Review Outlines Effective Diets, Exercise Techniques to Improve MS-Related Outcomes

A review of published literature revealed which diet methods and forms of physical activity are most effective at improving patient-reported outcomes in patients with multiple sclerosis (MS).

Combined exercise and training along with certain diets (ie, low-carbohydrate, Mediterranean, fast-mimicking) may have beneficial effects on the impact of multiple sclerosis (MS) on patient-reported outcomes, according to a review.

The review, published in Nutrients, analyzed published literature regarding the positive and negative effects of different forms of physical activity and diet strategies on patients with MS, as well as the symptoms and clinical outcomes that are affected.

Despite adhering to a normal calorie intake, patients with MS may have an imbalance in macronutrient intake with low-carbohydrate and high-lipid diets with abdominal obesity, higher body mass index, and a higher fat percentage, which can lead to increased inflammation and high serum levels of cytokines linked with MS pathogenesis and severity.

Although current disease-modifying therapies are effective in specific MS subtypes and phases, patients with a low tolerance, adverse effects, or comorbidities often experience treatment limitations. Additionally, because few disease-modifying therapies benefit cognitive functions in MS populations, researchers directed their focus toward use of exercise training as a noninvasive treatment option for MS.

Interest in research on the role of nutritional factors and physical activity in the pathogenesis of MS has been growing over the past few decades. The investigators sought to determine whether the association diets and physical activity have an additive effect in modifying disease severity.

Low-Carbohydrate Diets

Low-carbohydrate diets, such as ketogenic and Paleolithic diets, consist of patients restricting their carbohydrate intake. The benefits of ketogenic diets included improved memory and motor deficits, self-reported health-related quality of life, and Expanded Disability Status Scale scores after 6 months.

Paleolithic diets typically require participants to ingest nondomesticated meats, fish, vegetables, fruits, and legumes and avoid highly processed foods, dairy products, and gluten. Studies have shown that patients with MS who commit to a Paleolithic diet experienced improvements in quality of life, fatigue, gait, balance, anxiety, depression, and executive functions. However, avoiding cereals in modified diets may lead to deficiencies in folic acid, thiamine, calcium, and vitamins B, D, and E.

Mediterranean Diet

The Mediterranean diet consists of participants consuming higher contents of omega-3 polyunsaturated fats from fish or seafood and monounsaturated fats from olive oil as well as fruits, vegetables, bread, cereals, red wine, eggs, legumes, and nuts. Studies have shown that adherence to a Mediterranean diet was found to reduce risk of MS and long-term disability. Investigators have concluded that this diet is safe for patients with MS and could be considered as a therapeutic measure to improve quality of life.

Fasting-Mimicking Diets

Fast-mimicking diets involve a myriad of diet interventions that lead to a fasting state through prolonged period of little or no caloric intake, such as calorie restriction diets and intermittent fasting. A calorie restriction of 33% has shown to have an anti-inflammatory effect and a neuroprotective effect in patients with MS. A 66% calorie restriction has been found to suppress neurological signs related to inflammation as well.

Studies have found that intermittent fasting can improve experimental autoimmune encephalomyelitis and both diets have shown to improve the emotional health of patients with MS, suggesting that diet could have a role in mitigating depressive symptoms. However, fast-mimicking diets are difficult to adhere to, which can limit the diets’ effectiveness and could lead to adverse effects, such as reductions in bone mass and libido or abnormal menstrual cycles.

Physical Activity and Exercise Training

Researchers generally agree that, based on the most recent knowledge, a combined exercise training is best to achieve different beneficial effects in patients with MS. Studies have demonstrated that combined exercise led to increased levels of brain-derived neurotrophic factor serum after 8 weeks. Additionally, Pilates and aerobic combined training produced beneficial effects in cognitive impairment among mildly disabled patients with relapsing-remitting MS. Patients also experienced improvements in long-term verbal memory, cognitive fatigue quality of life, walking capacity, processing speed, visuospatial memory, and verbal fluency.


Fanara S, Aprile M, Iacono S, et al. The role of nutritional lifestyle and physical activity in multiple sclerosis pathogenesis and management: a narrative review. Nutrients. 2021;13(11):3774. doi:10.3390/nu13113774