Bring On The Sun!

Hi everybody!  I had a request to talk about vitamin D this week.  Seems I’m not the only one feeling sun-starved this time of year!  This is an awesome topic.  Thanks Michelle!

So what’s vitamin D?  Vitamin D is not actually a vitamin but a prohormone that is produced in the skin in response to sun exposure, actually UVB exposure.  The farther away from the equator one is, the greater the angle the sun’s rays from straight-up-and-down and the less intense the UVB exposure.  In Cleveland we are at 41 degrees north latitude and we have a “vitamin D winter” from November to March or so.  This means that if you were lying naked in the sun in February (NOT RECOMMENDED!!) you could not make vitamin D at all.  In Cleveland we need to supplement vitamin D in the winter.

What does vitamin D do?  There are receptors for vitamin D in every cell in your body.  Vitamin D is a powerful hormone that regulates expression of genes, turning some on and others off.  Its most well-known action is regulating calcium metabolism and bone health.  Vitamin D deficiency contributes strongly to osteopenia and osteoporosis.  Scientists are furiously researching the many roles of vitamin D and more studies are published every day.

How do you get vitamin D?  Today, February 23rd, in Cleveland, there’s only one way to get vitamin D and that’s to eat it.  It is available in dairy milk and other foods that are fortified with vitamin D, and as supplements.  What kind should you take?  Vitamin D3, or cholecalciferol, is the best form to choose.  D2, or ergocalciferol, requires some metabolism by the body before it’s active.

How do you get vitamin D from the sun?  Well first of all you need to be outside with exposed skin on a sunny day!  The best time of day to get your vitamin D is between 10 and 2, or anytime your shadow is shorter than you are.  The skin must be exposed, and you must be outside – UVB doesn’t penetrate clothing or window glass.  How much time is required?  According to the Vitamin D council, “… one will have made all the vitamin D they are going to make for the day in about one-half the time it takes for their skin to turn pink.”  So extended exposure and risking sunburn is not necessary.  The torso makes the most vitamin D, the arms and legs less, and the face and hands next to none.

What about sunscreen?  If you wear sunscreen you don’t make vitamin D.  Period.  SPF 8 blocks 95% of vitamin D production, and SPF 30 blocks it all.

What about tanning beds?  There have been studies showing higher blood levels of vitamin D in those who use tanning beds.  Maximal vitamin D production requires only a few minutes of exposure to the high-intensity UVB rays of a typical tanning bed, much less than is required to actually stimulate melanin production (i.e. tanning).

So how do we get enough vitamin D without risking sunburn and skin cancer?  That’s a tough one and there is no consensus at this point.  Some doctors are suggesting 10-15 minutes of bright-sun exposure BEFORE applying sunscreen.  Other suggestions involve supplementing (2000-5000 units daily) and using sunscreen anyway.

It is interesting to note that vitamin D deficiency increases the risk of sunburn.  There is evidence that the heat (i.e. dilation of blood vessels and increased blood flow) from sunburn increases vitamin D production in the skin.  So sunburn (more likely with vitamin D deficiency) helps to correct the deficiency!  Science is so cool 🙂  There are tanning salons that sell 10,000 IU vitamin D tablets to be taken for a month prior to starting tanning.  This decreases the risk of burning, increases the amount of time you can tolerate in the bed, and makes you tan faster.  If you’re going south for Spring Break and want to reduce your sunburn risk, start now with the vitamin D supplements!

I’m very excited that spring is coming.  Can’t wait for the opportunity to let my skin make some vitamin D again!  And yes, I take my vitamin D, I don’t want to burn 🙂



The Tender Heart

February is American Heart Month, and I wanted to write a bit about heart disease and some of the ways to decrease your risk of a heart attack.  I have been making posts daily on my Facebook business page, one simple (and sometimes not so simple) suggestion daily that you can implement to improve your heart health.  Please feel free to “like” my Facebook page and follow me for regular updates!

About half my suggestions are diet-related, foods you can add to your diet (or avoid) to be good to your ticker.  Some examples are fish oil, ground flaxseeds, red wine, olive oil, soy, nuts, oatmeal, coffee and tea.  There are many foods that have been shown to decrease your risk of a heart attack.

The rest of my suggestions are a mixed bag of lifestyle changes and other medical/health related items that are good for your heart (and the rest of you).  The most important one is to not smoke cigarettes.  If I could pick one thing that would decrease your heart risk the most, not smoking would be it.  Smoking a pack of cigarettes daily more than doubles your risk of a heart attack.  Since heart disease is the number-one killer of Americans, that’s a huge number of extra deaths due to smoking!

Some other ways to decrease your heart disease risk are to see the doctor for a blood pressure check at least every other year and get treatment if your blood pressure is too high.  Elevated blood pressure is a significant risk for heart attack, stroke and kidney disease.

It’s also important to get your cholesterol checked and be open to both lifestyle changes and possibly medications if you’re above goal.  Knowing your goal is more complicated than just the total cholesterol.  The different cholesterol fractions are important, like LDL, HDL and triglycerides.   The targets are also different based on your heart risk factors (age, gender, smoking status, weight, blood pressure, history of other medical problems like diabetes and family history of early heart disease are the most important ones).

If you have diabetes it’s critical to have all 3 parameters under good control:  sugar, blood pressure, and cholesterol.  Diabetics with NO known heart problems are as likely as a non-diabetic with known heart disease to have a heart attack over a given period of time.  That’s why we are so aggressive with cholesterol and blood pressure control in diabetics.  I tell patients all the time that if you’re a perfectly healthy and fit diabetic, I’m gonna treat you like you have heart disease.  Know why?  Because your risk is the same.  Sad but true.  Preventing the FIRST heart attack in a diabetic is as important as preventing the SECOND heart attack in a non-diabetic.

Some of my other suggestions are commonsense and pretty obvious, like losing weight and maintaining a healthy weight, exercising (it’s called cardio for a reason!) and managing your stress.  Some aren’t obvious.  For instance, I found that having a pet decreases your heart risk.  Also, married people are less likely to have a heart attack.  (That study was done in Finland.  Maybe married Finns are happier than married Americans?)  And childless men are 17% more likely to have a heart attack than men who have children.  Why?  Who knows?

So mosey on over to my Facebook page and click “like” to see more suggestions on how to keep your heart healthy and happy.  I’ve been posting pics from “the trenches” of Facebook fans who come to see me in the office, as well as operational updates like vacation notices and info about our waiting room remodel.

Hope you all had a happy Valentine’s Day!  Here’s to your heart!


SAD But True

Here come the dark, dreary days of mid-winter.  What is it they say, it’s always darkest just before dawn?  Well for me, February is a dark time.  I’m done with winter.  It’s been cold forever, it’s been snowing forever.  I’m tired of going to work in the dark and coming home in the dark.

I’m dreaming of sunny warm days and dinner on the deck.  The smell of hamburgers and hotdogs on the grill (hey just because I don’t eat them doesn’t mean they don’t smell great!) and a cold beer in my patio chair cupholder.  Swimming in the neighborhood pool with my kids.  Road trips south to visit my family and swim in the lake or at the beach.  Heat shimmers over the pavement, fundraising car washes, driving with the windows open belting Kid Rock’s “All Summer Long.”

While I get a little grouchy about this time every year and cherish every sunny day no matter how cold, there are those who truly suffer in the winter.  There is a medical condition called Seasonal Depression or Seasonal Affective Disorder (SAD).  It’s characterized by typical depression symptoms of sadness, nervousness, irritability, appetite and weight changes, sleep troubles and just not getting much fun out of life, but it is seasonal and generally starts in the fall.

The prevailing theory about SAD is that it is caused by the lack of bright-light stimulation of the brain (via the eyes).  In fact, studies have shown that use of a full-spectrum bright light in the evening (after sunset) to effectively fool the brain into believing the days are longer improves depression symptoms.  It seems that light therapy is as effective as antidepressants in treating SAD.

My reason for writing about SAD this week is to let all of you know that grouchiness in the late winter is fairly common, but that depression symptoms that recur in the winter and significantly affect quality of life ARE treatable.  Even those who are opposed to taking medication for depression symptoms should see their doctor because treatment with a bright full-spectrum light in the evening can improve symptoms without drugs.  It’s estimated that 5% of adults in the US are affected by SAD.  Bet you know somebody with it.  Keep a lookout, OK?

I think we’re in the home stretch of this long, cold, snowy yucky winter.  I’m sure Mother Nature has a few wallops left in store but March is on its way.  Ash Wednesday is this week which means Easter is only a few weeks away.  Before we know it the kids will have spring break and then it will be summer.

Beautiful green leafy summer 🙂

I can’t wait!


How Much Is Too Much?

Patients ask me frequently about protein intake for building muscle, weight loss, general health, etc.  I talk to a lot of people about weight loss and about a good healthy balanced diet all the time (it IS my job, after all, LOL!) but I am NOT a dietitian or nutrition expert.

My concern about patients, especially fitness aficionados, is that they will overdo the protein intake trying to build muscle faster and hurt themselves.  I had talked to my friend and colleague Ron Flauto, DO, some time ago about this topic, and I asked him if he would be kind enough to revisit the subject for the blog.  Recently I got an email from him and wanted to share his advice.

Dr. Flauto is a nephrologist (medical kidney specialist).  The kidneys function to get rid of stuff the body DOESN’T need and to hang on to the stuff the body DOES need.  Healthy kidneys let little or no protein escape into the urine.  Sometimes damaged kidneys give a clue by “leaking” protein through the filter into the urine, which can be seen on a routine urine test in the office or the lab.

I try to be sure to do a urine test regularly on those who have high blood pressure or diabetes.  These folks have a higher risk of kidney damage and protein in the urine can be an early hint.  Sometimes patients come in with urinary problems like those that would signal a urine infection or seeing blood when urinating, and the urine test also shows protein.  If it doesn’t go away on repeat testing, we have to dig a little more.

My go-to guy for kidney puzzles is Dr. Flauto.  More than once, somebody with persistent protein in the urine has turned out to be a bodybuilder who is taking megadoses of protein supplements in the hopes of looking like Arnold Schwarzeneggar in “Conan, The Barbarian.”  I always get a very nice letter back from Dr. Flauto with pointers like that, and I’ve learned to ask about high protein intake BEFORE referring patients.  (I think he’ll agree I haven’t sent him anybody like that recently.  Yes, she CAN be taught!)

So how much protein is too much?  From talking with Dr. Flauto and my own research, it seems that’s a tricky question.  Obviously if you’re taking so much your kidneys can’t handle it, that’s way too much.  We don’t want to get there.  It looks like it depends on your size and your activity level.  Dr. Flauto was kind enough to check with his practice’s dietitian, who is a high-level athlete as well.  Here is his guidance on carbohydrate and protein intake:

light to moderate training:
carbohydrate needs:  2.3-3.2 gms/pound
protein needs:  .55 – .8 gms/pound
heavy training and high intensity:
carbohydrate needs:  4.5 – 5.5 gms/pound
protein needs:  0.7 to 0.9 gms/pound
It is worth noting that protein needs are debated (even in the nephrology world).  They are a considered a minor fuel for endurance exercise.  Regarding fat intake, it is reasonable to recommend sticking to “healthy fats” including fish, nuts, olives, avocados, veg oils etc.  If fat is being consumed via dairy, I’d recommend the low fat versions such as low fat milk or low fat cheeses.  Finally, I would also recommend avoiding saturated fats.

Those of you who are very fitness conscious, trying to lose weight, or just trying to improve your diet in general, I hope this helps you stay within a range that is safe for your body and sensible for you as an individual.

PS – If you or anyone you know needs a great kidney doctor, please call Dr. Flauto.  He sees patients in Parma Hts and Middleburg Hts.  The Parma Hts office number is (440) 292-0226.