# Nutrition and diets in multiple system atrophy
Nutritional choices play a role in how people with multiple system atrophy (MSA) feel and how their body copes with the symptoms of the disease. Research into specific diets in MSA is still developing, but some nutritional patterns have been examined or are relevant in clinical practice.
Protein-rich nutrition
ResearchediPositive results in clinical studies, not yet standard treatment
High-protein nutrition means choosing foods with more protein — such as fish, meat, eggs, dairy products, nuts and legumes. In MSA, muscles can gradually diminish (atrophy), and protein is needed to maintain muscle tissue.
Research into physical activity and nutrition (2025) shows that protein is important to counteract muscle loss, especially if someone is less able to move. This also applies to people with neurodegenerative diseases. For MSA patients who want to remain mobile, treatment providers focus on ensuring that adequate protein is part of the nutritional pattern.
There is a risk that people with MSA who have difficulty swallowing (dysphagia) eat less and therefore consume insufficient protein. This requires individualized treatment: sometimes nutritious drinks, soft foods or modified textures are necessary. A dietitian experienced in neurodegenerative diseases can help ensure adequate nutrition without extra strain on the swallowing mechanism.
Fat restriction
ExperimentaliOngoing in study setting, outcome still unknown
Fat restriction means reducing the amount of fat in your diet — especially saturated fats from meat, dairy and processed foods.
A recent animal study (2026) showed that a diet high in fat worsened neuropathology (tissue abnormalities) in an MSA model. This suggests that the composition of fat may influence how the disease progresses, but this has not yet been studied in humans. The finding is interesting for future research, but too early to use as a recommendation for patients.
People with MSA also more often have problems with blood pressure drops (orthostatic hypotension), especially after eating. A very high-fat meal can worsen this. Many doctors therefore suggest smaller, regular meals rather than large fatty portions, but this is caution based on physiology, not specifically proven for MSA.
Nutritional patterns aimed at anti-inflammatory effects
ResearchediPositive results in clinical studies, not yet standard treatment
Nutritional patterns richer in antioxidants and polyphenols (substances in vegetables, fruit, nuts and seeds) are being studied because they can dampen inflammatory reactions in the body. In MSA there is evidence of inflammation and changes in the gut microbiome.
Research from 2025 shows that the gut flora in MSA patients is different from that in healthy people — certain bacterial strains are missing and metabolism is changed. Diet directly influences the gut flora. Foods with lots of fiber, such as vegetables, fruit, whole grains and legumes, feed certain beneficial bacteria.
Polyphenols from, for example, dark berries, green tea, olive oil and nuts have shown neuroprotective (nerve-protecting) effects in other research. Whether this also applies to MSA is still unclear. It is not a proven treatment, but the pattern fits into a generally healthy nutritional pattern and may be beneficial for gut flora and overall health.
Vitamin D supplementation
ResearchediPositive results in clinical studies, not yet standard treatment
Vitamin D is important for bone health, immune function and nerve function. Various studies into neurodegenerative conditions (especially MS and Parkinson-like diseases) suggest that vitamin D deficiency occurs more often and that supplementation may be beneficial.
Studies from 2025 on vitamin D supplementation in other neurodegenerative diseases show mixed results: some research suggests slower brain volume loss, others show no significant difference. For MSA specifically, such studies are still limited.
With MSA, vitamin D deficiency can be particularly severe because many patients spend less time outdoors due to movement problems, and because certain medications affect vitamin metabolism. Blood tests of vitamin D levels are therefore useful; a healthcare provider or dietitian can then determine whether supplementation is advisable.
Adequate fluid and nutrition to prevent malnutrition
ProveniIncluded in official guidelines, or approved by EMA or FDA
This is not a specific diet, but a basic principle: eating and drinking enough prevents malnutrition and dehydration, which are common in later stages of MSA.
People with MSA can develop swallowing difficulties, feel that food does not pass through properly, or have reduced appetite. Being unwell, lack of movement, and certain medications can also suppress appetite. Malnutrition accelerates muscle loss and weakens the immune system.
Recent research (2026) on invasive procedures in atypical parkinsonism (including MSA) shows that a feeding tube (percutaneous endoscopic gastrostomy, PEG) can help in certain stages to deliver adequate nutrition safely, especially if the risk of aspiration (inhalation of food into the lungs) is high. This is done under medical supervision. For drinking and medication as well: regular and adequate intake is important, although this becomes increasingly difficult over time.
Nutrition in orthostatic hypotension
ResearchediPositive results in clinical studies, not yet standard treatment
Orthostatic hypotension (sudden drop in blood pressure when standing up) is a common and troublesome symptom of MSA. It is related to the autonomic nervous system and causes dizziness and fainting risk.
Research from 2026 examined the relationship between body composition (muscle mass, fat mass) and orthostatic hypotension in neurodegenerative diseases. This suggests that nutritional status plays a role. In practical terms, this means:
- small, regular meals are better than large portions (large meals require a lot of blood circulation in the abdomen);
- a high salt content in food (in consultation with your healthcare provider) can sometimes be useful to promote fluid retention;
- adequate fluid, especially water, helps maintain blood volume.
This should always be coordinated with your healthcare provider, as other conditions (kidney, heart) can limit salt and fluid intake.
Gluten-free diet
UnproveniNo scientific evidence that it works
A gluten-free diet means food without gluten (a protein from grains). For most MSA patients there is no reason for this, but there are studies investigating gluten-related disorders (celiac disease and gluten sensitivity) in relation to neurological conditions.
Recent research (2026) showed that certain antibodies against transglutaminase (an enzyme involved in gluten processing) were present in some patients with neurodegenerative diseases. This is exceptional and does not mean that a gluten-free diet helps MSA in general. Only if your blood test shows gluten-related antibodies, or if you have been diagnosed with celiac disease or gluten sensitivity, is eating gluten-free relevant.
---
Summary: personalized nutrition
Nutritional choices with MSA are very personal and depend on your disease stage, symptoms (especially swallowing difficulties), medications, and other health conditions. There is no standard diet for MSA.
What does help:
- Eating and drinking enough and regularly, adapted to your ability to chew and swallow.
- Attention to protein and muscle maintenance, especially if you move less.
- A dietary pattern with plenty of vegetables, fruits, fiber, and healthy fats — good for digestive health and overall resistance.
- Small, regular meals if you experience a drop in blood pressure after eating.
- Regular contact with your healthcare provider or a dietitian specialized in neurodegenerative diseases, especially if eating becomes increasingly difficult.
Most nutritional interventions being studied for MSA are still too early to recommend as primary treatment. However, your dietary pattern can support your overall well-being and energy level, and prevent complications such as malnutrition, dehydration, and related problems.
_This information never replaces a doctor's judgment. Always discuss your situation with your own healthcare provider._