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  Dr. Sarah Connors HBSc, Naturopathic Doctor
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Vitamin D: Why Is It Important?

11/11/2020

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What Is Vitamin D?

Vitamin D is a fat soluble vitamin, like Vit A, E & K.
Although it is present in foods, it is not present in many foods, nor is it in abundant supply. We can get Vit D from the sun, and this is certainly a good idea, but we will touch on why this is often not enough, especially in colder climates like most of Canada. Supplementing and fortifying foods with Vitamin D is also something that helps, but again the question we should ask ourselves is, are we getting enough?

Inactive vs Active Vitamin D
Vitamin D collected from the sun, diet and some supplements are in the inactive form, which means it needs to be converted by the body to its active form.
- Liver --> Vitamin D --> 25 hydroxyvitamin [25 (OH)D] or calcidiol (D2).
- Kidneys --> physiologically active 1,25 dihydroxyvitamin [1,25 (OH)2D] also known as calcitriol (D3).
 What Does Vit D Do in the Body?

There are a number of important jobs that Vit D does:
  • Promotes calcium absorption in the gut
  • Maintains appropriate calcium and phosphate levels in the blood
  • Normal bone mineralization
  • Ensures that muscles contract properly
  • Monitor cell growth
  • Modulate cell differentiation and death
  • Neuromuscular and immune function
  • Activation of various genes and their associated proteins

Measuring Vitamin D status
Generally the next question I get from a lot of people is how do I know if I'm getting enough Vit D. Currently the best way to do this is to measure it in the blood by look at the blood or serum concentration of calcidiol (D2). Wait, didn't I say that the active form is calctriol (D3)?  The reason is the 1/2 life of D3 is too short to make it a good indicator as well as it being regulated highly regulated by parathyroid hormone, calcium and phosphate. D3 levels also do not normally decrease significantly until Vit D deficiency is severe. 

How Much Vit D is Needed?
If we understand how important Vit D is, the next thing my patients often ask is how much do I need?
As we mentioned above, to know if you personally are getting enough, getting your levels checked is going to be the best option. However, there are general recommendations made by the government which are based on what is called the RDA or Required Daily Allowance.  This depends on the average of what works best for a healthy population and maintaining basic requirements for health. In the case of Vit D that's enough to bone health and calcium metabolism, and then in addition the RDA is set based on minimal sun exposure as well. All of this combined, the current daily recommendation for adults and children over 4 years is 400 IU.

If we're trying to raise our levels of Vit D, 400 IU is definitely not going to be enough.


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Food Sources: Can I get Enough?
There are a few sources of dietary Vit D:
- Fatty fish such as salmon, makerel, and tuna or good quality fish oil products
-  Beef liver, egg yolks, and cheese will have small amounts
- Some mushrooms provide D2 in variable amounts

The good news is the body is primed to absorb food dietary Vit D, as it is often in the active form (D3) and this appears to be 5 times more potent that the parent vitamin based on some studies.

Fortification
I know there's lots of foods that have Vit D on the label, doesn't that mean there's Vit D in it? It's true, that in Canada we have been fortifying foods with Vit D since the 1930s. The main sources are milk (35-40 IU/100ml) and margarine (equal to or more than 530 IU/100g). Many other dairy products do not fortify (cheeses and ice cream), while others food products like orange juice, yogurt, and breakfast cereals do. Manufacturers are also not always required to list Vit D or how much, so that makes it challenging to estimate as well.

Can I Get Enough from the Sun?


Most people meet at least some of their Vit D requirements from the sun. However, what most people don't realize is that this depends. You need to be outside at the right time of day, and depending on where you live, time of year as well. We need to be exposed to UVB rays at wavelengths of 290-320 nanometers. Other factors that can affect this are: cloud cover, smog, melanin content of your skin (the darker your skin the more difficult it is to 'absorb' enough sun).

Optimal Sun Exposure
The factors previously mentioned and current research that's been done still makes it challenging to know exactly what the right amount of sun exposure is for each person. However, these guidelines are helpful to get some helpful exposure:
- In general, approx 5-30 mins of sun exposure between 10am -3 pm twice a week to arms, face, neck. legs or back without sunscreen [NOTE: if you are monitoring risk for skin cancer, than keep in mind any recommendations from your healthcare provider]
- Spring, Summer and Fall are the optimal times of year, particularly those who live in more northern latitudes

Can I Take Too Much?

Generally speaking you would need to be taking a lot of Vit D to cause harm. The general thought currently is taking 10,000 to 40,000 IU a day consistently for a prolonged length of time. The blood level would be more than 500 nm/L that would be considered toxic. The research is still determining what that exact level would be. The symptoms of Vit D toxicity are not very specific: anorexia, weight loss, polyuria (aka peeing a lot), and heart arrhythmias. If you are at all concerned, please do speak to your health care provider.
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Take Home Message
- Vit D is important for our overall health, and we're still figuring out the full extent of what this entails
- Vit D is present in the diet, and through exposure to the sun we are able to synthesize Vit D
- The drawback is it's tough to determine how much we're getting, so many of us will need to supplement with it at times
- There are safe and unsafe levels of Vit D, and finding out what works best for us personally is likely going to require getting our levels checked periodically.



Have questions about Vitamin D or making sure you're getting what you need to live your best life? Connect with me and we can get a personalized plan together that takes your individual needs into account.




Note: Talk to your Naturopathic Doctor today about getting assessed and treated if needed, and as always talk to your health care provider before beginning any new medication or supplement. This information is not meant to replace the advice/guidance of a medical professional, nor should it be acted upon by individuals unsupervised by the appropriate healthcare provider.
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Eating Well Doesn't Have to Be Complicated

11/8/2016

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Do you feel that in order to have a 'good diet' or 'eat well' that it requires a lot of sacrifice and hard work on your part? Well, I won't lie to you and tell you that it doesn't require any work, but I will tell you some simply changes you can make to increase your nutritious eating without becoming a gourmet chef!

Many of my patients will tell me something along these lines: "I eat pretty well most of the time, except for the weekends" or "I try to eat healthy, but I am so busy I just don't have time to cook". There are plenty of variations on that that I hear on a regular basis, but let's call them what they are, EXCUSES! Now believe me I get it, at different times in my own life I have been the queen of excuses for eating less than healthy. However if you continue to make excuses for yourself, instead of changes to your lifestyle, you won't like the outcome 10-20 years down the road.
I completely understand how important, small, manageable changes are to creating success! I see it all the time with my patients and the research also supports this approach. Therefore, I will only mention 3 small things you can do to make a big impact on your eating habits and your health.
Tip #1 Eat A Healthy Breakfast
Remember how many times you've heard it said that breakfast is the most important meal of the day? Well it really is. I have seen in my practice, and again the research supports it, when we eat a healthy breakfast we are more likely to feel full and satisfied, make better food choices throughout the day, and we start our metabolism and blood sugar levels off right. If you're the type of person who really likes to have a bowl of cereal with milk for breakfast or skip breakfast altogether just start by adding some protein or healthy fat into your meal. Some great choices are: eggs, avocado, cheese, yogurt, cottage cheese, nuts and seeds, nut butter, and lean meats. Smoothies are also a great way to pack in lots of nutrition, which are quick and easy to make as well as portable for the one the go individual! 
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Tip # 2 Prepare meals ahead of time
Have a meal or two prepared ahead of when you need it is a great way to avoid making poor food choices and eating take out food too often. There are lots of ways to do this. Utilize your slow cooker (or get one if you don't have one yet), there are so many recipes out there in books and online for making great slow cooked meals. Many you can even prep the night before then just dump in the pot before you leave in the morning for work, then you can come home to nice warm meal already prepared for you. Another strategy is to cook 1-2 meals that make lots of portions on the weekend. My current favourite is frittatas. I will make a batch or two on Saturday or Sunday afternoon and maybe another meal and there's breakfast/snacks for the week done. Often you can also make things and freeze them in anticipation of a day you don't feel like cooking, or don't have time to cook. Trust me, cooking is not my favourite activity to do, but by batch cooking I only need to 'cook' 2-3 times a week and I'm well set for eating well all week.
Tip #3 Source your food well
Where our food comes from and how it's prepared makes a big difference for our health. Unfortunately, the ways we changed farming and growing food in the last several decades has left us with food products that are severely depleted of nutrients. Whereas our grandparents and great grandparents were able to eat plenty of nutritious foods and get their daily vitamins and minerals without the help of supplements, and eating organic, we do.  One step we can take is to buy organic when possible. I understand that many of us cannot afford to eat organic all the time, I don't buy 100% organic everything either. However, by using things like the Clean 15 and Dirty Dozen List put out by the Environmental Working Group each year we can eat organic when it really matters and significantly decrease our exposure to pesticides.  This year's update of EWG's Shopper's Guide to Pesticides in Produce™ reports that USDA tests found a total 146 different pesticides on thousands of fruit and vegetable samples examined in 2014. Another great thing to do is source your food from farmer's markets or directly from farmers that you trust. You can often get good deals on buying bulk from the farmers and then you're buying local as well!
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There you have it. Some very simple changes you can make to how you eat to improve the quality of your diet. Now I am not saying you have to even do this all at once, pick one and start with that. Then you can look at adding the others over time. If you never start, you'll never get the benefits, but if you try to change everything at once you'll feel overwhelmed and eventually you will drop everything.

Have questions about these tips or how to have better eating habits? Talk to me about it. I love helping people make gradual, positive changes that benefit their health and well being.



Note: Talk to your Naturopathic Doctor today about getting assessed and treated if needed, and as always talk to your health care provider before beginning any new medication or supplement. This information is not meant to replace the advice/guidance of a medical professional, nor should it be acted upon by individuals unsupervised by the appropriate healthcare provider.
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Are You Protecting Your Skin From the Sun Properly?

7/1/2016

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Do you depend on sunscreen for skin protection? Millions of us do, but shouldn’t. The rate of melanoma diagnosis is increasing. The consensus among scientists is that sunscreens alone cannot reverse this trend.

Not As Well As You Think!
Stanford University dermatologists reviewed CDC national survey data, and found that people who relied solely on sunscreens for sun protection had more sunburns than people who reported infrequent sunscreen use, but wore hats and clothing to shield themselves from the sun (Linos 2011). In Sweden, increased use of sunscreen by children was linked to more sunburns (Rodvall 2010). Several other studies of real-world sunscreen use found that people who use sunscreen for skin protection during periods of intense UV exposure had more sunburns (Koster 2010, Autier 2007).
False Claims
Then there’s the issue of the various claims that sunscreen manufacturers make about their products. Based on the research that’s been completed to date, there is insufficient data to support most claims on the sunscreen bottle. Claims such as: ‘waterproof’, ‘sweatproof’ and ‘broad spectrum protection’ don’t hold up. In fact, probably the most misleading is ‘cancer protection’ or ‘prevents cancer’. Sunscreen alone has not actually been shown to protect against certain forms of skin cancer, particularly melanoma, which is the most deadly form of skin cancer.
Melanoma and Other Skin Cancers
Why should we be concerned about melanoma? Well, since 2000, the rates of new melanoma cases among both men and women have been climbing by 1.4 to 1.6 percent per year (CDC 2014). A number of studies conducted in the 1990s reported higher incidence of melanoma among frequent sunscreen users (Autier 1998, Beitner 1990, Westerdahl 2000, Wolf 1998). 
UVA & UVB
When it comes to burns, there are two types of radiation that we are most concerned about: UVA and UVB. Both types contribute to the risk of melanoma, particularly with extreme sun exposure. High-energy UVB rays burn skin and directly damage skin DNA, but they make up just 3 to 5 percent of UV radiation striking the earth’s surface. More numerous UVA rays, can be equally damaging without blistering the skin. Because UVA radiation penetrates deeper into the body than UVB, it can cause a different type of DNA damage than UVB (Cadet 2009).
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SPF: Is Bigger Better?
Does SPF or the Sun Protection Factor make a difference? Most of us believe that Bigger Is Better, but there is no definitive evidence of increasing protection as the SPF values increase. In fact, beyond SPF 50, there appears to be little benefit. Properly applied SPF 50 blocks approximately 98% of sunburn rays. Properly applied SPF 100 blocks 99%. When used correctly, sunscreen with SPF values in the range of 30 to 50 will offer adequate sunburn protection, even for people most sensitive to sunburns.
Chemicals of Concern
The Environmental Working Group (EWG), a reputable research group in the US, has been putting together a report on the best and worst sunscreens/sun products since 2007. In this year’s report EWG found at least ¾ of the products they reviewed contained worrisome ingredients. Chief among them these four:
- Oxybenzone
- Retinyl Palmitate
- 4-MBC/Enzacamene
- Methylisothiazolinone (MI)
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Oxybenezone and 4-MBC are hormone disruptors and frequently used UV filters used in sunscreens. Oxybenzone could be found in about 70% of the non-mineral sunscreens evaluated by the EWG this year. Retinyl Palmitate and other Vitamin A derivatives have been shown to result in more skin tumors and lesions on animals treated with this ingredient and then exposed to sunlight. While MI, has actually been labeled as an inactive ingredient or preservative, was called ‘the allergen of the year’ by the American Contact Dermatitis Society in 2013. In March 2015, the European Scientific Committee on Consumer Safety concluded that no concentration of MI could be considered safe in leave-on cosmetic products (EU SCCS 2014). MI is present in 66 sunscreens assessed in this year’s report.
What to Look for in a Good Sunscreen
All these concerns in mind, what can we do to better protect ourselves from the harmful effects of sun exposure? One thing, when using sunscreen, pick the right one. Based on current research, mineral sunscreens tend to rate best, particularly those with zinc oxide or titanium dioxide. They are stable in sunlight, offer a good balance between protection from the two types of ultraviolet radiation (UVA and UVB) and don’t often contain potentially harmful additives. (EWG report, 2016).
Additional Protection measures
In addition to using sunscreen be smart about your exposure.
  • Do not use sunscreen as a tool to prolong your time in the sun.
  • Cover up! Hats, shirts and sunglasses are the best protection.
  • Avoid sunburn.
  • Do not use a tanning bed or sunbathe.
  • Protect kids! Early life sunburns are worse, so keep little ones out of the hot sun.

  • Pick a sunscreen with strong UVA protection.
  • Get vitamin D. There is speculation but not proof that adequate levels of vitamin D can reduce the risk of melanoma. We know that vitamin D is good for combatting other types of cancer. Commit to getting screened for vitamin D deficiency.
  • Examine your skin. Check your skin regularly for new moles that are tender or growing. Ask your primary care doctor how often you should see a dermatologist.
Sunscreen is a helpful tool for protecting your skin from the harmful effects of the sun when used appropriately. Be sure to use it as recommended, and choose a sunscreen that has minimal/no harmful chemicals in it, particularly a mineral based one.  Keep these things in mind, and the additional measures you can take to protect your skin, and you can help decrease your risk of developing serious illnesses like skin cancer.
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Mom and Baby Nutrition: IRON

4/2/2014

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Iron

One of the nutrients I get a lot of questions about in general is iron.  Newly pregnant women are particularly concerned about their iron status and what impact that may have on their baby. In this blog, I will discuss why you don't need to worry too much about baby and how to ensure you both get enough.

First thing to remember about the growing fetus is that it is very good at getting what it needs. Baby will stock pile as much iron as it needs in utero. Even for mothers with iron deficiency anemia, which affects almost 50% of pregnant women, studies have found that their babies were still born with sufficient iron. In general, healthy full term babies have enough iron stores to last for the first 6-12 months of life, especially exclusively breastfed babies. However, if you are found to be iron deficient it's still important to supplement because you need sufficient iron just as much as your growing baby.

Why is Iron Important?


During pregnancy, iron requirements double in order to build new red blood cells (RBCs) in Mom and the developing fetus. Iron also plays a role in cognitive and behavioural maturity, making hemoglobin and protein in RBCs that delivers oxygen to the body’s organs, muscles and tissues.

Babies at risk for low iron stores: premature born (biggest grab for iron is in the third trimester), low birth weight babies (less than 6 lbs, 6 oz), babies born to mothers with poorly controlled diabetes during pregnancy, and babies fed cow’s milk instead of  breast milk or formula during the first year.

Iron Sources and Requirements

If you look at the following, you will see that the daily requirement for iron is not a huge amount.
The problem is, many people do not reach it daily and over time this will create a deficiency.


Infants 7-12 mos: 11 mg
1-3 yrs: 7 mg
4-8 yrs: 10 mg
Pregnant women: 27 mg
Breastfeeding mother: 9 mg
Non-anemic, non-breastfeeding women: 18 mg
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Iron can be divided into two forms, heme and non-heme. Our bodies can absorb heme sources (15-35%) better than non-heme (2-20%).  Dietary sources of heme are meat, chicken, and fish. Non-heme is in these and non meat foods (eggs, dairy, fruits and veggies). For the little ones iron has it’s highest absorption rate from breast milk (50-70%) due to the presence of Vitamin C and high levels of lactose in breast milk, as well as proteins lactoferrin and transferrin, help to increase absorption.

Other sources and their absorption rates:
o   Iron fortified dairy formula: 3-12 %
o   Iron fortified soy formula: 1-7%
o   Iron fortified cereal: 4-10%
o   Cow’s milk: 4-10%

When supplementing to correct iron deficiency use a non-ferrous sulphate supplement (ferrous gluconate, chelate, or fumarate form). Ferrous sulphate is one of the most commonly used in supplements because it’s inexpensive, but it’s not absorbed well (absorption rate is only 10%). Make sure you take your iron with Vitamin C, as it increases the uptake of iron, and between meals. Calcium, black tea and some herbals [chamomile and peppermint], coffee or cocoa, oxalates found in some dark leafy greens, and other minerals can bind with iron and decrease absorption.



If you're concerned about your iron status then talk to your Naturopathic Doctor today about putting together a plan that addresses your individual needs.





References:
Phillipson-Webb, L. 2010. Sprout Right: Nutrition from Tummy to Toddler. Penguin Canada.
Romm, A. 2003. Naturally Healthy Babies and Children: A Commonsense Guide to Herbal Remedies, Nutrition, and Health. Celestial Arts.
Skowron, JM. 2009. Fundamentals of Naturopathic Pediatrics. CCNM Press. Print.

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    Sarah Connors

    I am a Naturopathic Doctor and Doula providing care in the Kitchener-Waterloo area. I have a passion for helping people with their health issues and improving the birth experience for Moms, and their babies. I also have a life long love affair with soccer, curling, and the alto saxophone.

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