Don`t forget vitamin D when weakness /pain

Hopeblossom; it may not be low magnesium;General weakness and muscle pain / stiffness; one cause may be low vitamin D. I would suggest 5-10.000 IU + one hour with sunshine; daily, no sunscreen.
Ps I am also sensitive to magnesium supplements; one way to get your magnesium is chlorella algae; or spirulina, or barley grass juice/powder, or loads of greens like dandelions etc; free of charge outside your door.

http://www.medscape.com/viewarticle/538290


Lausanne, Switzerland - Vitamin-D deficiency may be an underlying factor in musculoskeletal pain and is a potentially treatable cause. This point is made by two groups of researchers in the recent literature [ 1 , 2 ] and echoes findings from US research [ 3 ] previously reported by rheumawire .

"Rheumatologists should screen patients of all origins with overall pain and/or risk factors for hypovitaminosis D3," says lead author Dr Gabrielle de Torrente de la Jara (Lausanne University, Switzerland). If vitamin-D deficiency is the diagnosis, treatment is beneficial and leads to a rapid resolution of symptoms, she adds. "Doctors should be aware of the importance of the disease and the impact of rapid diagnosis and treatment."

Writing in the July 17, 2005 issue of BMJ, Torrente de la Jara et al report 11 cases of symptomatic hypovitaminosis D3 in female asylum seekers [ 1 ]. These women presented after minimal exposure to sunlight and a history of bone pain, proximal muscle weakness, change in gait, or fatigue. They had had these symptoms for a mean duration of 38 months and were initially diagnosed as having possible somatization disorder (three patients), chronic back pain (four patients), or multiple unexplained somatic symptoms (three patients).

All the women had low levels of vitamin D, with a mean 25-hydroxycholecalciferol-serum level of 10.9 nmol/L. The researchers comment that although there is some dispute about the levels needed for health, anything below 20 nmol/L indicates severe deficiency, and concentrations of at least 75 nmol/L are necessary to maintain cellular function.

Treatment for most of the patients was two intramuscular injections of cholecalciferol (300 000 IU) at monthly intervals and an ongoing course of oral calcium (1000 mg) and cholecalciferol (20 g), the researchers write. Most patients' symptoms disappeared in one to three months, they note, but one patient needed treatment for seven months.

"We already know that hypovitaminosis D3 provokes clinical symptoms and that immigrant women are at risk because of lifestyle, but our study shows that in 11 female asylum seekers, hypovitaminosis D3 is slow to be diagnosed and is associated with a potential misdiagnosis of somatization," de Torrente de la Jara tells rheumawire . "Therefore, before considering a somatization disorder, hypovitaminosis D3 should be considered in immigrant women with musculoskeletal symptoms."

"Studies from Brussels and Boston have also shown that about 25% to 30% of asymptomatic adults have hypovitaminosis D3 at the end of the winter," says de Torrente. "The best test is 25-OH-vitamin D3 in the serum, but the timing is a bit tricky since the levels vary with the season. But if the patient has symptoms, the timing seems less relevant."

Separately, another group of researchers—this time from the UK—reports in the August 2005 issue of the Annals of Rheumatic Diseases a high incidence of widespread pain in people of South Asian origin [ 2 ]. They also report that all the Asian women who had widespread pain had low levels of vitamin D, with levels of 25-hydrocholecalciferol below 10 ng/mL.

Prompted by anecdotal reports from rheumatologists in the UK that patients with South Asian backgrounds are more likely to report widespread pain, Prof GJ Macfarlane (University of Manchester, UK) and colleagues carried out population-based cross-sectional surveys to determine whether this was indeed the case. When compared with 932 white Europeans, the 1945 South Asian subjects showed excess symptoms of widespread pain—12% vs 14%. After adjustments for age and sex, reducing the number of subjects to 137 South Asians and 121 white Europeans, pain among South Asians (9%) was higher than among Europeans (6%), a statistically significant difference (odds ratio 1.6, 95% CI 1.3-2.1).

Macfarlane et al reviewed blood samples from 114 South Asians and 105 white Europeans and found that levels of serum 25-OH-vitamin D3 were significantly lower in the South Asians. Of the 114 South Asian subjects, 81 registered levels of 25-OH-vitamin D3 below 10 ng/mL, whereas only 10 of 105 Europeans showed the same low reading.

"Owing to the small numbers, the relationship between vitamin D and widespread pain must be considered preliminary and requires further investigation," Macfarlane et al comment, but they add that "it may be one potentially treatable cause of widespread pain."

Stronger words came from the US researchers who found widespread vitamin-D deficiency among patients presenting with pain in an article published in the December 2003 issue of the Mayo Clinic Proceedings [ 3 ], reported at the time by rheumawire . The authors, led by Dr Greg Plotnikoff (University of Minnesota, Minneapolis), found that 93% of all patients presenting with persistent nonspecific musculoskeletal pain were deficient in vitamin D, many severely so, and they concluded that all patients presenting with such symptoms should be screened for hypovitaminosis D.



http://www.mja.com.au/public/issues/185_02_170706/ben10209_fm.html


he prevalence of vitamin D deficiency among Aboriginal people in Australia is unknown. One of the possible sequelae of vitamin D deficiency, muscle pain, appears to have a higher prevalence in Aboriginal people.

A deficiency of vitamin D can cause osteoporosis,1 rickets in children, muscle pain and weakness.2-4 It is one of the main causes of undiagnosed muscle pain in adults.2,3 Such pain resolves rapidly with adequate doses of vitamin D.3-5

Risk factors for vitamin D deficiency include darker skin pigmentation, urban lifestyle, veiling of women for cultural reasons, and intestinal malabsorption or a diet deficient in vitamin D.1,6-10

Refugees from Africa and the Middle East are known to have a high risk of rickets and muscle pain caused by vitamin D deficiency.2-4,8-11 There is also research showing a deficiency in asymptomatic patients, both those at high risk as well as those with no obvious risk factors.12 This is important for the infants of women who are deficient in vitamin D during their pregnancy, as their children will also be deficient in vitamin D,13,14 and hence at increased risk of both short- and long-term sequelae.8,13

A study of a rural Aboriginal community found that 95% of the population had chronic non-specific musculoskeletal pain, compared with 30% in the general population.15 Traditional Aboriginal people spent much of their day outdoors, but most now have an urban lifestyle.16 They are less likely to spend enough hours in the sun1 or have a diet rich in vitamin D.1,6

After noting a high prevalence of muscular pain among patients at our health service (Nunkuwarrin Yunti, an Aboriginal Community Controlled Health Service, at Elizabeth Downs in the northern suburbs of Adelaide), we conducted a case–control study to determine if muscle pain was associated with low vitamin D levels.
Methods

Discussions about the study’s relevance with Elder Aboriginal Women in the community, and with the staff and Chief Executive Officer of Nunkuwarrin Yunti acknowledged its importance to individuals, families and the community. Ethics approval was obtained from the University of Adelaide and the Aboriginal Health Research Ethics Committee.

Results from Indigenous patients seen in our clinical practice before the study showed a serum vitamin D (25-hydroxyvitamin D) range of 35–55 nmol/L (standard deviation, 5 nmol/L). Anticipating a difference between cases (with muscle pain) and controls (without muscle pain) of 10 nmol/L, we calculated that a sample of six cases and six controls would be required, assuming a power of 0.8 and a significance level of 0.05.

Data were collected from eight patients in each group in October and November 2005, at the end of the Australian winter. Blood samples were collected from patients aged 18 years and older with muscle pain and from a sex- and age-matched control group without muscle pain. People with renal failure or who had recently taken vitamin D supplements were excluded. All patients had what would be classed as medium skin pigmentation.17

The blood samples were sent to the local pathology service, where 25-hydroxyvitamin D was measured. Serum levels were tabulated and analysed using SPSS version 13.0 (SPSS Inc, Chicago, Ill, USA).
Results

Our results are summarised in the Box. All patients with muscle pain had a vitamin D level below the normal value of 50 nmol/L.1,18 The mean vitamin D level was 40.88 nmol/L (SD, 3.52 nmol/L) for patients with muscle pain, and 58.25 nmol/L (SD, 15.90 nmol/L) for controls.

Data were normally distributed and equal variances could not be assumed. A t test showed a mean difference between cases and controls of − 17.38 nmol/L (P = 0.017).
Discussion

The eight Aboriginal patients with muscle pain had lower vitamin D levels than those without muscle pain. Vitamin D deficiency was not observed in asymptomatic patients except for one with mild deficiency. Despite being at a lower risk of osteoporosis,19 Aboriginal people may have an increased risk of muscular symptoms of vitamin D deficiency. We did not assess intercurrent illness, severity of symptoms, skin pigmentation, diet, time spent outdoors and success of treatment, and this limitation may affect the generalisability of our findings.

We found that muscle pain is an indicator of vitamin D deficiency in urban Aboriginal patients. General practitioners are well placed to screen those at high risk and may be able to improve the lifestyle and level of function of many previously undiagnosed patients with chronic muscle pain by having a high index of suspicion for vitamin D deficiency.

As more research reveals the sequelae of vitamin D deficiency, its importance to general health is likely to increase. A larger study looking at the prevalence of muscle pain in the urban Aboriginal population, its effect on lifestyle, how that pain relates to vitamin D deficiency, and whether pain is reduced with treatment would clarify some of the issues. The potential for better quality of life resulting from successful treatment of muscle symptoms caused by vitamin D deficiency makes the clarification of this association a priority for Aboriginal health. Tweet