Table 2.
Level 1 evidence on benefits of diet in multiple sclerosis
| Study | Diet comparison | Evidence level | Population | Outcomes studied | Statistical significance |
|---|---|---|---|---|---|
| Weinstock-Guttman et al. [90] | LSF diet (omega-3 PUFA based) vs. Mediterranean diet | RCT | Adult RRMS | RR, fatigue | SS. Both diets reduced RR; Mediterranean diet reduced fatigue |
| Riccio et al. [55] | 25(OH)D3 (placebo) vs. CRD and 25(OH)D3 vs. 25(OH)D3 and other supplements | RCT | Adult RRMS | Fatigue, EDSS | Not SS |
| Yadav et al. [56] | LSF diet (vegetarian) vs. control | RCT | Adult RRMS | Fatigue, EDSS, MRI activity | Reduction in fatigue—SS; the rest—not SS |
| Choi et al. [91] | Control vs. 6 months of ketogenic diet vs. 1 week of MFMD followed by 6 months of Mediterranean diet | RCT | Adult RRMS | EDSS, depression, QoL | SS. Depression and QoL improved in both diets vs. controls |
| Hempel et al. [57] | PUFA-based diet vs. “hot nature food” vs. Chinese diet vs. very LSF diet supplemented with fish oil, low-saturated fat plant-based diet, vitamin B2 supplements | Review (37 RCTs) | Adult RRMS | EDSS | Not SS |
25(OH)D3 25-hydroxy vitamin D3, CRD caloric restricted diet, EDSS Expanded Disability Status Scale, LSF low saturated fat, MFMD modified fasting mimicking diet, MRI magnetic resonance imaging, PUFA polyunsaturated fatty acids, QoL quality of life, RCT randomized controlled trial, RR relapse rate, RRMS relapsing-remitting multiple sclerosis, SS statistically significant