Ramadan and fasting after bariatric surgery

During the Holy Month of Ramadan, patients who have undergone bariatric surgery, including gastric banding, sleeve gastrectomy and gastric bypass, need to take special measures to avoid health risks.

Patients are advised not to fast during the first 12–18 months after bariatric surgery to help prevent malnutrition and medical complications.

Patients who have had bariatric surgery may face a number of challenges during Ramadan.

Altered eating behaviours and poor nutritional intake

Following bariatric surgery, patients are usually advised to have small, frequent meals, eat slowly, chew thoroughly, separate eating and drinking and stop when they feel satisfied. However, fasting for long periods may lead to a desire to consume larger quantities of food more quickly when breaking the fast. This can result in abdominal discomfort, nausea and vomiting, leading to dehydration, malnutrition and possible vitamin and mineral deficiencies.

Dehydration

Following bariatric surgery, you are advised to drink at least 1.5–2 litres of fluid throughout the day to stay hydrated and help prevent constipation. You are also advised not to drink quickly, drink large amounts in one sitting or eat and drink together. These restrictions, together with fasting, particularly during long summer days, can increase the risk of dehydration.

Dumping syndrome

Patients who take part in Ramadan may be at increased risk of experiencing dumping syndrome and/or diarrhoea because of the restricted meal pattern during fasting and the consumption of traditional foods such as sugary desserts and deep-fried foods when breaking the fast.

Vitamin and mineral deficiencies

Following bariatric surgery, patients are advised by their specialist dietitians to take regular vitamin and mineral supplements, which need to be spaced appropriately throughout the day. One of the challenges during Ramadan is that reduced stomach capacity may make it difficult to take all of the recommended vitamins and minerals within the shorter period between dusk and dawn and to space them appropriately. This may increase the risk of deficiencies.

Hypoglycaemia

The risk of hypoglycaemia, or low blood glucose, is increased when fasting for a significant period of time, for example more than 10 hours between Suhoor and Iftar.

Dietary and lifestyle recommendations during Ramadan

  • Break your fast with water, dried fruit such as dates or soup to prepare your body for the main meal, which you should try to eat after Maghreb prayer. Beginning Iftar with water will help to address dehydration from fasting. Having 1–2 dried dates will help to raise your blood glucose level after fasting for many hours.
  • Make sure your main meal includes protein-rich food, vegetables or salad and slowly released carbohydrates. Aim to fill half of your plate with protein and the remaining two quarters with vegetables and carbohydrates. Eat the protein-rich foods first, followed by vegetables and then carbohydrates.
  • If you are fasting for a long period, for example more than 10 hours, eating Suhoor too early may result in hypoglycaemia before Iftar. In these circumstances, have Suhoor as late as possible.
  • Avoid sleeping directly after eating as this may lead to acid reflux, abdominal discomfort and/or regurgitation.
  • Remember the Golden Rules: eat slowly, chew thoroughly, separate eating and drinking, stop when you feel satisfied and avoid fizzy or sugary drinks.
  • Avoid foods high in fat and sugar, such as traditional desserts or deep-fried meals, to reduce the risk of dumping syndrome.
  • Make sure you stay well hydrated. Begin Iftar with 200–250ml of water and aim to have at least 1.5 litres of fluid per day.
  • Continue to take your vitamin and mineral supplements as recommended.
  • Continue with your usual physical activity during Ramadan, but schedule it at an appropriate time. For example, exercise 2 hours after breaking your fast and have a snack afterwards to support post-workout recovery.

Example meal plan for Ramadan

Iftar

  • 250ml water
  • 2 dates

15 minutes later:

Grilled or curried lean chicken, fish or beef (100g) with a small portion of salad or cooked vegetables and one of the following:

  • 2 tablespoons of rice
  • 1 slice of bread
  • 1 chapatti

First snack

Choose one of the following:

  • 1 pot of high-protein yoghurt
  • 1 handful of mixed nuts and a piece of fruit
  • another high-protein snack from the list below

Second snack

Choose one of the following:

  • 1 protein shake
  • 250ml skimmed or semi-skimmed milk mixed with 2 tablespoons of skimmed milk powder

Suhoor

Choose one of the following:

  • 1 boiled or poached egg with 1 slice of wholegrain or granary bread, 2–3 tablespoons of beans, 1 slice of low-fat cheese, 3–4 olives and a tomato and cucumber salad
  • an egg, tuna, low-fat cheese or mixed bean sandwich made with 2 slices of wholegrain or granary bread and salad, with 1 piece of fruit
  • 1 pot of high-protein yoghurt topped with a small amount of mixed nuts or seeds and a portion of fruit

Aim to keep yourself well hydrated and consume at least 1.5–2 litres of sugar-free fluids.

Suitable bariatric snacks

  • mixed nuts and dried fruit, a closed handful
  • sliced apple or celery with 1 tablespoon of natural peanut butter
  • 2 oatcakes topped with cottage cheese and black pepper
  • 1 small pot of low-fat yoghurt and a portion of fruit
  • 1 small pot of high-protein yoghurt
  • a handful of carrot sticks with 2 tablespoons of hummus
  • 1–2 Ryvita crackers topped with oily fish, such as pilchards, tuna or salmon flakes
  • 5 crab sticks
  • 1 chicken drumstick
  • 1 hard-boiled egg
  • 2 rice cakes topped with 1 tablespoon of peanut butter
  • homemade fruit or vegetable smoothie prepared with skimmed milk powder or protein powder
  • 1 protein bar
  • 1–2 mini Babybel or cheese triangles
  • 2 slices of turkey
  • pumpkin seeds, a closed handful
  • low-fat yoghurt drink
  • 1 small bowl of mixed fruit salad
  • 1 small bowl of salad with a matchbox-sized portion of feta cheese, with 2 teaspoons of olive oil and lemon dressing
  • 250ml skimmed or semi-skimmed milk mixed with 1–1½ tablespoons of skimmed milk powder. You can add sugar-free flavouring if required

Dessert alternatives

  • sugar-free jelly
  • dried dates, no more than 3
  • low-fat custard
  • other low-fat and low-sugar traditional dessert alternatives

Contact the Bariatric Dietitians

If you have any questions, please contact the Bariatric Dietitians.

T: 020 3315 8161
E: chelwest.bariatric.dietitians@nhs.net

Contributors
Liz Alden