There has been an interesting conversation in my coaching group this week and it is to do with getting blood work tested for Vitamin D levels – it appears that this isn’t done any more. Although my own Doctor does do this, so I haven’t had any push-back on this for a number of years now …. however, it seems that many women do.
Whcih is a shame, because one of the arguments I would be making, is that if Vitamin D levels are low, then is this the cause of poor sleep patterns in midlife and older women, thereby, sending them into changing cardiovascular and bone health as they age.
Healthy sleep patterns are essential for maintaining both physical and psychological health. But as women move into post-menopause, [when periods have stopped for a year or more], they may not realise that changing sleep patterns are not just related to their changing reproductive hormones, but to their levels of Vitamin D too.Â
I love everything about the photo of my cousin, Bridget, in the banner below. In post-menopause now, she looks healthy. Normally living in Italy where the winters are long and dark, there she is on a Perth beach late last year soaking up the sun. Storing it in her body for her return to Italy and a long, sun -deprived winter.
Vitamin D affects the Immune Health of your Clients
Vitamin D is a unique, fat-soluble vitamin, that is now recognised as being responsible for a host of immune responses in the body, including helping to regulate our sleep-wake cycle.
It’s not only a vitamin, but is now known to be a hormone – a powerful chemical messenger that is involved in numerous functions in the body.
I’ve spoken about Vitamin D in relation to skin changes as women move into peri-menopause and menopause in previous articles, but you may not know that Vitamin D receptors are also expressed in the parts of the brain that regulate the sleep-wake cycle.
When Vitamin D status (measured as serum 25(OH)D is low (less than 20ng/mL or 50ânmol/L), research suggests that this can seriously impair sleep. As such, this can lead midlife women down the slippery slope towards chronic insomnia, which can then contribute to heart disease and of course, weight gain.
For most fair-skinned people, 30 minutes a day of natural sunlight exposure (not in the heat of the day), can initiate the release of 50,000 IU (International Units or 1.25mg) of Vitamin D into the circulation within 24 hours of exposure. In darker skinned people, this amount of time yields around 20-30,000 IU.
For nearly a decade now, I’ve spoken about the importance of Vitamin D in the MyMTâą programmes . Whether women are experiencing insomnia or not, sleep quality and duration is closely linked to their symptoms, especially temperature dysregulation and muscle and joint pain.Â
Low Vitamin D is also linked to IBS and poor Calcium Absorption
When your midlife clients aren’t sleeping, this has an impact on their gut health. Furthermore, if they are also low in Vitamin D, this may be exacerbating their poor gut health. Vitamin D is known to be prevalent in patients with IBS (Yan et al, 2023).
When Vitamin D levels are low, this can impair the role of calcium absorption in the small intestine. If calcium absorption is low, this can also impact nervous system regulation, anxiety and muscle pain.
Joint pain and/or fibromyalgia, may also be due to changing Vitamin D levels. Research from Okura et al. (2008), reports that chronic pain is a marker of Vitamin D deficiency and individuals with both chronic pain and sleep deprivation, are reported as having higher inflammatory markers.Â
This is partly why Vitamin D deficiency may increase the risk of auto-immune disease as well as respiratory diseases. Hence, if your clients are doing shift work or spending much of their week inside, then exploring ways for them to get outside more, is part of your menopause-symptom advice too! Â
For years, it was thought that Vitamin D levels were ‘just’ related to bone health, however, now recognised as a hormone, this means that this crucial vitamin has far-reaching effects on the health of nearly every organ in the body.
Vitamin D plays a role in hormonal balance. It influences oestrogen and progesterone levels in the body, and levels of these hormones, impact menstrual regularity, menopause, fertility, and pregnancy.
With oestrogen receptors throughout the body, it makes sense that when oestrogen levels decline during the menopause transition, then it’s a pretty safe bet, that Vitamin D levels will undoubtedly change as well. If clients can get their levels tested, this is helpful, especially for symptoms of insomnia and muscle aches and pains. Â
What if your clients can’t get enough Vitamin D from sunlight?
With numerous nurses and other shift workers on my programmes as well as women in the Northern Hemisphere who are going into the winter months at the moment, this question is a frequent one in my own coaching groups.Â
Vitamin D is not found in many foods but the following foods provide good sources for women in post-menopause.
- Fatty fish such as, cod, trout, salmon, mackerel and sardines.
- Butter
- Milk – Food manufacturers also fortify (add) Vitamin D to milk. Whilst I don’t have a lot of milk intake on my programmes because of the high sugar content of milk, and because many women may be intolerant to lactose, if Vitamin D is low or if osteoporosis is present, then women are often recommended to have low-fat milk by their medical provider.Â
- Egg yolks
- Cod liver oil
In many diseases of older age for both men and women, there is often low Vitamin D status which commences in mid-life. For women, the change in Vitamin D status generally begins during menopause.Â
Part of the reason for lower Vitamin D levels impacting women during menopause, is due to declining skin levels of oestrogen.
Oestrogen receptors can be found throughout the body, including in epithelial tissue (skin). Oestrogens have an important function in many components of human skin including the epidermis, dermis, vasculature, hair follicle and the sebaceous, eccrine and apocrine glands, having significant roles in skin ageing, pigmentation, hair growth, sebum production and skin cancer. [Thornton, 2002].
 During the menopause transition, it’s not just the ovaries that are affected. Other oestrogen-attracting cells are affected too.
What this means is that women (both fair-skinned and dark-skinned women) don’t synthesize (produce) Vitamin D very well in menopause.
It also means that night shift-workers get a double-whammy of both declining skin levels of oestrogen and losing exposure to Vitamin D because they have less available sunlight hours if they sleep during the day.Â
Menopause is one the most crucial stages in a femaleâs life. For years, I’ve been talking to women on my programmes about getting their Vitamin D levels tested. Many continue to tell me that Doctors are somewhat reluctant to do this.
Hence, I was heartened when new research came my way recently stating that numerous education gaps remain in relation to the health-related needs of females during menopause. [Rostami-Moez et al., 2023].
One of these research gaps relates to Vitamin D.Â
Hormonal fluctuations, excessive clothing covering, sunscreen use, changes in body fat composition, a vitamin D-deficient diet, and a sedentary lifestyle can all predispose menopausal and postmenopausal women to Vitamin D deficiency.
But there is something else as well and that is menopause itself.
The changing hormonal profile as well as changing skin health, marks a significant shift in vitamin D requirements during menopause. This is why evidence suggests that vitamin D deficiency is linked to various menopausal health conditions, such as vasomotor symptoms (hot flushes), poor liver and gut health and of course, musculo-skeletal disorders. [Hassanein et al, 2023].
Women on the 12 week MyMTâą programmes learn very quickly about the relevance of Vitamin D in our symptom and weight management, especially as we move into post-menopause. As a Health Practitioner, I hope that you can share this information with your clients too. Â
This and so much more information is in the MyMTâą Education Courses, which I hope you can explore if you haven’t already.Â
Dr Wendy Sweet (PhD), MyMTâą Founder & Coach/ Member: Australasian Society of Lifestyle Medicine.Â
References:Â
Abboud M. Vitamin D Supplementation and Sleep: A Systematic Review and Meta-Analysis of Intervention Studies. Nutrients. 2022 Mar 3;14(5):1076. doi: 10.3390/nu14051076.
Coppeta, L., Papa, F., & Magrini, A. (2018). Are Shiftwork and Indoor Work Related to D3 Vitamin Deficiency? A Systematic Review of Current Evidences. Journal of Environmental and Public Health, 8468742. https://doi.org/10.1155/2018/8468742
Gao, Q., Kou, T., Zhuang, B., Ren, Y., Dong, X., & Wang, Q. (2018). The Association between Vitamin D Deficiency and Sleep Disorders: A Systematic Review and Meta-Analysis. Nutrients, 10(10), 1395. https://doi.org/10.3390/nu10101395
Hassanein MM, Huri HZ, Baig K, Abduelkarem AR. Determinants and Effects of Vitamin D Supplementation in Postmenopausal Women: A Systematic Review. Nutrients. 2023 Jan 29;15(3):685. doi: 10.3390/nu15030685.
Iruzubieta P, TerĂĄn Ă, Crespo J, FĂĄbrega E. Vitamin D deficiency in chronic liver disease. World J Hepatol. 2014 Dec 27;6(12):901-15. doi: 10.4254/wjh.v6.i12.901.
Nagai, M., Hoshide, S., & Kario, K. (2010). Sleep duration as a risk factor for cardiovascular disease- a review of the recent literature. Current cardiology reviews, 6(1), 54â61. https://doi.org/10.2174/157340310790231635
Okura K., Lavigne G., Huynh N., Manzini C., Fillipini D., & Montplaisir J. (2008). Comparison of sleep variables between chronic widespread musculoskeletal pain, insomnia, periodic leg movements syndrome and control subjects in a clinical sleep medicine practice. Sleep Med. 9(4):352-61. doi: 10.1016/j.sleep.2007.07.007. Epub 2007 Sep 4. PMID: 17804292.
Rostami-Moez M, Masoumi SZ, Otogara M, Farahani F, Alimohammadi S, Oshvandi K. Examining the Health-Related Needs of Females during Menopause: A Systematic Review Study. J Menopausal Med. 2023 Apr;29(1):1-20. doi: 10.6118/jmm.22033.Â
