Fasting in Ramadan – how important is water?

Soon the time has come again. Ramadan is coming. A whole month full of self-discipline, but also enormous joy and spiritual purification for all Muslims.

As urologists, we know that in the Ramadan, or soon after, the number of patients with kidney stones is rising sharply. Good for us, but not good for our patients.

Where does that come from?

Well, our kidneys produce urine. It is, of course, mainly made of water.

Did you know that humans are 60% water? Some organs more (brain and heart 73%, lungs 83%, muscles 79%) and others less (bones 31%!).

With the water, our kidneys transport residues and pollutants from our organism and regulate our water balance. These substances are dissolved as salts in water, and that is then urine.

You’ve probably noticed that urine becomes brighter and clearer with a lot of drinking (the salts in the urine are then severely diluted) or with less drinking yellow or even brown (the salts are then highly concentrated).

Imagine you have a glass of water. In that you then pour table salt under stirring. First the salt dissolves completely, but as the concentration increases this process becomes slower and salt crystals remain visible. The concentration of salt has exceeded the dissolution capacity of the water.

If you add more water again now, the salt solution will be diluted and the crystals will dissolve again..

And that’s exactly what happens in the urine. If we drink too little, the salts can no longer be dissolved and form salt crystals (mostly calcium and oxalate). They can then clump together and eventually grow into a kidney stone. It is unknown how quickly this can happen, but we know from experience that this process can only take days in some patients.

When fasting, you have no water intake for about 14 hours during Ramadan. If you do not drink enough during the night hours, there will be an overconcentration of the urine and thus a risk for stone formation.

The daily recommended amount of drinking in Europe is 2-2.5 litres of water a day. Of course, we do not forget that we live here in a very hot country. We lose about 1/2 litre of water with our breathing, and 1-1.5 litres of water while sweating. This needs to be replenished. A drinking volume of 3-3.5 litres may be needed.

Whether you’re fasting or not, in a country like the UAE, you should always drink plenty. Ideally, of course, spread over the day, but that’s not always possible. The amount of water to dilute and dissolve the salts is crucial.

So, don’t forget water. For it to be a relaxed Ramadan.