Vitamin D:  How much do we need? Where does it come from?

Vitamin D:  How much do we need? Where does it come from?

Vitamin D has been in the news a lot lately. There are many articles about it in medical journals as well, and most of those articles confirm numerous health benefits from it. This critical element is needed by virtually every tissue of the body, so it’s not surprising that there is a large number of health problems caused by a deficiency. This is particularly concerning because almost half of all Americans are low on vitamin D. Those with darker skin color are at especially high risk because it takes more sun exposure to make vitamin D.

80% to 90% of the body’s vitamin D comes from sun exposure. Sun exposure needs to be when the sun is high in the sky, and shouldn’t be enough to cause a sun burn. About 40% of skin needs to be exposed. Sun passing through glass and light from tanning beds don’t stimulate vitamin D production. Use of sun block lotions and clothing that covers most of the skin makes it harder to get enough exposure to the needed ultra violet B (UBV) rays.

For adequate production, people need 6 to 8 minutes a day of sun exposure in summer, and 24 to 97 minutes in winter; the time of day and latitude are significant variables. A light-skinned individual in a swimsuit lying in the midday sun for 30 minutes will create about 50,000 IU of vitamin D in the following 24 hours, but someone tanned or naturally dark-skinned will only produce 20,000 to 30,000 IU after the same exposure. Someone very dark-skinned would produce a mere 8,000 to 10,000 IU in such a situation since melanin decreases UVB effects.

The remaining amount of the vitamin has to come from food but there are only a few foods high in it. The best sources are oily fish like salmon and mackerel, and the yolks of eggs. Fortified cereal and milk as well as red meat are other sources of vitamin D.

Supplements can help, but sun exposure and foods are ideal sources. Fortified cereal and milk as well as red meat are other sources of vitamin D.

Since vitamin D is a fat-soluble vitamin, it is difficult for the body to get rid of excess vitamin D. The recommended intake for adults up to age 71 is 600 IU/day, and for those 71 and older its 800 IU/day. The upper limit is 4,000 IU/day. See your health care provider regarding the dose of vitamin D supplement that is right for you. When people are severely deficient, it is not uncommon for a large weekly dose to be prescribed.


Editorial, “Vitamin D:  Way more important in Critical Care than we may have Realized.” In Critical Care Nurse, June, 2017, Vol. 37, #3.

Joel Kreisberg, DC, “Preparing Patients for Proper Sun Exposure.” Integrative Medicine, Vol. 8, #4, August/September 2009

Fiona Hermann, “Vitamin D supplementation, sun exposure for Pregnant and breast-feeding women and their infants.” Midwifery News, September, 2011.


Diseases, Drugs and Nutritional Deficiencies that increase Depression risk

   Diseases, Drugs and Nutritional Deficiencies that increase Depression risk

     Although depression is a complex disease, research and other methods of learning about it have uncovered some things that can increase the chances of developing it. This is crucial information to aid people in preventing it or helping to lessen it. Depression can worsen the outcomes of some diseases such as heart attacks, and impact the quality of life.

The following disorders can cause or contribute to depression:

  • Parkinson’s disease, stroke, normal pressure hydrocephalus, dementia
  • Coronary artery disease, heart failure, TB, viral pneumonia, a high calcium level, low sodium or low potassium level
  • Diabetes, hypothyroidism, hyperthyroidism, cancer – especially GI or pancreatic
  • Hypoglycemia, hyperglycemia, liver or kidney disease, adrenal disorders
  • Rheumatoid arthritis, hip fracture, hepatitis, urinary tract infections
  • Chronic pain – and depression can increase pain
  • Stressors alone don’t contribute to the risk for depression but combined with a lack of social support can contribute to it.

There are also some medications that can cause depression or at least increase the risk of it developing. Those taking such medications should consult their health care provider if they suspect they have depression. Here are some of the medications that have been linked to depression:

Opioids and opiates including hydrocodone, barbiturates, benzodiazepines for anxiety

Indomethacin, beta blockers, digitalis, methyldopa, levodopa for Parkinson’s disease

Alcohol – those over age 65 are particularly sensitive to the adverse effects of alcohol including depression because of decreased breakdown of it

Cimetidine (for ulcers), estrogen, some chemotherapy agents, and corticosteroids such as prednisone

A lack of certain nutrients has also been associated with an increased risk of depression. Folate – a B vitamin, vitamin B12, iron, and vitamin D deficiencies have all been found to increase the risk of depression. And those with depression are more apt to not eat properly including not getting all the nutrients they need.

Nickel and its health effects

Nickel and health

Nickel is a naturally occurring substance but isn’t known to be an essential nutrient. A few nickel compounds pose a health risk.

Probably the most common and concerning exposure to nickel is nickel carbonyl. It is found in second-hand smoke. Nickel carbonyl is a potent carcinogen. This adds to the long list of hazards for those exposed to second-hand smoke, especially children.

Those working in nickel refinery and processing plants can be exposed to nickel through inhalation. If protection isn’t used, they are at risk for lung, laryngeal and nasopharyngeal cancer.

The most common problem with nickel is from skin contact. Ten to twenty percent of people are sensitive to nickel. It is a common cause of contact dermatitis. Jewelry, including white gold items, as well as watches and earrings are typical sources. Metal fasteners on clothing, if it is in contact with skin, is another source of exposure. Allergic dermatitis from nickel is more common after prolonged contact with skin. Dental prostheses may also contain nickel and cause problems.

Nickel and nickel compounds are toxic pollutants. Per the EPA, drinking water shouldn’t have any more than 0.1 mg/L of it.

Reference:  Pediatric Environmental Health, third edition. American Academy of Pediatrics, 2012.

Medications that can Increase Your Blood Pressure

Medications that can Increase Your Blood Pressure

Hypertension, or high blood pressure, doesn’t usually cause any symptoms but it can cause a lot of damage to the body. One of the most serious problems it can cause is arteriosclerosis – “hardening of the arteries” and that’s the major cause of heart attacks and strokes. These are the big killers of many Americans, and for survivors, the cause of so much suffering. Blood pressure medications can help lower the blood pressure but some medications can counteract their effects. Some of those medications are:

  • Drugs like ibuprofen and naproxen which belong to a drug class called NSAIDs (an acronym for non-steroidal anti-inflammatory drugs) can increase the BP. An occasional dose may be okay, but those with a high risk of cardiovascular disease should discuss limiting the dose and duration with their provider.
  • Oral decongestants used for colds and other sinus problems mimic the “flight or fight” response. That’s why people often don’t sleep well after an evening dose of it. Those with uncontrolled hypertension should avoid them.
  • Anti-depressants from a class called SNRIs can increase the blood pressure if the dose is on the high side.
  • Medications used for attention deficit hyperactivity disorder (ADHD) can increase the blood pressure as well.
  • Contraceptives with estrogen can also cause or contribute to hypertension.

Herbs can also have pharmacological (drug-like) actions. Some of those implicated in causing or contributing to hypertension are:  ephedra, bloodroot, bitter orange, green tea, hawthorn, licorice root, guarana, mistletoe, maca, coltsfoot, cola nut, scotch broom, grape seed, mate, and ginseng. Also, many herbs and supplements can interact with prescription drugs and cause side effects

This information is not intended to replace the care of your primary care provider. If you have a question about a prescribed or over-the-counter medication, herb or supplement, consult your provider or your pharmacist.

References:  Prescriber’s letter for Sept. 2017.

“What every Clinician Should know About Herb-Supplement-Drug Interactions,” by Catherine Ulbricht, PharmD. In Alternative and Complementary Therapies, Vol. 18, #2, April, 2012.

Totally Terrific Tea

Totally Terrific Tea

Can anyone beat the inexpensive, almost calorie-free, disease-preventing beverage called tea? Doubtful. Tea really is awesome, and research suggests the following reasons why:

  • Its tannins provide anti-viral activity.
  • Polyphenols in tea help strengthen resistance to and perhaps help fight infections including dysentery and chronic hepatitis.
  • Fluoride and other chemicals in tea can help prevent cavities from forming by keeping bacteria from sticking to teeth and decreasing bacterial acid production. It also lowers the chances of gum disease developing.
  • Their flavonoid polyphenols enhance bone-mineral density. This benefit is strongest among those who consistently drink tea for more than ten years.
  • Tea’s catechin (a type of flavonoid) is believed to strengthen capillaries. They also lower the LDL (bad) cholesterol level and help keep plaque from forming on the lining of arteries.
  • Catechins also have cancer-fighting properties.
  • The phenols in tea are powerful antioxidants – chemicals that counteract the oxygen-free radicals that cause so many diseases. This is one way they may prevent some types of cancer such as gastrointestinal and lung cancers.

Another way that phenols may decrease cancer risk is by preventing sodium nitrite and nitrate (found in cured meats like bacon) from combining with amines to form the powerful group of carcinogens called nitrosamines. Amines are common chemicals so this is no small threat to health. While vitamins C and E can prevent nitrosamine formation, the polyphenols in tea and coffee can also provide this protection and in amounts they are normally consumed.

To have a significant decrease in cancer risk, it may be necessary to drink as much as four cups a day of tea. The caffeine level is less than with coffee; how long it’s steeped affects that.

If you’re ready to increase your consumption of tea, keep in mind:

  • Brewed tea has more health benefits than instant tea
  • Steep tea at least three if not five minutes; don’t drink it when it’s very hot
  • Try to drink organic tea because tea may be sprayed with pesticides
  • Probable tea benefits are from black, green, white and oolong tea – herbal teas don’t contain all the phytochemicals discussed in this article
  • Green tea has the most benefits, decaffeinated has fewer
  • Tea can decrease absorption of iron from plant and it can worsen ulcers.
  • This article is not meant to replace the care of your health care provider.

Pesticides and Neurological Disorders

Pesticides and Neurological Disorders

Pesticide exposures are associated with numerous disorders. Some of those associations have been studied extensively but many are only suspected or somewhat likely. Research on the effects of different pesticides has obstacles such as metabolites being quickly eliminated or the long period of time between exposure to a chemical and the changes in tissues. Still, there is enough information to be able to guide decisions, such as whether to buy organic produce or what to use if you have insects in your house.

There are also a couple groups of people that are at high risk for some of the effects of pesticides. Infants, small children, and the elderly are particularly vulnerable. And considering the fact that pesticides are most often used on produce, people that try to eat the recommended number of fruit and vegetable servings each day are also susceptible to illnesses linked to pesticides. This will be the first of several articles on pesticide-associated diseases. It is a sad annotation that there are so many neurological disorders pesticides may cause that they warrant an entire article.

Infants and small children are so vulnerable because of their neurological development. Exposure to pesticides has been postulated to increase the chances of a child having an attention deficit disorder or developmental delay.

In “Dietary Intake and its contribution to longitudinal Organophosphorus Pesticide Exposure in Urban/Suburban Children,” by C. Lu, et al (Environmental Health Perspectives, vol. 116, #4, April, 2008) it is noted that levels of organophosphorus urine metabolites were higher in children during winter and spring. This is the time of year children are most likely to be fed fruits and vegetables imported from other countries. Since the Food Quality Protection Act of 1996, produce from the U.S. has had lower levels of such pesticides. Many countries don’t have these restrictions so their produce typically has more pesticide residues on them. The article also notes that children fed only organic produce usually don’t have pesticide metabolites in their urine, further underscoring that produce is the main source of pesticides.

There is also a suspected link between prenatal pesticide exposure and a group of neurological abnormalities called autism spectrum disorders. These disorders are more likely to develop if the mother was exposed to pesticides and had a folate deficiency while pregnant. This is from “Combined Prenatal Pesticide exposure and folic acid intake in relation to Autism Spectrum Disorders,” in Environmental Health Perspectives, 097007-1. Since 1 in 68 children is affected by one of these disorders, avoiding home and agriculture pesticides is certainly worth the extra effort.

The link between Parkinson’s disease is strong enough to also make changes. In “Association of Parkinson’s Disease and Its Subtypes with Agricultural Pesticide Exposures in Men:  A Case Control Study in France,” (by F. Maisan, et al, in Environmental Health Perspectives, vol. 123, #11, November, 2015) there is a 60% increase in Parkinson’s Disease risk associated with insecticide exposure. The subtype of the disease it may cause is tremor-dominant Parkinson’s, the most common type. Because there is a 3 to 7-year lag between the destruction of nerve cells and motor (movement) symptoms, it took a while to uncover this likely cause.

An individual’s risk of developing Alzheimer’s disease also increases with pesticide exposure. In “Alzheimer’s disease linked to DDT pesticide,” (in Nursing and Residential Care, April 2014, p. 189), those with an elevated level of DDE, a metabolite of DDT, had a quadruple risk of getting this disorder. This risk is even higher in individuals with one or more genes associated with Alzheimer’s disease. Of note, having a gene for a disease doesn’t automatically mean the person will get it, and the field of epigenetics covers the multitude of ways genetic effects can be modified. Conversely, not having a gene associated with a disease doesn’t mean you won’t get it.

In Dennis Relojo’s article “On the Road to Therapeutics:  Biological Mechanisms of Parkinson’s Disease and Alzheimer’s Disease,” (I-manager’s Journal on Nursing, vol. 5, #3, October, 2015) Alzheimer’s disease accounts for two-thirds of the cases of dementia and is the most common neurodegenerative disease. The second most common is Parkinson’s disease. Kind of makes organic produce, at least for produce from the “dirty dozen,” worth the extra money or effort, doesn’t it?








Vitamin D Deficiency and Diabetes

Vitamin D Deficiency and Diabetes

While vitamin D deficiency has long been linked with bone disorders such as rickets, a large number of research studies have found evidence that it may increase a person’s risk for autoimmune disorders, particularly type 1 diabetes. More recent studies have found that a lack of vitamin D may also increase the risk of type 2 diabetes. Conversely, having consistently adequate levels seems to offer protection from colon cancer, as well as infections. This may seem like a pretty broad effect but studies have uncovered some facts that may explain that.

According to the article “Role of Vitamin D in Insulin Resistance,” by C. Sung, et al (Journal of Biomedicine and Biotechnology, volume 2012, article ID 634195) vitamin D has been found to be involved in tempering both the adaptive immune and inflammatory responses. It is also involved in managing cell proliferation and differentiation. That translates to helping the body attack foreign invaders but keeping it from attacking its own tissues. Autoimmune disorders are caused by the immune cells attacking the body’s tissues. Many immune cells have vitamin D receptor so it isn’t surprising that immune cells damaged by a vitamin D deficiency would be more likely to do that.

It is a little more complicated how vitamin D deficiency may promote the development of type 2 diabetes. What we do know is that there are receptors for vitamin D on pancreatic cells and the vitamin protects the insulin-producing beta cells in the pancreas from harmful immune cell attacks. It also improves beta cell functioning.

Insulin receptors are found on skeletal muscles, fat cells and in the liver. When insulin fits in these receptors, it causes the cells to allow glucose to enter so that the cells can make energy. But those receptors don’t work very well in those with type 2 diabetes. It is significant that vitamin D improves insulin receptor functioning, or, as it is often called, insulin sensitivity. If the vitamin protects insulin producing cells in the pancreas and enhances the functioning of the insulin receptors, it isn’t surprising that it lowers the risk of type 2 diabetes.

Since vitamin D is a fat-soluble vitamin, it is difficult for the body to get rid of excess vitamin D. The recommended intake for adults up to age 71 is 600 IU/day, and for those 71 and older its 800 IU/day. The upper limit is 4,000 IU/day. In The Clinical Advisor for August 2017, a study of vitamin D intake noted that people are taking more of it (“High-dose vitamin D supplements and adverse events”). 3% in the study exceeded that amount. It is too soon to say what the harmful effects are from too much vitamin D, but there doesn’t seem to be any benefit from exceeding that upper limit. This information isn’t intended to replace consultation with your health care provider and their recommendations.