2400 Units of Vitamin D a Day for Fibromyalgia

Fibromyalgia, one of the most common joint and muscle diseases, afflicting millions of Americans, is characterized by widespread musculoskeletal pain, often accompanied by other symptoms, such as fatigue. The medical profession used to think it was all in people’s heads, “but today there is irrefutable evidence” that it is indeed a disorder of the body and not just the mind.

Back in 2003, an influential paper was published out of the Mayo Clinic in which a shocking 93 percent of fibromyalgia-type patients were found to be vitamin D deficient, so the researchers concluded that all such patients are at high risk of severe vitamin D deficiency. Wait a second, said the skeptics. There was no control group, and where’s the Mayo Clinic located? Minnesota. Maybe 90 percent of everyone in Minnesota is deficient in vitamin D.

When controlled studies were done, some did indeed find that those suffering from these kinds of pain syndromes were significantly more likely to be D deficient, but other studies did not find this. Even if all the studies did have the same findings, though, that doesn’t mean that low vitamin D levels cause fibromyalgia. Maybe chronic, widespread pain disorders like fibromyalgia cause low vitamin D. After all, it’s the sunshine vitamin, and perhaps fibromyalgia patients aren’t running around outside as much as healthy controls. To know if vitamin D is contributing to the disease, you have to put it to the test. 

Various studies found that the majority of those with pain syndromes and low D levels appeared to benefit from vitamin D supplementation, and clinical improvement was evident in up to 90 percent of patients. But these studies weren’t controlled either. Maybe the subjects would have gotten better on their own without the supplements, or maybe it was the placebo effect. There are many examples in the medical literature of treatments that looked great in uncontrolled trials, like hyperbaric oxygen therapy for multiple sclerosis, but when put to the test in randomized controlled trials, they failed miserably.

And, that’s what seemed to happen in the first randomized controlled trial of vitamin D for a fibromyalgia-type syndrome in 2008. As you can see at 2:55 in my video The Best Supplement for Fibromyalgia, researchers saw no significant difference in pain scores, though the study only lasted three months, and, in that time, the treatment was only able to get the vitamin D blood levels up to about 30. Unfortunately, no controlled study had ever been done pushing levels any higher, until 2014. As you can see at 3:23 in my video, fibromyalgia patients were given up to 2400 units of vitamin D a day for 20 weeks and their D levels rose up to about 50. Then, once they stopped the vitamin D, their levels came back down to match the placebo. That was reflected in their pain scores: a significant drop in pain severity while they were on the D and then back to baseline when they came off of it. The researchers concluded “that this economical [in fact, over-the-counter] therapy with a low side effect profile may well be considered in patients with FMS [fibromyalgia syndrome].”


What changes in our diet may help combat fibromyalgia? See my videos Fibromyalgia vs. Vegetarian and Raw Vegan Diets and Fibromyalgia vs. Mostly Raw & Mostly Vegetarian Diets.

What else can vitamin D supplements do? Check out:

What’s the best way to get vitamin D? See:

In health,

Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live presentations:

Is Milk Lowering Uric Acid a Good Thing or a Bad Thing?

Parkinson’s disease, the second most common neurodegenerative disorder after Alzheimer’s, is characterized by a slowness of movement, rigidity, tremor, and stooping posture, all of which worsen over time. Non-movement symptoms such as cognitive impairment and sleep, smell, and mood disturbances occur as the disease spreads to other areas of the brain. The cause of Parkinson’s is perhaps “one of the important questions posed by the neurobiology [science] of aging.” For example, why is the consumption of dairy products associated with increased risk of Parkinson’s? Perhaps because they contribute to our exposure to pesticides and other neurotoxins like dieldrin, which continues to be found in the autopsied brains of Parkinson’s victims. Even though dieldrin was banned decades ago, it lingers in the environment and we “continue to be exposed to the pesticide through contaminated dairy and meats…”

The cause of Parkinson’s “is unlikely to be due to milk compounds such as calcium, vitamin D, total fat, or total protein as these compounds are not associated with [the disease] when derived from other sources.” However, it could be lactose, the milk sugar, perhaps accounting for the increased associated risk of death and bone fractures, as well as Parkinson’s. Earlier onset of Huntington’s disease has also been identified. There is, however, a third possibility.

As I discuss in my video Parkinson’s Disease and the Uric Acid Sweet Spot, milk lowers uric acid levels, and uric acid may be protective against Huntington’s and also slow the decline caused by Parkinson’s. More importantly, it may lower the risk of getting Parkinson’s in the first place. Why? Perhaps because uric acid is an important antioxidant in the brain, something we’ve known for more than 30 years. We can demonstrate uric acid’s importance directly on human nerve cells in a petri dish. When the pesticide rotenone is added, oxidative stress goes up. Add the pro-oxidant homocysteine, and it goes up even more. But, when uric acid is added, it completely suppresses the oxidative stress caused by the pesticide.

Drinking milk, however, has a uric acid-lowering effect. In the paper making this assertion, a study they cited was “A cute effect of milk on serum urate concentrations,” but that was just a cute typothey meant Acute effect. Indeed, drink cow’s milk, and, within hours, uric acid levels drop 10 percent. Drink soymilk, and, within hours, they go up 10 percent. Now, for gout, a painful arthritic disease caused by too much uric acid, the uric acid-lowering effect of dairy is a good thing—but uric acid is “a double-edged sword.”

If our uric acid levels are too high, we can get gout, but, if they’re too low, it may increase our risk of neurodegenerative diseases, such as Alzheimer’s, Huntington’s, Parkinson’s, and multiple sclerosis.

Incidence rates of gouty arthritis over five years indicate that if our uric acid is over 10.0 mg/dl, we have a 30 percent chance of suffering an attack of gout within the next 5 years. However, at levels under 7.0 mg/dl, our risk is less than 1 percent, so it might make sense to have levels as high as possible without going over 7.0 to protect the brain without risking our joints. But having excessive uric acid in the blood puts more than just our joints in jeopardy. Yes, having levels that are too low may increase our risk of MS, Parkinson’s, Alzheimer’s, and even cancer, but having levels that are too high may increase our risk of gout, kidney disease, and heart disease.

In fact, having a uric acid level over 7.0 mg/dl isn’t only associated with an increased risk of gout, but also an increased risk of dying from all causes. However, having a low uric acid level may also shorten our lifespan by increasing mortality. High uric acid levels are associated with increased risk of death from heart disease, but low uric acid levels are associated with increased risk of fatal stroke. So, keeping uric acid at optimum levels, the sweet spot between 5.0 and 7.0 mg/dl, may protect the brain in more ways than one.

If we measure the uric acid levels in patients with Parkinson’s, they come in around 4.6 mg/dl, which may help explain why dairy consumption may increase risk for Parkinson’s since milk pushes down uric acid levels. Dairy intake may also explain the differences in uric acid levels among meat-eaters, vegetarians, and vegans. In the graph in my video, you can see that vegan men have significantly higher uric acid levels at 5.7 mg/dl than vegetarians, presumably because vegans don’t drink milk, and those who both eat meat and consume milk fall between the vegans and vegetarians.


For more on Parkinson’s see:

Uric acid as an antioxidant? I’ve touched on that before in Miocene Meteorites and Uric Acid.

If uric acid levels are too high consider cutting down on Flesh and Fructose and eating cherries. (See Gout Treatment with a Cherry on Top and Treating Gout with Cherry Juice for more information.) Also, check out Preventing Gout Attacks with Diet.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations:

The Benefits of Sesame Seeds for Knee Osteoarthritis

Doctors have been injecting arthritis patients with gold since the 1920s. In fact, “[g]old-based medicines have been in use for thousands of years…and remarkably…are still in clinical use as DMARDs,” or disease-modifying anti-rheumatic drugs, meaning they can slow the progression of rheumatoid arthritis. Unfortunately, such drugs can be toxic and even fatal, causing conditions such as gold lung, a gold-induced lung disease. “Although its use can be limited by the incidence of serious toxicity,” injectable gold has been shown to be beneficial to patients with rheumatoid arthritis. But maybe, as some researchers have suspected, some of that benefit comes from the sesame oil that’s injected, which is used as the liquid carrier for the gold.

As I discuss in my video Sesame Seeds for Knee Osteoarthritis, sesame seeds contain anti-inflammatory compounds with names such as sesamin and sesamol, which researchers suggest “may serve as a potential treatment for various inflammatory diseases.” Those observations, however, came from in vitro (test tube) studies. First, we have to see if sesame seeds have an anti-inflammatory effect in people, not just in cells in a petri dish, but there haven’t been any studies on the effects of sesame seeds on inflammatory markers in people with arthritis, for example…until now.

The abstract states: “Considering the high prevalence of osteoarthritis (OA) and since until now there had not been any human studies to evaluate the effect of sesame in OA patients, this study was designed to assess the effect of administration of sesame on inflammation…” Indeed, researchers found a significant drop in inflammatory markers, but what effect did sesame seeds have on the patients’ actual disease?

Fifty patients with osteoarthritis of the knee were split into two groups. Both received standard treatment, but the sesame group also received about a quarter cup of sesame seeds a day for two months. Before they started, the patients described their pain as about nine out of ten, where zero is no pain and ten is the maximum tolerable pain. After two months, the control group felt a little better and reported their pain was down to seven, but the sesame group dropped down to three and a half, significantly lower than the control group. The researchers concluded that sesame appeared to have a “positive effect…improving clinical signs and symptoms in patients with knee OA…”

The main problem with the study, though, is that the control group hadn’t been given a placebo. It’s hard to come up with a fake sesame seed, but without a placebo, researchers basically compared doing nothing to doing something, and any time you have patients do something, you can’t discount the placebo effect. That said, what are the downsides? That’s the nice thing about using food as medicine—only good side effects. Though the results are mixed, there have been studies using placebo controls that found that adding sesame seeds to our diet may improve our cholesterol and antioxidant status, and the amount of sesamin found in as little as about one tablespoon of sesame seeds can modestly lower blood pressure a few points within a month, enough, perhaps, to lower fatal stroke and heart attack risk by about 5 percent, potentially saving thousands of lives.


What other dietary interventions can help with arthritis? Check out:

If the placebo effect is really that powerful, should doctors prescribe them? They already do! Check out The Lie That Heals: Should Doctors Give Placebos? for more on this.

In health,
Michael Greger, M.D.

PS: If you haven’t yet, you can subscribe to my free videos here and watch my live, year-in-review presentations: