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Multiple Sclerosis (MS): Coimbra Protocol Care and Integrative Rheumatology, Online Worldwide

Medically reviewed by Dr Krushal Pabari, MD, PGCP - Rheumatic & Musculoskeletal Diseases · Last reviewed: 4 November 2026

Key facts

Multiple sclerosis (MS) is a long-term condition in which the immune system attacks the brain and nerves, according to the NHS [1]. About 2.8 million people live with MS worldwide, and it is most common in northern Europe, Canada and the northern United States [2][3]. Low vitamin D, Epstein-Barr virus infection, smoking and obesity in youth are established risk factors linked with MS [4][5][6]. Cure4Pain is an integrative rheumatology and functional medicine practice based in Mumbai, India, that sees people with MS online worldwide. Dr Krushal Pabari (MD, PGCP Rheumatic & Musculoskeletal Diseases) leads MS care, working with AT. Chintan Dalal, N.D. (BNYS, R.AP), a functional nutrition and Coimbra Protocol practitioner. The plan combines supervised vitamin D therapy (Coimbra Protocol) with cofactors, diet, gut health, exercise and blood tests every 6 to 8 weeks, alongside standard MS treatment; the UK’s NICE guideline advises against offering vitamin D solely to treat MS [7]. Any change to medicines is made under clinical guidance from Team Cure4Pain, in coordination with your neurologist and local physician.

Watch our explainer videos
AT. Chintan Dalal, N.D.

Scientific explainer videos in our Resources section

In our Resources section, our clinical team discusses multiple sclerosis and its management in detail: functional nutrition and supervised vitamin D therapy (Coimbra Protocol) with regular blood tests, alongside your neurologist's treatment.

Watch our scientific explainer videos

What is multiple sclerosis?

Multiple sclerosis happens when the immune system attacks the protective layer around nerves in the brain and spinal cord; it is not clear exactly what causes this, according to the NHS [1]. Symptoms may come and go in flare-ups (relapses) and may get worse over time [1].

  • How common: about 2.8 million people live with MS worldwide (35.9 per 100,000), the number has risen in every world region since 2013, the average age at diagnosis is 32, and women are twice as likely as men to have MS (Atlas of MS, 2020) [2].
  • Who is more likely to get MS: people aged 20 to 50, women, people with a parent, brother or sister with MS, smokers, and people who have had Epstein-Barr virus, according to the NHS [1].
  • Types: clinically isolated syndrome (a first episode), relapsing-remitting MS, and secondary or primary progressive MS; diagnosis uses MRI scans and sometimes spinal fluid tests, according to a 2018 review in The Lancet [8].

Why is MS more common in colder, northern countries?

MS is more common further from the equator, where there is less winter sunlight: in a 2019 meta-analysis, MS prevalence rose by about 5 cases per 100,000 people for each degree of latitude, and the gradient had grown stronger over time, pointing to sun exposure as a modifiable factor [9].

  • Highest rates: in the Global Burden of Disease 2021 data, the countries with the highest MS prevalence were Sweden (219 per 100,000), Canada (182), Norway (176), Ireland (163) and the United Kingdom (158), and northern US states such as Utah, Montana and Rhode Island had about double the incidence of southern states such as Hawaii and Louisiana [3].
  • Sunlight: among 39,801 US radiologic technologists, lower lifetime winter ultraviolet exposure went with a higher risk of MS [10].
  • Early life matters: in New Zealand, the latitude gradient was already present at birth, pointing to exposures in early life [11].
  • Latitude, not cold: research links the pattern with latitude, sunlight and vitamin D, together with genes and Epstein-Barr virus [9][4][5].

What causes MS? Vitamin D, Epstein-Barr virus and other risk factors

MS develops from a mix of genes and environment, and several risk factors are well established:

  • Low vitamin D: in a Mendelian randomisation study (which uses genes to test cause and effect), each standard deviation of genetically lower vitamin D about doubled the risk of MS [4]; in US military personnel, white participants with the highest vitamin D levels before diagnosis had a 62% lower risk of MS [12].
  • Epstein-Barr virus: in more than 10 million young adults in the US military, the risk of MS rose 32-fold after Epstein-Barr virus infection [5].
  • Youth: in a 2025 meta-analysis, active smoking and obesity in childhood and adolescence were linked with higher MS risk, as was vitamin D deficiency [6].
  • Vitamin D and relapses: in an Australian cohort, each 10 nmol/L higher vitamin D level went with up to a 12% lower risk of relapse [13].
  • India: MS is less common in India, but vitamin D deficiency was more common in Indian people with MS (71.8%) than in controls (53.7%) [14].

What are the symptoms of MS?

Common symptoms include extreme tiredness (fatigue), vision problems such as blurred vision or eye pain, numbness or tingling, problems with balance and coordination, muscle stiffness or spasms, bladder problems, and problems with memory or concentration, according to the NHS [1]. Everyone with MS is affected differently [1].

How is MS diagnosed?

MS is diagnosed by a neurologist with MRI scans and sometimes spinal fluid tests, using diagnostic criteria that also apply to a first episode (clinically isolated syndrome) [8]. Other conditions can look like MS, including neuromyelitis optica spectrum disorder, MOG antibody disease and vitamin B12 deficiency, which can cause nerve problems [15]. Your neurologist confirms the diagnosis; at Cure4Pain, Dr Krushal Pabari reviews these possibilities as part of the integrative plan and involves other experts where needed.

  • Tests at Cure4Pain: our standard panel of about 100 measures with ANA by the IFA method, including vitamin D, PTH, calcium, kidney function, vitamin B12, thyroid tests, HbA1c and lipids, with your MRI reports and neurologist letters.
  • Outside India, the tests are done at a laboratory near you and the reports are uploaded to our patient portal.

What is the standard treatment for MS?

Standard MS treatment includes disease-modifying therapies, which reduce how many relapses people have and how serious they are, steroid medicine for relapses, and treatments for symptoms, according to the NHS [1]. In a large study, starting high-efficacy therapy within 2 years of onset was linked with less disability 6 to 10 years later [16].

  • Never stop MS medicines on your own: at Cure4Pain, any change is made under clinical guidance from Team Cure4Pain, in coordination with your neurologist.

How does Cure4Pain manage MS?

Cure4Pain manages MS as a lifelong condition by adding supervised vitamin D therapy and a nutritional layer to standard MS care, never replacing it. Dr Krushal Pabari leads the care of people with clinically isolated syndrome, relapsing-remitting and progressive MS, and related conditions such as neuromyelitis optica spectrum disorder and MOG antibody disease, including children, and involves other experts where needed. The plan includes:

  1. Assessment first: your MRI reports, neurologist letters, medicines and our panel of about 100 measures with ANA by the IFA method.
  2. Supervised vitamin D therapy (Coimbra Protocol): doses set for each person and adjusted to blood tests, never on your own (see below).
  3. Cofactors: magnesium, vitamin K2, vitamin B12, folate, vitamin B2 and omega-3, within official upper limits where these exist.
  4. Diet: dairy removed to limit calcium (small amounts of fermented dairy such as yogurt or kefir may be allowed within the calcium limit set for you), at least 2.5 litres of fluid a day, and the same food exclusions as for allergic rhinitis (wheat, sugar, cold foods and drinks, nightshades), with cruciferous (Brassica) vegetables such as cabbage and cauliflower generally limited as an observational clinic practice.
  5. Gut health: fibre, probiotics and gut protocols managed by Dr Krushal Pabari.
  6. Exercise: we write an exercise protocol and refer you to a local physiotherapist, who monitors it and reports back to us every 3 months.
  7. Metabolic health, thyroid and sleep: checked and managed in the same plan.
  8. Monitoring: the full panel of about 100 measures with ANA every 6 to 8 weeks, which is mandatory during vitamin D therapy.
  9. Medicines: Dr Krushal Pabari manages symptom medicines and works with your neurologist, who is kept in the loop.

We do not offer acupuncture or needling for severe autoimmune conditions such as MS.

What is the Coimbra Protocol, and how does Cure4Pain use it?

The Coimbra Protocol is a method of high-dose vitamin D therapy for autoimmune conditions, developed by Dr Cicero Galli Coimbra in Brazil, in which doses are adjusted to blood tests alongside a strict low-calcium diet and at least 2.5 litres of fluid a day [17]. Our methods are derived from the work of Dr Coimbra, and we give the Coimbra Protocol full credit. At Cure4Pain, Dr Krushal Pabari and AT. Chintan Dalal, N.D. apply them within an integrative rheumatology practice that manages medicines and drug interactions, with detailed blood monitoring. High-dose vitamin D therapy should always be given under the clinical guidance of experts who understand pharmacology, drug interactions, rheumatology and autoimmunity. See our Coimbra Protocol page.

Does high-dose vitamin D help MS? What the research shows

Trials of high-dose vitamin D in MS show mixed results: the 2025 D-Lay MS trial in JAMA found less disease activity with high-dose vitamin D in early MS [18], while the 2018 Cochrane review and several other trials found no clear effect on relapses or disability [19][20]. The UK’s NICE guideline advises: “Do not offer vitamin D solely for the purpose of treating MS” [7].

StudyWhoWhat it found
D-Lay MS, JAMA 2025 [18]316 people with clinically isolated syndrome or early relapsing MS, high-dose vitamin D every 2 weeks for 24 monthsDisease activity in 60.3% vs 74.1% with placebo; fewer new and enhancing MRI lesions; relapses alone did not differ significantly
SOLAR, Neurology 2019 [21]Relapsing MS on interferon, daily high-dose vitamin D for 48 weeksMain outcome not met; fewer new MRI lesions
CHOLINE, 2019 [22]Relapsing MS on interferon with low vitamin DMain outcome not met; fewer new lesions and less disability progression in people who completed the trial
VIDAMS, 2023 [20]Relapsing MS on glatiramer acetate, high-dose compared with low-dose vitamin DNo reduction in relapses
EVIDIMS, 2020 [23]Relapsing MS on interferonNo difference; the trial was too small to decide
Cochrane review, 2018 [19]Trials up to 2018Very low-quality evidence; no clear effect on relapses, disability or MRI lesions
Meta-analysis, 2026 [24]Trials and observational studiesLower relapse rates in pooled studies; no significant difference from placebo in trials on relapses or disability
  • Observational studies: higher vitamin D levels went with fewer relapses [13] and a lower risk of developing MS [12].
  • What this means: vitamin D is not a replacement for MS medicines. At Cure4Pain it is used alongside them, under supervision, and further studies are needed.

Is high-dose vitamin D safe? Monitoring every 6 to 8 weeks

High-dose vitamin D can raise blood calcium and harm the kidneys [25], and high calcium (hypercalcaemia) and impaired kidney function are the main concerns raised about the Coimbra Protocol [17]. In a 2022 study of 319 people with autoimmune diseases treated with high-dose vitamin D under the Coimbra Protocol, with a strict low-calcium diet and at least 2.5 litres of fluid a day, average calcium and kidney results stayed within normal ranges for up to 3.5 years; the study came from one centre and had no comparison group [17].

  • Official limit: the upper limit for vitamin D without medical supervision is 1,000 to 4,000 IU a day depending on age, and taking calcium supplements with vitamin D may increase the risk of side effects, according to the US National Institutes of Health [25].
  • In MS trials: high doses were well tolerated in D-Lay MS, with no treatment-related serious side effects [18], and in a small dose-escalation study, blood levels rose to twice the top of the usual range without high calcium [26].
  • Why daily dosing: in the general population (not studied in MS), the Endocrine Society’s 2024 evidence review found that high doses given at long intervals may increase falls compared with lower daily doses [27].
  • At Cure4Pain: the full panel of about 100 measures with ANA, including vitamin D, calcium, PTH and kidney function, is mandatory every 6 to 8 weeks, and doses are adjusted to the results. Please never copy doses from the internet, from forums or from videos.

Which cofactors are used with vitamin D therapy?

Cofactors support how the body uses vitamin D and are given when tests or diet show a need; they are used within official upper limits, and trial evidence for each in MS is limited.

  • Magnesium: the enzymes that make and break down vitamin D need magnesium, and in a randomised trial magnesium helped balance vitamin D levels [28]. A blood test does not show how much magnesium the body holds; the upper limit from supplements is 350 mg of elemental magnesium a day for adults, and absorption varies by form [29].
  • Vitamin K2: used with vitamin D as clinic practice; we found no trial in MS. Vitamin K can interfere with blood thinners such as warfarin [30].
  • Vitamin B12 and folate: B12 deficiency can cause nerve problems such as numbness and tingling [15]; B12, folate and vitamin B2 (riboflavin) are given as clinic practice when tests or diet show a need.
  • Omega-3: the NICE guideline advises not to offer omega-3 or omega-6 fatty acids to treat MS, as there is no evidence that they affect relapses or progression [7]; at Cure4Pain, omega-3 is used as a general nutritional cofactor, not as an MS treatment.

What should you eat with MS? Diet and calcium

NICE explains that there is no evidence that a specific diet improves MS fatigue, and recommends a healthy, balanced diet [7]. As clinic practice during vitamin D therapy, Cure4Pain limits calcium and asks for plenty of fluids:

  • Calcium: dairy is removed to limit calcium; small amounts of fermented dairy such as yogurt or kefir may be allowed within the calcium limit set for you. A low-calcium diet and at least 2.5 litres of fluid a day were part of the protocol in the 2022 safety study [17].
  • Other exclusions: wheat, sugar, cold foods and drinks, and nightshades are removed, and, as an observational clinic practice, we generally suggest limiting cruciferous (Brassica) vegetables such as cabbage and cauliflower; we found no trial of these exclusions in MS.
  • Balanced replacements: the plan includes replacement foods so that protein, fibre and other nutrients stay adequate.

Can exercise help MS fatigue?

NICE encourages people with MS to exercise, advising that regular exercise may have beneficial effects and does not have any harmful effects on MS, and that aerobic, resistance and balance exercise, including yoga and pilates, may help MS fatigue [7]. A Cochrane review found that exercise therapy may reduce fatigue in MS [31].

  • At Cure4Pain: we write an exercise protocol and refer you to a local physiotherapist, who monitors it and reports back every 3 months.

Why does Cure4Pain check gut health, thyroid and sleep in MS?

Cure4Pain checks and manages gut health, blood sugar, weight, thyroid function and sleep in the same plan, because a comprehensive management programme that addresses other conditions is strongly recommended for everyone with MS, according to a 2018 review in The Lancet [8].

Online MS care for patients worldwide: how it works

Cure4Pain sees people with MS online from any country, including Europe, North America and Australia, with consultations led by Dr Krushal Pabari. Before anyone starts vitamin D therapy, we coordinate with their local physician where needed.

  1. Register your case on our patient portal with your MRI reports, neurologist letters, medicines and recent blood tests.
  2. Blood tests near you: the panel is done at a laboratory in your country and uploaded to the portal; in India, home collection is available.
  3. Consultation online with Dr Krushal Pabari and AT. Chintan Dalal, N.D.; available appointments are shown on the portal.
  4. Ongoing care: blood tests every 6 to 8 weeks and regular online reviews, with your neurologist and local physician kept in the loop.

Multiple sclerosis in pregnancy

In a large study, relapses became less frequent during pregnancy and rose in the first 3 months after birth [32]. NICE advises discussing vitamin D and folic acid supplements before and during pregnancy with people with MS [7]. At Cure4Pain, vitamin D is given only at standard supplement doses during pregnancy, with care managed in association with your neurologist and obstetrician.

MS in children and teenagers

MS can begin in childhood or adolescence, and smoking and obesity in youth are risk factors [6]. Dr Krushal Pabari sees children and teenagers with MS and involves paediatric and other experts where needed.

Is MS lifelong?

MS is a lifelong condition: the NHS says there is currently no treatment that makes it go away, but treatments can slow its progression and help manage symptoms [1]. At Cure4Pain, MS is lifetime management, with regular monitoring and reviews.

When should you get urgent help?

Call emergency services (112 in Europe, 911 in the US and Canada) if you have sudden weakness or numbness in one arm, loss or blurring of vision, or problems with balance and coordination, as these could be signs of a stroke, according to the NHS [1]. A suspected MS relapse needs prompt assessment by your neurologist. Cure4Pain does not treat emergencies.

Which doctor treats MS?

MS is diagnosed and treated by a neurologist, often with a team of nurses, physiotherapists and occupational therapists, according to the NHS [1]. At Cure4Pain, Dr Krushal Pabari, whose training is in rheumatic and musculoskeletal diseases, leads the integrative care of MS online and works with your neurologist.

How do I book a consultation?

Please register your case on our patient portal with your MRI reports, neurologist letters, blood tests and medical history. We take patients on only after reviewing these reports. Consultations are online worldwide or in person in Mumbai. Registrations and appointments are made only through our patient portal.

Evidence: key studies

StudyWhat it found
Atlas of MS, Mult Scler 2020 [2]2.8 million people with MS worldwide; women twice as often as men.
Simpson et al., J Neurol Neurosurg Psychiatry 2019 [9]MS prevalence rises with latitude, and the gradient is growing.
Bjornevik et al., Science 2022 [5]MS risk rose 32-fold after Epstein-Barr virus infection.
Mokry et al., PLoS Med 2015 [4]Genetically lower vitamin D raised MS risk.
Thouvenot et al., JAMA 2025 [18]High-dose vitamin D reduced disease activity in clinically isolated syndrome and early relapsing MS.
Cassard et al., EClinicalMedicine 2023 [20]High-dose vitamin D did not reduce relapses.
Jagannath et al., Cochrane 2018 [19]No clear effect of vitamin D on relapses or disability.
Amon et al., Nutrients 2022 [17]Average calcium and kidney results stayed normal in 319 supervised patients; single centre, no comparison group.

Multiple Sclerosis FAQs

Can I get Coimbra Protocol care for MS online?

Yes. Cure4Pain sees people with MS online worldwide, led by Dr Krushal Pabari with AT. Chintan Dalal, N.D. (Coimbra Protocol practitioner); blood tests are done at a laboratory near you every 6 to 8 weeks, and we coordinate with your local physician and neurologist.

Can I see a Coimbra Protocol practitioner online from Germany, Poland, Russia or North America?

Yes. Cure4Pain sees people with MS online from any country. Blood tests are done at a laboratory near you every 6 to 8 weeks and uploaded to our patient portal, and we coordinate with your neurologist and local physician before and during treatment.

Is the Coimbra Protocol safe for MS?

High-dose vitamin D can raise calcium and harm the kidneys, so it should be used only under close medical supervision [25]. In a single-centre study of 319 supervised autoimmune patients with no comparison group, average calcium and kidney results stayed within normal ranges [17]; at Cure4Pain, the full blood panel is mandatory every 6 to 8 weeks.

Does vitamin D therapy stop MS?

According to the NHS, no treatment makes MS go away [1]. High-dose vitamin D reduced disease activity in early MS in the D-Lay MS trial [18], but other trials and the Cochrane review found no clear benefit [19][20], and NICE advises: “Do not offer vitamin D solely for the purpose of treating MS” [7]. Cure4Pain uses vitamin D alongside standard MS treatment, never as the only treatment; this is an added clinic practice under supervision, and further studies are needed.

Why is MS more common in northern countries such as Germany, Scandinavia and Canada?

MS prevalence rises with distance from the equator, where winter sunlight is lower [9]; the highest rates are in Sweden, Canada, Norway, Ireland and the UK [3], and low vitamin D is a likely part of the reason [4].

How much vitamin D should I take for MS?

No single dose suits everyone with MS: the official upper limit without supervision is 1,000 to 4,000 IU a day depending on age [25]. Higher doses are used only under medical supervision with regular blood tests.

Do I have to stop my MS medicines?

No. Never stop or change MS medicines on your own. At Cure4Pain, vitamin D therapy is added alongside standard treatment, and any change to medicines is made under clinical guidance from Team Cure4Pain, in coordination with your neurologist.

What foods should I avoid with MS?

NICE notes there is no evidence that a specific diet improves MS fatigue and recommends a healthy diet [7]. During vitamin D therapy, Cure4Pain limits calcium by removing dairy (with small amounts of fermented dairy allowed within your limit) and removes wheat, sugar, cold foods and nightshades as clinic practice.

Does omega-3 help MS?

NICE advises not to offer omega-3 or omega-6 fatty acids to treat MS, as there is no evidence they affect relapses or progression [7]. At Cure4Pain, omega-3 is used only as a general nutritional cofactor.

Can I exercise with MS?

Yes. NICE advises that regular exercise may help and does not harm MS [7], and exercise may reduce fatigue [31].

Is MS hereditary?

MS is more likely if a parent, brother or sister has it, according to the NHS [1], but most risk comes from a mix of genes and environment, such as low vitamin D and Epstein-Barr virus [4][5].

Can I have a baby if I have MS?

Yes. NICE explains that fertility is not affected by MS and that pregnancy can be well managed [7]; in a large study, relapses fell during pregnancy and rose in the first 3 months after birth [32]. At Cure4Pain, vitamin D is kept at standard doses in pregnancy, with your neurologist and obstetrician.

Do you treat children with MS?

Yes. Dr Krushal Pabari sees children and teenagers with MS and involves paediatric and other experts where needed.

Do you use acupuncture for MS?

No. Cure4Pain does not use acupuncture or needling for severe autoimmune conditions such as MS.

Is this approach used in progressive MS?

Dr Krushal Pabari sees people with secondary and primary progressive MS as well as relapsing MS. Most vitamin D trials were in clinically isolated syndrome or relapsing MS [18][19], so the evidence in progressive MS is limited, and further studies are needed.

How much does MS care cost at Cure4Pain?

The consultation fee is shown when you book on our patient portal. Blood tests are done at a laboratory near you; in India, the panel is available at a lower cost through the portal.

Who treats you

  • Dr Krushal PabariMD, PGCP - Rheumatic & Musculoskeletal Diseases. Assistant Professor, Cooper Hospital; Guest Professor, CMP Homoeopathic Medical College.
  • AT. Chintan Dalal, N.D.BNYS, R.AP. Functional nutrition and Coimbra Protocol practitioner.

Consultations look at the whole person: alongside the medical and nutritional plan, we bring a strong interest in behavioural science to counselling on stress, sleep and lasting lifestyle change.

How consultations work: Mumbai or online worldwide

Book through our patient portal. You can see us in person at our clinic in Malad West, Mumbai, or online from anywhere. Your first consultation reviews your history and tests; we then agree a plan together and set the monitoring schedule.

Book Appointment

Related conditions and articles

This page is for education and does not replace medical advice. Do not start, stop or change any medicine or supplement without medical guidance.

References

1. NHS. Multiple sclerosis. nhs.uk/conditions/multiple-sclerosis

2. Walton C, et al. Rising prevalence of multiple sclerosis worldwide: Insights from the Atlas of MS, third edition. Mult Scler 2020;26(14):1816-1821. doi:10.1177/1352458520970841

3. Khan G, Hashim MJ. Epidemiology of Multiple Sclerosis: Global, Regional, National and Sub-National-Level Estimates and Future Projections. J Epidemiol Glob Health 2025;15(1):21. doi:10.1007/s44197-025-00353-6

4. Mokry LE, et al. Vitamin D and Risk of Multiple Sclerosis: A Mendelian Randomization Study. PLoS Med 2015;12(8):e1001866. doi:10.1371/journal.pmed.1001866

5. Bjornevik K, et al. Longitudinal analysis reveals high prevalence of Epstein-Barr virus associated with multiple sclerosis. Science 2022;375(6578):296-301. doi:10.1126/science.abj8222

6. Vitturi BK, et al. Childhood and Adolescent Environmental Risk Factors for Multiple Sclerosis: A Systematic Review With Meta-Analysis. Eur J Neurol 2025;32(11):e70398. doi:10.1111/ene.70398

7. National Institute for Health and Care Excellence (NICE). Multiple sclerosis in adults: management (NG220), 2022. nice.org.uk/guidance/ng220

8. Thompson AJ, et al. Multiple sclerosis. Lancet 2018;391(10130):1622-1636. doi:10.1016/S0140-6736%2818%2930481-1

9. Simpson S Jr, et al. Latitude continues to be significantly associated with the prevalence of multiple sclerosis: an updated meta-analysis. J Neurol Neurosurg Psychiatry 2019;90(11):1193-1200. doi:10.1136/jnnp-2018-320189

10. Gallagher LG, et al. Lifetime exposure to ultraviolet radiation and the risk of multiple sclerosis in the US radiologic technologists cohort study. Mult Scler 2019;25(8):1162-1169. doi:10.1177/1352458518783343

11. Sabel CE, et al. The latitude gradient for multiple sclerosis prevalence is established in the early life course. Brain 2021;144(7):2038-2046. doi:10.1093/brain/awab104

12. Munger KL, et al. Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis. JAMA 2006;296(23):2832-8. doi:10.1001/jama.296.23.2832

13. Simpson S Jr, et al. Higher 25-hydroxyvitamin D is associated with lower relapse risk in multiple sclerosis. Ann Neurol 2010;68(2):193-203. doi:10.1002/ana.22043

14. Pandit L, et al. Association of vitamin D and multiple sclerosis in India. Mult Scler 2013;19(12):1592-6. doi:10.1177/1352458513482375

15. Office of Dietary Supplements, US National Institutes of Health. Vitamin B12: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminB12-HealthProfessional

16. He A, et al. Timing of high-efficacy therapy for multiple sclerosis: a retrospective observational cohort study. Lancet Neurol 2020;19(4):307-316. doi:10.1016/S1474-4422%2820%2930067-3

17. Amon U, et al. Safety Data in Patients with Autoimmune Diseases during Treatment with High Doses of Vitamin D3 According to the “Coimbra Protocol”. Nutrients 2022;14(8). doi:10.3390/nu14081575

18. Thouvenot E, et al. High-Dose Vitamin D in Clinically Isolated Syndrome Typical of Multiple Sclerosis: The D-Lay MS Randomized Clinical Trial. JAMA 2025;333(16):1413-1422. doi:10.1001/jama.2025.1604

19. Jagannath VA, et al. Vitamin D for the management of multiple sclerosis. Cochrane Database Syst Rev 2018;9(9):CD008422. doi:10.1002/14651858.CD008422.pub3

20. Cassard SD, et al. High-dose vitamin D(3) supplementation in relapsing-remitting multiple sclerosis: a randomised clinical trial. EClinicalMedicine 2023;59:101957. doi:10.1016/j.eclinm.2023.101957

21. Hupperts R, et al. Randomized trial of daily high-dose vitamin D(3) in patients with RRMS receiving subcutaneous interferon β-1a. Neurology 2019;93(20):e1906-e1916. doi:10.1212/WNL.0000000000008445

22. Camu W, et al. Cholecalciferol in relapsing-remitting MS: A randomized clinical trial (CHOLINE). Neurol Neuroimmunol Neuroinflamm 2019;6(5). doi:10.1212/NXI.0000000000000597

23. Dörr J, et al. High-dose vitamin D supplementation in multiple sclerosis – results from the randomized EVIDIMS (efficacy of vitamin D supplementation in multiple sclerosis) trial. Mult Scler J Exp Transl Clin 2020;6(1):2055217320903474. doi:10.1177/2055217320903474

24. Li Y, et al. Vitamin D status, supplementation, and multiple sclerosis: a systematic review and meta-analysis. Front Immunol 2026;17:1775270. doi:10.3389/fimmu.2026.1775270

25. Office of Dietary Supplements, US National Institutes of Health. Vitamin D: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminD-HealthProfessional

26. Kimball SM, et al. Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr 2007;86(3):645-51. doi:10.1093/ajcn/86.3.645

27. Shah VP, et al. A Systematic Review Supporting the Endocrine Society Clinical Practice Guidelines on Vitamin D. J Clin Endocrinol Metab 2024;109(8):1961-1974. doi:10.1210/clinem/dgae312

28. Dai Q, et al. Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial. Am J Clin Nutr 2018;108(6):1249-1258. doi:10.1093/ajcn/nqy274

29. Office of Dietary Supplements, US National Institutes of Health. Magnesium: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/Magnesium-HealthProfessional

30. Office of Dietary Supplements, US National Institutes of Health. Vitamin K: Fact Sheet for Health Professionals. ods.od.nih.gov/factsheets/VitaminK-HealthProfessional

31. Heine M, et al. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev 2015;2015(9):CD009956. doi:10.1002/14651858.CD009956.pub2

32. Vukusic S, et al. Pregnancy and multiple sclerosis (the PRIMS study): clinical predictors of post-partum relapse. Brain 2004;127(Pt 6):1353-60. doi:10.1093/brain/awh152

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