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Pain & fever, Sun protection, Vitamins & minerals

What is Vitamin D3?  The Uses, Benefits, and Side Effects 

Vitamin D3 (also known as cholecalciferol) is a fat-soluble vitamin that is naturally synthesized by the body when the skin is exposed to sunlight.  It was first described in 1936 and is on the World Health Organization’s list of essential medicines.  You can look at the name cholecalciferol and see that it has something to do with calcium.  It’s called fat-soluble because it will disperse throughout the body and store in your fat cells.  Normally, your body does not produce vitamins.  Vitamin D is the only one you can make naturally in your own body.  Your body needs this nutrient for building and maintaining strong, healthy bones.  Without vitamin D3, you may develop soft, thin, brittle bones that can lead to fractures.  Most people know that you need calcium for strong bones, but did you know that you can’t absorb calcium unless vitamin D3 is there, too?  That’s why you need sunlight.  It’s the sunlight that stimulates your cells to start producing vitamin D3.  More specifically, your body needs those UVB rays.  However, there are a few factors that can affect how well your body can accept UVB, absorb it, and have it work like it should in your body such as: 

  • The strength of the sun which depends on:
    • The time of day (obviously it should be during the day, preferably when the sun is shining the strongest)
    • Season (is it a full sun summer day or a dark, dreary day in the winter)
    • Altitude (how close to the sun you are based on sea level)
    • Latitude (how close do you live to the equator)
    • Pollution
    • Cloud cover
    • Glass
  • Your age
  • Your skin tone (pigmentation)
  • How much skin you have exposed, and
  • How much sunscreen you put on and how well it blocks UVB rays (SPF)

Everyone needs vitamin D3 and we can all make it naturally in our bodies by getting enough exposure to the sun’s UVB rays.  The amount of time you need to sit outside in the sunshine depends on the factors listed above but around 5-30 minutes 2x/week should recharge your D3 battery.  To make it easy to remember, go out every SUNday for some fresh air and sunshine and every Wednesday (hump/slump day) to recharge.  It’s interesting to note that many people who suffer from depression also have a Vitamin D3 deficiency.  Although you do need to be cautious when sunbathing, don’t worry about overdosing on UVB.  Your skin will naturally reach an equilibrium and eventually start degrading the excess as fast as it is created but you can overexpose your skin.  We’ve all had those sunburns and none of us want skin cancer so if you haven’t been out in the sun for a while, you may need to get used to it slowly, starting with just 5 minutes at a time and working your way up over a week or two.  However, not everyone can go out and get some sun.  You also can get UVB from tanning beds and light bulbs.  There are many people that fail to get enough UVB light who fit into this category such as:

  • The frail
  • The elderly
  • The morbidly obese
  • Anyone who is housebound
  • Those who live in the Northern latitudes
  • Those who work long hours indoors and
  • Those who work night shift and sleep during the day

So how do you know if your vitamin D3 levels are good or if you have a deficiency?  A simple blood test can give you and your doctor the answer.  Most labs have similar but slightly different paraments but most often a level of 20 nanograms/milliliter to 50 ng/mL is considered adequate for healthy people. A level less than 12 ng/mL indicates vitamin D deficiency.  Vitamin D deficiencies are found in people with rickets, familial hypophosphatemia, hypoparathyroidism, and Fanconi syndrome.  If you find out that you have a vitamin D deficiency, your doctor may advise you to take a vitamin D supplement and come back for a follow-up to keep an eye on your D3 levels. If it is warranted, a very large “loading” dose also may be given. 

The Recommended Dietary Allowance (RDA) for vitamin D is:

  • 400 IU* for infants up to 1 year
  • 600 IU for adults up to age 70
  • 800 IU for adults 70+

This varies by country and makes sense because those who live nearer to the equator have greater access to full sunlight for longer periods of time.  *IU = International Units

There also are some drug interactions that you may need to talk to your doctor about before taking a vitamin D3 supplement.  These include medicines that are listed as anticonvulsant, cholesterol lowering, weight loss, heart/blood pressure, steroid, stimulant laxative, and psoriasis medications.

If you are a vegan or vegetarian, be aware that industrial production of vitamin D3 is made by extracting lanolin from sheep’s wool.  After cleaning, the cholesterol and waxes are extracted from the wool grease and undergoes a 4-step process to make vitamin D3 the same way your skin makes it.  It is irradiated with UVB light, unwanted compounds are removed, and a resin is left behind.  For vegans, there are plant-based sources of vitamin D3 supplements.

There are a few foods that contain vitamin D3 such as fish, beef liver, eggs, and cheese.  It also can be found in fortified foods such as milk and yogurt.  Vegans and vegetarians beware, it is primarily an animal by-product.  Check the labels for vitamin D3 and/or cholecalciferol.  Most people will choose to take a supplement and many of the over-the-counter (OTC) vitamin D3 supplements will be in the range of 1,000 IU to 10,000 IU.  Let your doctor recommend your dose.  Excessive doses can cause vomiting, constipation, weakness, and confusion and supplementation may not be effective in people with severe kidney disease.

Vitamin D3 is essential for strong healthy bones but it also may play a vital role as an anti-inflammatory, antioxidant, a neuroprotectant that supports your immune system, muscle function and brain cell activity.  Studies are showing it to be a very beneficial vitamin for the human body, possibly even decreasing some types of cancer.  However, much more research is needed in these areas.  Be sure to go out and get some fresh air and sunshine, recharge your vitamin D3 stores and have a great day!

Turner AG, Anderson PH, Morris HA. Vitamin D and bone health. Scand J Clin Lab Invest Suppl. 2012;243:65-72. doi: 10.3109/00365513.2012.681963. PMID: 22536765.

Simon J, Leboff M, Wright J, Glowacki J. Fractures in the elderly and vitamin D. J Nutr Health Aging. 2002;6(6):406-12. PMID: 12459891.

Cranney A, Horsley T, O’Donnell S, Weiler H, Puil L, Ooi D, Atkinson S, Ward L, Moher D, Hanley D, Fang M, Yazdi F, Garritty C, Sampson M, Barrowman N, Tsertsvadze A, Mamaladze V. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep). 2007 Aug;(158):1-235. PMID: 18088161; PMCID: PMC4781354.

Bischoff-Ferrari H. Vitamin D – from essentiality to functionality. Int J Vitam Nutr Res. 2012 Oct;82(5):321-6. doi: 10.1024/0300-9831/a000126. PMID: 23798050.

Bahrami A, Avan A, Sadeghnia HR, Esmaeili H, Tayefi M, Ghasemi F, Nejati Salehkhani F, Arabpour-Dahoue M, Rastgar-Moghadam A, Ferns GA, Bahrami-Taghanaki H, Ghayour-Mobarhan M. High dose vitamin D supplementation can improve menstrual problems, dysmenorrhea, and premenstrual syndrome in adolescents. Gynecol Endocrinol. 2018 Aug;34(8):659-663. doi: 10.1080/09513590.2017.1423466. Epub 2018 Feb 15. PMID: 29447494.

Głąbska D, Kołota A, Lachowicz K, Skolmowska D, Stachoń M, Guzek D. Vitamin D Supplementation and Mental Health in Multiple Sclerosis Patients: A Systematic Review. Nutrients. 2021 Nov 24;13(12):4207. doi: 10.3390/nu13124207. PMID: 34959758; PMCID: PMC8705844.

Stöcklin E, Eggersdorfer M. Vitamin D, an essential nutrient with versatile functions in nearly all organs. Int J Vitam Nutr Res. 2013;83(2):92-100. doi: 10.1024/0300-9831/a000151. PMID: 24491882.

Children & parent, Vitamins & minerals

What is Melatonin?  The Uses, Benefits, and Side Effects 

Melatonin is a chemical (a hormone) made naturally in your body that plays a role in your sleep.  It is produced primarily by a tiny gland in your brain called the pineal gland and to a lesser extent by a few other organs including your retina.  Which is interesting because the pineal gland, which used to be called the “third eye” and “seat of the soul,” contains optical tissue and has receptors for light. Your eyes are the primary way that you receive circadian signals from your environment.  Your senses help you survive within your environment.  When the receptors in your eyes receive light waves, natural and/or artificial, it affects your body’s biological circadian rhythm so that the pineal gland slows down its production of melatonin.  This helps you to wake up, become alert, and to function thoughtfully. Later in the day, when light decreases, these same receptors start stimulating the pineal gland to release more melatonin.  This hormone (melatonin) helps you become sleepy and to fall asleep when it’s dark.  This is important because good sleep is essential to human health.  If affects not only our physical health but our mental health as well. For example, have you ever noticed how cranky a child gets if they’re way too sleepy?  Some even have a mini meltdown right before they just simply fall asleep right there wherever they are, whatever they’re doing.  As adults, we have learned to force ourselves to stay awake and keep working till we literally burn out, physically and emotionally.  That’s when things get ugly.  Our work suffers.  Our relationships suffer.  We suffer. Melatonin can help.  It has helped millions of people.

Many people take melatonin to treat their insomnia, jet lag or shift-work disorder. Insomnia is a sleep disorder where it’s just hard for you to fall asleep, you can’t sleep for very long, you wake up several times during the night, and/or you wake up still feeling tired. Jet lag is where your body is having a hard time adjusting to a new environment:  a new time zone, a new climate, new lights, and noises, etc. Anyone who works odd shifts will tell you how hard it is to adapt to a new schedule and any new parent or pet owner will tell you the same thing.  Sleep?  What’s sleep?  Who gets that anymore?  A lack of good sleep can lead to depression, weight gain, irritability, decreased daytime performance, and maybe even reduce your body’s ability to fight off infection.  It’s just hard to get anything done when you’re sleep deprived. 

Age is a known factor that decreases the amount of melatonin produced by the body naturally so those over 50 may need to take a supplement.  Pain is another issue that affects sleep. Having a product that contains both melatonin and a pain reliever, may be your best option. Many older adults are also on prescription medications.  Be sure to talk to your doctor about melatonin, drug interactions, and dosing.  You may find it useful to use a journal to keep track of your medications, supplements, and how you feel physically and emotionally.  Take this journal to your doctor’s visit and use it to find what works best for you.

There are a few things you can do to improve your body’s natural ability to sleep. The first thing you should do is create a scheduled light-dark pattern for your daily/nightly routine.  One of the best ways, in this age of technology & artificial lighting, is to decrease the time you spend on electronics and to turn down the artificial lights a few hours before bedtime. This will decrease the amount of light waves hitting the receptors in your eyes which will, in turn, increase the amount of melatonin produced naturally by that tiny gland in your brain.  Make your bedroom as dark as you can, keep it at a cooler, comfortable temperature.  Make sure the bedding, blankets, and pillows are clean and cozy.  Light some candles and play some background music or white noise.  Do not bring your devices to bed with you.  If you do, make sure you turn down the device’s light to a “nighttime” level.  The light from your device causes your brain to think it’s still daytime.  It will not release the melatonin that your body produces naturally so it will be harder for you to fall asleep.

Melatonin has a very good safety profile and works well for many adults.  Occasionally, it is used in children as well.  Be sure to talk to your primary care physician or pediatrician if you’re planning to take it or give it to your children.  The side effects and risks are minimal but include headaches, nightmares, stomach aches and cramps, irritability, and daytime sleepiness.  If any of these occur, you may need to decrease the dosage, take it at a different time, or with food and plenty of water.  Some research says that melatonin may affect the way we metabolize our food so you should wait at least 2 hours after dinner to take it.  Everyone is different.  It may take some time to find your sweet sleep spot. 

The good news is that melatonin may not only be good for sleep but may also work as an antioxidant, antidepressant, anti-inflammatory, detoxifier and for its immune-enhancing and anticancer properties thereby supporting overall health in general.

Melatonin – A little precision for the use of too enthusiastic | medicine/science (medecinesciences.org)

Effect of melatonin supplementation on sleep quality: a systematic review and meta-analysis of randomized controlled trials – PubMed (nih.gov)

Melatonin, a Full-Service Anti-Cancer Agent: Inhibition of Initiation, Progression and Metastasis – PubMed (nih.gov)

Melatonin as an antioxidant: under promises but over delivers – PubMed (nih.gov)

Melatonin: Magic Potion or Unregulated Danger? (medscape.com)

B12, Diet & health, Vitamins & minerals

What is Vitamin B12?  The Uses, Benefits, and Side Effects 

Vitamin B12 is the most complex of all vitamins and one of eight B vitamins.  It is also known as cobalamin.  It is only made by some archaea and bacteria that is either eaten or produced in some animals.  It is not produced within the human body so must be eaten, supplemented, or injected.  There are some animals that eat or produce vitamin B12 and store it in their livers and/or pass it on through their eggs or milk.  Animal food sources that contain vitamin B12 include meat such as beef (especially liver because that’s where animals store it), fish, and fowl, as well as eggs and dairy products.  Fruits and vegetables do not contain vitamin B12.  You also can find vitamin B12 in fortified foods such as breakfast cereals, nutritional yeast, energy bars and energy drinks.  Vitamin B12 can also be synthesized in the lab.  Be sure to read the labels.  Look for cyanocobalamin.  It is more easily absorbed.

The Recommended Dietary Allowance for:

  • Infants (age 0-1) = 0.4 – 0.5 mcg/day
  • children (age 1-3) = 0.9 mcg/day
  • children (age 4-8) = 1.2 mcg/day
  • children (age 9-13) = 1.8 mcg/day
  • adults (age 14+) = 2.4 mcg/day
  • pregnant = 2.6 mcg/day
  • breastfeeding = 2.8 mcg/day

As you can see, our B12 requirements are very low.  So why then do most vitamin B12 supplements contain such high doses such as 1,000 – 5,000 mcg?  It’s because the vitamin B12 binds to the protein in the foods we eat and then gets broken down (unbound from the protein) in the stomach by the hydrochloric acid. From there, vitamin B12 combines with a protein called intrinsic factor so that it can be absorbed further down in the small intestine.  The high doses of vitamin B12 found in most supplements are not the amount that will be absorbed.  There needs to be an adequate amount of intrinsic factor (IF) as well.  Intrinsic factor is a protein produced by the parietal cells located in the gastric body (the largest section of your stomach) and fundus (the upper part of the stomach) and plays a crucial role in the transportation and absorption of vitamin B12 by the terminal ileum.  Intrinsic factor binds to vitamin B12 in the stomach and then travels to the intestines to be absorbed into the bloodstream.  Some people do not make enough intrinsic factor or have a condition that destroys it.  If your body does not make enough intrinsic factor, you can develop a type of vitamin B12 deficiency called pernicious anemia.  Surgical removal or bypass of the stomach and certain other health conditions can also cause you to stop making intrinsic factor.  Adults 50 and over may need to take supplements or eat fortified foods because as you age, the acidity of your stomach acid declines, and you may not be able to break down and absorb vitamin B12 as much as you used to.

Vitamin B12 is used by the body for:

  • produce DNA (fatty acid and amino acid metabolism),
  • normal functioning of the nervous system (synthesis of myelin), and
  • the circulatory system (maturation of red blood cells in the bone marrow). 

A deficiency of vitamin B12 can lead to severe and irreversible damage especially to the brain and/or nervous system.  The signs and symptoms of a vitamin B12 deficiency are:

  • tiredness, weakness, fatigue
  • headache, lightheadedness
  • breathlessness
  • loss of appetite
  • severe joint pain
  • brain fog, memory problems
  • depression, mania, and psychosis
  • reduced fertility           
  • pins and needles sensations, neuropathy and
  • pernicious anemia (an autoimmune, blood disorder with decreased red blood cell (RBC) production)

Pernicious anemia can lead to:

  • Gastrointestinal (GI) problems such as altered bowel motility (mild diarrhea or constipation)
  • Loss of bladder or bowel control
  • Gastric antral vascular ectasia (watermelon stomach)
  • Neurological problems such as sensory or motor deficiencies (absent reflexes and/or diminished vibration or soft touch sensation)
  • Subacute combined degeneration of the spinal cord

There is no gold standard way to test for a vitamin B12 deficiency.  Most doctors do not test for it unless there are some signs and symptoms.  If you do have signs and symptoms, be sure to ask your doctor to do a complete blood count (CBC).  The complete blood count (CBC) with differential is one of the most common laboratory tests performed today.  It gives information about the production of all blood cells and identifies your oxygen-carrying capacity through the evaluation of your red blood cell (RBC) indices, hemoglobin, and hematocrit.  It also provides information about your immune system through the evaluation of the white blood cell (WBC) count.  When you get your blood test back, it will list a range of components such as WBC (white blood cell count), RBC (red blood cell count), Hemoglobin, Hematocrit, and more.  It also will list your values and the standard range as well as a flag if it is too high or too low.  Your doctor will discuss the results with you.  This test is helpful in diagnosing anemia, infections, acute hemorrhagic states, allergies, and immunodeficiencies but it is possible that blood serum levels of vitamin B12 can be maintained and still appear normal while your stores are being depleted.  Further testing may be necessary.

Who is at Risk of a Vitamin B12 Deficiency?  Vegetarians, vegans, adults over 75, and people that have had gastric or small intestine resections, inflammatory bowel disease, or have used metformin (a diabetes medication) for more than four months, or have used of proton pump inhibitors, histamine H2 blockers, or antacids for more than 12 months.

Interesting Facts:

Hydroxocobalamin can be injected intramuscularly to treat Vitamin B12 deficiency but can also be injected intravenously for the purpose of treating cyanide poisoning.  The hydroxyl group is displaced by cyanide, creating a nontoxic cyanocobalamin that is excreted in the urine.

The B vitamins may help detox the liver of cannabinoids.

Resources:

Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins, and Choline. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. Washington (DC): National Academies Press (US); 1998. 9, Vitamin B12. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114302/

Harvard School of Health, Nutrition Source, Vitamin B12.  Available at https://www.hsph.harvard.edu/nutritionsource/vitamin-b12/

National Library of Medicine, MedLine Plus, Intrinsic Factor.  Available at https://medlineplus.gov/ency/article/002381.htm

Al-Awami HM, Raja A, Soos MP. Physiology, Gastric Intrinsic Factor. [Updated 2021 Jul 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546655/

American Family Physicians.  ROBERT C. LANGAN, MD, FAAFP, and ANDREW J. GOODBRED, MD, St. Luke’s Family Medicine Residency Program, Bethlehem, Pennsylvania.  Vitamin B12 Deficiency: Recognition and Management. September 15, 2017.  Available at https://www.aafp.org/afp/2017/0915/p384.html#:~:text=Patients%20with%20risk%20factors%20for,serum%20vitamin%20B12%20level.&text=A%20serum%20methylmalonic%20acid%20level,is%20normal%20or%20low%2Dnormal.

Mayo Clinic.  Complete Blood Count.  Available at https://www.mayoclinic.org/tests-procedures/complete-blood-count/about/pac-20384919#:~:text=Overview,blood%20cells%2C%20which%20carry%20oxygen

Good Rx Health.  Acid Reflux Medicine: Antacids vs. H2 Blockers vs. Proton Pump Inhibitors, What’s Best for Heartburn Relief? Amy B. Gragnolati, PharmD, BCPS, Joshua Murdock, PharmD. Reviewed by Joshua Murdock, PharmD. Updated on March 11, 2022. Available at https://www.goodrx.com/conditions/gerd/best-treatment-acid-reflux-antacids-h2-blockers-proton-pump-inhibitors

Green Flower Media “How to Detox from Cannabis” available at https://news.green-flower.com/how-to-detox-from-cannabis/