Nutritional considerations during fasting in RamadanAssima Alam
A bit about the author
Asalam Alaykum. My name is Shazia. Alhamdulilah I qualified as a nutritional therapist in December 2019 following my previous role in primary care where I worked as a prescribing support pharmacist. My interest has always been in health and my journey continues to evolve. InshaAllah the advice below will help you throughout the remaining days of Ramadan and thereafter.
Ramadan and nutrition
Ramadan is an exceptional time of the year. The month brings manifold blessings and people unite across the globe to partake in the magnificent rewards on offer by engaging in worship in all its beautiful forms.
One of the tools we have at our disposal to ensure we are in optimal form for worship is to provide ourselves with balanced nutrition. In order to achieve the latter, it is important to avoid blood sugar imbalances to sustain energy levels. When fasting is undertaken properly, i.e. by consuming foods that provide nourishment to the body, many secondary benefits may also be attained including a healthy weight, improvements in lipid profiles and gut health as well as improved insulin sensitivity.
The following thus presents some advice around the preparation and actions one may engage in to support oneself in achieving and exceeding their Ramadan goals.
Note: Please be advised about the generic nature of these recommendations. If you are taking medication, have a chronic illness, are pregnant or breastfeeding or fall into any other ‘special group’, please contact your medical professional for advice as there may be recommendations here that may not be appropriate for you.
Much joy is experienced in opening the fast and consequently it is easy to eat excessively as well as to eat too fast.
During periods of fasting, the ability of the stomach to accommodate food as it did previously is altered, hence it is recommended to consume food in small quantities to avoid discomfort such as bloating for example. Having an odd number of dates and some water to break the fast is ideal allowing the stomach to begin accepting the food. Chewing well allows the effective breakdown of food and reduces the digestive workload on the stomach. Furthermore, allowing a small interval before consuming the main meal by attending to the prayer is useful in avoiding overwhelming the digestive system. If you feel you need a bit more to sustain your focus in the prayer, however, then you may consume a small piece of fruit e.g. piece of apple with a few nuts (if you can have them) to avoid any initial erratic blood sugar fluctuations.
Whilst we can survive without food for days, we cannot go without water for more than two to three days.
An average adult is composed of about 60% water which serves many essential roles in the body including substrate transport, metabolism, temperature regulation and circulatory function. It is no surprise therefore that long hours of fasting may result in dehydration if insufficient water is consumed during feeding hours. The latter may manifest itself in cognitive, physiological and performance impairment depending on the severity with symptoms including thirst, headache and fatigue.
So how much water are we supposed to drink?
We are commonly advised to drink eight glasses of water a day, but is this applicable to everyone? The answer is that daily intake is individual depending on factors such as age, time of year, climate, diet and level of physical activity undertaken. So how can we work out the amount we need to consume individually?
The Institute of Medicine (IOM) recommendation for men is a minimum of 101 ounces of water per day (approximately 13 cups) whereas women are advised to drink at least 74 ounces (just over 9 cups). There are also recommendations for other groups of people including pregnant women and children. Of course, quantities may need to be reviewed depending on any specific circumstances of the individual (e.g. in those with certain medical conditions).
How do you achieve this intake practically? It’s probably best achieved by dividing your daily intake over the hours between iftar (time of breaking the fast at sunset) and suhur (time after which fasting begins) and drinking the calculated portions over the time intervals available. For example, if your intake is 50 ounces daily and the feeding window is from 9pm to 3am (6 hours), you could consume around 7 ounces of water within every hour between these times. Please note – daily water consumption must be divided throughout the drinking period – there is harm in consuming it all in one sitting as well as consuming too much – namely water intoxication and hyponatraemia (excessively low blood sodium) with severe cases resulting in serious complications.
There are several ways to remind yourself to drink including measuring out your daily amount into a large marked bottle and taking portions every so often as marked or by using a water reminder app. If you keep a jug of filtered clean water where you see it all the time, it will also prompt you to drink.
It is worth noting that water intake may be achieved by different means including herbal teas (naturally caffeine-free), home-made flavoured waters e.g. lemon and lime squeezed into the water and also through foods with high water content e.g. cucumber and watermelon. Try to avoid caffeinated beverages such as coffee and tea which can have a diuretic effect, hence increase water loss through frequent urination.
Remember – improving hydration will support better focus and therefore better worship!
So, let’s talk fat!
If you’re confused about whether fats are good or bad and also which fats to consume, you’re not alone…
Fats are an important macro-nutrient that we require in our diet to function efficiently.
For instance, fat has a role in hormone and energy production, organ protection and insulation as well as nutrient absorption of fat-soluble vitamins A, D, E, and K. Fat makes up almost 60% of our brains and every body cell is housed in a membrane composed of fat! It makes sense to take the time to really understand this nutrient so that we can make the best choices in achieving our best health.
Physically, fats may exist as liquid (oils) or solids at room temperature due to their chemical structures.
Things start to get complex when we divide fats into their various categories. We commonly hear about our foods containing saturated and unsaturated fats but may not be so familiar with trans-fats – fats that are largely produced artificially by chemical methods.
Saturated fats are generally animal-derived and are found in foods such as beef, lamb, full-fat milk, butter, cheese and coconut oil.
Unsaturated fat sources however are subdivided further into monounsaturated fatty acids (MUFAs) and polyunsaturated fatty acids (PUFAs).
Olive oil, nuts (e.g. almonds and cashews), as well as avocados, are sources of MUFAs whilst PUFAs are divided further into omega 3 and omega 6 fatty acids, also known as essential fatty acids which cannot be synthesised by the body and are therefore obtained from the diet.
Oily fish such as salmon, mackerel and sardines are excellent sources of omega 3 fats with some also obtained from plant-based options such as walnuts and flax.
Walnuts also contain omega 6 fats, the latter of which is also found in foods such as sunflower seeds, almonds, soy and vegetable oils.
Like in the case of walnuts, there are foods that actually contain a mixture of fats, hence allocating them to specific categories is an oversimplification when it comes to determining consumption of a particular fatty acid.
Comparatively, chemically synthesised trans-fats may be found in the more processed food groups including baked goods (cookies and cakes), fried foods, processed snacks and margarines.
It’s easy to see from the above how fats can be complicated to understand and the complexity only increases when we look at which are best for us to consume. There are no hard and fast rules about what to consume as not all fats are created equally. Rather, good fat intake is about the choices we make and the portions we consume – very much like another macronutrient I’ll be talking about soon.
So, what does the guidance state when it comes to fat consumption?
The Department of Health (DoH) recommends that for adults of an average population, fat should constitute about 35% of food energy or less with saturates at 11% or less. Trans fatty acids should be no more than 2%, whilst MUFAs and PUFAs around 13% and 6.5%.
It is important to note that compared to other macro-nutrients, fat provides more energy per gram – yielding 37 kJ (9 kcal). Fat intake based on standard daily calorie intake is calculated at 70g (of 2000kcal) for women and 95g (of 2500kcal) for men.
Fat is important for optimal health. So, what types of fats should or should we not consume?
Research shows trans fats have adverse effects on health such as an increased risk of coronary heart disease. The guidance is clear on minimising consumption and ideally, these fats should be phased out of the diet as soon as possible to minimise longer-term poor health consequences.
Where are these fats found?
Fried fast foods, baked goods e.g. cakes, pastries and doughnuts as well as margarine. It is worth reading the ingredients list to check if these fats are listed.
This is tough, I know! I have been there and it isn’t an easy journey with temptations all around. There are alternatives thankfully. The online world is full of recipes that are healthy, delicious and so easy to make to satisfy any sweet tooth! A popular choice in our home has been date and seed protein balls – ready in minutes and requires no cooking! Enjoy in moderation and every so often.
PUFAs – Omega 3 and 6
Excessive consumption of omega 6 fats in foods such as vegetable oils (e.g. sunflower or soybean oil) is associated with an increased prevalence of inflammatory disease since these fats promote inflammatory pathways whilst reducing beneficial anti-inflammatory effects of omega 3 fats.
Chronic health conditions such as cardiovascular disease, obesity, arthritis, asthma and Alzheimer’s disease as well as mental health disorders such as depression may all be linked to this imbalance.
Omega 6 over-consumption alters cell membrane structure and fluidity thereby changing cell function and cell communication leading to suboptimal functioning.
What food sources contain Omega 3 fats?
Excellent sources include wild-caught salmon, sardines and herring. Omega 3 fats may also be found in non-animal sources including walnuts, chia and flax.
MUFAs are another form of beneficial fats shown to have favourable effects on health including cardiovascular risk factors, weight, blood glucose and body composition. Excellent sources of MUFAs are found in olives and virgin olive oils as well as in avocados. Such amazing taste and so easy to incorporate into your diet. Try them in a salad or include as part of a main meal.
Found predominantly in animal sources but also in coconut oil.
These fats have carried a lot of negative connotation despite there being mixed or inconclusive evidence of links to unfavourable health outcomes.
It is due to this that we may see mixed advice regarding consumption. Some studies have shown saturated fat to increase low-density lipoprotein – LDL (“bad” cholesterol) – which is one risk factor for heart disease. A direct relationship between saturated fat and heart disease, however, has not been established, as is also the case in associating with stroke. Other studies, however, have found no increased risk of cardiovascular disease with saturated fat when compared to the consumption of vegetable oils.
So, what do we take from this?
Fats are not created equal and when we consider that there are different types of saturated fat with varying effects on health, this can help us to understand one reason why we may see conflicting research – does a diet based on fried and processed food have the same effect as another based on coconut oil and grass-fed organic meats?
It is also useful to consider that a macronutrient singled out for scrutiny is not as meaningful as considering the whole diet – nutrients interact within the body in complex ways.
Considering fats are important in our diet, quality fats are even more useful in times of fasting. The higher calorie content provides more energy to keep going through non-feeding hours whilst supporting blood sugar balance as they slow down digestion and maintain satiety for longer.
Quality is key and quantity can be determined using information labels on foods or more accurately through a nutrition tracking application that will add up the fat content of the foods you consume daily. There will be individuals who benefit from more tailored recommendations to support health goals, so it may be worth seeking out and working with a nutritional therapist.
Add some good fats into your next meal!
Carbohydrates are another macro-nutrient making up our diet and consist of sugars, fibre and starches.
The guidance states that at least 50% of our energy should come from carbohydrates and this mainly from starch. Dietary energy is supplied by sugars and starches with 1 gram providing 3.75 kcal (16 kJ). The fibre content from plants, however, is not absorbed and has an important role in maintaining a healthy digestive system.
Foods rich in carbohydrates include fruits, vegetables, whole grains and sweet potatoes.
Carbohydrates, like the other macro-nutrients, may be subject to scrutiny when it comes to health benefits. The key message from such debates is to focus on the correct portion and the correct form when these foods are being consumed i.e. the unrefined version in which the food naturally exists without having been modified in any way. So, for example, you may have a portion (about a quarter of your plate) of brown rice or whole-grain pasta) as part of your meal.
We all know how important fruit and vegetables are in our diet. These are wonderful sources of carbohydrates, vitamins, minerals and fibre. Some fruit has a higher natural sugar content than others e.g. grapes and mangos, so this is important to take into account when choosing your fruit. In terms of portions, previous advice was to consume five-a-day but this is now looking more like ten-a-day following on from studies indicating the additional benefits to health. It is important to know that the majority of this should come from vegetables – around seven portions with the rest from fruit. This will help manage your sugar whilst giving you that all-important fibre.
Know your portion sizes, consume a rainbow of fruit and vegetables (as many colours and varieties as possible) and use as many different methods to get them in. Soups and smoothies are excellent options to help reach the ten-a-day target, especially if you are not getting any or minimal portions in at present.
Vegetables like cauliflower and green beans will provide insoluble fibre which is important for bulking the stool. Try steaming these vegetables with herbs and spices as a side to your main meal. Soluble fibres have been shown to have a beneficial effect on cholesterol and supporting heart health; these can be found in foods such as oats and apples. Fibres are also beneficial in our diet as they feed our gut bacteria. Try soaking oats overnight in milk adding cinnamon and chia seeds for a healthy breakfast/suhur. Grating some apple on top before serving will enhance the flavour and provide additional health benefits.
Refined carbohydrates – as the name suggests – have been modified. They cause what many identify as the ‘blood-sugar roller coaster’ where blood sugar levels peak and then crash triggering cravings. These foods also lack essential nutrients making these options far from ideal. Examples include simple sugars found in sweets, biscuits, white bread and cereals and soft drinks.
What can you choose instead?
Replacing the white refined sugar we are all familiar with is definitely a good move and there are a number of alternatives to choose from. These all have their own benefits and can be enjoyed sensibly as part of a balanced diet. Examples include date syrup, organic honey, pure maple syrup and coconut sugar. It is important to avoid artificial sugars/sweeteners and products that contain high fructose corn syrup – always read the label before buying.
Fried foods are a particular problem during Ramadan with foods such as samosas and pakoras being frequently served at iftar. It is advisable to avoid these foods as they will cause exhaustion and fatigue. In addition, the fats used to fry these foods are often damaged which cause havoc in the body and the high salt content makes an individual more prone to the increasing experience of thirst. There is also strong evidence that suggests a greater risk of chronic disease development with frequent consumption of fried foods (i.e. four or more times per week).
What can you do instead?
Air frying has become increasingly popular and uses less oil than traditional deep frying. The evidence, however, does not point to this cooking option as the most appropriate, as the food is still being fried. Work towards substituting healthier cooking methods such as steaming, sautéing and baking to avoid the adverse effects of fried foods on health.
Protein is an essential macro-nutrient composed of individual units known as amino acids. Some of these are made by the body whereas others, known as essential amino acids need to be obtained from the diet.
Protein is used to synthesise muscle, enzymes and signalling molecules including hormones and neurotransmitters. Deficiency of protein may result in an array of problems including poor growth (stunting), anaemia, physical weakness and impaired immunity.
It is important to consume good quality protein from animal and plant sources unless of course, you follow a particular diet e.g. veganism. Animal proteins contain more essential amino acids and are more digestible than their plant counterparts. In excess, however, animal proteins, exert a pro-inflammatory effect. It may thus be advisable to consume more of the plant-based options to achieve the daily intake of protein, ensuring sufficient variety of sources, which is even more important if your protein intake is from plants alone.
Protein provides 17kJ (4 kcal) per gram and accounts for around 16% of energy in the British diet.
The RNI (Reference Nutrient Intake) of protein is 0.75 grams per kilogram of body weight equating to around 56g and 45g per day for men and women aged 19-50 years. The actual amount required for a specific individual will depend on numerous factors including their age, health status, physical activity level and muscle mass.
Daily protein requirements have been noted in studies for various groups including children, pregnant women, the elderly, athletes and those building muscles and strength. The RNIs for these individuals are likely to be higher than average which often raises the question as to how high is acceptable and safe. Whilst beyond the scope of this article, it may be advisable to work with a nutritional therapist to support a specific situation for such an individual.
So where can you find protein?
Sources of protein include animal sources such as meat (lamb, beef, chicken), fish (salmon, mackerel), eggs, dairy (milk, cheese, yoghurt). Plant sources include nuts (almonds, walnuts) and pulses (beans and lentils) as well as seeds and grains (quinoa, buckwheat, pumpkin, sunflower, chia and flax seeds).
Whilst grilled chicken or baked fish may be prepared to break your fast, there are other ways to incorporate protein into your food, particularly if you are falling short on your daily target. Think about adding seeds to your home baking or to sprinkle onto salads. Nuts (consumed in moderation) work well with a piece of fruit and nut butter (such as almond butter) can easily be added to your shake to increase protein content.
Protein-rich foods are satiating and this is useful especially during times of fasting. Including a protein source with each meal may reduce feelings of hunger whilst supporting blood sugar balance and reducing overall calorie intake. Once you have determined your daily requirement, this can be divided between the two main meals (suhur and iftar) and a small snack in between if you decide to have one.
Whilst it would be expected that the long hours of fasting in Ramadan would cause weight loss, the opposite is actually true with many of us gaining weight!
Now, this is probably due to a combination of factors and this is where optimising quality protein intake can be helpful. Higher protein intakes have been shown to support weight loss due to feeling fuller for longer leading to eating less often.
Conversely, there have been reports about protein in excess causing kidney damage and osteoporosis. The evidence is unclear in the former case and one study actually discussed the beneficial effects of protein in the latter.
What is clear about this amazing macro-nutrient is that quality is key – it’s not just about the quantity. With meats, for example, we should be aiming for grass-fed organic meats and fish that is unfarmed and wild-caught wherever possible. Aim to consume organic nuts and seeds which are stored appropriately – out of light and away from heat. Of course, these situations are the ideal, but it doesn’t mean that we shouldn’t make any positive change if this appears to blows our budget. Start small and go gradual.
What can I do to move towards my health goals?
Whilst it is not possible to cover everything in the short article, I hope it’s a starting place for you to explore food choices that will allow you and your family to experience your optimal health and well-being in the longer run.
Whilst the above provides some education on macro-nutrients alongside others with a few ideas to get you started, here are a few other points I would like to share in closing that I hope will serve you:
Preparation is key!
Now that you have some ideas about what foods you can experiment with, devise a family meal plan for suhur, iftar and snacks in between. Remember this can continue after Ramadan too, so it’s not too late. I will be posting recipes on my Facebook page for inspiration, so please join the journey.
Plan in advance
Prepare what you can in advance when you have time away from worship e.g. chop and freeze vegetables or even batch cook and freeze extra foods that you don’t need straight away. These will be useful for another day when you don’t have the energy to cook from scratch and will free your time for worship!
Start small and build
Use a daily tracker to see your progress on fruit and vegetable intake for example. How many did you get in? What colours did you manage from the rainbow? Reward yourself (with a healthy home-made treat once in a while if you’ve managed to progress) and if you haven’t, just keep going!
Be prepared to try something new
This is scary to begin with, but remember everything was first new! If you’re at the supermarket, pick up a new vegetable that you’ve never tried before and experiment with a new recipe. You might just add it to your regular shopping list thereafter!
Get the family on board
Things are always easier when there is support and encouragement. Get your family to help with preparing, shopping and even the cooking! Children will love the responsibility they get for making sure the healthy cookies look just right!
Sharing is caring
Politely educate others explaining why you’re changing the way you eat and how so to support them in making healthier choices too.
Look after other aspects of your well-being too
Nutrition is one facet of optimising your well-being. Be sure to work on your spiritual and physical health too (as per appropriate supervision) to achieve wholesome well-being.
It doesn’t matter where you are in your health journey this month, what matters is you take the opportunity when it arrives. Ramadan is an opportunity, a month for creating good habits and releasing those that don’t really serve. It’s never too late to make positive change.
Please visit: https://www.facebook.com/nutritiondefined to find out more about achieving optimal wellness through nutrition.
Photo credit by Pixabay from Pexels
Wilhelmi de Toledo F, Grundler F, Bergouignan A, Drinda S, Michalsen A. Safety, health improvement and well-being during a 4 to 21-day fasting period in an observational study including 1422 subjects. PLoS One. 2019;14(1):e0209353. Published 2019 Jan 2. doi:10.1371/journal.pone.0209353
Adawi M, Watad A, Brown S, et al. Ramadan Fasting Exerts Immunomodulatory Effects: Insights from a Systematic Review. Front Immunol. 2017;8:1144. Published 2017 Nov 27. doi:10.3389/fimmu.2017.01144
Özkul C, Yalınay M, Karakan T. Islamic fasting leads to an increased abundance of Akkermansia muciniphila and Bacteroides fragilis group: A preliminary study on intermittent fasting. Turk J Gastroenterol. 2019;30(12):1030–1035. doi:10.5152/tjg.2019.19185
Mehanna Hisham M, Moledina Jamil, Travis Jane. Refeeding syndrome: what it is, and how to prevent and treat it BMJ 2008; 336 :1495
British Nutrition Foundation (2018). Liquids. Available at: http://tiny.cc/hgctnz
Armstrong LE, Johnson EC. Water Intake, Water Balance, and the Elusive Daily Water Requirement. Nutrients. 2018;10(12):1928. Published 2018 Dec 5. doi:10.3390/nu10121928
Institute of Medicine of the National Academies. Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. The National Academies Press; 2006.
Chang C.Y., Ke D.S., Chen J.Y. Essential fatty acids and human brain. Acta Neurol. Taiwan. 2009;18:231–241.
Ibarguren, A., López, D.J., Escribá, P.V. (2014). The effect of natural and synthetic fatty acids on membrane structure, microdomain organization, cellular functions and human health, Biochimica et Biophysica Acta (BBA) – Biomembranes,1838, Issue 6:1518-1528
British Nutrition Foundation (2018). Fats explained. Available at: http://tiny.cc/0er0nz
Harvard TH Chan SPH (2020). Types of Fat. Available at: http://tiny.cc/dls0nz
British Nutrition Foundation (2018). Fat. Available at: http://tiny.cc/adu3nz
Liu AG, Ford NA, Hu FB, Zelman KM, Mozaffarian D, Kris-Etherton PM. A healthy approach to dietary fats: understanding the science and taking action to reduce consumer confusion. Nutr J. 2017;16(1):53. Published 2017 Aug 30. doi:10.1186/s12937-017-0271-4
Innes, Jacqueline K. et al. Omega-6 fatty acids and inflammation. Prostaglandins, Leukotrienes and Essential Fatty Acids, Volume 132, 41 – 48
Hayes J, Benson G. What the Latest Evidence Tells Us About Fat and Cardiovascular Health. Diabetes Spectr. 2016;29(3):171‐175. doi:10.2337/diaspect.29.3.171
DiNicolantonio JJ, O’Keefe JH. Effects of dietary fats on blood lipids: a review of direct comparison trials. Open Heart. 2018;5(2):e000871. Published 2018 Jul 25. doi:10.1136/openhrt-2018-000871
Chowdhury R, Warnakula S, Kunutsor S, et al. Association of Dietary, Circulating, and Supplement Fatty Acids With Coronary Risk: A Systematic Review and Meta-analysis. Ann Intern Med. 2014;160:398–406. doi: https://doi.org/10.7326/M13-1788
Mensink RP. Effects of Saturated Fatty Acids on Serum Lipids and Lipoproteins: A Systematic Review and Regression Analysis. Geneva: World Health Organization; 2016.
de Souza RJ, Mente A, Maroleanu A, et al. Intake of saturated and trans unsaturated fatty acids and risk of all-cause mortality, cardiovascular disease, and type 2 diabetes: systematic review and meta-analysis of observational studies. BMJ. 2015;351:h3978. Published 2015 Aug 11. doi:10.1136/bmj.h3978
Ramsden CE, Zamora D, Majchrzak-Hong S, et al. Re-evaluation of the traditional diet-heart hypothesis: analysis of recovered data from Minnesota Coronary Experiment (1968-73). BMJ (Clin Res Ed). 2016;353:i1246
Samra RA. Fats and Satiety. In: Montmayeur JP, le Coutre J, editors. Fat Detection: Taste, Texture, and Post Ingestive Effects. Boca Raton (FL): CRC Press/Taylor & Francis 2010 Chapter15 Available from https://www.ncbi.nlm.nih.gov/books/NBK53550/
Kubala, J. (2020). Is Saturated Fat Unhealthy? Healthline. Available at: http://tiny.cc/fqiioz
Imamura F, Micha R, Wu JH, et al. Effects of Saturated Fat, Polyunsaturated Fat, Monounsaturated Fat, and Carbohydrate on Glucose-Insulin Homeostasis: A Systematic Review and Meta-analysis of Randomised Controlled Feeding Trials. PLoS Med. 2016;13(7):e1002087. Published 2016 Jul 19. doi:10.1371/journal.pmed.1002087
British Nutrition Foundation (2018). Carbohydrates. Available at: http://tiny.cc/jgveoz
NHS (2017). Five-a-day of fruit and veg is good, but ’10 is better’ Available at: http://tiny.cc/v95foz
Dhingra D, Michael M, Rajput H, Patil RT. Dietary fibre in foods: a review. J Food Sci Technol. 2012;49(3):255‐266. doi:10.1007/s13197-011-0365-5
Holesh JE, Martin A. Physiology, Carbohydrates. [Updated 2020 Mar 23]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459280/
Meyers AM, Mourra D, Beeler JA. High fructose corn syrup induces metabolic dysregulation and altered dopamine signalling in the absence of obesity. PLoS One. 2017;12(12):e0190206. Published 2017 Dec 29. doi:10.1371/journal.pone.0190206
Hamad Medical Corporation (n.d.). Foods that should be avoided in Ramadan. Available at: http://tiny.cc/n3veoz
Fuhrman J. The Hidden Dangers of Fast and Processed Food. Am J Lifestyle Med. 2018;12(5):375‐381. Published 2018 Apr 3. doi:10.1177/1559827618766483
Gadiraju TV, Patel Y, Gaziano JM, Djoussé L. Fried Food Consumption and Cardiovascular Health: A Review of Current Evidence. Nutrients. 2015;7(10):8424‐8430. Published 2015 Oct 6. doi:10.3390/nu7105404
Wu G. Dietary protein intake and human health. Food Funct. 2016;7(3):1251–65.
Berrazaga I, Micard V, Gueugneau M, Walrand S. The Role of the Anabolic Properties of Plant- versus Animal-Based Protein Sources in Supporting Muscle Mass Maintenance: A Critical Review. Nutrients. 2019;11(8):1825. Published 2019 Aug 7. doi:10.3390/nu11081825
Hruby A, Jacques PF. Dietary Protein and Changes in Biomarkers of Inflammation and Oxidative Stress in the Framingham Heart Study Offspring Cohort. Curr Dev Nutr. 2019;3(5):nzz019. Published 2019 Mar 28. doi:10.1093/cdn/nzz019
British Nutrition Foundation (2018). Protein. Available at: http://tiny.cc/k12boz
Richter M, Baerlocher K, Bauer JM, et al. Revised Reference Values for the Intake of Protein. Ann Nutr Metab. 2019;74(3):242‐250. doi:10.1159/000499374
Kato H, Suzuki K, Bannai M, Moore DR. Protein Requirements Are Elevated in Endurance Athletes after Exercise as Determined by the Indicator Amino Acid Oxidation Method. PLoS One. 2016;11(6):e0157406. Published 2016 Jun 20. doi:10.1371/journal.pone.0157406
Campos-Nonato I, Hernandez L, Barquera S. Effect of a High-Protein Diet versus Standard-Protein Diet on Weight Loss and Biomarkers of Metabolic Syndrome: A Randomized Clinical Trial. Obes Facts. 2017;10(3):238‐251. doi:10.1159/000471485
Devries MC, Sithamparapillai A, Brimble KS, Banfield L, Morton RW, Phillips SM. Changes in Kidney Function Do Not Differ between Healthy Adults Consuming Higher- Compared with Lower- or Normal-Protein Diets: A Systematic Review and Meta-Analysis. J Nutr. 2018;148(11):1760‐1775. doi:10.1093/jn/nxy197
Groenendijk I, den Boeft L, van Loon LJC, de Groot LCPGM. High Versus low Dietary Protein Intake and Bone Health in Older Adults: a Systematic Review and Meta-Analysis. Comput Struct Biotechnol J. 2019;17:1101‐1112. Published 2019 Jul 22. doi:10.1016/j.csbj.2019.07.005