Feeling extremely tired is one of the most common symptoms of multiple sclerosis (MS). You may wake up exhausted after sleeping all night or have so little energy that getting through your day feels hard.
Probiotics and prebiotics may help ease your fatigue. These are foods that contain or nourish “good” bacteria, which naturally live in your gut. They’re not a cure, “but for many, they can be a supportive piece in managing fatigue and general health,” says Bharat Pothuri, a board-certified gastroenterologist in Houston, TX.
How Are the Gut and Brain Connected in MS?
MS is a complex disease that damages your central nervous system. It affects about 1 million people in the U.S. and causes symptoms such as dizziness, weakness, muscle stiffness, and problems with thinking and memory. Over time, these symptoms get worse.
MS happens when your immune system attacks the protective covering of your nerve cells by mistake. Experts still don’t know what sets it in motion. Many factors, from smoking to being exposed to a virus, can raise your risk of MS.
More and more research shows that what happens in your gut may also play a role.
“Your gut and brain are in constant conversation via your immune system, nervous system, and hormone signaling,” says Laura Acosta, DCN, an associate professor of food science and nutrition at the University of Florida.
Trillions of bacteria, fungi, viruses, and even harmless parasites live in your gut. While that might sound gross, most of these things exist for your benefit. Experts call this your “microbiome,” and it’s always changing.
When it’s balanced and healthy, your microbiome can help:
- Protect you from infections
- Manage your immune system
- Help your body function the way it should
An out-of-balance microbiome can lead to inflammation. That triggers an immune system reaction, which affects your brain and results in symptoms such as fatigue.
Doctors are finding other ways that your gut could play a role in autoimmune conditions such as MS.
For instance, some bacteria in your digestive tract are coated with an antibody known as immunoglobulin host A (IgA). It’s a type of “good” germ that’s sent into your gut by immune cells. Its job is to help remove “bad” bacteria that could harm your health. One study found that people recently diagnosed with MS had less IgA in their microbiomes than healthy people.
Role of Probiotics in Helping With MS Fatigue
While more research is needed, one way to improve your fatigue may be to focus on your gut health.
An easy way to do that is to eat more probiotics. These are living organisms, such as bacteria and yeast, that add more healthy bacteria to your gastrointestinal (GI) tract. They’re found in fermented foods like yogurt, kimchi, and sauerkraut.
A balanced microbiome could help regulate your immune system and ease inflammation.
“The net result can be a surge in energy and stamina, and a reduction in fatigue,” Pothuri says.
Role of Prebiotics in Helping With MS Fatigue
Prebiotics are also important for gut health. They’re special plant fibers that your body can’t digest. They pass through your digestive tract to your colon, where they feed the “good” germs that live there. You usually find prebiotics in high-fiber foods, such as berries, oats, and wheat bran.
“Probiotics often hog the spotlight, but prebiotics are the construction workers that help maintain gut health in the long run,” says Pothuri.
Low Preparation Prebiotic and Probiotic Foods
If you’d like to try prebiotics and probiotics to ease your fatigue, “food sources are typically the best first-line approach,” says Pothuri.
To get enough prebiotic foods, follow a Mediterranean-style diet that includes plenty of vegetables, fruits, whole grains, legumes (such as beans and lentils), lean meat, fish, and healthy fats (such as extra virgin olive oil).
“A diet like this naturally provides a lot of prebiotic fiber, which can go a long way in keeping your ‘good’ gut bacteria happy and thriving,” says Acosta.
Some prebiotic-rich foods include:
- Garlic
- Onions
- Bananas
- Whole grains
- Asparagus
- Seaweed
- Flaxseeds
- Apples
- Peas
Then, look for ways to add in probiotic foods, such as:
- Yogurt
- Kefir
- Kimchi
- Sauerkraut
- Miso
- Pickles (choose a refrigerated kind)
- Tempeh (soy)
- Kombucha (fermented tea)
For instance, you can:
- Add kimchi or sauerkraut to salads and sandwiches.
- Mix miso into salad dressing.
- Swap out red meat for steamed cubes of tempeh.
- Look for the words “live active cultures” on dairy products like sour cream.
- Use plain yogurt or buttermilk in recipes instead of milk.
“For most people, including a variety of prebiotic- and probiotic-rich foods is safe, can support digestive and immune health, and may help with energy levels if your fatigue is related to gut issues or inflammation,” says Acosta.
Keep in mind that just like some foods can help your fatigue, others could worsen it. Among them are ultra-processed foods such as fast foods, breakfast cereals, and packaged sweets.
“They tend to be low in fiber and high in added sugars, artificial ingredients and unhealthy fats — all factors that throw the microbiome out of whack and cause inflammation,” says Pothuri.
When you have an autoimmune condition like MS, “it’s just as important to steer clear or limit these items as it is to add beneficial ones in,” Pothuri says.
Probiotic and Prebiotic Supplements
“Supplements can be useful but should be chosen wisely,” says Pothuri.
Probiotic supplements contain different strains of yeast and “good” bacteria. But not every type may help with your fatigue.
One strain that does show early promise is the yeast Saccharomyces boulardii. One study asked people with MS to take probiotic supplements that included it. After four months, their fatigue and quality of life improved more than people who were given a placebo (a treatment that researchers knew wouldn’t help).
Other strains of bacteria and yeast have been studied in people with MS, too. They include Lactobacillus acidophilus, Lactobacillus casei, and Bifidobacterium bifidum.
But more research still needs to be done to confirm how well any of these strains work.
Prebiotics and Probiotics Risks and Interactions
Probiotic and prebiotic foods are safe to eat. You might have gas, bloating, or diarrhea for a few days if you add them to your diet too quickly.
Less research has been done about their safety in supplement form.
Unlike prescription medications and over-the-counter drugs, the FDA doesn’t review dietary supplements to confirm how well they work.
It’s important to choose a brand that’s been tested by an independent group like:
- ConsumerLab
- NSF International
- US Pharmacopeial Convention
Probiotic supplements that contain the lactobacillus or lactococcus strains or bifidobacterium are generally recognized as safe (GRAS) by the FDA. But you could have side effects such as:
- Constipation
- Weight gain
- Nausea
- More fatigue
- An MS flare-up
- Brain fog
- Dizziness
- Headaches
If you’d like to try probiotics and prebiotics to improve your fatigue, talk to your doctor. Always check with them first before starting any type of supplement.
