The main religion of the Middle East and North Africa (MENA) is Islam. Ramadan is a time of reflection, prayer and fasting for Muslims. COVID-19 is going to affect the way that Muslims mark the Holy Month. A time that is traditionally steeped in cultural traditions and communities coming together to pray and socialise, Ramadan in 2020 is going to be a very different experience. What changes can you expect to see and how can you ensure that your Ramadan maintains the core principles of prayer, reflection and fasting whilst staying safe and adhering to government guidelines? 2020 will go down in history as the year of [COVID-19](https://nabtahealth.com/covid-19/). Starting in China, the virus has swept across the planet, leaving barely a country or territory unaffected. Our day-to-day routines have been altered beyond recognition, with many countries implementing some form of [social distancing](https://nabtahealth.com/what-is-social-distancing/). Of course this has taken time to adjust to; changing our behaviours, habits and norms for what, for many, remains an invisible enemy, has been challenging. ##### Prayer Usually Ramadan is a time when mosque attendance increases. Unfortunately this year, in many locations, mosques have been closed in an attempt to reduce the spread of the virus. People are encouraged, where possible, to complete their prayers at home. All normal prayers in the day, and the more special prayers associated with Ramadan such as the late evening prayers (Taraweeh) and Eid al Fitr prayers, can be performed at home without a sermon. Families who live together can pray together, but larger congregations are not allowed. Of course, prayer and mosque attendance are both of spiritual importance, particularly during the Holy Month; but it should also be considered that for many, the act of coming together in prayer is a social activity. Maintaining contact with friends, family and loved ones is as important now as ever, even if that contact has to be via video calls. ##### Community On the topic of socialising, Ramadan has long been a time for family and friends to come together; to reflect and to pray, but also to break their fast together in the evening. With strict social distancing and active nightly curfews in some parts of the MENA region, the gatherings observed in previous years are not going to happen. It is traditional in some parts of the Gulf region for children to participate in Garge’aan on the fifteenth night of Ramadan. Dressed in traditional dress, they visit their neighbours, and sing local songs in return for sweets and nuts. Depending on their age, some children may struggle to deal with the disappointment of not getting to partake in this ritual. Even for adults, it is another sign that times are different this year and can be difficult to accept from an emotional perspective. ##### Health One of the biggest problems with COVID-19 to date is how little we really know about it. Scientists and doctors are working continuously to better understand the virus and to determine why some people are affected so much more severely than others. Currently, there are people considered to be at higher risk, including the elderly, those with a history of respiratory disease and those with non-communicable diseases, such as diabetes type 2 and obesity. However, amongst the many unknowns with regards to this virus, is the impact of diet on susceptibility and prognosis; certainly, consuming a diet rich in vitamin C (found in many fruit and vegetables, including oranges, papaya, guava, bell peppers and broccoli) and [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) (found in oily fish, mushrooms and eggs) seems to exert some protective effects. However, fasting is a major part of the observation of Ramadan; and it remains to be seen whether varying food intake over a sustained time period is going to put people at higher risk due to reduced nutrient and fluid intake. There are steps that can be taken to try and ensure a healthier fast, particularly during these uncertain times: * **Regular exercise**. Fasting can cause a lack of energy and, over time, muscle weakness. Try to exercise indoors after breaking your fast (or outside if local policy allows it). This will not only help to maintain physical fitness, but also improve your emotional wellbeing. * Those who are under a strict curfew may not be able to spend time outdoors. The sun is an excellent source of **[vitamin D](https://nabtahealth.com/glossary/vitamin-d/)** and those who are spending significant amounts of time indoors are at greater risk of [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) deficiencies. If fasting, try to ensure that your main meal is rich in [vitamin D](https://nabtahealth.com/glossary/vitamin-d/) containing foods. * During the month of Ramadan it is normal for regular sleep patterns and routines to be disrupted. Later meals and evening prayers can disturb the normal circadian rhythm, which can have a negative effect on the **immune system**. Maintaining a strong immune system is essential in the fight against COVID-19. Eat well when you can and try to ensure you still get sufficient sleep to maximise the health of your immune system, even during periods of fasting. * Look after your **mental health**. This article has already alluded to it, but an inability to do what you would normally do during the weeks ahead; such as partake in rituals, share food with neighbours, play games and break your fast with close friends and family; can all be highly detrimental to your state of mind. Adhering to strict social distancing rules is difficult and is a particularly big ask during the month of Ramadan. Seek help and support if you need it during these weeks. Video calls may not be the same as being with people, but they are a compromise and might be the start of new traditions and routines in years to come. In practical terms, not all Muslims are able to fast. Consideration is always given to those who are pregnant, or have underlying health issues. This year, frontline medical workers are also exempt from fasting if it is considered that they will weaken their immune system, or compromise their ability to treat patients. Those who have tested positive for SARS CoV-2, the virus responsible for COVID-19, are also exempt if their symptoms would make it difficult to fast. Ramadan in 2020 is going to be a restrained affair; a time of quiet contemplation and modest iftars, rather than extravagant socialising. Whilst change is always challenging and deviating from long-help practices and traditions is hard, the fundamental principles of Ramadan still remain. Those observing the Holy Month can use the time to reflect, to give thanks for all that they have and offer up Zakat for those in need. Nabta wishes all our readers a blessed, healthy Holy Month. Ramadan Mubarak.
During Ramadan, adult Muslims abstain from eating and drinking between sunrise and sunset. It is one of the five pillars of Islam and it is thought that over 400 million Muslims worldwide fast each year. Most Islamic scholars agree that pregnant and breastfeeding women are exempt from fasting and that they can choose to observe their fast at a later date. Despite this exemption, many women still choose to fast during Ramadan, preferring to observe the holy month alongside their family. Figures suggest that up to 90% of pregnant Muslim women choose to fast for at least part of the month. So, from a medical perspective, is it OK to fast, and how can you make this deeply spiritual process as stress-free as possible for your unborn child? **Is fasting during pregnancy safe?** A number of scientific studies have explored this question and yet the results are conflicting and there does not seem to be a definitive answer. In general, nutritional excesses and insufficiencies during pregnancy can [lead](https://nabtahealth.com/glossary/lead/) to complications including high or low birth weight and [preeclampsia](https://nabtahealth.com/glossary/preeclampsia/). Furthermore, they can contribute to health problems, such as diabetes and glucose intolerance later in life. However, the precise impact of fasting is inconclusive. One meta-analysis (a combination of data from different studies), found that fasting did not influence birth weight. However, the differing criteria used across the studies meant that no other [perinatal](https://nabtahealth.com/glossary/perinatal/) outcomes could be measured. Fasting during pregnancy is only really recommended if you have good overall health and an otherwise complication-free pregnancy. Women with pre-gestational, or [gestational diabetes](https://nabtahealth.com/glossary/gestational-diabetes/) are strongly recommended not to fast as the risk of [hyperglycaemia](https://nabtahealth.com/glossary/hyperglycaemia/) affecting them, or their unborn child is high. Your doctor will also suggest that you avoid fasting if you have high blood pressure, kidney infections, or heart problems **How can I ensure a healthy fast?** Firstly, tell your doctor or midwife that you are planning to fast and take their advice. They may wish to monitor you a little more closely during Ramadan. Dehydration is a risk, particularly during the long, hot summer months. If you start to feel dizzy, faint, weak and confused you should break your fast with a juice drink and a salty snack, to replace lost sugars, fluids and salts. To avoid this from happening, try not to overexert yourself; stay where it is cool and make sure you take in lots of fluids during suhoor and iftar. When you do eat, ensure that you consume plenty of food that has a high water content, for example, fruits, vegetables, soups and stews. Continue taking any supplements, such as folic acid and make sure that the food you eat at suhoor and iftar is nutritionally balanced. Consider eating foods with a low glycaemic index at suhoor, as these will release energy slowly throughout the hours that you are fasting. Examples include wholemeal pasta, wholemeal bread, bran-based cereals and beans. Finally, an option that works for many women is to fast on alternate days, or just at weekends. This reduces the number of days that need to be made up at another time and still enables the woman to feel like she is observing the holy month. Consider Nabta’s [at-home Physio](https://nabtahealth.com/product/at-home-physio/) if you consider fasting, have someone to guide you through. Fasting during Ramadan is a personal decision. Pregnancy can make it more of a physical challenge as the baby has additional nutritional requirements. Make sure the choice you make is well informed and that if you do choose to fast, prior to the start of Ramadan, ensure your overall health is good. **Sources:** * Al-Arouj, M, et al. “Recommendations for Management of Diabetes during Ramadan: Update 2010.” _Diabetes Care_, vol. 33, no. 8, Aug. 2010, pp. 1895–1902, doi:10.2337/dc10-0896. * Baynouna Al Ketbi, L M, et al. “Diet Restriction in Ramadan and the Effect of Fasting on Glucose Levels in Pregnancy.” _BMC Research Notes_, vol. 7, 24 June 2014, p. 392, doi:10.1186/1756-0500-7-392. * Danielewicz, H, et al. “Diet in Pregnancy-More than Food.” _European Journal of Pediatrics_, vol. 176, no. 12, Dec. 2017, pp. 1573–1579, doi:10.1007/s00431-017-3026-5. * Glazier, J D, et al. “The Effect of Ramadan Fasting during Pregnancy on [Perinatal](https://nabtahealth.com/glossary/perinatal/) Outcomes: a Systematic Review and Meta-Analysis.” _BMC Pregnancy and Childbirth_, vol. 18, no. 1, 25 Oct. 2018, p. 421, doi:10.1186/s12884-018-2048-y. * “Ramadan and Pregnancy.” _British Nutrition Foundation_, [www.nutrition.org.uk/healthyliving/nutritionforpregnancy/ramadanpregnancy.html](http://www.nutrition.org.uk/healthyliving/nutritionforpregnancy/ramadanpregnancy.html). * Ziaee, V, et al. “The Effect of Ramadan Fasting on Outcome of Pregnancy.” _Iranian Journal of Pediatrics_, vol. 20, no. 2, June 2010, pp. 181–186.
The holy month of Ramadan is a time for reflection and commitment to one’s faith. It is also an opportunity to spend time with loved ones, particularly at Iftar when family and friends come together to break their fast and socialise. Fasting between the hours of sunrise and sunset can be a psychological and physical challenge. It inevitably results in changes to the normal sleep pattern and a disruption to the body’s circadian rhythm. Dehydration is an issue, particularly in countries with a hot climate, and those who are fasting are encouraged to consume plenty of liquids between iftar and suhoor to replenish the lost fluids. So, at a time when the body is already under increased stress, is it safe to exercise, or should activity be kept to a minimum? #### **Should I exercise during Ramadan?** The answer may well be a surprise to some, but maintaining a reasonable level of physical activity can actually be beneficial. Experts recommend moderate exercise and explicitly discourage fasting Muslims from adopting too sedentary a lifestyle. Fasting without partaking in any exercise reduces [metabolism](https://nabtahealth.com/glossary/metabolism/), as well as physical strength and fitness; keeping active ensues that you stay healthy for the duration of the holy month. #### **What exercise is recommended?** The type of exercise depends not only on how physically fit you were prior to Ramadan, but also on when you are exercising. Vigorous, high impact exercise is only recommended after futoor, so that you can stay hydrated and replenish your nutrients straight afterwards. During the hours of fasting, high intensity exercises should be avoided as these will increase the amount of fluid lost, which, in turn, increases the risk of dehydration. Between suhoor and futoor, the best forms of activity include taking a brisk walk, or slow jog, or going for a bike ride. Use exercise machines at a low setting and, if you lift weights, consider reducing the load for the duration of Ramadan. Try to exercise in locations that have air conditioning. Also, bear in mind that Ramadan is a time when you are more likely to have disturbed sleep patterns, and, as a result, impaired vigilance and slower reaction times and as such you may wish to modify your usual training programme. #### **When is the best time to exercise?** If you choose to exercise before breaking your fast, aim for light exercises that will not cause you to lose too much body fluid. A good time to exercise is in the hour before iftar; this way your body will soon receive the required nourishment. This is ideal for those who use the breaking of their fast as a time of socialisation to be spent with family. However, if you feel particularly weak or dehydrated, you should avoid exercise until after you have eaten and replenished your blood sugar levels. If you exercise after iftar, try to wait for 2-3 hours so that your body has had time to digest the food. The advantage to exercising at this time is that you can continue to consume fluids as you work out and therefore, you can engage in heavier exercise. Another advantage is that lost fluids, salts and minerals can all be replaced at the pre-dawn meal, prior to starting the next day’s fast. Problems with exercising at this time, include finding facilities that are open at what would normally be considered to be ‘anti-social’ hours and fitting a workout into your own social schedule. The time between futoor and suhoor is typically quite hectic, involving socialising, eating, praying and sleeping. Depending on geographical location and time of year it may also be quite restricted timewise, so fitting exercise in, as well as everything else, might prove challenging. #### **If I want to exercise should I modify my diet at suhoor and iftar?** The main thing is to try and maintain a balanced diet at the times that you do eat. Increase your complex carbohydrate intake at suhoor. Eating the right sorts of carbohydrates (peas, whole grains and vegetables) will give slow energy release throughout the day. Avoid simple carbohydrates, such as sugars, fizzy drinks and baked goods, as they are low in nutrients and only provide short-term energy. Also include food with a higher fat content in your pre-dawn meal, as this will slow gastric emptying, meaning it will take longer for you to feel hungry and your body will have accessible energy for longer. Eat a nutritional meal at the break of fast and try to increase your protein intake. Consuming foods that are potassium-rich during iftar is also recommended, as potassium levels fall when body fluids are lost. Foods high in potassium include beans, leafy greens, potatoes and bananas. Maintaining hydration is essential, at both suhoor and iftar, so consume plenty of water and include foods that have high water content, for example fruits, vegetable, soups and stews. #### **Will fasting affect my performance?** This question is particularly relevant for athletes, who are keen to maintain their training schedule throughout Ramadan. You may wish to adjust the times at which you train to late at night and early in the morning, and it is also worth considering reducing the intensity of your exercise for the duration of the holy month. Studies have shown that whilst anaerobic performance reduces during Ramadan, aerobic power and muscle strength do not significantly change. The best way to maintain performance is to monitor your food intake between sunset and sunrise and try to avoid fatigue, by minimising sleep loss. Whilst keeping active during Ramadan is generally considered to be a positive thing, do take care of yourself. Consult a healthcare professional if you have any concerns and stop exercising immediately if you feel dizzy or nauseous, or experience chest pains. A big part of Ramadan comes from strengthening the communal spirit; taking the time to pray, eat and talk together as friends and family. Exercise and socialisation do not have to be independent events, for example, great pleasure can be obtained from taking walks as a family, either late at night, or first thing in the morning. Keeping active and healthy will help you observe the holy month and maximise your spiritual development. Try Nabta’s [energy booster](https://nabtahealth.com/product/energy-multivitamin-daily-booster/) and stay healthy **Sources:** * Baqer, H R. “Physical Activity during Ramadan.” _Hamad Medical Corporation_, Ministry of Public Health, [http://www.hamad.qa/EN/your health/Ramadan Health/Health Information/Pages/Activity.aspx](http://www.hamad.qa/EN/your%20health/Ramadan%20Health/Health%20Information/Pages/Activity.aspx). * Shephard, R J. “Ramadan and Sport: Minimizing Effects upon the Observant Athlete.” _Sports Medicine_, vol. 43, no. 12, Dec. 2013, pp. 1217–1241., doi:10.1007/s40279-013-0080-7.
It’s been over a month since Ramadan and the summer is on! The heat makes it so strenuous to out and get some exercise to shed the extra pounds gained during Ramadan. However, fear not, here are a few recipes that are low in carbs and high in protein to help you shed those pounds. This recipe takes no more than half an hour, so there’s no excuse to not get in the kitchen! ### Cooled Coconut Protein Oatmeal  **Ingredients:** * Porridge oats- 1 cup * Almond or coconut milk- half a cup * Almonds- handful * Banana – whole * Berries- handful * Protein bar – half a bar * Peanut butter- 1 large tablespoon **Method:** Prepare a cup of oatmeal made with almond or coconut milk- you can even make this the night before and leave in the fridge if you would like a cooler breakfast. Stir in a generous tablespoon of peanut butter. Sprinkle a handful of crushed walnuts and almonds on top. For greater sustenance you can even slice up rough pieces of your favourite protein bar or, for a fruitier meal, add in a sliced banana or your favourite berries! The oats are slow releasing energy and added protein from the nuts will keep you going for longer. **Recipe of The Day** ### Pakistani Omelette  **Ingredients:** * Eggs, 3-4 * Onion, half * Tomato, whole * Mushrooms, 4-5 * Ginger and garlic, 1 tablespoon of paste * Handful of spinach * Salt, chilli powder, black pepper, to taste * 25gms of feta * Fresh coriander **Method:** In a frying pan, put in a tablespoon of olive oil or ghee. Fry the onions, tomatoes, mushrooms, peppers, once sweated; add in the garlic, ginger and spices. Whisk up the eggs, and pour over the ingredients. Once cooked on the low heat, add in the chopped spinach and feta cheese and fold over. Sprinkle with coriander and serve! ### Spicy Shakshuka  **Ingredients:** * Can of tomatoes * One onion * One bell pepper * Tablespoon of garlic paste * Salt, black pepper, chilli powder, hot paprika, and tobasco (to taste) * Chopped parsley **Method:** In a skillet, fry the onions and peppers. Once sweated, add the garlic, chilli and add in the can of tomatoes. Cook on low heat for 20 mins. Add in the spices once the sauce has thickened. Use the back of a wooden spoon and make 3 or 4 grooves in the pan, and carefully crack the eggs in to the spaces. Place the pan in the oven or on low heat for 10-15 minutes until the eggs are set. Sprinkle some hot paprika, a couple shakes of tobasco, and finish with fresh parsley. ### Flourless Banana Pancakes  **Ingredients:** * 1-2 very ripe bananas * 2-3 eggs * 1/3 cup of almond or coconut milk * A teaspoon of vanilla extract * Half teaspoon of cinnamon * Honey/maple syrup/ yogurt/ berries/ nuts to your taste! * ¼ teaspoon of baking powder **Method:** In a large bowl whisk the eggs until runny and smooth. In another bowl, mash up the ripe bananas, add in the coconut/almond milk, keep mashing until smooth. Put the mixtures together in one bowl, add the baking powder, vanilla extract, cinnamon and whisk again until smooth. In a hot pan, add a tablespoon of coconut oil. Pour in a ladle of the mixture, cook until brown and flip over. Serve the pancakes hot, with maple syrup or honey, a dollop of Greek yogurt and your favourite berries. Crush some nuts over for more crunch! Also consider trying Nabta’s [Slim pack](https://nabtahealth.com/product/slim-multivitamin-healthy-digestion/) for better digestion.
