Tired and Sore? You Might Be Missing These 2 Nutrients

When you have chronic fatigue and muscle aches, a vitamin deficiency may not be the first thing on your mind, but it's possible the symptoms are linked to your diet.

Signs of vitamin deficiency can include everything from aches and pain to depression and anxiety. Vitamins play major roles in all of your body functions and if you're not getting enough of them on a daily basis, it can disrupt normal, healthy body function.

Vitamin D is most widely known for keeping the bones strong. This vitamin allows you to absorb calcium and blocks the release of parathyroid hormone, which contributes to thin and brittle bones, per the National Institutes of Health (NIH).

Vitamin D also keeps your immune system healthy and ensures proper muscle function.

Vitamin D isn't just a nutrient that you get from food; it's also a hormone that your body can make (with exposure to the sun), the Harvard T.H. Chan School of Public Health notes. That's why it's so important to overall health.

A May 2017 report in ‌Reviews in Endocrine and Metabolic Disorders‌ describes vitamin D deficiency as a "pandemic" and "global health issue" whose effects "cannot be under estimated."

According to the journal report, vitamin D deficiency affects more than one billion people worldwide. Vitamin deficiency symptoms are often nonspecific. Deficiency in vitamin D can cause uncomfortable symptoms like:

• Muscle aches and weakness
• Tiredness and chronic fatigue
• Inflammation
• Insomnia
• Depression
• Anxiety
• Increased frequency of colds and infections

It's also associated with chronic health problems, per the May 2017 report, including:

• Heart disease
• Autoimmune disorders
• Cancer
• Type 2 diabetes
• Neurological disorders (multiple sclerosis)
• Cavities
• Osteoporosis and other bone diseases

Although many health experts are concerned about the widespread low levels of vitamin D, others think it's more of a disagreement about numbers, and exactly what vitamin D level to consider a deficiency.

The current guideline from the NIH is that a blood level that falls below 20 nanograms per milliliter (ng/mL) is inadequate. Researchers published in the ‌New England Journal of Medicine‌ in November 2016 consider that cutoff number is too high and, because of that, people are misdiagnosed as deficient when they're not. Based on their analysis, the cutoff number should be 12.5 ng/mL instead. A report published in the Oct-Dec 2015 edition of the ‌Indian Journal of Community Medicine‌ agrees the cutoff level is too high.

However, other practitioners, like functional medicine doctor Dr. Mark Hyman and Dr. Michael Holick, director of the Bone Health Care Clinic at the Boston University Medical Center, think that vitamin D levels above 30 ng/mL may be better, reported in June 2018 in the ‌Mayo Clinic Proceedings‌.

Approximately 80 to 90 percent of the vitamin D stored in your body comes from the ultraviolet rays of the sun, per a September 2014 report in ‌Age and Aging‌. Because of this, inadequate exposure to sunlight, especially during the winter months, is one of the leading causes of vitamin D deficiency.

People with a darker skin tone are also at a higher risk of developing vitamin D deficiency because melanin, the pigment that gives skin its color, decreases the skin's production of vitamin D, per the Harvard T.H. Chan School of Public Health.

As you age, your body's natural ability to make vitamin D decreases, so older people have a higher risk of developing a vitamin D deficiency.

According to the Linus Pauling Institute at Oregon State University, older adults have a lower concentration of the vitamin D precursor in their skin, so they're unable to produce the same amount of vitamin D as younger adults, even when exposed to the same amount of sunlight. Being overweight or obese also increases your risk.

The amount of vitamin D you need daily depends on your age. Adults under 70 should aim for 600 IU per day, while adults 70 and older need 800 IU, according to the NIH.

Although most of the vitamin D you get comes from the sun, food sources of vitamin D include:

• Swordfish
• Salmon
• Tuna
• Sardines
• Beef liver
• Egg yolk
• Fortified cereal
• Fortified milk

Vitamin B12 plays major roles in keeping your nervous system and red blood cells healthy. Without enough vitamin B12, your body cannot make new, healthy red blood cells, according to the Harvard T.H. Chan School of Public Health.

Your body also uses vitamin B12 to make DNA, the genetic code in all of your cells. Like all the other B vitamins, vitamin B12 also plays a role in energy production and the metabolism of protein.

Vitamin B12 deficiency is another widespread health concern in the United States that affects approximately 6 percent of people under the age of 60 and almost 20 percent of people older than 60, per a September 2017 report in ‌American Family Physician‌.

Because vitamin B12 deficiency can cause a wide range of symptoms, it's often misdiagnosed or overlooked, per Harvard Health Publishing. Symptoms may develop gradually or come on suddenly and can include:

• Muscle aches and weakness
• Tiredness and fatigue
• Difficulty walking
• Numbness and tingling in the extremities
• Swollen tongue
• Shortness of breath
• Irritability
• Diarrhea
• Increased heart rate

If left untreated, vitamin B12 deficiency can lead to serious anemia, or a low red blood cell count, nerve damage (and lasting muscle aches) and degeneration of the spinal cord.

One of the most common causes of vitamin B12 is a lack of a substance called intrinsic factor, per an April 2015 report in ‌Clinical Medicine‌.

Intrinsic factor is a protein that's made and secreted by your stomach that allows you to absorb vitamin B12. Without it, proper absorption is impossible.

Other possible causes of vitamin B12 deficiency include:

• Veganism and vegetarianism
• Excessive alcohol intake
• Autoimmune disorders
• Gastritis (inflammation of the stomach lining)
• Use of oral contraceptives
• Other prescription medications (metformin, proton-pump inhibitors)
• Methylation defects
• Bariatric surgery

The current recommendation is that adults get 2.4 micrograms of vitamin B12 every day, per the Harvard T.H. Chan School of Public Health. The richest sources of vitamin B12 are animal foods like:

• Beef
• Chicken
• Fish
• Eggs
• Dairy products
• Beef liver
• Clams

Plant foods don't contain any vitamin B12 naturally, but some cereals are fortified with synthetic versions of the vitamin. This is why vegans and vegetarians have one of the highest risks of deficiency.

If you suspect you're low on vitamins, check with your doctor. Your doctor can order simple blood tests that can either confirm or rule out deficiencies.

If you do have low levels of a certain vitamin (or vitamins) your doctor may recommend a supplement or refer you to a nutrition professional who can work with you to design a balanced diet that gives you all of the nutrients you need to stay healthy.

It's best to talk to a doctor or qualified health professional about your concerns and/or any supplements before you start taking them.

If it's determined that your vitamin levels are due to an underlying medical issue, your doctor will work with you to correct the cause of the deficiency as well to prevent recurrence.