Is Vitamin D The Missing Link In Chronic Pain?

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

Chronic pain is one of the most common health concern for which people seek medical treatment. Research suggests that up to 50% of the population may be suffering from some kind of chronic pain, with back pain being the most common.1 There are number of possible causes such as diet, posture, age and injury that contribute to chronic pain but vitamin D is one factor that is now being added to the list. Vitamin D deficiency is a very common occurrence, especially in people living in colder climates. It has been linked to numerous health conditions, one of which being musculoskeletal (MSK) pain.2

A study published in November 2012 found that MSK pain is related to vitamin D deficiency, and replacement of vitamin D improved pain. The researchers found that 95.4 percent of the subjects were vitamin D deficient, and 85.5 percent of the subjects had improvement in pain with vitamin D supplementation.2 Of the subjects that responded to the treatment, post-treatment serum vitamin D levels were significantly higher than in the subjects who did not respond to vitamin D supplementation. The study concluded, “Treatment with vitamin D can relieve the pain in majority of the patients with vitamin D deficiency. Lack of response can be due to insufficient increase in serum vitamin D concentration.”2 This study confirms the results of a number of other studies that have found the same results.3,4,5 The studies found that vitamin D deficiency may be responsible for generalized, non-specific pain especially if it is resistant to manual and conventional treatments. 

Due to the large proportion of the population that experience both chronic pain and vitamin deficiency it would be prudent that both doctors and patients consider vitamin D levels a possible key-contributing factor. The most recent data suggests that less than 50 nmol/L of serum vitamin D is a deficient state. The optimal levels are 100-160nmol/L. The most effective and accurate way to determine what dosage is required to reach optimal levels is to have your serum 25-hydroxyvitamin D assessed. Most health agencies agree that 500-2000IU daily are effective to maintain adequate levels but its not enough if you are deficient. 

Vitamin D can be a simple yet very effective therapy for chronic, non-specific pain if you are deficient. To determine if is may be contributing to your pain, have a qualified healthcare practitioner assess your serum levels and supplement appropriately to restore your optimal levels. Consider liquid, oil based formulations to increase the ease of achieving higher dosages. In medicine, sometimes the simplest piece is often the most important. Vitamin D once again forces us to go back to the basics in the quest to achieve pain free function.  



1) Andersson HI, Ejlertsson G, Leden I, Rosenberg C. Chronic pain in a geographically defined general population: studies of differences in age, gender, social class, and pain localization. Clin J Pain. 1993;9(3):174-82

2) Abbasi M, et al. Is vitamin D deficiency associated with non specific musculoskeletal pain? Glob J Health Sci. 2012;1:107-11.

3) Plotnikoff GA, Quigley JM. Prevalence of severe hypovitaminosis D in patients with persistent, nonspecific musculoskeletal pain.

Mayo Clin Proc. 2003 Dec;78(12):1463-70.

4) Al Faraj S, Al Mutairi K. Vitamin D deficiency and chronic low back pain in Saudi Arabia. Spine (Phila Pa 1976). 2003 Jan 15;28(2):177-9.

5) Holick MF. Vitamin D deficiency: what a pain it is. Mayo Clin Proc. 2003 Dec;78(12):1457-9.

10 Things You May Not Have Known About Naturopathic Doctors

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

1) Even though a visit with a ND is not covered by OHIP most extended health plans now cover Naturopathic visits. Check yours to see if you are covered. This is actually a big advantage since ND's are not restricted by OHIP regulations (paid by the number of patients you see etc) and can take enough time to treat each patient thoroughly.  

2) Did you know that a typical visit your family doctor lasts on average 7 minutes? A first visit with your ND can be anywhere from 60-120 minutes and a follow up is approximately 30 minutes. This allows for enough time to address the root cause of your symptoms. 

3) ND's have eight years of post graduate education; this consists of four years of university undergraduate studies and four years of medical college. This is equivalent to the length of education for medical doctors and chiropractors. Our education includes a residency program, preceptorship and a possibility of specialization. 

4) ND's have are trained and certified in a wide variety of treatment modalities. These include:

  • Nutritional therapy
  • Orthomolecular medicine (vitamins and minerals)
  • Botanical medicine
  • Acupuncture
  • Naturopathic manipulation/hands on therapy
  • Injection therapy
  • Intravenous therapy
  • Homeopathy

5) In Ontario, ND's are now legislated under the Naturopathy Act (which is under the Regulated Healthcare Practitioners Act). This means they are government approved and supported. Full proclamation is slated for 2014. 

6) ND's practicing in British Colombia and some US states are able to prescribe certain pharmaceutical drugs such as antibiotics. This allows them to act as primary care doctors and better help their patients. As part of a ND's education they are required to learn pharmacology and the safety if how natural substances interact with drugs. 

7) Naturopathic medicine is evidence-based. As an example, a recent study (april 2013) published in the prestigious Canadian Medical Association Journal found that Naturopathic medicine reduced the risk of cardiovascular disease. There also is a large body of research supporting each of the therapies that are used by ND's. For example, try typing the word probiotics into pubmed to see how many references you get (hint: it's in the thousands).

8) ND's are the "Sherlock Holmes" of all healthcare practitioners. Many patients visit an ND after no other doctor or health care practitioner was able to help them or get to the bottom of their symptoms. ND's use a comprehensive assessment, physical exam skills and lab testing to assess all aspects of their patients.

9) ND's use both conventional and cutting edge lab testing to assess their patients. For example they look at standard blood values such as iron levels and white blood cells but also are able to use testing from around the world to assess for hidden infections such as Lyme disease or immune activation by food allergies. 

10) Did you know the word "doctor" means "teacher?" Naturopathic doctors take their roles as teachers very seriously. Our goal is to teach our patients how to improve their health through dietary and lifestyle changes so they can have lasting and vibrant health without having to take drugs or supplements forever.


Simple New Years Resolutions That You Can Actually Keep

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

It’s halfway through January and I hope your New Years resolutions are in full swing. You may have noticed that the gym is more full and the yoga studio is a tighter squeeze. While I am a big fan of resolving to live a healthier life, I think New Year resolutions usually don’t last, often leaving us frustrated. Because of this,  I wanted to give you some simple some resolutions that you will actually keep and will improve your health on multiple levels. 

The key to successful resolutions is keeping them simple and achievable. This will increase your chance to actually stick with the changes you want to make. Start with small steps before jumping to lofty goals. Also, challenge yourself to be healthier not just in your body but also in your mind and spirit. We need to respect all aspects of who we are and not ignore essential parts of what makes us truly healthy. 

1) Sweat more – This resolution seems simple but it actually covers a lot of key bases. Instead of resolving to exercise more, make a commitment to doing something that gets your sweaty at least once a week. This could be doing a spin class at the gym, going for a run, lifting weights, or doing a yoga class. It can also be something very simple such as climbing a flight of stairs or going for a brisk walk. It will be different for each person but just as powerful. We often are afraid to get sweaty but it’s our body’s way to eliminate toxins and promote circulation. Don’t be afraid to sweat this year!

2) Eat less – I think this is something we have all tried to do to lose a little weight. However, something so simple can be very helpful not just in cutting back on the extra calories but also promoting longevity. Studies have found that organisms that eat less live longer. Recent evidence shows that this approach promotes brain function and improves blood sugar control. Most North Americans over-eat so don’t fall into that trap this year and resolve to cut down your portions by as little as 20%. It doesn’t require calorie counting or weighing your food, just serve less food on your plate then you usually do. 

3) Vent more – We can’t avoid getting irritated or angry. It just happens, especially when we are stressed and tired. The key thing is what we do with that anger when we experience it. A recent study found those people that internalized anxiety ran the risk of an elevated pulse, which increases the risk of high blood pressure, heart disease and other ailments. This year resolve to vent or discharge your frustration or anger in a healthy way. This can be something like conscious deep-breathing exercise or even try martial arts or yoga. 

4) Sleep more – Sleep is one of the most important things you can do to maintain good health. Numerous studies have found that sleep improves immunity, increases the ability to cope with stress, and improves weight loss by cutting cravings. I often tell patients that the single, most powerful change you can make to improve your health is to go to bed one hour earlier. There are so many health benefits from making this simple resolution. 

5) Be silent more – Just as you have to exercise regularly to build your muscle you have to also prioritize time to build your mind and spirit. The problem is that we are so use to getting things done by doing more, not slowing down and doing less. Taking the time to meditate, pray or just be silent is one of the most difficult things to do for most people. However, once you make it a habit it becomes the most rewarding. I challenge you to start with just 5 minutes a day to just sit and be still. Don’t do this right before bed or when you are distracted but rather be deliberate with putting aside time in your day. To focus on the right thing try this simple method. Pick one simple shape or image and focus on that thing in your mind. Take a stopwatch or timer (your smart phone has one) and start it. Every time you lose focus on that one image or shape, re-start the timer. You will be surprised how short your focus can be. Challenge yourself to do this daily and work towards getting up to 5 minutes without re-starting. 

Making and keeping New Year’s resolutions does not have to be difficult. Implement these 5 simple changes and maintain them, even if you start by doing each one once a week. Remember, the road to failure is littered with good intentions. Make your 2015 resolutions simple and sustainable. 

Have a healthy and happy New Year and if you'd like to know more or would like to work with me to help you achieve some of your resolutions feel free to call our clinic in Vaughan at any time to book an appointment: 1-800-597-5733

Dr Paul Hrkal