U.S. Faces Epidemic of Vitamin D Deficiency

According to a recent report published in the Archives of Internal Medicine, a vitamin D deficiency epidemic has hit the United States and current recommendations for vitamin D supplements are inadequate. According to the National Health and Nutrition Examination Survey vitamin D deficiency has tripled since 1994. The analysis included serum specimens from 13,369 people ages 12-60 between 2001-2004 and compared them to 18,883 specimens obtained between 1998-1994.

Authors' observations:

• Vitamin D supplementation should consist of at least 1000 IU, especially during the winter months for those living in northern latitudes (i.e. above Atlanta, Georgia)
• Current recommendations for Vitamin D supplementation (200-600 IU/d) are too low
• It is unknown what the optimal serum level is for vitamin D - most likely above 40 ng/ml
• The average vitamin D level of people ages 12-60 was 24 ng/mL
  
• Vitamin D deficiency in the African American population is the highest at 29%
• Several factors contribute to vitamin D deficiency including decreased time outdoors, obesity and the use of sunblock. (SPF 15 decreases vitamin D synthesis by 99%)

What I tell my patients:

• Vitamin D deficiency contributes to osteoporosis, depression, diabetes, many forms of cancer, cardiovascular disease, multiple sclerosis, etc.
• 25-hydroxy vitamin D levels should be checked annually (optimally between November and April when levels are likely to be lowest)
• Those most at risk for vitamin D deficiency: elderly, people of color, people who are unable to get sun exposure, and those who routinely cover their heads when walking outside
  
• You need 20 minutes of sun exposure without sunblock 3 times per week for adequate vitamin D synthesis. Care should be taken to avoid sunburn.
• Thirty minutes of sun exposure in a bathing suits results in the formation of 20,000 IU of vitamin D
  
• Our food supply does not contain adequate amounts of vitamin D supplementation - not even dairy products
  
• Everybody, with very few exceptions, should be on vitamin D supplementation 1000 IU/d
• I recommend an optimal level of 52-80 ng/mL. One study demonstrated that a level of 52 ng/mL decreases your risks of colon, breast and ovarian cancer by up to fifty percent!
• Supplements of 1000 IU can be purchased without a perscription and are relatively inexpensive.

Reference:
Ginde AA, et al. Dmographic differences and trends of vitamin D insufficiency int he US population, 1988-2004. Arch Intern Med. 2009;169(6):626-632.

Low Vitamin D Increases Risk for Metabolic Syndrome

by Stephen Daniells

According to findings published in Diabetes Care, a study with 3,262 Chinese people aged between 50 and 70 showed that deficient levels of vitamin D may increase the risk of metabolic syndrome by 52% ....

Read complete article here.

Metabolic Syndrome Risk Assessment

by Lynn Marquardt, NP

ASSESSMENT - Answer each question with "YES" or "NO"

1. Do you have a family history of early heart disease?
(Parent, brother or sister, men before age 55, women before age 65?)

2. Do you use any tobacco products?

3. Do you have elevated blood sugar?

4. Are you overweight?
(Is your BMI greater than 25.0? Calculate your BMI)

5. Is your waist size greater than 35 inches?
(Measure 2 fingers above belly button)

6. Is your blood pressure over 135/85 or are you on
high blood pressure medication?

7. Is your HDL level lower than 50 mg/dl?

8. Is your triglyceride level >149 mg/dl?

If you answered “yes” to any of these questions, you may be at greater than normal risk for metabolic syndrome. The more “yes” responses you chose, the greater your risk.

Completion of this assessment is not a substitute for contacting a healthcare provider. Discuss your risks with your healthcare provider.

What is Metabolic Syndrome?

by Lynn Marquardt, NP

People with the metabolic syndrome are at increased risk of coronary heart disease and other diseases related to plaque buildups in artery walls and type 2 diabetes. Metabolic syndrome has become increasingly common in the United States. It’s estimated that over 50 million Americans have it.

The American Heart Association and the National Heart, Lung, and Blood Institute recommend that the metabolic syndrome be identified as the presence of three or more of these components:

• Elevated waist circumference:
  Men — Equal to or greater than 40 inches (102 cm)
  Women — Equal to or greater than 35 inches (88 cm)
• Elevated triglycerides:
  Equal to or greater than 150 mg/dL
• Reduced HDL (“good”) cholesterol:
  Men — Less than 40 mg/dL
  Women — Less than 50 mg/dL
• Elevated blood pressure:
  Equal to or greater than 130/85 mm Hg
• Elevated fasting glucose:
  Equal to or greater than 100 mg/dL

AHA Recommendation for Managing the Metabolic Syndrome:
The primary goal of clinical management of the metabolic syndrome is to reduce the risk for cardiovascular disease and type 2 diabetes. Therefore, the first-line therapy is to reduce the major risk factors for cardiovascular disease: stop smoking, and reduce LDL cholesterol, blood pressure and glucose levels to the recommended levels.

For managing both long- and short-term risk, lifestyle therapies are the first-line interventions to reduce the metabolic risk factors. These lifestyle interventions include:

• Weight loss to achieve a desirable weight (BMI less than 25 kg/m²)
• Increased physical activity, with a goal of at least 30 minutes of moderate-intensity activity on most days of the week
• Healthy eating habits that include reduced intake of saturated fat, trans fat and cholesterol

a. Commit to a healthy diet. Eat plenty of fruits and vegetables. Choose lean cuts of white meat or fish over red meat. Avoid processed or deep-fried foods. Eliminate table salt and experiment with other herbs and spices.

b. Get moving. Get 30 to 60 minutes of moderately strenuous activity most days of the week.

c. Lose weight. Losing as little as 5 percent to 10 percent of your body weight can reduce insulin levels and blood pressure, and decrease your risk of diabetes.

d. Stop smoking. Smoking cigarettes increases insulin resistance and worsens the health consequences of metabolic syndrome

e. Eat fiber-rich foods. Make sure you include whole grains, beans, fruits and vegetables in your grocery cart. These items are packed with dietary fiber, which can lower your insulin levels.

Summary

The term "metabolic syndrome" is a way of identifying individuals at high risk for the development of heart disease and diabetes. Patients at risk should receive education and counseling on lifestyle modification, and all risk factors for heart disease should be treated aggressively.

http://www.americanheart.org/presenter.jhtml?identifier=534

http://www.nhlbi.nih.gov/health/dci/Diseases/ms/ms_whatis.html

Food Consumption during Labor - Why Not?

There is an ongoing international debate about food consumption during labor. The current rationale for women fasting during labor is to protect them from pulmonary aspiration should general anesthesia be needed for an emergency cesarean delivery. Other concerns include increased cesarean rate (Scheeper, 2002) or prolongation of labor (Tranmer, 2005) should women be allowed to eat while laboring.

On March 24, 2009 the British Medical Journal published a well-done randomized controlled trial (O'Sullivan, 2009) of over 2000 women suggests we should revisit current practices of not allowing women to eat while in labor. Women were randomized to water-only or a "light diet". (They were advised to consume a low fat, low residue diet at will during labor. Suggested foods included fruits and vegetables, breads, soup, low fat yogurt, fruit juices and sports drinks.)

Results:

• No difference in vaginal delivery vs. cesarean delivery rate between the two groups (30% cesarean delivery rate in both groups).
• No difference in length of labor.
• No difference in Apgar scores or admission to the neonatal ICU.
• No cases of aspiration pneumonia (However, because aspiration is so rare, a much larger study would have been needed to see one case.)
• One maternal death occurred in the water-only group due to a brain hemorrhage.

Side note:
The UK Confidential Enquiries into Maternal and Child Health reviewed 2,113, 831 deliveries between 2003-2005. Six anesthesia-related deaths occurred, none of which was associated with pulmonary aspiration. Similar findings were reported by the Australian Anesthesia Incident Monitoring Study. This supports the statement that aspiration pneumonia is exceedingly rare.

References:
1. O'Sullivan G, et al. Effect of food intake during labour on obstetric outcome: randomised controlled trial. BMJ 2009;338:b784
2. Lewis G, ed. Saving mothers’ lives: reviewing maternal deaths to make motherhood safer—2003-2005. The seventh report on confidential enquiries into maternal deaths in the United Kingdom. London: CEMACH, 2007.

See complete MaternaCare review and references here.

PMS and Integrative Medicine (Part II): Botanicals

Chastetree, Black cohosh, Ginkgo biloba and Evening primrose are the most commonly used botanicals to treat premenstrual syndrome in the United States. Of those listed, Chastetree has been the most widely studied.

Some of the descriptions below refer to "The German Commission E". The German Commission E Monographs are a therapeutic guide to herbal medicine. There is an English translation by the American Botanical Council, with 380 monographs evaluating the safety and efficacy of herbs for licensed medical prescribing in Germany. Though the German Commission no longer exists, in Germany only those herbs with Commission E approved status are legally available.
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Chastetree Berry (Vitex agnus-castus) is the dried ripe fruit of the chaste tree. In a number of well conducted studies chastetree berry has been effective in reducing PMS symptoms, especially breast discomfort, when compared to placebo. The German Commission E has approved the use of chastetree berry for irregularities of the menstrual cycle, premenstrual symptoms and breast pain.

Chastree is considered safe. Possible side effects are mild and reversible. They include mild headache, diarrhea, abdominal cramps, decreased appetite, rash and itching. Possible drug interactions could include anti-psychotics, some antidepressants and estrogen-containing compounds. However all potential drug interactions are theoretical.

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Black Cohosh (Actaea racemosa) was used by American indigenous peoples for the treatment of respiratory complaints, muscuoskeletal pain and to aid in childbirth. It was most likely used for its anti-inflammatory and muscle relaxant properties.

Compounds in black cohosh bind to the 5-HT7 (serotonin) receptor which may explain its positive effect on depressive and anxiety symptoms in PMS. A study published by Dittmar in 1992 demonstrated a reduction of the PMS symptoms including anxiety, tension and depression. A number of studies show a benefit for various menopausal symptoms such as hot flashes, profuse sweating, sleep disturbance and depressed moods. Because these symptoms often exist in those suffering from PMS, many clinicians have recommended the use of black cohosh in this population, too. Black cohosh is approved by the German Commission E for use in women suffering from premenstrual symptoms, painful menstruation (i.e. dysmenorrhea) and menopause.

Side effects and drug interactions: Black cohosh is generally safe and well tolerated when used for 6 months; and has not been well-studied beyond 6 months duration. Caution should be exercised as there have been multiple case reports of liver damage while using black cohosh. As stated above, Black Cohosh has been studied as a therapy for menopausal symptoms, not PMS. At this time that there is insufficient evidence to support or refute the use of black cohosh for PMS.
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Ginkgo (Ginkgo biloba): Ginkgo is commonly used to sharpen mental focus and improve circulation. One well-done study suggests the ginkgo is more effective in decreasing psychological and congestive symptoms ( e.g. breast pain, breast tenderness and fluid retention) than placebo in PMS sufferers. More studies need to be conducted before strong recommendations can be made to support or refute the use of ginkgo for PMS.

Ginkgo is generally well tolerated and considered safe with similar side effect rates as placebo in several reviews. Ginkgo is thought to have a blood-thinning effect. Therefore, possible drug interactions can occur with anti-coagulants such as warfarin and aspirin.
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Evening Primrose Oil (Oenothera biennis): A systematic review of the literature published in 1996 included seven studies. Unfortunately, none of the studies found a beneficial effect of evening primrose oil for PMS symptoms; this included two well-designed, randomized, placebo-controlled trials that were adequately powered.

Potential side effects include headache, seizures among people with seizure disorder or taking anesthetics, nausea, vomiting, anorexia, diarrhea, hypersensitivity reactions, rash, inflammation and immunosuppression with long-term use. Possible drug interactions include anticoagulants, phenothiazines and other anti-seizure medication. In lite of the currently available information, EPO is not a recommended treatment for PMS.

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Other biologically based therapies: St. John’s Wort (Hypericum perforatum) is primarily used to alleviate depressive symptoms. Kava (Piper methysticum) has been proven effective for treating anxiety, though has a questionable safety profile. Valerian (Valeriana officinalis) is a common over-the-counter ingredient for sleep preparations and relaxants. Don Quai (Angelica sinensis) as a tonic for women with fatigue and low vitality. None have yet been adequately studied for the treatment of PMS.

References:
1. Daniele C, et al. Vitex agnus castus: a systematic review of adverse events. Drug Saf
2. Dittmar FW, et al. Premenstrual syndrome: treatment with a phytopharmaceutical. Therapiwoche Gynakol 1992;5:60-8.
3. Budeiri, D, Li Wan Po A, Doman JC. Is evening primrose oil of value in the treatment of premenstrual syndrome? Control Clin Trials 1996;17:60-8.
4. Tamborini A, Taurelle R. Value of standardized Ginkgo biloba extract (EGb 761) in the management of congestive symptoms of premenstrual syndrome. Rev Fr Gynecol Obstet
5. Blumental M, et al., eds. The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. Austin: American Botanical Council and Boston: Integrative Medicine communications, 1998.
2005;28(4):319-32. 1993;88:447-57

Healthy Oils for Cooking

6 good-for-you choices that'll add health and flavor to your cooking.

Most women know they need some fat in their diet. "But moderation is key — all oils have about 120 calories and 14 grams of fat per tablespoon," says nutritionist Ellie Krieger, R.D., host of Healthy Appetite on the Food Network. She suggests sticking to about two teaspoons of added fat per meal — and cooking with a variety of oils, since they all offer different body benefits. Here are some of the best kinds, plus delicious ways to get them in your diet.

Olive Oil
Why it's healthy: Of all the oils, olive has the highest amount of heart-protective monounsaturated fats and polyphenols — antioxidants that have anti-inflammatory and anticlotting properties. It's also a staple of the Mediterranean diet, which has been shown to lower your risk of heart disease, lengthen your life, reduce your odds of cancer and diabetes, and help you lose weight. Newly pressed extra-virgin olive oil contains oleocanthal, a compound that acts similar to ibuprofen, according to a recent University of Pennsylvania study. Researchers say that a diet rich in olive oil may have pain-relieving and heart-health benefits similar to those of taking a low-dose baby aspirin every day.

What it's best for: Let extra-virgin olive oil's strong flavor shine though in salad dressings, on bread, or atop grilled meats, fish, and veggies. And (surprise!) you can fry or sauté with olive oil too! Frying isn't as unhealthy as you may think: "When you fry a food in olive oil that's heated to about 350 degrees F, a crust will form and your food will absorb less oil," says Nicki Heverling, R.D., program manager for the Mediterranean Foods Alliance. Just know that extra-virgin olive oil has a smoke point of about 385 degrees F to 420 degrees F — so keep an eye on the heat or else the oil will burn and splatter.

The skinny on olive oil: Choosing an olive oil can be confusing. Here, Heverling explains how to pick the best bottle.

Always choose extra-virgin. It's made from the first pressing of olives, so it has the most antioxidants and flavor. Look for an oil that's cold-pressed, meaning no heat was used during the processing. Think that's too pricey? Opt for an inexpensive extra-virgin olive oil for cooking, then splurge on a high-quality, unfiltered one for drizzling and dipping. "This adds amazing flavor and health to your food — it's worth every penny," says Heverling.

Go imported. Spain, Italy, and Greece are the biggest olive oil producers, and their strict quality standards mean you'll get a better product. Look for the words product of (as in "product of Italy") to guarantee that the oil comes from that country.

Buy dark-colored bottles. And keep them in a dark, cool place, since light and heat can turn oil rancid. Olive oil is best used within six months but can last for two years if stored properly.

Canola Oil
Why it's healthy: Canola oil contains the lowest levels of unhealthful saturated fats of any oil, and it's also a good source of alpha-linolenic acid, a heart-healthy omega-3 fatty acid. The FDA recently approved canola oil products to carry the health claim that it may reduce the risk of coronary heart disease. Substituting it for other vegetable oils, and canola oil — based spreads for margarine, can significantly reduce the amount of saturated fats in your diet, according to a recent study.

What it's best for: Mild-flavored canola oil is the cheapest option for sautéing and frying, and it also works well as a shortening or butter substitute in baked goods.

Peanut and Sesame Oils
Why they're healthy: Consuming a diet rich in peanuts, peanut butter, and peanut oil may be as effective in protecting against heart disease as an olive oil-rich diet, according to a Penn State study. Peanuts contain resveratrol, an antioxidant also found in wine that has been associated with a reduced risk of cancer and heart disease. Sesame oil is a good source of vitamin E, magnesium, copper, calcium, iron, and vitamin B. It also contains sesamin and sesamolin, substances that have been shown to lower cholesterol and protect the liver.

What they're best for: These oils have a high smoke point, so they work best for stir-fries. Peanut oil has a bland, nutty flavor, making it an ideal choice in dishes featuring nuts or when you want other flavors in a recipe to shine. Sesame oil has a strong, distinctive taste. "I finish Asian dishes with a splash of toasted sesame oil," says Krieger.

Walnut and Flaxseed Oils
Why they're healthy: Both oils are high in omega-3 fatty acids. In fact, flaxseed has the highest concentration of omega-3s of all non-fish foods, and it also contains lignans, chemicals that may play a role in preventing cancer.

What they're best for: Their delicate flavor makes them ideal for no-cook items such as salad dressings and fruit smoothies; walnut oil can also be used for baking. Both oils must be refrigerated and used within a few months.

Originally published WebMD 9/9/2008

by Nicole De Coursy