The Efficacy of the Mediterranean Diet Across the Spectrum of Neurological Disease: A Systematic Review
Kanishka Khatri1, Yiorgos Antoniadis, MD2, Anshum Patel3
1Bharati Vidyapeeth Medical College, 2St. George's University School of Medicine, 3Mayo Clinic, Florida
Objective:
To systematically review the evidence from studies on the efficacy of the Mediterranean diet (MedDiet) across a comprehensive range of neurological disorders.
Background:
The MedDiet’s anti‑inflammatory and metabolic benefits may translate to neuroprotection across diverse neurological disorders. Recent trials and observational work span cognition, stroke, multiple sclerosis (MS), Parkinson’s disease (PD), epilepsy, headache, sleep, and ALS.
Design/Methods:
PRISMA‑guided search of PubMed and Google Scholar (through October 2025) identified human studies evaluating MedDiet interventions or validated adherence indices (e.g., MEDAS, Mediterranean Diet Score) with neurological outcomes (incident events or validated scales). Eligible designs were randomized trials, cohort, case–control, and cross‑sectional studies with a comparator. Inclusion required full‑text, English‑language reports; prespecified MedDiet exposure; clearly defined neurological outcomes; and sufficient extractable data (population, exposure, duration/follow‑up, primary results). We excluded animal studies, case reports, reviews; non‑Mediterranean diets; and studies without a comparator or validated outcome.
Results:
Twenty-nine studies met inclusion criteria. High-level evidence from two PREDIMED sub-trials showed a supplemented MedDiet improved global cognition in older adults at vascular risk. A large RCT reanalysis confirmed a reduction in major cardiovascular events, including stroke. In multiple sclerosis, a 6-month pilot RCT demonstrated reduced fatigue and a favorable EDSS trajectory, with two other RCTs corroborating the fatigue reduction. For neurodegenerative disorders, a longitudinal cohort linked higher MedDiet adherence to a lower incidence of prodromal Parkinson's disease. Cross-sectional data further associated the diet with lower odds of epilepsy, fewer and shorter migraine attacks, and improved sleep quality. In contrast, an interventional study in ALS found no benefit on functional decline despite modulating biomarkers.
Conclusions:
The MedDiet is associated with significant benefits across multiple neurological domains, particularly in cerebrovascular and cognitive health. This synthesis supports its trans-diagnostic potential, and large, disease-specific RCTs are now warranted to confirm causality.
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