Review casts doubt on clinicial benefits of a gluten-free diet in MS
Fatigue, quality of life gains may stem from broader dietary shifts
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Adhering to diets that exclude gluten may lead to some improvements in people with multiple sclerosis, but it remains unclear whether these benefits stem from avoiding gluten itself or other dietary changes, a review found. (Photo from iStock)
- A review reveals that current evidence does not establish a gluten-free diet as an effective disease-modifying treatment for MS.
- Some patients report improved fatigue and quality of life, but it remains unclear if these benefits stem from avoiding gluten or broader dietary shifts.
- Experts advise that gluten elimination should be viewed as an investigational adjunct rather than an established therapy for managing MS.
Adhering to diets that exclude gluten may lead to improvements in fatigue, quality of life, and some measures of disability in people with multiple sclerosis (MS), but it remains unclear whether these benefits stem from avoiding gluten itself or other dietary changes, a review of six studies found.
Overall, the evidence was of very low certainty for all seven outcomes assessed, and the researchers found no convincing evidence that eliminating gluten improves MS disease activity or disability.
“Current evidence does not establish that gluten elimination itself confers clinical benefit,” researchers wrote. “Adequately powered randomised trials that isolate gluten elimination, objectively verify adherence, and use clinically meaningful outcomes with longer follow-up are required.”
The study, “Gluten-Free and Gluten-Restricted Diets in Multiple Sclerosis: A Systematic Review of Disease Activity and Patient-Reported Outcomes,” was published in the journal Nutrients.
Conflicting evidence prompts review
MS is a chronic disease marked by inflammation that damages the brain and spinal cord. While several treatments are available to reduce disease activity and prevent disability, many people with MS use diet to help manage their symptoms and improve overall health. Some avoid gluten, a protein found in wheat and certain other grains, in the hope of reducing inflammation or improving disease outcomes.
But evidence supporting the impact of a gluten-free diet in MS is mixed. Some studies suggest a gluten-free diet may ease disability and improve body composition, while others have found no association between gluten and MS disease activity.
Given the conflicting evidence, a team led by researchers in Saudi Arabia conducted a review of published studies to assess whether gluten-free diets can help with MS. The analysis included six studies published between 2014 and 2025 that enrolled 20 to 186 people with MS, with follow-up ranging from about three months to 5.3 years.
Interventions varied considerably
The interventions varied considerably. Some studies examined gluten-free diets, while others tested broader dietary patterns that also restricted foods such as dairy, potatoes, legumes, or saturated fat. Because of these differences, the researchers summarized the findings rather than combining them in a pooled analysis.
Results from two non-randomized studies showed improvements in disability, assessed using the Expanded Disability Status Scale (EDSS), among people following a gluten-free diet.
A 2014 study involving 72 adults with relapsing-remitting MS (RRMS) reported lower EDSS scores among participants who adhered to a gluten-free diet than among those who did not (1.5 vs. 2.1 points). Fewer participants in the gluten-free group also had active lesions on MRI scans (28% vs. 67%), but relapses rates did not differ significantly between groups.
A 2025 study involving 54 women with RRMS also found a greater reduction in EDSS scores over six months with a gluten-free diet than with a regular diet. The gluten-free group also had a greater reduction in waist circumference and levels of LPS, a compound produced by bacteria that can promote inflammation.
However, neither study randomly assigned participants to their diets, so the findings may reflect differences between people who did and did not follow a gluten-free diet rather than the effects of gluten avoidance.
Across studies, evidence certainty very low for all outcomes assessed
In contrast, a 2023 crossover trial in which participants were randomly assigned to a diet found no significant difference in EDSS scores between periods of usual and reduced wheat intake. The wheat-reduced period was associated with changes in some inflammatory immune cells and improved pain-related quality of life, but no clear benefits were seen for disability or disease activity.
Other studies tested dietary patterns that excluded gluten alongside other foods, making it difficult to determine gluten’s contribution to any improvements.
A 2017 study tested a modified Paleolithic diet that removed gluten, dairy, potatoes, and legumes. Results showed improvements in in fatigue, mental quality of life, and fine motor performance in the dominant hand, but walking and cognitive measures did not improve.
[Current evidence] does not support a gluten-free diet as a disease-modifying treatment for MS. Until such evidence is available, gluten avoidance should be regarded as an investigational adjunct rather than an established MS therapy.
Similarly, the 2021 WAVES trial (NCT02914964) compared a modified Paleolithic elimination diet (Wahls diet) with the Swank diet, which is low on saturated fats, in people with RRMS. Both groups experienced improvements in fatigue and mental quality of life, but neither showed a significant change in walking function.
A 2023 observational study found no significant association between gluten intake and disease activity, measured using no evidence of disease activity-3 — meaning no relapses, no disability progression, and no new MRI activity. However, only eight of the 186 participants reported following a gluten-free diet.
Across all studies, researchers rated evidence certainty as very low for all outcomes assessed. Fatigue and quality of life improved most consistently in the multi-component dietary trials, but the findings fail to establish that eliminating gluten improves MS outcomes.
In their conclusion, the researchers wrote that the current evidence “does not support a gluten-free diet as a disease-modifying treatment for MS. Until such evidence is available, gluten avoidance should be regarded as an investigational adjunct rather than an established MS therapy.”
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