ram dam diet guide

8/2/2019 Ram Dam Diet Guide

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a guide to healthy fasting Supported by the

a m a d a n h

e a l t h g u id e


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Contents

Page 28 Tips for healthcare professionals

Page 3 Foreword

Page 4 Acknowledgements and useful contacts

Page 5 Introduction

Page 6 The physiological changes thatoccur during a fast

Page 8 Foods that benet andfoods that harm

Page 20 Frequently asked questions

Page 12 Spirituality and food

Page 14 What could you gain from fasting?

Page 16 Potential health complications andpossible remedies

Page 24 Key points in translation

FASTING is complete abstinence from food and drink between dawn and dusk. All those who are ill or frail, pregnant or menstruating women, breastfeedingmothers and travellers are exempted. They are required to make up thenumber of days missed at a later date or give a xed sum to charity.

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I am very pleased to support the development of the Ramadan health guide , which hasbeen independently produced by Communities in Action in order to provide informationand advice on maximising health gain during the Muslim fast. We hope it will also proveuseful to others fasting for religious or spiritual reasons.

The Department of Health is committed to responding to the needs and preferences of all sections of our diverse population, and this guide is one of a range of activities wehave supported in order to promote public health among all sections of the population.

There is considerable evidence to suggest that large sections within Muslimcommunities experience signicant health inequalities, although this is not uniformacross all Muslim communities or all aspects of health. In particular, Pakistani andBangladeshi communities tend to suffer poorer health than the general population.We hope that this guide, alongside the Departments targeted campaigns, such as our

Asian Tobacco Helpline, will help to address these inequalities.

As part of our commitment to creating a patient-led NHS, the Department of Health andthe NHS will continue to work in partnership with community-based organisations tomeet the needs of all communities, including faith communities, and to promote better health for all.

Surinder SharmaNational Director, Equality and Human RightsDepartment of Health

Foreword3


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Communities in Action would like to thank the following individuals for their contribution to this publication:

Edited and compiled by: Ajmal Masroor, Director, Communities in Action

Authors: Dr Razeen Mahroof, BM, MRCP(UK), FRCA, Anaesthetist, OxfordDr Rizwan Syed, BM, DRCLG, General Practitioner, BirminghamDr Ahmed El-Sharkawy, BM, MRCP(UK), Specialist Registrar inGastroenterologyTehseen Hasan, BSc(Hons), State Registered Dietitian, BirminghamSahra Ahmed, MPharm, Pharmacist, Manchester Dr Fuad Hussain

Revised: Dr Naveed AhmedDr Amar Ahmed

Research: Henrietta Szovati, Communities in ActionDr Shahnaz Ahmad, DRCOG, MRCGPDr Amar Ahmed, MBBS, DCH, DRCOG, MRCGPDr N Ahmad, MRCS, MSc, BSc(Hons), DO-HNS, SpecialistRegistrar in ENT Surgery

Advisors: Dr Fatima Husain, MBBS, MRCGP, MRCOG, DIPM, ConsultantObstetrician and Gynaecologist

Dr Usama Hasan,Imam and Lecturer

Layout and design:Nafe Anam

AcknowledgementsBritish Heart Foundation14 Fitzhardinge StreetLondon W1H 6DH020 7935 0185www.bhf.org.uk

Diabetes UK Central OfceMacleod House10 ParkwayLondon NW1 7AAtel: 020 7424 1000fax: 020 7424 1001email: [email protected]

NHS Asian Tobacco HelplineFor free and condential advice on how to stop

smoking or chewing tobacco:Bengali 0800 00 22 44Urdu 0800 00 22 88Punjabi 0800 00 22 77Turkish 0800 00 22 99Gujarati 0800 00 22 55

Arabic 0800 169 1300

NHS Smoking Helpline0800 169 0169

www.gosmokefree.co.ukThe Muslim Council of BritainPO Box 57330London E1 2WJtel: 0845 26 26 786fax: 020 7247 7079email: [email protected]

Useful contacts

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http://www.bhf.org.uk/mailto:[email protected]://www.diabetes.org.uk/http://www.gosmokefree.co.uk/mailto:[email protected]://www.mcb.org.uk/http://www.mcb.org.uk/mailto:[email protected]://www.gosmokefree.co.uk/http://www.diabetes.org.uk/mailto:[email protected]://www.bhf.org.uk/


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IntroductionHealth is the key to happiness, and what we consumedirectly affects our health. Islam encourages Muslims to

ensure that they are mindful of their health. The blessedProphet said: Take advantage of the good health beforeillnesses afict you. He also encouraged Muslims to trytheir best to take up a healthy living lifestyle that includesa balanced diet, regular mental and physical exercise anda balance between material and spiritual needs.

The Health Survey for England 2004 (Department of Health, 2005) has shown poor health and lifestyle choicesof the Asian community in general and Muslim communityin particular. Compared with the 24% of men in thegeneral population who smoked cigarettes, higher levelsof cigarette smoking were reported by Bangladeshi men(40%). South Asian men and women had the highestrates of diabetes. Pakistanis and Bangladeshis were upto ve times more likely than the general population tohave diabetes, and Indian men and women were up tothree times as likely. Some 33% of Pakistani men andwomen eat the recommended ve or more portions of fruit and vegetables a day,compared with 28% of Bangladeshi menand women.

The month of Ramadan is a great opportunity to focus onbringing back a balanced and healthy lifestyle in your life.

Through fasting you begin to learn how to manage your eating habits, how to improve self-control and discipline.This month requires you to give the stomach a break, andby doing so you are able to break down and expel theaccumulated toxins from your body.

This booklet is aimed at helping you understand thehealth issues related to fasting, so that you are able tomake more informed choices, minimise complicationsand maximise the benet of your fast. The booklet will:guide you through physiological changes that occur when you are fasting; give examples of benecial andharmful foods during fasting; discuss potential medicalproblems and remedies; suggest a diet plan; and respondto the most frequently asked questions about fasting ingeneral and medical issues in particular. The booklet alsocontains a section for doctors and medical professionals,to enable them to provide more informed services.

The booklet has been put together by medical experts,Islamic scholars and researchers, who have stayed withinthe spirit of Islam, while ensuring the medical advice andsuggestions are scientic and culturally sensitive.

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For many people, the key question regarding fasting iswhether it is good or bad for your health. The answer tothis requires a quick overview of what happens inside thebody during fasting: the physiology of fasting.

The changes that occur in the body in response to fastingdepend on the length of the continuous fast. Technicallythe body enters into a fasting state eight hours or so after the last meal, when the gut nishes absorption of nutrientsfrom the food. In the normal state, body glucose, which isstored in the liver and muscles, is the bodys main sourceof energy. During a fast, this store of glucose is used uprst to provide energy. Later in the fast, once the storesof glucose run out, fat becomes the next store source of energy for the body. Small quantities of glucose are alsomanufactured through other mechanisms in the liver.

Only with a prolonged fast of many days to weeks doesthe body eventually turn to protein for energy. This isthe technical description of what is commonly known as

starvation, and it is clearly unhealthy. It involves proteinbeing released from the breakdown of muscle, whichis why people who starve look emaciated and becomevery weak.

As the Ramadan fast only extends from dawn till dusk,there is ample opportunity to replenish energy stores atpre-dawn and dusk meals. This provides a progressive,gentle transition from using glucose to fat as the mainsource of energy, and prevents the breakdown of musclefor protein. The use of fat for energy aids weight loss,preserving the muscles, and in the long run reducesyour cholesterol levels. In addition, weight loss results inbetter control of diabetes and reduces blood pressure.

A detoxication process also seems to occur, as any

toxins stored in the bodys fat are dissolved and removedfrom the body. After a few days of the fast, higher levelsof certain hormones appear in the blood (endorphins),resulting in a better level of alertness and an overallfeeling of general mental well-being.

Balanced food and uid intake is important betweenfasts. The kidney is very efcient at maintaining thebodys water and salts, such as sodium and potassium.However, these can be lost through sweating. To preventmuscle breakdown, meals must contain adequate levelsof energy food, such as carbohydrates and some fat.Hence, a balanced diet with adequate quantities of nutrients, salts and water is vital.

The physiological changes that occur during a fast

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Normally produces insulin.During fasting, insulin production isshut down and hormones that tell theliver and muscles to release sugar stores are produced. Also, productionof digestive juices is reduced

Acid productionby the stomachis reduced duringfasting

No changesknown to occur during fasting

This is where a lot of thewater absorption occursfrom the food, and secondto the kidney it is importantin water balance in the body

Digestive juices productionis shut down and there areregular contractions of thewhole small intestine onceevery 4 hours

Concentrates bileduring the fast inreadiness for thenext meal

The bodys main controller of energy reserves. During

fasting, the liver releasessugar by breaking downstores in the organ

No changesknown to occur during fasting

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The fasts of Ramadan can improve a persons health, but if the correct diet is not followed can possibly worsenit! The deciding factor is not the fast itself, but rather what

is consumed in the non-fasting hours. To fully benet fromfasting, a person should spare a great deal of thought tothe type and quantity of food they will indulge in through theblessed month. As mentioned in the section on spirituality(see pages 1213), overeating can not only harm the bodybut it is thought also to interfere with a persons spiritualgrowth during the month. A diet that has less than a normalamount of food but is sufciently balanced will keep aperson healthy and active during the month of Ramadan.The diet should be simple and not differ too much fromones normal everyday diet. It should contain foods from allthe major food groups, as shown below.

Foods that benet andfoods that harm

Fruit and vegetables Bread, other cerealsand potatoes

Milk and dairy foodsMeat, sh and

alternatives Foods containing fat Foods containing sugar

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Complex carbohydrates are foods that will help releaseenergy slowly during the long hours of fasting. Complexcarbohydrates are found in grains and seeds, like barley,

wheat, oats, millets, semolina, beans, lentils, wholemealour, basmati rice, etc.

Fibre-rich foods are also digested slowly and includebran, cereals, whole wheat, grains and seeds, potatoeswith the skin, vegetables such as green beans andalmost all fruit, including apricots, prunes, gs, etc.

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Foods to avoid are theheavily-processed,fast-burning foodsthat contain renedcarbohydrates in the formof sugar, white our, etc.,as well as, of course, toomuch fatty food (eg cakes,biscuits, chocolates andsweets, such as IndianMithai). It may also beworth avoiding the caffeinecontent in drinks suchas tea, coffee and cola.

(Caffeine is a diuretic andstimulates faster water lossthrough urination.)

Foods to avoid Healthy/alternative foodsDeep-fried foods, eg pakoras,samosas, fried dumplings

Whole grains, eg chickpeas (plain,or with potato in yogurt with differentIndian spices), samosas baked insteadof fried, and boiled dumplings

High-sugar/high-fat foods, eg Indiansweets such as Ghulab Jamun,Rasgulla, Balushahi, Baklawa

Milk-based sweets and puddings,eg Rasmalai, Barfee

High-fat cooked foods, eg parathas,oily curries, greasy pastries

Alternate with chapattis made withoutoil, and baked or grilled meat andchicken. Try to make pastry at homeand use a single layer

Cooking methods to avoid Alternative cooking methodsDeep frying Shallow frying usually there is very

little difference in tasteFrying Grilling or baking is healthier and helps

retain the taste and original avour of the food, especially chicken and sh

Curries with excessive oil Start with measuring the oil used incurry and try to bring the oil contentdown gradually, eg reducing vetablespoons to four. This is a goodway of reducing oil without noticingmuch difference in the taste. A usefultip is to use more onions and tomatoesin the bulk of the curry

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Suhoor , the pre-dawn meal, should be a wholesome,moderate meal that is lling and provides enough energyfor many hours. It is therefore particularly important toinclude slowly-digesting foods in the suhoor .

Iftar is the meal which breaks the days fast. This mealcould include dates, following the Prophetic traditions.Dates will provide a refreshing burst of much-neededenergy. Fruit juices will also have a similar, revitalisingeffect. The meal should remain a meal and not becomea feast! Try to minimise the rich, special dishes thattraditionally celebrate the fast and keep to the adviceincluded in the table opposite.

Many of the foods which are mentioned and encouragedin this booklet are in the Holy Quran, and the Sunnah(the Prophetic traditions) also correspond to modernguidelines on a healthy diet and will help to maintainbalanced, healthy meals in Ramadan. The mostcommonly consumed foods by Prophet Mohammed(peace be upon him) were milk, dates, lamb/mutton andoats. Healthy foods mentioned in the Holy Quran arefruit and vegetables, such as olives, onions, cucumber,gs, dates, grapes as well as pulses such as lentils. Theencouragement of sh can be seen in the fact that Islamiclaw spares sh from any specic slaughter requirements,making it easy to incorporate sh in a meal.

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Food has a great signicance in Islam. It is associatedwith ones relationship with God. Chapter 20, verse 81 of the Quran states: Eat of the good and wholesome things

that We have provided for your sustenance, but indulge inno excess therein.

The physical body is a gift from God; it is given to humansas an amanah (in trust) to take care of for a xed period.How much food is consumed and the choice of food has adirect impact on the physical and spiritual well-being of theperson. The food that you consume affects your behaviour and personality. Wholesome, natural and healthy foodassists the development of a good personality. Overeatinghas long been frowned upon in Islam as it is thoughtto increase worldly appetites and cause sluggishness,thereby dulling the soul, hampering spiritual growth andincreasing physical ailments.

The blessed Prophet said: The children of Adam ll novessel worse than their stomach. Sufcient for him is afew morsels to keep his back straight. If he must eat more,

then a third should be for his food, a third for his drink, anda third left for air. (Sunan al-Tirmidh)

Islam sees health and well-being as much more than justbodily health: well-being or tranquillity requires a strongrelationship with ones spirituality, good physical health,mental happiness, a sense of purpose and good character and relationships. Islam makes a strong connectionbetween food and worship and teaches that all forms of worship have a deeper purpose and impact and contributein some way to individual and social well-being.

In chapter 7, verse 31 the Quran is categorical: Eat anddrink freely: but waste not by excess, for He does not likethe wasters.

Spirituality and food

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Islam thus creates a sense of responsibility in people to takea healthy living lifestyle as normal. Fasting in the month of Ramadan teaches us to manage and practise spirituality andnot to eat excessively. The essential part of spirituality infood is that we are grateful and thankful for the food we get.

The blessed Prophet once said: God has a right over you; your body has a right over you To strike a balancebetween the needs of the physical body and your spiritualneeds, you must on the one hand consume the right typeand amount of food and on the other hand develop excellentinterpersonal skills. The blessed Prophet Muhammad said:I have only been sent for the perfection of character.Fasting in the month of Ramadan is an opportunity to makesignicant changes in your lifestyle and develop the resolve

to make healthy living choices.

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Fasting is not only a physical but also aspiritual exercise that has many lastingbenets.

1. Heightened consciousness of GodFasting helps you to become lesspreoccupied with bodily appetites, andgives the heart and mind the freedom toreect upon deeper spiritual matters, suchas your relationship with God and withfellow human beings. It enables a person

to develop sustained consciousness of God (Taqwa).

2. Healthy lifestyle A fasting person learns restraint, andonly responds to hunger and thirst in theheightened level of consciousness anddiscipline. Through fasting, a personbegins to appreciate the value of food. Inthe Quran healthy and wholesome foodis described as the best of provisions.Thus fasting helps a person to choosea healthier lifestyle by making small yetlasting changes to their daily diet.

What could you gainfrom fasting?

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3. Compassion and charityWhen fasting, you should think of those in need who maybe fasting but have no food at the start or the end of their fast, those whose tiny children are also having to go hungrybecause of poverty. The Prophet Muhammad describedRamadan as the month of mercy. His companionsobserved: The Prophet (Muhammad) was the mostgenerous of people, but he would be his most generousduring Ramadan (Sahih al-Bukhari)

4. Community spiritDuring Ramadan, the one who fasts has heightenedconcerns for the well-being of the community rich andpoor, intellectuals and labourers. Community spirit ispromoted as people start fasting at the same time and breaktheir fast at the same time, and reect together throughlonger prayer and deeper devotions. It is greatly encouragedthat families invite each other to break their fast together.

5. A fast without the spirit is empty of blessing Abstention for long hours can be very hard physically andspiritually. However, by the end of the long month youshould feel cleansed and with a renewed spirit. Ramadanis an ideal time to break bad habits, to reect on personalityand to improve your character.

Those who fast but make no change to their lives exceptdelaying a meal cannot really expect to become anydifferent in their behaviour during or after Ramadan. Inmany ways, this is a wasted fast, as stressed in a number of sayings of the blessed Prophet: fasting is not merelyabstention from eating and drinking, but also from vainspeech and foul language. (Sahih al-Bukhari)

Fasting is, therefore, about much more than just givingup food and drink and hoping to lose a couple of pounds.By fasting, a person reects, acts and betters his or her character.

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Heartburn (indigestion)

The stomach is an acidic environment, designed to digest food andkill bacteria. The stomach and oesophagus (gullet) are normallyprotected from this acid by the bodys own special juices and valvesbetween these two organs. If either too much acid is produced or thevalve at the bottom of the oesophagus is faulty, you may experienceheartburn. Fasting usually reduces the amount of acid produced, butthoughts of food or the smell of it make the brain order the stomach toproduce more acid. Hence if there is a net increase in acid, heartburncould be a problem during the fast.

Those who are on regular medication for indigestion, such as antacids(eg Gaviscon), antihistamines (eg Zantac) or proton pump inhibitors(eg Losec, Zoton or Nexium) are advised to continue taking them, atthe pre-dawn meal for instance. The control of heartburn or belchingcan be aided by eating in moderation and avoiding oily, deep-friedor very spicy food. Reducing your caffeine intake and/or stoppingsmoking can also be of benet, if relevant. Preparations such aspeppermint oil may help reduce belching or colic. Sleeping with your head raised on a few pillows and long-term weight loss may also helpprevent heartburn.

Potential health complicationsand possible remedies

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Poor control of diabetesThose injecting insulin are advised not to fast, as the potentialrisk to health, both in the short and long term, of not taking

insulin is too great.People who have their diabetes under control using tablets

should ensure that they visit their GP prior to Ramadan, inorder to discuss any possible changes to their drug regimewhich would facilitate a safe fast. If not, such patients areat risk of poor control of their diabetes during and outside thefasting times.

Regular self-monitoring of your blood glucose is stronglyadvised. Low blood sugar levels (a hypo) are dangerous,

and if untreated may lead to fainting or ts, and hence must bestrictly avoided. Feeling dizzy, sweaty and disorientated mayall suggest a hypo. If this is suspected, you should immediatelyhave a sugary drink, or place sugar or a sugar-rich sweet belowthe tongue.

Long-acting tablets, such as Glibenclamide, increase the riskof having a hypo, and should be changed to a shorter-acting

variety before you embark on a fast.Diabetics with further complications, such as angina or heartfailure, stroke, retinopathy (eye disease), nephropathy (kidneydisease) or neuropathy (nerve disease of feet/hands withnumbness/loss of feeling) should seek careful advice from their doctor before starting a fast.

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HeadacheThis is a common problem and has many causes.Headaches during a fast could commonly be due todehydration or hunger, inadequate rest, or the absence of addictive substances such as caffeine or nicotine.

A moderate and balanced diet, especially not missingthe pre-dawn meal, consuming adequate quantities of uid and if necessary taking a dose of painkillers suchas paracetamol, may all go a long way towards either preventing or reducing the risk of developing a disablingheadache. Headaches can also be prevented by sensiblemeasures such as not exposing oneself to direct sunlight,wearing a hat when out, using sunglasses to reduce theeffect of glare from thesun and relieving anytense muscles with ashort, gentle massage.

Those with a history of frequent and/or disablingmigraines should aim to gain adequate control withlifestyle and/or medical treatment if required, prior tostarting a fast.

Despite the above measures, if you have a persistent,disabling headache, you should see a doctor.

DehydrationDehydration is a common occurrence during a fast. Thebody continues to lose water and salts through breathing,

sweat and urine; the quantity of water loss will varydepending on the weather, how much you had to drinkbefore your fast, the degree of physical exertion and theability of the kidneys to retain water and salts.

Prevention is always better than cure. However, if youdo not adequately rehydrate before a fast, your risk of dehydration is increased. This risk is higher in the elderlyand in those taking tablets such as diuretics. Dependingon the severity of the dehydration, you may experience ageneral feeling of being unwell, lethargy, muscle cramps,dizziness, disorientation and even collapse or fainting.

If you are unable to stand up due to dizziness, or you aredisorientated, you should urgently rehydrate with regular,moderate quantities of water, ideally with sugar and salt,or Dioralyte or Lucozade.

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If you faint due to dehydration, your legs should be raisedabove your head by others, and when you awake, you

should urgently rehydrate as outlined above.Complications of any common chronic diseasesDiabetes has been discussed above.

Other common diseases such as high blood pressure andasthma are controlled using medication that needs to betaken regularly every day of the year. This is necessaryin order to avoid possible complications from theinadequate control of disease, such as a stroke or an

asthma attack. A consultation with your doctor shouldprovide an opportunity to discuss any potential optionsfor completing a fast safely, while continuing to controlyour disease.

ConstipationConstipation could be a very irritating problem for someone undertaking a fast. Maintaining good hydrationoutside the fast, eating healthily, with lots of fruit and

vegetables in your diet, increasing the bre content of your food using bran, and being active all help to keepyour bowel motions as regular as would otherwisebe expected.

If the problem persists, a short course of bulk laxativesmay help.

StressLack of food and water, changes of routine and shorter

periods of sleep can all collude to increase stress levels.Hence it is important to address any potential sources of stress in order to minimise harmful effects. This can behelped by not taking on more than you can reasonablyhandle, not playing sports in the hot sun, controlling your anger in advance and abstaining from smoking.

ObesityStrange, but true! For the unwary, or those lacking incaution, food consumed during the pre-dawn and duskmeals may lead to some unintended weight gain.

Obesity is an epidemic in the making, and has numerouscomplications in its own right. It is ironic that you are ableto become overweight or obese while you are fasting. Butif you do not approach the fast with discipline and will,the opportunity to lose weight and become healthier is wasted.

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