Khaberni - Today’s newsletter from the Institute of Family Health Care (one of the King Hussein Foundation's institutes) discusses the physiological effects of fasting on hydration, and offers evidence-based medical recommendations to maintain optimal fluid balance during Ramadan.
The newsletter provides the reader with an explanation for understanding body fluid balance, those most at risk of dehydration, daily fluid requirements, special considerations for certain medical conditions, the importance of salt balance, and the impact of climate.
During Ramadan, fasting abstains from food and drink for long hours ranging from 12 to more than 18 hours. Although fasting has spiritual, psychological, and also metabolic benefits, it poses physiological challenges, especially in terms of maintaining sufficient water intake. Maintaining fluid balance is essential to prevent dehydration, ensure the efficiency of organ functions, and maintain overall health.
** Understanding body fluid balance
Water makes up about 50–60% of the human body. Fluid balance is precisely regulated through various organs and mechanisms including the kidneys, hormones (such as antidiuretic hormone and aldosterone), and the thirst mechanism. These systems work to maintain:
- Blood pressure.
- Salt balance (sodium and potassium).
- Body temperature.
- Kidney functions.
- Metabolic processes inside cells.
When fasting, especially in the absence of fluid intake, the body relies on internal mechanisms to conserve water. In hot climates or over long fasting hours, the risk of dehydration significantly increases.
** Physiological changes during fasting
1 - Increased water retention: The kidneys reduce urine production through hormonal regulation.
2 - Glycogen breakdown: The body uses its glycogen stores for energy, which releases small amounts of water.
3 - Potential salt imbalance: A lack of fluids may disrupt sodium and potassium levels.
Mild dehydration can cause various symptoms including: (headache, fatigue, dizziness, dry mouth, poor concentration) whereas severe dehydration can lead to low blood pressure, kidney strain, heat stress.
** Groups most at risk
Some groups are more prone to dehydration during Ramadan, including:
- The elderly.
- Children and adolescents.
- Pregnant and breastfeeding women.
- Kidney patients.
- Diabetics.
- Those working in hot environments or under direct sunlight.
These groups should consult a doctor before fasting.
** Daily fluid requirements
An adult typically needs about 2 – 3 liters of fluids daily depending on weight, activity level, and climate. During Ramadan, it is necessary to compensate this amount between Iftar and Suhur.
General recommendations:
- Women: about 2 liters daily
- Men: 2.5–3 liters daily
And water should be the primary source of fluids.
** How to maintain fluid balance during fasting?
1 - Gradually spread fluid intake
Avoid drinking large amounts in one go at Iftar. Preferably:
1-2 cups of water at Iftar.
1-2 cups between Iftar and bedtime.
1-2 cups before Suhur.
Gradual drinking helps improve absorption and reduces excessive urination.
2 - Prioritize water over sugary drinks
Sweetened beverages, soft drinks, and energy drinks:
- Cause a rapid rise in blood sugar.
- May increase urination.
- Do not achieve effective hydration.
3 - Reducing caffeine
Caffeine found in (coffee, strong tea, carbonated drinks) has a mild diuretic effect and may increase fluid loss and cause headaches. Moderate consumption is recommended.
4 - Consuming water-rich foods
Some foods help support hydration, such as:
- Watermelon.
- Cucumber.
- Oranges.
- Lettuce.
- Tomatoes.
- Soup.
Starting Iftar with soup is an effective way to compensate for fluids and salts.
5 - Reduce salt intake
Salty foods increase the sensation of thirst. Preferably reduce:
- Processed foods.
- Pickles.
- Fast foods.
- Salty snacks.
A balanced, low-salt Suhur meal reduces thirst during the day.
6 - Avoid overindulgence in fatty and fried foods
Heavy and fatty meals:
- Slow down digestion.
- Increase metabolic load.
- May increase the feeling of dehydration.
Preferably consume balanced meals containing complex carbohydrates, protein, and healthy fats.
7 - Improve the Suhur meal
The Suhur meal should contain:
- At least two cups of water.
- Complex carbohydrates (oats, whole grains).
- Protein (eggs, yogurt).
- Fruits or vegetables.
Yogurt is a good choice as it includes fluids, protein, and salts.
8 - Modify physical activity
Intense physical activity during fasting increases fluid loss through sweating. Recommended:
- Exercise after Iftar.
- Avoid peak heat times.
- Wear appropriate and light clothing.
9 - Monitor dehydration signs
Warning signs include:
- Dark-colored urine
- Less frequent urination
- Persistent dizziness
- Rapid heartbeats
- Severe fatigue
In the presence of severe symptoms, it is advisable to break the fast to preserve health.
** Special considerations for medical conditions
- Diabetic patients
Dehydration may increase the difficulty of controlling blood sugar levels. Close medical monitoring is necessary.
- Kidney patients
Fasting may increase the burden on the kidneys. Medical consultation is necessary.
- Pregnant and breastfeeding women
Hydration is essential for the health of the mother and fetus/infant. Therefore, it is necessary to consult a doctor before fasting.
** Salt balance
Hydration is not limited to drinking water only, but also maintaining salt balance. Foods rich in potassium such as bananas and dates support cell functions. Typically, a healthy person does not need oral rehydration solutions unless in cases of extreme sweating.
** Impact of climate
In hot areas or during long fasting hours, fluid loss through sweating increases. Therefore, increased attention to night-time hydration is necessary.
