Vitamin D Supplements and Hot Flashes

SAFM Team 

Vitamin D supplements can cause or exacerbate hot flashes. Yes! This is a great reminder that “Vitamin D” is really not just a vitamin; it’s a steroid hormone (like estrogen). Many of our clients have been told it’s their “imagination” or delusion that their hot flashes started or worsened after starting Vitamin D supplements. But I have seen this happen to several of my clients – and me too personally! Hard to argue with close, personal experimentation (and I’m a scientist at heart, so I get all structured about it). You want to be savvy about this as a practitioner.
As far as I am aware, no clinical study (yet!) has evaluated this explicitly. 

 We already know that estrogen affects Vitamin D metabolism. And we know that estrogen affects Vitamin D receptors and vice versa. For peri/postmenopausal women, there’s no consistent evidence that hot flashes are correlated specifically with serum levels of Vitamin D. However, in menstruating women, having higher Vitamin D reduces estrogen levels (perhaps one of the avenues via which having Vitamin D reduces the risk of breast cancer).
It’s also a good reminder to not get “supplement-crazy” with your clients and patients. By far, the best way for our clients to maximize their Vitamin D is with regular, wise sun exposure. Yes, many of our clients need more Vitamin D. And some can effectively use a supplement – even a high-dose one – without any side effects and lots of positive benefits. But some cannot. Everyone is different. If your client or patient gets a significant increase in hot flashes soon after starting Vitamin D, it’s time to thinking more thoroughly. 

 Keep in mind that all nutrients are interconnectedness. The body needs plenty of magnesium to convert Vitamin D to its final form (this is true with supplemental Vitamin D or that which we make in our skin from sun exposure). Sometimes our clients who start Vitamin D (especially if it’s very high dose such as the typically prescribed Rx for 50,000 IU D2) rapidly use up their magnesium and end up with symptoms of magnesium deficiency (e.g. achy muscles, reflux, muscle spasms, headache, constipation). 

 We also use Vitamin A and Vitamin K in concert with Vitamin D, so aggressively boosting one can deplete or cause imbalance in the others. I have had a couple of clients whose Vitamin D-mediated hot flashes went away when they added Vitamin K2 (a good strategy anyway to support bone density in peri/postmenopausal women). But in other cases, it didn’t make a difference at all.

I hope this quick clinical tip serves you and your patients and clients. Follow-up questions are welcome!
Warmly,