Abstract Background Metabolic syndrome doubles the risk of developing cardiovascular diseases and type II diabetes mellitus. Intermittent Islamic fasting is an effective health strategy associated with various benefits. Objectives to compare effect of intermittent Islamic fasting with lifestyle modification versus lifestyle modification only on weight management, blood pressure, blood glucose and lipid profile among a group of metabolic syndrome patients. Methods A Randomized control trial was conducted on (54 patients) with metabolic syndrome, their ages range from (30–45 years) attending the clinical nutrition outpatient clinic in the Zagazig University hospital from 1st of August (2023) to the end of February (2024). Intervention group (27 patients) followed Islamic fasting with lifestyle modification (Islamic fasting means: fasting two days per week (Monday and Thursday) with fasting (13, 14, 15) middle of lunar months) and control group (27 patients) followed lifestyle modification only. Results There is statistically non-significant difference between groups regarding healthy lifestyle score, clinical or laboratory parameters. There is statistically significant difference between the studied groups regarding percent of change in weight (p-value < 0.001), waist circumference (P-value < 0.001), systolic ( p-value = 0.042), diastolic blood pressure (P < 0.001), Fasting blood glucose (p-vale < 0.001), triglycerides (p-value < 0.001), HDL(p-value < 0.001) and total cholesterol (p-value = 0.023) with better improvement in intervention group, although no significant difference between them regrading lifestyle before or after intervention but both groups showed significant improvement after intervention. Conclusion Intermittent Islamic fasting (ISF) demonstrated a statistically significant enhancement in weight regulation, systolic blood pressure, triglyceride levels, total cholesterol, and HDL concentrations when compared to lifestyle modification alone.