Tabriz University of Medical Sciences Depiction of Health 2008-9058 17 3 2026 09 30 Fasting during Ramadan in Patients with Multiple Sclerosis: A Narrative Review 322 326 10.34172/doh.2026.25 EN Ahad Nourmohammad https://orcid.org/0009-0004-9535-6786 Sarvin Sanaie https://orcid.org/0000-0003-2325-5631 Amirreza Naseri https://orcid.org/0000-0001-9723-0109 REVIEW 10.34172/doh.2026.25 2025 12 14 2026 09 28 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.