Disclaimer: What is outlined below is a generalization of scientific findings related to nutrition that I attempt to synthesize with traditional wisdom and practice. It is not a replacement for medical advice, nor is it intended to be a treatment plan for a medical condition. Any attempts to implement concepts below should be done under the supervision of a healthcare professional.

It is hard to blame anyone for being completely confused with the rapid pace at which new nutritional recommendations are being made. It seems like everywhere you look there are new fad diets circulating in the news, social media and celebrity Twitter feeds.

For Muslims in particular, this trend may elicit even more head shaking. After years of having to defend against skepticism and backhanded comments from incredulous individuals in dismay about our backward Fasting practices, everyone is talking about fasting like the concept never entered the mind of a human being ever on the face of the earth.

Frustration aside, there is a lot we stand to gain from the advances in understanding nutrition and fasting through a Western lens. Even the most traditional non-Western urban societies are much closer in resemblance to Western culture than their predecessors 1500 years ago.

'It is hard to blame anyone for being completely confused with the rapid pace at which new nutritional recommendations are being made. It seems like everywhere you look there are new fad diets circulating in the news, social media and celebrity Twitter feeds.' Amr Madkour, MDClick To Tweet

And that means as much as we recognize, for example, the negative impact of a Standard American Diet (SAD, the most fitting acronym in the history of the English language) we need the same framework that produced that lifestyle to understand how to address it.

Modern science may even shed light on the past to address these problems in ways previously unimagined.

I have taken this all to heart, leveraging my background in medicine and a predilection to self-experimentation to develop a plan that incorporates the best of both worlds and times.

This year for Ramadan, I have a very specific goal: to be in a state of nutritional ketosis for the duration of the month.

Now, before you tune out what may sound like a fad diet approach to the holy month, let me add that I believe that this is completely in line with our deen (religion/way of life), the Sunnah of our Prophet , and an integral part of the journey to self-actualization; living the best version of ourselves.

We can benefit from an exciting field of research without getting sucked into the hype and misinformation that inevitably arises from the commodification of a “new” discovery.

Instead of struggling to focus, beating back hunger pangs and crushingly heavy eyelids, I propose we can approach this month in a way that improves our focus on worship and self-discovery, the depth of our connection with our Lord, and our resilience to engage this world and meet its challenges.

A good place to start this conversation is the current state of affairs when it comes to the average Muslim and Ramadan.

'Instead of struggling to focus, beating back hunger pangs and crushingly heavy eyelids, I propose we can approach this month in a way that improves our focus on worship and self-discovery' Amr Madkour, MDClick To Tweet

Misinformation on Muslims’ Health & Ramadan

It is a safe bet that we will hear at least once during this month about the negative impact our contemporary Ramadan culture has on us.

I have heard prominent figures lecturing on this topic, and already during one khutbah (sermon) this month, quote statistics that the average Muslim gains 5-10 pounds during Ramadan. But in a recent review of the medical literature, I have not found many high-quality studies that support this claim.

In fact, a recent systematic review [1] from earlier this year that included 70 different studies and almost 3000 participants showed a statistically significant drop in weight and Body fat percentage in Muslims fasting around the world.

This is despite the fact that 11 of the 25 most obese countries in the world are Muslim-majority countries [2]. If anything, this is reassuring that despite our worsening problems with overweight, obesity, and associated health conditions, we still have the capacity to realize positive change in relatively short periods of time.

It is also evidence that our Creator has endowed us with a “physiologic fitra”; that is, an inclination for our bodily functions and processes to trend towards health under the right circumstances.

Our worldview is one of an integrated human being, without the distinctions between mind and body that is inherent in contemporary mainstream Western thought.

Our view holds there is a primordial nature to our being, and that would necessarily entail a physiologic aspect. More on this later.

It is quite natural to approach this month from the health angle. However, this approach is flawed because our imperative is to worship God , not to be beach ready.

Any objective other than fulfilling a commandment dilutes our sincerity in the act, and, at our peril, risks the rejection of an act of worship for being directed to other than God .

Rather, by utilizing our current understanding of metabolism, and approximating the physiologic states expected from the descriptions found in our tradition, we bring ourselves into closer alignment with the Sunnah for the sole purpose of perfecting God consciousness and worship.

With this in mind, let us reacquaint ourselves with examples from the tradition, but first a tiny bit of human metabolism.

Understanding How Your Body Functions

Most of us subsist predominantly on the burning of carbohydrates for fuel. We do this by eating or drinking a form of carbohydrates every day.

It is safe to say the vast majority of people in wealthy nations do this every single day, multiple times a day, for all of their lives (when was the last time you truly had nothing to eat for more than a day. If you can think of a time, usually it’s a major life event).

When our brain and muscles take their share of what is needed for their purposes, the rest of the sugar in our blood has to be stored in some way. That is either in the liver or as fat.

Our liver functions much like a savings account and our body fat much like a safety deposit box to store fuel in a different form of currency.

As long as we continue to use carbohydrates as a dominant source of energy, we have little incentive to use this stored energy. What’s more, the hormone used to signal excess-sugar storage (insulin) has to be sent out at higher levels to keep up with the increasing resistance of the body to dealing with all the excess supply.

This is the basic, highly simplified, start of metabolic syndrome (think: diabetes, high blood pressure, fatty liver disease, and obesity).

Even if it has not gotten to that point, if you can’t have a snack without crashing, you get hungry almost as soon as you stop being full, and your mood and level of focus throughout the day is highly dependent on having eaten, you may be struggling because you are completely dependent on this metabolic pathway to function.

The metabolism of a person who does not regularly have large sources of carbohydrates is quite different.

When carbohydrates are scarce, either because calories overall are limited, such as during times of food scarcity (intentional, as in time-restricted eating AKA intermittent fasting, or circumstantial, like famine), or because carbohydrates specifically are limited (think keto diet, very low carb diet, Atkins diet, etc), the body needs to use other sources of fuel.

When in need of energy, and dietary fats are available, fats are broken down into their basic parts, called ketones, which can be used throughout the body for energy.

When there are measurable levels of ketones in the blood, this is a state of nutritional ketosis.

When this happens regularly, the body, through a complex mechanism of gene signaling and activation will build the cellular apparatus to make use of ketones.

This process becomes increasingly efficient over time, and the body goes on to be adapted to ketosis, or “keto-adapted”. This source of energy does not require insulin to be available for your brain or muscles. As such, mental clarity and alertness is increased, the crash after sugar spikes is avoided, and a whole host of other beneficial cellular pathways in the body are activated.

In addition to weight loss, people frequently report better energy levels, focus, and relief from hunger.

When the consumption of food is time-restricted, such as fasting from sunrise to sunset, a whole host of physiologic processes come into play. These seem to play a major role in protection from obesity, cardiovascular disease, and endocrine dysfunction [3].

The immune system, for example, is directed towards the cells of our body that are malfunctioning to be broken down for energy.

Inflammation throughout the body decreases. This seems to be particularly important in the gut, which needs time to recover from the highly inflammatory activity of digestion. These two approaches to nutrition taken together may be a key to unlock some of the body’s most powerful tools for healing and health promotion [4].

So how do we reconcile this take on nutrition with the common recommendations to track all calories as the same, to eat small frequent meals, and to never skip a meal (especially breakfast because it’s the most important meal of the day)?

Essentially, most of what you have heard and what continues to be perpetuated about nutrition is, at best, misguided and outdated by about 20 years.

At worst, it has been heavily influenced by the food industry [5].

Eating multiple small meals a day does not help you lose weight, and skipping meals is not the worst thing that will ever happen to you (especially if it’s processed sugar for breakfast).

Eating fat is not what causes you to gain fat, and not all calories are the same. Restricting calories alone can help in weight loss for a short while, but study after study has shown that it almost always comes back because of the adaptive slowing of our metabolism [6].

'When the consumption of food is time-restricted, such as fasting from sunrise to sunset, a whole host of physiologic processes come into play. These seem to play a major role in protection from obesity, cardiovascular disease, and endocrine dysfunction.'Click To Tweet

The Prophetic LifeStyle & its Impact on the Body

Compare this with the example of the Prophet and his companions from the Seerah (biography of the Prophet ) and Shama’il (virtues and noble character of the Prophet ).

During that time the majority of people were not faced with the problem of excess. Indeed, hunger was the norm, as described in a hadith in which the Prophet would spend many consecutive nights and his family did not have supper, and most of the time their bread was barley bread. [Jami’ at-Tirmidhi].

The hunger would be so extreme at times, he and his companions would sometimes resort to tying stones to their stomachs to quell the pangs [Sahih Muslim].

On days there was no food in his blessed abode, the Prophet would declare himself to be fasting [Sunan Ibn Majah].

The Prophet stated “A human being fills no worse vessel than his stomach. It is sufficient for a human being to eat a few mouthfuls to keep his spine straight. But if he must (fill it), then one-third of food, one third for drink and one third for air.” [At-Tirmidhi]

That is, the expectation is for a few morsels. The division of filling the stomach in thirds is to limit the most that should be consumed.

He was also reported in hadiths to be muscular and have toned physique. “His chest and stomach were in line, but his chest was broad and wide. The space between his shoulders was wide. The bones of his joints were strong and large (denoting strength).” [Shama’il Muhammadiyah, The Noble Features of the Prophet].

If we were to guess which forms of metabolism were predominant in that community, which is more likely? If we add on top of that a regular practice of fasting, all while continuing the vigors of an active pre-modern lifestyle, there is little doubt in my mind that our predecessors spent a significant amount of time in a ketogenic state.

One last bit of evidence to consider is the hadith on the breath of those who are fasting in which the Prophet was reported to say:

“By Allah in Whose Hand is the life of Muhammad, the breath of the observer of fast is sweeter to Allah than the fragrance of musk.” [Sunan an-Nasa’i].

There is no doubt that dry mouth contributes to bad breath, which is common during fasting, and this hadith is usually taken to mean that despite our perception of bad breath, God is pleased by the act of worship that produces it; thus it is sweeter than musk.

However, ketosis also has an effect on the breath. One of the ketones made is acetone, which is released in the breath and has a very distinct fruity smell. I find that be a much more compelling explanation for what is being referred to in the hadith.

So, What’s The Point?

Now, it may appear that I am advocating for a keto diet. It’s not quite that. What I am advocating for is a cyclic ketogenic state that can arise by a combination of caloric restriction, time-restricted eating (the least of what we do in Ramadan), significantly reducing carbohydrates and getting most of our nutrition from healthy fat.

Ramadan is a time where most of these things can happen, especially the first two, and the duration is limited.

The body very likely needs a balance between these different states of metabolism, and there isn’t a one size fits all. It also can’t be done haphazardly.

Reducing our intake to the extent described in our tradition rapidly for someone starting from a SAD diet (which is generally unhealthy) is unwise as it would ignore some harsh realities. Those include the fact most of us are not physically prepared or adapted to do this because of our modern lifestyles, and our food itself is far different in nutritional density than previously.

Our soil is depleted and we have less variation in our diet. We have also lost a lot of the diversity of our gut flora that likely plays an essential role for physiology (something called the “disappearing microbiome hypothesis”).

This is essentially another disclaimer that, despite the potential benefits, this is not a casual affair; a game plan, including consultations with a nutritionist familiar with this diet, is of the utmost.

Done correctly, I believe, this has the potential to transform Ramadan for many of us who are motivated to excel in all dimensions of life.

Ramadan is an opportunity to engage in a process of self-discovery and deep introspection with predictable regularity, fueled by the powerful realization an entire ummah is engaged in the same process.

Our first responsibility in the fulfillment of the trust our Creator places upon us is the mind, body, and soul on loan to us. It is with and through them that we engage the Divine will.

Speaking from personal experience, the focus in worship and sense of connectivity I have found in a state of ketosis is nothing short of a gift from our Creator . That we have exchanged the traditional lifestyle for a modern one means having to use the tools of the scientific method to understand how the average Muslim can use their physiologic fitra to help them on their spiritual journey.

Our integrated vision of the human being, not a separated mind and body, means one cannot benefit from an act spiritually without benefiting physiologically and cognitively. The inverse, I pray and trust is also true.

Anything true and of correct guidance in this is from Allah , any faults are my own. If you suspect I am wrong, please let me know as I continue to learn from my mistakes. If you are certain I am wrong and take a strong objection to this, I would ask, only partly in jest, to show me your six pack.

References:

1. Fernando HA, Zibellini J, Harris RA, Seimon RV, Sainsbury A. Effect of Ramadan Fasting on Weight and Body Composition in Healthy Non-Athlete Adults: A Systematic Review and Meta-Analysis. Nutrients. 2019 Feb 24;11(2). pii: E478. doi: 10.3390/nu11020478. Review. PubMed PMID: 30813495; PubMed Central PMCID: PMC6412279.
2. http://worldpopulationreview.com/countries/most-obese-countries/
3. Melkani GC, Panda S. Time-restricted feeding for prevention and treatment of cardiometabolic disorders. J Physiol. 2017 Jun 15;595(12):3691-3700. doi: 10.1113/JP273094. Epub 2017 Apr 25. Review. PubMed PMID: 28295377; PubMed Central PMCID: PMC5471414.
4. Longo VD, Panda S. Fasting, Circadian Rhythms, and Time-Restricted Feeding in Healthy Lifespan. Cell Metab. 2016 Jun 14;23(6):1048-1059. doi: 10.1016/j.cmet.2016.06.001. Review. PubMed PMID: 27304506; PubMed Central PMCID: PMC5388543.
5. https://www.theatlantic.com/business/archive/2016/06/how-marketers-invented-the-modern-version-of-breakfast/487130/
6. Fothergill, E. , Guo, J. , Howard, L. , Kerns, J. C., Knuth, N. D., Brychta, R. , Chen, K. Y., Skarulis, M. C., Walter, M. , Walter, P. J. and Hall, K. D. (2016), Persistent metabolic adaptation 6 years after “The Biggest Loser” competition. Obesity, 24: 1612-1619.

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