Vitamin D also called sunshine Vitamin actually doesn’t work like a vitamin rather it works like a hormone. Vitamin D involves not only bone formation it exerts wide range of biological effects inside the human body. Directly or indirectly Vitamin D regulates about 200 gene expressions which involves in cellular death, reproduction and differentiation. Details of which yet to be understand. Vitamin D also has inverse relations with markers of inflammation. Common factors like chronic fatigue, body pains, sleep disturbance has negative impact in quality of life in modern days. Less exposure to sunlight, most of the time living in shade are also some common factors in today’s life. Can low vitamin D level be a cause behind them? Is vitamin D deficiency linked with chronic fatigue and body aches?

The perspective on how vitamin D influences human health has changed dramatically based on the finding that the vitamin D receptor (VDR) and the vitamin D activating enzyme 1-α-hydroxylase are expressed in many cell types. VDR a member of the nuclear receptor family binds with the calcitriol or most active form of vitamin D and encodes the nuclear hormone receptor. And thus it involves in mediation of active form of vitamin D hormone.

Vitamin D pathway

You can find vitamin D in two forms vitamin D3 or cholecalciferol and vitamin D3 or ergocalciferol. Our body can synthesize vitamin D3 in the skin upon exposure to Sunlight with the help of cholesterol. Dietary source of vitamin D3 mainly includes few fatty fish, animal source like egg yolk, butter etc. While vitamin D2 comes from plant food like mushroom grown in UV light, fortified foods. You can find vitamin D2 in most fortified food since it is the cheaper form.

Vitamin D binds with a specialized protein called vitamin D binding protein (VDBP) and travels through blood. Both forms of vitamin D are transported to the liver where they are converted to 25-hydroxy vitamin D or 25(OH)D or calcidiol.

25(OH)D or calcidiol is the major circulating and stored form of vitamin D but biologically inactive and must be converted to the biologically active form 1,25-di-hydroxy-vitamin D or 1,25(OH)₂D or calcitriol. In kidney an enzyme called 1-α-hydroxylase converts 25(OH)D or calcidiol to the most active form 1,25(OH)₂D or calcitriol. And this active form of vitamin D moves through circulation to various parts of the body and exerts its action. However as mentioned the perception on effects of vitamin D on human body has changed after finding vitamin D receptor (VDR) and the vitamin D activating enzyme 1-α-hydroxylase are expressed in many cell types such as such as intestine, pancreas, prostate and cells of the immune system. (1)

Is vitamin D deficiency linked with chronic fatigue and body aches?

Role of vitamin D in osteoporosis and bone formation

Like every other living tissues, organs of our body, bones also have living cells. So they die and new bone cells form and this death and birth circle goes continuous. Through which our body removes old bones through a process called osteoclasts or bone resorption. And on the other hand new bones are formed through a process called oeteoblasts or bone formation. Bone resorption is followed by bone formation and one can’t be happened without the other.

In some way anti-resorptive drug or medicine prevent the resorption process and show good bone mineral density. But actually you are preserving the old bones and that can make your bone brittle.  

Bone formation

Calcium and phosphorus are two essential nutrients required for bone formation. Most of us know that vitamin D helps in absorption of calcium and phosphorus from our intestine and release to the circulation. And actually 1,25-dihydroxyvitamin D(3) or1,25(OH)(2)D(3), or the active form of vitamin D regulates calcium and phosphorus metabolism, thus become a key-player in bone-formation.(2) That’s why if you have low vitamin D level and you are likely to absorb lesser amount of calcium and phosphorus. And so that further impair the bone formation process. In other word vitamin D has direct co-relation with bone mineral density and people having osteoporosis also have low vitamin D level. (3,4)

One thing I wish to mention vitamin D helps in absorption of calcium from your intestine and release it into the circulation. And vitamin K2 places calcium from circulation in right place i.e. in bones and teeth. If you have low vitamin K2 the calcium of your circulation more likely to deposits in your blood vessels rather than bones and teeth.

Read more about with this article Vitamin K2-A crucial vitamin for benefits of heart and bone health

Crucial health benefits of vitamin K2 in brain health, beauty, in prevention of kidney stone, cancer and more, and daily dose.

Vitamin D has inverse relationship with Parathyroid Hormone (PTH)

Vitamin D has close relationship with Parathyroid Hormone (PTH) that is produced by parathyroid gland. PTH or Parathyroid Hormone maintains normal calcium level by acting on intestine, kidneys and bones. That means when your blood calcium level becomes low PTH brings it back to the normal. In bones PTH dissolve calcium and bring calcium into blood.

Vitamin D has inverse relationship with PTH. That means when you have low vitamin D level your PTH level becomes high. (5) Therefore people having vitamin D deficiency produces excess PTH which results excessive dissolving of calcium from bones. Also if you have low vitamin D level your absorption of calcium from food and release to blood circulation impairs. And thus these processes make bones weak and such individual begins to feel pain. In such case if you are not testing your PTH and vitamin D level and taking painkiller regularly then you are killing your own health. You need to identify the cause, the root cause.

Investigation of vitamin D level in patients of chronic pain and muscle aches at university affiliated clinic in Minneapolis, researchers found nearly all the patients had low D level and many had severe deficiency. (6)

What are the studies

Numbers of large observation studies have found people having vitamin D deficiency also had chronic lower back pain. (7,8)

Study on more than 9000 older women found association of low vitamin D with back pain. In severity they had difficulty in perform daily activities. (9) Another controlled study people having lower vitamin D level had experienced nearly twice bone pain in their legs, ribs or joints compared to those with the normal blood level range. (10)

Pain, Muscle weakness

In addition the bone formation, vitamin D exerts extra‐skeletal actions while reducing inflammation. Vitamin D and its associated minerals calcium, phosphorus has also roles in muscle function. Through its nuclear receptor (VDR) located throughout the body, including skeletal muscle, vitamin D initiates genomic and nongenomic pathways in regulating multiple actions as well as muscle function. Vitamin D has also play role in muscle development and deficiency can lead to muscle weakness, falls and sarcopaenia. Vitamin D deficiency is also associated with insulin resistance, but this is confounded by obesity or overweight and sedentary lifestyle, indoor living. (16, 11)

The vitamin D receptor of VDR is also present in nerve cells called nociceptors, which sense pain. And deficiency of vitamin D can contribute to stimulation of nociceptors and muscular hypersensitivity as well as pain. (12)Several studies had also shown supplementation of vitamin D on deficient can reduce various types of pain including musculoskeletal pain.(13,14,15) In 2018 published study vitamin D appears to play a role in muscle strength, injury prevention, and sports performance.(16)F

Fatigue and tiredness

Chronic pain can also lead to fatigue and tiredness. Vitamin D deficiency may contribute to symptoms of sleepiness via inflammatory component, including known sleep regulating substances. Vitamin D functions as a physiologic regulator of sleep and affects the central nervous system homeostatic sleep pressure. (17, 18) Although exact mechanism yet to be ascertained several studies had found association of low blood vitamin D level with fatigue as well as low quality of life with daytime sleepiness. Study suggest that clinicians should consider obtaining vitamin D levels in patients with daytime sleepiness/fatigue, nonspecific musculoskeletal (bones, joints, muscles, tendons, ligaments, or nerves) pain.(18,19)

A double-blind placebo-controlled study on 120 men and women with age around 30 year had found D treatment significantly improved fatigue symptoms. (20)

Fibromyalgia is a chronic disorder that cause widespread pain often accompanied by fatigue, depression, sleep disturbance, muscle stiffness, cognitive impairment, digestive problem etc. A meta-analysis revealed credible evidence that vitamin D can also be a determinant factor for fibromyalgia.(21)

Which Form of Vitamin D

In usual vitamin D comes in two forms vitamin D3(cholecalciferol) and D2(ergocalciferol). Vitamin D from the sun and fatty fish contains vitamin D3 and on the other hand D2 comes from vegetable sources. As human body can synthesize vitamin D3 not D2, so D3 can be considered as more preferred source of vitamin D than vitamin D2. Study showed vitamin D2 has less than one third potency of that vitamin D3 has. (22)

Daily Dose

Safe upper limit of vitamin D daily intake is as below: (23)

Vitamin D food sources(23)

Interaction

Vitamin D and calcium supplement might interfere with calcium channel blocker drug which disrupt the movement of calcium through calcium channels. High dose of vitamin D can be toxic to health.While symptoms of toxicity are unlikely at daily intakes below 10,000 IU/day depending upon physical condition of individual. (23)

Which Testing method?

Usually two types of vitamin D test are done through blood sample, determination 25(OH)D or calcidiol and 1,25-di-hydroxy-vitamin D or1,25(OH)2 D or calcitriol. While both test can give different results. Testing of 25(OH)D can taken as better test over 1,25-dihydroxy-vitamin D or 1,25(OH)2 D test due to following reasons:

• 25(OH)D form stays in blood for much longer period gives better stability.
• PTH stimulates the conversion of 25(OH) D vitamin D to 1,25(OH)2 D. So high PTH level can show false result.

Vitamin D deficiency is incredibly a common deficiency but most are not aware of it. Vitamin D deficiency can severely impact the quality of life as well as make people diseases prone. Fortunately you can fix it easily.

 
Disclaimer: Information provided here are generalized information for 
educational purpose only,  not intended to provide one to one health 
consultation or replace practice of a qualified practitioner. Different 
people may have different health condition and may have different reaction 
to the same food. Hence it has been advised to consult with health care 
provider before application of any of above guidelines.  
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23. National Institute of Health                                        

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