Vitamin D For Neuropathy: Research, Benefits & Dosage (2023)

Name: Vitamin D, Vitamin D3, cholecalciferol
Goes well with: Calcium, Magnesium
Number of scientific references: 29
Level of Evidence: Level II What is this?

Note: Rectifying existing vitamin D deficiency can help relieve pain and other symptoms of peripheral neuropathy. Its benefits on nerve function still need to be researched further in humans. The effective dose of vitamin D for neuropathy relief depends on your serum vitamin D levels.

The sunshine vitamin is produced in the skin after exposure to ultraviolet B and maintaining adequate levels of this micronutrient is essential for good bone health.

There are two types of vitamin D: Vitamin D2 (ergocalciferol) and Vitamin D3 (cholecalciferol). Vitamin D2 is produced by plants, and vitamin D3 is present in cod liver oil, salmon, mackerel.

After being synthesised or consumed via diet, Vitamin D is converted to inactive 25-hydroxyvitamin D [ 25(OH)D ] which is then converted to a biologically active form, 1,25-dihydroxyvitamin D.

The sunshine vitamin plays an important in absorption of various minerals including calcium.

Most practitioners agree that vitamin D deficiency is a 25(OH)D concentration less than 20 ng/ml. This deficiency is observed in various conditions like autoimmune diseases, cognitive dysfunction, cancer, heart diseases etc.

Low levels of the sunshine vitamin are associated with increased nonspecific musculoskeletal pain. The sunshine vitamin regulates pain transmission by interacting with receptors present on pain-sensing nerves, regulating the activity of neurotransmitters and by influencing inflammatory process.

Vitamin D supplementation can help in peripheral neuropathy by rectifying existing deficiency. This can help reduce neuropathic pain and symptoms of neuropathy. It can protect nerve health and may support nerve regeneration and remyelination.

Vitamin D For Neuropathy: Research & Benefits

Research has confirmed that patients with severe neuropathy have vitamin D deficiency. And few studies have demonstrated that supplementation with the sunshine vitamin helps relieve the symptoms of peripheral neuropathy.

1. Vitamin D relieves symptoms of diabetic neuropathy

Deficiency of the sunshine vitamin may also be associated with severity of nerve function impairment and inflammation in diabetes.

In 2012, the NHANES study confirmed that vitamin D deficiency is associated with peripheral neuropathy even after adjusting other factors such as the presence of other health conditions, use of medications.

A recent meta-analysis study published in The Journal of Clinical and Translational Endocrinology, 2017 reported that deficiency of the sunshine vitamin could contribute to the development of diabetic neuropathy in Caucasian patients.

They also observed that Asian patients with diabetes and vitamin D deficiency are 1.22 times likely to develop diabetic peripheral neuropathy than patients with normal vitamin levels.

In 2012, Dr Bell reported how vitamin D supplementation resolved the symptoms of diabetic neuropathy in a patient using tricyclic antidepressants, gabapentin, pregabalin and opioid analgesic oxycodone for pain relief.

The supplementation helped rectify the deficiency and successfully resolved nerve pain.

Multiple studies have been conducted to observe how rectifying the sunshine vitamin deficiency can relieve diabetic neuropathy symptoms.

A clinical trial was conducted where 112 type 2 diabetic patients with peripheral neuropathies were treated with Vitamin D or placebo for eight weeks. They received 50,000 IU cholecalciferol or placebo once a week for eight weeks.

Oral cholecaciferol supplementation improved plasma vitamin D levels in the treated group. Also, a reduction in neuropathy symptoms was observed; there was a significant reduction in neuropathic pain or burning pain. No changes in blood sugar control were noted.

But, no significant improvement was observed in nerve conduction velocity and neuropathy disability score. Only one patient had normal nerve conduction velocity after the therapy while three patients experienced improvement in nerve conduction velocity.

Researchers stated that perhaps it takes more than eight weeks for Vitamin D to regenerate nerves.

Basit et al. showed that a single intramuscular dose of 600,000 IU vitamin D improved serum vitamin levels and reduced symptoms of painful diabetic neuropathy over 20 weeks in type 2 diabetes patients.

12 weeks of aerobic exercise and vitamin D supplementation is proven to reduce symptoms of sensory-motor neuropathy in diabetes. (Advanced Biomedical Research, 2017) The combination therapy brought about a significant reduction in pain, numbness, tingling and improved touch and vibration perception.

Despite the fact that multiple human studies have confirmed that rectifying vitamin D deficiency benefits in diabetic neuropathy, the exact association of the vitamin levels and symptoms of diabetic neuropathy is not understood yet.

Esteghamati et al. demonstrated that participants with less 20ng/ml of vitamin D had high chances of developing symptomatic diabetic neuropathy and so were patients with vitamin D levels greater than 40ng/ml.

This suggests that vitamin D supplementation regime must be designed as per individual patient’s requirements and monitored accordingly.

Quick Gist: The prevalence of vitamin D deficiency in diabetic peripheral neuropathy patients is high. This may be linked to the increased level of inflammation and impaired nerve function.

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Rectification of this deficiency relieves pain and other symptoms in diabetic neuropathy; no improvement in nerve conduction and other physiological parameters has been reported yet. It is best to consult a health practitioner about the dose of vitamin D that would suit your condition.

2. Correcting Vitamin D deficiency may help in immune-mediated neuropathies

Systemic autoimmune conditions can affect both central and peripheral nervous system and in case of an attack on the peripheral nervous system peripheral neuropathy is the most common complication.

Antibodies refer to proteins produced in the body to attack foreign infections and eliminate them while autoantibodies are proteins that attack the body’s tissue in autoimmune conditions.

In autoimmune mediated neuropathies, these autoantibodies attack the nerve tissue such as myelin sheath and other proteins that influence brain and nerve health.

Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), antibody-mediated neuropathies are few immune-mediated neuropathies.

Individuals with autoimmune conditions like rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease and Sjögren’s syndrome may also experience peripheral neuropathies.

Patients with immune-mediated peripheral neuropathies may also be diagnosed with Vitamin D deficiency.

Researchers hypothesise that immune cells respond to the sunshine vitamin’s therapeutic action and hence rectifying this deficiency can help relieve symptoms of peripheral neuropathy in autoimmune conditions. (Journal of Neurological Sciences, 2014)

5 to 10% of the patients with Sjögren’s syndrome present with complications that involve the peripheral nervous system.

Sjögren’s syndrome patients are found to have low vitamin D levels, and this deficiency is associated with the development of peripheral neuropathy and lymphoma. It’s supplementation may benefit in such conditions; further research in human studies is warranted.

Quick Gist: Deficiency of the sunshine vitamin may play a pathogenic role in the development of peripheral neuropathies and other symptoms of autoimmune conditions. Rectifying this deficiency may help in relieving disease symptoms, but this still needs to be confirmed by human studies.

3. It can relieve neuropathic pain

Vitamin D deficiency has been linked to chronic pain. It influences pain manifestation at various levels- anatomical, hormonal, neurological and immunological.

Calcitriol is the active metabolite of the sunshine vitamin that is involved in multiple biological processes. It can regulate inflammation and activate the immune system.

Since it is a neuroactive steroid, it can regulate neurons and their ability to produce as well as to sense neurotransmitter levels. Abnormal sensitivity or abnormal neurotransmitter levels can contribute to pain.

It also influences synthesis of neurotrophins that are proteins required for survival and maintenance of nerve cells and are also involved in pain transmission.

Carpel tunnel syndrome is a condition that involves neuropathic pain in the hand due to nerve compression. The sunshine vitamin deficiency is found to be associated with neuropathic pain intensity in carpal tunnel syndrome.

Not only in case of nerve pain but also in other chronic pain-like conditions and rheumatic conditions, vitamin D deficiency contributes to increase in pain.

Dr Lee and Dr Chen explored the role of vitamin D as an analgesic or painkiller in diabetic neuropathy.

51 patients with type 2 diabetes and neuropathic pain were enrolled in the study. The pain was described as burning pain, tingling and throbbing sensations and reduce the sensation of touch was observed.

They were treated with cholecalciferol tablets (average dose of 2059 IU) for three months. Plasma calcitriol levels resumed to normal after supplementation and a significant reduction in pain score (about 48% reduction) were observed.

Vitamin D supplementation is proven to reduce pain and improve quality of life in patients with widespread chronic pain without affecting nerve conduction velocity. (International Journal of Rehabilitation Research, 2017)

QR-333 is a topical formulation containing quercetin, vitamin D3 and ascorbyl palmitate. Application of this topical formulation on the feet (three times a day for four weeks) was found to reduce numbness and jolting pain in patients with diabetic neuropathy.

Quick Gist: Since vitamin D is involved in inflammation and regulation of neurotransmitters, it actively influences pain manifestation and sensitivity. Its deficiency is observed in many chronic pain conditions as well as neuropathy.

Its supplementation is proven to relieve neuropathic pain by rectifying the existing deficiency.

4. It protects nerve health

Vitamin D has vital roles beyond bone health. It is a neuroactive substance: it regulates neurotransmitter activity, it interacts with the central nervous system at neurohormonal levels, and it regulates neurotrophic factors that are vital for growth and development of neurons.

Nerve Growth Factor is a protein that is essential for development and survival of nerve cells, and it also plays an essential role in pain transmission. The effect of Nerve Growth Factor on pain transmission is confounding: its depletion, as well as abundance, can contribute to pain.

In case of peripheral neuropathy, especially in diabetes, Nerve Growth Factor levels are depleted. Derivatives of the sunshine vitamin increase Nerve Growth factor levels and reduce neuropathic pain in diabetic neuropathy.

Myelin sheath is the insulating covering around the nerves that protects it. Nerve damage in peripheral neuropathies may cause loss of myelin sheath or demyelination.

Vitamin D supplementation supports myelination by activating myelin-associated genes. It supports re-myelination and regeneration of damaged nerves. (PLoS One, 2013)

Quick Gist: Vitamin D protects the peripheral nervous system. It supports regeneration and remyelination of damaged nerves.

Dosage of Vitamin D For Peripheral Neuropathy

The dose of vitamin D for peripheral neuropathy will depend on your serum vitamin D or calcidiol levels. A dose of 50000 IU cholecalciferol once weekly is proven to reduce diabetic neuropathy symptoms in 8 weeks.

A dose of 1000-2000 IU per day works for most individuals but in case of severe deficiency, your health practitioner may suggest higher weekly dosages.The dose could differ based on your serum calcifediol/ calcidiol or serum vitamin D levels.

Opt for vitamin D3 (cholecalciferol) and not D2 (ergocalciferol) supplements.

Sun exposure is a simple way of getting necessary vitamin D, but the high incidence of skin cancer and rising global warming makes it difficult to give specific advice on the duration of sun exposure.

For example, an individual residing in Northern Australia can produce 1000 IU vitamin D in 6-7 minutes ( in summer) and 9-12 minutes (in winter), if exposed to the sun between 10, am to 2 pm. But if that individual is in Tasmania, he may need 7-9 minutes (in summer) and 40-47 minutes (in winter) for equivalent levels.

Please consider working with a health practitioner to identify the dose that would suit your health.

Precautions with Vitamin D use

High levels of vitamin D may cause toxicity. It can increase calcium absorption, and high calcium levels (hypercalcemia) contribute to the toxicity.

Toxicity symptoms include nausea, vomiting, diarrhoea, anorexia, constipation at early stages etc. Other symptoms include kidney stones, bone pain, frequent urination, drowsiness, headaches irregular heartbeat, weakness, nervousness, itching etc.

Therefore, it is necessary to work with a health practitioner to identify a dose of vitamin D that would suit you and to decide the duration of therapy as well.

Certain medications that affect calcium levels in the body may have drug interactions with the sunshine vitamin. These include corticosteroids, phenobarbital, phenytoin. Also, drugs that interfere with fat metabolism such as orlistat and cholestyramine can reduce the vitamin absorption.

Magnesium levels need to be taken care of when taking Vit D supplements. Magnesium is involved in Vitamin D metabolism, and it may be linked to sunshine vitamin’s deficiency.

Please consult a health practitioner before taking Vitamin D supplements.

Suggested Vitamin D Supplements For Neuropathy

Please consult a health practitioner before taking any health supplements.

Vitamin D supplementation is helpful only in case of deficiency.Vitamin D supplements should not be taken over a long period, unless prescribed by a health practitioner, as it may cause toxicity.

It is essential to maintain calcium and magnesium levels while supplementing with vitamin D for best resolution of symptoms.

The vitamin is fat soluble and it is advisable to take it after a meal containing dietary fats.

Dosage: Please read the detailed dosage section below and try working with a health practitioner to identify a dose that suits you.

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Image Credit: Thorne Research, Inc.	Image Credit: Naturewise	Image Credit: Doctor’s Best
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Conclusion

Vitamin D plays an essential role in the functioning of the central and peripheral nervous system. Its deficiency is observed in patients with peripheral neuropathy.

Thus, it is hypothesised that supplementation with the sunshine vitamin will be beneficial for peripheral neuropathy and a few human studies have confirmed it. Further research is required to assess its effect in non-diabetic neuropathies as well.

Please consult a health practitioner to identify whether you are deficient in vitamin D and what dosage and duration of therapy may suit you.