Is it Safe for Multiple Sclerosis Patients to Fast?

Document Type : Short Communication


PhD, assistant professor, MS Research Center- Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran


Ramadan fasting predispose multiple sclerosis (MS) patients to a great challenge. Clinicians should have practical knowledge about the effects of fasting on MS. A mini-symposium was held in 2013 to answer the common questions about fasting in MS patients. In current review we present a summary of the mentioned mini-symposium.
Generally, fasting is possible for most stable MS patients. Thorough monitoring of symptoms, proper adjustment of drug regimens, as well as, providing patients with evidences on MS and fasting are inevitable parts of management. Data from experimental studies proposed that calorie restriction prior to disease induction ameliorated disease severity by reducing inflammation and demyelination. According to the results of the mini-symposium, fasting doesn’t have adverse effects on disease course in patients with mild disability (Expanded Disability Status Scale (EDSS) score ≤3). There was a general consensus that during fasting (especially in summer), some MS symptoms (such as dizziness, fatigue, fatigue perception, cognitive problems, spasticity, vision, weakness, gait, and balance) may exacerbate. However, they return to normal levels during feasting period. A majority of experts did not recommend fasting to patients: with EDSS score of 7 or more, during attacks, with active disease or coagulopathy; on high doses of anti-spastics, corticosteroids, and anti-convulsants.


  1. Al-Arouj M, Assaad-Khalil S, Buse J, Fahdil I, Fahmy M, Hafez S, et al. Recommendations for management of diabetes during Ramadan update 2010. Diabetes Care. 2010; 33(8):1895902.
  2. Azizi F. Islamic fasting and health. Ann Nutr Metab. 2010; 56(4):273-82.
  3. Beshyah SA, Fathalla W, Saleh A, Al Kaddour A, Noshi M, Al Hateethi H, et al. Ramadan fasting and the medical patient: an overview for clinicians. Ibnosina J Med Biomed Sci. 2010; 2(5): 240-57.
  4. Wingerchuk DM, Lucchinetti CF, Noseworthy JH. Multiple sclerosis: current pathophysiological concepts. Lab Invest. 2001;81(3):263-81.
  5. Jahromi SR, Sahraian MA, Ashtari F, Ayromlou H, Etemadifar M, Ghaffarpour M, et al. Islamic fasting and multiple sclerosis. BMC Neurol. 2014; 14(1):56.
  6. Maalouf M, Rho JM, Mattson MP. The  neuroprotective properties of calorie  restriction, the ketogenic diet, and ketone bodies. Brain Res Rev. 2009; 59(2):293-315.
  7. Esquifino A, Cano P, Jimenez V, Cutrera RA, Cardinali DP. Experimental allergic encephalomyelitis in male Lewis rats subjected to calorie restriction. J Physiol Biochem. 2004; 60(4):245-52.
  8. Opalach K, Rangaraju S, Madorsky I, Leeuwenburgh C, Notterpek L. Lifelong calorie restriction alleviates age-related oxidative damage in peripheral nerves. Rejuvenation Res.  2010; 13(1):65-74.
  9. Swerdlow RH. Treating neurodegeneration by modifying mitochondria: potential solutions to a “complex” problem. Antioxid Redox Signal. 2007; 9(10):1591-603.  
  10. Adcock IM, Caramori G. Cross-talk between pro-inflammatory transcription factors and glucocorticoids. Immunol Cell Biol. 2001; 79(4):376-84. 
  11. Rogozina OP, Bonorden MJ, Seppanen CN, Grande JP, Cleary MP. Effect of chronic and intermittent calorie restriction on serum adiponectin and leptin and mammary tumorigenesis. Cancer Prev Res. 2011; 4(4):568-81. 
  12. Esquifino AI, Cano P, Jimenez-Ortega V, Fernández-Mateos MP, Cardinali DP. Immune response after experimental allergic encephalomyelitis in rats subjected to calorie restriction. J Neuroinflammation. 2007; 4:6-16. 
  13. Piccio L, Stark JL, Cross AH. Chronic calorie restriction attenuates experimental autoimmune encephalomyelitis. J Leukoc Biol. 2008, 84(4):940-8. 
  14. Ahmed T, Das SK, Golden JK, Saltzman E, Roberts SB, Meydani SN. Calorie restriction enhances T-Cell–mediated immune response in adult overweight men and women. J Gerontol A Biol Sci Med Sci. 2009; 64(11):1107-13. 
  15. Latifynia A, Vojgani M, Gharagozlou M, Sharifian R. Neutrophil function (innate immunity) during Ramadan. J Ayub Med Col Abbottabad. 2008; 21(4):111-5.  
  16. Riccio P, Rossano R. Nutrition facts in multiple sclerosis. ASN Neuro. 2015; 7(1):1-20.  
  17. Manzel A, Muller DN, Hafler DA, Erdman SE, Linker RA, Kleinewietfeld M. Role of “Western diet” in inflammatory autoimmune diseases. Curr Allergy Asthma Rep. 2014; 14(1):404-17.   
  18. McCarty MF. A vegan diet of modest protein content, by down-regulating Akt-mTORC1 activity in lymphocytes, may aid induction of regulatory T cells. Med Hypotheses. 2014; 2:1-10.   
  19. El-Dayem SM, Zyton HA. The effect of  Ramadan fasting on multiple sclerosis. Egyp  J Neurol Psychiat Neurosurg. 2012; 49(4):341-5. 
  20. Saadatnia M, Etemadifar M, Fatehi F, Ashtari F, Shaygannejad V, Chitsaz A, et al. Shortterm effects of prolonged fasting on multiple sclerosis. Eur Neurol. 2009; 61(4):230-2.
  21. Chtourou H, Hammouda O, Chaouachi A, Chamari K, Souissi N. The effect of time-ofday and Ramadan fasting on anaerobic performances. Int J Sports Med. 2012; 33(2): 142-7.
  22. Assadi M, Akrami A, Beikzadeh F, Seyedabadi M, Nabipour I, Larijani B, et al. Impact of Ramadan fasting on intraocular pressure, visual acuity and refractive errors. Singapore Med J. 2011; 52(4):263-6.
  23. Souissi N, Chtourou H, Zouita A, Dziri C, Souissi N. Effects of Ramadan intermittent fasting on postural control in judo athletes. Biol Rhythm Res. 2013; 44(2):237-44.
  24. Tian HH, Aziz AR, Png W, Wahid MF, Yeo D, Constance Png AL. Effects of fasting during Ramadan month on cognitive function in Muslim athletes. Asian J Sports Med. 2011, 2(3):145-53.
  25. Aadil N, Fassi-Fihri A, Houti I, Benaji B, Ouhakki M, Kotbi S, et al. Influence of Ramadan on the pharmacokinetics of a single oral dose of valproic acid administered at two different times. Methods Find Exp Clin Pharmacol. 2000; 22(2):109-14.
  26. Singh BN. Effects of food on clinical pharmacokinetics. Clin Pharmacokinet. 1999; 37(3):213-55.
  27. Charman WN, Porter CJ, Mithani S, Dressman JB. Physicochemical and physiological mechanisms for the effects of food on drug absorption: the role of lipids and pH. J Pharm Sci. 1997; 86(3):269-82.
  28. Berry D, Millington C. Analysis of pregabalin at therapeutic concentrations in human plasma/serum by reversed-phase HPLC. Ther Drug Monit. 2005; 27(4):451-6.
  29. Shah J, Wesnes KA, Kovelesky RA, Henney HR 3rd. Effects of food on the single-dose pharmacokinetics/pharmacodynamics of tizanidine capsules and tablets in healthy volunteers. Clin Ther. 2006; 28(9):1308-17.
  30. Gidal BE, Maly MM, Kowalski JW, Rutecki PA, Pitterle ME, Cook DE. Gabapentin absorption: effect of mixing with foods of varying macronutrient composition. Ann Pharmacother. 1998; 32(4):405-9.
  31. Messina S, Patti F. The pharmacokinetics of glatiramer acetate for multiple sclerosis treatment. Expert Opin Drug Metab Toxicol.  2013; 9(10):1349-59.
  32. Sturzebecher S, Maibauer R, Heuner A, Beckmann K, Aufdembrinke B. Pharmacodynamic comparison of single doses of IFN-beta1a and IFN-beta1b in healthy volunteers. J Interferon Cytokine Res.1999;19(11):1257-64.
  33. de Jonge ME, Huitema AD, Rodenhuis S, Beijnen JH. Clinical pharmacokinetics of cyclophosphamide. Clin Pharmacokinetics. 2005; 44(11):1135-64.