Is It Safe for Multiple Sclerosis Patients to Fast ?

Ramadan fasting might predispose multiple sclerosis (MS) patients to major risks. Therefore, 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 among MS patients. In the current review, we present a summary of this mini-symposium. Generally, the majority of stable MS patients can adhere to this religious practice. Monitoring of the symptoms, proper adjustment of drug regimens and informing patients about MS and fasting are inevitable parts of patient management. Based on the data reported in experimental studies, calorie restriction prior to disease induction can ameliorate disease severity by reducing inflammation and demyelination. According to the results of this mini-symposium, fasting has no adverse effects on the course of the disease in patients with mild disabilities, indicated by Expanded Disability Status Scale (EDSS) score ≤ 3. A general consensus was reached on the exacerbation of some MS symptoms such as dizziness, fatigue, sensory deficit, cognitive problems, spasticity, vision impairment, weakness, abnormal gait and imbalance during fasting, especially during summer, although these symptoms subside during feasting. The majority of experts did not recommend fasting to patients receiving high doses of anti-spastics, corticosteroids and anticonvulsants or those with active MS, coagulopathy or EDSS score ≥ 7 during MS attacks.