Experienced. Intuitive. Women’s Wellness Re-imagined.

Spring is in the air!

Spring is in the air!

Spring is in the air and I’ve decided to dedicate this newsletter to the sunshine vitamin. Vitamin D has been in the news a lot lately and its touted benefits range from reducing the risks of cancers, auto-immune disease, and diabetes as well as a slew of other conditions. I’ll try to help you make sense of what you’re reading and make good, and safe, decisions about Vitamin D supplementation.

STONEVitamin D: Hope or Hype?
What is Vitamin D and what’s the best way to get it into my body?

Vitamin D is actually more similar to a hormone than a vitamin. Structurally, it looks a lot like sex steroids, like estrogen. It helps enhance the intestinal absorption of not just calcium, but also magnesium, phosphate, zinc and iron. Vitamin D is made in the skin, when we are exposed to UV light. Of course, these days most of us screen our skin with sunscreen, and even if we didn’t, at latitudes of 40 degrees and higher (Denver is at 40 degrees) the rays of the sun are too indirect during the winter to stimulate adequate Vitamin D production even if your skin is unscreened. (Plus, not a lot of our skin shows in the winter.) I don’t recommend going without sunscreen to get Vitamin D, either in the summer or the winter. It’s also difficult to get enough Vitamin D through diet. Foods that contain Vitamin D include fatty fish such as salmon, tuna, mackerel and the fish liver oils like Cod Liver Oil (yum!). Small amounts of Vitamin D are found in beef liver, cheese and egg yolks. Milk is often fortified with small amounts of Vitamin D.

How much should I take? What should my Vitamin D level be?

The RDA (recommended daily allowance) is 600mg daily, which I think is too low for most people. I recommend starting at 1000mg of Vitamin D3 and having your Vitamin D levels checked at this dose. (Your doctor would order a 25-hydroxy Vitamin D level.) Recommendations vary for what level to aim for. The Institute of Medicine recommends a very conservative level of 30. I usually recommend a level of 50-60 and some holistic practitioners aim for 80-100. I think the healthiest way to take Vitamin D is in combination with Vitamin K, either as a supplement or in food. (Patients who are on blood thinners should discuss this with their doctor first.) Foods that are rich in Vitamin K include the green leafy vegetables like kale and spinach, pickles, soybeans, and olive oil.

Why should I take Vitamin D? What happens if I take too much?

Numerous studies have shown an association between a decreased incidence of cancer (in particular colon cancer and possibly breast, prostate and pancreatic cancer), diabetes, heart disease, and auto-immune disease in patients with higher Vitamin D levels and an increased incidence of those conditions in patients with lower levels. However, and this is very important, it may be that instead of a low Vitamin D being part of the cause of these disease states, low Vitamin D may result from these diseases. This is a very important distinction and one we don’t have an answer for yet. There are not yet good, reproducible studies that prove that giving Vitamin D can decrease the incidence of a certain disease. There is also a potential downside to taking too much Vitamin D. Like Vitamin E and Vitamin A, Vitamin D is a fat-soluble vitamin, meaning that we don’t just pee away the excess – we can store it in our fat. Excessive Vitamin D increases calcium levels in the blood which can increase the risk of kidney stones and may be associated with an increased risk of heart disease.

What is my recommendation?

Take 1000mg of Vitamin D daily; ideally with about 100 micrograms (mcg) of Vitamin K. (Again, speak with your doctor if you are on blood thinners.) Have your Vitamin D levels tested at this dose. If your level is below 50, increase your dose by 500-1000mg increments and re-test, aiming for a level of 50-60. Your doctor may have a different recommendation so be sure and discuss this with him or her.

Q&A of the Day!
I get asked a variety of different questions from patients, and some are well worth sharing! Today’s question is… How often do I need to be seen for a well woman exam?

I have a number of patients who have been told by their PCP or gynecologist that they now only need to be seen every 3-5 years instead of yearly. I want to clarify this, both with my own opinion and with the opinion of the American College of OB-GYN (ACOG). ACOG presently recommends a yearly well woman visit. The Pap smear should be done with HPV testing (the virus that causes cervical cancer) every five years in a normal risk woman. This is where, I believe, the confusion lies. The pap is a screen for cervical cancer, nothing more, and every five years is a very appropriate screening interval if the pap and HPV test is normal. You, however, are more than a cervix and I feel strongly that a yearly exam is still of great benefit. Not only do I get a chance to do a full physical exam (and not just a breast and pelvic exam) but I get a chance to speak to my patients about what is happening in their lives, with their health habits and their stressors, and their health concerns. I get a chance to catch up on their personal and family medical history and share the new medical data about those conditions. This visit can be invaluable. I’ll elaborate soon in an upcoming blog post on how to make the most of your well woman visit.

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