Limitations and recommendations
RRMS
The current clinical trial has shown that supplementing It must be considered that conducting a 4-month prospective randomized double-blinded clinical trial with a restricted diet in an outpatient setting introduces additional limitations. Participants' adherence to the prescribed diet and medication regimen may have varied, and their exposure to external factors that can influence the results, such as environmental stressors and dietary triggers for MS symptoms, was not fully controlled. The study relied on self-reports from participants for dietary intake, medication adherence, and symptom assessment. This introduces the potential for recall bias, as participants may not accurately remember or report their activities and symptoms. Social desirability bias could also affect self-reported data. Moreover, maintaining the blinding of participants in an outpatient setting can be challenging. The placebo effect may have influenced participants' expectations and experiences, potentially affecting self-reported outcomes. The extent of this effect could not be precisely determined. Even though conducting dietary interventions in an outpatient setting is more practical and reflective of real-world scenarios for individuals with RRMS, the absence of an inpatient control group limits the ability to isolate and control variables that could influence the outcomes. MS is a complex condition affected by various factors, and the study did not have the advantage of inpatient control to minimize these confounding factors. The study prioritized real-world applicability in an outpatient setting, which led to certain limitations in control. This trade-off between generalizability and control should be acknowledged when interpreting the results.