As Chiropractors, we are known for our medical expertise, knowledge and training in examining and treating the musculoskeletal system, i.e. the muscles, joints and bones of the human body and the way in which they move (or don’t move) with respect to each other.

However, there is another area of a person’s overall health which we look at, known as ‘metabolic intervention’. In other words, the nutritional state of a person and how this could pertain to ill-health, pain and dysfunction(s) in their system.

Improving your metabolic processes allows your neuromechanical system to work as it should to achieve overall health and wellness. One such avenue of discussion, which is seeing more and more media attention, is the consequences of the right/wrong amounts of vitamin D.

Firstly, what is vitamin D?

The word ‘vitamin’ is derived from two words, ‘vital amine’, which basically means the body cannot make it. Now, with all the other vitamins, this holds true in that you only get them from your diet. But Vitamin D is a bit of an oddity because, at best, we only get 10% of vitamin D from our diet. Which then begs the question “Where does the rest come from”?

The answer is that vitamin D acts more like a hormone as it is made by the human body. The skin is responsible for producing vitamin D. During exposure to sunlight, ultraviolet radiation penetrates into the epidermis (the top layer of the skin) causing photolysis (the changing of molecules by the action of light).

This molecular change is where the inactive pro-vitamin D3 is converted, by this ultraviolet light, into the active pre-vitamin D3 whereupon it enters the bloodstream. Subsequent interactions in the liver and kidneys then convert this into the active form of vitamin D.

Therefore, people who present to the Practice with a history of liver or kidney issues should firstly have their vitamin D levels checked as it could be this which is causing their presenting problems.

Why would this be?

Well, vitamin D deficiency is a common cause of persistent pain and muscular dysfunction. It can result in poor mood, behavioural changes and fatigue. A significant percentage of our neuromechanical pain patients are deficient/insufficient in vitamin D.

NICE (National Institute for Health and Care Excellence) did a study in 2018 which said that it is important to maintain a good dietary intake of vitamin D by taking vitamin D supplements.

If a person falls below the measured serum levels of vitamin D, a condition known as osteomalacia, can develop. Symptoms include bone discomfort or pain in the low back, pelvis and lower extremities, impaired physical function, muscle aches and weakness which is most marked in the front of the legs and buttock regions.

Vitamin D deficiency causes chronic widespread pain. How many times have you heard someone say that when they get into the sunshine or take a winter holiday in a warm climate, they feel so much better? Could the increase in vitamin D levels - due to increased sun exposure - be playing a part?

So, what could be going on here?

Vitamin D is thought to play an important role in modulating the inflammatory system in humans by regulating the production of the chemicals involved in this process. A deficiency in vitamin D causes a sustained inflammatory response which can damage healthy cells. It can also affect the brain by changing mood and behaviour and can hypersensitise the nervous system.

At very low levels of vitamin D, common diagnosis can include fibromyalgia, chronic fatigue syndrome, depression, anxiety, growing pains in children and grumpiness in teenagers!

A 2018 study in the ‘’International Journal of Rheumatic Disease’ looked at evaluating the effect of vitamin D replacement on musculoskeletal symptoms and quality of life in patients with chronic widespread pain including fibromyalgia and vitamin D deficiency.

These people were given 50,000IU of vitamin D3/week for 3 months and then reassessed. Researchers found that there was a 47% reduction in pain levels, 35% reduction in depression and a 77% increase in vitality.

There is also evidence that Vitamin D can have a profound influence on your immunity

Research from a 2017 study (below) published in the British Medical Journal (BMJ) found that Vitamin D is very good at preventing respiratory tract infections (RTI) which, with the current Covid-19 situation, we should all be interested in. This study reviewed 25 randomised control studies and concluded that Vitamin D supplementation was safe and that it protected against acute RTI’s.

In addition, there is a theory that suggests that one of the reasons influenza comes around each winter is because vitamin D levels drop at this time of year which affects our immunity. Influenza is circulating throughout the whole year and yet it only seems to strike and affect us during the winter, as the results of the epidemiological study below concludes.

So, could vitamin D have a role to play in the Coronavirus pandemic?

Some research was published recently (May 2020) that specifically looked at patterns of mortality from Covid-19 and vitamin D. It looked at 780 cases with confirmed SARS Cov-2 plus vitamin D status including some other parameters (sex, age and pre-existing conditions).

The researchers found that older men with pre-existing conditions and below normal levels of serum vitamin D had a significant risk of mortality from Covid-19. This was already known from some similar findings in an Italian study that looked at the same parameters as this recent study but with one significant addition. This study (below) also looked at whether low serum levels of vitamin D had an effect.

The results in Table 1 (below) show that 49.7% of subjects had normal levels of serum vitamin D, 27% had insufficient levels and 23% were deficient.

Table 2 then shows the increased risk factors for the four variables considered in the study – age, sex, pre-existing conditions (aka co-morbidity) and vitamin D status.

The table shows that for those subjects over 50 years of age, mortality rates went up 10x. If the subject was male, mortality rose 5x. If there were pre-existing conditions present, mortality rose 11x but if a subject was deficient in serum vitamin D, that person’s mortality rose 19x and with insufficient levels rose 12x.

Any of you who have been watching the daily government briefings will know that, quite often, there is mention of higher mortality rates being seen in ethnic communities from Covid-19 and there are scientists who are very interested is considering whether low levels of vitamin D are playing a role in these individuals.

All of these findings are very interesting but it is important to be aware that the results are associated with a preliminary study with an early dissemination of results; meaning the data may be subject to change in the future. More work needs to be done to look at all aspects of our immune system but from previous work and research published, we do know that vitamin D is key to a normal immune response.

Skin production of vitamin D

The UK is situated in the northern hemisphere, so we can only produce vitamin D at certain times of the year for the simple reason that during the winter, the sun is too low in the sky. This means the ultraviolet light responsible for vitamin D production simply bounces off the Earth’s atmosphere and back into space. No matter how sunny an atypical winter’s day may be in the UK, you will get zero vitamin D skin production.

There are two ways to remember when it is a good time:

1. Between the clocks going forward (March) and back (October) you will produce vitamin D through skin exposure to the sun. Between October and March you will not produce vitamin D through skin exposure to the sun.

2. If your shadow is shorter than you, you will produce vitamin D. If your shadow is longer than you, there will be no vitamin D skin production.

Sun exposure needed for vitamin D skin production

The ‘Minimum Erythermal Dose’ or ‘MED’ is defined as the threshold dose that may produce sunburn. It is the equivalent to 20,000IU of vitamin D produced in 30 minutes. The aim is to get a third to a half of the ‘MED’ per day to receive the necessary levels of vitamin D required for good health.

Look to expose a minimum of 25% of your skin, usually the face, arms and legs for around 10 to 30 minutes per day depending on skin tone and type.

The best time of day for skin exposure is 11am to 3pm but be careful with the sun lotion. Factor 30 blocks out 99% of all vitamin D production. So, get a little sunshine first with no sun block, then splash on the sun protection afterwards.

Whatever you do, DO NOT BURN! The same ultraviolet light that does good in initiating vitamin D production also causes burning and long-term skin damage including carcinoma.

To ‘D’ or not to ‘D’? Who should take supplements and when?

Some of the symptoms associated with vitamin D deficiency include - as mentioned previously - depression, mood/behaviour issues, fatigue, sleep problems, over-eating and muscle pain; exactly the same symptoms associated with seasonal affective disorder (SAD). This means it is vital to maintain good Vitamin D levels year round.

As I said at the beginning, Vitamin D acts more like a hormone than a vitamin in that our bodies produce it. The added bonus is that we can also store it in our fat cells – brilliant!

Unfortunately, this store does not see us through the dark months of winter as the normal half-life of vitamin D is 6 weeks. So, even if you go into winter with a healthy store, by January/February, you may be severely depleted if you don’t supplement.

Low vitamin D levels are also a consequence of the aging process. The skin becomes less efficient in it’s ability to produce vitamin D with age. Therefore older people and those who cannot tolerate the sun should supplement all year round.

People who are overweight and obese naturally have a lot of fat and one would assume they don’t need to supplement. Unfortunately, this is not the case as the vitamin D is held in the fat and not in the blood where it is needed.

So, someone in this category would actually need to supplement by an extra 50% if they are 3 stone overweight and 100% if more than 5 stone overweight.

Just be careful where you get your supplement from. Always buy from a reputable source. If you have any concerns on this point, just contact me at the Practice on info@creativechiropractic.co.uk and I should be able to advise you.

One word of warning; people who suffer from a condition of the lungs known as sarcoidosis, as well as those with naturally high levels of calcium in the blood, should seek professional advice before considering supplementing with high doses of vitamin D.

Things you can do now!

Get out in the sunshine if you can, where you can.

During this testing and stressful time of social distancing, self-isolating and just being ultra careful, for some people this can be very difficult. Some of our more elderly and vulnerable patients have been in touch to ask for advice about their vitamin D and how they can get it.

If you cannot get outside for any reason, simply pull a chair up to an open window and allow your face and arms to get bathed in some sunshine for 15 to 30 minutes depending on skin type.

If you have any concerns due to an underlying condition or you are unsure of anything, always seek medical advice. Better to be safe than sorry.

Footnote: Following completion of this article by Michael, we were very interested to see a piece in The Guardian newspaper regarding an upcoming public health review into the effects of vitamin D on Coronavirus. We will await the results with great interest. You can read the Guardian article HERE