Paleolithic and Mediterranean diets reduce fatigue in Multiple Sclerosis

Electronic database searches were performed to include all randomized trials with a dietary intervention. Based on McDonald criteria, All adults with definitive MS and patient-reported outcomes for fatigue and/or QoL with a minimum intervention period of 4 weeks were included. Standardized mean differences (SMDs) were calculated for each outcome and included in random effects NMA to determine the pooled effect of each dietary intervention relative to each of the other dietary interventions. 

Results: Twelve trials comparing 8 dietary interventions (low-fat, Mediterranean, ketogenic, anti-inflammatory, Paleolithic, fasting, calorie restriction, and control [usual diet]), enrolling 608 participants, were included in the primary analysis. The Paleolithic (SMD: -1.27; 95% CI: -1.81, -0.74), low-fat (SMD: -0.90; 95% CI: -1.39, -0.42), and Mediterranean (SMD: -0.89; 95% CI: -1.15, -0.64) diets showed greater reductions in fatigue compared to control. The Paleolithic (SMD: 1.01; 95% CI 0.40, 1.63) and Mediterranean (SMD: 0.47; 95% CI 0.08, 0.86) diets showed greater improvements in physical QoL compared to control. For improving mental QoL, the Paleolithic (SMD: 0.81; 95% CI 0.26, 1.37) and Mediterranean (SMD: 0.36; 95% CI 0.06, 0.65) diets were more effective compared to control. However, the NutriGRADE credibility of evidence for all direct comparisons is very low due to most of the included trials having high or moderate risk of bias, small sample sizes, and the limited number of studies included in this NMA.