Pain From Vitamin D Deficiency – And What To Do

Pain from vitamin D deficiency is common. It’s also a component of many other kinds of pain. And it has a potentially easy fix.

Vitamin D is not technically a vitamin. It’s a “prohormone,” or a precursor to a hormone. The prohormone is called “vitamin D,” while the hormone is known as “activated vitamin D” or “calcitrol.” Activated vitamin D appears to have many functions in the body, but the best known function involves calcium, muscles, and bones.

Calcium

Vitamin D is required for your body to absorb calcium. My doctor says that if you are deficient in vitamin D, then it doesn’t matter if you take calcium supplements or not—your body will not be able to use the calcium!

You probably know that calcium is a mineral that is crucial for bones, muscles, and many bodily processes.

It’s not as widely appreciated that when your body doesn’t properly use calcium, you will feel pain.


Persistent Pain from Vitamin D Deficiency

A 2015 review article, “Vitamin D and Pain,” in the medical journal Pain Research and Treatment1, says that vitamin D deficiency is associated with persistent pain:

  • Bone demineralization
  • Myopathy (muscle weakness and related muscle symptoms)
  • Musculoskeletal pain

The authors list specific kinds of pain associated with vitamin D deficiency:

  • Headache
  • Abdominal pain
  • Knee pain
  • Back pain
  • Persistent musculoskeletal pain
  • Costrochondritic chest pain (“chest wall pain” where the ribs join the sternum)
  • Failed back syndrome (persistent pain following back surgery)
  • Fibromyalgia

Bone demineralization

Two painful conditions of bone demineralization caused by vitamin D deficiency are rickets and osteomalacia.

In rickets, children’s bones develop abnormally, into “bowed” arms and legs. There is a “softening of the bones,” pain, and weakness.

In the 19th century, it was discovered that cod liver oil would treat rickets. In the 20th century, it was discovered that sun exposure would cure it.

Unfortunately, childhood rickets is now increasing along with widespread vitamin D deficiency.

Osteomalacia is adult rickets, also caused by vitamin D deficiency. The symptoms are bone pain and muscle weakness. A 2015 article in the journal Pain Physician 2 describes osteomalacia as featuring “generalized body pain, especially in the shoulder, rib cage, and lumbar and pelvic regions.”

Weakness

A 2008 article in Pain Medicine3 says that vitamin-D associated myopathy (muscle weakness) “can result in severely impaired neuromuscular function even in the absence of biochemical markers of associated bone involvement.”

In other words: vitamin D deficiency can severely affect your muscles long before your bones are affected.​

Other conditions

Vitamin D deficiency is also associated with a weakened immune system, chronic inflammation, type 1 diabetes, multiple sclerosis, rheumatoid arthritis, lupus, other autoimmune rheumatic diseases, and pain in cystic fibrosis.


The Test for Vitamin D

Although vitamin D deficiency has been understood for decades, the first practical blood test wasn’t developed until 1992. It’s the 25(OH)D test, now a standard test acknowledged as the correct test for vitamin D.

Mayo Clinic Proceedings reported in a study in 20034, “More than 90% of the patients in this study with persistent, nonspecific musculoskeletal pain were found to have deficient levels of 25-hydroxyvitamin D.”

Unfortunately, the 25(OH)D test still isn’t routinely given to everyone. You may have to ask for this test.

“Defining vitamin D status in terms of plasma 25(OH)D is now widely accepted,” a 2007 article in the Journal of Bone and Mineral Research5 was able to summarize. It also comments, “Much data has been acquired to suggest that individuals with higher 25(OH)D levels have better health-related parameters such as BMD [bone mineral density], muscle strength, glucose tolerance, and lower cancer mortality.”

An amazing study was also published in 2007, in the American Journal of Clinical Nutrition, titled “Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial.”6 It was a “double-blind, randomized placebo-controlled trial” (the same standard as drug testing). It studied nearly 1200 healthy women over 55 for four years, The participants who were assigned an 1100 IU vitamin D supplement had a 60% decrease in cancer rate over the four years. Looking at just the last three years, it was a 77% decrease in cancer rate—suggesting that the vitamin D supplementation prevented new cancers from forming.


How the Body Gets Vitamin D

The body can get vitamin D from sunlight, food, and supplements.

Sunlight

When sunlight hits your skin, your skin creates vitamin D from cholesterol. This is the primary way of getting vitamin D.

Once everyone got vitamin D this way. Today, people don’t get enough sunlight–because of indoor occupations, northern climates and latitudes, clothing, sunscreen, dark skin—and are often vitamin D deficient.

Food

For the most part, it isn’t possible today to significantly raise your vitamin D levels with commonly available foods, unlike the way foods may have been in the past.

Researchers have found that prehistoric and primitive diets contained more than ten times the amount of vitamin D than our diet today does.

According to Sally Fallon in Nourishing Traditions, those diets included “butterfat, eggs, liver, organ meats, marine oils, and seafood, particularly shrimp and crab” that were high in vitamin D. You can imagine people of the far north eating a lot of seafood to compensate for the lack of sunlight in long winters.

In the past, cod liver oil was used to cure rickets. That would not be possible with today’s cod liver oil except through the vitamins added to the oil. Today, Sally Fallon writes, “most brands of cod liver oil go through a process that removes all of the natural vitamins,” and that some of those brands then add manufactured vitamin D.

Today, vitamin D is added in small amounts to milk and was formerly added to some other foods. You could not drink enough milk to significantly affect your vitamin D level.

Supplements

Fortunately, vitamin D is cheap and readily available in supplements!

There are two kinds of vitamin D you can take orally: the superior vitamin D3 and the inferior vitamin D2.

Vitamin D3 is chemically identical to the D made in the skin. It is usually made from lanolin, the oil in sheep wool; or from animal skins. It is sometimes made from fish skin or fish liver oil. It is more effective than D2 in raising and sustaining blood levels. It is found in over the counter supplements.

Vitamin D2 is chemically different from the D made in the skin. It is derived from mold. It is less effective, especially in older people, and has questions of toxicity. All prescription vitamin D is D2. D2 is also available in over the counter supplements.


Action Steps

Talk to your doctor

Talk to your doctor about vitamin D. Ask for a vitamin D blood test, or get a copy of your test results.

The correct Vitamin D test:​

  •  25(OH)D test

The wrong test: 1,25(OH)2D test

A medical journal article for you and your doctor

Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States
Pain and Therapy, June 2015

Be aware that it gives vitamin D levels in nmol/L instead of the American ng/ml.
(Convert from nmol/L to ng/ml by dividing the nmol/L by 2.5.)

If you can’t get the test through your doctor

If you can’t get the test through your doctor, there are several ways to get a Vitamin D test online.

The Vitamin D Council has authoritative information about testing, sells a mail-in test kit that involves pricking your finger at home, and other suggestions for getting a test online.

Testing for Vitamin D

Vitamin D Test Kits

The Life Extension Foundation sells a blood draw kit to take to a LabCorp blood draw center in your area (or to the Life Extension Lab).

How It Works: Life Extension Blood Tests

Vitamin D, 25 Hydroxy Blood Test

Why you need a copy of your test

You need a copy of your test to to check your results against the best recommendations.

If the lab report uses the word “sufficient,” and your doctor pronounces it “normal” based on the lab report, you might not find out if your level is actually high enough to get out of pain.

I copied the following table from the Vitamin D Council’s page on Testing For Vitamin D. It compares three different sets of recommendations, plus the way testing labs report results.

Vitamin D Level Guidelines

Vitamin D Council Endocrine Society Food and
Nutrition Board
Testing
Laboratories
Deficient 0-30 ng/ml 0-20 ng/ml 0-11 ng/ml 0-31 ng/ml
Insufficient 31-39 ng/ml 21-29 ng/ml 12-20 ng/ml
Sufficient 40-80 ng/ml 30-100 ng/ml >20 ng/ml 32-100 ng/ml
Toxic > 150 ng/ml

Source: Vitamin D Council

There have been controversies about correct or sufficient levels, as you can see from the table.

Below the level of 20 ng/ml, parathyroid hormone levels increase in the blood. That may be the source of the older idea that a level that low is adequate.

A physiatrist of my acquaintance believes 45 ng/ml is the minimum level necessary to get out of pain.

The Vitamin D Council recommends 50 ng/ml as a minimum level and explains each level on the I Tested My Vitamin D Level. What Do My Results Mean? page.

I Tested My Vitamin D Level. What Do My Results Mean?


Supplementing

Vitamin D can be obtained through sunlight, food, and supplements.

Sunlight is good and has other benefits. It’s even thought that there be may more to the vitamin D process than just the D3 that is made in your skin. Yet it is difficult to get enough sunlight to raise your blood levels. Some do use sunlamps to get vitamin D; not every sunlamp, however, is suitable.

Unfortunately, today’s food is totally inadequate for raising levels.

Supplements are available in two forms: Vitamin D3 (from either fish or lanolin) and Vitamin D2 (from mold).

Vitamin D3 (cholecalciferol)

This is the form of vitamin D identical to that made in your skin.

It is available in over-the-counter supplements.

The label should state if it is derived from fish or from lanolin (the oil from sheep’s wool).

Vitamin D2 (ergocaliferol)

This is an inferior form that is derived from the mold ergot.

It is available in vegan over-the-counter supplements (but harder to find).

All prescription vitamin D is in the D2 form. It typically would be prescribed in a hospital to an elderly patient in enormous pain, or in other emergency situations.

How much to take

The amount to take is very individual; it is hard to predict how much is necessary to raise an individual’s vitamin D level. Typically, your doctor would choose an amount and retest in about three months to evaluate how it worked.

You’ll see Vitamin D supplements in amounts ranging from 400 IU to 10,000 IU.

Taking an amount less than 1,000 IU per day would usually not be effective.

“Clinical research studies have shown that supplementing doses less than 1000 IU per day of vitamin D results in only modest increase in serum levels of 25(OH)D that may be inconsequential for achieving optimal serum levels of 75 nmol/L [30 ng/ml].”
“Vitamin D Deficiency and Pain,” Pain and Therapy, 20157

You may need to work with a physician to find the right dose.

The Vitamin D Council’s I Tested My Vitamin D Level. What Do My Results Mean? page has suggestions for starting doses.

I Tested My Vitamin D Level. What Do My Results Mean?

Some people need to take 5,000 IU or even 10,000 IU each day.

“Doses of 10,000 IU of vitamin D3 per day for up to 5 months have not been found to cause toxicity.”
“Vitamin D Deficiency and Pain,” Pain and Therapy, 20158

What to expect

It is common to have severely low, even undetectable, vitamin D levels.

Sometimes the level is difficult to raise. It is almost as if it get stuck once it gets too low. My doctor believes that common toxic exposures are causing this.

Under the best conditions, it will take months to raise very low blood levels.

“Long term daily dosing of vitamin D will result in a slow rise in circulating serum 25(OH)D levels that will reach a steady state at 3-6 months.”
“Vitamin D Deficiency and Pain,” Pain and Therapy, 20159


Vitamin D Resources

Vitamin D Council

Vitamin D Council
The non-profit organization of vitamin D expert Dr. John J. Cannell, MD

Testing for Vitamin D

I Tested My Vitamin D Level. What Do My Results Mean?

Vitamin D Test Kits

Life Extension Foundation

Blood Testing Services

Vitamin D Blood Test


References

Medical Journal Articles

Every link leads to free full text, except as noted. In some cases, to get to the full text, you’ll need to find and click an additional PDF or full text link .

PMID is the ID number in the free PubMed medical literature index. PMCID is the ID number in the free PubMed Central full-text archive.

The Case Against Ergocalciferol (Vitamin D2) as a Vitamin Supplement
Lisa A. Houghton and Reinhold Vieth
American Journal of Clinical Nutrition 2006;84;694-7
PMID: 17023693

Vitamin D and Calcium Supplementation Reduces Cancer Risk: Results of a Randomized Trial
Joan M. Lappe, Dianne Travers-Gustafson, K. Michael Davies, Robert R. Recker, and Robert P. Heaney
American Journal of Clinical Nutrition 2007;85:1586-91
PMID: 17556697

History of the Discovery of Vitamin D and Its Active Metabolites
Hector F. DeLuca
BoneKEy Reports 3, Article number: 479 (2014)
PMID: 24466410

Why Randomized Controlled Trials of Calcium and Vitamin D Sometimes Fail
Joan M. Lappe and Robert P. Heaney
Dermato-Endocrinology 2012 Apr 1;4(2):95-100
PMID: 22928064
PMCID: PMC3427206

Contemporary Diagnosis and Treatment of Vitamin D-Related Disorders
Glenville Jones, Ronald Horst, Graham Carter, and Hugh LJ Makin
Journal of Bone and Mineral Research 2007;22:S2;V11-V15
PMID: 18290713

Prevalence of Severe Hypovitaminosis D in Patients with Persistent, Nonspecific Musculoskeletal Pain
Gregory A. Plotnikoff and Joanna M. Quigley
Mayo Clinic Proceedings 2003 Dec 78(12):1463-70
PMID: 14661675
(Abstract only is free.)

Vitamin D Deficiency and Pain: Clinical Evidence of Low Levels of Vitamin D and Supplementation in Chronic Pain States
Elspeth E. Shipton and Edward A. Shipton
Pain and Therapy (2015 June) 4:67-87
PMID: 25920326
PMCID: PMC4470966

Prevalence and Clinical Correlates of Vitamin D Inadequacy among Patients with Chronic Pain
Michael K. Turner, W. Michael Hooten, John E. Schmidt, Jennifer L. Kerkvliet, Cynthia O. Townsend, Barbara K. Bruce
Pain Medicine 2008 9(8) 979-984
PMID: 18346069

Is Serum Hypovitaminosis D Associated with Chronic Widespread Pain Including Fibromyalgia? A Meta-analysis of Observational Studies
Ming-Yen Hsiao, Chen-Yu Hung, Ke-Vin Chang, Der-Sheng Han, and Tyng-Guey Wang
Pain Physician 2015 Sep-Oct  18(5):E877-E887
PMID: 26431141

Vitamin D and Pain: Vitamin D and Its Role in the Aetiology and Maintenance of Chronic Pain States and Associated Comorbidities
Edward A. Shipton and Elspeth E. Shipton
Pain Research and Treatment Volume 2015, Article ID 904967
PMID: 26090221
PMCID: PMC4427945

Vitamin D, Cod-Liver Oil, Sunlight, and Rickets: A Historical Perspective
Kumaravel Rajakumar
Pediatrics 112(2) August 2003
PMID: 12897318