Name: Vitamin D, Vitamin D3, cholecalciferol
Goes well with: Calcium, Magnesium
Number of scientific references: 46
Level of Evidence: Level III What is this?
Note: Vitamin D supplementation helps in fibromyalgia only in case of high risk or severe deficiency. Research shows that it helps improve pain, quality of life, mental health and physical function in fibromyalgia. It is necessary to consult a doctor about the right dose based on your serum vitamin D levels.
Vitamin D or the sunshine vitamin is a fat-soluble vitamin that functions as a steroid hormone. The reason for referring to it as the sunshine vitamin is that sun exposure is the primary source of this vitamin.
UVB rays convert 7-dehydrocholesterol to vitamin D in the skin. This is further converted to calcidiol (25-hydroxyvitamin D3) and this converted to Calcitriol (1,25-dihydroxyvitamin D3) which is the biologically active form.
Vitamin D receptors are present in most tissues and cells in the body, and the vitamin interacts with them to support multiple biological actions. This vitamin crosses the blood-brain barrier, and its receptors are present in the brain as well.
There are multiple natural and synthetic analogues (compounds with similar structures) of vitamin D, but the two major ones are:
- Vitamin D2: ergocalciferol which is produced by invertebrates, plants and fungi
- Vitamin D3: cholecalciferol which is produced in the skin by sun exposure
We do not make vitamin D2 in our body. Vitamin D from the skin or diet is biologically inert and needs to be converted into active forms.
Vitamin D insufficiency affects almost 50% of the population worldwide.
Vitamin D deficiency has been observed in some fibromyalgia patients. Vitamin D supplementation helps in fibromyalgia only in case of high risk or severe deficiency. It helps by relieving pain, strengthening mental health, improving bone mineral deficiency and by reducing inflammation.
The research to date on recommending the sunshine vitamin supplementation for fibromyalgia therapy is rather confounding, and in this post, we will go over the scientific evidence and see what we can ascertain from it.
Suggested Vitamin D Supplements For Fibromyalgia
Please consult a health practitioner before taking any health supplements.
Vitamin D supplementation is helpful only in case of deficiency. Vitamin D supplements should not be taken over a long period, unless prescribed by a health practitioner, as it may cause toxicity.
It is essential to maintain calcium and magnesium levels while supplementing with vitamin D for best resolution of symptoms.
The vitamin is fat soluble and it is advisable to take it after a meal containing dietary fats.
Dosage: Please read the detailed dosage section below and try working with a health practitioner to identify a dose that suits you.
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5 Evidence-Based Ways Vitamin D Helps In Fibromyalgia
Many research studies have evaluated the possibility of Vitamin D deficiency in fibromyalgia, but to keep up with the latest findings, I have included studies from around 2009 to date.
1.Vitamin D supplementation may help rectify deficiency and improve quality of life in fibromyalgia
Table of Contents
- 1 Suggested Vitamin D Supplements For Fibromyalgia
- 2 5 Evidence-Based Ways Vitamin D Helps In Fibromyalgia
- 2.1 1.Vitamin D supplementation may help rectify deficiency and improve quality of life in fibromyalgia
- 2.2 2.Supplementation with vitamin D3 may relieve pain and reduce tender points in fibro
- 2.3 3.It may protect bone health and reduce risk of osteoporosis in fibromyalgia
- 2.4 4.It may improve sleep quality and duration
- 2.5 5.The sunshine vitamin may strengthen mental health and function in fibromyalgia
- 3 Dosage of Vitamin D For Fibromyalgia
- 4 Precautions with Vitamin D Use
- 5 Conclusion
Some studies have found that the level indicating a deficiency of the sunshine vitamin in fibromyalgia is similar to that found in healthy counterparts, but the deficiency correlates with pain intensity and quality of life in the disorder.
A recent meta-analysis study published in The Korean Journal of Pain, 2017 took into account 12 eligible studies assessing vitamin D levels in fibromyalgia. After investigating for risk of bias, their results indicated that ‘vitamin D serum levels of patients with fibromyalgia was significantly lower than that of the control group.’
A study published in Pain Medicine, 2014 demonstrated that vitamin D deficiency is observed in 71% of the patients while 21% had insufficiency. Low vitamin levels were associated with impaired pain processing and increased pain sensitivity.
Pain-sensing nerves express vitamin D receptors. Tague et al. have demonstrated that vitamin D deficiency caused increase pain sensitivity in muscles but not skin. This was attributed to increasing in development of pain-sensing nerves in muscle fibres.
These findings explain why a deficiency in the sunshine vitamin causes chronic muscle pain.
The deficiency may even impair an individual’s ability to balance and affect gait especially in case of fibromyalgia (Modern Rheumatology, 2017).
A recent study published in The Eurasian Journal Of Medicine, 2017 examined the effect of vitamin D supplementation on quality of life in fibromyalgia patients.
70 patients with fibromyalgia were enrolled in the study. 60% of the patients were found to have vitamin D deficiency (<20ng/ml) and insufficiency (20-30 ng/ml). They were given 50,000 IU of the vitamin for 12 weeks.
After the therapy, significant differences in various parameters were observed as per the clinical assessment scale or questionnaire.
No significant improvement was observed in case of body pain and sleep scores.
However, there was a significant improvement in the quality of life. Physical function, social function, mental health, vitality, limitations in the physical and emotional role as well as general health factors improved.
Quick Gist: Vitamin D deficiency has been observed in fibromyalgia patients, but some studies have reported conflicting results.
A recently meta-analytical study has confirmed that fibromyalgia patients have lower vitamin D levels than healthy counterparts. Its supplementation is found to improve quality of life and mental health in fibro patients.
2.Supplementation with vitamin D3 may relieve pain and reduce tender points in fibro
The sunshine vitamin is linked to pain in multiple ways; it’s deficiency could contribute to bone demineralisation, muscle weakness, inflammation and even modulate pain processing.
Vitamin D receptors are expressed in various parts of the human central nervous system which indicates that the vitamin plays an important role in vitamin development.
The sunshine vitamin is also referred to as a neurosteroid hormone owing to its ability to regulate neurotransmitter levels.
Altered pain processing and neurotransmitter levels are one of the pathological features of fibromyalgia. Thus, regulation of these neurotransmitter levels by vitamin D may help relieve pain.
In 2009, Arvold and colleagues treated patients with vitamin D deficiency with 50,000 IU of cholecalciferol weekly for eight weeks. Post-treatment, the patients, showed mild short-term improvement in fibromyalgia symptoms.
In 2014, Wepner et al. conducted a similar study where patients were treated for 20 weeks with oral cholecalciferol and reevaluated after a further 24 weeks without vitamin supplementation.
A significant reduction in pain was observed. An improvement in physical functioning was also noted.
Researchers concluded that cholecalciferol is an inexpensive therapy with low side effects that should be considered for fibro therapy and further research including large study population is required.
Another study (International Journal of Rheumatic Diseases, 2016) found that 50,000 IU vitamin D3 supplementation per week for three months improved pain, tender points, depression, energy levels, sleep quality in patients with chronic nonspecific widespread pain.
Number of patients with fibromyalgia at the start of the treatment was 30 and reduced to 20 after the therapy. 85% of the patients were satisfied with the treatment.
A recent meta-analytical study published in Clinical Rheumatology, 2017 confirms that vitamin D supplementation can decrease pain scores and improve pain in conditions involving widespread chronic pain.
Quick Gist: Vitamin D plays an important role in development and processing of pain. It can reduce inflammation and regulate neurotransmitter levels to relieve pain. Studies in fibromyalgia patients have found that supplementation with cholecalciferol, in case of deficiency, relieves pain.
3.It may protect bone health and reduce risk of osteoporosis in fibromyalgia
Chronic pain reduces mobility in fibromyalgia, thus reducing sun exposure and causing vitamin D deficiency. This deficiency may increase the risk of osteoporosis.
A study published in Rheumatology International, 2013 reported that fibromyalgia patients had low 25-hydroxyvitamin D3 and reduced bone mineral density in the lower spine.
Low vitamin levels were associated with impaired short memory, confusion, mood and sleep disturbances, restless leg syndrome and palpitation. It was also correlated with increased and pain and depression scores.
Low bone mineral density in the spine was also linked with high depression and pain scores. Researchers concluded that low vitamin D levels in fibromyalgia might increase the risk of osteoporosis.
A recent review study published in Rheumatology International, 2017 confirmed that bone mineral density of the lower spine is less in fibromyalgia patients than in healthy individuals. Researchers stated that fibromyalgia patients must be assessed for osteoporosis risk.
I have not come across studies that have examined the effect of supplementation of cholecalciferol on bone mineral density in fibromyalgia.
But the summary of Lancet 2014 review study suggests that in case of deficiency, low dose vitamin D supplementation may hold benefits for the lower spine.
Quick Gist: Reduced sun exposure and subsequent vitamin D deficiency may impair bone health in fibromyalgia patients. Some studies have observed reduced bone mineral density in the lower spine in patients.
Rectifying this deficiency may help improve bone mineral density and overall bone health, but more research is required to confirm this aspect.
4.It may improve sleep quality and duration
Sleep disturbances in fibromyalgia may occur as a result of chronic pain, and sleep deprivation may further aggravate pain.
Vitamin D is a neuroactive steroid- it can regulate brain chemicals and various aspects of brain function. These properties suggest that it may be involved in initiation and maintenance of sleep.
High levels of inflammatory agents in the body impair sleep; the sunshine vitamin’s anti-inflammatory action can reduce these agents and improve sleep.
Huang and colleagues conducted a study where they treated 28 US veterans who complained of chronic pain and had low serum 25-hydroxyvitamin D levels with oral vitamin D supplementation.
A significant improvement in pain, sleep onset and duration, general health, social functioning and vitality was observed.
Quick Gist: Vitamin D regulates various neurotransmitters that are linked to sleep initiation and maintenance. Hence its supplementation may reduce sleep disturbances and improve sleep quality in fibromyalgia.
5.The sunshine vitamin may strengthen mental health and function in fibromyalgia
Neurotransmitters are chemicals in the brain that have multiple functions including regulation of mood, sleep, appetite and cognition. Abnormal changes in these neurotransmitter levels are said to be one of the causes of depression, anxiety and mood disturbances.
Vitamin D regulates neurotransmitter levels and this property may help alleviate mental health complaints and what is known as ‘fibro fog’. Also, low vitamin D levels can affect cognition, and multiple research studies have acknowledged this link.
Armstrong et al. screened 75 patients to assess the link between vitamin D and mental health. 13.3% were deficient, 56% had insufficient levels, and 30.7% had normal levels.
Those with a deficiency had higher depression scores than those with insufficiency and normal levels.
A meta-analysis study which did not include studies with biological flaws reported that vitamin D supplementation statistically improved depressive symptoms and the effect size was comparable to that of antidepressant medication.
Chronic pain, inflammation and other factors contribute to reduced cognition, confusion and impaired decision making in fibromyalgia. Replenishing vitamin D levels may help improve cognition in disorder, but this needs to be verified by clinical trials.
There has been one study that has noted that vitamin D supplementation reduces depressive symptoms and improves mental function and quality of life in fibromyalgia patients experiencing vitamin deficiency.
Quick Gist: Vitamin D deficiency has been associated with depressive and anxiety related symptoms and impaired cognition. Thus, supplementation with the sunshine vitamin may strengthen mental health and function in fibromyalgia.
Dosage of Vitamin D For Fibromyalgia
The dose of vitamin D for relieving fibromyalgia symptoms depends on your serum vitamin D levels. Research studies have used a dose of 50,000 IU cholecalciferol (vitamin D) per week for 8-12 weeks in case of deficiency (≤20 ng/mL) or insufficiency (21–29 ng/mL) in fibromyalgia patients.
A dose of 1000-2000 IU per day works for most individuals but in case of severe deficiency, your health practitioner may suggest higher weekly dosages.
The dose could differ based on your serum calcifediol/ calcidiol or serum vitamin D levels. Please consider working with a health practitioner to identify the dose that would suit your health.
Opt for vitamin D3 (cholecalciferol) and not D2 (ergocalciferol) supplements.
Sun exposure is the simplest way of getting vitamin D, but considering the whole pollution and global warming scene, use of sunscreens and the high incidence of skin cancer, recommendations on this aspect need to be tailor-made.
For example, an individual with moderately fair skin residing in Northern Australia can produce 1000 IU vitamin D in 6-7 minutes ( in summer) and 9-12 minutes (in winter), if exposed to the sun between 10, am to 2 pm. But if that individual is in Tasmania, he may need 7-9 minutes (in summer) and 40-47 minutes (in winter) for equivalent levels.
For India, one study has identified sun exposure between 11 am to 2 pm can promote the production of the sunshine vitamin.
Nevertheless, a regular 10-20 minutes sun exposure with appropriate care should work as a safe antidepressant and vitamin D source.
Precautions with Vitamin D Use
While it is necessary to maintain the sunshine vitamin within normal levels (30ng/ml approximately), high levels of vitamin D can have toxic effects.
High levels of the vitamin can increase calcium absorption, and this increase in calcium levels (hypercalcemia) may contribute to toxicity. Early symptoms include nausea, vomiting, anorexia, diarrhoea, constipation etc.
Other symptoms include kidney stones, bone pain, frequent urination, drowsiness, headaches irregular heartbeat, weakness, nervousness, itching etc.
It is necessary to work with a health practitioner to identify the dose of vitamin D that would suit you and also ascertain the duration of therapy.
Sun exposure does not cause vitamin D toxicity as sunlight degrades any excess vitamin D.
Certain medications that affect calcium levels in the body may have drug interactions with the sunshine vitamin. These include corticosteroids, phenobarbital, phenytoin. Also, drugs that interfere with fat metabolism such as orlistat and cholestyramine can reduce the vitamin absorption.
Please consult a health practitioner before taking Vitamin D supplements.
Vitamin D is an essential nutrient that has multiple functions in the body including pain processing and bolstering mental function.
Many studies have found that fibromyalgia patients are deficient in the vitamin or have insufficient levels. One reason for this could be that the disorder limits the patient’s from moving out and getting adequate sun exposure.
Theoretically, supplementation with the sunshine vitamin in fibromyalgia (in case of deficiency) should relieve pain, improve mental health, sleep and quality of life. And multiple studies in humans have confirmed this.
What can be concluded from this is that vitamin D supplementation can help in fibromyalgia only in case of high risk or severe deficiency.
The sunshine vitamin is a part of the puzzle; multiple factors need to be taken into account such as deficiency of other vitamins and minerals, mitochondrial activity and antioxidant status, the possibility of viral infections, genetic links.
Fibromyalgia is a heterogeneous disorder; individual patients may have different causes for the symptoms, and one of them is vitamin D deficiency.
In case of deficiency, it’s supplementation may have beneficial effects but it may not lead to complete relief or cure of the disorder. It can serve as an add-on therapy in fibromyalgia.
It may deliver better effects with magnesium supplementation which also provides relief in fibromyalgia. Also, high dose vitamin D supplementation may lead to depletion of magnesium stores in the body.
Please consult a doctor before you take vitamin D supplements as it is necessary to identify a dose that would suit your current vitamin D status.
Has vitamin D supplementation brought about a significant improvement in fibromyalgia symptoms for you? Do leave your comments below.