In Sidi Bel Abbès, Ramadan is unlike any other month. The rhythm of the household shifts from late afternoon onwards: the chorba is prepared, the dates are laid out, and the family waits together for the muezzin's call to break the fast. It is a deeply familial moment, eagerly awaited, a moment that gives the day its shape. For many of our dialysis patients, it is also a month they are determined to live fully — even when dialysis, diabetes, or both at once make the dietary equation trickier than it might appear.
Let us be clear from the outset: fasting on dialysis is not recommended for every patient, and the decision is taken together with your nephrologist, ideally several weeks before the month begins. Everything we write here does not replace that medical advice. It is a practical guide for those who have been given permission to fast, for the loved ones who do the cooking, and more broadly for all our patients who wish to understand why Ramadan eating, on dialysis, calls for a little more attention than usual.
Why Ramadan upsets the dietary balance
During Ramadan, food intake is concentrated into a few hours, in the evening and at night. Several studies have shown that one can reach, without realising it, 3,000 to 5,000 kcalories packed between the f'tour and the s'hour — often richer in fast sugars and fats than usual, and poorer in fibre (little fresh fruit and vegetables on the table). For a diabetic patient, this translates into a soaring blood sugar level. For a dialysis patient, it can also drive up interdialytic weight gain, potassium and phosphorus — and complicate the next session.
The aim is not to give up the pleasure of Ramadan. It is rather to understand the pitfalls of this period so as to avoid them better, and to rediscover, within the family rituals, the right balance that protects you.
The golden rule: three meals, not constant grazing
This is the first piece of advice, and probably the most effective. The temptation, when breaking the fast, is to nibble continuously between the f'tour and the s'hour: a little chorba, two dates, a zlabia, a tea, a piece of fruit, a plate of tajine, another tea, another sweet… Without one realising it, the calorie and blood-sugar bill climbs, the stomach works without respite, and sleep suffers for it.
Opt instead for an arrangement of three structured meals:
- The f'tour (breaking of the fast) — a proper, organised dinner, not an endless parade of dishes.
- A later meal during the night — light, around 10 pm or 11 pm.
- The s'hour (before dawn) — more substantial than a simple drink, to keep you going through the day.
This spread eases digestion, staggers the intake, and overall it is far more protective — both for blood sugar and for dialysis results.
The f'tour: the moment that sets the tone
The f'tour is a moment of joy, but it is also the one where the biggest nutritional mistakes can be made in a matter of minutes. Here is how to think it through, step by step.
Dates: a classic to portion out
Two or three dates to break the fast: that is the tradition — and it is a good tradition. Dates provide readily available sugar (useful after a day of fasting), magnesium, potassium, and a little fibre. Two dates are roughly equivalent to a portion of fresh fruit.
For the dialysis patient, mind the potassium: dates are rich in it. Two dates remain acceptable for most people, but avoid working your way through five or six without thinking, especially if your potassium level is already at the upper limit. Discuss it at your nephrology consultation — your doctor will give you your personal margin.
The chorba: your ally when well managed
The harira or the chorba frik is one of the most precious dishes of the f'tour: it rehydrates, it provides starchy foods (vermicelli, barley frik), it opens the appetite gently. A good chorba provides 20 to 30 g of carbohydrates per bowl — useful and reasonable.
A few points to watch on dialysis:
- Salt is the main pitfall: season only during cooking, never at the table. No industrial stock cubes. Flavour with fresh coriander, parsley, softened onion, lemon squeezed in at the end (the anti-fatigue vitamin C is a real bonus).
- Tomato concentrate is very high in potassium — a teaspoon is enough, completed with a small fresh tomato for colour.
- The volume: a bowl, not a large plate filled to the brim. The broth counts towards your fluid quota for the day.
Starchy foods: variety is better
During Ramadan, many families revolve around the same two or three starchy foods. That is a pity: diversity is rather your friend.
- Semolina, barley (frik), vermicelli, bulgur are less commonly eaten day to day and well tolerated — barley even has a lower glycaemic index than rice or pasta, which is of interest if you are diabetic.
- Bread keeps its full place. Choose it wholemeal to limit the constipation problems that are very common during this month. You can replace it several times a week with harcha or baghrir (bearing in mind what you serve with it).
- The smens (flaky pastries) and the sfenj (doughnuts), on the other hand, are much fattier: keep them for special occasions, not every evening.
Oriental sweets: portion out without going without
Ramadan is also the month of pastries, mint teas, and the trays of dainties shared at the end of the evening. We do not cut them out — we portion them.
A few useful orders of magnitude to keep in mind:
- 1 makroud ≈ 4 sugar cubes.
- 1 zlabia ≈ 17 sugar cubes.
- 1 portion of kalbe louz ≈ 5 to 6 sugar cubes, plus a significant phosphorus load (semolina + almonds).
These figures are not there to make you feel guilty. They are there to help you choose. Rather than a parade of three different pastries, choose half a portion of a single one that you really love. The pleasure stays whole, the sugar load stays reasonable, and both your blood sugar and your dialysis results will thank you.
Pastries and viennoiseries (croissants, pains au chocolat) are likewise rich in sugars and fats. To give a benchmark: a croissant is roughly equivalent to 50 g of buttered bread. Allowed as a replacement, not as an addition.
Nuts and oilseeds: the snacking friends to watch
Peanuts, pistachios, almonds: you find them on a tray in almost every sitting room, and they get picked at without counting during the long Ramadan evenings. They are rich in good fats, but also dense in calories, potassium and phosphorus. For a dialysis patient, this really matters.
The simple rule: not every day, and above all not on self-service on the table. An occasional small handful is perfectly fine. A full plate nibbled for two hours in front of the television is, in mineral load, the equivalent of a full meal.
Bricks and fried foods: the cooking changes everything
The bricks are one of the great stars of the Algerian f'tour — and they have their place. The trouble is not the food itself, it is the deep-frying in oil that turns them into calorie bombs.
A simple tip, which whoever cooks for you will soon adopt: put them in the oven. Brush the bricks lightly with oil using a pastry brush, bake them, turn them halfway through to brown the other side. The crispness is there, and so is the lightness. This technique also works for bourek, samboussek and, more broadly, anything that is usually deep-fried.
Hydration: the most critical point on dialysis
This is where Ramadan calls for the most vigilance for our patients. A whole day without drinking, followed by a night spent trying to make up for it: if you are on dialysis, your fluid margin stays the same as outside Ramadan. Therein lies the whole difficulty, and that is where your nephrologist guides you very precisely.
A few principles:
- Only water is essential. You can also hydrate with chorba, tea, coffee, herbal teas — but all of that counts towards your quota.
- Soft drinks are to be avoided: fast sugars, bubbles that cause digestive problems, sometimes hidden sodium. No nutritional value at all.
- Avoid very salty foods at the f'tour (large quantities of black olives, cured meats, very salty cheeses) — they leave you thirsty all night, and that is a guaranteed vicious circle.
- Spread out your quota: a little at the f'tour, a little during the evening, a little at the s'hour. Do not drink it all at once.
To go further on this specific subject, you can revisit our article Heatwave in Sidi Bel Abbès: 7 tips for managing thirst when you are on dialysis — many of the techniques (flavoured ice cubes, mouth rinsing, sugar-free sweets) adapt very well to Ramadan.
The s'hour: a meal you do not skip
The s'hour is what gets you through the day. Skipping it, or reducing it to a glass of coffee, is one of the most frequent mistakes — and one of the hardest to carry afterwards.
Build it with:
- A complex carbohydrate (wholemeal bread, harcha, lightly sweetened semolina, oat flakes) — it releases its energy slowly.
- A dairy product if you tolerate it (plain yoghurt, leben in measured amounts — mind the phosphorus and potassium for dialysis patients).
- A small portion of protein (egg, lightly salted fresh cheese).
- Water, without excess, respecting your quota.
Avoid coffee that is too strong at the s'hour: it is a diuretic and can heighten the feeling of thirst in the morning.
And what about blood sugar in all this?
For many of our dialysis patients, diabetes is a long-standing story — it is often even the initial cause of the kidney failure. Ramadan complicates blood-sugar balance in several ways: a long period without eating, concentrated and often sugary meals, disrupted sleep, a different level of physical activity.
A few rules your nephrologist and your general practitioner will remind you of:
- Monitor your blood sugar more often than usual, especially at the start of the month, while your body finds its rhythm.
- Adjust your medication intake (insulin, oral antidiabetics) only with your doctor. Never alter a prescription on your own. Ramadan is a period when diabetes can become severely unbalanced, in both directions — hyper- and hypoglycaemia.
- In the event of hypoglycaemia (sweating, trembling, dizziness, sudden hunger), break the fast immediately: religious law permits it for medical reasons, and it is even recommended.
A few practical tips to get through the month well
To sum up, and for those who like simple lists to stick on the fridge:
- Three structured meals rather than constant grazing.
- At each meal, aim for one food from each major group: starchy foods, vegetables, meat/fish/egg, dairy product (bearing in mind your personal restrictions on potassium and phosphorus).
- Prepare dishes rich in vegetables — that is often what is most lacking during Ramadan.
- Favour complex carbohydrates (semolina, barley, vermicelli) over simple carbohydrates (cakes, pastries, soft drinks).
- Go easy on Oriental pastries, msemen, biscuits, nuts and oilseeds, and viennoiseries.
- Hydrate regularly between f'tour and s'hour, without exceeding your prescribed quota.
- Monitor your blood sugar, and any unusual sign during the day.
When to break the fast — without hesitation
The fast of Ramadan is a deeply spiritual act, but it has never asked anyone to put themselves in danger. Religious law permits and even recommends breaking the fast in the event of illness, frailty, or a risky situation.
In concrete terms, break the fast without hesitation if you feel:
- Unusual tiredness, that does not resemble the ordinary tiredness of a Ramadan day.
- A feeling of faintness, dizziness, cold sweats, a drop in blood pressure.
- Signs of hypoglycaemia or severe hyperglycaemia.
- An intense muscle cramp, palpitations.
- The slightest doubt, particularly on the day of a dialysis session.
And seek advice afterwards — your general practitioner, your nephrologist, or the emergency department if needed. Resuming the fast the next day is always possible if the situation has returned to normal; persisting despite the warning signs can tip a fragile day into hospital admission.
At the ESSAADA Clinic, we prepare for Ramadan with you
Every year, in the weeks leading up to the holy month, our team takes time with each patient to take stock. Will your haemodialysis be compatible with fasting this year? Do your medications, your dry weight, your potassium and phosphorus targets need adjusting? Should your session slots move to the first morning series (4 am, before s'hour)?
These questions deserve a proper consultation, not a five-minute exchange in passing. We recommend that you make an appointment at least two to three weeks before the start of Ramadan. You will leave with a clear framework: what you can do, what you must watch for, and who to speak to if in doubt during the month.
To understand how sessions are organised during Ramadan, see also our dedicated page: Ramadan & dialysis — adapted slots. And for the wider background, Understanding kidney failure remains your foundational resource.
Ramadan is a month of sharing, of rituals, of family warmth. Well prepared, it remains possible for many of our patients. Not by gritting your teeth, not by going without — by organising yourself wisely, and by listening to yourself.
This article is an educational resource. None of its advice replaces the personalised opinion of your nephrologist or your general practitioner. The decision to fast and the adjustment of your treatment are made exclusively in consultation with your medical team.