The Hidden Players in Multiple Sclerosis Nutrition - A Narrative Review on the Influence of Vitamins, Polyphenols, Salt, and Essential Metals on Disease and Gut Microbiota

Sep 30, 2026

Multiple sclerosis (MS) is a chronic neuroinflammatory and autoimmune disorder of the central nervous system (CNS) whose cause remains unknown. Disease-modifying therapies (DMTs) are standard care, while complementary nutrition-based interventions may modulate disease activity. This narrative review synthesizes evidence on micronutrients (vitamins and essential metals), polyphenols, and salt in experimental autoimmune encephalomyelitis (EAE) and MS. It addresses links to gut microbiota and the gut–brain axis, noting heterogeneous vitamin B, C, E, and K findings, stronger effects for vitamins A and D, anti-inflammatory and neuroprotective polyphenol effects, and the potential role of balanced salt intake and essential metal levels. Results support development of personalized nutritional strategies to complement therapies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages34

Reading Time1 h 26 min

AccessFree to download

Introduction

Multiple Sclerosis Pathophysiology

Immune cell involvement

Inflammation patterns

Clinical phenotypes of MS

Review The Hidden Players in Multiple Sclerosis Nutrition: A Narrative Review on the Influence of Vitamins, Polyphenols, Salt, and Essential Metals on Disease and Gut Microbiota Rachele Rosso 1, Eleonora Virgilio 1,2, Matteo Bronzini 2, Simona Rolla 1, *, Alessandro Maglione 1,3,† and Marinella Clerico 1,2,† Academic Editor: Yongting Luo Received: 5 December 2025 Revised: 24 December 2025 Accepted: 25 December 2025 Published: 1 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Clinical and Biological Sciences, University of Turin, 10043 Orbassano, Italy; rachele.rosso@unito.it (R.R.); eleonora.virgilio@unito.it (E.V.); alessandro.maglione@unito.it (A.M.); marinella.clerico@unito.it (M.C.) 2 San Luigi Gonzaga University Hospital, 10043 Orbassano, Italy; [bronzini.matteo@gmail.com](bronzini.matteo@gmail.com) 3 Department of Computer Science, University of Turin, 10149 Torino, Italy * Correspondence: simona.rolla@unito.it † These authors contributed equally to this work. Abstract Multiple sclerosis (MS) is a chronic neuroinflammatory and autoimmune disorder of the central nervous system (CNS) whose cause remains unknown. Disease-modifying therapies (DMTs) are the current standard of care, yet growing evidence highlights the importance of complementary lifestyle-based interventions, including nutrition, in modulating disease activity. Given the influence of diet on immune function, several studies have examined its effects in MS, with particular attention to specific dietary patterns and macronutrients. However, fewer studies have focused on micronutrients, bioactive compounds, and minerals and their influence in MS. In this narrative review, we report the latest evidence on micronutrients such as vitamins and essential metals, along with polyphenols and minerals like salt, in both experimental autoimmune encephalomyelitis (EAE) and MS. We also discuss how these dietary components may influence the gut microbiota, which is considered a contributor to disease onset due to its interaction with the immune system in the gut–brain axis. While findings for vitamins B, C, E, and K remain heterogeneous, vitamins A and D show the most consistent immunological and clinical effects, with immunomodulatory, antioxidative, and neuroprotective effects in both EAE and MS. Polyphenols also display anti-inflammatory and neuroprotective properties in EAE and, to a lesser extent, in clinical studies. Lastly, evidence suggests the importance of balanced salt intake and adequate levels of essential metals, as dysregulation may contribute to comorbidities or enhance inflammatory pathways relevant to MS. Although only a limited number of studies have explored these aspects, the gut microbiota appears to be differentially affected by these dietary factors. Overall, advancing our understanding of how these components interact with immune and microbial pathways may support the development of personalized nutritional strategies to complement current therapies and improve patient outcomes. Keywords: micronutrients; vitamins; essential metals; polyphenols; salt; multiple sclerosis; experimental autoimmune encephalomyelitis; gut microbiota 1. Introduction Currently, approximately 2.9 million people worldwide are living with multiple sclerosis (MS), a chronic autoimmune and neuroinflammatory disease that affects the central nervous system (CNS) . MS is characterized by inflammation, demyelination, gliosis, and neuronal loss, and can lead to severe disability in affected individuals. Common clinical manifestations include visual impairment, focal weakness, cognitive dysfunction, and fatigue, together with typical magnetic resonance imaging (MRI) features. The average age at diagnosis ranges between 20 and 50 years, and women are affected more f

FAQs

What role do vitamins play in MS and EAE according to the review?

The review reports heterogeneous findings for vitamins B, C, E, and K, while vitamins A and D show the most consistent immunological and clinical effects in both EAE and MS, including immunomodulatory, antioxidative, and neuroprotective actions.

How might polyphenols influence MS?

Polyphenols are described as having anti-inflammatory and neuroprotective properties in EAE and, to a lesser extent, in clinical studies.

Why are gut microbiota and the gut–brain axis emphasized in relation to nutrition?

Dietary components are discussed as potential modulators of the gut microbiota, which is considered a contributor to disease onset through its interaction with the immune system along the gut–brain axis.

Sep 30, 2026

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