Main Article Content
Ramadan; Oriental foods; Oriental drinks; Dates, Diabetes, Licorice
Ramadan is a holy month of fasting for Muslims all over the world. It obligates a type of intermittent fasting from down to sunset. In oriental countries, Ramadan is linked to special foods and drinks like ingestion of dried fruits e.g. dates, apricot, figs, raisins and nuts; drinks e.g. carob, tamarind, hibiscus, sobya, doum, lemon, and licorice; foods e.g. yoghurt, beans and sugar rich desserts (kunafa and qatayef). Traditionally, these dietary habits are thought to improve vitality, but they were scarcely tested in scientific manner. Is there a health impact of oriental drinks and foods commonly used in Ramadan? This was the research question of this review.
In our search strategy, we used these dietary elements as key words in; Cochrane library, Web of Science (WoS), Ovid, Since Direct, Scopus, Directory of Open Access Journals (DOAJ), EbscoHOST, ProQuest, Institute for Scientific Information (ISI), EBESCO, Midline/Pubmed, Egyptian knowledge bank (EKB), Google scholar, or Research Gate. We review studies focusing the impact of each drink or food on health regardless fasting state. Studies focusing chemical structure or agricultural issues were not included.
Among the foods and drinks evaluated, ingestion of dried fruits (dates, apricot, figs, raisins), nuts, carob, tamarind, hibiscus, sobya, doum, lemon, yoghurt, beans, were found not only tolerable but also beneficial among healthy subjects and patients with chronic diseases.
The intake of licorice and sugar enriched desserts (kunafa and qatayef) should carefully be revised for patients with hypertension and diabetes due to slat retaining effect and high sugar content respectively.
1- Sakr AH. Fasting in Islam. J Am Diet Assoc 1975; 67: 17-21.
2- Emara MH, Soliman HH, Elnadry M, Mohamed Said E, Abd-Elsalam S, Elbatae HE, Zaher TI, Ezzeldin S Bazeed S, Abdel-Razik A, Youssef Mohamed S, Elfert A; “Egyptian Ramadan Fasting, Liver Diseases Interest Group”. Ramadan fasting and liver diseases: A review with practice advices and recommendations. Liver Int. 2021;41(3):436-448.
3- Ghnimi S, Umer S, Karim A, Kamal-Eldin A. Date fruit (Phoenix dactylifera L.): An underutilized food seeking industrial valorization, NFS Journal 2017; 6: 1-10.
4- Rahmani AH, Aly SM, Ali H, Babiker AY, Srikar S, Khan AA. Therapeutic effects of date fruits (Phoenix dactylifera) in the prevention of diseases via modulation of anti-inflammatory, anti-oxidant and anti-tumour activity. Int J ClinExp Med. 2014,15;7(3):483-91.
5- Alkaabi JM, Al-Dabbagh B, Ahmad S, Saadi HF, Gariballa S, Al Ghazali M. Glycemic indices of five varieties of dates in healthy and diabetic subjects. Nutr J2011;10:59.
6- Vinson JA, Zubik L, Bose P, Samman N, Proch J. Dried fruits: excellent in vitro and in vivo antioxidants. J Am Coll Nutr. 2005;24(1):44-50.
7- Tang ZX, Shi LE, Aleid SM. Date fruit: chemical composition, nutritional and medicinal values, products. J Sci Food Agric. 2013, 15;93(10):2351-61.
8- Rahmani AH, Aly SM, Ali H, Babiker AY, Srikar S, Khan AA. Therapeutic effects of date fruits (Phoenix dactylifera) in the prevention of diseases via modulation of anti-inflammatory, anti-oxidant and anti-tumour activity. Int J ClinExp Med. 2014, 15;7(3):483-91.
9- Ali A, Al-Kindi YM, Al-Said F. Chemical composition and glycemic index of 3 varieties of Omani dates. Int J Food Sci Nutr 2009; 60(S4): 51–62.
10- Miller CJ, Dunn EV, Hashim IB. The glycemic index of dates and date/yoghurt mixed meals: Are date the candies that grow on plants? Eur J Clin Nut 2003; 57: 427–430.
11- Al-Farsi MA, Lee CY. Nutritional and functional properties of dates: a review. Crit Rev Food Sci Nutr 2008;48:877–87.
12- Ibrahim M, Abu AlMagd M, Annabi FA, Assaad-Khalil S, Ba-Essa E, Fahdil I, et al. Recommendations for management of diabetes during Ramadan: update2015. BMJ Open DiabetesResearch and Care 2015;3:e000108.
13- Apricots, raw. Food Data Central. U.S. Department of Agriculture. Published April 1, 2019,available at: https://fdc.nal.usda.gov/fdc-app.html#/food-details/171697/nutrients.
14- Viguiliouk E, Jenkins AL, Blanco Mejia S, Sievenpiper JL, Kendall CWC. Nutr Effect of dried fruit on postprandial glycemia: a randomized acute-feeding trial. Diabetes. 2018, 11;8(1):59.
15- Cossu A, Posadino AM, Giordo R, Emanueli C, Sanguinetti AM, Piscopo A, et al. Apricot melanoidins prevent oxidative endothelial cell death by counteracting mitochondrial oxidation and membrane depolarization. Plos one. 2012;7(11), e48817.
16- Irwin SV, Fisher P, Graham E, Malek A, Robidoux A. Sulfites inhibit the growth of four species of beneficial gut bacteria at concentrations regarded as safe for food. PLoS One. 2017;12(10):e0186629.
17- Hernández-Alonso P, Camacho-Barcia L, Bulló M, Salas-Salvadó J. Nuts and Dried Fruits: An Update of Their Beneficial Effects on Type 2 Diabetes. Nutrients. 2017, 28;9(7):673
18- Al Rawi BJM, Al Ani LMA, Alywee AK. Study of Dried Apricot Effect on Type 2 Diabetic Patients as a Hypoglycemic Material Iraqi J. Comm. Med., Jan. 2012 (1): 82-87.
19- Mossine VV, Mawhinney TP, Giovannucci EL. Dried Fruit Intake and Cancer: A Systematic Review of Observational Studies. AdvNutr. 2020, 1;11(2):237-250.
20- Vinson JA, Zubik L, Bose P, Samman N, Proch J. Dried fruits: excellent in vitro and in vivo antioxidants. J Am CollNutr. 2005 Feb;24(1):44-50.
21- Lovejoy, J.C. The impact of nuts on diabetes and diabetes risk. Curr. Diab. Rep. 2005, 5, 379–384.
22- Da-Costa-Rocha I, Bonnlaender B, Sievers H, Pischel I, Heinrich M. Hibiscus sabdariffa L. - a phytochemical and pharmacological review. Food Chem. 2014, 15;165:424-43.
23- Riaz G, Chopra R. A review on phytochemistry and therapeutic uses of Hibiscus sabdariffa L. Biomed Pharmacother. 2018 Jun;102:575-586.
24- Serban C, Sahebkar A, Ursoniu S, Andrica F, Banach M. Effect of sour tea (Hibiscus sabdariffa L.) on arterial hypertension: a systematic review and meta-analysis of randomized controlled trials. J Hypertens. 2015;33(6):1119-27.
25- Najafpour Boushehri S, Karimbeiki R, Ghasempour S, Ghalishourani SS, Pourmasoumi M, Hadi A, et al. The efficacy of sour tea (Hibiscus sabdariffa L.) on selected cardiovascular disease risk factors: A systematic review and meta-analysis of randomized clinical trials. Phytother Res. 2020;34(2):329-339.
26- Hopkins AL, Lamm MG, Funk JL, Ritenbaugh C. Hibiscus sabdariffa L. in the treatment of hypertension and hyperlipidemia: a comprehensive review of animal and human studies. Fitoterapia. 2013;85:84-94.
27- Ojulari OV, Lee SG, Nam JO. Beneficial Effects of Natural Bioactive Compounds from Hibiscus sabdariffa L. on Obesity. Molecules. 2019, 8;24(1):210.
28- Nguyen C, Baskaran K, Pupulin A, Ruvinov I, Zaitoon O, Grewal S, et al. Hibiscus flower extract selectively induces apoptosis in breast cancer cells and positively interacts with common chemotherapeutics. BMC Complement Altern Med. 2019, 6;19(1):98.
29- Gouda M, Moustafa A, Hussein L, Hamza M. Three week dietary intervention using apricots, pomegranate juice or/and fermented sour sobya and impact on biomarkers of antioxidative activity, oxidative stress and erythrocytic glutathione transferase activity among adults. Nutr J. 2016, 12;15(1):52.
30- Fouad M, Moustafa A, Hussein L, Romeilah R, Gouda M. In-vitro antioxidant and antimicrobial activities of selected fruit and vegetable juices and fermented dairy products commonly consumed in Egypt. RJPBCS. 2015;6(2):541–50.
31- Melgarejo P, Calín-Sánchez A, Carbonell-Barrachina AA, Martínez-Nicolás JJ, Legua P, Martínez R, et al. Antioxidant activity, volatile composition and sensory profile of four new very-early AP (Prunus armeniaca L.). J Sci Food Agric. 2013;30:20–8.
32- Davis EA, Morris DJ. Medicinal uses of licorice through the millennia: the good and plenty of it. Mol Cell Endocrinol. 1991, 78(1-2):1-6.
33- NIH National Center for Complementary and Integrative Health. Licorice root. Updated December 1, 2016.
34- Raveendra KR, Jayachandra, Srinivasa V, Allan JJ, Goudar KS, Shivaprasad HN, et al. An extract of glycyrrhiza glabra (GutGard) alleviates symptoms of functional dyspepsia: a randomized, double-blind, placebo-controlled study. Evidence-Based Complementary and Alternative Medicine. 2012;2012:1-9.
35- Zadeh JB, Kor ZM, Goftar MK. Licorice (Glycyrrhiza glabra Linn) As a Valuable Medicinal Plant. International journal of Advanced Biological and Biomedical Research 2013; 1(10): 1281-1288
36- Stormer FC, Reistad R, Alexander J. Glycyrrhizic acid in liquorice evaluation of health hazard. Food Chem Toxicol 1993;31:303-312.
37- Armanini D, Bonanni G, Palermo M. Reduction of serum testosterone in men by licorice. N Engl J Med. 1999, 7. 341(15):1158.
38- Armanini D, Mattarello MJ, Fiore C, Bonanni G, Scaroni C, Sartorato P. Licorice reduces serum testosterone in healthy women. Steroids. 2004. 69(11-12):763-6.
39- Penninkilampi R, Eslick EM, Eslick GD. The association between consistent licorice ingestion, hypertension and hypokalaemia: a systematic review and meta-analysis. J Hum Hypertens. 2017. 31 (11):699-707.
40- Kumazawa S, Taniguchi M, Suzuki Y, Shimura M, Kwon M, Nakayama T. Antioxidant activity of polyphenols in carob pods. J. Agric. Food Chem. 2002; 50: 373-377.
41- Rasheed MG. A phytochemical study of certain Egyptian plants with antioxidant activity. M.Sc. thesis. Faculty of Pharmacy, Cairo University. 2006; 97-105.
42- Batlle I, Tous J. Carob tree. Ceratonia siliqua L. Promoting the conservation and use of underutilized and neglected crops, Rome, Italy: Institute of Plant Genetics and Crop Plant Research Gatersleben/International Plant Genetic Resource Institute.Bioactive Foods in Promoting Health Fruits and Vegetables 2010, Pages 245-263.
43- Ortega N, Macià A, Romero MP, Trullols E, Morello JR, Anglès N, et al. Rapid determination of phenolic compounds and alkaloids of carob flour by improved liquid chromatography tandem mass spectrometry. J Agric Food Chem. 2009, 26;57(16):7239-44.
44- Khatib S, Vaya J. Chapter 17 - Fig, Carob, Pistachio, and Health, In book: Bioactive Foods in Promoting Health 2010: pp.245-263. DOI: 10.1016/B978-0-12-374628-3.00017-7
45- Youssef MKE, El-Manfaloty MM, Ali HM. Assessment of Proximate Chemical Composition, Nutritional Status, Fatty Acid Composition and Phenolic Compounds of Carob (Ceratonia Siliqua L.), Food and Public Health 2012; 3 (6): 304-308.
46- Theophilou, I C, Neophytou C M , Kakas A, Constantinou AI. Carob and its Components in the Management of Gastrointestinal Disorders, J Hepatol Gastroenterol 2017; 1(1): 1:005.
47- Tsatsaragkou K, G. Gounaropoulos, I. Mandala. Development of gluten free bread containing carob flour and resistant starch. Food Science + technology. Science + Technologie Alimentaire, 2014, 58(1):124-129
48- Kumar CS, Bhattacharya S. Tamarind seed: Properties, processing and utilization. Critical Reviews in Food Science and Nutrition, 2008, 48: 1–20.
49- Almeida MMB, De Sousa PHM, Fonseca ML, Magalhães CEC, Lopes M de F G, Lemos TLG de. Evaluation of macro- and micro-mineral content in tropical fruits cultivated in the northeast of Brazil. Cienc Tecnol Aliment. 2009; 29(3):581–586.
50- Arshad MS, Imran M, Ahmed A, Sohaib M, Ullah A, un Nisa M, et al. Tamarind: A diet‐based strategy against lifestyle maladies. Food Sci Nutr. 2019;7: 3378–3390.
51- Gupta C, Prakash D, Gupta S. Studies on the antimicrobial activity of Tamarind (Tamarindus indica) and its potential as food biopreservative. International Food Research Journal 2014, 21(6):2437–2441.
52- Passosi TU, Sampaio HA, Sabry MO, de Melo ML, Coelho MA, Lima JW. Glycemic index and glycemic load of tropical fruits and the potential risk for chronic diseases. Food Sci. Technol, Campinas 2015, 35(1): 66-73.
53- Martinello F, Soares SM, Franco JJ, Santos AC, Sugohara A, Garcia SB, et al. Hypolipemic and antioxidant activities from Tamarindus indica L. pulp fruit extract in hypercholesterolemic hamsters. Food Chem Toxicol. 2006;44(6):810–818.
54- Khandare AL, Rao GS, Lakshmaiah N. Effect of tamarind ingestion on fluoride excretion in humans. Eur J Clin Nutri. 2002; 56(1):82–85.
55- Komakech R, Kim YG, Matsabisa GM, Kang Y. Anti-inflammatory and analgesic potential of Tamarindus indica Linn. (Fabaceae): a narrative review. Integr Med Res. 2019;8(3):181-186.
56- El-Beltagi HS, Mohamed HI, Yousef HN, Fawzi EM: Biological Activities of the Doum Palm (Hyphaene thebaica L.) Extract and Its Bioactive Components. http://dx.doi.org/10.5772/intechopen.74772.
57- Bayad AE . Influences of doum fruit Hyphaene thebaica extract on the reproductive parameters, blood picture, lipid profile and hepato-renal functions in rats. MRJMMS. 2016; 4:384-391.
58- Habib DF, Michael HN, Salib JY, Ahmed NM, Agaibyi MH. Hypolipidemic efficacy of Hyphaene thebaica In expermental nephrotic syndrome. International journal of pharmacy 2014; 4(3): 28-34.
59- Avello M, Jofré P, Pastene E, Fernández P. “Use of Citrus limon l. (lemon) in treating blood pressure sudden rises”. International Journal of Pharmacognosy and Phytochemical Research 2014;6(3): 606-611.
60- Chaturvedi D, Shrivastava Suhane RRN. “Basketful Benefit of Citrus Limon”. International Research Journal of Pharmacy 2016;7(6): 1-4.
61- Otang WM, Afolayan A.J. Antimicrobial and Antioxidant Efficacy of Citrus Limon, L. Peel Extracts Used for Skin Diseases by Xhosa Tribe of Amathole District, Eastern Cape, South Africa. S. Afr. J. Bot. 2016;102:46–49.
62- Klimek-Szczykutowicz M, Szopa A, Ekiert H. Citrus limon (Lemon) Phenomenon-A Review of the Chemistry, Pharmacological Properties, Applications in the Modern Pharmaceutical, Food, and Cosmetics Industries, and Biotechnological Studies. Plants (Basel). 2020,17;9(1):119.
63- Davidson, Alan (2014). The Oxford Companion to Food. Oxford University Press. pp. 33, 661–662. ISBN 9780199677337 – via Google Books.
64- "Qatayef with nuts"| Egyptian Cuisine and Recipes". egyptian-cuisine-recipes.com. Retrieved 2018-03-14.
65- Cornelis MC, Qi L, Kraft P, Hu FB. TCF7L2, dietary carbohydrate, and risk of type 2 diabetes in US women. Am J Clin Nutr. 2009;89(4):1256-62.
66- Livesey G, Taylor R, Livesey HF, Buyken AE, Jenkins D, Augustin L, et al. Dietary Glycemic Index and Load and the Risk of Type 2 Diabetes: A Systematic Review and Updated Meta-Analyses of Prospective Cohort Studies. Nutrients 2019, 11(6), 1280. https://doi.org/10.3390/nu11061280
67- Ojo O, Ojo OO, Adebowale F, Wang XH. The Effect of Dietary Glycaemic Index on Glycaemia in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Nutrients. 2018, 19;10(3):373.
68- Hosseinpour-Niazi S, Bakhshi B, Zahedi AS, Akbarzadeh M, Daneshpour MS, Mirmiran P, et al. TCF7L2 polymorphisms, nut consumption, and the risk of metabolic syndrome: a prospective population based study. Nutr Metab (Lond). 2021, 12;18(1):10.
69- Fernandez MA, Panahi S, Daniel N, Tremblay A, Marette A. Yogurt and Cardiometabolic Diseases: A Critical Review of Potential Mechanisms. Adv Nutr. 2017, 15;8[6):812-829.
70- Akın S, Özer FF, Şahin GG, Özer NT. Effects of Ramadan fasting on lean body mass in the older people. Eur Geriatr Med. 2020;11(1):163-168.
71- Hamdy O, Yuson BNM, Reda WH, Slim I, Jamoussi H, Omar M. DaR Practical Guidelines; the Ramadan Nutrition Plan [RNP) for Patients with Diabetes. International Diabetes Federation and the DAR International Alliance; Brussels, Belgium: 2016. pp. 81–85.
72- Karsen H, Güler EA, Binici İ, Taşkıran H, Yıldırım S, Koyuncu İ. Oxidant and antioxidant parameters in people who fast during Ramadan, and those who do not. Afr Health Sci. 2019;19[3):2713-2717.
73- Lessan N, Ali T. Energy Metabolism and Intermittent Fasting: The Ramadan Perspective. Nutrients. 2019;11(5):1192.
74- U.S. Department of Agriculture. Broadbeans (fava beans), mature seeds, raw: https://fdc.nal.usda.gov/fdc-app.html#/food-details/175205/nutrients
75- Lessan N, Saadane I, Alkaf B, Hambly C, Buckley AJ, Finer N, et al. The effects of Ramadan fasting on activity and energy expenditure. Am J Clin Nutr. 2018;107(1):54-61.
76- Harcke SJ, Rizzolo D, Harcke HT G6PD deficiency: An update. .JAAPA. 2019 Nov;32(11):21-26. doi: 10.1097/01.JAA.0000586304.65429.a7.PMID: 31609781