MS Diets

There is no one “MS diet,” just as there is no one universal MS experience. Some of the diets intended for use in MS have a few features in common – for example, they nearly all advise to eliminate ultra-processed foods – but they can also have considerable differences. The goal of these diets is to adequately nourish, eliminate toxic and otherwise aggravating influences, and exert anti-inflammatory, antioxidant, and remyelination benefits 142.

MS Diet Features: Elimination of Ultraprocessed Foods

MS diets frequently feature avoidance of ultraprocessed foods. While most foods are processed in some way – even rinsing of produce prior to sale is considered processing – there are degrees (Harvard University, undated-a), and they make for key differences in effects on the body.

Minimally processed foods have been slightly altered for the main purposes of safety and preservation, but have not undergone a substantial change in nutritional content. Examples include cleaning and removing inedible or unwanted parts, refrigeration, freezing, and vacuum-packaging. Fresh and frozen produce and meats/fish/poultry, nuts and seeds, whole eggs, and raw milk fall into this category.
Lightly processed food ingredients are derived from minimally processed foods by basic techniques such as pressing, grinding, milling, or churning. They are typically not eaten on their own but used to prepare other foods. Examples include dairy or natural nut butters; oils from plants, seeds, or nuts; flours from whole grains, nuts, or legumes; natural sweeteners such as maple syrup; and natural flavor extracts such as vanilla.
Lightly processed foods include those from either of the two previous groups that may have added water, salt, sugar, fats, vitamins, and/or minerals, and/or have undergone cooking, baking, pasteurization, or fermentation. Most canned fruits and vegetables, basic cheeses, plant-based milky beverages, plain yogurt, freshly made bread, whole grain or legume pasta, tofu, and canned fish are examples. These foods are generally made from more than one ingredient.
Ultraprocessed foods (also referred to as highly processed) feature ingredients that go beyond basic pressing/grinding/milling to include refinement, largely involving removal of nutritious food components either mechanically or chemically, and incorporate artificial colors, flavors, sweeteners, preservatives, and refined/hardened oils that promote shelf stability, preserve texture, and increase palatability. Examples include sugary drinks, “processed” luncheon meats and cheeses, and some prepackaged cookies and chips, breakfast cereals, spreads, and boxed and frozen meals. These have been suggested to contribute to the obesity epidemic and increasing prevalence of chronic diseases like heart disease and diabetes.

Ultraprocessed food and artificial food additive consumption is rising globally143-147, concurrently with the incidence of autoimmune diseases 148,149, including that of MS 9,149. Ultraprocessed food intake may impact disease risk by contributing to obesity and through exposure to food additives and contaminants 143, and has been associated with increased systemic inflammation 150.

Ultraprocessed foods tend to be of a poorer nutritional quality than minimally processed foods 151-156. Diets high in ultraprocessed foods have been observed to have greater energy density (more calories per weight), free sugar, and overall, saturated, and trans fats, and to be lower in fiber, protein, and essential minerals 151,153-155. As may be expected, individuals who follow such a diet tend to eat more calories (mainly from simple carbohydrates and fats) and gain more weight when compared to consumers of unprocessed diets 157, and are more prone to obesity 156,158-165, a suspected risk factor for MS 112,166.

Common food additives have been shown to negatively affect the intestinal epithelial barrier, which serves to protect the body from immune-triggering foreign agents. A compromised barrier and its “tight junction” have been linked to intestinal permeability – otherwise known as “leaky gut” – and ultimately to development of autoimmune disease. Tight junction leakage is particularly worsened by refined sugar 167-171, salt, certain emulsifiers, organic solvents, gluten, microbial transglutaminase, and nanoparticles, all of which are extensively and increasingly used by the food industry “to improve the qualities of food.” These additives may contribute to barrier dysfunction and ultimately permeability, resulting in entry of harmful antigens and activation of the autoimmune cascade 172.

Food contaminants, such as chemicals that are newly formed during the processing itself, have also been suggested as potential mechanisms linking ultraprocessed foods to higher disease risk. Through the associated chemical and biological transformations, the fundamental structure of the food changes, inducing the creation of “neoformed” substances like trans-fat, acrylamide, heterocyclic amines, polycyclic aromatic hydrocarbons, oxyhalides, and haloacetic acids, some of which are considered neurotoxic173,174. Additionally, some contaminants from food packaging, such as bisphenol A (BPA) have been observed to exert endocrine (hormonal)-disrupting effects 175 that may translate to autoimmune dysfunction 176 and neurogenerative disease 177, including MS 178.

Another potentially problematic component of processed foods is salt, specifically the sodium types. While sodium is an essential nutrient that contributes to the body’s normal functions – including neuromuscular – excessive intake has been associated with certain health risks in the cardiovascular system and kidneys. Salt is not often given specific attention in MS diets, but has been addressed in the scientific literature in the context of autoimmune disease, including MS, where findings are mostly of salt’s harm at excessive levels, e.g., more than 5 grams per day 179-181, though some animal studies have observed benefit 182,183.

Certain regulatory immune cells called Tregs are critical for “self-tolerance” (which keeps the body from attacking itself) and can be defective in autoimmunity. In MS, dysfunctional self-tolerance is partially enabled by dysfunctional Tregs that secrete interferon-gamma (IFNγ). It has been shown that increasing salt significantly impairs Treg function by increasing their IFNγ secretion, thus promoting proinflammatory autoimmune responses 184.

Additionally, it has been observed that high intake of salt (e.g., equivalent to 5400 mg/day of sodium) may contribute to CNS autoimmunity by promoting neuroinflammation-driving immune cell (Th17) responses 179,180 and changes in microbiota in both animals and healthy humans 185, linked specifically to worsening rather than initiation of disease 186,187. Fortunately, the reduction in friendly bacteria and associated immune cell reaction may be reversible with probiotic supplementation 185.

Among MS patients, a small study found sodium intake above 2000 mg/day to be associated with approximately three-fold increased exacerbation rate and radiological disease activity (including total T2 and CUA lesions) 188. Later and larger clinical studies found no such association 189, including in children 190,191. No less important, however, it was demonstrated that the effects of dietary sodium on autoimmune neuroinflammation are dependent upon genetics and gender, tending to impact females more 192.

Interestingly, it was shown in an animal study that high salt intake could curtail development of autoimmune disease. It may do this this by promoting tightening of the blood-brain barrier, thereby limiting entry of inflammatory T-cells into the CNS. The extra consumption of sodium 183,193,194 was equivalent to approximately 1350 mg in the average modern western human diet 95, which would bring the total to about 3750 mg, in line with average global intake 196-198 – 60% more than the 2300 mg daily recommended in the United States based on cardiovascular research 199, but less than the 5000 mg upper limit recommended by the World Health Organization (WHO)200.

The bottom line appears to be that salt restriction below national and international recommendations should perhaps be sought in women with active autoimmune disease and genetic predisposition to salt-sensitivity, with good probiotic intake among higher sodium consumers.

MS Diet Features: Fat Content

A major difference between popular MS programs is the amount of fat recommended, ranging from the lowest in the Swank and McDougall diets to the highest in the ketogenic plan. The following is some background regarding the effects of fat on the body and what foods are the highest sources.

The brain is high in fats, which support structural, biochemical and cell signaling functions 201,202. Local “cerebral” changes in fat balance have been associated with neurodegenerative disorders 203-206.

The fats involved in brain and other bodily functions need to be obtained from food or synthesized from building blocks in food. The brain typically gets its energy from sugar, made from carbohydrate and protein, but evolutionarily may have run on products of fats called ketones, something that is increasingly explored today 201.

The components of food that provide energy (calories) are fat, protein, carbohydrate, and alcohol. Of these, fat is the most dense, providing 9 calories per gram, compared to 7 in alcohol, 4 in protein, 4 in carbohydrate, and up to 2 in soluble fiber (a type of carbohydrate).

Fat is constructed by a glycerol “backbone” supporting fatty acids. There are two main types of fatty acids, saturated and unsaturated, with the latter further categorized into monounsaturated and polyunsaturated. Foods generally contain a combination of fatty acids from each of the categories, with differing proportions 201.

There is controversy about the association between total and different dietary fatty acids and risk of chronic “lifestyle” disorders such as coronary heart disease, an association that is considered to be relevant to MS.

Saturated Fatty Acids

These are highest in animal fat and hydrogenated, coconut, and palm oils. Saturated fats are completely solid at room or colder temperatures but liquefy in heat.

The long-term studies conducted by Roy Swank showed a close connection between saturated fat intake and the development and progression of MS. Specifically, it was found that MS patients who avoided saturated fats and favored unsaturated fats typically had reduced progression of MS 207. High levels of saturated fats have also been linked to cardiovascular disease and obesity 208,209 and are regularly used in experimental models to induce metabolic disruption 209,210. They may cause immune stimulation and inflammation 211, which can worsen MS symptoms.

A 2021 study of nearly 386,000 patients in nine countries found associations of saturated fatty acids with coronary heart disease in opposite directions depending on the food source: disease incidence was lower with greater intake of saturated fats from yogurt, cheese, and fish, but higher with saturated fats from red meat and butter 212.

Monounsaturated Fatty Acids

These are most commonly associated with plant foods such as avocado and its oil, certain nuts (including macadamia and hazelnut) and their oils, modified seeds (high-oleic sunflower and safflower) and their oils, and olive and its oil. Monounsaturates are also high in meats, particularly beef and pork, as well as high-fat hard cheeses such as cheddar, though the specific fatty acid make-up tends to be different from that in plant foods, with different effects on the body 213. Monounsaturated fats are liquid at room and warmer temperatures but solidify somewhat when refrigerated.

Monounsaturated fatty acids tend to be less associated with a high-risk cardiovascular profile than saturated fatty acids, and in some studies have been associated with significant health benefits, such as prevention of the metabolic syndrome and its complications 214.

Polyunsaturated Fatty Acids

Rich plant sources are primarily nuts and seeds and their oils, including flaxseed (linseed), grapeseed, pumpkin seed, rapeseed (canola), regular sunflower and safflower seed, sesame seed, almonds, peanuts, and walnuts; additional vegetal sources are corn, rice bran, and soybean and their oils. Rich animal sources include fatty fish such as mackerel, salmon, sardine, swordfish, trout, and tuna, as well as eggs. Polyunsaturated fats are liquid at all temperatures, and are prone to oxidation 215, more so than saturated fats 216.

Polyunsaturated fatty acids are commonly categorized into omega-3 and omega-6 varieties. Only these two groups are essential in the human diet (meaning we need to get them from food) and have their respective roles in the body 217. Both are involved in neurological function 218.

Unfortunately, modern western diets high in processed foods often provide a disproportionately high amount of omega-6s 219, which can be pro-inflammatory, and not enough omega-3s, which tend to be anti-inflammatory. Of note, traditional diets of populations with long healthy lives provide ratios between omega-6 to omega-3 of 5:1 or lower, compared to over 15:1 in the United States 220.

Polyunsaturated fats have long been recommended as a substitute for saturated fats in the diet to prevent and/or manage cardiovascular disease risk factors 221 and related health issues such as non-alcoholic fatty liver disease 214.

Hydrogenated Fats

Because polyunsaturated fats are highly susceptible to spoilage and often behave differently in food preparation than do saturated/hard fats, they may be “hydrogenated” to be hard at room temperature and resistant to rancidity and oxidization. The process, called “hydrogenation,” can extend the shelf life of products and mimic the structural properties and mouthfeel of saturated fat. Unfortunately, hydrogenation leads to generation of artificial trans-fatty acids, which have been linked to harmful processes in the body, including cancer, heart disease, and immune dysfunction 222.

Rules for Oil Use and Storage:

Do not reuse oil when cooking.
Do not heat oil to the smoking point.
Count oil used in cooking in your daily oil allowance (each teaspoon = 5 grams fat; 3 teaspoons = 1 tablespoon; 16 tablespoons = 1 cup).
Always refrigerate oil after opening to avoid rancidity, with the exception of olive oil.
Keep olive oil in a cool, dark place. Do not refrigerate.
If an oil clouds or hardens at refrigerator temperature, do not use. Olive oil is the exception to this rule.

MS Diet Features: Carbohydrates

Carbohydrates are the main source of energy (calories) in most food patterns around the world, with some cultures taking in up to 70% of their energy from that source. In contrast, some cultures have long survived on diets higher in fat and protein. In the modern western world, people are increasingly interested in reducing their carbohydrate intake for health reasons. Diets promoted for MS management range widely in their carbohydrate content, from the very high McDougall to the very low ketogenic and carnivore.

When the most basic carbohydrate – the simple sugar glucose – is available in the body, the human brain uses about 25% of the total for energy production, with the highest energy requirement in adult brain cells (neurons) 223. It was long thought that a continuous supply of glucose is needed from the bloodstream to the brain, as with a few exceptions, glucose has been considered to be the main source of energy 224. However, the brain can also use ketone bodies as an energy source, as observed in starvation, during strenuous exercise and development 225, and of course, when following a ketogenic diet. Whatever the predominant energy source, tight regulation of its metabolism is necessary for normal brain function, and any disturbances may contribute to the pathology of brain disorders 226.

Studies show that energy metabolism in the CNS of MS patients may be abnormal 227. Increased activity of metabolic enzymes in the cerebrospinal fluid of patients with disseminated sclerosis make them a sensitive indicator of active demyelination. The observed alterations in energy metabolism may contribute to the mitochondrial dysfunction and nerve fiber degeneration underlying MS progression 228. In demyelinating diseases, particularly MS, it is likely that cells need ample energy to survive. Unfortunately, the mechanism of energy-generating molecules in MS lesions may be reduced 229.

Significantly reduced “insulin sensitivity” (also called “insulin resistance”) has been observed in MS patients compared to healthy comparators (also known as “controls”) 230-233, and has frequently been linked to MS 234. Insulin is a hormone in the body that functions to pull glucose from the bloodstream into cells, including neurons, for use. Sensitivity to insulin is important not only for healthy energy production, but also to prevent glucose and insulin itself from building up in the bloodstream and causing neuronal dysfunction and even damage 235,236. Too much insulin in the blood (a condition known as “hyperinsulinemia”) has been linked to neurodegenerative disorders 236, including MS 237. One study found insulin resistance and impaired glucose metabolism already at an early stage of MS 230. No less importantly, other studies showed a link between the degree of insulin resistance in MS patients and severity of disability 233, chronic inflammation, and oxidative stress 231.

The principal food component associated with conversion to glucose and need for insulin activity in the body is carbohydrate. The type of carbohydrate that converts most rapidly is known as “simple,” and is highest in white sugar, associated foods such as syrups and candies, and refined grain and grain-substitute products, such as potato and tapioca flours. Fruits can also be high in simple carbohydrates, but they also contain complex carbohydrates – notably fiber – and water, which slow the conversion process. While most simple carbohydrate foods and beverages have been associated with impaired metabolism and inflammation, complex carbohydrate foods high in fiber have been attributed protective metabolic effects, including on brain function 238.

Numerous studies have compared the respective benefits of high-carbohydrate versus low-carbohydrate diets on health parameters such as weight management and control of blood glucose levels, with conflicting results. Recent data suggest that a well-composed high-carbohydrate diet can have a metabolic influence similar to that of a low-carbohydrate diet, well-composed meaning high in fiber and low in refined carbohydrates and glycemic index (GI) 239,240. GI is a scoring system of carbohydrate-rich foods according to how much each increases blood sugar levels 241, and while its adequacy has been debated, it is used as a general basis for assessing carbohydrate food quality.

MS Diet Features: Animal Foods

MS diets range from vegan to meat-rich Paleo in their animal product content, each with their specific justifications. Of the animal foods, dairy is the most commonly omitted, followed by eggs. As with other sensitivity issues, different bodies respond differently to different approaches, and each diet has their own advantages and disadvantages.

A vegan approach, as promoted by Dr.s John McDougall and Saray Stancic, omits all animal foods, and some people have found success in managing their MS with such plans. One of the reasons may be the lack of potentially aggravating factors found in meat 242, dairy243-245, and eggs 244-246, while another may be the particularly high content of powerful antioxidants and important fiber in plant foods247. Like most diets that omit major food groups, it is important to make sure your plan provides adequate nutrition and is not based on refined or ultraprocessed foods. Additionally, you should listen to your body and take care to not replace one set of allergenic or inflammatory factors with another. Common causes of controversy include legumes, given their lectin content, gluten, which is considered to be inflammatory even in non-celiac individuals, and grains in general, due also to lectins. These are discussed below.

The meat-inclusive Paleo approach favored by Dr.s Terry Wahls, Loren Cordain, and Sarah Ballantyne has also met with success in MS cases. It owes its influence in large part due to the omission of overly processed foods, but according to Wahls, also triggering foods such plant-based sources of protein (primarily legumes), eggs, and dairy.

Eating more meat, having less of certain bacteria in the gut, and more of certain immune cells in the blood, all link with MS. A recent analysis demonstrated an association between greater meat consumption and a decrease in the commensal (or helpful) species Bacteroides thetaiotaomicron in the intestines. This bacteria has been found to be protective against autoimmune disease 248, and is involved in digesting carbohydrates from vegetables, which in turn serve to feed other commensals that are important for general health 249. Higher meat consumption in MS patients was also linked to increased harmful Th17 cells in the immune system 242. While some healthy people eat a lot of meat, the analysis suggested that in MS, gut bacteria is disconnected from proper immune function, leading to greater autoimmune attacks on the nervous system with meat consumption 242. It is important to note that since the analysis was performed on widely differing populations, the quality of the meat may have been inferior to the pastured and grass-fed types recommended in some MS diets.

Eggs are a potential allergen246, the second most common food allergy in the United States after dairy, affecting primarily children 250. In adults, eggs are associated with possibly greater allergenicity in inflammatory autoimmune disorders due to overactivated intestinal immunity 244. An animal model and survey in adults suggested that eggs may be associated with aggravation of autoimmune inflammation245. However, if allergy to eggs is not an issue, they can represent an important source of high-quality protein, vitamins, and minerals, and in the case of certain fortified types, anti-inflammatory omega-3 fatty acids, including the docosahexaenoic acid (DHA) sought in fatty fish 251-253.

Similarly to eggs, dairy is a common allergen that affects primarily children, but can also affect adults. Also similarly, dairy has been observed to aggravate autoimmune inflammation244,245, but more specifically, has been shown to correlate with MS prevalence 254. Dairy contains the protein butyrophilin, which mimics part of myelin oligodendrocyte glycoprotein (MOG) 243, believed to be important in the myelination of nerves 255 and to serve as a mediator of interactions between myelin and the immune system 256. Therefore, a sensitivity to dairy may result in the immune system targeting MOG, triggering an immune reaction central to MS243,257,258. Casein is another key protein in dairy, considered to be perhaps the most allergenic 259, and which may also have cross-sensitivity with MOG. There is evidence of how an immune response against casein can aggravate the demyelinating pathology of MS as a result of similarity to MOG 254. While these reactions are dependent upon there being a sensitivity to the proteins in dairy, potentially greater general food sensitivity in MS is a concern 260. If the inclusion of dairy products is desired, there are lower-risk options such as goat’s milk, whose protein composition favors whey over casein, and which studies have shown is very low in the troublesome alpha S1 type of casein and primarily contains alpha S2 casein, which is far less allergenic 261. Another option growing in popularity is A2 milk, free of the A1 variant of β-casein, a protein that represents approximately 30% of the caseins in cow’s milk. A2 releases much smaller amounts than A1 of bioactive opioid peptide β-casomorphin 7 upon digestion, linked to harmful effects on human health 262.

MS Diet Features: Nightshade Elimination

Nightshades are plants from the Solanaceae family, comprising fruits, vegetables, herbs, flower, and trees. Some are highly toxic to humans, whereas others are considered edible. Some of the most common among the edibles are listed below.

Ashwagandha
Eggplant
Goji Berries
Okra
Paprika
Peppers (vegetables and spices, such as cayenne)
Potatoes (white)
Tomatillos
Tomatoes

What create toxicity in nightshades are compounds called alkaloids, present in large amounts in poisonous members of this family, and in small amounts in the edible members. The latter are harmless to most people, especially when eaten fully ripe. Importantly, the majority of alkaloids are found in the stems and leaves, which are not normally eaten. In sensitive individuals, however, even a small amount of the alkaloids that can contribute to flares of autoimmune conditions such as MS. Saponins, another type of molecule in nightshades, can create the type of exaggerated response from the immune system observed in autoimmune disorders.

MS Diet Features: Gluten

Many dietary approaches to MS include elimination of gluten and grains, while a few do not. This appears to be an individual issue, as some people thrive with grain intake, while others are more susceptible to the negative effects.

Observational studies have linked consumption of whole grain products with reduced risks for chronic inflammatory disorders such as type 2 diabetes, cardiovascular diseases, obesity, and some types of cancer 263, as well as decreased inflammatory markers (CRP, Il-6) 264. However, interventional studies do not always demonstrate a clear benefit265-270, and it has been speculated that other components in the diet or overall lifestyle may be impacting the immune response 271. For example, a diet high in whole grains with low glycemic index was associated with sustained reductions in glucose and inflammation in type 2 diabetics compared to a diet high in refined grain products with a high glycemic index. In addition to the inflammatory potential of glycemic index, whole grains contain phytochemicals that can exert anti-inflammatory effects, possibly offsetting potentially pro-inflammatory effects of gluten and other protein compounds called lectins 272. Of note, many intervention studies evaluating increased whole grain intake used refined grain diets as controls, thereby making it difficult to draw conclusions on the independent role of whole grains in disease and inflammation 273.

Wheat products have been reported to trigger allergic reactions such as rhinitis and asthma 274,275, which are essentially autoimmune in nature. Several proteins present in wheat, most notably gluten proteins, have been shown to react with an immune compound known as immunoglobulan E (IgE) in the body that is responsible for allergic responses 275.

More common than wheat allergies is gluten intolerance, which features in celiac disease, an autoimmune condition estimated to affect approximately 0.7-1.4% of the global population 276. Further, incidence of celiac disease is closely related to that of other autoimmune disorders such as type 1 diabetes, raising the possibility of a connection through gluten277,278.

Gluten is the main structural protein complex in wheat, making up about 80% of the total protein. It consists of glutenins and prolamins 279, the latter known as gliadins in wheat. Glutenins are polymers of individual proteins, while gliadins are monomeric proteins, classified as alpha/beta-gliadins, gamma-gliadins, and omega-gliadins 275. Gliadin antigens from wheat gluten and related prolamins from other gluten-containing cereal grains, including rye and barley, can trigger celiac disease in genetically susceptible people. Of note, while key genes (HLA-DQ2, HLA-DQ8) are active in nearly all celiac sufferers 278, there is a group of HLA-DQ2/DQ8-inactive individuals with digestive symptoms that respond well to a gluten-free diet 280,281. This is because gliadin’s stimulation of pro-inflammatory immune cells is not limited to celiac disease 278,282,283.

Gliadin interacts with immune cells by passing through the intestinal barrier, which exists to protect the rest of the body from offending substances present in the intestines 284,285. Gliadin does this by increasing barrier permeability, which is an important early step in autoimmune reactions 282,286,287. Chronically increased intestinal permeability (or leaky gut syndrome) allows for the undesirable movement of both microbial and dietary antigens to the bloodstream and ultimately a disturbance in immune tolerance 288. This has been associated with autoimmune diseases, including MS 284.

Though gluten sensitivity may not be causally linked to MS in general (Hadjivassiliou et al., 2003), and the prevalence of antigliadin antibodies has been found to be the same in MS patients as in the general population – about 10% (Sanders et al., 2003) – there appears to be a subset of patients who react to gluten not with digestive symptoms, but with a movement irregularity known as “ataxia” that improves with a gluten-free diet 289.

A systematic review of prospective studies and surveys investigating use of a gluten-free diet in MS revealed inconsistent results: some studies showed benefit, some did not, and one even found food sources of gluten such as cereals and breads to be protective 290. This suggests that other factors may be at play, and that each person’s response may be unique.

MS Diet Features: Grains and Pseudograins

Aside from gluten, there are protein compounds in wheat (including Kamut®, einkorn, spelt), other grains (e.g., rye, barley, oats), gluten-free pseudograins (e.g., quinoa, amaranth, buckwheat, teff), and similarly used foods (e.g., corn, rice) known as lectins, which have been shown in experimental models to stimulate pro-inflammatory immune cells. Lectins serve as defense mechanisms of those food plants against other plants and fungi, and are widely recognized as anti-nutrients, meaning that in high amounts (generally obtained from inadequate cooking) they can lead to poor absorption of nutrients and in some cases, food poisoning and/or organ damage 291. A key lectin is wheat germ agglutinin, which itself has been found to impair the integrity of the intestinal wall and increase permeability, allowing passage of small molecules, including other lectins 292 into the systemic circulation. The combination of wheat germ agglutinin and gliadin can result in an increase in microbial and dietary antigens interacting with cells of the immune system. Lectins have also been suggested to contribute to autoimmune disease by presenting errant immune system codes293 and stimulating white blood cells 294. Additionally, plant lectins such as those in grains and legumes have been shown to activate a key inflammatory network in the body to promote inflammation, mitochondrial damage, and related disorders 295, including MS296.

Fortunately, cooking, sprouting, or fermenting foods high in lectins can reduce the content to a negligible amount. No less importantly, a comprehensive review of the evidence from human trials has indicated that lectin-rich foods may not consistently cause inflammation, intestinal permeability, or nutrient absorption issues in the general population 297. However, there are clearly some individuals who respond unfavorably, and therefore may benefit from eliminating them 293.

For those who can safely consume them, lectin-rich plant foods are excellent sources of essential amino acids, prebiotic fibers, vitamins, minerals as well as powerful antioxidant and even anti-inflammatory compounds298,299, and are associated with reduced inflammatory biomarkers in both animal and human trials 300-303.

MS Diet Features: Legumes

Legumes, including lentils, beans, peas, and peanuts, have long been an important source of protein, vitamins, minerals, and fiber in the food supply 304. Some legumes have attracted scientific attention because of their health-promoting effects, including prevention and management of chronic diseases such as cancers, cardiovascular disease, obesity, and diabetes 304,305. These have been attributed to antioxidant and anti-inflammatory properties from compounds such as phenolic acids, flavonols, flavones, isoflavones, anthocyanins, saponins, and tannins306-309.

Legumes are also high in lectins (read more about these in “Grains and Pseudograins”), and thus are sometimes omitted from autoimmune diets. Negative effects of raw legume lectins have been observed in animals. In the digestive system, these include decreased acid secretion and changes in the intestines that can lead to poor nutritional 310-315, and systemic effects include promotion of inflammation and altered immune function295,316.

However, just like grain sources, legume lectins can be minimized through cooking, sprouting, and fermenting291,297. Moreover, beneficial antioxidant and anti-inflammatory compounds can actually be increased in the process 300.

Of note, some legume lectins may themselves be beneficial, and in fact are being explored for their anti-cancer assistance – they can identify cancer cells, and therefore can improve the target specificity of conventional chemotherapy agents, potentially reducing harmful side effects317-319. Moreover, legume lectins isolated from lentils, chickpeas, jack beans, peas, and common beans have all demonstrated their own activity against various cancer cell lines320.

Since legumes are rich in nutrients, antioxidants, and anti-inflammatory compounds, it is recommended to only eliminate them after careful assessment of a genuine need321,322.

MS Diet Features: Nuts and Seeds

Nuts and seeds can induce an allergic reaction – a type of autoimmunity – in some people, and so may be eliminated to prevent triggering responses relevant to MS. In the Autoimmune Protocol (AIP) Diet, they are among the foods to be avoided during the initial phase, though they may be added back if tolerated.

As early as 1936, a link between food allergies and multiple sclerosis was suspected 323. Soon after, it was noted that the most severe MS attacks were in individuals with food allergies 324. It was more recently observed that people with autoimmune disease are more likely to have biochemically confirmed food intolerances than healthy people 260. In turn, MS patients with food allergies were shown to have more relapses and a higher likelihood of lesions compared with those with no known allergy257.

Peanut allergies are well-known, but tree nuts (e.g., almonds, Brazil nuts, cashew nuts, hazelnuts, macadamia nuts, pecans, pine nuts, pistachios, walnuts) can also elicit severe symptoms and a life-threatening anaphylactic reaction. Together with peanuts, hazelnuts account for 90% of deaths due to food allergy. Importantly, peanut – being a legume with characteristics of a nut – can cross-react with other plant-based foods, notably other legumes and tree nuts, meaning that peanut-allergic individuals can be both co-sensitized and co-allergic to such items. Unfortunately, desensitization to peanut – a form of oral immunotherapy to improve the body’s tolerance – has not been shown to have an effect on legume cross-sensitization325.

Allergies to seeds (e.g., coriander, mustard, poppy, pumpkin, sesame, sunflower) tend to be rarer, with sesame seed considered to be the most allergenic, affecting people of all ages 326.

For people who are not sensitive to their allergenic potential, nuts are valuable nutrient-dense foods rich in monounsaturated and polyunsaturated fatty acids and other bioactive compounds, including protein, fiber, minerals, tocopherols (vitamin E and related compounds), phytosterols, and antioxidant phenolics 327. Through these nutrients and phytochemicals, nuts have been linked to wide-ranging health benefits. Observational studies in humans report that nut consumption is associated with lower risks for cardiovascular disease, high blood pressure, cancer, and premature death. At the randomized clinical trial level, the PREDIMED study showed a protective effect of nuts against cardiovascular disease, and other human studies showed that nuts lower LDL cholesterol levels and improve insulin sensitivity and blood vessel integrity328.

Edible seeds also contain a diverse range of phytochemicals with beneficial biological activities, such as antioxidant, anti-inflammatory, antidiabetic, and anti-tumor effects298 especially when sprouted 329. For example, in an animal model of the neurodegenerative disorder Parkinson’s disease, an extract of pumpkin seed demonstrated antioxidant and anti-inflammatory properties that together improved symptoms 330.

Since nuts and seeds are rich in nutrients, antioxidants, and anti-inflammatory compounds298,328,331, it is recommended to only eliminate them after careful assessment of a genuine need.

MS Diets: Popular Types

A review of various dietary patterns applied to MS concluded that “An appropriate and balanced diet can be extremely helpful in improving the condition and well-being of patients with MS, and effectively support drug therapy” 332. The review paid particular attention to the Mediterranean diet, Mediterranean-DASH intervention for neurodegenerative delay (MIND), intermittent fasting, gluten-free, ketogenic, Paleo, the Wahls, McDougall, and Swank diets, all of which (and more) are described here.

Note that if you are seriously ill and/or on medication, it is generally advised to not make a dramatic dietary change – with the possible exception of giving up ultraprocessed foods – without the care of a professional who knows about nutrition and its effects on health. No less important, it is best to ease into a new program with gradual changes, allowing them to slowly become second nature and the body to adapt to them.

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