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Effects of prolonged fasting on fatigue and quality of life in patients with multiple sclerosis


Fasting is one of the recommended worships of several great religions in the world. During the month of Ramadan, circadian rhythm and pattern of eating changes result in physiological, biochemical and hormonal changes in the body. Many Muslims with medical conditions ask their physicians about the feasibility and safety of fasting during Ramadan. In this study, we aim to assess the effect of Ramadan fasting on the quality of life and fatigue in multiple sclerosis (MS) patients. Relapsing-remitting MS (RRMS) patients according to McDonald’s criteria who had mild disability (EDSS score ≤3) were included in this study. Fatigue and quality of life were were assessed using the validated Persian versions of modified fatigue impact scale (MFIS) and multiple sclerosis quality of life-54 (MSQOL-54) questionnaires, respectively. 218 patients (150 females and 68 males) were enrolled in our study. There was no statistically significant difference between the mean total score of MSIF before and after fasting (25.50 ± 13.81 versus 26.94 ± 16.65; p = 0.58). The mean physical health and mental health composites of quality of life increased significantly after fasting (p = 0.008 and p = 0.003 respectively). Despite the observed lack of favorable effects on fatigue, our results showed increased quality of life of MS patients once Ramadan has ended. Whether this is specifically related to Ramadan-related fasting deserves further testing in appropriately designed larger prospective clinical studies.

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  1. 1.

    Azizi F (2010) Islamic fasting and health. Ann Nutr Metab 56:273–282

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Saadatnia M, Etemadifar M, Fatehi F et al (2009) Short-term effects of prolonged fasting on multiple sclerosis. Eur Neurol 61:230–232

    Article  PubMed  Google Scholar 

  3. 3.

    Esquifino AI, Cano P, Jimenez-Ortega V, Fernandez-Mateos MP, Cardinali DP (2007) Immune response after experimental allergic encephalomyelitis in rats subjected to calorie restriction. J Neuroinflammation 4:6

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Etemadifar M, Sajjadi S, Nasr Z et al (2013) Epidemiology of multiple sclerosis in Iran: a systematic review. Eur Neurol. doi:10.1159/000355140

    PubMed  Google Scholar 

  5. 5.

    Piccio L, Stark JL, Cross AH (2008) Chronic calorie restriction attenuates experimental autoimmune encephalomyelitis. J Leukoc Biol 84:940–948

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Shephard RJ (2013) Ramadan and sport: minimizing effects upon the observant athlete. Sports med 43(12):1217–1241

    Article  PubMed  Google Scholar 

  7. 7.

    Attarzadeh Hosseini SR, Sardar MA, Hejazi K, Farahati S (2013) The effect of ramadan fasting and physical activity on body composition, serum osmolarity levels and some parameters of electrolytes in females. Int J Endocrinol Metab 11:88–94

    Article  PubMed  PubMed Central  Google Scholar 

  8. 8.

    Etemadifar M et al (2014) Estimated prevalence and incidence of multiple sclerosis in iran. Eur Neurol 72(5–6):370–374

    Article  PubMed  Google Scholar 

  9. 9.

    Polman CH, Reingold SC, Edan G et al (2005) Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald Criteria”. Ann Neurol 58:840–846

    Article  PubMed  Google Scholar 

  10. 10.

    Krupp LB (2003) Fatigue in multiple sclerosis: definition, pathophysiology and treatment. CNS Drugs 17:225–234

    CAS  Article  PubMed  Google Scholar 

  11. 11.

    Ghaem H, Borhani Haghighi A, Jafari P, Nikseresht AR (2007) Validity and reliability of the Persian version of the multiple sclerosis quality of life questionnaire. Neurol India 55:369–375

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Ghajarzadeh M, Jalilian R, Eskandari G, Ali Sahraian M, Reza Azimi A (2013) Validity and reliability of Persian version of modified fatigue impact scale (MFIS) questionnaire in Iranian patients with multiple sclerosis. Disabil Rehabil 35:1509–1512

    Article  PubMed  Google Scholar 

  13. 13.

    Opara JA, Jaracz K, Brola W (2010) Quality of life in multiple sclerosis. J Med Life 3:352–358

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Jaracz K, Pawlak M, Gorna K, Kolcz B, Woloszyn D, Kozubski W (2010) Quality of life and social support in patients with multiple sclerosis. Neurol Neurochir Pol 44:358–365

    PubMed  Google Scholar 

  15. 15.

    Rajaei AR (2010) Religious cognitive-emotional therapy: a new form of psychotherapy. Iran J Psychiatry 5:81–87

    PubMed  PubMed Central  Google Scholar 

  16. 16.

    Mirzaei B, Rahmani-Nia F, Moghadam MG, Ziyaolhagh SJ, Rezaei A (2012) The effect of ramadan fasting on biochemical and performance parameters in collegiate wrestlers. Iran J Basic Med Sci 15:1215–1220

    CAS  PubMed  PubMed Central  Google Scholar 

  17. 17.

    Martin B, Mattson MP, Maudsley S (2006) Caloric restriction and intermittent fasting: two potential diets for successful brain aging. Ageing Res Rev 5:332–353

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Varady KA, Hellerstein MK (2007) Alternate-day fasting and chronic disease prevention: a review of human and animal trials. Am J Clin Nutr 86:7–13

    CAS  PubMed  Google Scholar 

  19. 19.

    el Ati J, Beji C, Danguir J (1995) Increased fat oxidation during Ramadan fasting in healthy women: an adaptative mechanism for body-weight maintenance. Am J Clin Nutr 62:302–307

    PubMed  Google Scholar 

  20. 20.

    Al-Shafei AI (2013) Ramadan fasting ameliorates arterial pulse pressure and lipid profile, and alleviates oxidative stress in hypertensive patients. Blood press 23(3):160–167

    Article  PubMed  Google Scholar 

  21. 21.

    Gilgun-Sherki Y, Melamed E, Offen D (2004) The role of oxidative stress in the pathogenesis of multiple sclerosis: the need for effective antioxidant therapy. J Neurol 251:261–268

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Adlouni A, Ghalim N, Benslimane A, Lecerf JM, Saile R (1997) Fasting during Ramadan induces a marked increase in high-density lipoprotein cholesterol and decrease in low-density lipoprotein cholesterol. Ann Nutr Metab 41:242–249

    CAS  Article  PubMed  Google Scholar 

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Correspondence to Zahra Nasr.

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Etemadifar, M., Sayahi, F., Alroughani, R. et al. Effects of prolonged fasting on fatigue and quality of life in patients with multiple sclerosis. Neurol Sci 37, 929–933 (2016).

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  • Multiple sclerosis
  • Fatigue
  • Quality of life
  • Fasting
  • Islam