Top 5 tips for fasting with irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) is a functional disorder which affects the digestive system. Women living with IBS may need to make additional preparations and dietary and lifestyle adjustments during Ramadan.

A study on Ramadan Fasting Dietary Patterns and Gastrointestinal Discomforts¹ showed that most people did not have proper diets based on medical-nutritional principles during Ramadan. Despite the religious and medical recommendations to avoid overeating and high-sugar and high-fat foods, people consume high-calorie-dense meals in Suhoor and Iftar to eliminate hunger during fasting. It can be one reason for worsening IBS symptoms during Ramadan. The subgroup analyses of this study also showed that the total energy intake of women during Ramadan did not significantly change; however, it did represent that men were more physically active than women during Ramadan fasting. 

Preparing Suhoor and Iftar meals (however, trends are changing) may also affect sleep and movement. Changes in dietary routine and habits, sleep patterns, and less movement can exacerbate IBS symptoms. 

Here are the top 5 tips with IBS in Ramadan. 

1)         Diet at Suhoor & Iftar:

Eat mindfully at Suhoor and Iftar, and make sure that food is adequately chewed. Many people rely on coffee and tea at Suhoor. As much as it helps to wake up someone with IBS, it may cause stomach pain and diarrhoea. Therefore, intake of caffeine should be limited. There is also a growing trend of including fizzy drinks at Iftar, which should be avoided. They not only have caffeine but are carbonated; some may contain fructose corn syrup. All three of them are primary IBS triggers. Fried foods should be limited at Iftar as they may also result in abdominal pain and diarrhoea. People tend to overeat at Iftar. Break the fast with a light snack, and after Maghrib prayers, have the main meal. Try including a variety and watch the portion sizes of the meals. Keep a food and symptom diary and see which foods may or may not affect symptoms. 

2)         Hydration

Sufficient hydration is recommended for people with IBS. For instance, it has been shown that adults who consumed 2 litres of water significantly increased evacuation frequency and were associated with improved constipation.² Aim for around three glasses of water at Suhoor and 3-4 glasses post Iftar. Fruit juice, herbal/fruit teas, soups, curries, and fruit and vegetables with high water content will also contribute to hydration. 

3)         Sleep 

Sleep disruption can aggravate IBS symptoms, and during Ramadan, this is the case. Try taking short naps during the day.

Naps are necessary during Ramadan; even if 20 minutes are taken out of the day, it will help with energy and concentration levels. Make a sleep plan that works for you. Listen to your mind and body. 

4)         Exercise 

Low- to moderate-intensity activity can help relieve symptoms of IBS. A busy schedule and not feeling energetic overall may hinder movement. Therefore, include whatever is easy for you. It can be a short walk or yoga. 

5)         Managing IBS in Ramadan 

If you are on specific medication for your IBS, it is essential to discuss with your GP to correlate the medicines with the new meal timings. If you feel unwell, it is okay to have rest days and start again when you feel well enough to fast again. In Islam, there are exemptions for those who are ill or whose health could be adversely affected by fasting.  

Helpful Hints³

If symptoms include bloating and wind:

1. Limit intake of gas-producing foods, e.g. daals and beans, cauliflower, and onions.
2. You may find it helpful to eat oats at Suhoor. For example, it can be oat masala, oat chilla, cereal, or porridge. 
3. Include flax seeds (up to one tablespoon daily) at Suhoor or post-Iftar meal. 

If symptoms include constipation:

1. Try to include fibre-rich foods at both Suhoor and Iftar. Include whole grain roti, chapati, bread, and oats. Increase fruit and vegetable intake. Vegetables can be eaten as a curry, and fruit can be enjoyed as a fruit chaat. 
2. Try adding one tablespoon of flax seeds a day to your curry or Iftar drink. Ensure you have taken at least 150 ml of fluid with each tablespoon of flaxseeds.
3. Avoid eating extra wheat bran. 

If symptoms include diarrhoea:

1. Make sure you have plenty of fluid at Suhoor and Iftar. 
2. Limit caffeine intake from tea and coffee as much as you can. Try decaf teas or fruit teas. 
3. Avoid soft drinks. 
4. Try reducing your intake of high-fibre food (such as whole-wheat ata, roti, and chapati).
5. Avoid sugar-free sweets, mints, gum, and drinks containing sorbitol, mannitol, and xylitol.

Disclaimer: This blog does not replace the advice of your healthcare professionals and your treatment.

References: 

1. Jafari, T., Ganji, F., Batenipoor, M., Nasiri, J. (2021). ‘Ramadan Fasting Dietary Patterns and Gastrointestinal Discomforts’, Journal of Nutrition,Fasting and Health, 9(2), pp. 137-145. doi: 10.22038/jnfh.2020.45830.1247

• Salari-Moghaddam A, Hassanzadeh Keshteli A, Esmaillzadeh A, Adibi P. Water consumption and prevalence of irritable bowel syndrome among adults. PLoS One. 2020 Jan 24;15(1):e0228205. doi: 10.1371/journal.pone.0228205. PMID: 31978193; PMCID: PMC6980581.

• BDA Food Fact Sheet . Irritable Bowel Syndrome.https://www.bda.uk.com/resource/irritable-bowel-syndrome-diet.html