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Vitamin D for Joint Pain

Vitamin D functions as a hormone to promote the mineralization of the bone. However, it has a bigger but rarely mentioned function: it is the best natural painkiller for treating chronic musculoskeletal disorders like arthritis.
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What is Vitamin D?

Vitamin D is a group of five fat-soluble secosteroids. The 2 most important forms of this vitamin are vitamin D2 or Ergocalciferol and vitamin D3 or Cholecalciferol.

Vitamin D is not an essential vitamin because it can be synthesized in the body. Usually, this vitamin is produced from cholesterol when the skin is exposed to moderate sunlight.  This is why it is called the sunshine vitamin.

Even though vitamin D can be synthesized naturally in humans, most people do not make enough of it and have to rely on dietary sources and supplements of the vitamin to make up their daily recommended intake.

The body normally regulates the production of vitamin D to make up for the amount of the vitamin obtained through dietary sources. This is done in order to avoid vitamin D toxicity.

The form of vitamin D made in the skin is vitamin D3.

This is produced from ultraviolet (UVB) irradiation of 7-dehydrocholesterol.

Once ingested or produced, the different forms of vitamin D are converted to calcidiol in the liver and then to calcitriol in the kidneys. Calcidiol, a prohormone, is the compound measured in the serum to determine vitamin D levels in the body while calcitriol is the biologically active form of vitamin D.

Calcitriol functions like a hormone. Its main role is controlling the blood levels of calcium and phosphate, the two compounds which are most essential to bone health.

Calcidiol can also be converted to calcitriol by the cells of the immune system. The calcitriol produced from these cells takes on the role of cytokines which protect the body against infections.

Calcitriol is also useful for controlling inflammation.

How Vitamin D Protects the Bone
  • Increase the absorption of calcium in the small intestine
  • Maintain calcium and phosphate levels for proper mineralization of the bone
  • Promote the resorption or recovery of bone
  • Regulate the action of the parathyroid hormone to improving the control of the serum level of calcium

Vitamin D: Sources, Supplements and Deficiency

Dietary sources of the two popular forms of vitamin D vary.

Vitamin D2 is mostly obtained from alfalfa and mushrooms. The vitamin is actually synthesized from precursors found in these plant and fungi following ultraviolet irradiation in humans.

Vitamin D3 is mostly found in fatty fishes such as catfish, salmon and tuna. It can also be obtained from fish liver oils, beef liver and eggs.

The recommended daily intake value of vitamin D is 15 micrograms for anyone younger than 70 years. Those older than 70 year should take 20 micrograms of the vitamin per day.

Vitamin D supplements are majorly used to correct a deficiency in the vitamin. There are two main disease conditions caused by vitamin D deficiency. These are osteomalacia in adults and rickets in children.

Both osteomalacia and rickets are caused by softened bones. In children, this leads to deformities while in adults, bone fragility causes fractures and chronic musculoskeletal pain. This is why joint pain is one of the symptoms of vitamin D deficiency.

Studies Linking Vitamin D and Joint Pain

A number of studies have been done to determine whether vitamin D levels affect joint pain. Most of these studies found a positive link between the vitamin and the joint pain experienced as symptom of a number of diseases.

A 2009 study published in Translational Research: The Journal of Laboratory and Clinical Medicine examined the effect of vitamin D deficiency on patients with musculoskeletal pains who were placed on a class of cholesterol-lowering drugs called statins. 

The study concluded that musculoskeletal pain is worsened when in people with vitamin D deficiency.

This pain is believed to be due to the interaction between statins and the vitamin deficiency.

A more direct link between vitamin D deficiency and joint pains was established by a group of researchers who examined the vitamin D levels of 231 patients. These patients were receiving treatment for arthritis and other musculoskeletal diseases in South Infirmary-Victoria University Hospital in Cork, Ireland.

The study found a high prevalence of vitamin D deficiency among these patients.

70% of them had low vitamin D levels and 26% had severe deficiency of the vitamin. These high rates are believed to be related to the cause and presentations of arthritis, rheumatism and osteoporosis affecting the patients.

A 2011 study involving 1993 post-menopausal women whose vitamin D levels were monitored compared vitamin D supplement intake with the severity of joint pain.

First, the study showed that the study participants with low serum levels of vitamin D had high joint pain scores. The researchers also found vitamin D deficiency and joint pain are common in post-menopausal women.

They also found that dietary sources and regular vitamin D supplements only modestly improve vitamin D levels. This last finding may suggest the need for higher doses of the vitamin to improve joint pain in elderly women.

A 2008 study published in the Journal of Clinical Oncology supports this conclusion.

In that study, the effect of high doses of vitamin D was accessed for the relief of joint pain and fatigue in post-menopausal women using letrozole in breast cancer treatment.

The results of the study showed that standard doses of vitamin D do not increase serum vitamin D levels.  The researchers found that, in some patients, letrozole actually reduced vitamin D levels even when standard doses of the supplement are regularly taken.

However, high doses of vitamin D supplements were found to increase the serum levels of the vitamin and also relieve fatigue and joint as well as improve the movement and articulation of the affected joints.

How Vitamin D Helps Joint Pain

Some scientists believe vitamin D is the best analgesic for chronic musculoskeletal pain and joint pain.

However, vitamin D does not work like a typical analgesic. It does not just treat the symptoms; rather, it addresses the root causes of joint pain.

More specifically, the ability of vitamin D to improve the pain symptoms of degenerative and musculoskeletal diseases is linked to calcium. Vitamin D deficiency quickly creates calcium deficiency. When the calcium level is lowered, parathyroid hormone is increasingly produced in the body.

The parathyroid hormone reduces bone density and mineralization. These two effects can cause osteopenia and osteoporosis.

However, the most direct effect of the parathyroid hormone on bone architecture is that it triggers the formation of a spongy mass under the membrane covering the bones.

This spongy mass absorbs fluids and expands. Its expansion creates a pressure against the tissues surrounding bones. Since there are nerves carrying pain sensations in these tissues, the outward pressure generated by the expanding spongy mass causes musculoskeletal pain.

When this happens at the joint, it causes joint pain.

Therefore, vitamin D supplements can help prevent and reverse this cascade reaction. By preventing calcium deficiency, vitamin D controls the release and effect of parathyroid hormone. By extension, this effect prevents the formation of the spongy mass pressing against pain nerves.

In addition, vitamin D can help prevent and relieve joint pain by other means.

Different studies have shown that increased vitamin D supplementation improves posture and stability and reduce the risk of falls in the elderly. This means that vitamin D can ultimately prevent pain due to fractured bones.

Furthermore, vitamin D is involved in the inflammatory response of the immune system. Vitamin D reduces the production of cytokines that cause inflammation while increasing the levels of cytokines that reduces inflammation.

Examples of pro-inflammatory cytokines are interleukin 6, interleukin 12, C reactive protein and tissue necrosis factor-alpha. Interleukin 10 is an example of anti-inflammatory cytokines.

By modulating the effect of these cytokines, vitamin D can relieve joint pain especially in inflammatory arthritis diseases especially where an autoimmune reaction is involved.

How to Take Vitamin D for Joint Pain

Vitamin D is often supplied in doses ranging from 400 IU to 800 IU in multivitamin preparations. However, this is not enough to relieve joint pain. Therefore, you should add vitamin D supplements and take a daily dose of 2000 IU.

The total daily intake of vitamin D recommended for people suffering from joint pain is 2400 IU to 2800 IU.

This is still a safe dose of the vitamin since the upper tolerable limit is placed at 4000 IU per day.

This recommended dose of vitamin D can be continued for as long as necessary. Scientists believe that long-term supplementation of vitamin D has no adverse effect. Still, some physicians advise reducing the dose after a year especially during the summer months and when more foods rich in vitamin D are introduced to the diet.

The effects of vitamin D are not instantaneous but cumulative. Therefore, while some may see the first signs of positive results within weeks, others may need to wait for months.

When no positive results are seen after 3 months of dedicated use of the vitamin, a short course of treatment with higher doses of vitamin D and calcium supplements may be needed to quickly increase the levels of the vitamin and mineral in the body.

Sources


http://www.ncbi.nlm.nih.gov/pubmed/19100953

http://www.ncbi.nlm.nih.gov/pubmed/21184246

http://www.ncbi.nlm.nih.gov/pubmed/21093181

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