Research
Nutrition and Multiple Sclerosis: The Gut is Key
by Magdalena Wallkamm1 and Nicole Jankovic1,2
1Institute for Integrative Health Care and Health Promotion, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
2Institute of Nutrition, Consumption and Health, Faculty of Natural Sciences, Paderborn University, 33098 Paderborn, Germany
Cite as: Wallkamm, M. & Jankovic, N. (2025). Nutrition and Multiple Sclerosis: The Gut is Key. THE MIND Bulletin on Mind-Body Medicine Research, 7, 3-9.
Abstract
Background: Nutrition and the gut microbiome can be either risk factors or health-promoting factors for patients with Multiple Sclerosis (MS).
Methods: A literature review was conducted.
Results: Diet plays a crucial role in shaping the microbiota composition and metabolism. Moreover, studies have shown that individuals with MS exhibit microbial dysbiosis in comparison to a healthy control group. Microbial dysbiosis in the gut can affect the central nervous system and promote inflammation.
Conclusion: Nutrition plays an important role and should be considered in Mind-Body-Medicine interventions for patients with MS.
Background: Multiple sclerosis (MS) is a chronic, inflammatory, and neurodegenerative disease of the central nervous system. It is characterized by inflammation, oxidative stress, and mitochondrial dysfunction (Stoiloudis et al., 2022). This leads to symptoms like fatigue, bladder, bowel, and sexual dysfunction, pain, paresthesia, spasticity, disability, depression, anxiety, dizziness, memory dysfunction, balance and coordination problems (Crayton & Rossman, 2006; Ghasemi et al., 2017; Jellinger, 2024; Sadeghi-Bahmani et al., 2022; Thornton & Raz, 1997). The pathogenesis is influenced by genetic, environmental, and gender-related factors (Sharifa et al., 2023), and around 2/3 of MS patients are female (McGinley et al., 2021). Moreover, there is an interaction between genetic, environmental, and lifestyle factors (Olsson et al., 2017). Environmental factors include vitamin D levels and Epstein-Barr virus infection; main lifestyle factors are stress, smoking, obesity, and dietary factors (Dobson & Giovannoni, 2019; Esch et al., 2002; Olsson et al., 2017; Qian et al., 2023).
Diet and the Microbiome
The gut microbiome is influenced by lifestyle, diet, pollution, genetics, infections, and stress. These factors can contribute to a reduction in beneficial bacteria and can lead to dysbiosis (Campagnoli et al., 2024). Moreover, dysbiosis in the gut can lead to oxidative stress (Sharifa et al., 2023), to which the central nervous system is sensitive (Buga et al., 2023). Diet is an important factor regarding inflammatory status and oxidative stress. Hence, diet can either lead to health promotion (Stoiloudis et al., 2022) or may become a booster of inflammation (Boziki et al., 2020).
Microbial dysbiosis in the gut can affect the central nervous system and promote inflammation (Rutsch et al., 2020). Therefore, the gut-brain axis plays a crucial role in the pathogenesis of MS (Parodi & Kerlero de Rosbo, 2021). For example, there is a connection between microbiota composition and inflammatory activity in the brain (Rutsch et al., 2020). The microbiome synthesizes vitamins and produces neurotransmitters like GABA, histamine, dopamine, and serotonin (Brown et al., 2020).
Vitamin D is well-known as a risk factor for the development of multiple sclerosis, but it also plays a significant role in the course of the disease (Ruth Dobson et al., 2018). A deficiency in vitamin D can negatively alter the microbiome composition and can influence the integrity of the gut epithelial barrier (Murdaca et al., 2021). However, vitamin D can reduce oxidative stress (Stoiloudis et al., 2022), and there is evidence that it positively influences the microbiome composition and functionality (Akimbekov et al., 2020; Waterhouse et al., 2019).
Furthermore, dysbiosis can alter the relationship and communication between the central nervous system and the gut microbiome (Ullah et al., 2023). It remains uncertain whether gut dysbiosis is a cause or consequence of MS (Brown et al., 2020). Studies have shown that individuals with MS exhibit microbial dysbiosis in comparison to a healthy control group (Kozhieva et al., 2019; Ordoñez-Rodriguez et al., 2023). This dysbiosis may represent a reduction in beneficial gut bacteria, like bacteria that produce anti-inflammatory metabolites (Ladakis & Bhargava, 2023), which could influence disease progression in MS patients (Nitzan et al., 2023).
Therefore, the gut plays an important role in the pathogenesis of MS (Parodi & Kerlero de Rosbo, 2021; Rutsch et al., 2020). Moreover, a diet rich in sugar, animal fat, trans-fatty acids (found in processed products like margarines), and salt cannot only contribute to gut dysbiosis and inflammation but also to gut barrier and blood-brain barrier permeability (Boziki et al., 2020). Furthermore, food high in fat and calories activates the reward system in the brain, potentially having negative health effects in the long term (Esch et al, 2006). Therefore, it is of great importance to focus on dietary factors. Especially Western style dietary patterns, which are mainly characterized by low fiber intake, high salt content, animal fat, red meat, fried foods, and sugar-sweetened beverages show positive associations with inflammation (Riccio & Rossano, 2015). Low physical activity can additionally have a negative impact on the microbiome (Moles & Otaegui, 2020).
Diet as health promotion
A balanced and tailored diet can support the well-being of patients with MS (Zielińska & Michońska, 2023). Nutrition has shown promising results in influencing MS symptoms and progression (Stoiloudis et al., 2022). A well-balanced diet can positively influence MS symptoms, slow disease progression, and support overall health (Sand et al., 2018; Tryfonos et al., 2024). Dietary patterns labeled as “healthy” could improve quality of life (MSQOL-54), mental health (e.g. lower depressive symptoms) (Dakanalis et al., 2024), and fatigue in MS patients (Moravejolahkami et al., 2024).
Furthermore, diet influences the gut microbiome through the gut-brain axis which has implications for cognition and emotional functioning. Both conditions are main problems for MS patients (Schneider et al., 2024). Pre- and probiotic foods may play an important role in the diet of MS patients since they are under discussion regarding their supportive role for the microbiome and the homeostasis of the central nervous system (Moles & Otaegui, 2020; Riccio & Rossano, 2015; Stoiloudis et al., 2022).
In addition, diet plays a crucial role in shaping microbiota composition and metabolism. A rich and diverse microbiome is an important contributor to health and the maintenance of microbiome homeostasis (Diaz-Marugan et al. 2023). In summary, the gut microbiome can support metabolic and intestinal health (Ross et al., 2024) and in consequence may even influence eating behavior and prospective food choices positively or negatively (Rutsch et al., 2020).
With MS, an anti-inflammatory diet is advisable. An anti-inflammatory diet is characterized by a combination of food components that have anti-inflammatory and antioxidative characteristics such as fruit and vegetables, polyphenoles, flavanoides, probioticas, prebioticas, micronutrient, plant-based protein, fiber, unsaturated fatty acids, omega 3 fatty acids, and a small amount of meat (Riccio & Rossano, 2015; Tryfonos et al., 2024). Short-chain fatty acids like propionic acid seem to be of major importance in the condition of MS because MS patients show reduced propionic acid amounts in comparison to healthy persons. Gut bacteria can process propionic acid from indigestible dietary fiber (Duscha et al., 2020), hence they act as nourishing for the gut. One convenient possibility to increase propionic acid if not via diet is supplements (Lorefice & Zoledziewska, 2024). Propionic acid may promote neurite recovery (Gisevius et al., 2024).
A study found that MS patients who did not consume food groups associated with inflammation like dairy or meat had significantly higher physical and mental health composite scores (Altowaijri et al., 2017). Moreover, in a study with 55 participants a higher immunoglobulin G response to animal-sourced milk was found for the 35 patients with MS compared to the 20 healthy people in the control group (Chunder et al., 2023).
The Mediterranean diet (Med-diet) is one example of an anti-inflammatory diet. The Med-diet is high in fruit, vegetables, and fiber, unsaturated fatty acids and low in ultra-processed foods, sugar, trans-fatty acids, fried food, and refined carbohydrates (Clemente-Suárez et al., 2023; García-Montero et al., 2021). Lean and oily fish are also recommened in the Med-diet (Felicetti et al., 2022). High fish consumption is associated with a more favorable MS disability progression (Johansson et al., 2025).
Earlier studies reported that the Med-diet positively affects the gut microbiome; it can reduce oxidative stress, neurodegenerative impairment, and inflammation state (Dakanalis et al., 2024; Di Majo et al., 2022). Nutraceuticals, e.g., in vegetables like phenolic acids, stilbenes, flavonoids, and lignans, terpenoids such as carotenoids and tocopherols, and unsaturated fatty acids can have a positive effect on cognitive performance, which, as mentioned above, is an important determinant in MS (Di Majo et al., 2022). The Mediterranean diet has not only proven a positive effect on health, quality of life, disability, and the gut microbiome but also in slowing down disease progression for chronic diseases like MS (Dakanalis et al., 2024; Ross et al., 2024).
Discussion
When it comes to the microbiome, influenced by a person’s diet, we clearly touch a very new field in nutritional research, which is called personalized nutrition (Linseisen et al., 2025). In consequence, the same diet can have different effects for different people because the microbiome is individual (Johnson et al., 2019) which also means that not one size fits all. However, anti-inflammatory diets may clearly come with benefits for MS patients.
Conclusion
On the one hand, diet is one important risk (Brown et al., 2020) and on the other hand a health-promoting factor for Multiple Sclerosis and should be taken into account when it comes to the therapeutic setting (Dakanalis et al., 2024; Ross et al., 2024; Tryfonos et al., 2024) particularly in the field of Mind-Body-Medicine. Personalized dietary approaches are essential, as microbiome composition and responses to diet vary among individuals and should be studied more thoroughly also in the context of MS.
Keywords: Multiple Sclerosis, gut, dysbiosis, nutrition, microbiome
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