Abstract
Background. Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of the central nervous system in which an abnormal immune response leads to the destruction of myelin, axons, and neurons in the brain and spinal cord. During the month of Ramadan, Muslims abstain from eating, drinking, smoking, and sexual activity from dawn until sunset. The potential effects of Ramadan fasting on patients with MS remain a challenging clinical concern. This narrative review aimed to summarize the available evidence regarding the effects of Ramadan fasting in patients with MS.
Methods. In this narrative review, a comprehensive search was conducted across PubMed, Scopus, Embase, and Web of Science databases. The search was conducted from database inception through the end of 2025 using the keywords (islam OR islamic OR ramadan OR muslim OR ramazan) AND fasting AND “Multiple sclerosis”. A total of 56 articles were initially identified, of which 6 studies were included after screening. Eligible studies included those providing clinical evidence on evaluating the potential effects of Ramadan fasting in patients with MS. Animal studies and studies investigating other fasting-based dietary regimens (e.g., intermittent fasting) were excluded. Given the narrative nature of this review, no formal quality assessment of the included studies was conducted.
Results. Based on six studies (two case-control studies and four cross-sectional studies), Ramadan fasting was not associated with an increased risk of MS relapse or worsening disability. The available evidence also suggests a beneficial association between Ramadan fasting and quality of life. However, higher levels of disability and longer disease duration were identified as factors associated with an increased risk of MS activation during Ramadan.
Conclusion. Current evidence does not support the notion that Ramadan fasting is harmful to patients with MS, particularly those with mild disability. Moreover, fasting may be associated with improvements in quality of life among patients with MS. Nevertheless, these findings should be interpreted with caution, as the available evidence is derived from small studies conducted exclusively in the Eastern Mediterranean region.
Research Insights
· Multiple sclerosis (MS) is a chronic and disabling neurological disease, and Ramadan fasting represents an important clinical concern for many Muslim patients with MS.
· This narrative review synthesized the available clinical evidence identified through searches of four major databases and included six studies, comprising two case-control and four cross-sectional studies.
· Despite its clinical relevance, the available evidence remains sparse, fragmented, and largely based on small observational studies.
· The available evidence suggests that Ramadan fasting is not associated with increased relapse or worsening disability in patients with MS, particularly those with stable disease and mild disability, and may be associated with improved quality of life. Future studies are needed to provide more definitive clinical recommendations.
Extended Abstract
Background
Multiple sclerosis (MS) is a chronic, immune-mediated inflammatory disease of the central nervous system in which an abnormal immune response leads to the destruction of myelin, axons, and neurons in the brain and spinal cord. Irreversible axonal damage and neuronal degeneration are responsible for the progression of neurological disability. MS manifests with episodes of relapse and remission or with a progressive course, and its symptoms depend on the site of lesion involvement. The most common manifestations include optic neuritis, paresthesia, limb weakness, ataxia, spasticity, dysarthria, sphincter symptoms, cognitive impairment, and mild psychiatric symptoms. During the month of Ramadan, Muslims must abstain from eating, drinking, smoking, and sexual activity from dawn until sunset. Studies have shown that fasting during Ramadan is associated with improved health outcomes and a reduction in certain forms of psychological distress. The potential effects of Ramadan fasting on patients with MS represent a challenging clinical concern, which is addressed in this narrative review.
Methods
Primary clinical studies reporting any health effects of Ramadan fasting in MS patients were considered for inclusion in this study. Reviews, animal studies, editorials, letters, case reports, and commentaries were excluded. An electronic search was conducted in the PubMed, Scopus, Embase, and Web of Science databases, and following the final selection of studies, the required information was extracted, summarized, and analyzed. The search strategy was as follows: ((islam OR islamic OR ramadan OR muslim OR ramazan) AND fasting AND "Multiple sclerosis"). The initial database search yielded 56 articles, of which six studies (two case-control and four cross-sectional studies) were included. EndNote X9 reference management software was used to organize the references, screen titles and abstracts, and identify duplicates.
Results
Across the included studies, a consistent pattern emerged suggesting that Ramadan fasting does not negatively influence the clinical course of MS in patients with relapsing-remitting disease and mild disability, and in several instances may have favorable effects on patient-reported outcomes. In the study by Nasr et al., fasting during Ramadan was associated with a significant improvement in quality of life, while fatigue levels remained stable when comparing pre- and post-fasting assessments. These findings indicate that fasting did not exacerbate fatigue and may even confer psychological or lifestyle-related benefits that translate into better perceived well-being. Importantly, no adverse events were reported during the fasting period, reinforcing the safety of Ramadan fasting among this patient subgroup. Similarly, the prospective study by Etemadifar et al. demonstrated a significant improvement in quality-of-life scores following Ramadan fasting, without any significant changes in fatigue. These results complement those of Nasr et al., suggesting that fasting does not worsen fatigue and may positively affect measures linked to wellness and daily functioning. Longitudinal evidence was provided by Saadatnia et al., who followed 80 patients for six months after Ramadan. Their data revealed no increase in clinical relapses or disability progression, indicating that Ramadan fasting does not alter the short-term clinical trajectory of MS. Patients who chose to fast showed disease stability comparable to that of the non-fasting control group, supporting the absence of detrimental effects. Further reinforcing this, the study by Abd El-Dayem et al., which compared fasting and non-fasting groups over the course of one year, reported no differences in imaging or clinical indices of disease activity or severity. Their findings strengthen the conclusion that Ramadan fasting does not contribute to structural worsening or acceleration of inflammatory disease processes. Finally, the large retrospective cohort reported by Hassan et al. found no evidence of increased disease activity, even among patients assessed over a relatively short follow-up period. Patients with mild disability and low relapse frequency tolerated fasting well, with no worsening of symptoms or new relapses observed. Taken together, these results collectively indicate that Ramadan fasting is clinically safe for patients with RRMS who have mild baseline disability. Moreover, while fasting does not appear to influence objective markers of disease activity, it may be associated with improved quality of life, potentially through mechanisms related to psychological well-being, lifestyle, or spiritual practice.
Conclusion
The impact of Ramadan observance on patients with MS is an important clinical concern, especially in Muslim communities, and deserves careful consideration by healthcare professionals. The purpose of this review was to summarize current evidence on how fasting may influence MS. Available studies generally show that fasting during Ramadan does not lead to serious worsening of disease in patients with mild disability. In some reports, fasting is even linked with better quality of life, without increases in fatigue or relapse rate. These findings suggest that fasting may be safe for many patients, provided their disease is stable and they do not have major neurological limitations. However, individuals with marked disability or long-standing disease may be at higher risk of symptom fluctuation during fasting. Further prospective research with larger cohorts and longer follow-up periods is needed to clarify these effects and to guide practical recommendations for MS management during Ramadan.
Practical Implications of the Research
• Current evidence suggests that many patients with stable multiple sclerosis and mild disability may be able to observe Ramadan fasting under the supervision of their treating physician.
• Decisions regarding Ramadan fasting should be individualized based on disease severity, level of disability, history of relapses, and the patient’s pharmacological treatment regimen.
• In patients with active disease, moderate-to-severe disability, or limitations in adjusting medication schedules, careful medical evaluation is essential before fasting.
• Given the limited available evidence, particularly among patients with substantial disability, future studies are needed to provide more definitive clinical recommendations.