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Fasting during Ramadan: What dietitians need to know & how to help your clients

Mohamed, a dietitian from Egypt, shares tips for working with clients that participate in Ramadan and provides an example meal plan.

MRHS.jpgMohamed Rezk completed a B.Sc. in Biomedical Sciences from the University of Waterloo before completing his dietetics degree at Mount St. Vincent University. Mohamed currently works in his private practice, Re-Direct Nutrition Counselling, in Toronto and has a very strong interest in gastrointestinal diseases. He specializes in developing healthy and balanced lifestyles for his clients through behavioural reading & change. Mohamed grew up in Egypt and moved to Canada at the age of 20. This experience helped him realize the importance of learning about other cultures to help make his counselling more effective. You can reach Mohamed at He also blogs on his website:


Ramadan is the one month per year where Muslims fast from dawn until sunset every day by refraining from food, water, smoking, medications, and even gum. Pregnant and breastfeeding women, children, seniors, and those on important medications or requiring nutrition care (such as people with diabetes, renal failure, or patients on tube feeds) are exempt from fasting.

During this month, Muslims spend more time getting closer to God, refrain from bad habits, and focus on spiritual growth. This year, Ramadan starts on June 7th. In Canada, Muslims will be fasting 16-17 hours per day, which allows for only 7-8 hours to nourish their bodies and sleep. While Muslim countries cut down their workdays by half during Ramadan, this is not the case in Canada. The combination of high expectations at work or school, long fasting hours, and poor nutrition could be a disaster for Muslims’ health.


The only variable within control for Muslims during Ramadan is nutrition. If we, as dietitians, manage to improve our client’s nutrition for the hours they can eat, then we will maximize their productivity and help them emerge from Ramadan feeling well. Encourage your Muslim clients to complete blood work pre and post Ramadan as a tool for measuring their health and the effects of fasting. It provides interesting insights!

When counselling Muslim clients, it’s important not to tell them that fasting is unhealthy or wrong for them (unless they are part of the exempt population) as it will be viewed as disrespectful. No studies have demonstrated that fasting during Ramadan is dangerous for the healthy population. 
Focus on what your client should be eating and the frequency of meals. The key here will be getting in enough calories, micronutrients, and water. Do so by encouraging 4-5 small meals, with two hours at most in between. The rest is simply filling in those meals with the best choices.

Here are five key considerations when working with clients participating in Ramadan:

1) Understand fasting & medical issues

You will come across many Muslims with medical conditions who still choose to fast to fulfil their religious obligations or spiritual desires. The biggest concern for health care professionals is patients on important medications who choose to fast and skip them. As the Islamic faith forbids Muslims from partaking in an activity that causes physical self-harm, this could be used to illustrate that a client skipping medications may be acting against religious advice.

Use motivational interviewing. For example, “I heard that fasting is allowed as long as it causes no harm?” Followed by, “Skipping your medication may cause you severe health problems, how do you feel about that?”

2) Breaking the fast: Become familiar with common practices

Breaking the fast is one of the most important meals and is comparable to breakfast. The Muslim Prophet Muhammad advised us to fill a third of our stomach with food, a third with water, and leave a third empty. This ensures hydration and prevents overeating, which is a common problem while breaking the fast.


A common recommendation is to eat 5-6 dates soaked in one cup of milk. Many Muslims already do this but it’s neat to explain the science behind it: Dates are a potassium dense food, which aids in hydration and restores electrolyte balance. Milk is high in calcium, and water, and is balanced in macronutrients. This combination is perfect for restoring energy.

After breaking the fast with a snack, such as the dates and milk, it is recommended that Muslims go and complete sunset prayer (which usually takes 5-10 minutes) before they sit down to eat their main meal. This allows the body to absorb some of the nutrients and suppresses extreme hunger.

3) The importance of snacking

It is recommended to eat at least two small snacks between breaking the fast and going to sleep. Since the window for eating is tiny, it is best to focus on faster digesting foods.

For example:
  • Proteins with high absorption factors, such as egg whites, fish, skinless chicken, and whey protein.
  • Nutritious carbohydrates such as fruits and whole grains.

The last snack before going to bed should be higher in complex carbohydrates and good fats such as avocados, nuts, and seeds.

4) Suhour: Maximizing energy for the day

“Suhour” is a very important meal for fasting Muslims. This is when Muslims wake up 1-2 hours before their fast begins to eat one last meal (between 2-3:30 am). If this meal is properly balanced, it can help those fasting to remain high energy for the morning-noon portion of the day.

Advise your clients to prepare this meal before going to bed so they can sleep for as long as possible. A meal high in complex carbohydrates, fibre, slower digesting protein (such as the casein in Greek yogurt), and good fats is ideal to slow gastric emptying.

5) Putting it together: One-day meal plan example
  • 8:50 pm (breaking fast): 5-6 dates soaked in 1-cup milk or small soup
  • 8:55 pm: Complete sunset prayer
  • 9:05 pm (main meal): Skinless chicken breast + 1-cup brown rice + sautéed veggies with olive oil, and a fruit for dessert + 1-cup water or soup
      *2-cups water
  • 10:30 pm (snack #1): Fruit with low fat yogurt + 1-cup water
       *2-cups water
  • 11:30 pm (or 15 min before bedtime): Half-cup rolled oats + walnuts + blueberries + 1-cup milk or kefir + 1-cup water
  • 3:10 am (Suhour: 20 min before holding fast): Fava beans + eggs + ½-1 avocado + sprouted grain bread + Greek yogurt for dessert + 1-2 cups water

Ramadan provides a chance for Muslims to “cleanse” their lifestyle from bad eating habits and junk food. Since the time for eating is so small, it is important for those that are fasting to cut out nutrient poor foods and focus on eating nutritious ones.

The eating recommendations during Ramadan reflect a normal healthy lifestyle but over a condensed period. After Ramadan, advise your clients to continue these healthy habits over the course of a normal day. I have used Ramadan as an opportunity to start to develop a healthier lifestyle for some of my clients who come to me ready to change.

Editor’s note: Thanks for your great insights, Mohamed! Taking the initiative to learn about other cultures and their dietary habits can help your counselling be more effective. Practice-based Evidence in Nutrition has many great culturally adapted handouts to help you as well.
Do you have other tips to share for those participating in Ramadan? Please share your thoughts or questions for Mohamed below!
  1. Hi Saima,

    If you are able to express milf while fasting then this shouldn't be a problem. Make sure you are eating a nutritious menu. Dietitians of Canada have some guidelines for breastfeeding here:

    Ultimately, if you are unable to express milf because of fasting then my advice would be to not fast. Baby's nutrition and well-being is always a priority :)

    The sample meal plan would apply to you although I would increase the amounts of fruits (double).
  2. Very informative and insightful article Mohammad. Thanks for sharing!
    One of my neighbor, who are fasting approached me day before for some tips on fasting. They are visibly obese. I got concerned after I heard what they eat for breaking fast in the evening; fried chicken, spring rolls, pakoras followed by rice and curry meat.
    I am sure this article will be helpful to them.
  3. Very useful and much needed article. I am a breastfeeding mom of 1 year old i would highly appreciate if you can provide me with little guideline for the fasting during Ramadan.
  4. Thank you all for the great comments. Always puts a smile on my face.

    Dima yes I will be attending the conference. I will be presenting some research on post bowel resection diets at he abstract presentations as well. We should definitely connect :)

    Bushra it is always best to have the client/patient try fasting and monitor their condition. If they drop too low they should break their fast. It will vary depending on how severe their diabetes is. My views on pre diabetics or non insulin dependent diabetics is that their condition can be reversed and I have had 3 clients do so. Being dependent on insulin is a different story.

    Cristina that is an excellent point. The fried foods leaves no room for nutritious foods and can fill people up for a long time again preventing them from getting in good nutrition. It is a very big problem in the middle east and has carried over to Canada. I personally manage to avoid these scenarios but its a lot of work let me tell you that :)
  5. Excellent post. My family is muslim and we understand that having medical conditions are a contraindication for fasting.
    I am always concerned about a few family members eating samosas, pocoras, and fried foods to break fast which does not leave much for nutritious foods.

    Thank you for sharing your wisdom!
  6. Thank you Mohamed.. I loved this blog post. Let me know if you are planning to come to Winnipeg for DC conference. Would love to connect with you.
  7. Hi Beth,

    I find that most diabetics will still fast unless they're seniors and have other health complications. I have family members who are non insulin dependent and they fast.

    I would definitely be interested in helping out. Send me an email whenever you like :)
  8. Hi Mohamed
    Thank you foo your blog. Very interesting. you indicate that people with medical conditions are exempt e.g. diabetics. Any idea if most of them choose to be exempt or do they still fast?

    Several years ago I worked with a dietitian from Australia who was interested in developing some content for PEN on the topic of Ramadan and impact of fasting. I have reconnected with her to see if she is still interested in developing something.

    Perhaps we can "chat" via email.

    Beth Armour
    PEN Content Manager
  9. Thanks for this informative and timely blog. Dietitians are privileged to gain insights to other cultures through their food and special celebrations.
  10. Thank you for the positive comments :)

    Veronik-- It is very common to nap in Ramadan. Many Canadians will choose to do so after work and before breaking their fast. It's definitely more difficult for commuters or those waking up super early. There is also an exemption from fasting for travelers (long distance commuting) I think the distance is around 60 km (Although many still fast anyways)

    Pat-- Excellent question. Its a bit complicated but its measured according to prayer times. There are 5 prayers per day in Islam. Fasting begins at the observance of Fajr prayer (dusk/sunrise) and is broken at Maghrib prayer (Sunset).

    So according to this years calendar, Nunavut has close to 21 hours of fasting. Muslims there are allowed to fast according to the times of the closest country to them that is within the maximum limit. Fasting is not meant to be burdensome to that extent. So they will end up fasting 16-17 hours. Some choose to follow Mekkah in this case(Muslim holy city) which is close to 13 hours. I hope this helps a bit.
  11. Thanks for writing this article - it's very practical and informative.

    Is there a standard definition for sunset/sunrise times that dictated the times you chose for your sample meal plan? How might a Muslim household living in Nunavut handle this.... considering Ramadan is in June this year, it doesn't leave much time between sunset and sunrise!
  12. Very interesting info. To see it broken down like this is great - but there doesn't seem to be much time for sleep! I wonder if napping is common during Ramadan...

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