Nutrient Status Is Rarely Measured in Chronic Pain, Fatigue, and Traumatic Stress

By Chris Junge, Founder, Solprana · B.S. Biomedical Science · Updated October 20, 2026

Chris Junge | Founder, Solprana | solprana.net

About one in five American adults lives with chronic pain. The Centers for Disease Control and Prevention estimated 51.6 million adults in 2021, and its 2023 survey put the share at 24.3 percent (1, 2). Many of these people also describe fatigue that sleep does not resolve, and a substantial number carry the lasting effects of traumatic stress. Most are under medical care, and for many of them care means long-term management of symptoms.

Modern life measures a great deal, from daily steps to stages of sleep. Nutrient status is seldom among the things measured when these conditions are assessed. This article sets out what has been observed about nutrient status in chronic pain, fatigue, and traumatic stress, what has not been shown, and what a proper test would look like. It does not argue that nutrients cause or cure these conditions. It argues that the question has not yet been asked with adequate methods.

What has been observed in chronic pain

The largest recent data set comes from the National Institutes of Health All of Us research program. A 2025 cross-sectional analysis compared blood nutrient levels in adults with no pain, mild or moderate pain, and severe pain (3). Each nutrient had its own cohort, ranging from 656 people for vitamin C to 93,445 for magnesium. Adults with severe chronic pain had lower serum vitamin D, vitamin B12, and folate than the other groups, and magnesium deficiency was more frequent among them.

The findings were not uniform. Results differed by sex and by ethnicity, and in one subgroup, Asian women with severe pain, vitamin B12 was the highest of any group. More importantly, a cross-sectional study records one moment in time and cannot establish direction. Pain changes diet, physical activity, time outdoors, and medication use, and each of those can change nutrient status. The study shows that the two travel together. It does not show which comes first.

The measurement itself has a limit. The study used serum values, and serum magnesium is a weak indicator of the body’s magnesium, most of which sits inside cells and in bone (4). Any future study of magnesium in these conditions should report red blood cell magnesium alongside the serum value.

What has been observed in fatigue

Here the evidence runs against a simple story. A 2017 systematic review and meta-analysis gathered 45 studies of vitamin and mineral status in chronic fatigue syndrome and fibromyalgia, a condition of widespread pain that affects about 4 million adults in the United States (5, 6). Only vitamin E was lower in patients than in controls, and that difference disappeared when lower-quality studies were set aside. The authors concluded that there was little evidence that vitamin and mineral deficiencies play a role in these conditions, or that supplements are effective in these patients.

That conclusion deserves to be stated plainly. Individual studies have reported lower levels of particular nutrients in people with chronic fatigue, but the pooled evidence does not show a consistent pattern of deficiency. Most of the underlying studies also relied on serum measures and small samples, so the question is better described as poorly tested than as settled.

What has been observed in traumatic stress

No published study has measured magnesium status in a group of people with post-traumatic stress disorder. That is the central gap. What exists is adjacent. Small human studies suggest that acute stress, such as examination periods, noise, and sleep restriction, is accompanied by greater urinary magnesium loss or lower red blood cell magnesium (7). The review that assembled those studies included two authors employed by a consumer health company, and none of the studies involved traumatic stress. If stress does raise magnesium requirements, the accurate description is competing demand on a shared pool. It is not a draining of stores, and it has not been measured in this population.

Vitamin D has been measured once. A 2025 chart review from a Veterans Affairs clinic examined 55 Gulf War veterans with post-traumatic stress disorder, all of whom were being seen for a digestive condition (8). Most were vitamin D deficient at the outset, with a mean level near 19.7 ng/mL. After about three months of supplementation, roughly 80 percent reported feeling less depressed and less anxious. The study had no control group, used no standardized symptom scale, and relied on physician questioning. Its value is practical: it shows that measuring a nutrient in this population, correcting a documented shortfall, and recording the result can be done in an ordinary clinic.

Some symptoms of low magnesium, including fatigue, irritability, and mild anxiety, overlap with common symptoms of stress (7). Overlap is a reason to measure. It is not evidence that one explains the other.

Medications and nutrient status

Some medications do change nutrient status, and the evidence is strong for a small number of them. Long-term use of acid-suppressing medicines can lower blood magnesium (4). Long-term use of the most widely prescribed first-line diabetes medicine is associated with vitamin B12 deficiency, which was found in 4.3 percent of users against 2.3 percent on placebo at five years in one large follow-up study (9). Certain diuretics increase the loss of magnesium and potassium, and long-term oral steroid treatment affects calcium, vitamin D, and bone (10). The review cited for the last two points included two authors employed by a supplement company.

For the medicines most often used in chronic pain, low mood, and anxiety, the picture is different. Long lists of nutrients said to be reduced by these medicines circulate widely, but for most of them no human study shows the effect. One laboratory study found that high concentrations of common anti-inflammatory pain relievers inhibited a magnesium-transporting channel in cultured cells (11). It did not measure magnesium uptake, and nothing comparable has been examined in people. Anyone concerned about a specific prescription should raise it with the prescriber or a pharmacist, and no one should stop a medication on the basis of this article.

Why the question is reasonable

The body converts carbohydrate, fat, and protein into usable energy through enzymes that depend on specific vitamins and minerals. Magnesium is among the most basic of these, because the form of ATP that most enzymes use is ATP bound to magnesium (12). National survey data from 2013 to 2016 indicate that 48 percent of Americans consume less magnesium from food and beverages than the Estimated Average Requirement for their age and sex (4). The Estimated Average Requirement is a population benchmark, so this figure describes intake across a population. It does not show that any individual is deficient. A companion article, The Body Is Not a Calorie Counter, covers this ground in more detail.

History offers a caution about waiting for a complete explanation. In 1882 and 1883 the Japanese naval training ship Ryujo recorded 169 cases of beriberi among 376 crew, with 25 deaths. In 1884 the naval physician Takaki Kanehiro sent the Tsukuba along the same route with a revised diet, and 14 of 333 crew fell ill with none dying (13). Takaki believed the cause was too little protein. The missing factor, thiamine, was not isolated until 1926 and was synthesized in 1936. The intervention was right decades before the explanation was. Beriberi is the extreme case, however, and whether milder shortfalls contribute to chronic pain, fatigue, or traumatic stress remains a hypothesis.

What is not being measured

There is some evidence that nutritional factors are seldom considered in routine pain care. In a 2020 randomized study, 151 primary care physicians in the United States worked through simulated patient cases of chronic pain. Physicians without access to a urine biomarker panel addressed nutritional deficiency in 8.8 percent of cases, against 59.5 percent of those given the panel (14). The study was funded by the company that sells the panel, one author was its employee, and no real patients or pain outcomes were involved. It indicates what physicians tend to look for. It says nothing about whether looking improves outcomes.

What would test the idea

A useful study would begin with measurement. It would enroll adults with chronic pain or post-traumatic stress disorder alongside matched controls, and record red blood cell magnesium, serum 25-hydroxyvitamin D, vitamin B12, and folate, together with diet and current medications. Where a documented shortfall is found, a randomized trial of correction against placebo would follow, with validated outcome measures such as a standard pain interference scale and a standard symptom checklist for post-traumatic stress.

That design could fail, and it should be allowed to. If nutrient status in these groups matches that of controls, or if correcting a shortfall changes nothing, the hypothesis is wrong and should be set aside. Until such a study is done, the observations above remain associations.

None of this argues against medical treatment. Medications make severe pain bearable and stabilize conditions that would otherwise be disabling. The case here is narrower. Nutrient status can be measured accurately and at modest cost, it is rarely measured in these conditions, and the existing evidence is too thin to say whether that omission matters.

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References

1. Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic Pain Among Adults: United States, 2019–2021. MMWR Morb Mortal Wkly Rep. 2023;72(15):379–385.
2. Lucas JW, Sohi I. Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. NCHS Data Brief. 2024;(518).
3. Goon M, Schmidt N, Berwal D, Branisteanu DDB, Barron G, Morris DR, DiMarzio M, Goudman L, Pilitsis JG. Micronutrients and Chronic Pain: A Cross-Sectional Analysis. Pain Pract. 2025;25(5):e70053.
4. National Institutes of Health, Office of Dietary Supplements. Magnesium: Fact Sheet for Health Professionals. Updated January 6, 2026.
5. Joustra ML, Minovic I, Janssens KAM, Bakker SJL, Rosmalen JGM. Vitamin and mineral status in chronic fatigue syndrome and fibromyalgia syndrome: A systematic review and meta-analysis. PLoS One. 2017;12(4):e0176631.
6. Centers for Disease Control and Prevention. Fibromyalgia. Last reviewed May 25, 2022.
7. Pickering G, Mazur A, Trousselard M, Bienkowski P, Yaltsewa N, Amessou M, Noah L, Pouteau E. Magnesium Status and Stress: The Vicious Circle Concept Revisited. Nutrients. 2020;12(12):3672.
8. Kesavan C, Strong DD, Strong RM. Correction of Vitamin D Deficiency Improves PTSD Symptoms in Gulf War Veterans. Brain Sci. 2025;15(11):1135.
9. Aroda VR, Edelstein SL, Goldberg RB, et al. Long-term Metformin Use and Vitamin B12 Deficiency in the Diabetes Prevention Program Outcomes Study. J Clin Endocrinol Metab. 2016;101(4):1754–1761.
10. Mohn ES, Kern HJ, Saltzman E, Mitmesser SH, McKay DL. Evidence of Drug–Nutrient Interactions with Chronic Use of Commonly Prescribed Medications: An Update. Pharmaceutics. 2018;10(1):36.
11. Chokshi R, Bennett O, Zhelay T, Kozak JA. NSAIDs Naproxen, Ibuprofen, Salicylate, and Aspirin Inhibit TRPM7 Channels by Cytosolic Acidification. Front Physiol. 2021;12:727549.
12. Romani AM. Cellular magnesium homeostasis. Arch Biochem Biophys. 2011;512(1):1–23.
13. Sugiyama Y, Seita A. Kanehiro Takaki and the control of beriberi in the Japanese Navy. J R Soc Med. 2013;106(8):332–334.
14. Peabody J, Paculdo D, Tamondong-Lachica D, Cabaluna IT, Gunn J. Randomized Trial on the Clinical Utility of a Novel Biomarker Panel to Identify Treatable Determinants of Chronic Pain. Diagnostics (Basel). 2020;10(8):513.

This article is for information and is not medical advice.