Nutrition and MS Fatigue: What Food Can (and Can’t) Actually Do
When food changes don't shift your fatigue the way you hoped, the problem might not be what you're eating. It might be the kind of fatigue you're trying to fix — or a more basic question no one thought to ask first: are you eating enough?
Most MS nutrition advice opens with weight. The unspoken assumption is that if you're carrying extra weight, you're eating too much of the wrong things. For some people, that's true. For many others, the problem runs the opposite direction — they aren't eating enough — and almost no one is asking. Fatigue is often the first clue.
Before any of that, though, one distinction shapes everything else. As covered in this earlier post, primary MS fatigue comes from the disease itself: nerve damage, inflammation in the brain and spinal cord, and a nervous system working overtime to do things that used to be automatic. No food, diet, or supplement has been shown to reverse it. Secondary MS fatigue comes from everything else that piles on while you live with MS — poor sleep, medication side effects, depression or anxiety, deconditioning, coping with symptoms, other health conditions, and what and how you eat. That's the layer nutrition can actually move.
This article is about that layer: how food helps with secondary fatigue, and the question that gets skipped most often. Are you eating enough?
Quick Takeaways
There are two kinds of MS fatigue: primary, which comes directly from the disease, and secondary, which is everything that piles on top. Nutrition can only help with the secondary kind.
No food, diet, supplement, or eating pattern has been shown to alter the course of MS. Disease-modifying therapies work in that space. Food does not.
What nutrition can do: correct deficiencies, steady your blood sugar, and address dehydration. The step that matters most — making sure you're eating enough — is what a proper nutrition assessment can determine.
Multiple trials show whole-food eating patterns reduce perceived fatigue in MS, but no single "MS diet" convincingly beats the others. Adequacy and consistency matter more than the name on the protocol.
The biggest nutrition-related cause of secondary fatigue may be the one people rarely mention: not eating enough. MS creates at least six barriers to getting enough food — and none of them are about food choices.
Table of Contents
What Nutrition Can and Cannot Do
Let me be clear, because being vague about this doesn't help anyone.
Nutrition cannot reverse the nerve damage MS causes. It cannot suppress the inflammation inside the central nervous system, where the disease does its damage. It cannot change disability scores. It cannot replace disease-modifying therapies.
Nutrition can correct deficiencies that worsen secondary fatigue. It can help keep your blood sugar steadier, which supports more even energy throughout the day. It can lower markers of systemic inflammation — the kind in your bloodstream that a doctor can measure with a blood test. It can improve metabolic health, which matters for other conditions that affect about two-thirds of people with MS. And it can ease practical drivers of fatigue, such as dehydration and blood sugar crashes. The biggest driver of all — whether you're eating enough in the first place — isn't something food fixes on its own. It's something a nutrition assessment has to surface first.
A quick note about inflammation, since this is where MS nutrition advice gets slippery. Diet affects systemic inflammation, which is tied to heart and metabolic health. It has not been shown to reduce inflammation inside the central nervous system, where MS does its damage. These are two different compartments, and conflating them is how "eat to fight your MS" becomes a marketing line. More on what "anti-inflammatory" actually means in research — and what it doesn't.
Food is one lever among several. Sleep, movement, stress, and mental health all sit alongside what you eat, and sometimes they matter more.
Are You Eating Enough? The Most Under-Asked Question in MS Nutrition
Most MS nutrition advice fixates on what to eat — and what to avoid.
Far fewer people ask whether you're eating enough in the first place. That's because the question only surfaces in a nutrition assessment: Is your eating pattern adequate? Are you getting the calories and nutrients your body needs?
Picture a racecar pulling into the pit. The crew changes the tires, checks the brakes, tops off the fluids — and nobody puts fuel in the tank. The car rolls back onto the track on fresh tires and premium brake pads, then runs out of gas three laps later. Everything got optimized except the one thing that makes the car move.
That's what happens when we obsess over food rules and "eat this, not that" lists without first checking that someone is eating enough to meet their needs. You can improve food quality all you like, but if total intake is too low, the fatigue stays. Often, fatigue is the first signal that the tank is running low.
This is more common than most people realize. MS itself creates real barriers to eating enough — never mind eating well — and they're exactly what a clinical nutrition assessment is designed to identify. And address.
Six Reasons People with MS May Struggle to Eat Enough
1. The spoon cost of feeding yourself. Every stage of eating — planning, shopping, cooking, cleaning up — costs energy. For someone managing MS fatigue, the full lifecycle of a meal can feel like Dante's nine circles of hell just to feed yourself. The grocery store alone demands standing tolerance, cognitive planning, carrying bags, and navigating a space built for people who don't fatigue easily. By the time the food is home, the energy to cook it may already be gone. This isn't laziness. It's resource economics.
2. Medication side effects that affect appetite. Dimethyl fumarate (Tecfidera) can cause GI symptoms — nausea, stomach pain, diarrhea — that make eating unpleasant. High-dose steroids during relapses can change how food tastes and make appetite unpredictable. Drugs like gabapentin and baclofen, used for symptoms, can blunt appetite or cause nausea. These effects are common and listed in the prescribing information, and they can directly reduce how much you eat.
3. Depression, anxiety, and apathy. Depression affects up to half of people with MS. One of its hallmarks — anhedonia, the loss of interest in things you used to enjoy — can turn eating into a chore. Food that once brought pleasure starts to feel like nothing. Anxiety about food choices, especially when advice makes you feel like you're eating "wrong," can tip into avoiding food instead of enjoying it. And MS-related apathy — a neurological symptom, not a personality flaw — can make feeding yourself feel not worth the effort.
4. Swallowing difficulties. Dysphagia — difficulty swallowing — affects far more people with MS than most realize. Self-report questionnaires put it around 36 percent, but objective testing pushes that to 56–81 percent (Mirmosayyeb et al., 2021; Solaro et al., 2020). Many people live with swallowing problems that were never formally assessed, and the gap between "I have trouble swallowing" and "testing shows your swallow is abnormal" means a lot of people quietly change what they eat without anyone connecting the dots. Rates climb with progression: about 22 percent in relapsing-remitting MS, but over 40 percent in secondary and primary progressive forms.
Here's how it connects to eating enough. When swallowing feels difficult or unsafe, people avoid the hardest foods to swallow — meats, raw vegetables, fibrous foods — which are often the most nutritious. Meals take longer, so fatigue arrives before the plate is finished. Worry about choking leads to smaller portions or skipped meals, especially around others. Over time, those small changes add up to less food, less protein, fewer nutrients — not because anyone chose to eat less, but because eating got harder. About one in four people with MS who get a swallowing assessment need to change their diet as a result (Solaro et al., 2020). This is a nutrition status problem hiding in plain sight.
5. Mobility and dexterity challenges. Tremors can make cooking with sharp tools risky. A weak grip makes opening containers tough. If you can’t stand for long, it’s hard to spend time at the stove. Heat sensitivity can make the kitchen itself uncomfortable. Each of these barriers can be managed on its own, but together they make eating well a daily challenge.
6. GI and bowel problems. Gastroparesis, which is when the stomach empties more slowly than it should, constipation, and general GI slowing are all common in MS. When your stomach doesn’t empty well, you feel full before you’ve eaten enough. Chronic constipation decreases hunger. Ongoing bowel discomfort makes sitting down to a full meal unappetizing.
None of these barriers show up in clinical trials of MS diets. None get a mention in wellness articles about "eating to support your immune system." And yet they're part of daily life with MS — and they shape how well, and how much, you actually eat.
If you recognize yourself in any of those six, the problem isn't you. It's that the conversation about MS and food started in the wrong place. We argue over which foods are best when the real question is whether eating itself has become hard, why, and what that's doing to your nutrition status.
The racecar example explains part of this. It’s easy to focus on details like tire type and brake fluid and forget to check the fuel gauge. If you’re not getting enough fuel, there’s usually a reason. These six barriers aren’t the whole story, but they’re a good place to begin.
Blood Sugar, Meal Timing, and the Energy Connection
Blood sugar swings are one of the more overlooked causes of secondary fatigue in MS. This is partly because the connection isn’t unique to MS, so it doesn’t always come up when talking about managing the disease.
In simple terms, when you eat foods that digest quickly, like highly refined carbs, sugary drinks, or low-fiber snacks, your blood sugar rises fast and then drops quickly. That drop brings fatigue, trouble concentrating, irritability, and cravings for something sweet or a strong cup of coffee to feel better. For someone already dealing with primary MS fatigue, these blood sugar crashes add to the problem.
Let’s return to the racecar example. Not eating enough is like leaving the pit stop without fuel. Blood sugar swings are like having a tank that’s half gas and half air. The engine sputters. You get a burst of speed, then nothing. The car didn’t run out of gas, but the fuel was delivered so unevenly that it might as well have.
Skipping meals makes this worse. When you go long stretches without eating and then consume a large amount at once, the blood sugar spike is bigger, and the subsequent crash is steeper. This is especially relevant for people with MS who skip meals, not because they’re trying to fast, but because any of those six barriers we just talked about got in the way.
The most useful steps here don’t require a complete diet overhaul:
Don't skip meals, especially earlier in the day.
Pair carbohydrates with some protein and fat rather than eating carbs alone.
Choose less refined grains more often than not.
Eat at reasonably regular intervals instead of going long and then compensating with one big meal.
These aren't exciting recommendations. They won't generate clicks on Instagram. But they target a contributor to secondary fatigue that's both common and correctable — and that doesn't ask you to eliminate a single food.
We don't yet have a trial testing whether these strategies specifically reduce MS fatigue. But one is underway. The FOOD for MS trial is a 32-week study in which researchers provide the meals, testing whether eating to keep blood sugar steadier (lower glycemic load, in research terms) reduces fatigue and improves physical function in people with MS (Martin et al., 2024). It's the most rigorous test of this question designed for this population, and I'll be watching for the results. In the meantime, the biological rationale is solid, the strategies are low-risk, and nothing in this section requires you to wait for a peer-reviewed paper to try it.
What the Dietary Pattern Research Actually Shows
Does Changing What You Eat Actually Reduce MS Fatigue?
So far, we've been talking about whether you're eating enough and when you're eating. But does changing the overall pattern actually reduce MS fatigue?
The honest answer is that dietary changes probably help some people, to some extent. But the research has important limits you should understand before making major changes.
The most comprehensive attempt to answer this question was published in 2023. Snetselaar and colleagues analyzed 12 randomized controlled trials including 608 people with MS (Snetselaar et al., 2023). Instead of looking at just one diet, they used a method called network meta-analysis. This approach allows researchers to compare multiple diets, even when those diets were not directly compared within the same trial.
Think of it like comparing restaurants when different critics reviewed different places. You piece together the overall picture from overlapping comparisons.
Here is what they found:
Paleolithic diets significantly reduced fatigue compared with a usual diet (Snetselaar et al., 2023).
Low-fat diets significantly reduced fatigue compared with a usual diet (Snetselaar et al., 2023), a finding echoed in a dedicated low-fat diet RCT (Chase et al., 2023).
Mediterranean diets significantly reduced fatigue compared with a usual diet (Snetselaar et al., 2023), consistent with a single-center RCT of a modified Mediterranean diet (Moravejolahkami et al., 2020).
Quality of life also improved, especially with Paleolithic and Mediterranean approaches (Snetselaar et al., 2023).
That sounds promising, and it is.
But, as usual, the devil is in the details.
The researchers rated the overall credibility of this evidence as “very low” (Snetselaar et al., 2023). That is not a statement that diet does not work. It is a technical assessment of study quality. The available trials were generally small, short-term, and varied widely in how diets were defined and implemented.
Most studies lasted only a few months. Participants were predominantly white women with relapsing-remitting MS, which limits how broadly we can apply the findings. Some trials had meaningful differences between groups at baseline. Fatigue was measured using different tools across studies, making it more difficult to combine results. This isn't unique to this analysis: earlier systematic reviews of diet and MS reached similar conclusions, finding that the available trials were too few, too small, and too inconsistent to draw firm conclusions about fatigue (Pommerich et al., 2018; Harirchian et al., 2022).
In research language, “very low” credibility means the findings are promising, but future well-designed studies could change the conclusions. Larger, longer, and more consistent trials are still needed.
A few additional findings help add context.
The WAVES trial directly compared two popular approaches, the Swank low-saturated-fat diet and the Wahls modified Paleolithic diet, in 87 people with relapsing-remitting MS over 24 weeks (Wahls et al., 2021). Both diets significantly reduced fatigue, and neither outperformed the other. This suggests that the benefit may come from improving overall dietary quality and consistently eating enough, rather than from following restrictive food rules.
A follow-up analysis of the same trial asked whether metabolic improvements accounted for the changes in fatigue. They didn't: improvements in weight, cholesterol, and BMI did not account for the reductions in fatigue (Villa et al., 2023). The common assumption that better metabolic markers automatically mean less fatigue wasn't supported. Something else is contributing, and we don't yet fully understand what that is.
One consistent finding across trials is that dietary interventions improved how people experienced their fatigue, but they did not change disability scores. That distinction matters. Diet appears to influence secondary fatigue, the part shaped by energy balance, inflammation, sleep, and overall health. It does not appear to alter the underlying neurological disability itself.
So what matters more than the name of the diet?
Are you eating enough to meet your energy needs?
Do you have nutrient deficiencies that can be corrected?
Does your eating pattern keep blood sugar steady throughout the day?
Is the approach sustainable in your real life, not just for a few motivated weeks?
The name of the diet matters less than making sure your body gets what it needs, without turning eating into another source of stress or exhaustion. For a full comparison of Wahls, Swank, Mediterranean, keto, and more — including the evidence, risks, and real-life challenges — see MS Diets Explained. Still wondering what the "best" diet for MS actually is? The evidence might surprise you.
What About Intermittent Fasting?
You have probably seen the headlines. Intermittent fasting (IF) is one of the most searched nutrition trends online, and it has made its way into the MS conversation, usually with more excitement than evidence.
So what do we know?
The strongest evidence we have comes from a 2024 randomized controlled trial by Ghezzi and colleagues, published in The Journal of Neurology, Neurosurgery & Psychiatry. In this study, 42 people with relapsing-remitting MS were assigned to one of two groups for 12 weeks:
Intermittent calorie restriction: two non-consecutive fasting days per week, limited to 500 calories from non-starchy vegetables on those days
Usual diet: no changes
Here is what happened:
Adherence was very high — 99.5% in the first six weeks, 97.2% in the second (Ghezzi et al., 2024).
The approach appeared safe, with no serious adverse events (Ghezzi et al., 2024).
The fasting group saw significant reductions in weight, BMI, waist circumference, and central body fat (Ghezzi et al., 2024).
Cognitive processing speed improved, measured by the Symbol Digit Modalities Test (SDMT), one of the most common cognitive tests in MS research (Ghezzi et al., 2024).
The study's primary outcome was met: leptin — a hormone produced by fat cells that influences appetite and metabolism — decreased significantly (Ghezzi et al., 2024).
What did not clearly improve:
Fatigue. Scores dropped in the fasting group, but the difference between groups wasn't statistically significant (Ghezzi et al., 2024). In plain terms, we can't confidently say the improvement was due to fasting rather than chance. The outcome that people with MS care about most didn't clear the bar.
This was a small study with 42 participants and a 12-week duration. That is enough to demonstrate feasibility and short-term safety, but not enough to establish a clear clinical benefit for MS fatigue.
What the trial does tell us is that this approach can be implemented safely in people with relapsing-remitting MS under structured research conditions. Three participants in the fasting group reported mild symptoms on fasting days, including headache, lightheadedness, tiredness, and bloating. None withdrew because of these symptoms (Ghezzi et al., 2024).
But a 12-week clinical trial with close monitoring isn't the same as real life with an unpredictable illness. Here is where I need to put on my dietitian hat for a moment.
We've spent this entire article talking about the importance of consistent fueling — eating enough, eating regularly, keeping the tank from running empty. Intermittent fasting, by design, removes pit stops from the race. And pit stops exist because the car cannot finish without them. The question isn't whether fasting is interesting science — it is. The question is whether your car can afford to make fewer pit stops than it's already making.
Fasting days mean fewer calories. For someone already struggling to eat enough — because of the six barriers we just covered — structured calorie restriction adds another layer of inadequacy to an intake that may already be insufficient.
Fasting can acutely worsen fatigue, even if it improves metabolic markers over time.
Medication timing gets complicated when meals are squeezed into narrow windows. For people on disease-modifying therapies that need to be taken with food, skipping meals isn't just about hunger.
During acute relapse or periods of active disease, additional physiological stress of fasting may not be advisable (Liao, Ghezzi & Piccio, 2022; Lorefice, Pitzalis & Zoledziewska, 2024).
The broader literature on intermittent fasting and MS echoes these concerns. Observational studies during Ramadan fasting have documented temporary worsening of fatigue, dizziness, cognitive symptoms, and spasticity during fasting periods, with symptoms typically resolving after the fast was broken (Jahromi et al., 2014; Baghbanian et al., 2018). A small pilot study of time-restricted eating in relapsing-remitting MS found the approach was feasible for participants, but with only 12 people enrolled, it was too small to draw conclusions about whether it actually helps (Jahromi, 2015). Low blood sugar is also a documented risk in intermittent fasting trials, including in people without MS (Baig et al., 2024).
So where does this leave us? Intermittent fasting is not currently an evidence-based recommendation for MS fatigue.
If intermittent fasting interests you, a personalized discussion with your neurologist and a registered dietitian is an important first step. Useful questions to consider include:
Is your disease stable?
Are you currently meeting your nutritional needs?
How would fasting interact with all of your medications?
Would it realistically improve or worsen your energy?
At this stage, the evidence is promising but preliminary. Intermittent fasting appears feasible and short-term safe in selected individuals with relapsing-remitting MS (Ghezzi et al., 2024). It is not yet a proven treatment for MS fatigue.
You don't need a meal plan. You need a plan for meals.
Food cannot fix what MS did to your nervous system. That's worth saying plainly, because a lot of what's online suggests otherwise.
What food can do is reduce the extra exhaustion that doesn't have to be there. The fatigue from deficiencies, blood sugar swings, dehydration, and a body that isn't consistently getting what it needs. That's secondary fatigue, and it's not a small thing. For many people, addressing it makes a real, day-to-day difference in how much energy they have left for the things that matter.
The evidence points toward whole-food, varied eating patterns. No named MS diet or protocol required. What seems to matter most is eating enough, keeping blood sugar steady, and staying hydrated. So, not a cure. But not nothing, either.
The catch is that the six barriers above can quietly stand between you and any of it. You can know exactly what to eat and still not be eating enough, because the spoon cost of feeding yourself is too high, a medication is killing your appetite, or swallowing has become a problem that hasn’t been identified yet. That's why the starting point isn't a list of foods. It's figuring out what's actually getting in the way.
If you're managing fatigue and wondering whether your eating has anything to do with it, here's a reasonable place to start.
Talk to your care team about having your labs checked. Vitamin D, B12, iron, and folate are sensible starting points. Ask yourself whether you're actually eating enough, and whether any of the six barriers ring true for you. Pay attention to blood sugar, not with a continuous glucose monitor and an app, but by noticing whether skipping meals or eating refined carbohydrates alone leaves you crashing a couple of hours later.
And if the approach you're using right now is so complicated, restrictive, or exhausting that the diet itself has become another source of fatigue, that's information worth taking seriously.
A plan for meals. Not an obstacle course on the way to dinner.
If you were recently diagnosed and talking about diet feels overwhelming, start here instead. The rest will be waiting for you when you’re ready.
FAQ
Can any food or diet cure MS fatigue?
No. Primary MS fatigue is caused by the disease process itself — nerve damage, inflammation in the brain and spinal cord — and no dietary intervention has been shown to reverse it. What nutrition can address is secondary fatigue: the modifiable layer of exhaustion from deficiencies, blood sugar instability, dehydration, and under-eating.
What’s the best diet for MS fatigue?
There isn’t one standout winner. Multiple clinical trials show that whole-food dietary patterns — including Mediterranean-style, Swank, and Wahls — all reduce perceived fatigue to a similar degree. What matters more than the name on the protocol is whether you’re eating enough, getting adequate nutrients, and keeping your blood sugar reasonably stable.
Should I try intermittent fasting for MS fatigue?
The current evidence doesn’t support it as a fatigue intervention. The most rigorous trial to date (Ghezzi et al., 2024) found that the fasting group’s improvement in fatigue was not statistically significant compared with controls. It also carries specific risks for people with MS, including worsening existing barriers to adequate intake and complicating medication timing. Talk to your neurologist before trying it. Consider talking to a dietitian as well.
How do I know if I’m not eating enough?
Persistent fatigue that worsens over the course of the day, difficulty concentrating, irritability, and unintentional weight loss are all signs. But many people with MS are chronically under-eating without realizing it — because the barriers (fatigue, medication side effects, depression, swallowing difficulty, mobility challenges, GI problems) reduce intake gradually. A registered dietitian can assess whether your intake is adequate.
What should I ask my doctor to test?
A reasonable starting panel: serum 25-hydroxyvitamin D, serum B12 with homocysteine, serum folate, CBC with iron panel and ferritin, and serum magnesium. These cover the nutrient deficiencies most commonly associated with secondary fatigue in MS.
References
Baig, A., Abdulsamad, H. M. R., Rabeh, N., Aljoudi, S., Dimassi, Z., & Hamdan, H. (2024). Diet and its potential impact on the prognosis of multiple sclerosis: Fasting diets. In H. Hamdan (Ed.), Exploring the effects of diet on the development and prognosis of multiple sclerosis (MS) (Nutritional Neurosciences). Springer. https://doi.org/10.1007/978-981-97-4673-6_12
Chase, E., Chen, V., Martin, K., Wooliscroft, L., Silbermann, E., Jelinek, G. A., & Yadav, V. (2023). A low-fat diet improves fatigue in multiple sclerosis: Results from a randomized controlled trial. Multiple Sclerosis Journal, 29(13), 1722–1731. https://doi.org/10.1177/13524585231208330
Ghezzi, L., Tosti, V., Shi, L., et al. (2024). Randomised controlled trial of intermittent calorie restriction in people with multiple sclerosis. Journal of Neurology, Neurosurgery & Psychiatry, 96(2), 158–169. https://doi.org/10.1136/jnnp-2024-333465
Harirchian, M. H., Sahraian, M. A., Shirani, A., et al. (2022). Diet and disease-related outcomes in multiple sclerosis: A systematic review of clinical trials. Current Journal of Neurology, 21(1), 62–70. https://doi.org/10.18502/cjn.v21i1.9362
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Liao, E., Ghezzi, L., & Piccio, L. (2022). Dietary restriction in multiple sclerosis: Evidence from preclinical and clinical studies. Advances in Clinical Neuroscience & Rehabilitation. https://doi.org/10.47795/mcln8939
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Mirmosayyeb, O., Ebrahimi, N., Shekarian, A., Afshari-Safavi, A., Shaygannejad, V., Barzegar, M., & Bagherieh, S. (2023). Prevalence of dysphagia in patients with multiple sclerosis: A systematic review and meta-analysis. Journal of Clinical Neuroscience, 108, 84–94. https://doi.org/10.1016/j.jocn.2023.01.006
Moravejolahkami, A. R., Paknahad, Z., Chitsaz, A., Hojjati Kermani, M. A., & Borzoo-Isfahani, M. (2020). Potential of modified Mediterranean diet to improve quality of life and fatigue severity in multiple sclerosis patients: A single-center randomized controlled trial. International Journal of Food Properties, 23(1), 1993–2004. https://doi.org/10.1080/10942912.2020.1840390
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Wahls, T. L., Titcomb, T. J., Bisht, B., et al. (2021). Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Multiple Sclerosis Journal—Experimental, Translational and Clinical, 7(3). https://doi.org/10.1177/20552173211035399
This article is for informational purposes and is not a substitute for individualized nutrition or medical advice. If something here makes you reconsider your eating habits, bring it to your next appointment rather than making big changes on your own. Your care team is the best place for decisions about your health. I’m simply here to help you ask better, more informed questions.
