The Role of Nutritional Lifestyle and Physical Activity in Multiple Sclerosis Pathogenesis and Management: A Narrative Review

Abstract

Studies on the role of nutritional factors and physical activity (PA) in the pathogenesis of multiple sclerosis (MS) go back a long time. Despite the intrinsic difficulty of studying their positive or negative role in MS, the interest of researchers on these topics increased during the last few decades, since the role of diet has been investigated with the perspective of the association with disease-modifying drugs (DMD). The association of DMD, diets, and PA might have an additive effect in modifying disease severity. Among the various diets investigated (low-carbohydrate, gluten-free, Mediterranean, low-fat, fasting-mimicking, and Western diets) only low-carbohydrate, Mediterranean, and fast-mimicking diets have shown both in animal models and in humans a positive effect on MS course and in patient-reported outcomes (PROs). However, the Mediterranean diet is easier to be maintained compared to fast-mimicking and low-carbohydrate diets, which may lead to detrimental side effects requiring careful clinical monitoring. Conversely, the Western diet, which is characterized by a high intake of highly saturated fats and carbohydrates, may lead to the activation of pro-inflammatory immune pathways and is therefore not recommended. PA showed a positive effect both in animal models as well as on disease course and PROs in humans. Training with combined exercises is considered the more effective approach.

Increased Levels of Beta-Endorphin and Noradrenaline after a Brief High-Impact Multidimensional Rehabilitation Program in Multiple Sclerosis

“…In conclusion, our study reinforces the hypothesis that a multidimensional intervention focused on a proper lifestyle could represent a good proposal in the array of interventions dedicated to the management of the progression of this challenging chronic disease, due to the well-known relationship between lifestyle and the reduction of the inflammatory process in MS pathology [ 31 ]. Lifestyle factors (including physical activity, mental well-being, and an anti-inflammatory diet) should be increasingly considered in the field of rehabilitation, since chronic diseases, especially multiple sclerosis, are now viewed as “lifestyle diseases” [ 32 ].…”

Additive beneficial effects of aerobic training and royal jelly on hippocampal inflammation and function in experimental autoimmune encephalomyelitis rats

“…Regarding the effect of exercise on autoimmune diseases, exercise seems to increase brainderived neurotrophic factor (BDNF) and TrkB by improving blood ow to the brain, and by activating antioxidants, it can increase the regulatory T family, increase IL-10 and TGF-β. Furthermore, improvement of neurotrophins can improve mood and reduce anxiety and depression [44]. Intestinal-brain axis adaptation following exercise seems to be of particular importance in regulating the immune system in EAE patients, because favorable changes in the microbiota of the gastrointestinal tract following resistance training lead to a decrease in in ammatory cytokines such as IL-17 in the animal model of MS [45].…”

A Brief Overview on BDNF-Trk Pathway in the Nervous System: A Potential Biomarker or Possible Target in Treatment of Multiple Sclerosis?

“…Physical activity in MS patients has been shown to have numerous beneficial effects, being able to improve, for example, the gait stability and walking ( 123 , 124 ). A single exercise session can increase BDNF and NGF levels measured in the periphery ( 125 , 126 ), and physical exercise can have positive effects on symptoms progression in MS patients ( 126 ).…”