X-linked adrenoleukodystrophy: current aspects of dietary therapy (narrative review)

X-linked adrenoleukodystrophy (X-ALD) is a rare genetically determined peroxisomal disorder caused by mutations in the ABCD1 gene, characterized by progressive accumulation of saturated very long-chain fatty acids (VLCFAs, C26:0) in cells. Dietary therapy for this condition, in particular Lorenzo’s oil, has been used for approximately 40 years as part of the comprehensive management of patients with X-ALD. This review summarizes current evidence on the mechanisms of action of Lorenzo’s oil (competitive inhibition of elongases, primarily ELOVL1), its effects on plasma C26:0 levels, clinical efficacy, indications, and limitations. Lorenzo’s oil reduces plasma C26:0 concentrations; however, despite its pronounced biochemical effect, there is no convincing evidence of improvement in neurological outcomes in patients with clinical manifestations. Potential benefits are mainly discussed in asymptomatic individuals. Special attention is given to supportive nutritional strategies in patients with dysphagia, sarcopenia, and cachexia, as well as the role of antioxidants, B vitamins, and polyphenols in mitigating oxidative stress. Literature was retrieved from PubMed/MEDLINE, Scopus, and eLIBRARY.ru as of March 2026, as well as federal clinical guidelines for the diagnosis and treatment of X-linked adrenoleukodystrophy and international consensus documents. A total of more than 97 sources were analyzed, of which 47 were included in the review. Keywords: X-linked adrenoleukodystrophy, Lorenzo’s oil, very long-chain fatty acids, dietary therapy, nutritional support, oxidative stress, ELOVL1, peroxisomal diseases.