Coffee and Multiple Sclerosis (MS): Does Coffee Reduce MS Risk and Improve Symptoms?

Coffee is one of the most widely consumed beverages worldwide, and interest in its potential effects on multiple sclerosis (MS) has grown rapidly in recent years. Patients often ask whether coffee is “good” or “bad” for MS, whether they need to limit their intake, and whether caffeine can help with symptoms such as fatigue or balance problems. Recent scientific data provide a more nuanced, evidence-based answer.

Can coffee reduce the risk of developing MS?

According to the most recent and comprehensive systematic review and meta-analysis of observational studies, coffee consumption is associated with a decreased risk of developing multiple sclerosis.^[1] Overall, people who regularly drink coffee appear to have a lower probability of being diagnosed with MS compared to those who do not consume coffee.

This inverse association is supported by large case–control studies that demonstrate a dose-dependent reduction in MS risk among individuals with high coffee intake (for example, more than 900 mL per day, roughly equivalent to four large cups). In these studies, the adjusted odds ratios for developing MS ranged from 0.42 to 0.70 compared with non-consumers, meaning that high coffee intake was associated with a 30–60% lower relative risk of MS.^[2][3]

Several biological mechanisms have been proposed to explain this potential protective effect. Coffee contains caffeine and other bioactive compounds with neuroprotective and anti-inflammatory properties. Experimental data suggest that caffeine can:

• modulate immune responses and reduce the production of proinflammatory cytokines,
• influence adenosine receptors involved in neuroinflammation,
• support the integrity of the blood–brain barrier,
• potentially protect neurons and oligodendrocytes from injury.^[2][3]

Taken together, observational data and plausible biological mechanisms suggest that coffee may be a protective lifestyle factor with respect to the development of MS. However, this is only part of the picture.

Is the link between coffee and MS risk causal?

An important question, both for patients and clinicians, is whether the association between coffee consumption and lower MS risk is truly causal, or whether it simply reflects other differences in lifestyle, health behaviour or genetics.

So far, prospective cohort studies have not consistently confirmed a protective effect. Some cohorts have reported no significant association between coffee or caffeine intake and the subsequent risk of MS, even after long-term follow-up and adjustment for several confounders.^[4] This weakens the argument for a clear causal relationship.

In addition, modern Mendelian randomization analyses – which use genetic variants associated with coffee intake as “natural experiments” – do not support a causal link between higher coffee consumption and a reduced risk of MS.^[5] These genetic studies suggest that the observed protective associations in case–control data may be at least partly explained by other factors, such as:

• overall lifestyle (diet, physical activity, smoking status),
• socioeconomic status and education,
• other health conditions or medications,
• reverse causation (for example, early subtle symptoms influencing coffee habits).

Therefore, while observational studies point towards a possible protective association, current evidence does not allow us to state that coffee definitively prevents MS. Further large, well-designed prospective and mechanistic studies are needed.

Coffee, caffeine and MS symptoms

For people who already have MS, the key question is different: can coffee or caffeine help with symptoms or disease progression? Here the data are still limited but increasingly interesting.

Disease progression and disability

Some observational work suggests that regular coffee consumption may be associated with slower disability progression in patients with relapsing-onset MS, but not in those with primary or secondary progressive onset.^[6] These findings should be interpreted cautiously (because of possible confounding and the observational design), but they raise the possibility that coffee could modestly influence long-term outcomes in certain subgroups.

Fatigue, balance and mobility

Fatigue is one of the most common and disabling symptoms of MS, and many patients already use coffee intuitively to cope with it. Small clinical studies suggest that caffeine may improve subjective fatigue and enhance alertness in some individuals with MS, although responses are variable.^[7]

A pilot clinical trial has also provided preliminary evidence that caffeine ingestion can improve balance and mobility in people with MS, with participants showing better performance on functional tests after caffeine intake.^[8] These results need replication in larger randomized controlled trials, but they support the idea that caffeine could be a simple adjunct to rehabilitation strategies in selected patients.

Quality of life and daily functioning

Beyond strictly measurable outcomes, many people with MS report that coffee helps them feel more energetic, focused and engaged in daily activities. When used in moderation and timed appropriately (for example, earlier in the day), coffee may contribute to better quality of life for some patients. At the same time, others may notice increased anxiety, palpitations or sleep disturbances – highlighting the importance of individualized recommendations.

How much coffee are we talking about?

In the case–control studies that found a significant risk reduction, “high coffee consumption” typically meant around 900 mL per day or more – approximately four or more large cups of coffee daily.^[2] This level of intake is higher than what many people habitually drink and may not be suitable for everyone.

For most adults, general nutrition and cardiology guidelines consider up to 3–4 standard cups of coffee per day as a reasonable upper limit, provided there are no contraindications such as uncontrolled hypertension, significant arrhythmias or severe anxiety disorders.

Importantly, there is no established “therapeutic dose” of coffee for MS. The goal should not be to force very high consumption in the hope of preventing the disease, but rather to integrate coffee sensibly into an overall healthy lifestyle.

Safety, side effects and who should be cautious

In the available studies, regular coffee consumption in people with MS was generally well tolerated, with few reported adverse effects.^[7][8] However, coffee and caffeine are not risk-free, especially at higher doses.

People with MS should be particularly cautious if they have:

• uncontrolled high blood pressure or significant cardiovascular disease,
• tachyarrhythmias or frequent palpitations,
• severe anxiety, panic attacks or insomnia,
• gastrointestinal symptoms worsened by coffee (e.g. reflux),
• pregnancy or breastfeeding (where more restrictive caffeine limits apply).

In all these situations, individual medical advice is essential. It is also important to avoid using coffee as a substitute for adequate sleep, regular physical activity or evidence-based disease-modifying therapies.

Practical takeaways for people with MS

• Current observational data suggest that regular coffee consumption is associated with a lower risk of developing MS, especially at higher intakes, but causality remains unproven.^[1–4]
• For people who already have MS, coffee and caffeine may help with fatigue, alertness, balance and mobility in some individuals, and could be a simple adjunct to other therapies.^[7][8]
• There is no reason, based on current evidence, to systematically prohibit coffee in people with MS, as long as there are no clear contraindications.
• Coffee should not be viewed as a “treatment” or as a substitute for disease-modifying therapies, vitamin D optimisation, smoking cessation, physical activity and other proven strategies.
• The optimal approach is usually moderate, individualized coffee intake, coordinated with your neurologist or treating physician.

If you have MS or are at increased risk and are unsure how coffee fits into your overall management plan, discuss your current consumption and possible adjustments with your neurologist. Together you can decide what is appropriate for your specific situation.

Scientific summary for clinicians

Observational evidence, including the most recent systematic review and meta-analysis, indicates an inverse association between coffee consumption and MS risk, with high intake (>900 mL/day) associated with adjusted odds ratios of approximately 0.42–0.70 compared with non-consumers.^[1–3] Mechanistically, caffeine and other coffee components may exert neuroprotective, anti-inflammatory and blood–brain barrier–stabilizing effects via adenosine receptor modulation, cytokine suppression and antioxidant properties.^[2][3]

However, prospective cohort data are inconsistent, and several studies have reported no significant associations between coffee or caffeine intake and incident MS.^[4] Mendelian randomization analyses do not support a causal protective effect of higher coffee consumption on MS risk, suggesting residual confounding and/or reverse causation.^[5]

Regarding disease course, limited observational data suggest a potential association between coffee consumption and slower disability progression in relapsing-onset MS, but not in progressive-onset disease.^[6] Small interventional studies indicate that caffeine may improve fatigue, balance and mobility, with generally good tolerability.^[7][8] At present, the evidence base is insufficient to support formal guideline recommendations, but coffee can be discussed as a potentially beneficial component of a healthy lifestyle in suitable patients.

References

1. Amirnia M, Raeisnia K, Ashayeri H, et al. Coffee Consumption and Risk of Multiple Sclerosis: A Systematic Review and Meta-Analysis. Autoimmunity Reviews. 2025;24(7):103822. https://doi.org/10.1016/j.autrev.2025.103822
2. Hedström AK, Mowry EM, Gianfrancesco MA, et al. High Consumption of Coffee Is Associated With Decreased Multiple Sclerosis Risk; Results From Two Independent Studies. J Neurol Neurosurg Psychiatry. 2016;87(5):454–460. https://doi.org/10.1136/jnnp-2015-312176
3. Evans E, Piccio L, Cross AH. Use of Vitamins and Dietary Supplements by Patients With Multiple Sclerosis: A Review. JAMA Neurol. 2018;75(8):1013–1021. https://doi.org/10.1001/jamaneurol.2018.0611
4. Massa J, O'Reilly EJ, Munger KL, Ascherio A. Caffeine and Alcohol Intakes Have No Association With Risk of Multiple Sclerosis. Mult Scler. 2013;19(1):53–58. https://doi.org/10.1177/1352458512448108
5. Zhang J, Liu Y, Xu G, et al. Causal Relationship Between Coffee Intake and Neurological Diseases: A Mendelian Randomization Study. Eur J Clin Nutr. 2024;78(2):114–119. https://doi.org/10.1038/s41430-023-01355-y
6. D'hooghe MB, Haentjens P, Nagels G, De Keyser J. Alcohol, Coffee, Fish, Smoking and Disease Progression in Multiple Sclerosis. Eur J Neurol. 2012;19(4):616–624. https://doi.org/10.1111/j.1468-1331.2011.03596.x
7. Herden L, Weissert R. The Effect of Coffee and Caffeine Consumption on Patients With Multiple Sclerosis-Related Fatigue. Nutrients. 2020;12(8):2262. https://doi.org/10.3390/nu12082262
8. Dadvar A, Jameie M, Azizmohammad Looha M, et al. Potential Efficacy of Caffeine Ingestion on Balance and Mobility in Patients With Multiple Sclerosis: Preliminary Evidence From a Single-Arm Pilot Clinical Trial. PLoS One. 2024;19(2):e0297235. https://doi.org/10.1371/journal.pone.0297235