Vitamin D In Musculoskeletal Pain
Observational studies have indicated that sufficient vitamin D levels are important for normal muscular function and strength . In addition, several studies have shown an association between vitamin D levels and neuromuscular coordination . However, the presence of the vitamin D receptor in adult skeletal muscle cells has been debated. Studies from VDR knock-out mice have shown that the muscle fibers were small and variable in size, although overall myocyte differentiation occurred normally . Recently it was shown that the vitamin D-activating system can be detected in human muscle precursor cells, but is low or non-detectable in adult skeletal muscle . Neither did a review of bioinformatics approaches in analyzing VDR signaling reveal a significant role for VDR in muscle tissue .
In a randomized, placebo-controlled study on 80 patients with musculoskeletal pain, 4000 IE vitamin D/day for 3 months resulted in improvement of symptoms recorded as decline in visual analogues scale score . The included patients had mean 25-OHD levels of 55 nmol/L at baseline. Interestingly, this study also showed that vitamin D supplementation resulted in decreased levels of inflammatory and pain-related cytokines in plasma, such as Prostaglandin E2 , TNF and Leukotriene B4 .
How Much Should You Really Be Getting
The NIH suggests adults get 600 IU of vitamin D daily, while adults over the age of 70 should get 800 IU per day.
Some other organizations recommend higher doses, but according to the Mayo Clinic, taking in more than 4,000 IU a day is dangerous, and could result in side effects like nausea and vomiting, heart rhythm problems and kidney damage.
Yet, about 1 billion people worldwide are deficient in vitamin D, according to the June 2019 article in StatPearls. And half of the global population has insufficient, but not medically deficient, levels of the nutrient.
Vitamin D Is Linked To Improved Muscle Health
Getting adequate vitamin D is also necessary for your muscle health and strength, according to a November 2012 study in Sports Health.
Increasing your vitamin D can help improve your muscle protein synthesis and ATP concentration, a compound that supplies your body with the energy needed for muscle function.
Vitamin D supplementation can also help reduce inflammation or pain, making it helpful for athletes, according to the above-mentioned study. Increasing vitamin D levels is tied to helping improve athletic factors like strength, jump height, jump power, exercise capacity and physical performance.
So What Causes Leg Cramps
Muscle cramps are thought to be caused by one of three underlying causes. First, inadequate blood supply by narrowing of the arteries or temporary obstruction can lead to muscle cramps.
Second, medical conditions including lower motor neuron disorders, cirrhosis, dialysis, or taking certain medications can cause muscle cramps.
Finally, mineral depletion and nutrient imbalances such as hypocalcemia , hypoglycemia , hyponatremia , and hypokalemia may lead to muscle dysfunction and cramping. However, most muscle cramps are idiopathic, meaning the cause is unknown.
Aside from staying hydrated and eating various nutrient-dense foods to ensure adequate vitamin and mineral intake, some other suggested interventions for muscle cramps have been proposed .
These include stretching before bed, vitamin B complex, vitamin E, magnesium, and gabapentin. Muscle cramps usually disappear on their own and are not harmful. However, see your doctor if your muscle cramps are associated with leg swelling and changes to skin appearance, muscle weakness, occur often enough to affect your quality of life or are not resolved in a reasonable time. Also, speak with your doctor before adding new supplements or medications to your routine.
Vitamin D And How It Can Help In Pain Management
|As Chiropractorsand Physiotherapists, we often treat patients with problems such as chronic lower back pain, neck pain, osteoporosis, Multiple Sclerosis, and stenosis of the spine.New research has proven that low levels of Vitamin D can play a significant role in making joint and muscle problems worse. As physical therapists, we focus our efforts on finding and correcting the underlying source of your problem. While chiropractic adjustments and physio treatment can correct subluxations , eliminate or mitigate pain, and restore normal nerve function, low levels of Vitamin D can continue to negatively affect your health, and possibly prevent your physical treatment from being as effective as it could be.|
Various studies conducted by trusted health bodies have reported the following:
- People living with chronic pain who were deficient in vitamin D are most likely to benefit from taking vitamin D supplements .
- Adults with a vitamin D deficiency who are older than 50 are more likely to develop pain in their hip and knee joints. Studies have concluded that the associated pain is likely to get worse if the deficiency isnt treated.
- In studies conducted on people with rheumatoid arthritis , most of the participants had low vitamin D levels.
It is important to note that Vitamin D is not a cure for pain, but if you have a vitamin D deficiency, this could be contributing to increased pain and hindering your recovery.
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Vdr Rapid Response Mechanisms Regulate Sensory Neurite Outgrowth
VDRs can signal through either classical nuclear genomic binding sites or rapid response pathways via membrane-bound receptors that modulate ion flux and generation of second messengers . The enrichment of VDR in growth cones of vitamin D-sensitive sensory axons, but not insensitive sympathetic axons, suggests that axon outgrowth may be regulated by nongenomic VDRs. To determine whether sensory axon outgrowth is regulated by rapid membrane signaling mechanisms, we used JN, which selectively binds to and activates membrane VDRs but has no effect on nuclear VDR signaling . JN was applied to DRG cultures in the same concentrations as 1,252D3 in the previous experiment. Immunostaining for large-diameter NFH-ir neurons, which primarily express only nuclear VDRs in vivo , showed no effect of JN on outgrowth, indicating that large-diameter neurons fail to respond to low levels of membrane VDR activation with increased outgrowth . However, JN did elicit neurite outgrowth of peripherin-ir fibers at low concentrations similar to those of 1,252D3, with peak outgrowth occurring at 20 pm . Therefore, low levels of rapid response VDR activation are most likely to enhance neurite outgrowth from putative nociceptors.
Vitamin D Deficiency Does Not Impair Mobility Or Muscle Strength
Many factors could contribute to impaired beam-walk performance in vitamin D-deficient rats, including myopathic changes known to occur in protracted vitamin D deficiency . To assess whether overt muscle dysfunction occurs in our model of vitamin D deficiency, we measured grip strength . Forelimb grip strength increased with age in all groups, and vitamin D-deficient rats showed no deficits relative to rats on control diet, consistent with maintenance of normal muscle function. To determine whether the apparent balance deficits were associated with diminished mobility, the pattern of exploratory locomotor activity of each rat was analyzed in a force-plate actimeter. There were no significant differences in the overall activity between treatment groups, including total distance traveled and number of rearing events . Thus, the balance deficits observed in our vitamin D-deficient rats do not appear to result from grossly impaired locomotor mobility or overt muscle weakness.
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Visceral Pain Vitamin D And Gut Microbiota
Similar to nociception where the stimuli are sensed by the skin , the lining of the gut is also an inside out interface to our external environment and is essential in visceral nociception. Visceral pain is defined as that which originates from the tissues of the internal organs in the body, and pathologically affects more than 20% of the world’s population. There is some homology between visceral nociceptors and those in the skin. For example, similar to the skin, the DRG nerve fibers that innervate the serosa and the muscle layer in the intestine also synapse in the spinal cord . Most visceral nociceptors are highly sensitive to pro-inflammatory signals, ischemia, and to chemicals released from the ischemic tissues.
Figure 1. Vitamin D and its receptor in pain signaling pathways. Vitamin D is synthesized in the skin. Vitamin D receptor is expressed in neurons in the skin, dorsal root ganglia , spinal cord, brain, and the intestine. Nociceptors, from the specific area of the periphery and viscera respond to environmental nociceptive stimuli such as thermal, mechanical, or chemicals by converting the stimuli into a chemoelectrical signal . The signal travels as a nerve impulse through dorsal root ganglia nerve fibers from the skin to the spinal cord where it gets transmitted to secondary neurons in the dorsal horns of the spinal cord . After modulating the signal, the secondary neurons relay it to the cortex where the message gets decoded and pain is perceived .
Assessing Vitamin D Status
Clinical Indicators. From a clinical perspective, a number of factors may suggest that chronic musculoskeletal pain and related problems may be due to inadequate vitamin D intake. Researchers have stressed that the gold standard for a presumptive diagnosis of inadequate vitamin D is a review of patient history, lifestyle, and dietary habits that might pose risks for deficiency.¹¹ Along with this, indicators of defects in bone metabolism may include chronic muscle, bone, or joint pain, as well as persistent muscle weakness, fatigue, and possibly difficulty walking.²¹¹¹² Radiological changes potentially associated with osteomalacia are seen only in advanced stages.²¹³
Signs/symptoms of calcium deficiency due to vitamin D deficiencies relate to neuromuscular irritability. Patients sometimes complain of paresthesias in their lips, tongue, fingertips, and/or toes, along with fatigue and anxiety. Muscles can be painfully achy, progressing to cramps or spasms.¹¹ Lethargy, poor appetite, and mental confusion may be part of the syndrome.¹
The diverse signs and symptoms may be erroneously attributed to other causes. Holick¹ and others¹6 caution that osteomalacia due to vitamin D deficiency can be misdiagnosed as chronic fatigue syndrome, arthritis or rheumatic disease, depression, or fibromyalgia.
Biochemical Markers. Laboratory assessments usually pertain to the measurement of biomarkers that could denote osteomalacic processes, including:¹
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Vitamin D And Your Health
Vitamin D is called the sunshine vitamin for good reason. Not only does your body make vitamin D when your skin is exposed to the sun, but we also know vitamin D can ward off many health problems.
Vitamin D is a naturally occurring compound that regulates the bodys use of calcium and phosphorus. Its crucial for the formation of bone and teeth.
Because vitamin D is so important to bone growth, some researchers have wondered if supplements can help joint pain.
One study found that patients living with chronic pain who were deficient in vitamin D were the most likely to benefit from taking vitamin D supplements. However, more information is needed to determine whether vitamin D supplements can help everyone living with chronic pain.
Another study predicted that adults with a vitamin D deficiency who are older than 50 are more likely to develop pain in their hip and knee joints. The study also noted that the pain is more likely to get worse if the deficiency isnt treated.
A looked at vitamin D levels in people who have rheumatoid arthritis , an autoimmune condition that causes the body to attack its joints. The study found that most of the participants had low vitamin D levels.
The researchers concluded that the low vitamin D levels were a complication of RA. Other have concluded that people with RA have low vitamin D levels from their corticosteroid medications.
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What Is Vitamin D Exactly
Vitamin D is a fat-soluble vitamin and hormone-like compound that plays multiple roles within the body, Dr. Jagim details. He says that most notably, vitamin D is known for its role in maintaining musculoskeletal health, adding that in the past two decades, low vitamin D levels have also been identified as a risk factor and associated with several chronic diseases, including:
Severe asthma and rickets in children
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Vitamin D Absorption Biosynthesis And Tissue Distribution
Vitamin D, although identified as a fat-soluble vitamin, is increasingly being recognized as a prohormone. Traditionally, vitamin D was considered to be essential for calcium and phosphate homeostasis and thereby, bone health, and its deficiency causes rickets and osteomalacia. Recent evidence, however, advocates a role for vitamin D that extends beyond bone metabolism . Our body obtains vitamin D both directly from the diet, albeit from a narrow range of food sources, and through biosynthesis in the skin. Vitamin D3 is the natural form of vitamin D and is produced from 7-dehydrocholesterol in the skin. UVB irradiation helps convert 7-dehydrocholesterol, the precursor in the skin, into pre-vitamin D3 and then to vitamin D3. Synthesis in skin serves as an essential source of vitamin D3 and depends crucially on season and geographical latitude . Studies involving human and pig models indicate that vitamin D3 is predominantly distributed in fat tissue and in smaller amounts in muscles, liver, and skin. Distribution of 25-D3 was somewhat similar within compartments . The body fat content has also been reported to inversely correlate with serum levels of 25-D3, which could indicate that those with high body fat content might be at risk of vitamin D3 deficiency .
A Rat Model Of Vitamin D Deficiency
Vitamin D deficiency in people occurs as a result of insufficient sunlight exposure and dietary limitations. In the laboratory rat, diet is the primary source of vitamin D and a diet depleted of vitamin D produces conditions that resemble deficiencies in humans. Groups of Sprague Dawley rats were fed one of three diets: Control: normal vitamin D, calcium, and phosphate VD/+Ca: vitamin D-depleted, elevated calcium and phosphorus or VD: vitamin D-depleted, normal calcium and phosphorus . Rats fed vitamin D-deficient diets showed weight gains comparable to control subjects over the 4 week study . However, food consumption was increased in the VD/+Ca group and in the VD group at week 4 compared to controls . Serum 25D concentrations in both VD/+Ca and VD rats were reduced below 25 nmol/L by week 2 and below 10 nmol/L by week 4 . Serum Ca and P levels at week 4 were not reduced, even though Ca is reported to be decreased with longer duration of vitamin D deficiency . Therefore, dietary vitamin D restriction in rats produced a selective deficiency in serum 25-hydroxyvitamin D levels, similar to that seen in humans.
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Can You Get Vitamin D Through Windows
While sunlight can pass through window glass, the UVB wavelengths in sunlight cannot, according to the NIH.
Because you need UVB exposure to jump-start the vitamin D production process, sunlight that passes through a window cannot increase your vitamin D levels, even if it strikes bare skin.
Bottom line: You won’t get any vitamin D from absorbing sunlight through windows or glass and you need direct sunlight for vitamin D.
How Often Do You Need To Get Your Vitamin D Levels Checked
Doctors do not usually order routine checks of vitamin D levels, but they might need to check your levels if you have certain medical conditions or risk factors for vitamin D deficiency. Sometimes vitamin D levels can be checked as a cause of symptoms such as long-lasting body aches, a history of falls or bone fractures without significant trauma.
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What Does Your Diet Have To Do With Getting Enough Vitamin D
Vitamin D doesnt occur naturally in many foods. Thats why certain foods have added vitamin D. In fact, newer food nutrition labels show the amount of vitamin D contained in a particular food item.
It may be difficult, especially for vegans or people who are lactose-intolerant, to get enough vitamin D from their diets, which is why some people may choose to take supplements. It is always important to eat a variety of healthy foods from all food groups. The vitamin content of various foods is shown in the following table.
Vitamin D content of various foods
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It is important to check product labels, as the amount of added vitamin D varies when it is artificially added to products such as orange juice, yogurt and margarine.
How Much Vitamin D Should I Be Getting
Ive talked about the effects of too little and too much vitamin D but how much should we actually be getting? The recommended daily amount of vitamin D is 100 micrograms which roughly translates to between 400 and 600IU per day. Many vitamin D supplements contain triple and sometimes more than this amount! So be weary when picking a supplement and always read the label to see how much youre actually taking.
Another option might be our Balance Mineral Drink which not only contains 100% of your RDA, but it is also full of other important minerals including zinc, calcium, magnesium and potassium all of which play important roles in maintaining the health of our muscles and joints.
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What Does This Mean If You Exercise Regularly
A good place to start would be determining what your vitamin D levels are. You can either assume, as you live in the UK, that you are deficient in vitamin D or you can get it tested.
If low or deficient be sure to increase your intake of vitamin D.
This can be done by ensuring that your diet includes foods like:
- oily fish like salmon, mackerel, and sardines
- red meat
Or you can start taking vitamin D supplements to increase your levels. You can check your vitamin D levels at home as part of a vitamins blood test.