If you have never had your serum 25(OH)D level tested, I suggest you do it even if it is just out of curiosity. If your level is above 75nmol/L, good on you and if it is below that, then take your clothes off and lie in the sun. Either that, or consider vitamin D supplements and light therapy.
“The low dietary intake (Vit. D) and decreased solar radiation exposure during the polar winter reduce serum vitamin D levels in otherwise healthy individuals, which suggests that supplementation may be necessary.”(Premkumar et al 2013)1
As a result of low light and/or poor dietary intake, vitamin D deficiency can lead to osteomalacia (weak bones), and has been associated with depression, diabetes, hypertension, multiple sclerosis and even chronic pain. 2,3
Vitamin D deficiency is not only common in northern countries such as Canada but also in some Middle Eastern and North African countries. Despite the intense sunshine in those countries, Vitamin D deficiencies are widespread especially among the women in the population.4
“The Middle East and North African regions have a very high rate of vitamin D deficiency, which reaches 81 percent among various age groups.” (Alamoudi 2019)4
There are a number of factors that decrease the skin’s production of vitamin D such as aging, dark skin, sunscreen application and the covering of skin.5 One study proposes that vitamin D produced in the skin may last longer in the blood than with vitamin D from diet.6
It doesn’t matter where you live; get outside, expose some skin and walk in the sun, especially if you have pain. You may say, “It’s winter, it’s cold and there is no sun!!”
In that case, definitely consider Vitamin D tablets or drops as this systematic review on the efficacy of Vitamin D supplementation and chronic pain concludes, “vitamin D supplementation is able to decrease pain scores and improve pain” (Yong et al 2017) 7
A 2019 meta-analysis concludes, “Vitamin D supplementation favorably impacted depression ratings in major depression with a moderate effect size.” (Vellekkatt 2019) 8
How about trying an inexpensive light therapy lamp? (Sold on-line at Home Depot, Best Buy and Amazon)
One multicenter RCT demonstrated that a 3-week course of light therapy reduced depressive symptoms and pain intensity in patients with chronic low back pain. 9
Clinical relevance: Have your patients with persistent pain and low mood, consider
i) Direct sunlight
ii) Vitamin D supplementation (3000IU/day)
iii) 30 minutes of daily light therapy
I have one in front of me right now as I am typing this report. Hope you enjoy reading it :o)
- Premkumar M et al Vitamin D homeostasis, bone mineral metabolism, and seasonal affective disorder during 1 year of Antarctic residence. Arch Osteoporos. 2013;8:129.
- von Känel R et al Vitamin D and central hypersensitivity in patients with chronic pain. Pain Med. 2014 Sep;15(9):1609-18.
- Ascherio A et al Vitamin D as an early predictor of multiple sclerosis activity and progression. JAMA Neurol. 2014 Mar;71(3):306-14.
- Alamoudi LH et al Awareness of Vitamin D Deficiency among the General Population in Jeddah, Saudi Arabia. J NutrMetab. 2019 Mar 3;2019:4138187.
- Al-Daghri NMVitamin D in Saudi Arabia: Prevalence,distribution and disease associations.J Steroid BiochemMol Biol. 2018 Jan; 175():102-107.
- Haddad J. G., Matsuoka L. Y., Hollis B. W., Hu Y. Z., Wortsman J. Human plasma transport of vitamin D after its endogenous synthesis. Journal of Clinical Investigation. 1993;91(6):2552–2555.
- Yong WC et al Effect of vitamin D supplementation in chronic widespread pain: a systematic review and meta-analysis. ClinRheumatol. 2017 Dec;36(12):2825-2833.
- Vellekkatt F et al Efficacy of vitamin D supplementation in major depression: A meta-analysis of randomized controlled trials. J Postgrad Med. 2019 Apr-Jun;65(2):74-80.
- Leichtfried V et al Short-term effects of bright light therapy in adults with chronic nonspecific back pain: a randomized controlled trial. Pain Med. 2014 Dec;15(12):2003-12.