fat.

During Ramadan increased gastric acidity is often noticed, Iraki, et al. (5), exhibiting itself with symptoms such as a burning feeling in the stomach, a heaviness in the stomach, and a sour mouth. Whole wheat bread, vegetables, humus, beans, and fruits -- excellent sources of dietary fiber -- trigger muscular action, churning and mixing food, breaking food into small particles, binding bile acids, opening the area between the stomach and the deudenum-jejunum and moving digesta in the small intestine, Kay (11). Thus, dietary fiber helps reduce gastric acidity and excess bile acids, Rydning et al. (12). In view of dietary fiber's role in moving digesta, it prevents constipation. It's strongly suggested that peptic ulcer patients avoid spicy foods and consult a doctor for appropriate medicine and diet. Diabetic subjects, particularly severe type I (insulin dependent) or type II (non-insulin dependent), must consult their doctor for the type and dosage of medicine, and diet and precautions to be taken during the month. Generally diabetes mellitus, type II, is manageable through proper diet during Ramadan, Azizi and Siahkolah (13).

Pregnant and lactating women's needs for energy and nutrients are more critical than the needs of men (14). There is a possibility of health complications to the pregnant woman and the fetus or the lactating mother and the breastfed child, if energy and nutrient requirements are not met during the month of Ramadan (15-19). Governments, communities, and heads of the family must give highest priority to meet women's dietary needs. In African countries, Bangladesh, India, Pakistan and many other places malnutrition is a major problem, especially among women from low-income groups. Further more, it is common among these women to perform strenuous work on farms or in factories, and other places. Malnutrition and strenuous conditions may lead to medical problems and danger to life. Under these conditions one must consult a medical doctor for treatment and maulana or shiekh for postponement or other suggestions regarding fasting. Quran Al-Hakeem and Hadith allow pregnant women and lactating mothers flexibility during the month of Ramadan.

For practical purposes and estimation of nutrients a diet was formulated, given below:

Iftar

Nutritionist IV (20) was used to estimate energy and nutrient content in the above diet, which was as follows: energy, 2136 kilocalories; protein, 70g; carbohydrate , 286g; fat, 87g, 35 % of energy of the total intake, (saturated fat 16.9g; mono saturated, 28.4g; poly unsaturated, 34g; other 7.3g; - oleic, 25.6g; linoleic, 29.5; linolenic, 0.6g; EPA-Omega-3, 0.006g; DHA-omega-3, 0.023g; dietary fiber 34g; calcium, 1013mg; sodium, 3252 mg; potassium, 2963mg; iron 13.3mg; zinc, 10mg. When the nutrients were compared with the Recommended Dietary Allowance (RDA), for an adult non-pregnant and non-lactating female (14), the diet met 100% or more of the RDA for protein, calcium, sodium, potassium, and vitamin A, K, B₁, B₂, B_3, B₆, B₁₂, folate, and C. The energy was close to the RDA, (97%). The dietary fiber level also was met as per the recommendation (11). Consuming food in the above amount by pregnant or lactating female may not meet the RDA for all of the nutrients. They may need supplementation of some minerals and vitamins such as, iron vitamin D, and more energy through bread or rice.

DISCUSSION

Further suggestions:

Drink sufficient water between Iftar and sleep to avoid dehydration.

Consume sufficient vegetables at meal s. Eat fruits at the end of the meal.

Avoid intake of high sugar (table sugar, sucrose) foods through sweets or other forms.

Avoid spicy foods.

Avoid caffeine drinks such as coke, coffee or tea. Caffeine is a diuretic. Three days to five days before Ramadan gradually reduce the intake of these drinks. A sudden decrease in caffeine prompts headaches, mood swings and irritability.

Smoking is a health risk factor. Avoid smoking cigarettes. If you cannot give up smoking, cut down gradually starting a few weeks before Ramadan. Smoking negatively affects utilization of various vitamins, metabolites and enzyme systems in the body.

Do not forget to brush or Miswak (tender neem tree branch, Azhardicta indica or other appropriate plant in a country, about 1/4-1/2 inch diameter and 6-8 inches length, tip partially chewed and made brush like). Brush your teeth before sleep and after sahur. Brush more than two times or as many times as practicable.

Normal or overweight people should not gain weight. For overweight people Ramadan is an excellent opportunity to lose weight. Underweight or marginally normal weight people are discouraged from losing weight. Analyzing a diet's energy and nutritional component, using food composition tables or computer software, will be useful in planning an appropriate diet.

It is recommended that everyone engage in some kind of light exercise, such as stretching or walking. It's important to follow good time management practices for Ibada (prayer and other religious activities), sleep, studies, job, and physical activities or exercise.

In summary, intake of a balanced diet is critical to maintain good health, sustain an active lifestyle and attain the full benefits of Ramadan.

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Dr. Mohammad Zafar A. Nomani, is Professor Emeritus, West Virginia University;  and recipient of the first King Hassan II award for outstanding research contributions on Ramadan fasting, honored by Hassan II Foundation for Scientific and Medical Research on Ramadan, Casablanca, Morocco, at the First World Congress on Health and Ramadan.