 You hear that familiar wheeze or cough although you barely did any exercise. You may have just gone up a set of stairs, stepped out into the cold, or emptied out the dust compartment of the vacuum cleaner. Here it goes again, you think, as you reach for your inhaler…
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 We’re heading into the Christmas holidays, where parties, friends, and family abound, and gifts and hugs are shared. Unfortunately, these close quarters are also prime opportunities for the flu and other viruses to be shared among us. If our immune systems are compromised with our lack of sunlight at this time of the year (and therefore low Vitamin D), and further taxed by lack of sleep, stress, alcohol, sweets, dry heated environments, and lack of exercise, we can be more susceptible to coming down with the flu.
So what’s the scoop on Vitamin D, and can it help you prevent and/or treat the flu? Low Vitamin D levels are associated with higher flu rates. There are many studies showing that deficient levels of Vitamin D are associated with higher rates of flus and respiratory tract infections. Now, keep in mind that just because there is a correlation, it doesn’t mean that the lack of Vitamin D is actually causing the increase in flus, and it’s definitely not the only factor. But clinically, we do see that optimizing Vitamin D levels and correcting deficiencies generally decreases patients’ frequency of getting sick with the flu. Vitamin D supplementation has been studied in the context of preventing one kind of influenza, influenza A. It was found that supplementing with Vitamin D decreased influenza A flus in schoolchildren, with the added bonus of decreasing asthma rates in those susceptible (Urashima et al., 2010). Optimize Your Vitamin D Levels I frequently test my patients for their Vitamin D levels in the blood (25-0H Vitamin D), and very rarely are they adequate, even in those that are taking 1000-2000 IU of vitamin D on a daily basis! So often, if your levels were very deficient to start with, blindly taking the recommended intake won’t help very much. You also don't want to take too much and overdose! The average blood level of Vitamin D in Canadians is below 75 nmol/L (the lower end of the “normal” range), and 1/3 of those people are likely quite deficient, with levels below 50 nmol/L. Levels in the winter are even lower than that! I aim not only for normal ranges, but optimal ranges for my patients. This usually requires prescription level doses of Vitamin D (>1000 IU a day), which I can prescribe. Getting your levels checked can allow me to dose your Vitamin D appropriately and safely, bringing your levels up quickly and efficiently. Vitamin D is also important for so many other things, including bone health, mood, and energy! Treatment Of Flu With “The Vitamin D Hammer” Most of us have come down with the flu at some point or another, and we know it can make us feel quite miserable. What if you could cut that misery short? Can Vitamin D help once you already have the flu? There isn’t much research in the area. However, there is some evidence clinically from doctors who use high doses of Vitamin D that it can be very helpful. We’re not talking about 800-1000 IU a day in these instances, as this likely would be too little, too late for most people. Dr. Gerry Schwalfenberg, MD, and his colleague use very high doses of Vitamin D (we’re talking high prescription doses) at the onset of the flu for 2-3 days. They call this “the Vitamin D hammer”, flooding the body with Vitamin D short-term! With this protocol, they find that patients’ symptoms resolve within 48-72 hours, which is amazing considering that the usual flu will often last a week or more, and can be followed by feeling weak and rundown for a while still afterwards. Do you want to minimize your chances of getting the flu? Then among your arsenal, a good personalized dose of Vitamin D would probably be a good idea. We can get you tested to optimize your levels, and include other immune-boosting measures and supplements into your treatment plan so that you keep up your energy and smile all winter long! References Schwalfenberg G. (2015). Vitamin D for influenza. Can Fam Physician, 2015 Jun; 61(6):507. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/ Urashima M., Segawa T., Okazaki M., Kurihara M., Wada Y., and Ida H. (2010). Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr, 2010 May;91(5):1255-60. doi: 10.3945/ajcn.2009.29094. Epub 2010 Mar 10.  Fatigue is a very common concern that patients come to see me for in my practice. A lot of the time, patients have had a standard workup done with their medical doctor, but were told everything came back as “normal”. You may find yourself in the same situation. You know you could feel better, but you don’t know what you can do about it. So, you keep dragging yourself from one day to the next with just barely enough energy to get through the day. Chances are, you CAN get better, and a naturopathic doctor can help you figure out what needs to change. We all feel tired once in a while. If you’re wondering if your level of energy is normal or not, here are some signs that things could be better:
Of course, there are some basic lifestyle factors that can lead to fatigue. These are things that you would easily be able to identify yourself, like lack of sleep, a diet of highly processed food, or lack of exercise (which you may not be able to bring yourself to do if you are feeling very run down). What I’ll share with you today are the top 7 causes that I take into account when assessing a patient with longstanding fatigue. Keep in mind that there are many other causes. If these show up as optimal for you, then I’ll keep digging to find the cause of your fatigue. #1 – Iron Deficiency OR Iron Overload Most women who have regular menstrual cycles have sub-optimal iron levels. Furthermore, those who eat vegan or vegetarian diets are at greater risk of an iron deficiency. Even if you are not anemic (where iron levels drop to a minimum), you can still feel low in energy if your storage level of iron (ferretin) is sub-optimal. I generally aim for ferretin to be in the 60-80 range for women. Note that you could be in the “normal” levels with levels of ferretin as low as 10, but obviously you wouldn’t be feeling your best! Before you go ahead and start supplementing with iron, do get your ferretin levels checked. It is possible to take too much iron, which can cause all kinds of problems long-term. Some people feel unwell because their body stores too much iron, a condition called hemochromatosis. I’ve seen this issue more commonly in men than in women, but it can happen in either. #2 – Vitamin Deficiencies, Especially VitB12 And VitD A Vitamin B12 deficiency is very common in vegans and vegetarians, so if you are eating little to no animal protein, you are probably deficient. However, even if you do eat meat regularly, it is possible to be B12 deficient. This can be due to problems assimilating the B12 from your diet due to issues such as malabsorption, food sensitivities, or low stomach acid. As well, if you are prone to depression or anxiety, you may need higher levels of B12. Vitamin D deficiency is also very common here in Canada. It is very rare for me to measure a patient’s blood levels and find them in the optimal range if they are not supplementing with at least a minimal amount of Vitamin D. Adequate Vitamin D not only helps with energy, but it also helps with hormone balance, immune system support, skin health, and cancer prevention. Most people need prescription levels (i.e. >1000 IU per day) of Vitamin D at least temporarily, and getting your blood levels measured helps to individualize that prescription for you. #3 – Blood Sugar Imbalances If you crave carbs or sugary snacks and need that cookie to get your energy back up, a blood sugar imbalance might be behind your fatigue. Sugary foods can bring your energy levels up, but only temporarily. This is soon followed by a crash in energy, which will have you reaching for another quick source of energy. Having more balanced meals with plenty of protein and vegetables can help you keep your energy more even throughout the day. You can test this out by seeing how you feel after pasta dish compared to how you feel after a hearty chicken salad. #4 – Sub-Optimal Thyroid Function Hypothyroidism is a condition in which the metabolism slows down, and people generally feel more fatigue. If you’ve been diagnosed with this, you know how it feels. However, even if your doctor measured your thyroid stimulating hormone (TSH) and it was within the normal range, it could be functioning sub-optimally. If you suspect this might be a problem, see my post about the thyroid here. #5 – Food Sensitivities Reactions to food can have local effects (such as digestive symptoms of bloating, gas, diarrhea, constipation), but they can also lead to systemic effects, such as brain fog and fatigue. Many patients notice more energy once they go on a detox or elimination diet that removes the most common food sensitivities at once. You can find out if food sensitivities are playing a role in your fatigue either through an elimination diet, or through IgG food sensitivity testing. #6 - Adrenal Fatigue If you’ve been under chronic stress for a while, chances are you have adrenal fatigue. Your adrenal glands are little glands that sit on top of your kidneys and help you deal with stress. For short-term stress, they produce adrenaline, but for longer-term stress, cortisol is the prevalent hormone. Your cortisol levels vary throughout the day, so the best way to measure the health of your adrenal glands is through a 4-point salivary adrenal test (taken at 4 times during the day). We typically also test for other hormones in females when running this test, as being chronically stressed can wreak havoc on your other hormones. #7 - Depression This one doesn’t have a lab test to rule it out, but careful questioning can help your doctor assess if depression might be causing your fatigue. In this case, the fatigue can be mental/emotional, and you may not feel motivated to do things that used to be enjoyable for you. There are questionnaires, such as the Beck Depression Inventory, that can help us see where you stand. If you do have symptoms of depression, a naturopathic doctor can also see if some of the above factors could be contributing to you feeling depressed. These are just some of the most common causes of fatigue I have seen in practice. As you can see, finding and treating the cause of your fatigue is key – only then will you be able to see lasting improvement in your day to day energy! Do you want to wake up in the morning with a spring in your step and energy to last throughout the day? If yes, then I invite you to start your journey towards thriving with me! In health, Dr. Tamar Reference Image from 123rf.com We will soon be heading back into the cold and flu season in Canada, which usually begins around November and ends in April. While limiting exposure to the viruses associated with these respiratory tract infections is indeed important, making sure that your immune system is in top shape to quickly and effectively clear any infectious microbes it encounters is the best way to prevent a full-blown illness. If you tend to get sick frequently during the winter months, now is a good time to make sure that your immune system is working at its best. Vitamin D3 is one of your key tools for helping you fight off these microbes.
Vitamin D exists in our body in an inactive form, and it only transforms into its active, vitamin D3 form if our skin is exposed to sunlight. Needless to say, this is difficult to do in the winter, and most Canadians are deficient in vitamin D3 unless they supplement with the active form throughout the fall and winter months. Vitamin D3 has been shown to activate the innate immune response and leads to the production of antimicrobial peptides (called cathelicidin and defensins) which help fight off viruses and secondary bacterial infections. Adequate vitamin D3 levels have been associated with a decreased risk of influenza and other respiratory tract infections. One study even showed that this decreased risk is passed on from pregnant mothers to their children for their first year of life. One way to check if you have enough vitamin D is through a blood test, serum 25(OH)D. While levels above 50nmol/l are generally considered sufficient, many experts in the field believe that levels of 100nmol/l or higher are more optimal. Studies so far have shown that those who were most deficient prior to vitamin D3 supplementation gained the most anti-viral protective effects. Darker skinned individuals, who tend to produce less active vitamin D3 when exposed to the sun, are especially prone to being deficient during the winter months. Although vitamin D3 status plays a powerful role in immunity, it is far from the only variable affecting our defenses against colds and flus. Naturopathic doctors have many other preventative treatments available, and can individualize your treatment protocol based on your health status, unique susceptibilities, current medications, diet, and lifestyle. References: Am J Clin Nutr May 2010 vol. 91 no. 5:1255-1260. Epidemiology. 2012 Jan;23(1):64-71. Int J Infect Dis. 2010 Dec;14(12):e1099-105. Epub 2010 Oct 29. J Clin Virol. 2011 Mar;50(3):194-200. Epub 2011 Jan 15. |
 AuthorDr. Tamar Ferreira is a Naturopathic Doctor in Brampton, Ontario. Her areas of focus include digestive health, hormone balance, and skin conditions. 
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