Multiple sclerosis (MS) is one of the most common neurological disorders. It affects almost 914,000 U.S. adults and over 2.1 million people worldwide, and it’s two to three times more common among women than men (
This article explains how diet may affect MS and provides a guide for dietary changes that may help manage its symptoms.
Multiple sclerosis (MS) is an autoimmune disorder that gradually destroys the protective coverings that wrap around your nerve fibers. These coverings are called myelin sheaths.
Over time, this disease can permanently damage your nerves, affecting communication between the brain and body (
Symptoms of MS include (
- tingling and numbness
- bladder and bowel dysfunction
- movement difficulties and spasticity
- impaired vision
- learning and memory difficulties
MS is highly complex, and the way the disease progresses varies from person to person. Scientists are still not certain what causes MS and how to cure it, but they do know immune, environmental, and genetic factors are involved. (
Multiple sclerosis (MS) is a neurological condition that gradually destroys the protective coverings, which are called myelin sheaths, that wrap around your nerve fibers. Scientists do not fully understand the disease, and there is no cure.
Currently, there are no official dietary guidelines for people with MS.
No two people with MS experience it the same way (
However, scientists believe a combination of genetic and environmental factors may cause the disease, as well as that nutrition can have an influence. The fact that MS is more prevalent in Western countries than in developing nations is one clue that diet may play a key role (
That is why dietary guidelines and recommendations for people with MS should aim to help manage symptoms to improve overall quality of life.
Diet may help with MS in several ways, including:
- preventing or controlling its progression
- helping manage its symptoms
- reducing flare-ups
Ideally, an MS-friendly diet should be:
- high in antioxidants to fight inflammation
- high in fiber to aid bowel movements
- adequate in calcium and vitamin D to fight osteoporosis
- pack plenty of vitamins and minerals to fight fatigue and promote wellness
It should also limit foods that have been linked to chronic inflammation and other poor health outcomes, or those that simply make day-to-day activities more difficult for someone with MS.
Some evidence suggests that other dietary patterns, including ketogenic diets, may help improve symptoms in people with MS. However, this research is ongoing, and scientists need to further investigate the role of diet in MS.
A study involving 60 people with MS found that fast-mimicking diets, or a dietary pattern that involves periodic cycles of low calorie intake, and ketogenic diets had potential to treat relapsing-remitting multiple sclerosis (RRMS). Still, the researchers suggested that more high-quality studies on the effects of fast-mimicking diets in humans were needed (
Another study that gave people with MS a ketogenic diet that restricted carbohydrate intake to less than 20 grams per day for 6 months found that the diet helped improve fatigue and depression, promoted fat loss, and reduced inflammatory markers (
A separate study found certain nutrients, including fish oil, B vitamins, N-acetylcysteine, and CoQ10, may benefit people with mild to moderate MS, potentially leading to better general functioning, as well as an improved quality of life and ability to move around (
The nutrients associated with these positive changes included increased fat, cholesterol, folate, iron, and magnesium intakes. On the other hand, decreased carb intake appeared to be beneficial (
Clinical trials investigating the effects of ketogenic diets and intermittent fasting on MS are currently underway (
There’s also evidence that people with MS are more likely to be deficient in some nutrients, including vitamins A, B12, and D3 (
Preliminary evidence suggests that taking certain vitamins, minerals, fatty acids, antioxidants, plant compounds, and melatonin may help improve some symptoms (
Scientists need to do more research before making official recommendations about many of the dietary patterns discussed above. However, preliminary research is promising.
There are no official dietary guidelines for MS. However, research suggests that making certain dietary changes may help slow disease progression and help manage MS symptoms to improve quality of life.
Based on current and ongoing research, an MS-friendly diet should help people with MS manage their symptoms.
In particular, it should help manage disease progression and aim to minimize the effects that common MS symptoms have on overall quality of life.
Here is a list of foods to include on an MS-friendly diet:
- fruits and vegetables: all fresh fruits and vegetables
- grains: all grains, such as oats, rice, and quinoa
- nuts and seeds: all nuts and seeds
- fish: all fish, especially fresh fish and fatty oily fish, such as salmon and mackerel, as they’re high in omega-3 fatty acids and vitamin D
- meats: all fresh meats, such as beef, chicken, lamb, and more, especially beef liver which is particularly high in vitamin D and biotin
- eggs: good source of biotin, vitamin D, and other important nutrients
- dairy products: such as milk, cheese, yogurt, and butter
- fats: healthy fats, such as olive, flaxseed, coconut, and avocado oils
- probiotic-rich foods: such as yogurt, kefir, sauerkraut, and kimchi
- beverages: water, herbal teas
- herbs and spices: all fresh herbs and spices
In short, the guidelines for an MS-friendly diet are similar to an overall nutrient-rich, well-balanced diet. However, it emphasizes consuming more plant-based foods and grains.
That is because plant-based foods and grains are higher in fiber, vitamins, minerals, and fluid, which can help with MS symptoms, such as constipation, fatigue, and bladder dysfunction.
They’re also higher in plant-based compounds that function as antioxidants, which are molecules that help defend your cells against free radical damage and inflammation. These compounds may help fight inflammation and potentially slow MS progression (
Fish, particularly fatty fish, such as salmon and mackerel, appear to be beneficial for MS, possibly because they’re high in anti-inflammatory omega-3 fatty acids. They’re also high in vitamin D, which can help keep your bones strong when combined with calcium (
Current research on the effects of red meat and saturated fat intakes on MS symptoms shows mixed results. However, eating red meat in moderation, while focusing on more fruits, vegetables, and grains, is likely beneficial for people with MS (
Dairy products also show mixed results. In some studies, dairy products have been linked to disease activity. However, they’re a good source of calcium, vitamin D, vitamin A, and potassium, so you can try including them in moderation on an MS-friendly diet. Talk with your doctor if you believe dairy products are making your MS symptoms worse (
In addition, some research shows that people with MS may have a higher risk of celiac disease, an autoimmune condition that causes damage to the small intestine in the presence of gluten (
Gluten is a group of proteins in wheat, barley, and rye.
If you have MS and experience extreme discomfort when eating gluten-based products, such as bread, pasta, crackers, and baked goods, it’s important to notify your healthcare team to see whether you have celiac disease. Other symptoms of celiac disease include bloating, diarrhea, fatigue, abdominal pain, chronic headaches, and anemia.
People with MS who do not have celiac disease may still benefit from healthy grains in their diet.
Eating plenty of fruit, vegetables, grains, and fish may help with managing MS symptoms. A person with MS may eat red meat and dairy in moderation, as current research on their effects is mixed.
While an MS-friendly diet allows plenty of nutrient-dense, delicious options, there are still some food groups you should limit to help manage MS symptoms.
Here’s a list of foods to avoid if you have MS:
- processed meats: such as sausages, bacon, canned meats, and meats that are salted, smoked, or cured
- refined carbs: such as white bread, pasta, biscuits, and flour tortillas
- fried foods: such as french fries, fried chicken, mozzarella sticks, and doughnuts
- highly processed foods: such as fast food, potato chips, and convenience and frozen meals
- trans fats: such as margarine, shortening, and partially hydrogenated vegetable oils
- sugar-sweetened beverages: such as energy and sports drinks, soda, and sweet tea
- alcohol: limit consumption of all alcoholic beverages as much as possible
If you have celiac disease, aim to avoid all gluten-based foods, such as foods containing wheat, barley, and rye.
An MS-friendly diet is similar to a diet focused on promoting overall health and well-being. It restricts some foods, such as processed meats, refined carbs, and trans fats. These foods do not help manage MS symptoms and may worsen inflammation.
Several diets specifically aim to help slow progression and prevent flare-ups of MS. They include the Swank diet and variations of the Wahls diet. These diets are popular within the community of individuals with MS.
- avoid processed foods that contain saturated fat or hydrogenated oils
- limit saturated fat to 15 grams per day; consume no more than 20 to 50 grams per day of unsaturated fats
- avoid red meat for 1 year, then limit red meat to 3 ounces per week
- avoid dark meat poultry and limit fatty fish to 50 grams per day
- choose only dairy with 1% fat or less
- avoid egg yolks
- consume as many fruits and vegetables as you want
- enjoy whole grain breads, rice, and pastas
- snack on nuts and seeds daily
- consume 1 teaspoon of cod liver oil, and a multi-vitamin and mineral supplement daily
Research on the efficacy of the Swank diet is limited to a series of reports Dr. Swank published. The reports follow a group of individuals with RRMS who adhered to the Swank low fat diet for 50 years. Dr. Swank assessed individuals for compliance with the diet, frequency and severity of MS attacks, and performance status (wheelchair use, ability to walk, and ability to work) (
Those who adhered to the diet (consumed 20 grams of fat or less) had fewer and less severe MS-related exacerbations than those who consumed greater than 20 grams of fat. Individuals with lower performance status at the start of the observation period or who were in the progressive phase of MS were likely to experience continued decline, even if they complied with the Swank diet (
While Swank’s studies had a long follow-up duration and large cohort size, they were not randomized controlled trials and were subject to several forms of bias. Larger, better-designed studies are needed to determine whether the Swank diet can help improve symptoms or delay progression of MS.
Dr. Terry Wahls developed the modified Paleolithic Wahls diet for managing MS in 2008.
The Wahls diet is a version of the Paleolithic (Paleo) diet, which recommends you eat meat, fish, eggs, vegetables, fruits, nuts, seeds, herbs, spices, healthy fats, and oils, and that you avoid processed foods, sugar, grains, most dairy products, legumes, artificial sweeteners, vegetable oils, margarine, and trans fats.
The modified Paleo Wahls diet makes the following recommendations beyond the Paleo diet (
- eat nine or more cups of fruits and vegetables daily (three cups each of green leafy vegetables, sulfur-rich vegetables, and intensely colored fruits or vegetables)
- emphasize consumption of seaweed, algae, and nutritional yeast
- consume limited servings of gluten-free grains and legumes
- avoid eggs
- consume lower meat and fish intake than the Paleo diet
In one small randomized, controlled trial, 17 individuals with RRMS who followed the Wahls diet for three months experienced improved quality of life and less fatigue compared to those who continued their usual diet (
Dr. Wahls developed The Wahls Elimination diet in 2015, which recommends avoiding all grains (including those that are gluten-free), legumes, and nightshades (including tomatoes, white potatoes, eggplant, peppers, and seed spices) to reduce lectin in the diet (
It also recommends avoiding all dairy and allows for unlimited consumption of saturated fat. Like the modified Paleolithic Wahls diet, the Wahls Elimination diet recommends at least nine cups of fruits and vegetables daily, as well as seaweed, nutritional yeast, and fermented foods.
While a study comparing the impact of the Swank and Wahls Elimination diets on MS-related fatigue and quality of life is currently underway, no research is available on the efficacy of the Wahls Elimination diet (
It is important to note that diets that exclude whole food groups (like grains and dairy in the Wahls Elimination diet) increase the probability of nutritional insufficiency. However, taking supplements when on these diets can help reduce the risk of nutritional deficiency.
Both the Swank diet and Wahls Elimination diet were developed to slow progression and prevent flare-ups of MS. Limited research on the efficacy of these diets for MS is promising; however, more well-designed research is needed. Keep in mind, any diet that eliminates whole food groups (like the Wahls Elimination diet) increases your risk for nutritional insufficiency.
In addition to the diet guidelines above, people with MS may want to consider the following food tips to help manage their symptoms.
- Make sure you eat enough food. Eating too few calories can cause fatigue.
- Prep your meals in advance. If you have time, batch-making meals can help you save energy later. If you’re often fatigued, this can be especially helpful.
- Rearrange your kitchen. Place food, utensils, and other equipment in areas that are close by and easy for you to clean up. This will help you save energy.
- Try “ready-to-use” items. Buying precut fruits and veggies can help you shave minutes off cooking time and make cooking simpler.
- Make thicker drinks. If you have difficulty swallowing, preparing thicker beverages like a nutrient-rich smoothie may be easier to manage.
- Soft foods may help. If chewing too much is making you fatigued, try choosing softer foods like baked fish, bananas, avocado, and cooked veggies.
- Limit crumbly foods. If you have difficulty swallowing or find yourself choking on food often, consider limiting foods that crumble, such as toast and crackers.
- Reach out for help. Even if you do not like asking for help, having members of your support network help with small tasks, like preparing meals, cleaning, or simply setting the table, can help ease your fatigue.
- Stay active. Although exercise can make a person with MS feel fatigued, it’s especially important for helping achieve and manage optimal health and a moderate weight. It’s also important for preventing osteoporosis, which is more common among people with MS.
If you have other MS-related concerns not addressed above, it’s important to notify your healthcare team. They can offer personalized tips to help you manage your symptoms better.
The tips listed above can help improve your quality of life with MS by helping you maintain a moderate weight and manage symptoms like fatigue and swallowing issues.
If you are considering changing your diet to help control your MS symptoms and would like more information, here are some good resources:
- National Multiple Sclerosis Society — Diet and Nutrition
- Swank MS Foundation — The Swank Low-Fat Diet for the Treatment of MS
- American Autoimmune Related Diseases Associtaion, Inc. — The Wahls Protocol
- National Multiple Sclerosis Society — Vitamins, Minerals & Herbs in MS
- National Multiple Sclerosis Society — Diet and Multiple Sclerosis: A Neurologist’s Perspective
A registered dietitian nutritionist (RDN) who specializes in MS can make personalized dietary recommendations to help you manage your symptoms and reduce flare-ups of MS. To find one near you, use the Find a Nutrition Expert search function at the Academy of Nutrition and Dietetics website.
Multiple sclerosis (MS) is an autoimmune condition that affects the nervous system.
There are no official dietary guidelines for MS. However, making certain dietary changes may help relieve common MS symptoms, such as constipation and fatigue, as well as improve overall quality of life.
Dietary changes that may help include eating more grains, fish, and plant-based foods.
In addition, avoiding low-nutrient foods may help with managing MS symptoms and potentially slow disease progression.
It’s recommended that people with MS avoid certain foods, including processed meats, refined carbs, junk foods, trans fats, and sugar-sweetened beverages.
Other tips to manage MS symptoms include:
- making meals in bulk
- using “ready-to-use” grocery items
- rearranging your kitchen for convenience
- choosing foods with appropriate textures
- reaching out for help to manage daily activities
As with any new diet, it’s important to notify your healthcare team before making major changes to your diet to manage MS.