Personalized Advice from Dietitian Improves Calcium Intake in People With MS


Some people with multiple sclerosis follow dairy-free or plant-based diets that may be low on calcium and vitamin D.

Individuals with multiple sclerosis have an increased risk of developing osteoporosis compared with the general population. With osteoporosis, there is decreased bone mineral density resulting in weak and brittle bones, which increases the risk of bone fractures. The risk of osteoporosis can be lowered with adequate calcium and vitamin D intake.

Factors contributing to an increased risk of osteoporosis in patients with MS include reduced mobility, decreased exposure to sunlight, which limits vitamin D production, and long-term use of corticosteroids. In addition, some people living with autoimmune disorders, including MS, choose to follow certain dairy-free or plant-based diets because they are believed to help alleviate MS symptoms. However, these diets often fall short in providing adequate dietary calcium and vitamin D. Patients following these diets must find ways to replace these nutrient deficiencies.

A study published last month in Frontiers in Nutrition evaluated whether getting personalized advice from a dietitian could improve calcium intake in participants with MS compared with individuals receiving a pamphlet with standard information on calcium intake. The randomized, controlled trial, led by Sandrine Fiorella from the Department of Neurology at the University Hospital Center of Nimes in Montpellier, France, included 182 adults, ages 18 to 69, wwith relapsing-remitting MS ages.

Participants were randomized to one of two groups between July 2016 and April 2019. The control group received a pamphlet with standard information about target daily calcium intake and the calcium content in various food groups. The group that received advice received the same pamphlet and personalized counseling from a dietitian at baseline and one month and three months after enrollment. Consultations with the dietitian included discussions to develop a plan for optimizing calcium intake based on the patient’s individual situation and dietary preferences.

Results showed a significant difference in median calcium intake between the two groups after six months. The median calcium intake for the advice group increased by 241 milligrams per day versus a decrease of 120 milligrams per day in the control group.

The researchers found that the results were not affected by the participants’ age, cognitive status, or level of disability. However, they discovered that dietary advice was more effective in patients with a high education level (high school diploma or higher) compared with those with a low education level (less than a high school diploma).

The authors concluded that “personalized advice by a dietitian appears to be more effective than the delivery of written recommendations to increase daily calcium intake in MS patients.” They add that “due to the potential benefits of nutritional education on the overall health of patients, dietary management might be proposed to integrate the general therapeutic education program in these patients.” The researchers also suggest that increasing calcium intake via dietary changes could reduce the use of calcium supplements and, in turn, lower the risk of kidney stones. Fiorella and colleagues wrote that further long-term follow-up studies are necessary to determine the effect of PDA on osteoporosis prevention.

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