All of my patients have chronic pain, and to all of them i tell them to take
vitamin d. it's not because vitamin D is a
treatment for chronic pain. it's for something else. so i stay here
and we'll talk about vitamin d and chronic pain.
a couple of years ago i used to measure the blood levels of vitamin d in all of
my patients. well, almost 99 percent of my patients had
vitamin d insufficiency which means the levels were between 50
and 75 nanomoles per liter, or deficiency where the levels were less
than 50 nanomoles per liter. in canada we use international units and
the normal range is between 75 and 250 nanomoles per liter. in the
united states they use the gravimetric units and the
equivalent is between 30 and 100 nanograms per milliliter.
does it mean that low vitamin d is causing the chronic pain?
no, not really. the most probable explanation
is it is that, it's just a coincidence. in canada
we have very low exposure to natural sunlight,
and when it's summer we apply sunscreen, or we prefer to stay in the shade.
also the sun rays that come to canada are not the same
as those that go to the equator. a person with light skin color
needs only 13 minutes of sun exposure around noon,
three times a week to make enough vitamin d during the summer months.
people of darker skin color, they have a natural sunscreen called melanin
that prevents them from getting sunburned, but also
from making vitamin D because melanin blocks the ultraviolet
b rays in penetrating the skin. vitamin d is a pro-hormone, it's made in our body
when cholesterol is exposed to ultraviolet b sunlight
in the skin. then it is transformed to 25 hydroxy vitamin d in the liver, and then
it's transformed to 1,25 di-hydroxy vitamin d or calcitriol,
which is the active form of vitamin D. calcitriol is important for a variety of
functions in our body for example: the absorption of calcium
from our guts, then depositing this calcium in our
bones, which is important for developing strong bones and preventing osteoporosis.
for muscle strength which is important for balance, to reduce
falls, and to reduce muscle pain. also for the immune system which is important to
fight cancer and infections, and also vitamin d is
important for depression, it's implicated people who have low
levels of vitamin d their mood is more depressed. so you
may be asking if people with chronic pain have low
vitamin d levels then giving them vitamin D improves the
pain? that would be wonderful but it's not easy like that. vitamin d is not an
analgesic which means it's not supposed to reduce pain,
there are many conflicting studies in this area. some show that if you give
vitamin d to people who are deficient or severely
deficient in vitamin d, there will be a reduction in pain
intensity but there are other studies that did not show
any reduction in pain. however the consequences of prolonged periods of
vitamin d insufficiency or deficiency may cause problems that could lead to
chronic pain, for example osteoporosis, fracture, poor
balance, muscle weakness, insomnia, recurrent
infections, cancer, and depression. so for this reason
i recommend all of my patients to take vitamin D.
so let's talk about where we can get vitamin D?
first, the natural source is the sun. only 10 to 15 minutes a day during the summer
would be enough. but who has the time in discipline to do
that. it's interesting that when we make vitamin D in this way
we'll never produce more than what we can handle.
it will always be the right amount. second, vitamin D is found naturally
in some food like fish: salmon, sardines, herring, mackerel, trout, and tuna.
also in cod liver and egg yolk. third, many foods are fortified with
vitamin D. in canada vitamin d fortification is
mandated for margarine, infant formula, cow's milk, and
substitutes, egg products, food for use on a variety
of low energy diets, meals replacements, and
nutritional supplements. the fourth, source of vitamin d is from supplements
and there are mainly two types of supplements of vitamin d.
d2 or ergo calciferol and d3 cholecalciferol.
vitamin d2 is made from plants and d3 is made from animals. most fortified foods
use vitamin d2 because it's much cheaper than vitamin d3.
however our body uses vitamin d3 better than d2.
what are the recommended daily doses of vitamin d supplementation?
for children from age 4 to 18 years of age it's 600 international units per
day. for adults between 19 and 50 years of
age is 400 to 1000 international units per day. and
people above 50 years of age is between 800
and 2000 international units per day. when the blood levels are above 250
nanomoles per liter this may indicate that the person is
taking too much supplements. the maximum daily dose that is safe is 4,000 international units per day. more than this there is the risk of
vitamin d toxicity. in acute cases hypercalcemia occurs
which is too much calcium in the blood. and the symptoms
include muscle weakness, headaches, anorexia,
irritability, nausea, vomiting, and bone pain.
but in chronic cases the symptoms include all of the above plus
constipation, abdominal cramps, thirsty, kidney stones, hypertension, and even
kidney failure, and cardiac arrhythmias. i've seen
some research studies where they give high dose of vitamin
d at once. like for example 100,000 in a single dose, in a bolus, and although
that sounds like a good idea, it's funny that the majority of the studies that do
this they do not show a benefit of vitamin d to improve
the immune response, for example to prevent infections or to
reduce cancer. perhaps a bolus of a high dose of
vitamin d is enough to help to put calcium in
the bones, but if someone wants to have all the
benefits of vitamin d including the immune system,
regulated mood, strong muscles, and bones, the best method is to take daily
supplements. this resembles more what is like to make
natural vitamin d from sunlight exposure.
please remember that this video is not intended to offer medical advice.
if you think you have problems with vitamin d please
consult your pharmacist or physician to get a proper diagnosis and treatment
plan for you. the intention of this video is only for
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you for watching. bye