Background: Relapsing-remitting multiple sclerosis (RRMS) is a demyelinating central nervous system disease affecting approximately 2.2 million people globally. The majority of disability accumulation occurs during progression independent of relapse activity (PIRA), which responds poorly to disease-modifying therapies (DMTs). While dietary interventions for MS may improve fatigue and quality of life, no controlled trials have demonstrated effects on objective measures of disability.
Methods: We present a 60-year-old woman with RRMS diagnosed in 2000 who experienced progressive functional decline despite continuous DMT treatment. The Expanded Disability Status Scale (EDSS)—a spectrum from 0 (neurologically normal) to 10 (death)—was used to estimate disability. In 2018, she initiated a modified Wahls protocol—a Paleolithic-based diet emphasizing vegetables and organ meats while excluding dairy, grains, and legumes, modified to permit oats.
Results: Her EDSS scores increased from 4.0 in 2014 to 6.0 in 2017, with clinical findings including unilateral ambulation support, Romberg sway, and widened-base gait. Following diet initiation, her EDSS decreased and stabilized to 2.5 by 2022. In 2025, examination showed normal gait and negative Romberg. She has remained relapse-free since 2016 and discontinued DMTs in 2024. This represents a 3.5-point sustained EDSS improvement, compared to approximately 0.6-point improvements observed with high-efficacy DMTs.
Conclusion: Potential mechanisms include anti-inflammatory effects via Nrf2 pathway activation, though the contribution of late DMT effects, natural disease fluctuation, or concurrent lifestyle modifications cannot be excluded. This case highlights the need for controlled trials investigating anti-inflammatory diets with objective disability measures as outcomes in MS.
Methods: We present a 60-year-old woman with RRMS diagnosed in 2000 who experienced progressive functional decline despite continuous DMT treatment. The Expanded Disability Status Scale (EDSS)—a spectrum from 0 (neurologically normal) to 10 (death)—was used to estimate disability. In 2018, she initiated a modified Wahls protocol—a Paleolithic-based diet emphasizing vegetables and organ meats while excluding dairy, grains, and legumes, modified to permit oats.
Results: Her EDSS scores increased from 4.0 in 2014 to 6.0 in 2017, with clinical findings including unilateral ambulation support, Romberg sway, and widened-base gait. Following diet initiation, her EDSS decreased and stabilized to 2.5 by 2022. In 2025, examination showed normal gait and negative Romberg. She has remained relapse-free since 2016 and discontinued DMTs in 2024. This represents a 3.5-point sustained EDSS improvement, compared to approximately 0.6-point improvements observed with high-efficacy DMTs.
Conclusion: Potential mechanisms include anti-inflammatory effects via Nrf2 pathway activation, though the contribution of late DMT effects, natural disease fluctuation, or concurrent lifestyle modifications cannot be excluded. This case highlights the need for controlled trials investigating anti-inflammatory diets with objective disability measures as outcomes in MS.