Optimal Vitamin D Levels Support Immunity and Improve Back Treatment Outcomes

Most healthcare practitioners are aware of Vitamin D’s effects on calcium homeostasis and bone health, but the multitude of studies, which show that Vitamin D is effective at strengthening the immune system, have made it clear that Vitamin D has other important roles to play in the body.

Vitamin D is able to regulate both the innate (general first-line defense) and adaptive (specific to a particular antigen) immune response in the body. That’s why a Vitamin D deficiency is associated with increased autoimmunity (a misfiring of the immune system in which the body becomes confused and attacks itself) as well as susceptibility to infection.¹

Immune cells like T cells and B cells have a Vitamin D receptor and are capable of synthesizing the active Vitamin D metabolite, which allows Vitamin D to act as an autocrine signaling agent between these immune cells.

More specifically, a systematic review of five clinical trials has shown that adequate Vitamin D levels play an important role in reducing the rate and severity of acute respiratory tract infections.² In the midst of the current COVID-19 pandemic, that conclusion makes Vitamin D a very valuable resource for patients who are concerned about contracting a severe viral infection and therefore want enhanced immune support.

Patients Need Vitamin D

We’ve established that maintaining an optimal level of Vitamin D can improve immune system function and prevent (or reduce the severity of) many health issues, from cold and flu to autoimmunity and infections. Vitamin D is necessary for robust health, but in today’s world it can be difficult to get enough sunlight for the body to produce adequate Vitamin D without dietary changes like eating more leafy greens or Vitamin D3 supplementation.


According to various studies, Vitamin D deficiency can result in many abnormal conditions, including obesity, diabetes, hypertension, depression, arthritis, fibromyalgia, chronic fatigue syndrome, and osteoporosis. However, an optimal level can improve patients’ mood, regulate insulin, support heart & lung function, protect the brain from toxic chemicals, and help limit lumbar disc degeneration, low back pain, and muscle spasms.*

Vitamin D—What’s The Right Level?

Vitamin D is key to the health of every cell in the body. It is vital to cell proliferation (when cells grow and divide) and cell differentiation (when a cell changes from one cell type to another). Overall, Vitamin D influences more than 200 genes, each of which has the propensity to become impaired without adequate levels. Yet, Vitamin D deficiency has reached epidemic proportions.

It is estimated that 1 billion people worldwide may be Vitamin D deficient,³ including over 40% of Americans.4 According to Harvard Medical School, it’s not uncommon to see patients with a Vitamin D level that is less than 20 ng/ml. When levels are that low, they suggest patients be told that they are deficient, and that practitioners recommend a fairly aggressive replenishment protocol as well as ongoing supplementation.5

In 2011, the respected Endocrine Society, the world’s oldest and largest organization of scientists devoted to hormone research, issued a report urging a much higher minimum blood level of Vitamin D. Their experts concluded: “Based on all the evidence, at a minimum, we recommend Vitamin D levels of 30 ng/mL, but to guarantee sufficiency, we recommend between 40 and 60 ng/mL for both children and adults.”6

Vitamin D Deficiency, Lumbar Disc Degeneration, & Low Back Pain

When I consult with colleagues that treat musculoskeletal pain on a daily basis, a majority of them don’t take into consideration that a Vitamin D deficiency could exacerbate the symptoms of their typical patient with back pain and muscle spasms. Yet, research suggests a correlation.

Vitamin D deficiency is common in people with chronic low back pain. Studies show that this deficiency can be the primary cause of the pain, as well as make the condition worse if it is already present.7

Some practitioners forget that back pain is a common symptom of osteomalacia. The Mayo Clinic describes osteomalacia as a marked softening of the bones that is most often caused by Vitamin D deficiency. The typical symptoms they list are aching pain that affects the lower back, pelvis, hips, legs, and ribs. They suggest that the pain is often worse at night, which may explain the reason that many patients complain of morning back pain.8

Vitamin D deficiency is also associated with lumbar disc degeneration and low back pain among postmenopausal women, according to new research from the scientific journal Menopause.9

The study found that women who had a Vitamin D insufficiency or severe deficiency were more likely to experience serious musculoskeletal pain. Based on these findings, the authors concluded that Vitamin D deficiency is prevalent among postmenopausal women and is strongly correlated with lumbar disc degeneration and low back pain in this population.

The authors recommend that healthcare practitioners tell their at-risk patients about the benefits of Vitamin D supplementation to reduce Vitamin D deficiency among postmenopausal women.

What to Look For When Dispensing Vitamin D

Vitamin D supplements are available in two forms: D2 (ergocalciferol) and D3 (cholecalciferol). According to a fact sheet for healthcare professionals from The National Institutes of Health, D3 is more effective because it’s the same form produced by the body when skin is exposed to sunlight.9 Always look for a Vitamin D supplement that contains 125 mcg of cholecalciferol per capsule to provide 5,000 IUs each. In addition, make sure to recommend a veggie capsule that contains no gluten, wheat, or dairy, which can be inflammatory.

Dr. Don Hayes

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(1) www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/

(2) www.ncbi.nlm.nih.gov/pmc/articles/PMC3543548/

(3) www.ncbi.nlm.nih.gov/pmc/articles/PMC4143492/#AFU104C1

(4) www.pubmed.ncbi.nlm.nih.gov/21310306/

(5) www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

(6) www.ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

(7) Plotnikoff, GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain. Mayo Clin Proc. 2003 Dec;78(12):1463–70. PubMed #14661675

(8) www.mayoclinic.org/diseasesconditions/osteomalacia/symptomscauses/syc-20355514

(9) www.contemporaryobgyn.net/view/vitamin-d-deficiency-leads-lower-back-pain

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