During the Holy Month of Ramadan, the necessity to partake in a total fast can pose significant challenges and risks to the health of people who have undergone weight loss surgery. Bariatric surgery patients should be aware of potential health complications when fasting. It is crucial for individuals to comprehend the associated risks before deciding to fast during Ramadan, allowing them to take specific measures to mitigate these health concerns. In this blog, we will delve into whether or not you can fast in the early days post-bariatric surgery, explore the challenges some may face when fasting, and provide tips on how to manage your diet whilst fasting.
Can you fast in the early days post-bariatric surgery?
In the first 12-18 months after surgery, it is advisable not to fast in order to prevent malnutrition and surgical complications. People who are physically incapable of fasting because of health reasons can decide to exempt themselves from fasting to maintain their health and wellbeing. It is strongly encouraged that individuals who have recently undergone a bariatric procedure (within 12-18 months) need to follow medical advice carefully and abstain from fasting. The body needs to make a strong recovery from the surgery and meeting nutritional requirements is paramount for this. Abstaining from fasting in the first 12-18 months following surgery will help the patient to enjoy an improved quality of life and to continue Ramadan fasting in the future.
Patients who have had bariatric surgery may face some challenges when fasting:
Malnutrition and dehydration
Patient are at risk of not meeting their nutritional requirements following bariatric surgery and fasting. In particular patients are at risk of malnutrition and dehydration and special care needs to be taken to avoid this. Meeting nutritional requirements becomes very difficult to achieve considering the window for eating and drinking is significantly reduced and there is a reduced capacity and only small amounts can be eaten on drank at one time.
Disordered eating behaviour
Building healthy eating behaviours can also be interrupted by fasting; it is difficult to eat small and frequent meals, eat slowly and mindfully and to separate out eating and drinking. It can be more difficult to tune into the body’s signals that it is full or satisfied when taking part in Ramadan and this may induce disordered eating behaviours and increase the risk of pain and discomfort when eating as well as reflux and regurgitation. All these factors can lead to dehydration, malnutrition and vitamin and mineral deficiencies.
Vitamin and mineral deficiencies
After bariatric surgery, patients are required to take regular multivitamin and mineral supplements. Fitting these in whilst fasting can be problematic since they can be quite filling and may put the patient off eating, or they might not be able to fit them in at all in the short time window that they can be consumed. This may result in some deficiencies. It is recommended that patients continue to take their vitamin and mineral supplementation during Ramadan.
Hypoglycaemia
When fasting for a significant period such as during the Holy Month of Ramadan there is an increased risk of hypoglycaemia (low blood sugar) which can have an impact on their quality of life and ability to safely drive and use machinery. This risk must be taken into account when considering taking part in Ramadan.
Dumping syndrome
Dumping syndrome and/or diarrhoea can be more of a risk to Gastric Sleeve or Gastric Bypass patients. This is due to the restrictions posed by the fast and the consumption of traditional foods like sugary desserts and deep-fried foods when breaking the fast.
How to manage your diet and lifestyle during Ramadan
- Start by breaking the fast with water, dried fruit, yoghurt or soup to get your body ready for the main meal. Following an extended period of fasting, your body might experience dehydration, making it crucial to replenish with sufficient water. Blood glucose levels may have dropped so aim to have a small snack of dried fruit such as 1-2 prunes with a few tablespoons of high-protein yogurt will help with bring up your blood glucose level steadily.
- Aim to get in at least 1.5L-2L of fluid in the day. Start with a small glass of water or milk.
- When it comes to your main meal remember to include a protein rich food such as beans, lentils, chicken, meat, dairy, meat or meat alternatives such as tofu or Quorn. Make sure you start with the protein first, then the vegetables and lastly the carbohydrate such as rice, chapatti or potatoes, if you have the room.
- Try to avoid going straight to bed after eating as this can cause issues such as acid reflux, abdominal discomfort and/or regurgitation.
- Follow the golden rules: take small bites, eat slowly, chew food well, stop eating once you are feeling satisfied, avoid drinking too soon after food, and avoid fizzy/sugary drinks.
- It is best to avoid foods that are high in fat or sugar such as deep-fried meals or sweet desserts as they may cause dumping syndrome.
- Always continue to take your vitamin and mineral supplements as advised by your team.
- Continue to keep yourself active although you may need to slow down a little during the times you are fasting to avoid hypoglycemia (low blood glucose). Be mindful that while fasting you might not have the energy to continue your usual exercise routine if you are particularly active. Ideally, exercise 2 hours after breaking your fast and then have a snack following your workout.
Example meal plan for Ramadan
Iftar
250ml water
2 dates with 2 tablespoons of high-protein yoghurt or lentil/chicken soup
15minutes later:
100g of grilled or curried lean chicken/fish/beef with a small portion of salad (or cooked vegetables) and 2 tablespoons of rice or 1 slice of bread or 1 chapatti.
First snack
High protein yoghurt or pudding pot or a small handful of nuts and a piece of fruit
Second snack
Hummus with vegetable crudites or 1-2 mini babybel cheese
Suhoor
1 boiled egg on 1 slice of wholegrain/wholemeal toast with 2-3 tablespoons of beans, 1
slice of low-fat cheese, 3-4 olives, tomato and cucumber salad.
OR
Egg or tuna or low-fat cheese or mixed beans
sandwich made with 2 slices of wholegrain or wholemeal
bread and sala and 1 piece of fruit
OR
1 tub of high-protein yoghurt topped up with a sprinkle
of mixed nuts/seeds and a portion of fruit.
Snack ideas
- Apple or celery with peanut butter
- Two oatcakes topped with cottage cheese and a few grapes
- Small handful of nuts and dried fruit
- Hummus with carrot and pepper crudites
- 1-2 ryvita crackers or thins topped with tinned sardines or tuna
- 5 crab sticks with cucumber
- 2 mini babybel with 1 rice cake
- 1-2 boiled eggs with salad
- Yoghurt drink such as keffir or ayran
- feta cheese and olives
- cup of warm milk with cinnamon or cardamon
- small handful of roasted chickpeas or edamame
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