Nutrition and fatigue in MS


We are told to watch what we eat when it comes to health. Nutritional status has fundamental links to a healthy metabolic function, which is responsible for the release of energy for your body. It is therefore not surprising that researchers want to investigate how nutritional status affects MS, in particular fatigue.

In a sizable study conducted in France investigators looked at the influence of nutritional status (magnesium, albumin, calcium, iron, vitamin D and vitamin B12 levels), dietary habits including restrictions (allergies, intolerances etc.), sleep quality, existence of any taste disorders/swallowing issues, depression scores and treatments including anxiolytics and sleeping pills, on fatigue.

Following a multivariable analysis the factors that they found that negatively impacted on fatigue were as follows: depression (mild: OR = 5.05, 95%CI= [2.6–10.13], moderate-severe: OR = 7.58, 95%CI= [3.74–16.34]), sleep quality (OR = 0.99, 95%CI = [0.98–1]), and use of sleep medication (OR = 3.72, 95%CI= [1.16–14.4]). Nutritional values were not associated in a surprising twist of experimental outcomes.

Depression understandably causes mental and physical fatigue even outside of a neurological disorder, but often we overlook the small sleeping pill. It is probably one of the most widely used prescription medications by general public outside of analgesics and anti-depressants. Sleeping pills have a long-half life and this may be one of the main reasons for their association with fatigue (see Table below).

Table: Benzodiazepines and their half lives (source: M Mula, Epileptic Disorders 2016)


Rev Neurol (Paris). 2023 Feb 13;S0035-3787(23)00752-X.

NUTRISEP: Assessment of the nutritional status of patients with multiple sclerosis and link to fatigue

C Donzé C Massot G Defer P Vermersch P Lecoz O Derepeer A Abdullatif V Neuville P Devos B Lenne M A Guyot L Norberciack P Hautecoeur 

    Background: Fatigue is a common complaint in patients with multiple sclerosis (PwMS) and reduces quality of life. Several hypotheses for the pathogenesis of fatigue in MS are proposed ranging from neurological lesions to malnutrition, but none has been conclusively validated through clinical research.

    Objectives: The goal of this study was to examine the correlation between fatigue and nutritional status and dietary habits in PwMS.

    Methods: This was a cross-sectional, multicenter study conducted at 10 French MS centers and enrolling PwMS with an Expanded Disability Status Scale (EDSS) score between 0 and 7. Plasma level of albumin, magnesium, calcium, iron, vitamin D and B12 evaluated nutritional status. A semi-structured eating behavior questionnaire has been developed to evaluate dietary habits. Evaluation of fatigue used specific questionnaire (EMIF-SEP). Quality of sleep was evaluated by visual analogue scale (VAS), depression with Beck Depression Inventory (BDI-II); dysphagia by DYsphagia in MUltiple Sclerosis questionnaire (DYMUS) and taste disorders by gustometry. Association between nutritional deficiencies and different data such as socio-demographic data, disease characteristics, swallowing and taste disorders, food intake, depression and sleep quality was investigated.

    Results: A total of 352 patients mean age: 48.1±10.1 years, mean duration of MS: 15.3±9.1 years and median EDSS: 4 were analyzed. Bivariate and multivariate analyses showed a statistically significant correlation between fatigue and depression and use of sleeping pills, while none of the variables related to dietary habits or nutritional status correlated significantly with fatigue.

    Conclusions: Dietary habits and nutritional status have little impact on fatigue and general population nutrition recommendations remain the rule for PwMS. In cases of fatigue, specific attention should be paid to depression and use of sleeping pills.

    About the author

    Neuro Doc Gnanapavan


    • Unsurprising, really. It’s not just what you put in your mouth, but when you eat, who you eat with, how food connects to mood and so on. All of which is hard to disentangle, especially when you’ve got MS…..

    • I used to take CBD and melatonin for sleeping problems. I thought it did help and maybe did for anxiety related sleeping problems. Recently I threw it al away and focused on early sunlight exposure and avoiding bright lights at night. I now sleep better than ever before. Meds ans sups might have their place but focusing on behavioral adjustments is key IMO

    • Interesting.
      So how many out of the 352 MS patients did not take sleeping pills. Were those people analysed separately?

    • My fatigue abated when I stopped teaching full time. My stress level dropped. Sleep was affected by the need to self-inject on a daily basis and I would put it off later and later as a needlephobe. Thankfully stopped using that medication. So, less stress, more hours of sleep due to not teaching and not self-injecting were key. I get at least 8 more hours of sleep a week now. Maybe not getting up in the dark helps as well.



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