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Ramadan is about both the spiritual and the physical.

On the spiritual side, the ninth month of the Islamic calendar is a time to reflect on virtues such as patience, sacrifice and thanksgiving. That focus is sharpened by physical self-restraint – most notably, by fasting from sunrise to sunset.

That can be done in a way that enhances health, experts say – but the observant also need to be aware of potential pitfalls.

So ahead of Ramadan, which is expected to begin the evening of March 10 in North America, here's expert advice about how to celebrate in the healthiest way possible.

Is fasting safe?

"Historically, it's been proven over and over again that fasting is actually very safe" for most people, said Dr. Babar Basir, an interventional cardiologist at Henry Ford Health in Detroit, where he's director of the acute mechanical circulatory support program.

A Ramadan fast is a type of intermittent fasting, he said, "and intermittent fasting has really taken off" as a way to lose fat without losing muscle. He noted that fasting can improve insulin levels and boost human growth hormone, which helps burn fat.

In 2021, a published in the Journal of the ·¬ÇÑÊÓƵ linked Ramadan fasting to lower blood pressure. Blood pressure results from other Ramadan studies have been mixed, although other research into fasting has shown it can be beneficial.

But that doesn't mean fasting is for everyone, Basir said.

People with chronic illnesses are among those the Quran exempts from the Ramadan fast. Basir said that would include people with Type 1 diabetes who need to have regular intake of sugar.

Dr. Manal Elfakhani, a registered dietitian and an assistant teaching professor in nutritional sciences at Penn State University in University Park, Pennsylvania, has counseled people with diabetes about fasting. Some find ways to fast, she said, but "my recommendation in the end is that a person should always consult with their physician."

Ramadan fasting can be more challenging than other types of intermittent fasting, said Nazima Qureshi, a registered dietitian in Toronto.

One big difference, she said, is that Ramadan fasting requires abstaining from water and other beverages. "This is a dry fast," said Qureshi, who co-runs a consulting business aimed at providing culturally tailored health advice for Muslims. "And the other big difference is the majority of the fasting hours are during the waking hours," whereas with intermittent fasting, most of the fasting hours might overlap with sleep, "making it a lot easier."

Qureshi said Muslims and their doctors need to understand who can be exempt from Ramadan fasting, which may also apply to children, older adults and pregnant women, among others. "The most important thing is making sure that we are healthy and it's safe," she said.

What about heart patients?

While studies have found that Ramadan fasting is safe for people with stable heart disease, it's "really important" for people with heart issues to make a plan with their cardiologists, Basir said, especially regarding medications.

Most cardiovascular medicines are taken once or twice a day, he said, "so those medications can be easily taken at the beginning and the end of fasting." Fasting might also affect the timing or function of diuretics, which are prescribed for high blood pressure.

How to handle mornings

It can be tempting to stay in bed instead of waking up for the suhoor, the pre-dawn meal, Elfakhani said.

"I've seen people skip this meal," she said, "and I don't think that's a good idea."

Suhoor is the last opportunity to nourish your body for the day, Qureshi said, and missing it sets you up for not feeling energized all day. The focus should not be about eating as much as you can before rushing out the door, she said, but "eating the right things."

Elfakhani suggested that the morning meal include a whole grain, a fruit or vegetable and a protein. The whole grain could be cereal, bread or oatmeal. Bananas, apples or strawberries are fine fruits. For protein, try a glass of milk, a cup of yogurt or some scrambled eggs.

Nuts can provide protein and healthy fat, and she said that people of Arab descent often enjoy olives, which also can be a healthy source of fat. (They also can have lots of sodium, so she suggests not eating more than five at a meal.)

Qureshi said that some families prefer having a dinner-type meal, "which is OK," as long it includes protein and some sources of complex carbohydrates, such as fruits, vegetables or whole grains.

The most important part of suhoor, she said, is "making sure you're drinking enough water."

Drink this, not that

Managing water intake is crucial. Exactly how much each person needs will vary, but "you should be drinking the same amount of water that you would be in a nonfasting day," Qureshi said.

Avoid sugary drinks, she said. And as tempting as they might be before dawn, Elfakhani recommends avoiding coffee and tea as well. They're diuretics, which can lead to fluid loss later.

Break each fast carefully

People can gain weight during a month of fasting, Basir said. How is that possible? "They eat poorly during the evenings when they break their fast."

The No. 1 mistake people make regarding Ramadan eating, he said, is choosing unhealthy foods and binge-eating at the evening meal.

That meal, called iftar, is a time for gathering with others, "sort of like Thanksgiving," Elfakhani said. "We're with our families, and we're just tempted to eat a little bit more than we probably should."

Qureshi puts it this way: "There's a lot of celebratory foods." They'll vary by culture, but many of them are deep-fried, appetizer-style foods, plus plenty of desserts. And after a day of fasting, people are hungry and tend to eat a lot in a hurry.

With some, one piece could be hundreds of calories, and most people don't stop at just one piece. "So, before you've gone into dinner, you've already had a couple thousand calories," Qureshi said. If you're doing that every single day for 30 days, she said, "you really start feel it."

A traditional approach to breaking the fast can actually be the healthiest, Qureshi and Elfakhani said. Many people choose to start with a glass of water, then eat one to three dates before heading off to the evening prayer, which takes 10 to 15 minutes.

During that time, your body will start to register it's being fed, Qureshi said, "and you don't have that extreme hunger anymore. So now, when you go back to the dinner table, you're able to make a calmer, more level-headed decision."

Eat well all evening

Elfakhani recommends "a good balanced meal" when breaking your fast. Avoid fried, salty foods. Emphasize healthy proteins and whole grains.

And vegetables, Qureshi added. Iftar meals tend to offer more refined carbohydrates than healthy fiber. That leads to digestive issues.

Don't forget to drink plenty of water, Basir said. And remember that calories add up during Ramadan the same as any other month. Many people will fit in a third meal at night, he said, "so their caloric intake for the day is about the same, if not more, than during a normal day. And this is really problematic for many patients."

What non-Muslims should know

Just being aware of what Muslims go through during Ramadan can go a long way, Basir said.

Small gestures help. "One thing that is universally helpful is not asking all the time, 'Do you want to go out to lunch?'" Basir said.

Elfakhani said that while fasting, her most productive hours shift to the evening, and her lectures are a little tougher when she can't drink water. She keeps that in mind when setting expectations for students who also are Muslim.

The effects of fasting are something all schools should keep in mind, she said.

"I wish sometimes that elementary schools would be a little bit more understanding" that households will function differently as kids are served late meals and families stay up later. She's grateful that her oldest daughter's high school sets aside space so fasting students don't have to spend the lunch hour in the cafeteria.

A reset for health

The spiritual aspect of the month does lead to having a more healthy, mindful attitude toward food choices, Elfakhani said.

"When you're asked to not eat and drink, you start to realize how much we take our meals for granted," she said, and many people think, "Oh, wow. I didn't realize how much I eat during the day."

Fasting for 30 days straight is not easy, she said, "but it is a very beautiful spiritual experience."

Scientific and religious recommendations do overlap during Ramadan, Basir said.

"Our Islamic faith actually really highly encourages us to be very healthy," Basir said. "We're really encouraged to eat natural foods, to be cognizant of the amount of food that we eat."

That makes the month an opportunity for change.

"My advice in this scenario is to use Ramadan as a springboard for making good healthy choices from a dietary standpoint," Basir said. If you can emphasize healthy habits for those 30 days, "they can become habits that you can carry for the rest of your year."