Who gets to benefit from Ramadan?
Health benefits of fasting, or is it?
Humans have been fasting throughout their history for varied reasons, both as a necessity and as a choice. Some of these reasons were food conservation during famines, spiritual upliftment, legal requirement, and most recently as one surefire lifestyle choice to enjoy its multiple health benefits. Amongst the fasting rituals one of the most notable is the fasting in Ramadan, when about 1.6 billion Muslims fast as a religious obligation.
Ramadan is a Holy month of the Hijri Calendar that many Muslims look forward to, some for the short workhours, and the Ramadan Allowance (of about 200 USD), but most look forward to the month, for the promised spiritual rewards of fasting or its often-praised health benefits. Maldives, being a Muslim country, has been fasting during the month of Ramadan for the last 800 years, and again another Ramadan will fill the salty air with celebration, festive iftars (breaking the fast at sunset), and the hauntingly beautiful Azan, followed by the heart-rendering recitations of the Holy Quran during the nightly Tarawih prayers. Even the non-Muslim tourist or the expatriate resident would often fast a few days to immerse in the rich cultural and spiritual experience that is fasting.
Talking about health benefits, the advent of the lunar annual visitor brings about a social media phenomenon where it is often flooded with research, articles and researchers, explaining the benefits of fasting. Research shows that Ramadan fasting leads to weight loss, improved biochemical markers of chronic health conditions, decreased blood pressure, positive impacts on smoking cessation, and mental health, alongside the vast spiritual benefits it entails. A quick google search would bear testament to this with no less than 8 health benefits that would make anyone wonder, ‘why are we not fasting all the time?’
Delving a bit deeper, we find that some research done in Muslim countries, had taken a surprising turn. A study published in the Nutritional Journal, in 2011 found that contrary to the widely known effects of fasting, weight was gained by the Saudi participants during Ramadan. Numerous other studies either point towards statistically insignificant weight gain or no weight gain. A study on another health outcome, compliance with medical advice, shows that 58% of the participants altered crucial medication regimens in order to fast. Yet another study done in Saudi Arabia indicated the altered sleep pattern, excessive sleeping in the day and staying awake most of the night, uncouples an important feedback mechanism leading to increased cortisol, the “stress hormone”, which negates the glycemic, (sugar-related), health benefits of fasting. And another points towards an increased incidence of diabetic emergency visits to the ER during Ramadan. To add to this ball of happiness, a significant portion of the weight loss reported in the studies have been attributed to the loss of muscle mass alongside the loss of fat.
So where have the benefits of fasting suddenly gone? Should we be asking the question, ‘why are we fasting at all?’
Despite all the results with apparent detriments, the consensus is out on the research on fasting, and the verdict is truly, astoundingly, positive with respect to the health benefits of fasting. Yet even a quick self-reporting survey done within our network of associates found that 38% reported weight gain, 48% reported no notable change in weight, and the minority, 14%, reported weight loss during Ramadan. And Muslims who, with determination and zeal, attempt to stop smoking in Ramadan are back on it before its end, or soon after. So, why are these health benefits anecdotally unobservable for fasting individuals in Ramadan? Or is there something missing?
Yes. Indeed, somethings are missing in the practice of Ramadan fasting. Though highly variable across world cultures, these are the six factors that mainly decide on who benefits from Ramadan fasting.
Food Intake
Ramadan is the month of fasting, but paradoxically, it is also the month of increased demand for food items in the market. Especially the ones that are unhealthy with high glycemic indices, the sweet kind, the fried kind, and the fatty kind. These types of foods, as well as sweetened cold drinks are part of the cultural iftar in the Maldives and the Muslim world, but it should be helped in moderation. There is no lack of scientific literature that proves their detriment to human health, and this holds true even in Ramadan. Foods with a high glycemic index leads to increased blood sugar levels, cholesterol and fat levels, as well as increased storage of fats. Other health conditions that are often triggered by such a diet include gastritis, and constipation, both of which have a higher incidence of acute presentation to healthcare providers during Ramadan. One other cause of acute onset of gastric pain is sudden overeating during iftar.
These foods, coupled with the relative decrease in physical activity during Ramadan, results in a net excess of calories for a given day, leading to weight gain. So, what should be done?
- Balance your diet with proteins, carbohydrates, fats, and minerals.
- Take foods rich in fiber, such as dates, fruits, vegetables, and wholegrain.
- Reduce the intake of foods with high salt content such as Rihaakuru.
- Avoid foods with high-glycemic indices or have them in moderation.
- Eat in moderation during set times after iftar.
- Make sure iftar is a light, energetic meal, especially with proteins if you are exercising before iftar.
- Avoid smoking altogether, and the triggers that lead you to smoke, such as excessive idle time.
It is important to note here that this advice is more effective when followed in a consistent manner whether it is Ramadan or not, as these practices have been scientifically proven to have beneficial health outcomes.
Water
Water is essential to life, and sufficient amounts of water need to be consumed by all living things to live a sustainable, healthy life. Contrary to most regimens of intermittent fasting practices from across the world, in Ramadan fasting, or the religious fasts of Muslims, both food and water intake is to be avoided. This could lead to dehydration during the day, especially if the climate is hot and adequate water is not taken during the hours between iftar and suhoor (the last meal had right before fasting begins). In turn, dehydration usually works towards a detrimental cycle (vicious cycle) of worsening health especially if you are already ill. Diabetic emergencies, hypotensive episodes, constipation, and dehydration caused by vomiting and diarrhea can be precipitated during fasting hours due to the lack of water intake.
Further, decreased intake of water is also associated with decreased satiation, which can lead to overeating. Dehydration also leads to poor athletic performance and early fatigue, resulting in additional decrease in physical activity. So, what shall be done?
- Take at least 4 glasses during iftar, 2 after tarawih and 2 at suhoor. This is enough water to avoid overeating and remain hydrated.
- Ensure additional hydration if you are hitting the gym, or exerting yourself physically during the day or night.
- Reduce caffeine intake, it can cause loss of water through its diuretic activity.
- Reduce the intake of foods with high salt content such as Rihaakuru.
- Look for signs of dehydration, especially in children, the elderly, and the chronically ill. These signs can be extreme dry mouth, dry and wrinkled skin, difficulty concentrating, excessive fatigue, difficulty urinating, and palpitations.
Anyone fasting should be aware that fasting should not be undertaken at the risk of one’s health, and if any sign of dehydration is seen, breaking the fast or going to the ER is of utmost importance.
Sleep
Muslim life is filled with prayer and contemplation of God, and even more so in Ramadan, where many Muslims will join the Tarawih prayers soon after iftar, and then stay up late into the night, or wake up after short bouts of sleep, to observe Tahajjud prayer. In addition to this, the majority of Muslims will wake up sometime before prayer for the suhoor and dawn prayer. Moreover, due to the fasting condition in the daylight hours, many restrict physical activity, gatherings, or entertainment to the late hours of the night sacrificing precious hours of nighttime sleep. All of these put together, sleep is scarcely rewarded at night, and daytime sleep is common amongst fasting Muslims. This in turn leads to decoupling of the biological clock and the circadian cortisol rhythm, decreased physical activity, increased risk of cardiovascular diseases, increased hunger, and basically, all the benefits of fasting going out the window.
So how shall this be dealt with?
- Decrease caffein intake after Tarawih.
- Enjoy the company of your friends and entertainment early in the night or during the daytime, and sleep as soon as you are idle at night.
- Try to get at least 5 hours of sleep after Tarawih, and 2 hours of sleep after the Fajr (the dawn prayer).
- Avoid sleeping for extended periods during the daytime, unless you work night-shifts.
Sleep is a vital need for humans which affects every aspect of human physiology. Sacrificing sleep has shown diabetic-like changes in healthy individuals, and increased blood pressure, both of which could be exacerbated by fasting itself. Having adequate sleep is a simple, effective, and necessary way towards health benefits regardless of the time of the year.
Physical Activity
- Increase daytime waking hours by spending time entertaining yourself with children, or family members, outside the home. (Roadha kurukuraa Cycle Buru, aka. Motorcycle rides to “shorten” the fast, does not count!)
- Any physical activity you usually do can be done during Ramadan.
- If you are exercising, do not stop because it is Ramadan. Do it routinely, right before iftar, soon afterwards, or immediately after Tarawih. If you are used to exercising at a specific time, or planning to after Ramadan, try to shift the time away from the fasting hours, unless it is right before iftar.
- Slowly increase the intensity of physical activity from the first day of Ramadan to the last.
- Do not skip it if you feel the weight of fasting, reduce the intensity.
Compliance with Medical Advice
Those that are ill are especially relieved from the obligation of fasting on Ramadan. However, it is a difficult choice for Muslims to miss a day’s fast unless it is unavoidable. So much so that many would rather skip doses or ignore the doctor’s advice in favor of completing the fast. This could very quickly become a dangerous choice to have made, depending on the condition and circumstances that are better understood by health professionals.
So, what shall be done here?
- Consult with the relevant doctors before making any changes to your medication regimen or to ask if you should be fasting at all.
- Ensure that the right doses are taken and do not miss meals that are prescribed.
- Monitor your health condition throughout the day, and break your fast if it seems to worsen.
- Do not hesitate to seek help even if there is a risk of having to break your fast.
- Do not fast if you are medically advised not to do so.
Instead of modifying the doses yourself, or completely coming off an important treatment plan, it is better for you to ask a doctor to modify it for you. Many, if not all doctors are willing to incorporate religious choices into the treatment plan and would give you the right guidance and right plan for you to have a healthy Ramadan.
Persistent Health Consciousness
One of the many reasons that Muslims look forward to Ramadan is a predetermined resolution to take advantage of Ramadan to get their lives in order. ‘I will stop smoking.’ ‘I will stay off excessive “carbs”.’ ‘I will lose x kgs.’ ‘I will pray all the prayers in the mosque.’ Etc. etc. are some of the many resolutions that Muslims attempt.
But often Iftar is had, not just to satiate the hunger at the end of the day, but to drive out fasting from living memory! Many Muslims, after the day’s fast, continues to eat, at irregular intervals, throughout the night. Some find that the drowsiness and fatigue of fasting sends them to bed at odd times during the day. Some put off physical exercise and activities for a more energetic day or spend most of the night time on friends and entertainment, eating, and having coffee, and smoking away the many resolutions. Many, on the other hand, will succeed in these determinations with a healthy weight loss, a smoke-free Ramadan, and improved fitness; a successful change, spiritually, and physically, only to fall off the wagon and rapidly gain the lost weight and go back to pre-Ramadan conditions, with none of the benefits of Ramadan. So, what shall be done after Ramadan?
- Before the end of Ramadan, plan the days ahead to continue taking food in a healthy manner.
- If you have stopped smoking, plan ahead before facing your triggers.
- Shift the exercise and physical activity times to a feasible time closer to the Ramadan time.
Therefore, and at the risk of repeating myself, it is evident that this advice is better followed in a consistent manner whether it is Ramadan or not, as these practices have been scientifically proven to have better health outcomes.
Finally, ‘who gets to benefit from Ramadan?’ has been answered; it is those who consciously practice better health habits around the six key factors above, to ensure that the health benefits keep coming, that are finally rewarded with the health benefits of Ramadan. Just as the spiritual benefits of Ramadan are conditional, on the observation of patience, sincerity, charity, and prayer, so are the physical benefits conditional on getting the right amount of sleep, being active, staying hydrated, moderation in diet, staying on a health regimen advised by professional doctors. But more important that that, just as Muslims believe that it is a sign of God’s acceptance of the prayers and good deeds during Ramadan’s, when they persist in patience, sincerity, charity, and prayer after Ramadan, those who truly get to reap the better health outcomes of Ramadan, are those that take to heart the right health habits that they develop during Ramadan, and are consistent in their practice throughout the rest of the year. So, the answer to the question, ‘who gets to benefit from Ramadan?’ finally boils down to the hadith of the Prophet Muhammad ﷺ, “The most beloved of deeds to God are those that are most consistent, even if it is small.”
