Multiple sclerosis (MS) is a chronic, often debilitating disease affecting nearly 1 million people in the United States. Neurological difficulties are very common with this disease, and they often get worse over time, even with aggressive treatment. Emerging research suggests that adopting a Mediterranean diet may offer a protective effect against cognitive decline and disability progression in individuals living with MS.
What is the Mediterranean Diet?
Inspired by the traditional eating habits of people in Spain, Italy, and Greece, the Mediterranean diet emphasizes:
- Abundant plant-based foods: Vegetables, fruits, whole grains, beans, and legumes form the foundation of this dietary pattern.
- Healthy fats: Olive oil and other non-tropical vegetable oils are the primary sources of fat, along with nuts and seeds.
- Lean protein: Fish and other low-fat proteins are preferred over red meat.
- Moderate dairy: Low-fat dairy products are included in moderation.
- Limited intake: Red and processed meats, butter, and sugary beverages are consumed sparingly.
News & World Report’s Best Diets has consistently ranked Mediterranean-style eating plans as a top choice, recognizing their effectiveness in promoting weight loss and cardiometabolic health. Cardiometabolic health includes several risk factors, including type 2 diabetes and insulin resistance, cardiovascular disease, cholesterol levels, high blood pressure, and overweight and obesity.
Cognitive Benefits: Preserving Memory and Thinking Skills
A recent study presented at the Icahn School of Medicine at Mount Sinai in New York investigated the link between adherence to the Mediterranean diet and cognitive function in 563 people with MS. Participants were scored from zero to 14 based on how closely they followed the diet, as determined by a questionnaire. Cognitive impairment was identified in 19% of the participants.
The study revealed that individuals who adhered most closely to the Mediterranean diet had a 20% lower risk of cognitive impairment compared to those who did not follow the diet. Moreover, 34% of participants with lower adherence to the diet experienced cognitive impairment, compared to only 13% in the group with the highest adherence.
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Dr. Ilana Katz Sand, a study author and neurologist at The Mount Sinai Hospital in New York, highlighted that dietary alignment with the Mediterranean pattern was the strongest predictor of cognitive scores, even when considering other lifestyle factors like socioeconomic status, smoking, body mass index, high blood pressure, and physical activity level.
Impact on Disability: Lessening Physical Limitations
Another study evaluated the impact of the Mediterranean diet on disability in people with MS. The MS Functional Composite (MSFC) was tool used to objectively measure disability in MS, including cognition, arm coordination, and walking speed alterations. Patient-reported outcomes assessed physical impairment, fatigue, walking and cognitive dysfunction, depression, and anxiety.
Researchers grouped participants according to their Mediterranean Diet Adherence Screener (MEDAS) scores, with a higher score indicating better adherence to the Mediterranean diet. The team found that higher scores were associated with better MSFC performance (meaning less disability), independent of demographic factors such as age, sex, race, ethnicity, and socioeconomic status, or other health conditions. Each MEDAS point score increase was linked to a 15 percent lower risk for MSFC impairment.
“MEDAS was by far the best health-related predictor of MSFC,” the authors wrote. More closely following the Mediterranean diet was also associated with lower disability across all patient-reported outcomes, regardless of demographic factors or other health issues. Among patient-reported outcomes, depression had the strongest association with MEDAS scores. “Depression was worse among patients who use butter, drink sugary beverages, and consume less fish,” according to researchers.
The Role of Inflammation
Chronic inflammation can worsen symptoms of medical conditions and cause damage to the brain, heart, and other organs, according to Cleveland Clinic. The Mediterranean diet's emphasis on plant-based foods is believed to play a significant role in reducing inflammation. Kristin Kirkpatrick, MS, RDN, a nutritionist and the author of “Skinny Liver” as well as manager of Wellness Nutrition Services at Cleveland Clinic Wellness Institute, told Healthline the benefits of the Mediterranean diet most likely come from its inclusion of multiple plant-based foods. Individual foods within the diet, such as extra virgin olive oil and nuts, also show potent anti-inflammatory impacts.
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By limiting inflammatory-promoting processed and ultra-processed food products, dairy products, red and processed meats, and saturated fatty acids, the Mediterranean diet may help to quell disease activity and manage symptoms in people with MS.
A UK Biobank Study: Exploring the Link Between Diet and MS Onset
To further evaluate the potential connection between diet and multiple sclerosis onset, Mazzucca et al conducted what they deemed one of the largest cohort studies to date, using data gathered from the UK Biobank. Their cohort included 502,507 participants across England, Scotland or Wales, dating back to the initiation of a UK Biobank cohort study in 2006. These individuals ranged from 40-69 years, and each completed a food frequency questionnaire (FFQ) at baseline, where they reported their typical food and alcohol intake (quantity and frequency) over the last year. There was also a component where a select number of enrollees were asked to report their diet over the last 24 hours (24 h recall) in an online interview.
In total, the final cohort included 499,563 eligible individuals. On average, the participants engaged in 12.29 years of follow-up and exhibited 7.78 multiple sclerosis events per every 100,000-person year.
Researchers notably observed that consuming oily fish once or twice per week was associated with lower risk of multiple sclerosis compared with no consumption (once: aHR, 0.642; 95% CI, 0.480-0.859; twice: aHR, 0.666; 95% CI, 0.474-0.934; P = .0035). Furthermore, regularity of one’s alcohol consumption was inversely related to multiple sclerosis risk in regard to weekly vs monthly consumption (HR, 0.799; 95% CI, 0.648-0.984). While the overall trends with adherence to the Mediterranean diet did not reach statistical significant, Mazzucca et al emphasized the positive trends they witnessed, indicating a potentially protective effect.
“It is often difficult to identify possible correlations between individual foods and clinical outcomes,” Mazzucca et al wrote, adding, “However, the most recent research in nutritional immunology focuses on the role of complex nutritional patterns, rather than on single foods/nutrients, in chronic disease risk.”
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Applying this approach to their own study, the authors concluded, “These data provide a basis for more specific studies addressing the role of diet in MS [multiple sclerosis] onset, which may help to build evidence-based indications for MS prevention and management. Moreover, given the heterogeneity of disease subtypes and the existence of different MS ‘phenotypes’, the application of this pipeline on other study cohorts, in which the number of incident cases is enough to permit further stratifications, may lead to new insights useful for personalizing dietary approaches in the context of precision nutrition.”
The Gut Microbiota Connection
Emerging evidence suggests that a perturbed gut microbiota may be linked with MS susceptibility. The relationship between diet and gut microbiota is of growing interest as the microbiota may facilitate several health benefits. Interestingly, the gut microbiota’s gene composition (metagenome) in youth with pediatric-onset MS reflects a diet depleted in fiber, whole-grains, and iron. However, the interplay between diet and the microbiota in people with MS is largely unexplored, especially in younger individuals early in their disease course.
Challenges and Future Directions
While the findings are promising, it’s crucial to acknowledge that research on diet and MS is ongoing. As Bionews reported, prior research has not argued for a particular diet regimen in patients with multiple sclerosis; however, multiple analysis have suggested the possible benefits multiple diets can have on damage to the brain. Mazzucca et al echoed these sentiments, pointing to a plethora of data in the realm of diet’s impact on multiple sclerosis. As they noted, this literature produced conflicting results. For example, vitamin D has been indicated as beneficial for patients with multiple sclerosis, yet, dairy products-that typically have high concentrations of vitamin D-have been negatively associated with disease outcomes.
Dr. Katz Sand emphasizes that more longitudinal and interventional studies are needed to confirm the benefits of the Mediterranean diet for people with MS. These studies should follow people over time and involve well-designed clinical trials.
Researchers are also exploring the potential mechanisms by which the Mediterranean diet may exert its beneficial effects. This includes investigating the role of specific nutrients, such as omega-3 fatty acids and antioxidants, as well as the impact of the diet on the gut microbiota.
Practical Implications: Adopting a Mediterranean Lifestyle
For individuals with MS, incorporating elements of the Mediterranean diet into their daily lives may be a worthwhile strategy. Kathy Zackowski, PhD, the associate vice president of research for the National Multiple Sclerosis Society, emphasizes that diet is an important part of wellness and can work hand-in-hand with disease-modifying therapies to manage symptoms and quell disease activity.
The National Multiple Sclerosis Society encourages individuals to follow general healthy-eating guidelines, such as preparing meals at home, incorporating vegetables and fruits, and limiting intake of ultra-processed items.
At the Cleveland Clinic, providers recommend the Mediterranean diet for people with MS. “There’s so much literature behind the benefits of the diet, including improved mortality, a reduced risk of cardiovascular diseases, neurodegenerative diseases, and some types of cancer,” says Rensel.
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