Ramadan fasting is observed by most of the 1.8 billion Muslims around the world. It lasts for a month per the lunar calendar year and is the abstention from any food and drink from dawn to sunset.
Outside of the pre-dawn to sunset window, Muslims can eat, drink, and take medications as normal. In a typical fast, they have a pre-dawn meal (termed ‘suhoor’) and a meal at sunset to break their fast (termed ‘iftar’). An Islamic lunar month can be 29 or 30 days and falls 11 days earlier each year compared with the Gregorian solar calendar. In temperate regions, when Ramadan falls in the winter, fasts are shorter. Conversely, summer fasts in some countries can be as long as 20 hours per day.
For cardiac patients
May be able to fast after medical advice:
Stable hypertension
Stable angina
Stable, non-severe heart failure: LVEF >35%
Implantable loop recorder
Permanent pacemaker (single or dual chamber)
Mild/mild-moderate valvular disease
Supraventricular tachycardias/atrial fibrillation/non-sustained ventricular tachycardia
Mild/moderate pulmonary hypertension
Who should not fast?
Poorly controlled hypertension (as defined by your specialist)
Recent acute coronary syndrome/myocardial infarction (<6 weeks)
Hypertrophic cardiomyopathy with obstruction
Severe valvular disease
Severe heart failure without advanced features
Poorly controlled arrhythmias (as defined by your specialist)
High risk of fatal arrhythmias (eg, inherited arrhythmia syndromes, arrhythmogenic cardiomyopathy)
Implantable cardioverter defibrillator ± cardiac resynchronisation therapy
Guidelines for first-time Ramadan fasting
Suhoor:
Start your day with a balanced meal that includes complex carbohydrates, protein, and healthy fats to provide sustained energy throughout the day. Opt for whole grains like oats, whole wheat bread, or brown rice. Include protein sources such as eggs, yogurt, cheese, or legumes. Drink plenty of water to prevent dehydration during the day. Avoid sugary and processed foods as they can cause energy crashes later in the day.
Iftar:
Begin your iftar with dates and water to replenish your body’s glucose levels and rehydrate. Consume a balanced meal that includes carbohydrates, protein, healthy fats, and plenty of vegetables. Choose lean protein sources like chicken, fish, tofu, or lentils. Incorporate a variety of vegetables to ensure you get a wide range of nutrients. Avoid fried and heavy foods, as they can cause digestive discomfort. Consume foods rich in potassium, such as bananas, to help maintain electrolyte balance.
Hydration:
Drink plenty of water between iftar and suhoor to stay hydrated. Avoid caffeinated beverages like coffee and tea.
Snacking:
If needed, have a light, nutritious snack like fruits, nuts, yogurt, or whole-grain crackers between iftar and suhoor to keep your energy levels stable.
Moderation:
Be mindful of portion sizes, especially when breaking your fast, to avoid overeating. Focus on quality rather than quantity, choosing nutrient-dense foods to fuel your body.
Physical activity:
Engage in light physical activity and avoid strenuous exercise.
Sadhvika Srinivas
@sadhvikaaa (dietitiansadhvika@gmail.com)
(Sadhvika is a clinical nutritionist who attends to metabolic disorders. She also works towards sports nutrition.)