Vitamin D, CO2, and Fibromyalgia: The Unexpected Missing Link
Overbreathing: The Hidden Trigger for Chronic Pain
What if hyperventilation, often dismissed as a minor issue, was actually fueling chronic pain disorders like fibromyalgia? A groundbreaking hypothesis suggests that overbreathing might disrupt your body’s ability to produce vitamin D—and that could have devastating effects on your health.
The Problem: What’s Really Going On?
A study by JM Lewis et al. [ref1] dives into respiratory alkalosis, a condition caused by excessive breathing that lowers carbon dioxide (CO₂) levels in the blood.
Here’s the kicker: this CO₂ drop sets off a chain reaction, preventing your body from producing calcitriol—the active form of vitamin D.
Fibromyalgia has long been a medical mystery, leaving many patients without clear answers. But what if the culprit isn’t genetics or inflammation—but how we breathe?
This research suggests that long-term hyperventilation may actually mimic or even trigger fibromyalgia symptoms. The link? A suppressed ability to regulate calcium, nerve function, and energy production due to a hidden vitamin D deficiency.
The Big Reveal: What the Researchers Discovered
Hyperventilation → Low CO₂ → Kidney Dysfunction → Less Vitamin D → Chronic Symptoms
The study suggests that fibromyalgia and acute mountain sickness (AMS) may share a common root cause: an inability to properly regulate CO₂ and pH balance. This could explain why both conditions share symptoms like:
✅ Muscle pain and fatigue
✅ Sleep disturbances
✅ Brain fog and dizziness
✅ Sensitivity to touch and temperature
If this theory holds up, it could change the way fibromyalgia is treated forever.
How Did They Figure This Out?
Instead of dismissing fibromyalgia as a “mystery illness,” the researchers looked at how the kidneys struggle to compensate for prolonged respiratory alkalosis. Their findings?
Hyperventilation puts the kidneys into overdrive, forcing them to excrete excess bicarbonate in an attempt to rebalance pH. This process is slow and exhausting, leaving other kidney functions compromised.
🛑 With chronic hyperventilation, the kidneys struggle to release phosphate—a key ingredient for producing active vitamin D (calcitriol).
🛑 Without enough vitamin D, the body loses its ability to regulate calcium and nerve function, potentially leading to chronic pain, fatigue, and heightened sensitivity.
🛑 This could explain why many fibromyalgia patients experience chronic stress, anxiety, and shallow breathing—not just as symptoms, but as a possible root cause.
So… Should You Stop Breathing?
Not exactly. But this research challenges the mainstream approach to treating fibromyalgia. Instead of relying solely on painkillers, antidepressants, or endless stretching routines, the key could be restoring proper CO₂ balance.
The paper hints at a potentially game-changing solution: Instead of more medications, low, slow, rhythmic nasal breathing, CO₂ therapy, and even mild metabolic acidosis (through diet changes) could help restore the body’s natural balance—and potentially reverse symptoms.
The Bottom Line: Why This Matters
For years, traditional treatments for fibromyalgia have focused on managing pain instead of addressing the root cause. But this research suggests that we may have been looking at it all wrong.
Instead of adding more medications, maybe we need to focus on something far simpler: restoring CO₂ levels through Conscious Breathing and metabolic regulation.
It’s time to stop ignoring the breath-body connection and start asking the right questions.
Scientific References
Title: Respiratory alkalosis may impair the production of vitamin D and lead to significant morbidity, including the fibromyalgia syndrome
Authors: Lewis JM, Fontrier TH, Coley JL.
Journal: Med Hypotheses. 2017 May;102:99-101. doi: 10.1016/j.mehy.2017.03.013. Epub 2017 Mar 8. PMID: 28478843.
Link to PubMed: Respiratory alkalosis may impair the production of vitamin D and lead to significant morbidity, including the fibromyalgia syndrome 
Abstract: Hyperventilation caused by physical and/or psychological stress may lead to significant respiratory alkalosis and an elevated systemic pH. The alkalotic pH may in turn suppress the normal renal release of phosphate into the urine, thereby interrupting the endogenous production of 1,25-dihydroxyvitamin D (calcitriol). This could cause a shortfall in its normal production, leading to a variety of adverse consequences. It might partially explain the pathogenesis of acute mountain sickness, a treatable disease characterized by severe hyperventilation secondary to the hypoxia of high altitude exposure. Milder degrees of hyperventilation due to different forms of stress may produce other conditions which share characteristics with acute mountain sickness. One of these may be the fibromyalgia syndrome, a chronic painful disorder for which no satisfactory treatment exists. Should fibromyalgia and acute mountain sickness have a common etiology, may they also share a common form of treatment? Evidence is presented to support this hypothesis.
Title: Breathing evaluation and retraining as an adjunct to manual therapy
Authors: McLaughlin L, Goldsmith CH, Coleman K.
Journal: Man Ther. 2011 Feb;16(1):51-2. doi: 10.1016/j.math.2010.08.006. Epub 2010 Oct 8. PMID: 20933458.
Link to PubMed: Breathing evaluation and retraining as an adjunct to manual therapy
Abstract: Back and neck pain are extremely common reasons for patients seeking manual therapy treatment. Epidemiological evidence supports a link between breathing difficulties and back pain. Since trunk muscles perform both postural and breathing functions, it is theorized that disruption in one function can negatively impact the other. Altered breathing mechanics can change respiratory chemistry and therefore pH causing smooth muscle constriction, altered electrolyte balance and decreased tissue oxygenation. These changes can profoundly impact any body system. Increased excitability in the muscular and nervous systems may be most relevant to a manual therapist. Respiratory function can be tested via capnography which measures CO₂ at the end of exhale known as End Tidal CO₂ (ETCO₂). ETCO₂ closely reflects arterial CO₂ in people with normal cardiopulmonary function. A case series of twenty nine outpatients with neck or back pain who had plateaued with manual therapy and exercise were identified all of whom were found to have low ETCO₂. Breathing retraining improved ETCO₂, pain and function in all patients with 93% achieving at least a clinically important change in either pain or function. Screening for breathing dysfunction using capnography may improve patient outcomes in those patients where manual therapy, exercise and education do not provide full resolution of symptoms.
Title: Hypocapnia in women with fibromyalgia
Authors: Jonsson K, Pikwer A, Olsson EMG, Peterson M.
Journal: Scand J Pain. 2024 Jun 21;24(1). doi: 10.1515/sjpain-2024-0003. PMID: 38907689.
Link to full text: Hypocapnia in women with fibromyalgia 
Abstract: Objectives: The purpose of this study was to investigate whether people with fibromyalgia (FM) have dysfunctional breathing by examining acid-base balance and comparing it with healthy controls. Methods: Thirty-six women diagnosed with FM and 36 healthy controls matched for age and gender participated in this cross-sectional study. To evaluate acid-base balance, arterial blood was sampled from the radial artery. Carbon dioxide, oxygen, bicarbonate, base excess, pH and lactate were analysed for between-group differences. Blood gas analyses were performed stepwise on each individual to detect acid-base disturbance, which was categorized as primary respiratory and possible compensation indicating chronicity. A three-step approach was employed to evaluate pH, carbon dioxide and bicarbonate in this order. Results: Women with FM had significantly lower carbon dioxide pressure (p = 0.013) and higher lactate (p = 0.038) compared to healthy controls at the group level. There were no significant differences in oxygen pressure, bicarbonate, pH and base excess. Employing a three-step acid-base analysis, 11 individuals in the FM group had a possible renally compensated mild chronic hyperventilation, compared to only 4 among the healthy controls (p = 0.042). Conclusions: In this study, we could identify a subgroup of individuals with FM who may be characterized as mild chronic hyperventilators. The results might point to a plausible dysfunctional breathing in some women with FM.
