Research Review: Provider Barriers to MS Nutrition Counseling & Mood and Cognitive Assessment

Two papers caught my attention highlighting how healthcare providers view the role diet can play in MS care, and another exploring the connection between mood, fatigue, and cognitive function.

I’ve included a high-level overview of what each paper covered, as well as my key takeaways from both.

"I See Diet Almost as Another Disease Modifying Therapy. It's That Important." A Qualitative Study of Dietitian and Nursing Perspectives on the Role of Diet and Brain Health for Multiple Sclerosis (Mult Scler Relat Disord. 2025;102:106613)

This study used in-depth interviews to understand how dietitians and nurses view the role of diet in multiple sclerosis care. Researchers interviewed ten dietitians and nine MS nurses to explore their perspectives on nutrition and brain health.(1)

The findings revealed that while many healthcare providers view diet as another disease-modifying tool, significant barriers prevent them from having in-depth dietary discussions with patients. Time constraints in busy clinics limit these conversations, and neither nursing nor neurology training programs include MS-specific nutrition education. Additionally, limited insurance reimbursement for dietetic services restricts patient access to nutritional support.

Despite these challenges, nurses reported high levels of patient interest in dietary self-management. They observed that when patients improved their nutrition, many symptoms improved, including better moods, increased energy, and reduced muscle spasticity.

Dietitians felt they were underutilized and could play a larger role in managing comorbid conditions like high blood pressure, obesity, insulin resistance, and diabetes. The study called for creating culturally sensitive educational materials about anti-inflammatory meal patterns, meal ideas, and nutrient-rich snacks. Researchers also suggested the need for studies comparing dietary interventions to disease-modifying drug treatments (DMTs).

My Takeaway

This research confirms growing awareness that people with MS want their neurology team to help them understand how diet fits into their wellness plan. While I don't expect to see studies comparing diet alone to DMTs in the near future, this study shows that the medical community is finally starting to recognize and acknowledge the importance of diet as it relates to disease management.

Keep asking your neurologist and specialists about nutrition's role in your wellness plan. If they can't provide guidance, check with your primary care team. Start by reducing ultra-processed foods (sugar and white flour-based items), replacing sweetened beverages with water and teas, and swapping white flour cereals, pasta, and bread for whole grains or starchy vegetables.

You can learn more about how diet can help manage and/or improve MS symptoms in my book, The Wahls Protocol®.

Subjective Cognitive Function in Individuals with Multiple Sclerosis: Associations with Objective Cognitive Function, Anxiety, Depression, and Fatigue (J Neurol Sci. 2025;475:123593)

This study enrolled 120 people with relapsing-remitting or progressive MS to examine the relationship between how people perceive their thinking abilities versus their actual cognitive performance. Participants completed surveys about their thinking skills, fatigue levels, mood (anxiety and depression), and daily life functioning. They then took three cognitive tests: a processing-speed task matching symbols to numbers, a verbal memory exercise recalling word lists, and a visual memory challenge remembering shapes and locations.⁽²⁾

The study found only a weak connection between people's self-reported thinking problems and their actual cognitive test scores. Processing-speed performance showed a small relationship to self-ratings, but memory tests did not. However, depression and fatigue were strongly tied to how people rated their thinking abilities. People who were more fatigued or depressed rated their cognitive function as more impaired.

Since this was an observational study, it can identify relationships, but it cannot prove causation—meaning we can't say that fatigue or depression directly causes thinking problems. Only that we see a connection.

My Takeaway

These findings align with what I've observed in our clinical trials: more severe depression and/or fatigue correlates with greater perceived cognitive impairment. The encouraging news is that as people improved their nutrition—whether following a modified Paleolithic diet or low saturated fat diet—their fatigue declined, anxiety reduced, depression improved, and mental clarity increased.^(3-6)
If you're experiencing problems with your thinking, I encourage working on your nutrition. Reduce ultra-processed foods like sugar-sweetened beverages and white flour-based cereals, breads, and pasta. Remember, additions are easier than subtractions. Try to find beverage swaps for sugary drinks and replace white flour foods with whole grains (rice, oats) or starchy vegetables (squash, potatoes, yams).

Because many people with MS have nutritional deficiencies that can contribute to fatigue, poor mood, and brain fog, I also recommend key brain-supporting supplements: vitamin D3 + vitamin K2, Multivitamin/multimineral, Fish oil, and magnesium, all of which I have combined into the Wahls Protocol® basic support kit for convenience.

Citations

1. Ware-Maloney E, Wills O, Probst Y. "I see diet almost as another disease modifying therapy. It's that important." A qualitative study of dietitian and nursing perspectives on the role of diet and brain health for multiple sclerosis. Mult Scler Relat Disord. 2025;102:106613.
2. Glanz BI, Kletenik I, Singhal T, Zurawski JD, Chitnis T, Weiner HL, et al. Subjective cognitive function in individuals with multiple sclerosis: Associations with objective cognitive function, anxiety, depression, and fatigue. J Neurol Sci. 2025;475:123593.
3. Irish AK, Erickson CM, Wahls TL, Snetselaar LG, Darling WG. Randomized control trial evaluation of a modified Paleolithic dietary intervention in the treatment of relapsing-remitting multiple sclerosis: a pilot study. Degener Neurol Neuromuscul Dis. 2017;7:1-18.
4. Lee JE, Bisht B, Hall MJ, Rubenstein LM, Louison R, Klein DT, et al. A Multimodal, Nonpharmacologic Intervention Improves Mood and Cognitive Function in People with Multiple Sclerosis. J Am Coll Nutr. 2017;36(3):150-68.
5.  Lee JE, Titcomb TJ, Bisht B, Rubenstein LM, Louison R, Wahls TL. A Modified MCT-Based Ketogenic Diet Increases Plasma beta-Hydroxybutyrate but Has Less Effect on Fatigue and Quality of Life in People with Multiple Sclerosis Compared to a Modified Paleolithic Diet: A Waitlist-Controlled, Randomized Pilot Study. J Am Coll Nutr. 2021;40(1):13-25.
6.  Wahls TL, Titcomb TJ, Bisht B, Eyck PT, Rubenstein LM, Carr LJ, et al. Impact of the Swank and Wahls elimination dietary interventions on fatigue and quality of life in relapsing-remitting multiple sclerosis: The WAVES randomized parallel-arm clinical trial. Mult Scler J Exp Transl Clin. 2021;7(3):20552173211035399.