The Multiple Sclerosis (MS) Guide to Vitamin D Supplements

It’s no secret that vitamin D is an essential vitamin for everyone. If you have MS, it may be even more important to pay attention to your vitamin D blood levels and supplement with extra sources of vitamin D if you’re deficient.

Dr. Brian Steingo, a neurologist with Sunrise Medical Group, says vitamin D deficiency is associated with increased risk of developing MS (demonstrated even in the risk for infants of pregnant women deficient in vitamin D) and an increased risk of worsening in those with MS.

According to the National Multiple Sclerosis Society, several studies have determined that there’s an association between low levels of vitamin D and an increased risk of MS attacks and developing new brain or spinal cord lesions.

Researchers and doctors have found that low levels of vitamin D appear to be associated with increased levels of disability.

“Several studies have shown that MS patients had lower vitamin D levels in the winter and that the lower vitamin D levels correlated with increased risk of relapse and worse disease progression,” explains Dr. Michael Sy, a neurologist at UC Irvine Health.

MS has also been linked to a higher incidence of developing osteoporosis, so supplementing with vitamin D can help increase bone health and decrease the risk factors associated with developing this condition.

Since the studies on vitamin D and MS are relatively new, there’s not a definitive answer about optimal levels. That said, many experts agree that people with MS need higher levels of vitamin D than those without MS.

These levels are not easy to obtain through sunshine and diet alone. You’ll almost always need to supplement appropriately to achieve the recommended levels.

Getting your baseline levels tested is very important as well.

Steingo says the normal range for vitamin D levels in most labs is 30 to 100 nanograms per milliliter (ng/mL). For people with MS, he says the goal is to aim for a level of 70 to 80 ng/mL.

Naturopathic healthcare provider Dr. Rob Raponi says that, in his clinical experience, a good majority of people have a very hard time maintaining vitamin D adequacy year-round if they’re not taking supplements.

“Personally, I don’t like to deal with ‘adequate.’ I always strive for ‘optimal,’ and optimal levels of vitamin D for someone with MS should be no lower than 90 ng/mL and as high as 125 ng/mL,” Raponi says.

Before you head to your local health food store, make an appointment with your doctor for a baseline blood test to determine your vitamin D levels. You should also talk with them about the appropriate dose of vitamin D.

Dr. David Mattson, a neurologist at Indiana University Health, says that if someone has a low vitamin D level at the time of an MS diagnosis, they may be predisposed to increased MS disease activity.

“While this is not a hard conclusion, rather, a suggestion, we tend to check levels at diagnosis and supplement if levels are low, as a protective factor,” he shares.

The amount of vitamin D you add as a supplement depends on many factors, such as:

• your diet
• your current blood levels
• other supplements you may be taking that contain vitamin D

Since Vitamin D is fat soluble, taking high doses for extended periods of time can cause toxic accumulation, Raponi points out.

He recommends having your vitamin D levels checked before beginning to supplement and again within 3 months of starting to see what level they’ve risen to.

When levels rise to recommended ranges, dosing needs to be reduced in order to maintain that level and to not increase further.

For everyone from ages 1 year to 70 years old, the recommended dietary allowance of vitamin D is 600 units (IU) per day. For people over 70 years old, it’s 800 IU per day.

Mattson tends to recommend 1,000 to 2,000 IU per day to people with MS, even if levels are normal, to boost the protective factor against MS activity.

“If vitamin D levels are low, I tend to recommend 2,000 units per day. Some [doctors] would have patients take 50,000 units per week until levels have normalized and then switch to a more typical daily dose as maintenance,” Mattson explains.

Raponi says good food sources of vitamin D include:

• fish (the smaller, the better)
• liver
• mushrooms
• eggs

Since supplementing is very important for people with MS, he recommends looking for a good vitamin D supplement.

“I always recommend a drop form, suspended in a healthy fat (MCT oil is a good choice) and always ensuring you are supplementing with the active form, vitamin D3,” explains Raponi.

“Any supplement you find in the D2 form, or as a tablet or capsule that is not suspended in a fat, is less effective and a waste of your money,” he adds.

While the studies point toward a promising trend, many experts say more research is needed on the optimal dose of vitamin D for reducing the risk of MS.

However, despite the lack of definitive evidence, experts say vitamin D is viewed as safe, inexpensive, and likely to provide a benefit to people with MS, especially if they’re considered vitamin D deficient.

Editor’s note: These interviews were originally conducted in 2018, and this article was originally published on June 26, 2018. It received an additional medical review in 2021.

Sara Lindberg is a freelance writer focusing on health, wellness, fitness, and nutrition. She has a Bachelor of Science degree in exercise science and a Master of Education in counseling. Her work has appeared in a variety of publications including Livestrong, Active.com, Headspace, Insider, Bicycling Magazine, Runner’s World, Men’s Health, SheKnows, Ovia Health, and many more.