Dietary Patterns and Nutritional Factors in Multiple Sclerosis: A Narrative Review.

Multiple sclerosis (MS) is a chronic immune-mediated disorder of the central nervous system characterized by inflammation, demyelination, and progressive neurological dysfunction. Increasing attention has been given to the potential role of diet as an adjunctive strategy for improving symptoms, modulating inflammation, and enhancing quality of life in people with MS. This narrative review examines current evidence from clinical trials, observational studies, and relevant reviews on the effects of dietary patterns and selected nutritional components on clinical outcomes in MS, with particular focus on the Mediterranean diet, the Swank diet, the Wahls diet, ketogenic diets, plant-based diets, and individual components such as omega‑3 fatty acids, antioxidants, and saturated fats. Available data suggest that some dietary interventions may be associated with improvements in fatigue, quality of life, metabolic parameters, and, in certain studies, disability-related outcomes. Overall, patterns rich in fruits, vegetables, whole grains, unsaturated fats, and anti-inflammatory nutrients, and low in saturated fat, appear most consistently beneficial, although findings remain heterogeneous and limited by methodological variability. Proposed mechanisms include modulation of systemic inflammation, reduction of oxidative stress, favorable alterations in gut microbiota composition, and support of metabolic health. Diet may therefore represent a useful adjunct to conventional MS management, particularly when centered on balanced, anti-inflammatory Mediterranean-style or plant-rich patterns, but it should not be regarded as a substitute for established pharmacological therapies. Larger, long-term, and methodologically rigorous randomized trials are still needed to clarify the efficacy, safety, and sustainability of specific dietary interventions and to define clear, evidence-based dietary recommendations for people living with MS.