This review article examines how diet and exercise may influence multiple sclerosis (MS) symptoms by affecting inflammation in the body. Western-style diets high in salt, sugar, and processed foods can increase inflammation and harm gut bacteria, while healthier diets rich in vegetables, fruits, and fish—combined with regular exercise—may reduce inflammation and support beneficial gut bacteria. The authors suggest that better nutrition might help reduce side effects from MS medications and improve chronic fatigue symptoms.
Why It Matters
While this review focuses on MS rather than ME/CFS, it is relevant because both conditions involve chronic inflammation and fatigue. Understanding how diet and exercise modulate inflammatory pathways and gut microbiota composition may inform nutritional approaches for ME/CFS patients, who similarly experience post-exertional malaise and often struggle with chronic fatigue.
Observed Findings
Western-style high-calorie diets (high salt, animal fat, red meat, sugar-sweetened drinks, fried food, low fiber) are associated with increased inflammation and dysbiotic gut microbiota
Anti-inflammatory diets based on vegetables, fruits, legumes, fish, prebiotics, and probiotics are associated with upregulated oxidative metabolism and reduced proinflammatory molecule synthesis
Physical exercise promotes oxidative metabolism and reduces systemic inflammation
Diet and exercise modulate both metabolic pathways and gut microbiota composition, which in turn affect intestinal immunity
Nutritional interventions may potentially reduce side effects of immune-modulatory drugs and chronic fatigue symptoms
Inferred Conclusions
Dietary factors and lifestyle significantly influence inflammatory status in MS through modulation of metabolic pathways and gut microbiota
Anti-inflammatory dietary patterns and exercise may serve as adjunctive interventions to ameliorate MS symptoms and improve patient wellness
Nutritional science should be integrated into MS clinical care and therapeutic strategy
Remaining Questions
What are the optimal macronutrient and micronutrient compositions for reducing inflammation in ME/CFS specifically?
What This Study Does Not Prove
This review does not provide direct evidence from randomized controlled trials testing dietary interventions in MS or ME/CFS patients. The study does not establish causation—only that dietary factors are associated with inflammatory markers. The applicability of MS findings to ME/CFS remains unclear, as these are distinct diseases with different pathophysiology.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
Do the mechanistic findings in MS translate to improved clinical outcomes when dietary interventions are tested in randomized controlled trials in ME/CFS patients?
Which specific bacterial taxa or microbial functions are most critical for reducing fatigue and inflammation in post-viral conditions?
How do individual genetic and epigenetic factors modulate the response to dietary interventions?