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Open Access Highly Accessed Debate

Islamic fasting and multiple sclerosis

Soodeh Razeghi Jahromi1, Mohammad Ali Sahraian1*, Fereshteh Ashtari2, Hormoz Ayromlou3, Massoud Etemadifar11, Majid Ghaffarpour4, Ehsan Mohammadianinejad5, Shahriar Nafissi6, Alireza Nickseresht7, Vahid Shaygannejad8, Mansoreh Togha1, Hamid Reza Torabi9 and Shadi Ziaie10

Author Affiliations

1 MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran

2 Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran

4 Iranian Center for Neurological Research, Imam Khomini Hospital, Tehran University of Medical Sciences, Tehran, Iran

5 Department of Neurology, Golestan Hospital, Ahwaz University of Medical Sciences, Ahwaz, Iran

6 Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

7 Department of Neurology, Namazi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran

8 Department of Neurology, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

9 Jam Hospital, Iranian MS Society, Tehran, Iran

10 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran

11 Iran MS and Neuroimmunology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

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BMC Neurology 2014, 14:56  doi:10.1186/1471-2377-14-56

Published: 22 March 2014

Abstract

Background

Month-long daytime Ramadan fasting pose s major challenges to multiple sclerosis (MS) patients in Muslim countries. Physicians should have practical knowledge on the implications of fasting on MS. We present a summary of database searches (Cochrane Database of Systematic Reviews, PubMed) and a mini-symposium on Ramadan fasting and MS. In this symposium, we aimed to review the effect of fasting on MS and suggest practical guidelines on management.

Discussion

In general, fasting is possible for most stable patients. Appropriate amendment of drug regimens, careful monitoring of symptoms, as well as providing patients with available evidence on fasting and MS are important parts of management. Evidence from experimental studies suggests that calorie restriction before disease induction reduces inflammation and subsequent demyelination and attenuates disease severity. Fasting does not appear to have unfavorable effects on disease course in patients with mild disability (Expanded Disability Status Scale (EDSS) score ≤3). Most experts believed that during fasting (especially in summer), some MS symptoms (fatigue, fatigue perception, dizziness, spasticity, cognitive problems, weakness, vision, balance, gait) might worsen but return to normal levels during feasting. There was a general consensus that fasting is not safe for patients: on high doses of anti-convulsants, anti-spastics, and corticosteroids; with coagulopathy or active disease; during attacks; with EDSS score ≥7.

Summary

These data suggest that MS patients should have tailored care. Fasting in MS patients is a challenge that is directly associated with the spiritual belief of the patient.

Keywords:
Ramadan fasting; Multiple sclerosis; Calorie restriction