Dieta w stwardnieniu rozsianym Artykuł przeglądowy
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Opublikowane:
wrz 30, 2025
Słowa kluczowe:
stwardnienie rozsiane, składniki mineralne, witaminy, dieta
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Abstrakt
Stwardnienie rozsiane jest przewlekłą chorobą autoimmunologiczną ośrodkowego układu nerwowego przebiegającą z wieloogniskową demielinizacją. Charakteryzuje się ona występowaniem zróżnicowanych objawów neurologicznych. Mechanizm patogenezy stwardnienia rozsianego nie został dokładnie poznany, ale uważa się, że do powstawania tej choroby przyczyniają się czynniki genetyczne i środowiskowe. Coraz więcej dowodów sugeruje, że odpowiednio zbilansowana dieta może modulować przebieg stwardnienia rozsianego oraz łagodzić objawy towarzyszące. Szczególnie obiecujące są strategie dietetyczne, które wspierają działanie neuroprotekcyjne. Zaobserwowano także, że nasilenie niektórych objawów choroby może być powiązane z określonymi składnikami diety. Choć ich wpływ nie został jednoznacznie potwierdzony, to uważa się, że odpowiednia terapia żywieniowa, eliminująca te składniki, może poprawić ogólny stan zdrowia pacjentów. Dobór diety powinien również uwzględniać aktualny stopień zaawansowania choroby oraz być dostosowany do indywidualnych potrzeb pacjenta i uwzględniać płeć, wiek, aktywność fizyczną i ewentualne choroby współistniejące. Z uwagi na ograniczoną liczbę badań klinicznych oceniających wpływ konkretnych składników odżywczych na przebieg stwardnienia rozsianego konieczne jest przeprowadzenie bardziej zaawansowanych badań, które pozwolą jednoznacznie ocenić, czy odpowiednio dobrana dieta może mieć istotny wpływ na rozwój choroby.
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Bibliografia
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2. McGinley MP, Goldschmidt CH, Rae-Grant AD. Diagnosis and Treatment of Multiple Sclerosis: A Review. JAMA. 2021; 325(8): 765-79.
3. Dighriri IM, Aldalbahi AA, Albeladi F et al. An Overview of the History, Pathophysiology, and Pharmacological Interventions of Multiple Sclerosis. Cureus. 2023; 15(1): e33242.
4. Zakrzewska-Pniewska B, Adamczyk-Sowa M, Brola W et al. Leczenie i postępowanie objawowe w stwardnieniu rozsianym Rekomendacje Sekcji SM i Neuroimmunologii Polskiego Towarzystwa Neurologicznego, Polski Przegląd Neurologiczny. 2019; 15(14): 191-217.
5. Bagur MJ, Murcia MA, Jiménez-Monreal AM et al. Influence of Diet in Multiple Sclerosis: A Systematic Review. Adv Nutr. 2017; 8(3): 463-72.
6. Stoiloudis P, Kesidou E, Bakirtzis C et al. The Role of Diet and Interventions on Multiple Sclerosis: A Review. Nutrients. 2022; 14(6): 1150.
7. Carbogno-Barnabe V, Łabuz-Roszak B. The role of diet in multiple sclerosis. Wiad Lek. 2022; 75(9 pt 1): 2131-5.
8. Zielińska M, Michońska I. Macronutrients, vitamins and minerals in the diet of multiple sclerosis patients. Postep Psychiatr Neurol. 2022; 31(3): 128-37.
9. Włodarek D, Lange E, Kozłowska L et al. Dietoterapia. Wydawnictwo Lekarskie PZWL, Warszawa 2015.
10. Jarosz M. Normy żywienia dla populacji polskiej. Instytut Żywności i Żywienia Warszawa 2017.
11. Koukach D, Aljumaily M, Al-Attiyah N et al. From prevention to management: Exploring the impact of diet on multiple sclerosis. Transl Neurosci. 2025; 16(1): 20250371.
12. Langer-Gould A, Black LJ, Waubant E et al. Seafood, fatty acid biosynthesis genes, and multiple sclerosis susceptibility. Mult Scler. 2020; 26(12): 1476-85.
13. Bjørnevik K, Chitnis T, Ascherio A et al. Polyunsaturated fatty acids and the risk of multiple sclerosis. Mult Scler. 2017; 23(14): 1830-8.
14. Chen L, Pang XW, Zhou LQ et al. Diet and the Risk of Multiple Sclerosis: Evidence with UK Biobank Nested Case-Control Study and Mendelian Randomization Analysis. Mol Nutr Food Res. 2025; 69(24): e70313.
15. Ramirez-Ramirez V, Macias-Islas M, Ortiz G et al. Efficacy of fish oil on serum of TNFα, IL-1β, and IL-6 oxidative stress markers in multiple sclerosis treated with interferon beta-1b. Oxid Med Cell Longev. 2013; 2013: 709493.
16. AlAmmar WA, Albeesh FH, Ibrahim LM et al. Effect of omega-3 fatty acids and fish oil supplementation on multiple sclerosis: a systematic review. Nutr Neurosci. 2021; 24(7): 569-79.
17. Sedighiyan M, Djafarian K, Dabiri S et al. The Effects of Omega-3 Supplementation on the Expanded Disability Status Scale and Inflammatory Cytokines in Multiple Sclerosis Patients: A Systematic Review and Meta-Analysis. CNS Neurol Disord Drug Targets. 2019; 18(7): 523-9.
18. Jelinek G, Hadgkiss E, Weiland T et al. Association of fish consumption and omega-3 supplementation with quality of life, disability and disease activity in an international cohort of people with multiple sclerosis. Int J Neurosci. 2013; 123(11): 792-801.
19. Tredinnick AR, Probst YC. Evaluating the Effects of Dietary Interventions on Disease Progression and Symptoms of Adults with Multiple Sclerosis: An Umbrella Review. Adv Nutr. 2020; 11(6): 1603-15.
20. Weinstock-Guttman B, Zivadinov R, Mahfooz N et al. Serum lipid profiles are associated with disability and MRI outcomes in multiple sclerosis. J Neuroinflammation. 2011; 8: 127.
21. Tettey P, Simpson S, Taylor B et al. An adverse lipid profile and increased levels of adiposity significantly predict clinical course after a first demyelinating event. J Neurol Neurosurg Psychiatry. 2017; 88(5): 395-401.
22. Riccio P, Rossano R. Nutrition facts in multiple sclerosis. ASN Neuro. 2015; 7(1): 1759091414568185.
23. Katz Sand I. The Role of Diet in Multiple Sclerosis: Mechanistic Connections and Current Evidence. Curr Nutr Rep. 2018; 7(3): 150-60.
24. Simpson S Jr, Blizzard L, Otahal P et al. Latitude is significantly associated with the prevalence of multiple sclerosis: a meta-analysis J Neurol Neurosurg Psychiatry. 2011; 82: 1132-41.
25. Pierrot-Deseilligny C, Souberbielle JC. Vitamin D and multiple sclerosis: An update. Mult Scler Relat Disord. 2017; 14: 35-45.
26. Thouvenot E, Laplaud D, Lebrun-Frenay C et al. High-Dose Vitamin D in Clinically Isolated Syndrome Typical of Multiple Sclerosis: The D-Lay MS Randomized Clinical Trial. JAMA. 2025; 333: 1413.
27. Serag I, Abouzid M, Alsaadany KR et al. Role of vitamin D as adjuvant therapy on multiple sclerosis: an updated systematic review and meta-analysis of randomized controlled trials. Eur J Med Res. 2025; 30(1): 736.
28. Amirinejad R, Shirvani-Farsani Z, Naghavi Gargari B et al. Vitamin D Changes Expression of DNA Repair Genes in the Patients with Multiple Sclerosis. Gene. 2021; 781: 145488.
29. Spiezia AL, Falco F, Manganelli A et al. Low Serum 25-Hydroxy-Vitamin D Levels Are Associated with Cognitive Impairment in Multiple Sclerosis. Mult Scler Relat Disord. 2023; 79: 105044.
30. Pietruszkiewicz J, Mrozek K, Zwierz M et al. The Neuroprotective Potential of Vitamin D3. Nutrients. 2025; 17(20): 3202.
31. Farina G, Crescioli C. Vitamin D Associated with Exercise Can Be Used as a Promising Tool in Neurodegenerative Disease Protection. Molecules. 2025; 30(18): 3823.
32. Atabilen B, Akdevelioğlu Y, Acar Özen P et al. Examining dietary habits in the context of multiple sclerosis: A comprehensive investigative approach. Mult Scler Relat Disord. 2024; 83: 105467.
33. Abbasi H, Allogmanny S, Khoshdooz S et al. Exploring the Link of Serum Vitamin B12, Folate, and Homocysteine Concentrations in Individuals with Multiple Sclerosis: An Umbrella Meta-analysis of Case-control Studies. Neuroscience. 2025; 583: 179-86.
34. Dardiotis E, Arseniou S, Sokratous M et al. Vitamin B12, folate, and homocysteine levels and multiple sclerosis: A meta-analysis. Mult Scler Relat Disord. 2017; 17: 190-7.
35. Kocer B, Engur S, Ak F et al. Serum vitamin B12, folate, and homocysteine levels and their association with clinical and electrophysiological parameters in multiple sclerosis. J Clin Neurosci. 2009; 16(3): 399-403.
36. Najafi MR, Shaygannajad V, Mirpourian M et al. Vitamin B(12) Deficiency and Multiple Sclerosis; Is there Any Association? Int J Prev Med. 2012; 3(4): 286-9.
37. Pan L, Yin Y, Chen J et al. Homocysteine, vitamin B12, and folate levels in patients with multiple sclerosis in Chinese population: A case-control study and meta-analysis. Mult Scler Relat Disord. 2019; 36: 101395.
38. Fahmy EM, Elfayoumy NM, Abdelalim A et al. Relation of serum levels of homocysteine, vitamin B12 and folate to cognitive functions in multiple sclerosis patients. Int J Neurosci. 2018; 128(9): 835-41.
39. Nozari E, Ghavamzadeh S, Razazian N. The Effect of Vitamin B12 and Folic Acid Supplementation on Serum Homocysteine, Anemia Status and Quality of Life of Patients with Multiple Sclerosis. Clin Nutr Res. 2019; 8(1): 36-45.
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