Vitamin D Deficiency Reasons for Pain
By Dana Walters, RN, MBA

Vitamin D Deficiency Reasons for Pain

My brother and his wife take high levels of Vitamin D under medical supervision. My brother’s wife stated that pain so common in fibromyalgia (where you hit the floor with your feet hurting) no longer happens to her. In fact, she said her pain level has significantly improved and she can move more freely. My mother also was prescribed it, and recently my niece stated that she was found low in Vitamin D, which her doctor thought was contributing to her pain. What they all have in common is chronic pain.

A 2008 review of 22 clinical studies in “Practical Pain Management,” (July/August 2008 in an article entitled “Vitamin D for Chronic Pain”) found that “the percentage of patients with pain, having inadequate vitamin D concentrations ranged from 48% to 100%, depending on the patient selection and the definition of 25(OH) D ‘deficiency’. In most cases, <20ng/mL, was used as the threshold of deficiency.” What this means is that “vitamin D deficiency and its potential association with osteomalacia (softening of the bones) should be considered in the differential diagnosis of all patients with chronic neuromuscular pain, muscle weakness or fatigue, fibromyalgia, or chronic pain syndrome.”

What Does Vitamin D Have to Do With Pain?

Some claim vitamin D is mislabeled a vitamin as it acts more like a pro-hormone with its own receptors found in practically every human tissue. Besides the tissues and bones, vitamin D receptors have been found in the heart, pancreas, breast, prostrate, lymphocytes and other tissues suggesting it has application in the treatment of many disorders. Vitamin D is essential in the absorption of calcium from the intestines and it sustains a wide range of functions throughout the body. Research indicates that vitamin D may affect the function of up to 1,000 different genes controlling cell growth or differentiation.

While in children a vitamin D deficiency is associated with Rickets. In adults, a vitamin D deficiency may cause a dysfunction in bone metabolism, which can lead to osteomalacia (softening of the bones). This is the explanation for why patients with low vitamin D have dull persistent, generalized aches, pains and weakness. Radiographic changes associated with osteomalacia are only seen in advanced stages so it is best to diagnosis and treat it before too much damage occurs. The elderly are less able to convert sunlight into the metabolites of vitamin D through their skin so they are more prone to fractures. If you have loved ones in institutional settings, where exposure to sunlight in adequate doses is a common issue, get them tested for vitamin D deficiency.

Blood Tests You or Your Doctor Can Order

The most important test for vitamin D deficiency is circulating 25(OH) D concentrations in the serum as it reflects both D2 plus D3 intake. Measuring 1,25(OH) D is not recommended, as it is a poor and misleading indicator. You may also ask for your parathyroid levels. If you do not have a doctor, there are several labs that can do the tests on your order. In Texas, some labs will take lab orders directly from patients but you have to pay for the tests yourself. One such lab is HEALTHCHECKUSA at (210) 829-1159. Nationwide there are many labs that can do testing at patient request such at the Life Extension Foundation which you can reach via the Internet at www.lef.org or by calling (800) 226-2370 for a health advisor. It is normally less expensive to get the test done through a pay as you go lab than if you have to pay in a doctor’s office.

Do not expect your physician to be an expert regarding vitamin D. I recommend that you bring the following articles from the Internet with you to help the doctor. From the Linus Pauling Institute you can get a well-referenced article on vitamin D at http://lpi.oregonstate.edu/infocenter/vitamins/vitaminD. Several important pain related research articles concerning pain and vitamin D could be found at

http://pain-topics.org/clinical_concepts/vitamind.php.

Keep in mind three things regarding lab testing:
1. Not all labs use the same criteria for vitamin D deficiency
2. Blood for vitamin D has to be frozen to send out and how it is thawed can affect results
3. Most medical professionals depend on the vitamin D lab results just as they are -without additional critical evaluation. Therefore, you need to see the results and do your own research to be certain both adequate doses are taken and appropriate follow-up is done so you do not overdue the dosing. Too much vitamin D over time can result in excess deposits of calcium, which is one of the main ingredients of the plaque in your blood vessels as well as kidney stones. Your body controls calcium within narrow limits so you can get too much vitamin D.

How Long Would Treatment Take Before Pain is Relieved?

Muscle pain may take 6 months to improve but muscle weakness and fatigue may take longer. Vasquez and colleagues recommended 5 to 7 months are needed to fully access the effectiveness of Vitamin D therapy.

Mechanism of Vitamin D Production in Our Bodies

The suns UVB rays make (suggest the word – create instead of “make”) vitamin D from a chemical located in our skin. This vitamin D travels to the liver where it is again converted by an enzyme to a storage form of vitamin D stored mostly in the liver, but (also)some in fat tissues (as well). [The next step is the most crucial] as the vitamin D metabolite is converted within the kidneys into 1,25 D metabolite that does most of the work for the body. The parathyroid gland controls vitamin D production.

After 20 to 30 minutes in strong sunlight with UVB exposure, a healthy white complexion person manufactures vitamin D needed and then stops the production based on the bodies needs. Once the active 1,25 D metabolite is formed it only lasts six to eight hours, while storage vitamin D survives for twenty days or more.

For those of darker skin and the elderly, the amount of time needed in the sun is greater. It is more difficult for those of darker skin and the elderly to acquire adequate vitamin D from sun exposure so they tend to be more deficient. UVB rays do not pass through glass so it is important to actually go outside. In one US study 42% of African American women between 15 to 49 years of age were vitamin D deficient compared to 4% of white women. So it is very important for African American women to be tested for vitamin D deficiency.

The Question of the Dangers of UV Rays

While some schools of thought promote using the sun to create vitamin D as the best method (as then your body can better regulate how much is stored or used), others advise avoiding the UV rays of the sun. The truth is that the amount of UV rays reaching the earth is now increasing as the protective layer of ozone is decreasing.

Overexposure to UV rays can cause irreparable skin damage in the form of winkled leathery skin or skin cancer. UVB rays are needed for the creation on vitamin D for the body. Because pollution has damaged the ozone layer, it is difficult to know how much time anyone really needs in the sun. Both, your location on the earth and the amount of pigment you have in your skin, determine how long you can safely stay in the sun. Just find the safest combination of sun and food or supplements best for you.

How Much Vitamin D Is Recommended to Correct Its Deficiency?

According to the “The China Study” by T. Colin Campbell, “under optimal conditions, sunshine exposure alone can supply all the vitamin D that we need to produce the all-important 1,25 D at the right time.” “If you know how much sunshine causes a slight redness of your skin one-fourth of this amount provided two to three times a week, is more than adequate to meet our vitamin D needs and to store some in our liver and body fat.”

Stewart Leavitt, PhD recommends (in “Vitamin D for Chronic Pain”) a conservative dosing protocol of adding a daily supplement of 2,000 IU to a daily multi-vitamin regime bringing the total to 2,400 IU to 2,800 IU. The Linus Pauling Institute recommends generally healthy people take 2,000 IU of vitamin D daily. Numerous sources cite recommendations in this range but the RDA is significantly lower. The RDA is based on the minimal level, not the optimal level and people are unique in their vitamin and mineral requirements. For those in chronic pain there is speculation that the dose most effective could be higher.

Form of Vitamin D Recommended

If taken in a supplement, Stewart Leavitt, PhD recommends taking only vitamin D3 (also called cholecalciferol).

Counterproductive Conditions to Vitamin D Creation

According to T. Collin Campbell, PhD, in his book “The China Study,” “Animal protein containing foods creates an over acidic environment in the blood that blocks the kidney enzyme from producing the vitamin D metabolite 1,25 D.” Another challenge is that as blood calcium goes up, 1,25 D goes down and as blood calcium goes down, 1,25 D goes up. Therefore, too much animal protein and too much calcium reduce the blood levels of vitamin D. He points out that cow’s milk is high in both protein and calcium so he recommends avoiding it.

Caution About Taking Too Much Vitamin D

Vitamin D is a fat-soluble vitamin so that it does accumulate in the fat tissues and can build up to toxic levels. The US Office of Dietary Supplements notes that hypercalcemia can result from taking 50,000 IU/day or more taken for an extended period of time.

What Medications Can Cause Vitamin D Deficiency?

In “The 24-Hour Pharmacist” by Suzy Cohen, R.Ph. the medications that can contribute to Vitamin D deficiency are:

· Acid-reducing drugs (ranitidine, cimetidine, famotidine)
· Antacids
· Colestipol
· Laxatives containing aluminum hydroxide or magnesium
hydroxide
· Mineral oil
· Orlistat
· Seizure medications (phenytoin, primidine, ethosuximide, carbamazepine)
· Steriods (dexamthosone, hydrocortisone, flutiasone, methylprednisolne, prednisone)

Summary

Several studies have linked chronic pain to vitamin D deficiency. The most important test for Vitamin D deficiency is circulating 25(OH) D concentrations in the serum as it reflects both D2 plus D3 intake. The best form of vitamin D to take is D3 and the dose recommended for healthy people by the Linus Pauling Institute is 2,000 IU per day.

The sun can provide vitamin D through converting sunlight into vitamin D but many factors can interfere with someone getting enough vitamin D safely. The best measure to use is to retest until you know you have a regime that gives you enough to stay healthy without having too much. It is always best to consult your health care provider as some medical conditions and medications prohibit taking vitamin D supplements.

Key References:

Leavitt, MA, PhD., Stewart, “Vitamin D for Chronic Pain” July/August 2008, Practical Pain Management,

Campbell, PhD. T. Collin, Campbell II, Thomas M, The China Study, First BenBella Books, Dallas, TX, January 2005.

Higdon PhD., Jane, Drake PhD, Victoria J., “Vitamin D”, Linus Pauling Institute, lpi.oregonstate.edu/inforcenter/vitamins/vitaminD

Cohen, R.Ph., Suzy. The 24-Hour Pharmacist, Harper Collins, New York, NY 2007.

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