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.

Addressing The Metabolic Aspects of Concussions With Nutrition And Natural Compounds

Dr. Paul Hrkal, Naturopathic Doctor

Dr. Paul Hrkal, Naturopathic Doctor

Traumatic brain injuries (TBI) and concussions are generating greater medical and research interest as public awareness grows, especially in the impact on younger and more vulnerable populations. An explosion of recent research has uncovered some of the underlying pathways involved in TBI and concussions. While one complete theory has yet to be confirmed, there is emerging science that brain trauma causes neurotransmitter and calcium release which initiates a viscous cycle of excitotoxin production, impaired energy production, neuro-inflammation and immune activation. 

People that have a concussion undergo a very brief period (minutes to hours) of increased energy production as brain cells try to restore balance followed by a period of reduced brain function, as the ability of brain cells to produce energy is greatly impaired. This state can last 7 days or longer (30 days in severe cases) depending on the severity of the injury. While in this “impaired” state, the risk of a concussion appears to increase when the brain has suffered a prior concussive injury and has not yet fully healed. 

Unfortunately, at this time there are no neuro-protective treatment options that exist to improve symptoms after a TBI or post concussive syndrome. Drug and pharmaceutical approaches have shown limited benefits and currently are not recommended as a treatment. Now many scientists are starting to study a wide range of natural compounds and vitamins that have promising broad-spectrum, neuroprotective and anti-inflammatory activity. Curcumin, green tea, essential fatty acids, resveratrol, and vitamin E are some of the compounds with potential therapeutic benefit. 

Considering the large number of changes that occur after a brain injury a potential solution also needs be able to have a broad spectrum of therapeutic action. Unfortunately drugs can be very effective but are inadequate in TBI since they usually address one very specific factor. This is where nutrition and natural substances can be a very powerful tool to speed up injury recovery and promote healing. The foods that you eat can powerfully reduce the amount of overall inflammation in you have in your body. Specific evidence based natural supplements can also address a wide range of targets including mitochondrial function and neuro-inflammation. Additionally this approach can also improve the ability of your brain to heal during and after a concussion if employed as a preventative strategy. If you are looking to improve your overall brain resilience or want address the chronic effects of a brain injury consider enhancing your brain metabolism with nutrition and natural supplementation. 

Key definitions:

Neurotransmitter: A signaling molecule found in the brain (i.e glutamate)

Mitochondria: The part of each cell that is responsible for energy production. They are essential in order for a cell to survive.  

Calcium release: Calcium is a mineral that plays a key role in nerve function. Excessive calcium release after a concussion can damage the ability of a nerve cell to produce energy. 

Excitotoxin production: excitotoxins are signaling molecules produced in the brain after trauma. They disrupt normal brain function by excessively stimulating nerve activity. 

Impaired energy production: Excessive calcium and excitotoxin production damage the mitochondria in brain cells which in turn impairs their ability to produce energy. Without energy brain cell function slows and eventually can stop. This the mechanism behind many post-concussion related symptoms. 

Neuro-inflammation: inflammation is produced to stimulate healing in the short term but can be very damaging when it continually in produced without being resolved. 

Immune activation: Specialized immune cells in the brain called microglia are turned on after a brain injury. Once fully activated they can produce inflammation. 



Giza CC, Difiori JP. Pathophysiology of sports-related concussion: an update on basic science and translational research. Sports Health. 2011 Jan;3(1):46-51

Maroon JC, Lepere DB, Blaylock RL, Bost JW. Postconcussion syndrome: a review of pathophysiology and potential nonpharmacological approaches to treatment. Phys Sportsmed. 2012 Nov;40(4):73-87

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.