What You Should Know About Vitamin D

We all think of vitamin D to build strong bones, but it has many other functions in the body as well.  Vitamin D is a fat-soluble vitamin, which is naturally present in only a few foods.  The good news is that your body can make it.  All you need is sunlight.  That is why vitamin D is called the sunshine vitamin. 

Why do you need vitamin D?

Vitamin D promotes calcium absorption in the gut and maintains adequate blood levels of calcium and phosphate which enable normal bone development and maintenance of bone density.  Without enough vitamin D, bones can become, thin and brittle, or deformed.  It prevents rickets in children, and osteomalacia (softening of the bones) in adults.  Together with calcium, it helps protect against osteoporosis (weakening of the bones) in older adults.

Vitamin D is also vital in many body processes, including cell growth, neuromuscular function, immune function, and reduction of inflammation in the body.

How does your body make vitamin D?

When ultraviolet rays from sunlight strike your skin, this triggers vitamin D synthesis.  This vitamin D is biologically inactive, so it must then undergo two different chemical changes in your body to become activated.  The first chemical change happens in the liver, and the second occurs primarily in the kidneys.  The final, physiologically active form of vitamin D is known as calcitriol.

What are sources of vitamin D?

Sunlight, as I mentioned above is a great source of vitamin D.  Since we have started using more sunscreen, and people have been spending more time indoors, vitamin D deficiency has become increasingly prevalent in recent years.  It is still a good idea to limit exposure of the skin to sunlight, due to the risk of skin cancer.  Some studies indicate that between 5 and 30 minutes of sun exposure to your arms, legs, or face, twice a week between 10 am and 3 pm usually leads to sufficient vitamin D synthesis.  You don't need to be a sunbather to get your vitamin D.

Besides sunlight, there are a few foods which contain this vitamin.  The best natural sources are fish liver oils and the flesh of fatty fish, like salmon, tuna, and mackerel.  Small amounts of vitamin D are found in beef liver, cheese, and egg yolks.  Some mushrooms contain vitamin D.  In the US, most of the vitamin D in our diet comes from fortified foods.  Milk is voluntarily fortified with vitamin D, which was started in the 1930s to combat rickets in children.  Other dairy products made from milk are not usually fortified.  Breakfast cereals are often fortified with vitamin D, as well as some orange juice brands, yogurt, and some other food products.

Who is at risk for vitamin D deficiency?

• Breastfed infants - The American Academy of Pediatrics recommends that exclusively and partially breastfed infants be supplemented with 400 IU of vitamin D per day.
• Older adults - As we age, our skin is not as good as making vitamin D.  We are also more likely to spend less time outdoors, which gives us less sunlight. 
• People with very limited sun exposure - Based on occupation, religious clothing, etc.
• People with darker skin - More melanin in the skin reduces vitamin D production.
• People who are obese or who have had gastric bypass surgery
• People who take certain medications, such as steroids

How do you get enough vitamin D?

Most of us get enough sun exposure if we are spending a little time outdoors every day.  Otherwise, the most recent nutritional guidelines recommend that Americans should meet their nutritional needs through a variety of natural food sources, rather than supplements.  Certainly if you have a vitamin D deficiency, you may need supplements for a period of time, but in general, we should try to eat a varied diet, full of fruits and vegetables of various colors and textures, whole grains, milk and milk products, fish, lean meats and poultry, eggs, beans/peas, as well as nuts and seeds.

More is not necessarily better

Excessive intake of vitamin D can lead to toxicity.  Vitamin D toxicity can cause a variety of health problems, and can even increase your risk for certain types of cancer.  Vitamin D supplements can also interact with many medications.  I would not recommend taking Vitamin D supplements, other than the amount found in a good multivitamin, without first talking with your doctor.

If you have any questions about Vitamin D, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Pinworm Infection

I have recently answered a few questions about pinworm infections, so I thought this would make a good topic for our Health Tip this week.

What is a pinworm infection?
The pinworm is a parasitic worm which is in the class of worms called roundworms.  It is a tiny white worm, which is thin and shorter than ½ inch long.  It has the largest geographic range of any parasitic worm, and is the most prevalent human parasitic worm in the United States. It is quite common, with more than 30% of children worldwide infected.  It is most common in children, but anyone can get it.  Adults frequently get it from their kids.


What are the symptoms of pinworm infection?
The usual symptom of infection is itching in the anal area.  This itching is usually most severe at night, so kids who have pinworm infection are also restless at night and move around a lot in the bed.

You may actually be able to see the tiny worms on your child's bottom at night.  Or you may see them in your child's stool.  Pinworm eggs are so small that they are only seen under the microscope.

How is a pinworm infection spread?
Pinworms are easily spread from child to child.  When a child has an itchy bottom, they will scratch it.  This allows the tiny eggs to get on the child's hands and especially under their fingernails.  They can then stay on the skin for several hours, and are easily spread to a playmate through a toy or direct contact.  Children often put their hands or toys into their mouths.  That microscopic egg will then enter the intestinal tract and the infection has begun.

Children who are infected will have pinworms or more commonly their eggs, on their clothing or on their bed sheets.  The eggs can then be transferred all around the house and to other family members.  Sometimes this happens simply from Mom or Dad shaking the covers while helping to make the bed.

Pets do not spread pinworms.  This particular worm is only carried by humans.

How do we diagnose pinworm infection?
A tape test is the best test to diagnose pinworms.  Pinworms usually crawl out of the anus while a child is asleep to lay eggs.  The tape test takes advantage of this fact.  To do a tape test, when your child first wakes up, before they get out of bed, pat a small piece of clear tape on the skin around the anus.  Then fold the sticky side of the tape together.  Do this for 3 days in a row, then take the tape to your child's doctor.  The tape is examined under the microscope for pinworms or their eggs.

How is pinworm infection treated?
Most pinworm infections are easily treated.  The treatment of choice is a prescription medicine called mebendazole.  It is a single chewable tablet, which is taken once, then again about 2-3 weeks later if the infection is not cured.  There is another medication called pyrantel, which is available over the counter.  This medication is not quite as reliably effective, so it is generally recommended to repeat the dose in 2-3 weeks, whether you feel the first dose was effective or not.

In addition to the medication, you must take other steps to rid your home of pinworms to minimize the chance of reinfection or spread to other family members.  These steps should be taken at the same time as the medication is given, and repeated until the 2- 3 week repeat dose.  These steps include:

• Wash all sheets, blankets, towels, and clothing in the house in hot water.
• Carefully clean under every family members' fingernails and cut them short.
• Scrub toys, countertops, floors, and any surface that the infected child has touched.
• Vacuum all carpets and rugs.

Here is a link to more information about pinworms from the CDC.  https://www.cdc.gov/parasites/pinworm/index.html
                     
If you have any questions about Pinworm Infection, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Tips of Winter Exercise

Many people prefer to hibernate in the winter months.  I know that it is harder for me to get up to exercise this time of year.  The days are shorter, and boy is it cold here in the Northeast!  Who wants to get out and exercise?  Let's talk about the reasons why you should exercise in the winter, and some tips for adjusting your exercise routine to the cold weather.

Why should you exercise in the winter?

• Sunlight is your friend during the winter months - Exposure to sunlight is beneficial in many ways this time of year.  It helps to provide your body with vitamin D, which often becomes low in the winter months.  This helps you maintain strong bones, and good immune function.  Vitamin D also helps you maintain energy and helps to ward off muscle aches and pains.  Sunlight also helps to improve your mood as we discussed in our recent Health Tip about seasonal affective disorder.
• Exercise keeps you warm - There is a rise in your body temperature during a workout, which actually has a soothing, calming effect on your body.  It actually makes you feel warmer than using a heater, because it is warming you from the inside.  You may be cold when you first step outside, but if you dress correctly, you will be warm within no time after you start exercising.
• Avoid the cold and flu - Research has shown that regular exercise improves your immune function.  A healthier immune system is better able to fight off those cold and flu viruses that are so prevalent this time of year.
• Fresh air is healthier - The air inside our homes, especially in the winter when all of the windows are closed up, is not nearly as healthy for us as the air outside.  When you are exercising outdoors, you get to breathe deeply without the worry of breathing in a virus from your coworker! 
• Avoid that winter weight gain - Exercising in the cold burns more calories than in the warmer weather.  It just takes more calories to heat up your body.  It is easy to gain weight in the winter for many reasons.  Take any opportunity to burn calories.

How should you adjust your routine for exercising in the cold weather?

• Check the weather conditions and forecast before heading out.  Even people who are used to exercising in the cold should not be out when the temperature is too low.  If the air temperature is below 5 degrees F, or if there is a significant wind chill, exercise inside.  If it is raining or snowing, remember that being wet really makes you more vulnerable to the cold.  Exercise indoors or put off your workout until after the precipitation has stopped.
• Dress appropriately - Wear layers of clothing so that you can be warm enough when you start, and peel off layers as you get warm, then put layers back on as you get to your cool down.  The layers, especially those closest to your skin, should be made of fabric that wicks moisture away from your skin.   Fabrics that hold moisture against your skin, such as cotton, make it nearly impossible to stay warm in the cold weather.   Don't forget your gloves and be sure to cover your ears and head.  If you are shivering during your workout, you are not working hard enough or more likely you are under-dressed!
• Warm up inside before you go out into the cold.  Take 5 or 10 minutes to do some jogging in place or maybe some jumping jacks or other aerobic activity. 
• If you have asthma, or other medical problems that can be worsened in the cold, be sure to check with your doctor before exercising outdoors in the winter.
• Watch out for icy or slippery patches on the street or sidewalk.
• Since the days are shorter, you may not get home from work before sundown.  Remember to wear light colored or reflective clothing if exercising when it is dark outside.

With a few extra steps to stay safe, you can enjoy winter exercise.

If you have any questions about winter exercise, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor

Healthy Resolutions for the New Year

About 45% of Americans make some form of a resolution for the New Year; with many of those including health conscious goals. Some goals are set too high and may not be realistic. Some resolutions are better for your health than others. For instance, going on a crash diet to lose a lot of weight quickly, can lead to a weakened immune system, cardiac stress, and dehydration. It also often results in quick regain of weight as soon as the "diet" is over.

Let's talk about some healthy resolutions, and healthy ways to set those resolutions. First of all, you need to set reasonable goals. If you set a goal that is unreasonable, you are just setting yourself up for failure and feelings of guilt. When thinking about setting a goal, whether it be weight loss or exercise, try to set a small goal that you will be able to reach. Instead of resolving to lose 40 pounds, try setting your goal at 5 or 10 pounds. When you reach that goal, you can always set another goal for 5 more! You may be surprised at how satisfying it is to reach your goal, even if it is small.

Think of these resolutions as a change in lifestyle, rather than a "diet", which we often consider temporary.
Instead of resolving to exercise a certain number of minutes or hours each week, resolv
e to spend as much time exercising each day as you spend watching TV. This will either push you to exercise more, or watch TV less, both of which would be good for you!

If weight loss is a goal you would like to achieve, consider resolving to get more sleep. Getting insufficient sleep is one of the causes of weight gain, because it causes hormonal changes that increase your appetite and impair your ability to metabolize sugar adequately.

Instead of focusing on eating fewer calories, why not focus on choosing foods that contain "healthier" calories. You might consider resolving to eat more healthy fats, rather than resolving to eat less fat. Replacing unhealthy fats with healthy fats, such as omega-3 and omega-9 fats, can make a difference in your overall health. Healthy fats don't promote inflammation in the body like those unhealthy fats do. Healthy fats are found in foods like fish, avocados, olive oil, canola oil, walnuts. You might also resolve to choose more healthy carbohydrates, such as fruits and vegetables, and whole grains, rather than more processed carbohydrates such as potato chips. All calories are not created equal.

If improving your health is a goal that you would like to achieve, consider resolving to spend more face-to-face time with friends. Research has shown that individuals who don't see friends in person regularly are more likely to have poor health than those who visit with friends regularly. Online "friendships" are not adequate to improve your health. You can have hundreds of friends on Facebook and still be quite isolated. People really do need people! Resolve to visit with at least two friends or relatives each week, particularly people with whom you feel comfortable being yourself.

Reducing stress is often a goal for the New Year. If that is one of your goals, consider resolving to focus on deep breathing for 5 minutes twice a day. You would be surprised how much that can reduce stress. You might also consider a resolution to try some meditation or Yoga. Maybe resolve to take more pictures of your loved ones to your office, which is also a way to reduce stress.

By making small changes, a little at a time, you can eventually make big changes in your life. These changes can improve your overall health, both physically and emotionally.

If you have any questions about New Year's resolutions, please log into your account and send us your question. We are here to help.

Dr. Anita Bennett MD - Health Tip Content Editor