MS and nutrition: 5 diets compared

Source: Jeleefstijlalsmedicijn

Multiple sclerosis (MS) is a complex and unpredictable condition, but there is good news: nutrition and lifestyle can play an important role in improving symptoms and possibly slowing the disease. This article on MS and nutrition explores how metabolic health and nutrition are connected to MS, looks at which diets work for it and whether supplements can help, and thus offers practical tools for addressing MS symptoms and (possibly) slowing disease progression.

Key points from this article (reading time 14 minutes)

[Risk factors such as obesity, smoking, lack of vitamin D, and metabolic dysfunction play a crucial role in MS.]
[Improving metabolic health can reduce the chance of MS and possibly improve disease progression.]
[Avoiding ultra-processed food and limiting carbohydrates contribute to better metabolic health.]
[Various diets (such as paleo, ketogenic, and Mediterranean) show promising results in terms of reducing fatigue, improving quality of life, and counteracting disability in MS patients.]
[Supplements such as fish oil and vitamin D, on the other hand, appear to be not very effective.]

Read on and discover how nutrition can be a powerful tool in addressing MS.

1. Multiple Sclerosis

Multiple sclerosis (MS) is a disease that causes the breakdown of the protective layer around nerves (myelin). This disrupts communication between the brain and the rest of the body. Eventually, the disease can cause permanent damage to the nerve fibers in the brain and spinal cord.

The symptoms of MS vary from person to person, depending on the location of the damage in the nervous system and the severity of the damage to the nerve fibers. Multiple sclerosis can cause numbness, weakness, walking problems, vision changes, and other symptoms. The course of the disease varies depending on the type of MS.

There is no cure for multiple sclerosis. However, there are treatments available that can help with faster recovery after attacks, that can influence the course of the disease, and that can manage symptoms.

2. Risk factors for MS

Research shows that there are several factors that increase the risk of multiple sclerosis:

Sex Women are two to three times more likely than men to develop MS.
Family history If someone’s parent, brother, or sister has MS, the risk of getting the disease is 12 times higher.
Certain infections Various viruses have been linked to MS, including the Epstein-Barr virus.
Vitamin D A low vitamin D level and little exposure to sunlight give a two times higher risk of MS (Belbasis, 2019).
Obesity People who have obesity or had obesity as a child have twice the chance of MS (McKay, 2016).
Smoking Smokers have a 2.3 times higher risk of MS than people who do not smoke.

The last three risk factors (vitamin D, obesity, and smoking) make one think: if lifestyle apparently plays such a large role in the risk of developing MS, could living as healthily as possible reduce the risk of MS? Or slow down or even reverse the decline in MS?

3. The connection between brain disorders and metabolic dysfunction

In this chapter, we look at the connection between a healthy lifestyle and MS. We start broader: we first look at the effect of lifestyle on brain disorders in general. These disorders have two things in common: they often occur together and have a relationship with metabolic unhealthiness.

3.1. Each brain disorder is associated with every other brain disorder

Having one disorder increases the chance of another disorder by a factor of two to thirty (Plana-Ripoll, 2019). A few examples:

Patients with depression have a two times greater chance of developing Alzheimer’s (Ownby, 2006).
Patients with an anxiety disorder have an eight to thirteen times greater chance of schizophrenia (Plana-Ripoll, 2019).
Patients with epilepsy have a three to six times greater chance of developing anxiety disorders (Kanner, 2011).
Patients with schizophrenia have a twenty times greater chance of developing Alzheimer’s (Stroup, 2020).

**Why is this connection relevant? **

When scientists see that two disorders often occur together, they suspect a common cause. Think of a runny nose and a sore throat: these are not separate conditions, but both symptoms of a cold. With the cold virus as the common cause.

What could be a common cause of brain disorders?

3.2. Brain disorders often occur together with metabolic unhealthiness

In metabolic dysfunction, metabolism is dysregulated. Metabolic dysfunction manifests through a large waist circumference, elevated blood sugar levels and blood pressure, and abnormal fat values in the blood. Metabolic dysfunction often occurs together with type 2 diabetes and obesity.

A few examples of the connection between these forms of metabolic unhealthiness and brain disorders:

Patients with schizophrenia have a three times greater chance of diabetes (Rajkumar, 2017).
Diabetes patients have a fifty percent greater chance of developing epilepsy (Baviera, 2017).
Children with autism have forty percent more chance of obesity (Mische Lawson, 2016).
Weight gain around puberty gives a four times higher chance of depression as a young adult (Perry, 2021).

We know from epidemiological research (see chapter 2) that MS is associated with obesity (a form of metabolic dysfunction). In this, MS is not unique, as we have seen many other brain disorders are also associated with metabolic dysfunction.

Could it be that improving our metabolic health helps to reduce the chance of MS? Can living healthier relieve MS symptoms, slow down decline, or even reverse the disease?

The evidence for this can only be provided by so-called clinical studies that can demonstrate a causal relationship between what people do and the course of their MS. Such studies exist (for various diets) and we will describe them in chapter 5. Before we do that, we make another intermediate step in chapter 4: how can you improve metabolic health with nutrition?

4. Improving metabolic health with nutrition

Metabolic health can be improved with lifestyle adjustments. Think of eating healthier, getting enough sleep, relaxing better, and exercising more. All these adjustments improve the causes of metabolic dysfunction: insulin resistance and low-grade chronic inflammation.

In insulin resistance, there is a reduced sensitivity of body cells to the hormone insulin. Insulin works as a kind of ‘key’ for the sugars in the blood. Insulin opens the cells, allowing sugar to enter the cell. If too often, too much, and too quickly digestible sugars are supplied, the cells become insensitive to insulin. That is called insulin resistance.

With insulin resistance, the body produces more and more insulin to get the excess sugars out of the blood. Insulin resistance leads to metabolic dysfunction and thus to an increased risk of many conditions, including MS.

Central to improving insulin resistance (and thus metabolic health) is our nutrition.

4.1. Avoiding ultra-processed food

In the past fifty years, the consumption of ultra-processed food has increased sharply. 61 percent of the energy intake of the average Dutch person now consists of this industrially produced food (Vellinga, 2022). Examples of ultra-processed food are soft drinks, cookies, candy, supermarket bread, seed oils, breakfast cereals, sauces, and diet drinks.

Eating ultra-processed food has a strong negative effect on our health. A French study (Rico-Campa, 2019) in which 170,000 people were followed for 10 years showed the connection between the consumption of ultra-processed food and increased risks of type 2 diabetes, cardiovascular diseases, cancer, dementia, depression, and stomach and intestinal disorders.

This study showed that people who ate and drank the most ultra-processed foods had a 62 percent higher mortality risk than those who consumed the least.

Ultra-processed food and MS

An Italian study (Guglielmetti, 2023) shows that MS patients who eat more ultra-processed food have two to three times more severe symptoms than people who eat less of that highly processed food.

Dutch research (Broos, 2024) shows that in MS patients the omega 3/omega 6 ratio is disrupted (with too much omega 6). An elevated level of omega 6 is associated with chronic inflammation in the body and faster decline in MS.

Omega 6 is mainly found in industrially produced seed oils (such as sunflower oil). These seed oils are processed in many ultra-processed foods such as cookies, sauces, and margarines. In addition to these seed oils, meat from grain-fed cattle contains a lot of omega 6. A much more favorable omega 3/omega 6 ratio is present in fish, nuts, and meat from grass-fed cattle.

4.2. Other nutritional interventions

Avoiding ultra-processed food helps to become metabolically healthier. Additionally, it helps to:

Choose foods with a low glycemic load. Certain foods contain quickly digestible carbohydrates (sugar and refined flour) that cause high insulin spikes and thereby increase insulin resistance. Think of fruit juice, (factory) bread, pasta, and white rice. Food that causes fewer insulin spikes is meat, fish, dairy, eggs, nuts, seeds, fruit, and vegetables.
Limit the amount of carbohydrates. Depending on someone’s health, someone can tolerate more or fewer carbohydrates. To determine how many (or few) carbohydrates someone can handle, a continuous glucose meter is a handy tool. Ideally, the glucose rise after a meal is less than 1.6 mmol/L. For many patients with insulin resistance, this requires limiting the intake of carbohydrates to less than 50 grams per day.
Limiting the number of eating moments. Eating less often helps against insulin resistance by reducing the number of glucose spikes. With wholesome, natural food, two to three eating moments per day are sufficient. Incidentally, limiting the number of eating moments becomes easier if someone eats fewer carbohydrates. After eating or drinking (refined) carbohydrates, there is first a rapid glucose and insulin spike and then a sharp drop in blood glucose. This glucose dip can be accompanied by a strong need for food.

5. MS and nutrition: studies on the effect of different diets

If unhealthy eating with lots of ultra-processed food increases the chance of MS and leads to more severe symptoms, then research should show that healthy eating in patients leads to improvement. But is that so?

The way to demonstrate that is through so-called randomized controlled trials (RCTs). These are studies where two groups of patients are formed who each receive their own treatment. One group gets the diet being tested, the other (control) group a ‘standard’ diet.

In this chapter, we list the research on MS and nutrition regarding five different diets: low-fat, less animal, ketogenic, Mediterranean, and paleo. We look at what these diets do regarding fatigue, disability, quality of life, and — where studied — certain physical tests (see table 1). We use two meta-analyses (collections of RCTs):

Harirchian, 2022. This article on MS and nutrition contains the names of the underlying studies that we describe one by one below.
Snetselaar, 2023. This article on MS and nutrition shows which type of diet has more effect than others. We will return to Snetselaar’s conclusions after listing the different diets.

Below is an overview from these meta-analyses of different diets and their effect on MS symptoms:

Outcome	Low-fat	Less meat	Ketogenic	Mediterranean	Paleo
Fatigue	Significant	Significant	Significant	Significant	Significant
Quality of life	Partial	Partial	Significant	Significant	Significant
Disability (EDSS)	No effect	Significant	Significant	Significant	-
Relapses	-	Significant	-	-	-
Physical tests	None/partial	-	Significant	-	Significant

Table 1 - Overview of different diets and their effect on MS symptoms. Based on meta-analyses by Harirchian (2022) and Snetselaar (2023).

These are the results of the studies on MS and nutrition per diet type:

5.1. Low-fat

Two studies examined the influence of limiting fat:

Yadav, 2016 A low-fat diet (10% fat, 14% protein, 76% carbohydrates) limited in animal food, for twelve months, improved fatigue but had no significant influence on disability, quality of life (QoL), or physical function.
Wahls, 2021 The Swank diet was tested with limited saturated fat (maximum 15 grams per day), four servings of whole grains per day, and also vegetables and fruit. After twelve weeks, fatigue decreased significantly and physical quality of life improved. Mental quality of life and walking distance did not change significantly.

5.2. Less meat

Two studies focused primarily on plant-based food, each with a limited amount of fish and lean meat:

Riccio, 2016 A calorie-restricted, semi-vegetarian diet (1700 to 1800 kcal, 50% carbohydrates, 30% fat, 20% protein) for seven months showed no significant changes in quality of life and disability. However, medium to large effects were found on fatigue.
Saresella, 2017 A twelve-month diet rich in vegetables, fruit, nuts, and olive oil, with limited consumption of animal proteins (twice a week fish, once chicken) and processed foods, resulted in a large improvement in disability and a reduction in the number of relapses

5.3. Ketogenic diet

Two studies examined the ketogenic diet:

Bock, 2015 In this study with sixty patients with RRMS (relapsing-remitting MS, the most common form of MS), the ketogenic diet was found to have a large influence on quality of life. Other measures were not measured.
Brenton, 2022 Sixty-five people with RRMS participated in a six-month study with the ketogenic diet. They were monitored by having their urine tested daily for ketones. Participants had almost 50 percent less fatigue and depression. Their physical and mental quality of life improved, as did their walking distance, hand dexterity, and disability score.

5.4. Mediterranean diet

One study examined the Mediterranean diet:

Sand, 2019 Women with MS were randomly assigned to groups that followed a Mediterranean diet or control diet for 6 months. The Mediterranean diet contained lots of fish, healthy fats, fruit, vegetables, and whole grains, and limited the consumption of meat, dairy, processed food, and salt. The group that followed the Mediterranean diet showed a significant decrease in fatigue and disability compared to the other group.

An interesting, recent Dutch study is the ‘Live! with MS’ study. Although this is a multi-domain lifestyle study, which also looked at exercise and relaxation, nutrition was a very important component. The dietary intervention in this study was aimed at an adapted Mediterranean diet of unprocessed food, lots of vegetables, healthy fats, and high-quality proteins. Sugar and processed foods were avoided. Study participants reported, among other things, a significant decrease in fatigue and an improvement in quality of life (but no improvement in physical symptoms) (Nauta, 2025).

5.5. Paleo diet

Two studies examined the paleo diet:

Irish, 2017 This study examined the paleo diet in MS patients. That diet contains lots of vegetables, fruit, and nuts, and few legumes, dairy, sugar, processed food, oils, and gluten-containing grains, with a moderate amount of meat. Compared to the usual American diet, the paleo diet improved fatigue, mental and physical quality of life, and motor function of the hands.
Wahls, 2021 The diet used contained 6-9 servings of vegetables and fruit, 150-300 grams of meat per day, while excluding grains, legumes, eggs, and dairy (except ghee). After 12 and 24 weeks, the diet showed a significant reduction in fatigue and improved physical and mental quality of life in people with MS.

Looking at the whole of studies on MS and nutrition, several conclusions can be drawn:

The studies used are limited in evidence strength. Snetselaar’s analysis shows that the evidence strength of the studies is limited, due to the small numbers of participants (609) and the limited number of studies.
All mentioned diets do better than the control diet. That control diet generally consists of the standard Western diet.
When comparing the diets, paleo stands out the most. Snetselaar quantifies the contribution of the diets on two components: fatigue and quality of life (physical and mental). On both components, the paleo diet does best, followed by the ketogenic diet for quality of life and the Mediterranean for fatigue.

6. Studies on supplements

In addition to studies on complete diets that we described in chapter 5, there have also been many studies on the possible effects of supplements on MS symptoms.

An example is Mahler, 2024, a meta-analysis of clinical research (RCTs) on vitamin D3 supplementation. The research shows that vitamin D3 did not significantly reduce disability scores (EDSS), annual relapse rate, or new lesions after 6-24 months.

In a review study (Parks, 2020), all known clinical studies (RCTs) on other forms of supplementation in MS were listed. The outcome of the studies was disappointing: “There is insufficient evidence that supplements with antioxidants or other nutrients have any impact on MS-related outcomes.”

The same researchers encountered a number of different forms of supplementation and concluded the following:

Replacing saturated fats (MUFA) with unsaturated fats (PUFAs). PUFAs come from fatty fish, nuts, and seeds, MUFAs from products like olive oil and avocado. According to the researchers, there is insufficient evidence to confirm differences between PUFAs and MUFAs in MS patients. The impact on relapses, decline, or change in disabilities is unclear.
Supplementation with omega 3 (fish oil). Little to no difference was found between supplementing omega 3 or omega 6 fatty acids in MS patients regarding relapses, changes in disabilities, decline, or new lesions. That supplementing with omega 3 apparently does not work while we earlier noted that a lack of omega 3 leads to a worse course of MS may be because supplements are not well absorbed in the body.
Antioxidants. Antioxidant supplements (such as vitamin A) have little to no effect on relapses, disabilities, or decline in MS patients.

In short, research shows that these forms of supplementation are not effective.

7. Conclusions on MS and nutrition

Although multiple sclerosis remains a complex and unpredictable disease, nutrition offers a hopeful angle to relieve symptoms and possibly slow disease progression.

Various studies show that diets such as the paleo, ketogenic, and Mediterranean diets show promising results, with observed improvements in fatigue, quality of life, and even physical function. What these diets have in common is their focus on natural, unprocessed foods and limiting carbohydrates and avoiding ultra-processed food.

On the other hand, supplementation with omega 3, antioxidants, and vitamin D3 appears to be not very effective. This emphasizes that the power of nutrition lies not in individual components, but mainly in an overall picture of healthy nutrition.

For people with MS, this means that adjusting nutrition can be an accessible and powerful tool. With a focus on metabolic health and avoiding harmful food, it is possible to positively influence the course of the disease and daily quality of life.

Veelgestelde vragen

Which diet works best for MS?

Research shows that the paleo diet, followed by the ketogenic and Mediterranean diets, provide the most improvement in fatigue, quality of life, and disability in MS patients.

Do supplements like fish oil and vitamin D help with MS?

Research shows disappointingly little effect from supplements. Vitamin D3, omega-3 (fish oil), and antioxidants do not appear to significantly help with MS symptoms. The power of nutrition lies in the overall picture, not in individual supplements.

What is the connection between metabolic dysfunction and MS?

MS is associated with metabolic dysfunction: people with obesity have twice the chance of developing MS. Improving metabolic health through nutrition may reduce the chance of MS and relieve symptoms.

What do effective MS diets have in common?

All diets that work for MS (paleo, ketogenic, Mediterranean) focus on natural, unprocessed foods and limit carbohydrates and ultra-processed foods. They thereby improve insulin sensitivity and reduce chronic inflammation.

Does ultra-processed food make MS symptoms worse?

Yes, research shows that MS patients who eat more ultra-processed food have two to three times more severe symptoms than people who eat less processed food.

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