Afia’a Mohammed Al Masri, Manager of Hemya Diet Centre at the Al-Ahli Hospital
It is important for people to create a proper meal plan in advance that will enable healthy eating and ensure their body gets its daily required nutrients during the Holy Month of Ramadan.
Meals during Ramadan are divided into four parts – Iftar; after Taraweeh prayers; after midnight; and Suhoor (pre-dawn). It is common to have Iftar full of flavored dishes as it can include food choices from both lunch and dinner but it should still be a healthy meal and overeating should be avoided.
Afia’a Mohammed Al Masri, Manager of Hemya Diet Centre at the Al-Ahli Hospital discussed about healthy diet and its importance during Ramadan.
The ideal meal plan
Main rules:
- Break your fast with drinking water and taking 3 pieces of dates. Dates contain simple sugars, fibers and essential minerals such as potassium and magnesium. This will help your glucose level and blood pressure return to normal and help you control your appetite during the main meal.
- We advise you to eat and drink slowly and chew your food well.
- Incorporate soups that are homemade, not creamy and loaded with vegetables and legumes.
- Salads can be also a good starter if it contains a variety of fresh watery vegetables such as tomatoes, cucumbers, beets, lettuce and other green leafy vegetables.
- Make time space between meals and try to divide your Iftar meal into three to four small meals.
- Stay away from fried and fatty food as much as possible and substitute frying with baking, roasting, grilling or steaming. Fatty foods disturb digestion and cause undesirable weight gain.
- Avoid eating sweets every day during Ramadan and restrict them to few times only and not every day, substitute desserts which are fatty and loaded with sugar with fresh fruits or fruit juices .
Stay away from salty foods like pickles, processed meat, frozen foods, packaged or canned soups, preserved sauces, seasonings and salad dressings.
Those items can increase your feeling of thirst a few hours after you start your fast.
- Drink as much water as possible between Iftar and sleeping time.
- Avoid caffeinated drinks such as coke, coffee or tea because they are diuretic and may cause dehydration. Also the amount of caffeine in these beverages might cause insomnia, disturbed sleep and fatigue.
- Try to avoid refined carbohydrates and sugar (e.g. white bread, white rice, sweets, and pastries) which can cause blood sugar surges leading to weight gain.
Do not skip Suhoor (pre-dawn meal) as this will increase the length of your fast, which is not advisable in this hot season and may result in dehydration and fatigue.
- For Suhoor meal, it is advisable to eat lean proteins and complex carbohydrates such as in beans, and drink a cup of fresh juice or eat a piece of fruit.
Iftar meal: Divided into 4 small meals
First: Eat three dates with one cup of water.
Second: Eat soup every day. This will help to overcome thirst and replenish your body with needed amount of water and minerals. Avoid creamy and fatty soups and replace them with vegetables, legumes (such as lentils), grains( such as barley), or chicken soups (cream free).
Third: Appetizers such as stuffed vegetables or salads.
Eating appetizers after soup will prepare your stomach to begin the digestion process. Therefore, it is recommended to choose appetizers that are rich in vegetables such as stuffed vine leaves, marrow or cabbage, fattoush, green salad or tabbouleh sprinkled with a hint of lemon or vinegar without any added salt. Use virgin olive oil, sesame oil ,and dried or fresh herbs to add richness and flavor to your salad.
Fourth: The main dish
It is preferable that Ramadan tables feature one main dish, as food variety and indulgence generally lead to overeating. Food for the Iftar meal should include a source of carbohydrates such as rice, pasta, or bread preferable made from whole grains. And light protein source from trimmed red meat, skinless chicken or fish.
Here are a few examples: Thareed, meat kabsa, grilled skinless chicken with vegetable salona, pasta cooked with tomato sauce and vegetables (not creamy) , and hariss.
Suhoor meal:
The best time to eat Suhoor is half an hour before the Adhan. You can break your fast with something light such as:
-Whole grain bread with labneh/milk plus a piece of fruit/ fresh juice especially water melon , apple, or sweet melon juices.
-Cereals with fresh milk plus dried fruits
- Eggs or legumes such as Hummos and foul.
Advice for pregnant and breastfeeding women before fasting in Ramadan
Pregnant women who are willing to fast during Ramadan should seek their doctor’s advice throughout the month to make sure that fasting is not affecting their baby. It is important for pregnant women to follow up with their doctors before they decide to fast. While they are fasting, they should ensure to take rest frequently throughout the day and also ensure that they get the right nutrients and calories when they break their fast each evening. They should also ensure to consume up to three liters of water at Suhoor and Iftar. Pregnant women should also avoid sweets and other sugary snacks usually consumed after Iftar.
There are some concerns that fasting may affect how well a baby grows in the uterus (womb), or that fasting may be linked to premature labor. Some studies suggest that more babies are born early if their mums fast during Ramadan. If Ramadan coincides with summer, this means hot weather and long days, which puts pregnant women at greater risk of dehydration due to low fluid intake and this could induce premature labor and subsequently lead to preterm births.
Fasting pregnant women should contact their doctor as soon as possible if:
They are not putting on enough weight or are losing weight.
They become very thirsty.
Urinating less frequently or if their urine becomes dark-colored and strong-smelling. This is a sign of dehydration, and it can make them more prone to urinary tract infections or other complications.
They develop a headache or other pains or a fever.
They become nauseous or start vomiting.
Fasting pregnant women should also contact their doctor straight away if:
There is a noticeable change in their baby’s movements, such as if their baby is not moving around or kicking as much.
They notice contraction-like pains. This could be a sign of premature labor.
They feel dizzy, faint, weak, confused or tired, even after they have had a good rest.
If any of the instances above occur, women should break their fast immediately and drink water. They should also contact their doctor immediately. There is usually an increase in the number of women visiting the emergency department during Ramadan due to fasting and pregnancy.
Breastfeeding mothers
Because it is highly recommended that women whose babies are aged 0-6 months breastfeed their babies exclusively (feeding babies only with breast milk without supplementing with water and other food) such women may not be able to fast. Mothers of older babies who are already taking supplementary food in addition to mother’s milk can fast, as scientific literature proved that fasting for 24 hours or less will show very little changes in the amount of breast milk produced and in its composition.
If women are exclusively breastfeeding their babies, they are not expected to fast during Ramadan. Mothers who wish to fast need to assess their general medical condition by consulting a physician and reporting the medications they might be using to boost their breast milk supply before making a decision to fast. This will help avoid any complications that could cause harm to them and their baby while breastfeeding between Iftar and Suhoor.
People with chronic diseases
Patients should consult their physician before changing the timings of thier medications when fasting.
Not only would unsupervised change of medication timings render the medications useless, it could also cause serious complications to patients’ health. Therefore, patients that need to take medicines constantly are advised to talk to their doctor, in advance, about the suitable timings for taking their medications during Ramadan.
For example : Hypertensive medications are mostly taken once or twice daily, so patients with hypertension could fast and manage the timings and dosages of their medication without problems; however, they are advised to avoid salty foods and drink plenty of water during Iftar and at Suhoor.
Diabetic patients have to decide, together with their endocrinologists, whether they are able to fast or not. In most cases, diabetic patients of Type one diabetes are not able nor advised to fast because they take their medications on several intervals during the day and they have to maintain a certain level of blood sugar throughout the day that is compatible with insulin mode and dosage, and having a stable level of blood glucose is highly unattainable if the patient is fasting.
On the other hand, diabetic patients of type Two or gestational diabetes can fast if they control their eating habits and timings of their meals in correspondence with their medications if they taking any.
Diabetic patients should avoid changing their medication timings arbitrarily in order to avoid complications such as hypoglycemia or hyperglycemia.
If diabetics experience symptoms of hypoglycemia, including extreme hunger, fatigue, dizziness, headache, severe sweating, trembling hand, increased heart rate and the tendency to lose consciousness, they should break their fast immediately and have some juice or any sweetened drink in addition to a carbohydrate-rich meal in order to avoid a hypoglycemic coma.
Patients may also experience hyperglycemia (elevated blood sugar) if they do not adhere to their medication timings and dosages or if they overindulge in consuming sweets and sugars or carbohydrates during Iftar or Suhoor.
Symptoms of hyperglycemia include extreme thirst, frequent urination, dry throat, vomiting, abdominal pain, fatigue and exhaustion. Like hypoglycemia, hyperglycemia can lead to a coma. Patients who experience symptoms of hyperglycemia are advised to drink water immediately and seek medical care before their condition further deteriorates.
Some insulin-dependent patients are under the false impression that since they eat no food while fasting in Ramadan they would not need to adhere to their medication schedule. Failure to adhere to their medication regimen could lead to serious complications such as ketoacidosis (ketones build up in the blood) that can, in turn, lead to diabetic coma.
