1. Fasting Fasting guidelines for men, women, and chronic health conditions

2. General Fasting Guidelines Good nutrition is always needed Good nutrition is always needed Make wise choices for food Make wise choices for food Do not over-indulge Do not over-indulge Break your fast slowly, do not increase your blood sugar too rapidly Break your fast slowly, do not increase your blood sugar too rapidly Break your fast with something light like soup or dates Break your fast with something light like soup or dates

3. Food Pyramid 6-11 servings from the grain group 6-11 servings from the grain group 2-4 servings from the fruit group 2-4 servings from the fruit group 3-5 servings from the vegetable group 3-5 servings from the vegetable group 2-3 servings from the meat, Poultry, Fish, Dry beans, eggs, and Nuts group 2-3 servings from the meat, Poultry, Fish, Dry beans, eggs, and Nuts group 2-3 servings from the milk, yogurt, and cheese group 2-3 servings from the milk, yogurt, and cheese group Use Fats, Oils, and sweets sparingly Use Fats, Oils, and sweets sparingly

4. Grain Group Serving = Serving = 1 slice bread. ½ pita bread, bagel, bun, or English muffin. ½ cup cereal, rice, or pasta. 3-4 small crackers.

5. Fruit Group Serving = Serving = 3 dates. 1 apple, small banana, orange, nectarine. ¾ cup fruit juice. ½ cup berries. ½ cup diced, cooked, or canned fruits.

6. Vegetable Group Serving = Serving = ½ cup cooked or raw vegetables. 1 cup leafy raw vegetables. ½ cup cooked legumes.

7. Meat Group Serving = Serving = 2-3 oz lean, cooked meat, poultry, or fish 1 egg 1/3 cup nuts ½ cup cooked legumes

8. Milk Group Serving = Serving = 1 cup milk or yogurt. 1 ½ oz cheese.

9. Fats, Oils, and sweets include butter, margarine, salad dressings, oils, mayonnaise, cream, sour cream, sauces, dessert, candies, and soft drinks.

10. Remember What you eat is more important that how much you eat What you eat is more important that how much you eat Choose foods from each of the major food groups Choose foods from each of the major food groups Do not overindulge in sweats or “wasted- calorie” foods Do not overindulge in sweats or “wasted- calorie” foods Meal planning Meal planning

11. Fiber Fiber aids in maintaining the health of the digestive tract and help to prevent or control certain diseases. Some people suffer from constipation during Ramadan. Eating enough fiber is a good solution.

12. Fiber (cont.) Recommended amount of fiber is around 25 grams. Recommended amount of fiber is around 25 grams. Good sources of fiber are whole grains, legumes, fruits, and vegetables. Good sources of fiber are whole grains, legumes, fruits, and vegetables.

13. Water, Water, Water Any person needs to drink between 8 to 10 glasses of water per day Any person needs to drink between 8 to 10 glasses of water per day

14. Some good food choices to break your fast are: Fresh fruits Fresh fruits Fresh fruit juice Fresh fruit juice Porridge with skimmed milk and fresh or dried fruit (go dates!!) Porridge with skimmed milk and fresh or dried fruit (go dates!!) Low-fat natural yogurt with fresh dried fruits and seeds Low-fat natural yogurt with fresh dried fruits and seeds Boiled egg/grilled chicken/baked beans on whole meal toast Boiled egg/grilled chicken/baked beans on whole meal toast

15. Larger meal, a few hours later… Whole-meal bread roll without butter (herbs instead), filled with egg and tomatoes, chicken and salads, low-fat cheese and salad, or tuna with cucumber and tomato. Whole-meal bread roll without butter (herbs instead), filled with egg and tomatoes, chicken and salads, low-fat cheese and salad, or tuna with cucumber and tomato. Whole meal pasta with tomato based sauce, with a large salad Whole meal pasta with tomato based sauce, with a large salad Salad with fish, chicken, or low-fat cottage cheese. Add whole meal bread or rice Salad with fish, chicken, or low-fat cottage cheese. Add whole meal bread or rice Baked potato (no butter or oil) with tuna or low-fat cottage cheese Baked potato (no butter or oil) with tuna or low-fat cottage cheese Vegetables (raw) with hummus Vegetables (raw) with hummus

16. Good sahour foods…. Boiled egg with nan bread and fresh fruit juice Boiled egg with nan bread and fresh fruit juice Low fat yogurt sprinkled with granola and fresh fruit Low fat yogurt sprinkled with granola and fresh fruit Brain muffin, with scrambled eggs and white cheese Brain muffin, with scrambled eggs and white cheese

17. Golden Rules…. Avoid too much fat/sugar/salts and caffeine Avoid too much fat/sugar/salts and caffeine Always have fresh food available Always have fresh food available Stick to a low fat diet. Cut out fried foods Stick to a low fat diet. Cut out fried foods Choose fresh fruits and vegetables whenever possible Choose fresh fruits and vegetables whenever possible Eat sweets in moderation – high sweat intake can give thrush to breastfeeding babies, sugar is a great environment for bacteria to grow!!! Eat sweets in moderation – high sweat intake can give thrush to breastfeeding babies, sugar is a great environment for bacteria to grow!!!

18. Exercise You still need to exercise You still need to exercise Used to maintain you current fitness level and gain strength for a less difficult delivery Used to maintain you current fitness level and gain strength for a less difficult delivery Greatest appetite suppressant is exercise Greatest appetite suppressant is exercise 20-minutes of aerobic exercise it great!! 20-minutes of aerobic exercise it great!! When to do it? When to do it?

19. Caloric Needs Adolescents – about 2500 cal /day Adolescents – about 2500 cal /day Men- about 2200 cal/day Men- about 2200 cal/day Women – about 2000 cal/day Women – about 2000 cal/day Pregnant women – about 2400 cal/day Pregnant women – about 2400 cal/day Breastfeeding women – 2800 cal/day Breastfeeding women – 2800 cal/day

20. Fasting and for women 3 serving of milk, yogurt and cheese group are recommended for teenagers, young adult, pregnant/lactating women, and women past menopause. 3 serving of milk, yogurt and cheese group are recommended for teenagers, young adult, pregnant/lactating women, and women past menopause.

21. Especially important nutrition for women Iron Liver, beef, veal, Lamb, turkey Liver, beef, veal, Lamb, turkey Iron enriched breads and cereals Iron enriched breads and cereals Dried beans, green leafy vegetable, raisins, dried prunes, apricots Dried beans, green leafy vegetable, raisins, dried prunes, apricots Nuts and seeds Nuts and seeds Vit. C helps with the absorption of iron – drink orange juice Vit. C helps with the absorption of iron – drink orange juice

22. Nut. For women cont. Folic Acid Good sources of Folate Good sources of Folate Green leafy vegetables (Spinach, beets, and turnip greens), kidney, liver, beef, wheat products, eggs. Green leafy vegetables (Spinach, beets, and turnip greens), kidney, liver, beef, wheat products, eggs.

23. Nut. For women cont. Calcium Especially important for any woman for good bone development and management Especially important for any woman for good bone development and management Prevents osteoporosis Prevents osteoporosis Important for breastfeeding mothers-when the child breastfeeds it depletes your stores of calcium Important for breastfeeding mothers-when the child breastfeeds it depletes your stores of calcium Examples: Milk group (milk, yogurt, cottage cheese, cheese). Examples: Milk group (milk, yogurt, cottage cheese, cheese). Fish with bones (canned salmon), tofu Dark leafy vegetables, bok choy, broccoli, beans Figs, sunflower seeds, tahini, almond butter Calcium fortified soya milk, juices, and cereals

24. Fasting and Pregnancy Always consult your doctor about your wishes to fast Always consult your doctor about your wishes to fast It is strongly advised that you do not fast if you are suffering from Diabetes, Hypertensions, easting disorders, or digestive system disorders It is strongly advised that you do not fast if you are suffering from Diabetes, Hypertensions, easting disorders, or digestive system disorders During pregnancy the doctor may discourage you from fasting during the summer months due to the high likelihood of dehydration During pregnancy the doctor may discourage you from fasting during the summer months due to the high likelihood of dehydration Pregnant/breastfeeding women should drink at least a minimum of 2 liters of water every day in non fasting hours Pregnant/breastfeeding women should drink at least a minimum of 2 liters of water every day in non fasting hours

25. Fasting and preg. Cont. May get water in the form of non-caffeine drinks (ie. Juice, sprite,milk), limit two per day May get water in the form of non-caffeine drinks (ie. Juice, sprite,milk), limit two per day Caffeine (in tea and coffee) actually dehydrates you more Caffeine (in tea and coffee) actually dehydrates you more Low water consumption may make the pregnant woman experience “false” labor contractions called Braxton-Hicks contractions Low water consumption may make the pregnant woman experience “false” labor contractions called Braxton-Hicks contractions If this happens, break your fast, drink plenty of water, and rest. With these interventions the contractions should slow down and be irregular, if not contact your doctor If this happens, break your fast, drink plenty of water, and rest. With these interventions the contractions should slow down and be irregular, if not contact your doctor You may see a slight decrease in the amount that you can breastfeed You may see a slight decrease in the amount that you can breastfeed Feed baby more frequently during non-fasting hours Feed baby more frequently during non-fasting hours Make sure to drink high calcium beverages such as milk AND PLENTY of water when you are not fasting Make sure to drink high calcium beverages such as milk AND PLENTY of water when you are not fasting

26. Disclaimer for Late Pregnancy There has been research conducted showing that women that fast late in pregnancy have a harder time fasting and experience lower levels of blood sugar and excessive hunger (condition known as ‘accelerated starvation’) it may be necessary to defer fasting There has been research conducted showing that women that fast late in pregnancy have a harder time fasting and experience lower levels of blood sugar and excessive hunger (condition known as ‘accelerated starvation’) it may be necessary to defer fasting

27. Call the doctor Don’t be afraid to express your need/want to fast to your doctor- they are there for you Don’t be afraid to express your need/want to fast to your doctor- they are there for you Make a plan/contract with the MD Make a plan/contract with the MD

28. Fasting and Diabetes Speak with your doctor if you are on diabetic medication, adjustment of medication may be necessary. Speak with your doctor if you are on diabetic medication, adjustment of medication may be necessary. Especially if you are on insulin Especially if you are on insulin Do not overindulge during non fasting hours Do not overindulge during non fasting hours Continue your exercise routine Continue your exercise routine Test, test, test with your glucometer. Test, test, test with your glucometer.

29. LOW BLOOD SUGAR Weakness, dizziness, tiredness, poor concentration, perspiring easily, feeling shaky (tremor), unable to perform physical activities, headache, palpitations are symptoms of low blood sugar. Weakness, dizziness, tiredness, poor concentration, perspiring easily, feeling shaky (tremor), unable to perform physical activities, headache, palpitations are symptoms of low blood sugar. Plan certain important activities before the hunger of the afternoon, or see if they can wait till after you break your fast. Plan certain important activities before the hunger of the afternoon, or see if they can wait till after you break your fast. Causes in non-diabetics: Having too much sugar i.e. refined carbohydrates especially during the meal before Dawn (sehri or suhur). The body produces too much insulin causing the blood glucose to drop. Causes in non-diabetics: Having too much sugar i.e. refined carbohydrates especially during the meal before Dawn (sehri or suhur). The body produces too much insulin causing the blood glucose to drop. Remedy: Eat something at suhur (sehri) and limit sugar- containing foods and drinks. Eat more protein. Remedy: Eat something at suhur (sehri) and limit sugar- containing foods and drinks. Eat more protein. Caution: Diabetics may need to adjust their medication in Ramadan, consult your doctor. Caution: Diabetics may need to adjust their medication in Ramadan, consult your doctor.

30. Fasting and Constipation Constipation can cause pain and bleeding and can be associated with indigestion with a bloated feeling. Constipation can cause pain and bleeding and can be associated with indigestion with a bloated feeling. Causes: Too much refined foods, too little water and not enough fiber in the diet. Remedy: Avoid excessive refined foods, increase water intake, use bran and brown flour in baking. Causes: Too much refined foods, too little water and not enough fiber in the diet. Remedy: Avoid excessive refined foods, increase water intake, use bran and brown flour in baking.

31. Fasting and Indigestion Causes: Over-eating. Too much fried and fatty foods, spicy foods, and foods that produce wind e.g. eggs, cabbage, lentils, carbonated drinks like Cola also produce gas. Causes: Over-eating. Too much fried and fatty foods, spicy foods, and foods that produce wind e.g. eggs, cabbage, lentils, carbonated drinks like Cola also produce gas. Remedy: Do not over-eat, drink fruit juices or better still drink water. Avoid fried foods, add foods that produce a lot of gas ie. Cabbage. Remedy: Do not over-eat, drink fruit juices or better still drink water. Avoid fried foods, add foods that produce a lot of gas ie. Cabbage.

32. LETHARGY ('low blood pressure') Excessive sweating, weakness, tiredness, lack of energy, dizziness, especially on getting up from sitting position, pale appearance and feeling faint are symptoms associated with "low blood pressure". This tends to occur towards the afternoon. Excessive sweating, weakness, tiredness, lack of energy, dizziness, especially on getting up from sitting position, pale appearance and feeling faint are symptoms associated with "low blood pressure". This tends to occur towards the afternoon. Causes: Too little fluid intake, decreased salt intake. Causes: Too little fluid intake, decreased salt intake. Remedy: Keep cool, increase fluid and salt intake. Remedy: Keep cool, increase fluid and salt intake. Caution: Low blood pressure should be confirmed by taking a blood pressure reading when symptoms are present. Persons with high blood pressure may need their medication adjusted during Ramadan. They should consult their doctor. Caution: Low blood pressure should be confirmed by taking a blood pressure reading when symptoms are present. Persons with high blood pressure may need their medication adjusted during Ramadan. They should consult their doctor.

33. HEADACHE Causes: Caffeine and tobacco-withdrawal, doing too much in one day, lack of sleep, hunger usually occur as the day goes by and worsens at the end of the day. When associated with "low blood pressure", the headache can be quite severe and can also cause nausea before Iftar (Breaking Fasting). Causes: Caffeine and tobacco-withdrawal, doing too much in one day, lack of sleep, hunger usually occur as the day goes by and worsens at the end of the day. When associated with "low blood pressure", the headache can be quite severe and can also cause nausea before Iftar (Breaking Fasting). Remedy: Cut down caffeine and tobacco slowly starting a week or two before Ramadan. Herbal and caffeine-free teas may be substituted. Reorganize your schedule during the Ramadan so as to have adequate sleep. Remedy: Cut down caffeine and tobacco slowly starting a week or two before Ramadan. Herbal and caffeine-free teas may be substituted. Reorganize your schedule during the Ramadan so as to have adequate sleep.

34. MUSCLE CRAMPS Causes: Inadequate intake of calcium, magnesium and potassium foods. Causes: Inadequate intake of calcium, magnesium and potassium foods. Remedy: Eat foods rich in the above minerals e.g. vegetables, fruit, dairy products, meat and dates. Remedy: Eat foods rich in the above minerals e.g. vegetables, fruit, dairy products, meat and dates. Caution: Those on high blood pressure medication and with kidney stone problems should consult their doctor. Caution: Those on high blood pressure medication and with kidney stone problems should consult their doctor.

35. PEPTIC ULCERS, HEART BURN, GASTRITIS AND HIATUS HERNIA Increased acid levels in the empty stomach in Ramadan aggravate the above conditions. It presents as a burning feeling in the stomach area under the ribs and can extend up to the throat. Spicy foods, coffee, and Cola drinks worsen these conditions. Increased acid levels in the empty stomach in Ramadan aggravate the above conditions. It presents as a burning feeling in the stomach area under the ribs and can extend up to the throat. Spicy foods, coffee, and Cola drinks worsen these conditions. Medications are available to control acid levels in the stomach. People with proven peptic ulcers and hiatus hernia should consult their doctor well before Ramadan. Medications are available to control acid levels in the stomach. People with proven peptic ulcers and hiatus hernia should consult their doctor well before Ramadan.

36. KIDNEY STONES Kidney stones may occur in people who have less liquids to drink. Therefore, it is essential to drink extra liquids so as to prevent stone formation. Kidney stones may occur in people who have less liquids to drink. Therefore, it is essential to drink extra liquids so as to prevent stone formation. Avoid high calcium foods. Avoid high calcium foods.

37. JOINT PAINS Causes: The increased pressure on the knee joints during Salat. In the elderly and those with arthritis this may result in pain, stiffness, swelling and discomfort. Causes: The increased pressure on the knee joints during Salat. In the elderly and those with arthritis this may result in pain, stiffness, swelling and discomfort. Remedy: Lose weight so that the knees do not have to carry any extra load. Exercise the lower limbs. Being physically fit allows greater fulfillment, thus enabling one to be able to perform salat with ease. Remedy: Lose weight so that the knees do not have to carry any extra load. Exercise the lower limbs. Being physically fit allows greater fulfillment, thus enabling one to be able to perform salat with ease.

38. Questions? Please contact me via email if you need help determining you caloric needs or if you have any other questions Please contact me via email if you need help determining you caloric needs or if you have any other questions jsimpson@radford.edu Business: office hours