The evidence for diet interventions in multiple sclerosis (MS) is growing, showing that certain dietary approaches can influence symptoms, quality of life, and some markers of disease activity, although no diet has yet been proven to definitively slow disease progression or reduce brain lesions. Research highlights several diets that have been studied in MS, including the Mediterranean, ketogenic, Swank, Wahls, gluten-free, and fasting-based diets, each with varying degrees of evidence and potential benefits.
The Mediterranean diet, which emphasizes whole foods, fruits, vegetables, healthy fats like olive oil, moderate protein, and limited processed foods, is often regarded as the most sustainable and beneficial for people with MS. It is associated with reduced inflammation, slower disability progression, and improved mental health outcomes. Its flexibility and palatability make it easier for patients to adhere to over the long term, which is crucial for any dietary intervention to be effective.
The ketogenic diet, characterized by very low carbohydrate intake and high fat consumption, has shown promise in reducing fatigue and depression in MS patients. It may also promote neuroprotection and remyelination—the repair of nerve insulation damaged by MS. However, its restrictive nature and potential side effects, such as gastrointestinal discomfort and nutrient deficiencies, make it challenging for long-term adherence. Despite these challenges, preliminary evidence supports its safety and potential efficacy as an adjunctive therapy.
Other diets like the Swank and Wahls diets have also been studied. Both have demonstrated effectiveness in reducing fatigue, with the Wahls diet additionally improving mental quality of life and cognitive function. The Wahls diet focuses on nutrient-dense foods, including a high intake of vegetables and elimination of gluten, dairy, and processed foods, aiming to reduce inflammation and support mitochondrial function. The Swank diet emphasizes low saturated fat intake and increased consumption of fruits and vegetables.
Gluten-free diets have shown inconsistent results. While some small studies suggest benefits for certain patients, the evidence is not strong enough to recommend it broadly for MS management.
Fasting protocols, including intermittent fasting and time-restricted eating, have attracted attention for their potential to reduce inflammatory markers and improve both mental and physical health outcomes. These diets may modulate immune function and promote cellular repair processes. However, their sustainability is questionable for many MS patients, especially those experiencing fatigue or cognitive difficulties.
Beyond specific diets, dietary modification combined with nutrition education and counseling plays a vital role in managing metabolic comorbidities common in MS, such as obesity, diabetes, hypertension, and dyslipidemia. These comorbidities negatively impact MS outcomes, and tailored dietary strategies can help improve metabolic health, which in turn may influence disease progression and quality of life. Addressing barriers to dietary change through behavior change techniques and personalized counseling supports sustainable improvements.
Clinical trials have shown that while diets like ketogenic and fasting improve metabolic health markers such as blood fats, weight, and blood pressure, they do not significantly affect the formation of new brain lesions, which are a hallmark of MS disease activity. However, these diets may contribute to a stable disease course and offer benefits in cognition and mood, such as reducing depression symptoms.
Physical activity combined with diet is also important, as exercise has been shown to improve mobility, reduce fatigue, and enhance mental well-being in MS patients. Integrating nutritional and exercise-based strategies is increasingly recognized as essential for optimal long-term management.
In summary, the evidence supports that diet interventions can positively influence inflammation, fatigue, mental health, metabolic comorbidities, and overall quality of life in MS. The Mediterranean diet stands out for its sustainability and broad benefits, while ketogenic, Swank, Wahls, and fasting diets show promise but require further research and consideration of individual patient needs and tolerances. Personalized, sustainable dietary approaches combined with education and lifestyle modifications offer the best potential for improving outcomes in people living with MS.
