Ramadan fasting in multiple sclerosis: A systematic review

During Ramadan, the ninth month of the Islamic calendar, Muslims should abstain from eating, drinking, smoking, and sexual activity from sunrise to sunset. The possible effects of Ramadan observance in patients with multiple sclerosis (MS) is a challenging concern which is addressed in this systematic review.

Following the JBI and PRISMA methods, a broad search was conducted in PubMed, Scopus, Embase, and Web of Science databases, and clinical evidence regarding the probable effects of Ramadan fasting in MS patients was collected. Reviews, case reports, animal studies, editorials, letters, conference abstracts and commentaries were not included. The risk of bias was assessed using the JBI critical appraisal tools.

The initial search yielded 48 articles, of which four reports (total n= 481; 426 fasting and 55 non-fasting patients), were found to meet the eligibility criteria. The study settings were Iran (two studies) and Egypt; and one multicenter study was conducted in Egypt, Morocco, and Saudi Arabia. Ramadan fasting was not found to be associated with increasing frequency of MS relapsing or worsening of disability. Also, evidence suggests benefits regarding the quality of life and cognitive domain score of modified fatigue impact scale; however, a higher level of disability and longer disease duration are found to increase the risk of MS activation during Ramadan.

Based on the limited available evidence, Ramadan fasting, especially in patients with mild levels of disability, can be associated with improvements in the quality of life with no considerable negative effects. Reported outcomes in this investigation should be interpreted with circumspection as these effects were observed only in small studies, all in the Eastern Mediterranean Region.