Some patients have very short memories, have you noticed?

One day they are in persistent pain, depressed and exhausted. Then as they recover, they (understandably) want to forget it ever happened.

I sometimes wonder if this is to preserve their self-identity as healthy people to avoid cognitive dissonance that maybe they are not infallible.

The challenge is once they “forget” how they used to be before they received your care, it’s pretty easy to slip back into old habits and habits are what form our health. It’s what you do on a daily basis that usually determines the longer term picture.

That chocolate biscuit on its own won’t make you obese, but do it daily and it adds up and soon it will. Sadly a little bit of what you fancy will hurt you if you do it daily.

In order to help them stay healthy, one of the best ways to remind patients of their past issues to have objective data to show the before and after.

That’s one of the reasons I love doing range of motion multiple times in a treatment visit. If what you are adjusting or releasing myofascially is clinically relevant and correct you really should see range of motion change and ideally be retained with 50% (or more) at the next visit.

In nutritional terms the easiest low hanging fruit is vitamin D.

Have you seen the news recently? It’s been all over the papers about vitamin D and cancer risk.

Even the government is telling us to take it (albeit the dose they recommend is far too low). In reality we have known this for years but the media like new science to discuss:

Did you know you can order a vitamin D home finger prick test kit for only £29? (Order it here: )

I have tested a lot in the past, not so much now, but the ones I do test are the ones I think are really really low. To pick those, think of the trio of symptoms:

I have tested a lot in the past, not so much now, but the ones I do test are the ones I think are really really low. To pick those, think of the trio of symptoms:

  • Pain (persistent)
  • Brain (mood and behaviour)
  • Fatigue

If they are under 25nmol/L, they will be symptomatic and they will know it’s not right.

The really consistent symptom is fatigue, they are exhausted.

Because they are so tired they lack any motivation, and thus are diagnosed with depression.

Look for a history of recurrent depression with relatively poor/none response to antidepressants, especially SSRI’s.

If they are currently on them you may have to ask carefully about the response, especially if it was on the recommendation of friends and family that they should see their GP.

They may be taking them as advised, but ask them very specifically if they are better on them than before?

Frequently they are not (or very minimally which is usually placebo), but don’t know what else to do and are then scared to come off them.

The pain is usually vague but persistent in the muscles of the extremities and often broad areas of central low back.

It affects kids too, “growing pains” are frequently due to low vitamin D. Nowadays, kids are not allowed out of the house without factor 50 on, like some kind of small vampire trying to day walk.

The most common risk factors that make being under 25 nmol/L likely are:

  • Obesity
  • Darker skin tone
  • Elderly

Vitamin D is a fat and is stored in adipose tissue leaving less for blood circulation into the cells. If you are more than 4-5 stones overweight you are way more likely to be deficient.

If you are non-caucasian, you have higher levels of melanin in your skin and make far less vitamin D.

By the time you are 60-70 years of age, you skin produces far less vitamin D in response to UVB.

Remember at this time of year levels are starting to rise and hit a peak in September, so always consider the level in relation to the time of year. Whatever level they are now, how low will they be in March after a long winter?

Find patients with the trio of symptoms and one or more of the big risk factors and test them.

Bear in mind also, sometimes the very fair skinned, whilst having the ability to make lots of vitamin D, are also often very diligent with the factor 50 and thus are also arguably at a high risk).

Have you got any patients with seasonal affective disorder (SAD)? Got any patients that have to leave the country for winter sun in January or they get terribly depressed? Do they have to use a light box or they get depressed?

Test them.

Use the vitamin D functional range interpretation chart I sent out to talk to them about the levels and symptoms it shows and use the dosing chart to bespoke their dose.

Then re-test in 3 months and show them the changes to prove the treatment has worked.

Longer term this is great for maintaining compliance which is in their interest in the long run.

For test kits

Please tell patients to ignore the labs reference ranges (they are set too low) and to bring the value in at their next visit and show them the functional range chart (if you don’t have a copy please email me and I will send it to you).

Action to take today: Identify the most at risk patients and prescribe them daily vitamin D.

And as always, don’t waste those valuable adjustments…