Do not drink much water because it distends the abdomen and raises abdominal pressure; even when thirsty during long fasting hours just wet the lips; fasting three days in a row each week without food and drink is not harsh.
Original statement
وعدم الإفراط في شرب الماء حتى لا يتمدّد البطن ويرتفع ضغطه
verbatim according to source. Translation by the project; the Arabic wording is authoritative.
Translation
Do not drink much water because it distends the abdomen and raises abdominal pressure; even when thirsty during long fasting hours just wet the lips; fasting three days in a row each week without food and drink is not harsh.
Origin
- Source status
- Archive editors
- Attribution
- Archive editors summarising Elawady's view (homepage summary; not the quote box)
- Origin
- https://eltayebat.com/
- Attribution uncertainty
- Homepage summary written by the archive operators describing Elawady's views; partly cites his 'statement of the theory' video (aEbRfVSJIOw), otherwise no video reference.
- Claimed mechanism
Water raises intra-abdominal pressure.
- Claimed health effect
Avoiding abdominal pressure
- Population concerned
General population
- Geographic restriction by Elawady
none found
Diverging source versions
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! شريحة في الدماغ (Open source)
- Published
- 1 February 2026
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
- Source status
- Video transcript (own words)
- Attribution
- Elawady (machine transcript)
- Video
- Dr.D Clinics - Diaa Al Awady is live! الكلي (Open source)
- Published
- 20 May 2025
- Timestamp
- not available (transcript has no timings)
- Attribution uncertainty
- Archive transcript (YouTube CC or AI-generated); no timestamps; 'published' is the date listed by the archive and may be the upload date. Live-stream transcripts can contain viewer comments read aloud; the quoted passage was checked in context to be spoken by Elawady.
Scientific assessment
Mostly false – Essential parts of the statement are not supported by the evidence or are strongly exaggerated.
Certainty of evidence: moderate – Further research may still affect the assessment.
1. What was claimed?
Avoid drinking water; wet lips only; multi-day dry fasting is acceptable.
2. What is demonstrably correct?
Excessive water intake far beyond needs is unnecessary (I-FAST-08) and extreme volumes can cause hyponatraemia (not reviewed here).
3. What is wrong or exaggerated?
High water intake prevents stone recurrence (I-FAST-09). Withholding water when thirsty, especially during long fasts or in heat, causes dehydration. Dry fasting for three consecutive days is not comparable to Ramadan (daily fasts with nightly fluid intake), and even during Ramadan guidelines stress adequate fluid intake between sunset and dawn (I-FAST-11). In people with diabetes, dehydration contributes to hyperosmolar states and DKA (I-INS-07).
4. What remains unclear?
Whether any group benefits from deliberately low water intake.
5. Which studies support it?
I-FAST-08 (no need for fixed high intake; limited). The only study of multi-day dry fasting (10 healthy volunteers, 5 days) reported physiological compensation, but its authors state that medical supervision is obligatory and that intact endocrine and kidney function is required (I-FAST-125).
6. Which studies contradict it?
I-FAST-09 and I-FAST-122 (more water prevents stone recurrence), I-FAST-11 and I-FAST-108 (Ramadan guidance: fluids at night; dehydration risk in heat, labour, hyperglycaemia), I-INS-07, I-FAST-124 (EFSA: about 2.0-2.5 L total water/day), I-FAST-112 (dehydration requiring hospital care even in supervised water-only fasting).
7. What applies to Germany and Europe?
Not region-specific.
8. What is known about Egypt?
Hot summers in Egypt make deliberate water restriction particularly risky.
9. What practical conclusion is appropriate?
Drink when thirsty and more in heat, illness or exercise; do not suppress thirst. Multi-day fasts without water are dangerous.
Assessment details
- Rationale for certainty of evidence
No evidence that normal water intake raises intra-abdominal pressure in a harmful way; water is absorbed rapidly. Restricting water when thirsty and multi-day dry fasting cause dehydration with risks of kidney injury, stones and circulatory problems, especially in heat. Certainty moderate because direct studies of the 'abdominal pressure' hypothesis do not exist; the harm of dehydration is physiologically certain. The 3-day statement is from a live stream where a viewer's question is followed by a short answer; attribution of 'not harsh' as an answer is probable but not certain.
- Source quality
Homepage paraphrase plus own words in live streams.
- Regional transferability
Hot climate increases risk.
- Regional scope of the claim
- general (biological/medical)
- Last reviewed
- 26 October 2026 provisional
Scientific evidence in detail
Not supported by high-quality evidence – There is no good evidence for the claim; this alone does not prove it wrong.
Research question: Is restricting water intake (to avoid abdominal distension), only wetting the lips when thirsty during fasting, and fasting three consecutive days per week without food and drink safe?
Research question in detail (PICO)
- Population
- General population incl. older adults, people with diabetes or kidney disease, hot climate
- Intervention or exposure
- Water restriction; multi-day dry fasting
- Comparison
- Thirst-guided or adequate water intake; daily Ramadan-type fasting with night drinking
- Geographic scope
- climate-dependent
- Outcomes
- Dehydration, AKI, electrolytes
- Kidney stones
- Hospitalisation
Study results as reported by the authors. Our assessment follows below.
What speaks for the claim?
Five days without food or water
Papagiannopoulos-Vatopaidinos IE et al.. Metabol Open 2025 · PMID 40585323 · DOI 10.1016/j.metop.2025.100363 Case series / case reportfull text checkednewly addedTen healthy adults compensated a 5-day dry fast physiologically under supervision.
- Actual result
- Insulin fell; glucose dipped then recovered; GFR increased; LDL rose.
- Methodological quality
- very low (10 people, uncontrolled, no prospective ethics approval)
- Relevance
- direct but tiny; authors say supervision is obligatory
- Limitations
- Not generalisable.
Ramadan guidelines for people with diabetes
International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021 Guideline / position statementfull text checkednewly addedDaily Ramadan dry fasting does not cause pathological dehydration in normal circumstances.
- Actual result
- Guideline statement; risk in heat, heavy labour, hyperglycaemia.
- Methodological quality
- moderate (guideline)
- Relevance
- indirect: daily fasts with night drinking, not multi-day
- Limitations
- Not about multi-day dry fasting.
What speaks against the claim?
Drinking more water to prevent kidney stones
Bao Y et al.. Cochrane Database Syst Rev 2020 · PMID 32045491 · DOI 10.1002/14651858.CD004292.pub4 Systematic reviewabstract checkednewly addedMore water prevents kidney stone recurrence.
- Actual result
- RR 0.45 (0.24-0.84).
- Methodological quality
- low certainty (1 RCT, Cochrane)
- Relevance
- direct against water restriction for stone formers
- Limitations
- Single trial.
Side effects of supervised water-only fasting
Finnell JS et al.. BMC Complement Altern Med 2018 · PMID 29458369 · DOI 10.1186/s12906-018-2136-6 Case series / case reportfull text checkednewly addedSupervised water-only fasting (with water) still caused dehydration requiring hospital care and severe hyponatraemia.
- Actual result
- SAE: dehydration on day 3 (73-year-old man).
- Methodological quality
- low
- Relevance
- direct for multi-day fasting harms
- Limitations
- Case series.
EU reference values for water
EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). EFSA Journal 2010 · DOI 10.2903/j.efsa.2010.1459 Guideline / position statementabstract checkednewly addedAdults need about 2.0-2.5 L total water per day in moderate conditions.
- Actual result
- EFSA adequate intakes.
- Methodological quality
- moderate (agency opinion)
- Relevance
- direct
- Limitations
- Moderate climate only.
What does the overall evidence say?
Editorial assessment based on the studies above – not itself a study result.
Which position is better supported?
No evidence supports the idea that normal drinking harmfully raises abdominal pressure. Suppressing thirst and weekly multi-day dry fasts risk dehydration, kidney injury and electrolyte disorders, particularly in heat, in older people and in people with diabetes or kidney disease. Daily Ramadan fasting with night-time drinking is a different, generally tolerated practice.
Why some studies weigh more
Physiology of water balance and agency reference values outweigh one 10-person dry-fast series.
Is a causal relationship established? Yes, established Dehydration causally impairs circulation and kidney function; no study tests the abdominal-pressure hypothesis.
Remaining uncertainty
Safety of repeated weekly 3-day dry fasts (never studied).
Justified conclusion
Not supported and potentially dangerous.
Why do studies seem to disagree?
Dry-fasting physiology studies (I-FAST-125) and Ramadan guidance concern supervised or daily fasts with night intake; they do not test unsupervised weekly 3-day dry fasting.
Does this depend on the country?
- General biological effects
- Universal water physiology.
- Eating habits
- Egypt's hot climate and outdoor labour increase water needs and dehydration risk.
- Origin of the food
- Not applicable.
- Contaminants
- Not applicable.
- National production conditions
- Not applicable.
- Legal rules
- Not applicable.
- Actual monitoring data
- No Egyptian surveillance data assessed.
A regional difference that changes the conclusion is not supported by robust data.
Statistical re-check
- SAE proportion – 2/768 = 0.26% (paper: 0.002%). recalculated
- ARR/NNT – ARR 14.9 points, NNT about 7 over 5 years. recalculated
Certainty of the overall evidence (GRADE, simplified)
- Main outcome
- Harm from water restriction and multi-day dry fasting
- Starting level
- low (observational studies)
- Reasons for downgrading
- indirectness (no direct study of the advised regimen)
- Reasons for upgrading
- established physiology of dehydration
- Result
- moderate
Simplified assessment by a single reviewer, following the GRADE approach; not a formal GRADE panel. GRADE rates the body of evidence for one outcome, not individual studies.
Clinical guidelines and official statements checked
- IDF and DAR International Alliance: Diabetes and Ramadan: Practical Guidelines 2021 (2021) · Original publication
All individuals should break the fast if blood glucose <70 mg/dL (3.9 mmol/L) or >300 mg/dL (16.7 mmol/L) or with symptoms of hypoglycaemia or acute illness; people with T1DM are high/very high risk; during fasting glucose falls and insulin secretion is suppressed; when glycogen is depleted and insulin is low, fat is converted to ketones. - EFSA NDA Panel: Dietary Reference Values for water (2010) · Original publication
Adequate total water intake 2.0 L/day women, 2.5 L/day men in moderate conditions.
Search strategy
Documented literature searches for this review (search strings in the original database syntax).
| Database | Date | Search | Looking for | Hits | Included |
|---|---|---|---|---|---|
| Europe PMC | 26 October 2026 | ("dry fasting" OR "dry fast" OR "fluid restriction") AND (healthy OR volunteers) AND (days) AND (kidney OR renal OR dehydration) | both directions | 1376 | |
| Europe PMC | 26 October 2026 | TITLE:("dry fasting") | supporting evidence | 11 | |
| Europe PMC | 26 October 2026 | ("dry fasting" OR "without food and fluid" OR "food and fluid intake") AND ("5 days" OR "five days" OR "consecutive days" OR "multi-day") AND (humans OR participants OR subjects) | supporting evidence | 533 | |
| Europe PMC | 26 October 2026 | JOURNAL:"Cochrane Database Syst Rev" AND TITLE:(water OR fluid) AND (stones OR nephrolithiasis OR urolithiasis) | contradicting evidence | 6 | |
| Web (direct PDF fetch) | 26 October 2026 | IDF-DAR 2021 guideline chapter 'Fluid balance and Ramadan' (media.idf.org PDF) | guidelines | 1 | |
| PubMed | 26 October 2026 | ("dry fasting"[tiab] OR "Ramadan"[ti]) AND (hydration OR dehydration OR "kidney function") AND healthy | supporting evidence | 29 | |
| PubMed | 26 October 2026 | ("water intake"[ti] OR "fluid intake"[ti]) AND ("intra-abdominal pressure"[tiab] OR bloating[tiab] OR distension[tiab]) | supporting evidence | 10 | |
| PubMed | 26 October 2026 | (dehydration[ti] OR hypohydration[ti]) AND ("acute kidney injury"[tiab] OR "kidney"[ti]) AND (heat OR fasting) | contradicting evidence | 20 | |
| PubMed | 26 October 2026 | ("water intake"[ti] OR "increased water"[ti]) AND (randomized controlled trial[pt] OR systematic review[pt]) AND (stones OR nephrolithiasis OR outcomes) | contradicting evidence | 28 |
Open questions
Any data on followers practising weekly dry fasts.
How deeply was this checked?
9 linked studies: 4 checked in full text (0 of them with a structured risk-of-bias assessment), 5 on the basis of the abstract, 0 bibliographically only. No formal assessment with two independent reviewers and no independent human expert review has taken place yet.
Last scientific review: 26 October 2026
History of the verdict
- 25 October 2026 · Phase 1 · Initial assessment: Mostly false (moderate)
- 26 October 2026 · Phase 4 (systematic evidence review) · Re-examined with extended evidence; verdict unchanged: Mostly false (moderate)
New evidence (EFSA values, Cochrane on stones, adverse events in water-only fasting) supports the existing verdict; the only supportive dry-fasting study is tiny and itself requires supervision.
New sources: I-FAST-108 I-FAST-112 I-FAST-122 I-FAST-124 I-FAST-125
In plain language
There is no evidence that normal drinking harms the belly. Ignoring thirst, only wetting the lips, or going several days without food and water can lead to dehydration, kidney problems and, in people with diabetes, dangerous blood sugar crises.
Studies on this claim
Studies supporting the claim (2)
-
Do we need eight glasses of water a day?
Valtin H. Am J Physiol Regul Integr Comp Physiol 2002 · PMID 12376390 · DOI 10.1152/ajpregu.00365.2002Narrative reviewindependent cross-checkabstract checkedNo proof for 8 glasses in healthy adults in mild climates, but more is needed in heat, hard work and some diseases.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Is there evidence for '8 x 8' glasses of water a day?
- How was the study done?
Narrative review
- How many people, animals or samples were studied?
not applicable; Healthy adults
- What was actually found?
No evidence for 8 x 8.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Thirst usually suffices if healthy and in mild climate.
- What are the study's limitations?
Narrative; Old
- What does it say about Elawady's specific claim?
Supports C-FAST-09; partly C-FAST-10 (no fixed high intake), with stated exceptions.
- Do the results apply to Germany and Europe?
Temperate climate applies to Germany.
- What can explicitly not be concluded from this study?
Advice for hot climates or patients.
-
Five days without food or water
Papagiannopoulos-Vatopaidinos IE et al.. Metabol Open 2025 · PMID 40585323 · DOI 10.1016/j.metop.2025.100363Case series / case reportindependent cross-checkfull text checked★ key studyTen healthy people under supervision coped with a five-day dry fast, but the researchers say medical supervision is essential.
10 healthy adults compensated a supervised 5-day dry fast physiologically; authors state supervision is obligatory.
Does the study support the specific claim? Partly · Methodological quality: very low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Describe body responses to dry fasting.
- How was the study done?
Daily measurements in 10 people.
- How many people, animals or samples were studied?
10 healthy Greek adults.
- What was actually found?
Insulin fell; glucose dipped then recovered; LDL rose; GFR increased.
- How large was the observed effect?
Not applicable.
- What do the results mean in everyday life?
Dry fasting is not safe without medical supervision and healthy kidneys.
- What are the study's limitations?
Tiny, uncontrolled, no prospective ethics approval.
- What does it say about Elawady's specific claim?
Weakly supports tolerability; does not support unsupervised weekly 3-day dry fasting.
- Do the results apply to Germany and Europe?
Applies; same physiology.
- What can explicitly not be concluded from this study?
Safety in people with disease, in heat, or repeated weekly.
No study in this group is marked as key.
Studies contradicting or limiting the claim (6)
-
Drinking more water to prevent kidney stones
Borghi L et al.. J Urol 1996 · PMID 8583588Randomised controlled trialindependent cross-checkabstract checkedOver five years, stones came back in 12% of those drinking a lot vs 27% without advice.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
High water intake and calcium stone recurrence
- How was the study done?
Randomised prospective 5-year study
- How many people, animals or samples were studied?
199 patients; First-episode idiopathic calcium stone formers (plus 101 controls)
- What was actually found?
Recurrence halved.
- How large was the observed effect?
12% vs 27%
- What do the results mean in everyday life?
Stone formers should drink more.
- What are the study's limitations?
Not blinded; Single centre
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
Italian; directly applicable.
- What can explicitly not be concluded from this study?
Benefits in people without stones.
-
IDF-DAR Ramadan guidelines 2021
Hassanein M et al.. Diabetes Res Clin Pract 2022 · PMID 35016991 · DOI 10.1016/j.diabres.2021.109185Guideline / position statementindependent cross-checkabstract checkedPeople with diabetes who fast need individual risk assessment and medical guidance.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Management of diabetes during Ramadan fasting
- How was the study done?
Practical guideline (IDF and DaR International Alliance)
- How many people, animals or samples were studied?
not applicable; People with diabetes who fast
- What was actually found?
Guidance on risk stratification.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Fast only with a medical plan.
- What are the study's limitations?
Abstract only read
- What does it say about Elawady's specific claim?
- Do the results apply to Germany and Europe?
Applicable to fasting Muslims in Europe.
- What can explicitly not be concluded from this study?
Specific thresholds (not in abstract).
-
International guideline on diabetic ketoacidosis
Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032Guideline / position statementindependent cross-checkfull text checked★ key studyInsulin, fluids and potassium are the core treatment; with this, fewer than 1% of adults die.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Diagnosis and management of DKA and HHS in adults
- How was the study done?
International consensus report based on systematic examination of literature since 2009 (ADA, EASD, JBDS, AACE, DTS)
- How many people, animals or samples were studied?
not applicable; Adults with diabetes
- What was actually found?
Insulin is the cornerstone; glucocorticoids worsen hyperglycaemia.
- How large was the observed effect?
Mortality <1% with treatment
- What do the results mean in everyday life?
Ketoacidosis needs hospital treatment with insulin.
- What are the study's limitations?
Consensus, not trial
- What does it say about Elawady's specific claim?
Directly contradicts C-INS-08; supports danger in C-FAST-03; contradicts C-INS-07, C-INS-10.
- Do the results apply to Germany and Europe?
EASD and JBDS (UK) co-authored; directly applicable.
- What can explicitly not be concluded from this study?
Outcomes of untreated DKA quantitatively.
-
Side effects of supervised water-only fasting
Finnell JS et al.. BMC Complement Altern Med 2018 · PMID 29458369 · DOI 10.1186/s12906-018-2136-6Case series / case reportindependent cross-checkfull text checked★ key studyAmong 768 supervised water-only fasts, about one in four had a severe (grade 3) side effect; two people needed hospital care.
Dehydration requiring hospital care occurred on day 3 of a supervised water-only fast in a 73-year-old man.
Does the study support the specific claim? No · Methodological quality: low · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Describe adverse events of water-only fasting.
- How was the study done?
Chart review of 768 clinic visits.
- How many people, animals or samples were studied?
Adults at a US fasting centre.
- What was actually found?
72.3% mild/moderate highest AE; 27.6% grade 3; 2 SAEs.
- How large was the observed effect?
Cumulative incidence grade>=3 AE: 0.28 at day 10.
- What do the results mean in everyday life?
Even with medical supervision and water, multi-day fasting often causes significant side effects.
- What are the study's limitations?
Retrospective; clinic-run; conflicts of interest.
- What does it say about Elawady's specific claim?
Contradicts claims that multi-day fasting strengthens the body.
- Do the results apply to Germany and Europe?
Applies; same physiology.
- What can explicitly not be concluded from this study?
Outcomes of unsupervised fasting at home.
-
Drinking more water to prevent kidney stones
Bao Y et al.. Cochrane Database Syst Rev 2020 · PMID 32045491 · DOI 10.1002/14651858.CD004292.pub4Systematic reviewindependent cross-checkabstract checked★ key studyPeople who had kidney stones and drank enough to pass 2 litres of urine a day had fewer new stones.
Higher water intake prevents stone recurrence; restricting water is the opposite of what helps stone formers.
Does the study support the specific claim? No · Methodological quality: high · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Assess water for stone prevention.
- How was the study done?
Cochrane review.
- How many people, animals or samples were studied?
1 RCT, 220 people.
- What was actually found?
RR 0.45 for recurrence.
- How large was the observed effect?
149 fewer recurrences per 1000.
- What do the results mean in everyday life?
Stone formers should drink more than thirst alone suggests.
- What are the study's limitations?
Only one trial.
- What does it say about Elawady's specific claim?
Limits the thirst-only rule; contradicts water restriction.
- Do the results apply to Germany and Europe?
Applicable; stone disease common in Egypt's hot climate.
- What can explicitly not be concluded from this study?
Primary prevention.
-
EU reference values for water
EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). EFSA Journal 2010 · DOI 10.2903/j.efsa.2010.1459Guideline / position statementindependent cross-checkabstract checked★ key studyEuropean experts set adequate total water intake at 2.0 L/day for women and 2.5 L/day for men, including water in food.
Adults need about 2.0-2.5 L total water/day in moderate conditions; wetting lips or 3-day dry fasts are far below this.
Does the study support the specific claim? Partly · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Set reference values for water.
- How was the study done?
Expert review of intake and urine data.
- How many people, animals or samples were studied?
not applicable
- What was actually found?
AIs by age and sex.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
Normal water needs are substantial; heat increases them.
- What are the study's limitations?
Only for moderate climate and activity.
- What does it say about Elawady's specific claim?
Contradicts water restriction; neutral on thirst-guided drinking.
- Do the results apply to Germany and Europe?
EU reference; Egypt's hotter climate implies higher needs.
- What can explicitly not be concluded from this study?
Needs in hot climates.
No study in this group is marked as key.
Studies with mixed or unclear results (1)
-
Ramadan guidelines for people with diabetes
International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021Guideline / position statementindependent cross-checkfull text checked★ key studyPeople with diabetes who fast must stop fasting if blood sugar goes above 300 mg/dL or below 70 mg/dL.
Daily Ramadan dry fasting does not cause pathological dehydration in normal circumstances, but heat, heavy labour and hyperglycaemia raise the risk; the guideline concerns daily fasts with night-time drinking, not multi-day dry fasts.
Does the study support the specific claim? No · Methodological quality: moderate · Certainty of evidence: see overall assessment of the claim
Original publication · Scientific details
Study explained simply
- What did the researchers want to find out?
Give practical advice for safe fasting with diabetes.
- How was the study done?
International expert guideline.
- How many people, animals or samples were studied?
not applicable
- What was actually found?
Risk stratification; break-fast thresholds; T1D high risk.
- How large was the observed effect?
not applicable
- What do the results mean in everyday life?
High blood sugar during fasting is a reason to stop fasting and check for danger, not a sign of health.
- What are the study's limitations?
Consensus-based.
- What does it say about Elawady's specific claim?
Contradicts the claim for people with diabetes.
- Do the results apply to Germany and Europe?
Used by clinicians in Egypt and the Gulf and by European diabetes services for Muslim patients.
- What can explicitly not be concluded from this study?
Precise risk of DKA per fasting day.
No study in this group is marked as key.
Regional context
Germany / EU
Not region-specific.
Egypt
Hot summers in Egypt make deliberate water restriction particularly risky.
What applies in my country?
General scientific assessment
Mostly false Restricting water against thirst and multi-day dry fasts are risky and unsupported.
This statement concerns biological or medical relationships. The scientific assessment above applies regardless of the country; country-specific food data do not change it.
References
- "Drink at least eight glasses of water a day." Really? Is there scientific evidence for "8 x 8"?. Valtin H. Am J Physiol Regul Integr Comp Physiol 2002 · PMID 12376390 · DOI 10.1152/ajpregu.00365.2002
- Hypoglycemia compensation mechanisms in dry fasting.. Papagiannopoulos-Vatopaidinos IE et al.. Metabol Open 2025 · PMID 40585323 · DOI 10.1016/j.metop.2025.100363
- Urinary volume, water and recurrences in idiopathic calcium nephrolithiasis: a 5-year randomized prospective study.. Borghi L et al.. J Urol 1996 · PMID 8583588
- Diabetes and Ramadan: Practical guidelines 2021.. Hassanein M et al.. Diabetes Res Clin Pract 2022 · PMID 35016991 · DOI 10.1016/j.diabres.2021.109185
- Hyperglycemic Crises in Adults With Diabetes: A Consensus Report.. Umpierrez GE et al.. Diabetes Care 2024 · PMID 39052901 · DOI 10.2337/dci24-0032
- Is fasting safe? A chart review of adverse events during medically supervised, water-only fasting.. Finnell JS et al.. BMC Complement Altern Med 2018 · PMID 29458369 · DOI 10.1186/s12906-018-2136-6
- Water for preventing urinary stones.. Bao Y et al.. Cochrane Database Syst Rev 2020 · PMID 32045491 · DOI 10.1002/14651858.CD004292.pub4
- Scientific Opinion on Dietary Reference Values for water.. EFSA Panel on Dietetic Products, Nutrition, and Allergies (NDA). EFSA Journal 2010 · DOI 10.2903/j.efsa.2010.1459
- Diabetes and Ramadan: Practical Guidelines 2021 (IDF-DAR), International Diabetes Federation and DAR International Alliance. International Diabetes Federation and DAR International Alliance (ed. Hassanein M). IDF (Brussels) 2021