Chronic Low Back Pain? It Might Be a Vitamin Deficiency

Dr. Frank Shallenberger, MD

December 23, 2019



Chronic back pain is an entirely too prevalent problem in our country. It has contributed to the tragic misuse of prescription painkillers. It’s decreased quality of life for countless people. And it’s left many doctors scratching their heads, unsure of how to help their patients when surgeries and drugs fail.

Some of the causes of chronic back pain are obvious. But others are surprising. An article in the Journal of the American Board of Family Medicine may have found at least one: a vitamin deficiency.

The fact that a vitamin deficiency could cause such intense pain for so long is certainly surprising. But it’s also much simpler to correct than many other back pain issues. So it’s worth considering. And the article’s findings align with what I’ve been saying for years about this important vitamin.

The article looked at six patients, all of whom had severe, longstanding back pain. All but two of these patients were over 50. And all of them had one thing in common: their back pain was disabling. Keep in mind that these were difficult cases. Three patients had already suffered through multiple surgeries and still had no resolution to their pain. All were on chronic pain medication.

Given their terrible histories of pain, the researchers gave every one of the patients supplemental vitamin D. And every single one of the patients responded positively. Let me tell you about three of these cases.

The first was a 63-year-old man. He was a regular attendee at the local pain management clinic. And his addiction to pain medication had existed for years. He had a history of four back operations for disc protrusion. The last one was 15 years ago. He was on permanent, long-term disability. When the researchers checked his blood level of vitamin D (25, hydroxy vitamin D), they found it was only 20 nmol/l (nanimoles per liter). His doctor then placed him on 4,000 units of vitamin D3. Six weeks later, his vitamin D level was 87 nmol/l, and “his symptoms completely resolved.”

That one story is absolutely amazing. But there’s more.

Another man in the study was 47 years old. Let me just quote from the report: “This patient had a long history of back pain. He required disc surgery and initially had improvement, but symptoms returned within six months. His pain became progressively worse: he had to curtail his usual activities and was no longer able to do yard work or play golf. He used medication for pain control.” This was a severe case. The report does not give his initial vitamin D level.

The doctors started him on 2,000 units of vitamin D3. Not long after, he “was able to return to his usual activities and had no further back pain. He no longer required any pain medications.”

Again, the report’s comments severely understate the miracle that just took place with this man. A simple and inexpensive supplement completely CURED one of the most serious back pain cases you’ll ever see.

But that’s not all. Another case involved a 30-year-old woman. I quote again: “This patient had significant back pain, which had become worse after pregnancy (a known risk factor for vitamin D deficiency). She was not able to work for a number of years. Each morning she had difficulty getting out of bed because of severe back pain. Pain medication only partially controlled her pain.”

The researchers in this study found that she had a severe deficiency of vitamin D. So they started her on 2,000 IU of vitamin D. The results, again, were incredible. Her back pain improved within three to four weeks. And it completely resolved within six weeks. “She was able to return to work and has been gainfully employed.” Her initial vitamin D level was 18 nmol/l. The treatment brought her levels up to 82 nmol/l.

These are absolutely remarkable cases. They make you wonder how many people are going to undergo surgery and/or become chronically addicted to pain medication when all they really have is a vitamin deficiency.

It Affects More Than Back Pain

It also brings to mind a case of chronic fibromyalgia I treated many years ago. It refused to respond to the alternative therapies of several experts in this field.

This woman had severe pain in her neck and shoulders, as well as her lower back. When I checked her vitamin D level, it was 6 ng/ml! That’s the lowest I have ever seen.

So I put her on 5,000 units of vitamin D3. Within four weeks, her level was still only 17 ng/ml. So I kept on increasing her dose until her level went over 80 ng/ml. It wasn’t until we got her to that level that her symptoms all but completely disappeared. This was one of the toughest cases of fibromyalgia I have ever treated. It took 20,000 units per day of vitamin D3 to get her to an acceptable level.

How Much Should You Take?

So what is an “acceptable level”? The author of the article I quoted here used a measurement of vitamin D in nmol/l. Most laboratories and studies use a different measurement, that of nanograms per milliliter or ng/ml. So don’t get them confused because they are very different.

A level of 75 nmol/l is about the same as a level of 30 ng/ml. The reference range for vitamin D is between 30-100 ng/ml. But I and many other doctors consider anything less than 50 ng/ml to be insufficient. So if you have chronic back pain, make sure that you have your level checked. If it’s below 50 ng/ml, work with your doctor to establish a dose that will get it up to sufficient levels.

And yes, you might need these high doses for a while – even if you spend plenty of time outside. In fact, I go outside a lot. And I need to take 15,000 units of vitamin D every day to keep my levels where I want them. But why?

The Cause of Vitamin D Deficiency

Most doctors and researchers have assumed that the problem comes from aging, the use of sun blocks, sunglasses, shunning the sun, and staying indoors. But that can't be the reason. There have been too many reports of tanned young men who work construction all day long outdoors in Hawaii wearing only swim trunks without sun blocks or sunglasses that can't get close to optimal levels. And the patients I’ve treated for extremely low levels weren’t cloistering themselves in windowless rooms. Now, finally, we’re getting some answers to this question. It’s genetics.

Researchers reported that certain genetic variations in vitamin D binding protein can account for the problem. According to the authors, “Common genetic variants in the CYP2R1 and GC genes modify vitamin D concentrations in the same manner after artificial ultraviolet exposure induced vitamin D and consumption of vitamin D3-fortified bread and milk.” They are saying that the same genetic differences that account for why so many people can’t get adequate vitamin D levels from sun exposure also accounts for why they often need to take such high doses.

The scientists learned this when they exposed 92 healthy men and women to the same doses of ultraviolet vitamin D-stimulating light. They measured their vitamin D levels before and after. Then they analyzed 25 different gene variations involved in vitamin D synthesis, transport, activation, or degradation. Sure enough, they were able to predict who would respond best to the ultraviolet light simply by seeing the pattern in these genetic variations.

To study the effect of vitamin D supplements, they did the same kind of before and after study on 201 healthy Danish families who were given vitamin D3-fortified bread and milk or placebo for six months during the winter. The results were the same. The same genes determined how much vitamin D you can make from sunlight as well as how much you can get from your diet or supplements. But here's the point.

Don’t Be Afraid of Vitamin D

Take as much supplemental vitamin D as you need to get your blood levels up to the optimum of 60-75 ng/ml. For some, it won’t take much. Start at 5,000 IU daily. For others, like me, it will take a lot. And yes, it’s safe to do so. In fact, it’s much more dangerous to have vitamin D levels that are too low than to take “too much” vitamin D.

People with vitamin D3 levels over 50 ng/ml are about one-fifth as likely to get cancer as those with levels in the lower end of the range. And of course, as you’ve seen, a vitamin D deficiency can lead to incredible pain.

Your levels of vitamin D only become toxic when they’re around 200 ng/ml. And it takes way more vitamin D than I’ve recommended here to reach that level.

In fact, researchers at the University of California in San Diego looked at the vitamin D3 levels of 3,667 men and women between the ages of 40 to 65 years. It turns out that the dose necessary to ensure that almost all (97.5%) of these people had at least 40 ng/ml was 9,600 units per day. And even 9,600 units a day was not enough for many people to achieve the optimal levels (over 60) needed for maximum cancer prevention.

In the entire group of patients, a rather large group, not one of them reached the potential toxic vitamin D limits of 200 ng/ml. Even those with a total vitamin D intake (supplements and diet) as high as 13,300 units per day didn’t get close. The authors concluded by saying that “universal intake of up to 40,000 IU vitamin D per day is unlikely to result in vitamin D toxicity.” And I have never found it necessary to give anyone more than 20,000 units to reach optimal levels.

So don’t be afraid of vitamin D3. Take enough to bring your levels up to between 50-80 ng/ml. Once they are up there, check your blood calcium levels. The only risk I’ve ever found with this amount of vitamin D is that occasionally, optimal levels of vitamin D will result in excessive blood calcium levels. This could cause kidney stones. But I have seen this in only two patients in the past 10 years. And your doctor can help you adjust your calcium and vitamin D levels as needed to find the balance that’s right for you.

If you have chronic back pain, this simple blood test could change your life. And one more thing.

Vitamin D supplements can cause a vitamin K deficiency. That’s because vitamin D increases the expression of certain proteins that use up vitamin K. So, make sure that you take 80 mcg of vitamin K in the form of menaquinone-7 (MK-7) for every 5,000 units you take of vitamin D.


Schwalfenberg, G. “Improvement of chronic back pain or failed back surgery with vitamin D repletion: a case series.” J Am Board Fam Med., 2009 January-February;22(1) :69-74.

April 2015:

August 2011:

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