House Call, MD

by Marissa Camilon, MD 2011 | camilon@myhousecallmd.com

What it is? Where can you find it?

When we were kids, vitamin C lozenges were the equivalent of candy. Actually, they were even better than candy because they tasted great and they were healthy. As we grow older (and become more educated), we have to ask ourselves if this is really true.  Is all that delicious vitamin C actually good for our bodies?

Vitamin C, also called ascorbic acid, is a “water-loving” vitamin that, like other vitamins, cannot be made in your body and must be consumed as part of your diet. Luckily, vitamin C can be found in lots of foods (not just citrus fruits). Other sources of vitamin C include potatoes, brussel sprouts, broccoli, cauliflower, tomatoes, cabbage, strawberries and spinach. Once inside your body, vitamin C plays a role in a number of metabolic reactions, including making collagen, transferring fatty acids into specific parts of your cells, assisting in hormone production and helping your immune response.  It is also considered one of the “antioxidant” vitamins. Read the rest of this entry →

by Leah Frankel, MS, RD | frankel@myhousecallmd.com

We all know that breakfast is the most important meal of the day but did you ever stop and wonder why? With so many wise tales out there suggesting why you should eat breakfast, it can be difficult to understand the real benefits.  Once you’ve decided that breakfast is a good idea, you’re faced with the task of deciding exactly what you’re suppose to eat in the morning for this vital meal. We’re here to discuss the benefits of eating breakfast as well as what to include in your well-balanced morning-starter. Finally, we’ll tackle some common excuses for skipping breakfast and debunk them with some helpful time-saving tips. Read the rest of this entry →

by Leah Frankel, MS, RD | frankel@myhousecallmd.com

You’re standing in the checkout aisle at the grocery store when you glance over at the newest entertainment magazine and see that yet another celebrity just lost all the weight she gained during her pregnancy in record time and looks even better than she did before the baby. You’re thinking to yourself, “Why can’t I lose my stubborn pregnancy weight?” One of the reasons many women have difficulty losing their post-pregnancy weight is because they don’t know how much weight they should be gaining during their pregnancy. While you are eating for two, you’re not eating for two adults!  We’ll discuss appropriate weight gain during pregnancy, what essential nutrients women need during pregnancy, some diseases that can develop during pregnancy and finally some tips to help lose weight after the big delivery.

Read the rest of this entry →

by Leah Frankel, MS, RD | frankel@myhousecallmd.com

With increasing numbers of Americans diagnosed with high blood pressure (also known as hypertension), it’s likely you or someone in your family is battling this disease (probably with a smattering of medications). While most people diagnosed with high blood pressure end up taking medications at some point, this can be prevented with a few minor dietary changes. You probably know a few of these tricks, for instance that a high salt intake is bad for hypertension, but that’s just the tip of the iceberg!  We’ll explore hypertension as well as what you can do to manage your high blood pressure while concurrently enjoying the food you eat.

What is hypertension?

Hypertension is defined as persistently elevated blood pressure, with a systolic blood pressure of 140 mm Hg or higher and/or a diastolic blood pressure of 90 mm Hg or higher. You’ve probably been told that your blood pressure is “something over something”; the first “something” is the systolic pressure and the second “something” is the diastolic pressure.  What the heck does that mean?  Systolic blood pressure is our blood pressure when the heart is contracting and diastolic blood pressure is the pressure when our heart is relaxed. The most common type of hypertension is known as essential (also called “primary”) hypertension.  Essential hypertension is diagnosed when the cause of the high blood pressure is unknown (yes, doctors came up with a fancy term to say, “Your blood pressure is high but we don’t know why.”); as opposed to secondary hypertension which is caused by another disease, such as chronic renal failure, endocrine disorders or certain medications.  While high blood pressure usually doesn’t present with any symptoms, uncontrolled blood pressure can lead to death or other diseases including congestive heart failure and stroke.

What’s actually happening in your body when you have high blood pressure?

Blood pressure depends on two factors, the amount of blood being pushed out of the heart and the resistance the blood feels as it moves through the blood vessels. When the diameter of the blood vessel narrows, there is more resistance and blood pressure rises. Think of it this way: your body is trying to push all this blood around but you made the opening smaller, so it has to push harder (the increased blood pressure) to get as much blood to circulate through the body. Some medications work by dilating the vessels so there is less resistance to flow and your blood pressure is lowered. There are also a few systems in the body that help regulate blood pressure: the sympathetic nervous system and the kidneys. The sympathetic nervous system regulates blood pressure in the short term by secreting norepinephrine, a stress hormone, which constricts the arteries leading to increased blood pressure (this is why your blood pressure goes up when you’re under stress). The kidneys have two mechanisms to maintain blood pressure: they control the volume of fluid in the blood (with less volume you don’t need to push as hard, therefore lowering blood pressure) and by activating the renin-angiotensin system which affects 1) how much salt or water is retained and 2) the constriction of blood vessels.  When any of these systems aren’t doing their job correctly, hypertension develops.

How diet changes can help

When most people think of dietary interventions to control high blood pressure the first thing that comes to mind is sodium intake. However, not everyone’s blood pressure is affected by salt intake. Only about 30-50% of people with hypertension are salt sensitive meaning that their blood pressure is affected the amount of salt they consume. We know what you’re thinking, “If I’m not sensitive to sodium then I’m destined to end up on medication.” Luckily, reducing your salt intake is only one approach to controlling high blood pressure.

The most common intervention for controlling hypertension is the DASH (Dietary Approaches to Stop Hypertension) diet. The DASH diet suggests consuming:

• 7-8 servings of grains a day, primarily whole grains

• 4-5 servings of vegetables each day

• 4-5 servings of fruit a day

• 2-3 servings of dairy, with an emphasis on low-fat or fat free food

• 2 servings of meat a day, but sticking with only lean meats

• 4-5 servings of nuts or beans a week

• 2-3 servings of fat/oil per day with an emphasis on polyunsaturated and monounsaturated oils, and limiting sweets

So how does the DASH diet differ from a standard well balanced diet? It’s actually quite similar. The DASH diet simply puts more emphasis on lean proteins, healthy fats, a reduction in processed foods and an increase in fruits and vegetables (you can see the full DASH Diet Pyramid at the end of the article).  Studies investigating the DASH diet have proven that following the DASH guidelines can lead to significantly lower blood pressure, even when sodium intake isn’t reduced (1). However, study participants who followed the DASH diet and reduced their salt intake had an even better outcome.

Sodium in your food

If you’re already following a well-balanced diet like to the DASH diet but want to know how to reduce your sodium intake, it’s important to know what foods to look out for.  Everyone has different sodium needs/restrictions based on medical conditions including congestive heart failure and chronic kidney disease.  That being said, a typical low sodium diet should contain no more than 2 g (2000 mg) sodium per day. In order to follow a low sodium diet, you want to limit or avoid: canned foods, cured meats, salted snacks, soups, and dairy products; the more processed a food is, the more likely its high in sodium.

Sodium content in various foods (some of the numbers may surprise you):

• 8 oz milk: 120 mg

• 1 oz cheese: 200 mg

• ½ cup fresh or frozen vegetables: 10 mg

• ½ cup canned vegetables: 230 mg

• ½ cup fresh or frozen fruit: 2 mg

• 1 slice bread: 150 mg

• 1 tsp salted butter or margarine: 50 mg

• 1 tsp unsalted butter or margarine: 1 mg

• 1 tbsp salad dressing: 350 mg

• 1 cup soup: 900 mg

• 1 cup low sodium soup: 25 mg

• 1 tsp salt: 2300 mg (that’s more than your whole day’s worth!)

Check the labels on the foods you buy.  We guarantee that you’ll be surprised to discover how much sodium is in the food you eat each day.  Be especially careful when eating out.  New laws require restaurants to include nutritional information so you’ll be able to monitor how much salt you’re actually eating.   If you’re cooking at home, an easy trick is to substitute salt with spices that are sodium free.

Let’s not forget about exercise

As we know, exercise provides a number of benefits including 1) decreased risk of developing many diseases including diabetes and cardiovascular disease, 2) help with weight loss and/or maintenance and 3) improved energy level and mood. Numerous studies have shown that physical activity can also help improve hypertension. A meta-analysis (a study that compares the results of multiple other studies) by Kelley et al. showed that walking decreased blood pressure by an average of 2% (2).  Time to put on your walking shoes!

So when do I start?

Following the DASH diet, decreasing sodium intake and exercising can be beneficial for people with or without hypertension.  Yes, following these guidelines has been shown to reduce blood pressure even in people without high blood pressure (1). So whether you’re recently diagnosed with hypertension, have been on medications for your high blood pressure for years or would like to prevent hypertension in the future, these small changes can make a big difference.  We say you start today.

Questions? E-mail the Author: frankel@myhousecallmd.com

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References:

1. Appel LJ, Moore TJ, Obarzanek E, et al. The effect of dietary patterns on blood pressure: results from the Dietary Approaches to Stop Hypertension trial. New England Journal of Medicine 1997;336:1117-24.

2. Kelley GA, et al. Walking and resting blood pressure in adults: a meta-analysis. Preventative Medicine 2001; 33:120-127.

by Leah Frankel, MS, RD | frankel@myhousecallmd.com

The sun is finally shining (at least in most of the country), but before you go outside you might want to reconsider your current sun protection routine. Hopefully you’re lathering up with sunscreen to prevent skin cancer but did you ever consider the idea that too much sunscreen could be detrimental to your health? Vitamin D, sometimes know as the sunshine vitamin, is the only vitamin that we can produce without eating anything since your body can create enough vitamin D by spending some time in the sun.  The question remains: How can you get your vitamin D without increasing your risk of developing skin cancer?

The Sunshine Vitamin

Vitamin D is a fat-soluble vitamin (meaning it is absorbed when consumed with fat, as opposed to water-soluble vitamins which are absorbed when consumed with water). Vitamin D helps with the absorption of calcium while also helping to regulate the levels of phosphorus and calcium in your blood stream. Unlike any other vitamin or mineral, vitamin D can be consumed from food sources or produced with exposure to the sun.  In line with the fact that there are two ways we can obtain vitamin D, there are two forms of the vitamin: the form that we consume in foods, ergocalciferol (vitamin D­₂), and the form that we produce with a little help from the sun, cholecalciferol (vitamin D₃). Vitamin D­_2­ or D₃ are then converted into the active form of vitamin D₃ by the liver and kidney.

How Much Sun Do You Need?

Most people can produce enough vitamin D with 10-15 min of sun exposure, 3-5 days a week.  However, these recommendations are based on the assumption that the person is not wearing sunscreen and some of the body, typically the face and arms, are uncovered by clothing and therefore able to receive direct sunlight. It is important to remember that the amount of vitamin D produced in response to sun exposure can vary depending on clothing type, the amount of melanin in the skin and the use of sunscreen. It is believed that casual exposure to sunlight without sunscreen will typically provide sufficient vitamin D to last through the winter months.  However, if you live in an area where there is little sun year round or you do not spend any time in the sun, it is important to consume adequate dietary sources of the vitamin or supplementation may be necessary.

Getting Vitamin D Without the Sun

As we discussed earlier there are two forms of vitamin D: vitamin D­_2­ and vitamin D₃. Vitamin D₂ is derived from dietary sources, mainly fatty fish, dairy products (including fortified milk, cheese, butter, cream, and margarine), fortified cereal or other enriched foods and multivitamins.

While there has been some debate regarding the amount of vitamin D that should be consumed, the Adequate Intake (amount that is necessary to maintain adequate health) recommended by the U.S. Institute of Medicine of the National Academy of Sciences is 5 micrograms (200 IU or International Units) daily for all individuals (males, female, pregnant/lactating women) between the ages of 18-50 years. For anyone 50-70 years-old, 10 micrograms daily (400 IU) is recommended. For those who are over 70 years-old, 15 micrograms daily (600 IU) is suggested. For infants, children and teenagers under the age of 18, 5 micrograms (200 IU) is recommended daily, however, recent studies suggest 10 micrograms (400 IU) may be beneficial.

While those recommended intake numbers sounds spectacular, they aren’t much help if you don’t know how much vitamin D is actually in the foods you eat…so we’ve included a list of foods that are high in vitamin D below:

• Herring, fresh, raw, 1 oz: 6.6 micrograms 

• Salmon, cooked, 1 oz: 3.5 micrograms

• Cow’s Milk, fortified, 1 cup: 2.5 micrograms

• Sardines, canned, 1 oz: 2.1 micrograms

• Egg yolk: 0.6 micrograms

Looking at some of these foods, you might wonder how you can reach your daily intake.  Do you really have to consume a can of sardines every day (which we do not recommend for social reasons alone)?  If you look closely at the serving sizes you’ll notice that, for example, 1 oz. of salmon provides 3.5 micrograms of vitamin D…and most people consume significantly more than 1 oz of fish at any given time.  The take home message: make sure to factor serving size into your calculation!

Consuming Too Much or Too Little?

Deficiencies in vitamin D result in rickets in children and osteomalacia or osteoporosis in adults; these diseases are characterized by defects in bone mineralization.  Rickets is a condition in which the mineralization of growing bones is impaired as a result of insufficient vitamin D, calcium and phosphorus, all of which are important for normal bone growth. Osteomalacia, which means soft bones (you can see the change in bone density in the x-ray to the left), is seen in adults with inadequate dietary intake of vitamin D, insufficient sun exposure or chronic diseases including kidney and liver disease. On the other hand, osteoporosis is characterized by calcium loss from the bones leading to increased risk of bone fractures.

As with most things in life, too much is never a good thing.  Too much vitamin D can cause your body to absorb too much calcium leading to calcium deposits in soft tissue. Since vitamin D is fat soluble, excess doses are stored in your body’s fat (as opposed to water-soluble vitamins which are excreted in urine when you consume too much).

Vitamin D and Aging:

As you age, your experiences a 75% reduction in its ability to produce vitamin D₃ as a result of less efficient production in your skin as well as reduced sun exposure, making the elderly particularly at risk for vitamin D deficiency (1). Since the elderly are at a higher risk for bone fractures and osteoporosis (for a number of reasons, many of which we are sure you can imagine), multiple studies have looked at the effect of vitamin D supplementation on bone health. A study by Trivedi et al, examined the effect of vitamin D supplementation on risk of fracture in the elderly (2). The study provided the 2,686 male and female subjects ages 65-85 years, with 100,000 IU of vitamin D, or a placebo, every 4 months for a 5-year period. The study showed a reduction in fracture risk in the hip, wrist/forearm and vertebrae by 33% in the group receiving the vitamin D supplementation. However, the RECORD (Randomized Evaluation of Calcium and/or vitamin D) trial compared the effects of 1000 mg calcium carbonate, 800 IU vitamin D₃, combined 800 IU vitamin D­₃ and 1000 mg calcium carbonate to a placebo on 5,292 men and women over the age of 70 years with previous a fracture, during a 2 year period (3). No significant differences were seen between the various groups in regards to bone fractures.  Very confusing, we know.  Science has a way of doing that to us.

So What Do I Do?

There are many ways to get your needed dose of vitamin D, whether through the sun, food or supplements.  The best plan of attack depends on your lifestyle, age and a number of other factors. Most of the population meets their body’s vitamin D needs from sun exposure alone.  If you are unable to spend 10-15 min in the sun without sunscreen, make sure you eat enough foods high in vitamin D. In the elderly or people living in areas with little sunlight, supplementation may be necessary to reach adequate levels.  Remember that you only need a little sunlight to get all of the vitamin D your body needs.  If you’re planning a day in the sun, don’t forget your sunblock!

Questions? E-mail the Author: frankel@myhousecallmd.com

References:

1. Palacios C. The role of nutrients in bone health, from A to Z. Critical reviews in food science and nutrition. 2006;46:621-8.

2. Trivedi DP, Doll R, Khaw KT. Effect of four monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomised double blind controlled trial. BMJ. Clinical research ed. 2003 Mar 1;326:469.

3. Grant AM, Avenell A, Campbell MK, McDonald AM, MacLennan GS, McPherson GC, Anderson FH, Cooper C, Francis RM, et al. Oral vitamin D3 and calcium for secondary prevention of low-trauma fractures in elderly people (Randomised Evaluation of Calcium Or vitamin D, RECORD): a randomised placebo-controlled trial. Lancet. 2005 May 7-13;365:1621-8.