Is there anything this amazing nutrient can’t do? 01/15/2021
Breaking News: A preliminary study published January 8, 2021, has found that hospitalized COVID-19 patients with the highest levels of omega-3 fatty acids in their blood had only 25 percent of the chance of dying as those with lower levels. The study was small, encompassing 100 patients, has not been peer-reviewed, and the authors state “These preliminary findings need to be confirmed in larger studies.” See a summary and the complete study.
If you have chronic pain, it’s possible that a common, inexpensive nutrient could help you: vitamin D.
Vitamin D is not technically a vitamin, but rather a powerful prohormone, which means it helps the body make other hormones (Norman, 2008). Our bodies produce vitamin D from exposure to the sun; ideally at least ten minutes on (at least) the face and arms at midday. If you live in a northern climate or don’t get outside often you’re at risk of a deficiency, especially as you age. We all tend to become less efficient at producing and using vitamin D over time.
You also can get vitamin D from food. Wild fatty fish such as salmon, tuna, and mackerel are the top sources (National Institutes of Health Office of Dietary Supplements, 2020., Jakobsen et al., 2019).
Vitamin D deficiency, roughly anything less in a blood test than 12 nanograms per milliliter, expressed as ng/mL, has been associated with inflammation, a root cause of many diseases and their symptoms, including pain (Helde-Frankling and Bergman, 2017), and it seems to “cross-talk” with genes involved with sending pain signals (Habib et al.,2020).
Supplements may help, especially if you carefully monitor your blood levels over time and work with your doctor to fine-tune the most helpful dose. The evidence in this area is early, but research is progressing for several types of pain, including pain related to diabetes, muscle aches, and even cancer.
Vitamin D and diabetes-related pain
Pain from diabetes is more common than you might guess. A third to half of all type 2 diabetes patients have diabetic peripheral neuropathy (DPN), which causes pain and numbness or tingling in the legs and feet.
That matters, considering that type 2 diabetes is epidemic, affecting about 25 percent of American seniors, some 13 percent of American adults, and an estimated three percent of the population with undiagnosed cases (National Diabetes Statistics Report 2020).
DPN attacks both the large nerves that govern balance and the small ones, including a kind that creates the sensation of being shocked or burned. The pain can be quite severe and like pain from other causes, can disrupt your sleep and trigger depression and anxiety. Even success with managing your blood sugar won’t necessarily cut the pain, so doctors turn to prescribing drugs. More than 60 percent of DPN patients have been getting opioids, though these drugs are linked to depression, dependence, and overdoses, without making patients more functional (Callaghan, 2019).
Unfortunately, other standard options often don’t reduce the pain. In a 2017 meta-analysis, a team at Johns Hopkins in Baltimore found "moderate" evidence supporting the antidepressants duloxetine (Cymbalta) and venlafaxine (Effexor) as effective for DPN, but only “weak” evidence for other commonly used medications (Waldfogel et al., 2017).
So if vitamin D helps, it could fill a huge need. There is an established link between low vitamin D levels and DPN (Shillo et al., 2018), and early evidence suggests relief from resolving deficiencies. In a small 2020 randomized, placebo-controlled study of patients with DPN and low vitamin D levels, volunteers reported on their pain by questionnaire and took balance tests at the beginning of the study, and then received an injection of 300,000 I.U. of vitamin D (a massive dose that should not be taken without a physician’s supervision). When they took the same tests and answered questions about pain 12 weeks later, patients felt fewer shock and burning sensations and did better on the balance tests (Sari et al., 2020). In a meta-analysis this year, again of small studies, another group found promising results (Yammine et al., 2020).
Vitamin D and muscle pain
Back pain? Join the club!
Back pain is a common form of what doctors call musculoskeletal pain. We need sufficient vitamin D levels for normal muscle strength and coordination, though it’s unclear whether adults have receptors for the vitamin in their muscles.
As with diabetes-related pain, small studies have shown that vitamin D supplements beat placebo at reducing pain in people with musculoskeletal pain, including fibromyalgia, but only if they had deficiencies. For example, in a randomized, placebo-controlled study of 80 patients with muscle pain, those who took 4,000 I.U. of vitamin D a day for three months reported less pain and also showed lower blood levels of pain-related cytokines, a marker of inflammation (Gendelman et al., 2015).
Another team found that giving supplements to overweight or obese volunteers with low levels of vitamin D helped cut their back pain (Brady et al., 2018).
Some people who take statin drugs get muscle pain, which has been associated with a vitamin D deficiency. However, there’s not much evidence that taking a supplement helps statin-induced pain (Helde-Frankling and Bergman, 2017).
Vitamin D and cancer pain
Cancer patients generally have lower vitamin D levels than healthy controls. When scientists in Stockholm saw that cancer patients with low vitamin D were taking high doses of opioids, they tried giving a group vitamin D. After a month, their required Fentanyl doses fell, continuing to fall over the next two months (Helde-Frankling et al., 2017).
Getting more vitamin D
A 3.5 oz serving of wild-caught salmon typically packs enough vitamin D to more than meet a standard daily requirement; you’ll get less in farmed salmon (Jakobsen et al.,2019). Other seafoods are good sources, as are mushrooms and fortified milk. Try to get a daily sunshine session of at least 20 minutes if you possibly can, especially around midday, when the sun’s path to earth is most direct. Show as much skin as propriety and/or local laws permit.
Another tip: Ask your doctor about your magnesium levels, too. We need magnesium to process vitamin D and magnesium deficiency is common (DiNicolantonio et al.,2018).
Our bodies are designed to be painlessly strong, mobile, and flexible, but they need the kind of food and environment that’s at least similar to the one in which we evolved. That means time outdoors, exercise, sleep, sociability - and a diet rich in nutrients, including vitamin D.
Brady SR, Naderpoor N, de Courten MP, et al. Vitamin D supplementation may improve back pain disability in vitamin D deficient and overweight or obese adults. J Steroid Biochem Mol Biol. https://pubmed.ncbi.nlm.nih.gov/30201225/ Published September 7, 2018 (ePub).
Callaghan BC, Reynolds E, Banerjee M, Kerber KA, Skolarus LE, Burke JF. Longitudinal pattern of pain medication utilization in peripheral neuropathy patients. Pain. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6377284/ Published March 1, 2019.
DiNicolantonio JJ, O'Keefe JH, Wilson W. Subclinical magnesium deficiency: a principal driver of cardiovascular disease and a public health crisis https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5786912/Open Heart. Published January 13, 2018.
Gendelman O, Itzhaki D, Makarov S, Bennun M, Amital H. A randomized double-blind placebo-controlled study adding high dose vitamin D to analgesic regimens in patients with musculoskeletal pain. Lupus. https://pubmed.ncbi.nlm.nih.gov/25801891/ Published April 24, 2015.
Habib AM, Nagi K, Thillaiappan NB, Sukumaran V, Akhtar S. Vitamin D and Its Potential Interplay With Pain Signaling Pathways. Front Immunol. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7270292/ Published May 28, 2020.
Helde-Frankling M, Björkhem-Bergman L. Vitamin D in Pain Management. Int J Mol Sci. https://pubmed.ncbi.nlm.nih.gov/29057787/ Published October 18, 2017.
Helde-Frankling M, Bergqvist J, Klasson C, et al. Vitamin D supplementation to palliative cancer patients: protocol of a double-blind, randomised controlled trial 'Palliative-D'. BMJ Support Palliat Care. https://pubmed.ncbi.nlm.nih.gov/28904010/ Published September 13, 2017.
Jakobsen J, Smith C, Bysted A, Cashman KD. Vitamin D in Wild and Farmed Atlantic Salmon (Salmo Salar)-What Do We Know?. Nutrients. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6566758/ Published April 29,2019.
National Diabetes Statistics Report 2020 Centers for Disease Control and Prevention https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.Pdf
National Institutes of Health Office of Dietary Supplements, Vitamin D. https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/ Accessed October 27, 2020.
Norman, A. W. (2008). From vitamin D to hormone D: Fundamentals of the vitamin D endocrine system essential for good health. The American Journal of Clinical Nutrition, 88(2). doi:10.1093/ajcn/88.2.491s
Sari A, Akdoğan Altun Z, Arifoglu Karaman C, Bilir Kaya B, Durmus B. Does Vitamin D Affect Diabetic Neuropathic Pain and Balance?. J Pain Res. https://pubmed.ncbi.nlm.nih.gov/32021406/ Published January 16, 2020.
Shillo P, Selvarajah D, Greig M, et al. Reduced vitamin D levels in painful diabetic peripheral neuropathy. Diabet Med. https://pubmed.ncbi.nlm.nih.gov/30102801/ Published September 20, 2018.
Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review [published correction appears in Neurology. Neurology. https://pubmed.ncbi.nlm.nih.gov/28341643/ Published August 22, 2017.
Wu Z, Malihi Z, Stewart AW, Lawes CM, Scragg R. Effect of Vitamin D Supplementation on Pain: A Systematic Review and Meta-analysis. Pain Physician. https://pubmed.ncbi.nlm.nih.gov/27676659/ Published Sept-October, 2016.
Yammine K, Wehbe R, Assi C. A systematic review on the efficacy of vitamin D supplementation on diabetic peripheral neuropathy. Clin Nutr. https://pubmed.ncbi.nlm.nih.gov/32089370/ Published October, 2020.