Vitamin D3 – Starting Supplementation in Childhood

For those of us living relatively far North of the equator, vitamin D deficiency is a common finding, and the health consequences are a popular topic in adult healthcare. Adequate levels of the active form of the vitamin (Cholecalciferol) are necessary for proper immune function, maintaining cardiovascular health, preventing osteoporosis, cancer prevention, healthy pregnancies and more.

When considering vitamin D supplements as a therapy, one group that may be commonly overlooked is children. Although children receive vitamin D supplementation through fortified milk, fortified non-dairy beverages, and healthy food choices, new research funded by the Canadian Institutes of Health Research and St. Michael’s Foundation conveys that current diets may not provide enough.

Dietary records of Canadian infants suggest they are consuming only 11% of their recommended daily allowance of vitamin D at one year of age. Vitamin D deficiency in children can disrupt proper growth and development, and predispose them to asthma, allergies and more. Doctor Jonathan Maguire’s most recent study looked at serum levels of the vitamin in 1,898 children, and compared it to their variable intakes of vitamin D supplements and fortified milk. The researchers discovered that children under 6 years of age were most likely to maintain higher blood levels if they were given both a vitamin D supplement and 2 glasses of cow’s milk daily.

Many children do not receive daily vitamin D supplements, and for some, cow’s milk is an allergen that must be avoided. For these children, vitamin D supplementation is especially important.

Here in the NW, where sun is rare and families often avoid intake of dairy for reasons of allergy or conscience, I recommend considering vitamin D supplementation for your little ones. Below are some suggestions and general information.

 

 Safe Vitamin D3 (Cholecalciferol) Dosing for Children:

~For infants, children & adolescents, 400 IU daily is a safe dosage

~400 IU is safe in addition to breastfeeding, infant formula, or cow’s milk

~Do not exceed 1,000 IU daily in infants under 12 months of age

~Consider 600-1,000 IU daily for children >12 months old who do not drink cow’s milk

 

Recommended Sources:

Chewable – Natural Factors, Vitamin D3 for Kids

Liquid Drops – Nordic Naturals, DHA Infant (contains omega-3 fatty acids & vitamin D3)

 

Dr. Kaley Bourgeois

References:
Jonathon L. Maguire et al. Modifiable Determinants of Serum 25-Hydroxyvitamin D Status in Early ChildhoodOpportunities for PreventionDeterminants of Early Childhood Vitamin D Status. JAMA Pediatrics, 2013; : 1 DOI: 10.1001/2013.jamapediatrics.226
St. Michael’s Hospital. “Supplements and cow’s milk play biggest roles in determining vitamin D levels in children.” ScienceDaily, 14 Jan. 2013. Web. 15 Jan. 2013.
Dietary Supplement Fact Sheet: Vitamin D. Office of Dietary Supplements – National Institutes of Health. 24 June, 2011. http://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

Balancing Hormones & Blood Sugar to Lose Weight

As we head into the new year, many of us resolve to make a new start on weight loss and fitness. For some, this means attempting the most recent and celebrated diet. For others, it means continuing the same calorie-restrictions and exercise plans, often without results.

According to a physician with the Loyola University Health System, recent findings suggest that only 20% of dieters successfully achieve and maintain weight loss. Healthy diet and exercise are key in slimming down, but there are additional factors to consider when the pounds won’t budge.

~Blood Sugar Balance~
There is a direct relationship between elevated blood sugar and weight gain. In fact, the body relies upon blood sugar and insulin levels to tell it when to begin storing fat, rather than burn it.
When blood sugar spikes, such as it does after eating a cookie, bread, or some other simple carbohydrate, the pancreas must produce an especially large amount of insulin. This insulin allows our cells to use the sugars, but it also signals them to convert the sugar into fat. Even on a low-calorie diet, the wrong food can cause a spike in your blood sugar, leading your body to think it is time to store, when it is actually time to burn.
Blood sugar balance can often be controlled by changing the types of foods we eat, and when we eat them. However, other factors can disrupt blood sugar balance, including cortisol fluctuations due to chronic stress and other hormonal imbalances.

~Thyroid Dysfunction~
It is no secret that low thyroid function plays a significant role in weight gain and resistance to weight loss. Sadly, many people are not screened for thyroid dysfunction, and those that are tested do not always receive a thorough screening.
Each of our cells require thyroid hormone in order to burn calories and produce energy. Without healthy thyroid function, the body will not respond properly to diet changes and exercise. To effectively screen for thyroid imbalances when weight loss is a struggle, it is important to measure more than just the TSH (Thyroid Stimulating Hormone), as TSH is not always a reliable indicator of thyroid health and metabolism. Additional tests include, but are not limited to, inactive and active thyroid hormone levels. A normal TSH level does not always rule out low thyroid function. Pursue more thorough testing if you struggle with weight loss.

~Hormone Imbalance~
Thyroid is not the only hormone that can cause weight fluctuations in your body–cortisol, estrogen and testosterone all play a role in metabolism and fat storage. Imbalances in these and other hormones can disrupt your body’s ability to burn fat. The calorie-burning, energy-producing components of your cells, called mitochondria, need adequate levels of these hormones in order to do their job.
Physical traumas, mental and emotional stress, and even aging can cause imbalances in these hormones which then disrupt metabolism. Botanical supplements, focused nutritional therapies and physiological doses of bio-identical hormones can help to restore balance and make your body more responsive to diet changes and exercise.

~Under-Eating~
Our bodies are designed to survive, and they do so brilliantly. In times of starvation, we produce a cascade of hormones that tell our cells to slow metabolism and store fat in preparation for hard days to come. Though we no longer live in times of famine, our bodies still carry this self-protection mechanism. Calorie restriction and other forms of stress, both physical and emotional, can activate this hormone cascade, leading to increased body fat.
A common mistake made by dieters is over-restriction of calories. Fewer calories does not always equal fewer pounds. When the body detects starvation, it creates changes in thyroid hormone production and mitochondrial function in order to slow metabolism. While over-eating can lead to fat deposition, so can under-eating. A balance must be found between moderate calorie restriction and therapies that support metabolism. Exercise is a great way to stimulate mitochondria, but as mentioned above, blood sugar and hormone balance are just as important. For the best results, fuel your body with healthy foods, exercise daily, and work with your physician to address blood sugar and hormonal imbalances.

 

Dr. Kaley Bourgeois

 

Reference:

Loyola University Health System (2013, January 3). Top four reasons why diets fail. ScienceDaily. Retrieved January 4, 2013, from http://www.sciencedaily.com­ /releases/2013/01/130103192352.htm

CPAP Benefits

Our take:

“This is a very good article describing the importance of diagnosing apnea and correcting it through appropriate interventions by a sleep specialist. Airway devices are sometimes helpful for the very mild forms of apnea, though we’ve seen incredible improvements in our Fibromyalgia Syndrome FMS and Chronic Fatigue Immune Dysfunction Syndrome CFIDS patients after Obstructive Sleep Apnea OSA has been appropriately been diagnosed and corrected.

We’ve seen in practice, as the study below indicates, that energy levels, concentration, sense of well being, blood pressure, weight and body composition improves after appropriate correction of OSA. The opposite is also true, in patients that did not have their sleep apnea corrected, treatments for their chronic degenerative conditions were not as effective as patients who experienced restorative sleep with adequate oxygenation.”

 

CPAP During Sleep Improved Blood Pressure, Cholesterol, Blood Sugar, Waist Size

Along with helping people with obstructive sleep apnea get a better night’s sleep, machines that help keep the airways open during sleep can also help improve the symptoms of metabolic syndrome, according to new research.

Metabolic syndrome is a group of symptoms that indicate a higher risk of heart disease. These symptoms include excess weight, especially in the abdomen, high blood pressure, abnormal cholesterol levels, higher blood sugar levels and insulin resistance. Many people with obstructive sleep apnea also have metabolic syndrome, according to the study.

After three months of continuous positive airway pressure (CPAP) treatment, study participants with obstructive sleep apnea and metabolic syndrome had improvements in their blood pressure, cholesterol, and blood sugar levels. Thirteen percent of those who received the breathing treatment had such significant reductions in their symptoms that they no longer qualified as having metabolic syndrome after three months of therapy.

“Patients with obstructive sleep apnea should be actively screened for metabolic syndrome or constituents of metabolic syndrome, and, in addition to lifestyle modification, weight reduction and dietary modification, [should be given] proper counseling for CPAP use, and a CPAP machine should be used regularly,” said the study’s lead author, Dr. Surendra Sharma, a professor and head of the department of internal medicine at the All India Institute of Medical Sciences in New Delhi, India.

Results of the study are published in the Dec. 15 issue of the New England Journal of Medicine. Funding for the study was provided by a grant from Pfizer. Sharma said that Pfizer does not produce CPAP machines, and they were not involved in the study’s design, implementation or interpretation.

Obstructive sleep apnea occurs when the airways close during sleep, causing a lack of oxygen that startles the person awake momentarily, though they may not be aware of awakening. This can happen several times to 100 times an hour, according to the U.S. National Heart, Lung, and Blood Institute.

The current study included 86 adults between the ages of 30 and 65. All had obstructive sleep apnea, but none was being treated with CPAP. Eighty-seven percent also had metabolic syndrome.

The study volunteers were randomly assigned to receive CPAP or sham CPAP treatment for three months. CPAP treatment involves wearing a face mask during sleep that continuously delivers air into the airway so it remains open. The sham CPAP had modifications to reduce the airflow, and the mask used had tiny holes that allowed extra air to escape. The modifications were done in such a way that even the researchers couldn’t tell who was receiving standard CPAP and who received the sham treatment.

After three months, the study volunteers went one month without treatment, and then switched groups for another three months of therapy with the opposite treatment.

Compared to the sham treatment, people treated with CPAP had an overall drop of 3.9 mm Hg systolic (the top number) blood pressure and 2.5 mm Hg diastolic blood pressure. Total cholesterol levels went down 13.3 milligrams per deciliter (mg/dL), and LDL cholesterol, the bad type, dropped by 9.6 mg/dL in the treatment group. Levels of triglyceride, another important and potentially harmful blood fat, went down by 18.7 mg/dL in those who received treatment, according to the study.

Blood sugar levels went down slightly, as did waist circumference, according to the study.

Eleven patients (13 percent) no longer qualified as having metabolic syndrome after receiving CPAP, compared with just 1 percent receiving sham CPAP.

Sharma said these positive effects likely come from the restoration of normal oxygen levels. When the body becomes oxygen-deprived in obstructive sleep apnea, it causes the body to become distressed, which causes the release of hormones that can cause cell damage that may lead to metabolic syndrome, according to Sharma.

“This study adds to the growing body of knowledge that obstructive sleep apnea has long-term consequences for your health, and that treatment reverses some of those consequences,” said Dr. David Rapoport, an associate professor of medicine and director of the Sleep Disorders Program at NYU Langone Medical Center in New York City.

Rapoport said it wasn’t clear from this study if any of the benefits seen came solely from weight loss in those on CPAP and weight gain for those on sham treatment.

“This study is thought-provoking and could be really wonderful news that using a breathing machine could have all of these beneficial effects. But, ultimately, we’d want to see clinical end points, such as the incidence of cardiovascular deaths, in order to know if an intervention is appropriate and helpful,” said Dr. Tara Narula, a cardiologist at Lenox Hill Hospital in New York City.

SOURCES:

Surendra K. Sharma, M.D., Ph.D., professor, and head, internal medicine, All India Institute of Medical Sciences, New Delhi, India; David Rapoport, M.D., associate professor of medicine, and director, Sleep Disorders Program, NYU Langone Medical Center, New York City; Tara Narula, M.D., cardiologist, Lenox Hill Hospital, New York City; Dec. 15, 2011, New England Journal of Medicine

HealthDay

4 Common Medications Carry Great Risk – Reduce Their Use

 

All medications come with side effects, some minor and others extreme. In cases of advanced disease, high-risk infections and other extreme health conditions, the benefits of medication greatly outweigh the side effects. For others, the medications are used largely as a form of preventative medicine, and the potential side effects may not be a worthwhile risk.

Especially in our elderly population, overprescription is common, and fewer medications may improve quality of life and prevent hospitalizations. A study on the USA’s geriatric population (New England Journal of Medicine) published earlier this year found that over 99,000 medication-related emergency hospitalizations occurred between 2007 and 2009. Four common drug prescriptions were responsible for 67 percent of these emergencies:

Warfarin 

Oral antiplatelet agents

Insulin 

Oral hypoglycemic agents 

 Of these four medication classes, none are considered “high-risk.” In fact, only 1.2 percent of the hospitalizations mentioned above were due to high-risk medications. 

Why is this significant? 

Firstly, because medications perceived as lower-risk are more likely to be prescribed, and to be used for disease prevention. This study shows that such forms of “prevention” are more likely to be life-threatening to our elderly population than expected.

Secondly, because the four medication classes addressed in this study are often used for diseases (Diabetes Type II, Coronary Artery Disease) that are preventable through natural medicine, and manageable with integrated care that requires fewer prescriptions. 

The key to reducing hospitalizations due to adverse drug reactions is to reduce the need for such drugs. This can be done safely and effectively through natural and integrative medicine.

 

Dr. Kaley Bourgeois

 

 Source:

Daniel S. Budnitz, MD, et al. Emergency Hospitalizations for Adverse Drug Events in Older Americans. N Engl J Med. 2011 Nov 24;365(21):2002-12

Motherhood & Lupus: Taking Steps Toward a Healthy Pregnancy

For young women living with Lupus, becoming a mother can be a challenge both emotionally and physically. As the disease progresses, there is an increased risk of pregnancy complications such as miscarriage and preeclampsia. Furthermore, pregnancy has been known to increase the risk of worsening symptoms and disease flares for the expectant mother.

A recent study, spotlighted by the National Institute of Health earlier this month, suggests a healthy pregnancy and birth may not be far from reach for hopeful young women living with Lupus. If general health is supported prior to conception, and antibodies are reduced such that there is low disease activity, there is a significant decrease in risk of pregnancy complications. Disease flares, especially, are reduced.

While lower Lupus activity during pregnancy lessens risk to both mother and child, the route taken to stabilize the disease is just as important. The conventional treatment of Lupus involves immunosuppressive medications that are harmful to a developing fetus. Methotrexate, commonly used to treat Lupus, is known to cause birth defects and cannot be used during or after conception. Corticosteroids, conventionally given to pregnant mothers to reduce a disease flare, have an unknown effect on the fetus and should also be avoided. All immunosuppressive medications increase the risk of infection for the mother, and therefore the child.

Complementary and alternative medicine is often used in treatment of Lupus and other autoimmune conditions, and may offer fewer side effects for mother and child. Below is an example of some research-based treatment options that should be considered in the treatment of Lupus before conception:

High Dose Vitamin D

Another study shared by NIH revealed high-dose vitamin D therapy to boost general immune function, while reducing activity of autoimmune cells, thereby reducing Lupus activity levels. As vitamin D is known to play a significant role in the brain development of a fetus, assessing for adequate levels in any future mother is important.

Omega-3 Essential Fatty Acids

Dietary supplementation of omega-3 fatty acids has a therapeutic effect on Lupus activity, as well as offering cardiovascular protection and benefitting fetal development.

DHEA

DHEA is a mild corticosteroid made naturally in the body, and found to be low in Lupus patients. Supplementation to balance hormone deficiencies prior to conception may help to reduce symptoms and disease activity by controlling excessive inflammation.

 

Work with your healthcare provider to create the appropriate treatment plan for yourself and your future child. There are many options available for addressing autoimmune disease and supporting your overall health.

Questions? Feel free to contact us at (503) 747-2021.

 

Dr. Kaley Bourgeois

 

Resources:

-Pregnancy Safe for Most Women with Lupus: Study. Nov 7, 2011. MedlinePlus, US National Library of Medicine-NIH, http://www.nlm.nih.gov/medlineplus/news/fullstory_118393.html

Vitamin D, Interferon Alpha Vaccine Show Promise Against Lupus, Nov 7, 2011. MedlinePlus, US National Library of Medicine-NIH, http://www.nlm.nih.gov/medlineplus/news/fullstory_118395.html

A randomised interventional trial of omega-3-polyunsaturated fatty acids on endothelial function and disease activity in systemic lupus erythematosus. Ann Rheum Dis. 2008 Jun;67(6):841-8. Epub 2007 Sep 17. 

 –Dehydroepiandrosterone suppresses interleukin 10 synthesis in women with systemic lupus erythematosus. Ann Rheum Dis. 2004 Dec;63(12):1623-6.

Folic Acid Supplementation Before & During Pregnancy

The need for folic acid supplementation in pregnancy to prevent neural tube defects is already well known by both physicians and many mothers-to-be. In addition to preventing these birth defects, there are multiple reasons for young, fertile women to take folic acid before and during pregnancy, all of which are equally important and beneficial for their future child. The following discussion highlights just a few of these reasons.

Recent studies suggest maternal folic acid supplementation may help to: 

-Prevent delays in childhood speech development

-Decrease childhood behavioral difficulties

-Support fertility in both partners

-Prevent pre-term labor

Printed in a recent addition to the Journal of American Medical Association, an article by clinical psychologist Christine Roth discussed the connection between low maternal folic acid and childhood speech development:

“Maternal use of supplements containing folic acid within the period from four weeks before, to eight weeks after conception was associated with a substantially reduced risk of severe language delay in children at age 3 years”

These findings support current recommendations for young, fertile women to take folic acid before and during early pregnancy. Since folic acid deficiency is known to disrupt nervous system development early in pregnancy, it is not surprising to find that there may be other symptoms of an impaired nervous system, such as delayed speech. There is great potential for other neurological symptoms to arise in mothers not getting enough folic acid.

Early data from another study, this one published in the Journal of Child Psychology and Psychiatry, suggests more behavioral difficulties arise in children (average age of 8 years) whose mothers had a lower level of folate during early pregnancy. Specifically, these children were at greater risk for hyperactivity and difficulties with peers.

Folic acid supplementation doesn’t only apply to future moms. Both women and men should consider supplementing before pregnancy, as it is an essential part of the reproductive system for both sexes. Research suggests  a deficiency in folate (the body’s form of folic acid) may impair fertility for both partners, as it is an important nutrient in sperm and egg maturation.

Another widely studied basis for taking folic acid is to prevent early labor. In one such study of moms, all with varied but normal folate levels, those with higher levels were as much as 60% less likely to give birth to a pre-term baby. With so many known health risks for preemies (learning disabilities, delayed development, death, etc.), taking folic acid should be a step every women takes before starting her family.

 

According to the National Institutes of Health, foods richest in folic acid include:

   Enriched grains

   Legumes: Black-eyed peas, Great Northern beans, Lentils, Peanuts

   Vegetables: Spinach, Green peas, Broccoli, Asparagus

Common causes of folate deficiency include:

   Pregnancy and breastfeeding

   Alcohol intake

   Malabsorption

   Medications such as Metformin

Potential symptoms of folate deficiency:

   Loss of appetite

   Irritability

   Diarrhea

   Heart palpitations

   Weakness

   Sore tongue

If you are planning on beginning a family, or you are already pregnant, speak with your healthcare provider today about the right supplements for you.

 

Dr. Kaley Bourgeois

 

References:

NIH: Office of Dietary Supplements, http://ods.od.nih.gov/factsheets
MedlinePlus–Healthday, Folic Acid in Pregnancy May Prevent Kids’ Language Delays, 2011
Scholtz, W., et al., Lower maternal folate status in early pregnancy is associated with childhood hyperactivity and peer problems in offspring., J Child Psychol Psychiatry, 2010 May; 51(5): 594-602.
Ebisch, I., et al., The important of folate, zinc and antioxidants in the pathogenesis and prevention of subfertility., Oxford Journal: Human Reproductive Update, vol. 13, issue 2, pp. 163-174.
Bodnar, LM., et al., Maternal serum folate species in early pregnancy and risk of preterm birth., Am J Clin Nutr. 2010 Oct; 92(4): 864-71.

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