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Advanced Neurology Fatigue management in patients with MS

aquatic, yoga, Pilates, and walking). Studies have reported patients. Recent studies have highlighted various dietary
its positive effects not only on fatigue but also on a spectrum modifications, such as the Mediterranean, Paleolithic,
of associated symptoms, including anxiety, depression, anti-inflammatory, or ketogenic diets, alongside vitamin
sleep disturbances, and spasticity, ultimately improving supplementation, as effective strategies for reducing fatigue
overall quality of life for MS patients. Moreover, exercise is and ameliorating a range of symptoms and quality of life in
a cost-effective intervention devoid of adverse side effects. MS patients. Notably, investigations into dietary modifications
Table 2 summarizes recent randomized controlled trials that among patients with MS have not reported any adverse effects.
investigate the impact of exercise on fatigue in MS patients. However, it is noteworthy that studies involving the ketogenic
diet have documented side effects in different patient groups,
3.2.2. Non-pharmacological management: Diet such as the downregulation of the ghrelin hormone. Table 3
61
Dietary modification stands out as a researched method summarizes the ongoing randomized controlled trials that
with reported effectiveness in alleviating fatigue among MS investigate the effect of diet on fatigue in MS patients.

Table 3. Studies investigating the effect of dietary modification on fatigue in patients with multiple sclerosis
Study Intervention Proven effectiveness Outcome analysis
Achiron et al. 62 Vitamin D analog (Alfacalcidol) Yes It enhances the quality of life without any adverse effects.
Sanoobar et al. 63 Coenzyme Q10 Yes Research has demonstrated that it is more effective than placebo in
reducing fatigue and depression.
Bertoglio et al. 64 Andrographis paniculata Yes The study reported that the treatment was well tolerated by patients and
more effective than the placebo in reducing fatigue.
Coe et al. 65 Flavonoid-rich dark cocoa Yes A moderate effect on fatigue has been reported.
Bitarafan et al. 66 Vitamin A supplementation Yes (i) It has been demonstrated to be superior to the placebo group in
reducing fatigue and depression.
(ii) It also contributed to the improvement of anti-inflammatory
mechanisms.
Albrechtsen Diet regulation Yes (i) Dietary carbohydrate intake is positively associated with physical
et al. 67 activity capacity, while fat consumption is negatively associated.
(ii) Consumption of omega-3 and vitamin D has a positive effect on
reducing fatigue.
Coe et al. 68 Flavonoid-rich cocoa beverage Yes A minor positive effect on fatigue has been reported.
Katz Sand et al. 69 Modified Mediterranean dietary Yes It has been reported to be effective in reducing fatigue and other multiple
program sclerosis symptoms.
Bahr et al. 70 Ketogenic diet and intermittent Not applicable The research protocol has been established, but the research has not yet
fasting been finalized, and the findings are not yet available.
Lee et al. 71 Ketogenic diet-modified Yes The effectiveness of the Paleolithic diet in reducing fatigue is greater than
Paleolithic diet that of the ketogenic diet.
Mousavi Modified anti-inflammatory diet Yes A modified anti-inflammatory diet has been shown to improve fatigue
-Shirazi-Fard and quality of life and may increase the level of interleukin-4.
et al. 72
Wahls et al. 73 Swank and Wahls diets Yes Both diets are individually effective in reducing fatigue and improving
quality of life.
Motaghi et al. 74 Lavender Yes Consuming lavender flower capsules is effective in reducing fatigue.
Bohlouli et al. 75 Modified Mediterranean diet Yes Fatigue was significantly reduced in individuals who adhered to a
modified Mediterranean diet for six months compared to those who
followed a traditional Iranian diet.
Chase et al. 76 Low-fat diet Yes Restricting fat intake in the diet can effectively reduce fatigue.
Moravejolahkami Anti-inflammatory-antioxidant Yes Combined supplementation of an anti-inflammatory and antioxidant-rich
et al. 77 modifications and synbiotics diet, along with synbiotics, has been reported to improve fatigue, pain,
sexual function, and bowel/bladder status.
Asghari et al. 78 Probiotic supplement Yes In addition to fatigue, studies have reported significant effects on
inflammatory markers, oxidative stress indicators, pain, and quality of life.
Chen et al. 79 Low-fat diets Yes Fatigue was significantly reduced in patients who followed a low-fat diet
compared to the control group.

Volume 3 Issue 2 (2024) 5 doi: 10.36922/an.2576