Dietitian advice assists MS patients to improve calcium intake: Trial

A tailored diet plan from a dietitian may help people with multiple sclerosis (MS) ingest more calcium from foods, which could make their bones stronger and less prone to osteoporosis.

That’s according to data from CalciCoach (NCT02664623), a clinical study that compared the amount of dietary calcium consumed by MS patients who received three sessions of personalized advice from a dietitian versus how much was consumed among those who received nutritional advice from a leaflet.

The study, “Personalized dietary advices provided by a dietitian increase calcium intake in outpatients with multiple sclerosis—Results from a randomized, controlled, single-blind trial,” was published in Frontiers in Nutrition.

People with MS may be more prone to developing osteoporosis, a condition where bones become weak and brittle and more likely to break. To keep bones healthy, it’s important to get enough calcium from food. It’s also important to have enough vitamin D, which helps absorb calcium.

Many factors can contribute to osteoporosis with MS. They include inactivity or reduced mobility, long-term use of glucocorticoids, a type of corticosteroids, and low exposure to sunlight that can result in not enough vitamin D being produced.

Dairy products and fatty fish are good sources of calcium, but many people with MS go on dairy-free and plant-based diets, such as the McDougall diet or the paleo diet, because they’ve been suggested to ease the symptoms of MS. Those who decide to go on such diets must make sure they get all the nutrients they need, calcium included.

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Working with dietitian aids patients’ calcium gains

A team of researchers in France conducted a clinical trial involving 182 participants, ages 18-70, with relapsing-remitting MS to see if getting personalized advice from a dietitian on what to eat could help people with MS get enough calcium from their diet.

The participants were randomly assigned to two groups. A control group received an informative leaflet with standard advice and a personalized dietary advice group received the leaflet along with personalized advice from a dietitian at the entry to the study (baseline), and after one and three months.

Each session with a dietitian lasted at least 20 minutes and touched on topics such as eating more calcium-rich foods from a list of their choice and limiting the risk of osteoporosis-associated fractures by maintaining a balanced diet rich in protein as adapted to a person’s weight and physical activity levels.

Most participants (79%) were women (median age, 42), and their median Expanded Disability Status Scale (EDSS) score was 2, indicating minimal disability. At baseline, the median calcium intake was significantly lower in the personalized diet group than the standard advice group (778 vs. 947 mg/day).

After six months, however, the median calcium intake increased by 241 mg/day in the personalized dietary advice group and decreased by 120 mg/day in the standard advice group. At the six-month assessment, those in the personalized group ingested a median of 1,016.5 mg of calcium a day, significantly higher than the 816 mg in the standard group.

The researchers then focused on those with an insufficient daily calcium intake. This is defined by French guidelines as less than 900 mg/day for men older than 65 and postmenopausal women older than 51, or less than 750 mg/day for others.

Among patients in this group, those who received the dietitian’s advice saw a median increase in calcium consumption of 358 mg/day, while the standard group had a 66 mg/day increase. This translated into more than 60% of patients in the personalized advice group no longer having an insufficient daily calcium intake after six months, while 76% of those in the control group still were not ingesting enough calcium.

Of those with a daily calcium intake just below the recommended limit at baseline, half who received the dietitian’s advice went on to exceed the recommended limit after six months. Of those who received standard advice, only 19% moved categories.

“Personalized advice by a dietitian appears to be more effective than the delivery of written recommendations to increase daily calcium intake in MS patients,” the researchers concluded, adding that the approach resulted in no serious side effects.