EP.284/ Signs You’re Low in Vitamin D and How it Affects Endo
Recently, I’ve had a lot of low levels or deficiencies show up with clients. Many of them were experiencing low moods, cyclical pain or heavy menstrual bleeding, fatigue, heart palpitations, aching muscles, and overall feelings of inflammation.
Whilst yes, these can all be due to or linked to endometriosis, we have to be careful about blaming everything on endo and not investigating these kind of situations further. In some of these cases, I suspected low iron and in others low vitamin D, or low B12, depending on the symptoms presenting. I think many of us just don’t always believe these essential nutrients can make such a big difference, but they absolutely can. And lo and behold, each client I tested, was low in the nutrients I suspected and felt a significant difference with prescription level supplements.
So, I’m not sharing this to show off and prove I was right – I’m sharing this to alert you to the fact that some of your symptoms may not just be endo.
Today we’re focusing on low vitamin D symptoms in particular and how they may very well look like endo symptoms. In the winter especially, low vitamin D levels are much more common and additionally, studies suggest that women with endometriosis often have lower vitamin D levels, so this is a common deficiency to be aware of.
Okay, so let’s dive in (oh and just a reminder before we jump in, this is a bitesize episode, but I’ve linked to further reading in the show notes).
Fatigue
First up is chronic fatigue. An easy one to dismiss as endometriosis, but vitamin D is crucial for energy production and research shows that those with low or deficient levels report fatigue, whilst supplementation improves this symptom.
Period pain/Endo pain
Research has shown a strong association between menstrual disorders, endometriosis, and vitamin D deficiency, including its development and severity. But endometriosis isn’t the only chronic pain condition linked to low vitamin D levels, in fact, research has shown that 71% of people with a chronic pain condition may suffer from the deficiency. This is in part due to many chronic pain conditions being of an inflammatory nature, and vitamin D is anti-inflammatory, but also because vitamin D is involved in pain signalling.
Studies have suggested vitamin D supplementation can help with certain pain and menstrual related conditions, including dysmenorrhea (which means period pain) and PMS.
I see many of my client’s endometriosis related ovulation and period pain and PMS symptoms improve dramatically when supplementing with vitamin D. I actually had one client whose symptoms weren’t very responsive to strategies, until we investigated, discovered a vitamin D deficiency, and began supplementation, after which, the improvement was profound.
Body pain
I’m calling this one body pain, because so many clients describe it to me in this way, but vitamin D's role in maintaining healthy bones and muscles means that low levels can result in increased bone pain and muscle pain. Often clients say to me their whole-body hurts or they feel inflamed everywhere, so it’s not always as obvious as calve muscles hurting, for example. And in fact, research has linked vitamin D deficiency with “chronic widespread pain” so please don’t dismiss your full body pain as only down to endo related inflammation because this may be playing a role too!
Depression and Mood Swings
I work a lot with clients who have anxiety and depression, both of which have been linked to endo. I also work with a lot of clients with PMDD. I have noticed that they struggle most or experience an increase in symptoms when they’re low in vitamins D, B12, folate or iron, which is unsurprising as all of these nutrients have been linked to depression and vitamin D in particular has been associated with anxiety, depression, and mood disorders in research.
Heart palpitations
As you may have heard me bang on about over the past two years or so, we are seeing more associations with endometriosis and dysautonomia conditions, in particular, POTS. POTS stands for postural tachycardia syndrome and is a condition that affects the normal functioning of the autonomic nervous system, which is the system that controls involuntary bodily functions, like heart rate and blood pressure. In POTS, when a person stands up, their heart rate increases significantly more than usual but people with POTS often experience a range of full body symptoms (like fatigue) all day. The classic symptoms include a racing heart, dizziness, difficulty breathing, heart palpitations and sometimes heart pain and fainting, but the symptoms are wide reaching.
Now, because we are seeing more connections between POTS and endo (I’ll put some resources in the show notes by the way), many clients come to me wondering if they have it, or they already have a diagnosis, and think that they’re just having a really bad flare up, when in actual fact, their vitamin D levels were low, which was causing heart palpitations, etc.
The reason why vitamin D deficiency causes heart palpitations is largely to do with calcium. Adequate vitamin D levels are essential for maintaining healthy calcium levels and calcium is heavily involved in regulating our heartbeat. Without sufficient levels, we can experience heart palpitations and over time, further complications. In fact, multiple studies have linked low vitamin D and calcium to abnormal heart beats.
Other symptoms
So, there are definitely other symptoms associated with vitamin D deficiency, including getting sick regularly and hair loss, however, those are the ones I see most frequently and ones that could be mistaken as symptoms of endometriosis alone.
Testing
So, if any of this sounds familiar, I imagine you’ll want to check.
You can get a simple vitamin D test from your doctor, and this will be a blood test. Explain to your doctor your symptoms and I’ve listed a few other resources for symptoms in the show notes so you can compare what you’re experiencing with those. It’s worth also just saying you don’t supplement, as in the UK, I think the US and in many cloudy places, vitamin D supplementation is recommended in winter to prevent deficiencies and so they may take you more seriously if you say that!
If they refuse to test, which I’m afraid to say, many do, then I’ve linked to a few places you can order some online and those will be finger prick tests.
So, what are you looking for in terms of results?
Well, conventional medicine is basing its ranges on averages, so they take a mix of people with healthy vitamin D levels and unhealthy levels, and they base ‘normal’ levels on those averages. In contrast, functional medicine, which is what I’m trained in, is based on optimal levels, not averages.
For those of you who are rolling your eyes (I know there are some of you), I want to give you an example of how using normal levels can be detrimental.
I had three clients in the past several months who I suspected had low iron levels. One came back with ferritin levels of 14 ug/L (micrograms per litre) and was told she was normal; another came back with I think 11 or 12 and was given prescription iron supplementation, another came back with 8 and was given iron blood transfusions. My client who was 14, was just outside of deficient, had all the symptoms of anaemia, but was told she was normal with not even a suggestion of increasing her iron levels – this is despite the fact that the conventional reference range was between 13 and 150.
In my functional medicine training, we’re looking at healthy ferritin levels as being above 70 (micrograms per litre) so you can see how far out these clients were, though my client with 14 being told she was normal.
Okay, so you get the point, so now let’s talk about vitamin D. Conventional reference ranges for vitamin D will vary from country to country, but in the UK, above 50 nmol/L (nanomoles per litre) is considered sufficient, whereas in functional medicine, we’re looking for between 30-50 ng/mL (nanograms per millilitre), which converts to 75-125 nmol/L.
If you do need to supplement, a good maintenance dose is 2000 IU (international units) a day, but some countries will recommend lower but generally, this is a safe dose.
5000IU daily is the recommendation for low levels of vitamin D (though some doctors will prescribe 20,000 IU a few times a week) but because of the risk of vitamin D toxicity if you take too much, you should work with your doctor to agree on the required dose for you personally and retest between 60 to 90 days after beginning to supplement at these higher levels. Once you’re at a healthy range, you can drop down to a maintenance dose.
Regardless, please remember that this is general information and is never tailored medical advice, so please consult your doctor or health practitioner whenever you start a new supplement regime.
Okay, that’s it! I hope this episode has helped you understand the importance of checking your vitamin D levels for good endometriosis management.
Show Notes
Palpitations
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9220304/
https://www.theendobellycoach.com/podcast/pots-dysautonomia-with-endo?rq=POTS
https://www.theendobellycoach.com/podcast/endo-and-dysautonomia?rq=POTS
https://www.theendobellycoach.com/podcast/endometriosis-and-ehlers-danlos-syndrome?rq=POTS
Mental health
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9468237/
https://pubmed.ncbi.nlm.nih.gov/35022097/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011048/
Chronic pain
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260782/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10260782/
Menstrual issues, endo, PMS, etc.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6265788/
https://pubmed.ncbi.nlm.nih.gov/29447494/
https://www.sciencedirect.com/science/article/abs/pii/S2666571922000202
Testing
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/
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Produced by Chris Robson