High-dose Vitamin D Supplementation: Is it safe and effective?

By Dr. Iva Lloyd, ND

There has been a lot in the media over the last couple of years encouraging people to take high doses of vitamin D. The potential benefits of supplementation include:

• fewer falls and fractures
• increased bone density
• prevention of influenza virus
• prevention or reduction in asthma attacks
• increased insulin sensitivity
• decreased blood pressure
• and the prevention of some cancers and autoimmune disease

Not that long ago the recommended dosage for vitamin D supplementation was 400 IU / day.  Currently it is not unusual for individuals to be dosing at 10 to 20 times that amount. Lately it has been questioned whether or not the benefits of vitamin supplementation are still achieved at high dosages. The concerns include:

• Serum 25 hydroxyvitamin D (the standard blood test for vitamin D status) may not be a reliable indicator as it's half-life is 3 weeks. Also, 25 hydroxyvitamin D is only one of more than 50 vitamin D metabolites in blood and it is questionable as to the validity of using it as the primary indicator.
• The safety and efficacy of vitamin D supplementation cannot be inferred from data regarding the safety and efficacy of sunlight exposure. Many of the promoted benefits of vitamin D supplementation are actually from studies looking at sunlight exposure itself.
• Vitamin D is a fat-soluble nutrient and hence it can accumulate within the body and cause other concerns. For more information: http://www.ndhealthfacts.org/wiki/Vitamin_D
• Most of the studies on vitamin D supplementation are less than 20 weeks long hence the long-term safety of dosages greater than 2,000 IU/day is questionable.
• Vitamin D levels decline in response to inflammation. Therefore blood work that indicates low levels of vitamin D may be more indicative of inflammation level versus vitamin D status.
• There are some studies that indicate that vitamin D supplementation may exacerbate atherosclerosis.
• Studies suggest that moderate dosages of vitamin D may be protective against cancer; whereas high doses were not and may actually increase the risk.
• Bone density measurements were better with low-to-moderate dosages of vitamin D.

There are some conditions, such as Celiac disease, Crohn's, multiple sclerosis and some cancers where dosing high with vitamin D may be advantageous.  The new research indicates that 800 to 1200 IUs / day is generally effective for most people. Ideally, the best way to ensure adequate vitamin D status is to enjoy 5-15 minutes of sunlight exposure 2 to 3 times a week between 10 a.m. and 3 p.m.  For the majority of people living in Canada vitamin D supplementation is advisable between October and March when the amount of sunlight is limited.

If you have any questions about the optimal amount of vitamin D supplementation for yourself, talk to your naturopathic doctor.

Reference:
Gaby, Alan 2011 Controveries in Nutrition. Presented at the Ontario Association of Naturopathic Doctors annual Conference.

Key to a Strong Mind

A strong healthy mind is something that everyone seems to desire. For many it is taken for granted until there are signs of decline. Memory loss and cognitive decline is not inevitable. It is not a natural part of aging. Achieving and maintaining a strong mind requires work and constant attention.

Mental health and cognitive function is strongly determined by the strength of the blood-brain barrier (BBB). The BBB is a tight barrier that surrounds the brain and ensures that only the nutrients, water and other elements that are meant to get into the brain, do. When the BBB becomes damaged or weakened, signs of mental decline, decreased sensory and cognitive function start to appear. The factors that impact the integrity of the blood brain barrier include:

• Dehydration, especially chronic dehydration is strongly correlated with decreased mental and cognitive function.  The body is primarily water. As a person becomes dehydrated, the tight junctions in the brain become more permeable and the brain is not as effective at blocking the entry of toxins.
• Nutritional imbalances, especially as it relates to vitamins, minerals and oils are strongly associated with decreased cognitive function. The most vitamin deficiency associated with dementia and Alzheimer Disease is Vitamin B12. 
• Head injuries and trauma, such as whiplash, contact sport injuries, falls and motor vehicle accidents can weaken the integrity of the BBB, especially if the injury is not properly addressed and results in chronic inflammation.  
• Poor posture, especially forward-head posture, puts additional stress on the head and the brain.
• Pathogens such as viruses, bacteria, parasites and mold can contribute to decreased cognitive function.
• Environmental toxins, such as heavy metals (aluminum, mercury and lead) and chemicals contribute to cognitive decline and many other chronic health problems.
• There are a number of prescription medications that contribute to decreased cognitive function. Check with your naturopathic doctor to see if any of the medications that you are taking are associated with decreased cognitive function.
• Sleep is when the body heals and recovers from the stress of the day. Lack of sleep, especially chronic insomnia, is strongly associated with decreased cognitive function.

Other factors that are associated with decreased integrity of the BBB include:

• high ferritin levels which often indicate high inflammation levels in the body
• high insulin levels which often indicate diabetes
• high sodium levels which are often associated with increased salt intake
• high triglyceride levels which are linked to both high cholesterol and high fruit or fructose intake
• decreased blood flow to the brain which is often seen in atherosclerosis or peripheral artery disease
• and increased oxidative stress on the body.

The key to a strong mind is to:

Address the factors that impact the integrity of the BBB, such as:

• Ensure that you continue to drink adequate water on a daily basis. Generally speaking you want to drink half your body weight in ounces a day.
• Your diet is one of the key contributing factors to your ongoing cognitive function. It is also the one that you have the most direct control of. Ensuring that food sensitivities are addressed is a great place to start. It is also important to ensure that your diet is balanced with adequate lean protein, vegetables and healthy fats.
• Ensure that you take the steps necessary to ensure that your blood sugar and cholesterol concerns are addressed with natural solutions. Simply taking medications, without addressing the underlying causes may actually increase your risk of cognitive decline.
• Ensure head injuries are adequately addressed. The main threat to the BBB is unresolved head trauma and chronic inflammation. There are a number of natural therapies that can effectively decrease chronic inflammation and that can minimize the impact of sport injuries.
• Work with your naturopathic doctor to determine if heavy metals are a factor. Heavy metals disrupt the normal functioning of the brain, they decrease the body's ability to absorb nutrients and they cause a more dramatic decline than other lifestyle factors.

Other factors that are essential to a strong mind include:

1. Use it or lose it. The mind, in many ways, is like a muscle. If you want a strong mind you have to work every aspect of it.  To the mind, memory, speed, problem solving, attention, flexibility (multi-tasking) are all different aspects. Numbers, words and names are all processed in different aspects of the mind. Working the mind on an ongoing basis is key to health. Some options include:
• Ensure that you continue to read, preferably not on a computer or e-book (too much computer time can actually contribute to weakening the BBB.
• Work whatever aspect of the mind is a concern.  If you have problems finding words then do word searches and cross word puzzles. If you have problems remembering names then practice by going through old pictures and saying the names of people out loud when you meet them.
• Check out www.lumosity.com  It is a website geared to working all aspects of the mind.
2. Decrease anxiety. Chronic anxiety is exhausting. It is also dehydrating. There is a strong link between chronic anxiety and decreased overall cognitive function.
3. Be positive. A positive mind is associated with increased cognitive function and decreased memory loss. 
4. Take care of your senses. There is a strong link between hearing, seeing and cognitive function, as well as mental health.

Most importantly, don't wait until you have a problem. Like most health issue, your best chance of being healthy is to prevent disease. It is about being proactive and recognizing that most health issues, especially as you get older are simply an accumulation of your life. It is like a life-long balance sheet that weighs the impact of the positive and negative factors.

If you would like to learn more about what you can specifically do to achieve a strong mind book an appointment with Dr. Iva Lloyd, ND.  To learn more about how the breakdown of filters in the body contributes to disease check out the presentation that Dr. Lloyd, ND gave at Health Fusion in June 2013.

Sugar and Salt -- Foods or Poisons? - Part 2: Sodium-Potassium Balance

In a previous blog we discussed the health impact of sugar.  The other "drug" or "poison" that is associated with many chronic diseases is salt. Salt is both essential to health and toxic. What determines its impact is the amount that is consumed and the balance between sodium and potassium in the body.

Facts on Salt:

• Generally speaking, an adult requires about 1500 to 2000 mg of sodium a day.  Unfortunately the amount in a typical North American diet is between 4000 and 9000 mg. 
• Roughly 80% of salt comes from processed food; 5% is found naturally in food and only about 10 to 15% is added at the table.  It is the salt from processed food that is the major problem! 
• When it comes to the impact of salt on health the type of salt has little impact. Sea salt, kitchen salt, commercial cooking salt, Himalayan, Fleur de Sel or kosher salt is all the same.
• Infants who have been introduced to starchy foods early in life tend to have a greater preference for salty foods and as a result develop a taste for sugar.

Sodium-Potassium Balance
Salt is made up of sodium chloride (NaCl). Sodium (Na) is the primary extracellular electrolyte. The concentration of sodium on the outside of the cell is about 10X greater than inside. The amount of sodium in the body has to balanced with potassium (K). Potassium is the primary intracellular electrolyte. The concentration of potassium inside the cell is about 30X more than it is outside the cell. This delicate balance between sodium and potassium is required to maintain health and to sustain life. It also determines the electrochemical gradient which is critical for nerve impulse transmission, muscle contractions, heart health and for the movement of other essential electrolytes across the cellular membrane.

The main reason for a sodium-potassium imbalance is diet. Other reasons may include vomiting and diarrhea or prescription medications. Talk to your naturopathic doctor about your prescription medications to determine what impact they may be having on your sodium/potassium balance. Medications such as diuretics, corticosteroids, laxatives and many slow-release medications can cause decreased potassium levels.

Symptoms and diseases associated with sodium/potassium imbalance include:

• dehydration
• electrolyte dysregulation
• muscle pain and tension
• hypertension
• cardiovascular disease
• stroke
• diabetes
• osteoporosis
• obesity
• cancer
• multiple sclerosis
• autoimmune disease
• kidney disease
• lung disease
• growth retardation in young children
• cognitive decline, including dementia and Alzheimer's disease

Maintaining a healthy sodium / potassium balance:

• A diet high in whole foods, primarily fruits and vegetables, is the best way to maintain a healthy balance of sodium to potassium. Trust mother nature. Eating food in its natural state is the easiest way to maintain health.
• Eliminate or greatly reduce processed food as that is the primary source of sodium (salt). Most restaurant food is very high in salt.
• If buying any canned, frozen or processed food read the labels and ensure that the sodium level is minimal.
• Increase your consumption of potassium-rich foods such as: 
• dark leafy vegetables such as beet greens, spinach, kale
• vegetables such as potatoes, tomatoes, mushrooms and squash
• legumes such as white beans, pinto beans, kidney beans, lentils
• fish such as salmon, halibut, haddock and sardines
• fruits such as prune juice, papaya, bananas, avocados, plums and oranges

The most accurate way to measure your Na/K balance is a 24-hour urine collection test. To learn more about this talk to your naturopathic or medical doctor.

To read more details on the impact of high sodium - low potassium on health, check out the research article "Salt in Health and Disease - A Delicate Balance" by TA Kotchen, AW Cowley and ED Frohlich.

Sugar and Salt -- Foods or Poisons? - Part 1 (Sugar)

Increasingly research points to the fact that most chronic diseases are correlated with increased sugar and salt consumption. Both of these readily available "foods" are being designated in the research and medical community as drugs or poisons due to their extreme impact on health.

Sugar
There are three main concerns about sugar:

1. Fructose and fructose-based products, such as corn syrup, is that high levels of fructose do not directly stimulate insulin directly, which is why drinking a large soft drink actually increases appetite, versus making you feel satisfied. Insulin is the hormone in the body that indicates that you are full. If you are consuming high amounts of fructose, your body doesn't realize that it has reached a point of satiety and therefore you keep eating or drinking. Insulin levels eventually increase, but the increase is later, after you have over-eaten. Other forms of sugar spike insulin more quickly and result in feeling full faster. 
2. What also happens is that high-fructose consumption results in leptin-resistance. Leptin is considered the "starvation hormone". With leptin-resistance the body feels that it is in starvation mode resulting in it storing food versus burning it off.  Leptin-resistance is directly associated with obesity. When individuals are in a state of leptin-resistance, instead of sugar consumption causing hyperactivity or a "sugar-high" as the body attempts to burn off the sugar, the trigger to "burn" off excess insulin is turned off and instead they are constantly hunger and content with being sedentary.
3. High sugar consumption contributes to dehydration and nutrient deficiencies which are associated with most chronic diseases. In order to prevent chronic diseases sugar and fructose need to be greatly reduced in the diet.

Diseases associated with increased sugar consumption include:

• hyperglycemia
• hypoglycemia
• insulin resistance
• diabetes
• metabolic resistance
• cardiovascular diseases such as hypertension and high cholesterol
• vitamin and mineral imbalances
• obesity
• decreased immune function
• fatigue and chronic pain
• increased food reactions and sensitivities
• candida
• mood disorders such as anxiety and depression
• and many other chronic diseases.

To avoid high-fructose foods and drinks you want to eliminate or greatly reduce the following from your diet: 

• soft drinks - especially pop - both diet and regular and fruit drinks
• high-fructose corn starch - which is a common additive in many processed foods such as baked goods, breads, cereals, snack bars, yogurt, soups, condiments, soft drinks and ice cream.
• limit your fruit to 1 or 2 a day and eat it in its natural state versus as a juice.

For most people a paleo-based diet is best way to achieve and maintain health.  For information on what diet regimen is best for you, work with your naturopathic doctor.

Tests that can help determine if fructose or leptin-resistance is affecting your health include the following: Hb1aC, ALT, Triglycerides, Uric Acid and leptin levels.

To learn more about the impact of sugar and fructose on health, check out the U-Tube Video "Sugar - The Bitter Truth".

Watch for Part 2 next week which will discuss the impact of salt on health.  To learn more about this, please talk to one of our naturopathic doctors. 

Heartburn Heartache

By Dr. Iva Lloyd, BScH, BCPP, ND

Heartburn, or gastroesophageal reflux disease, is common after the holidays.  The most common symptom of heartburn is burning pain in the upper abdomen or chest that is worse with bending or stooping, lying down or eating. It can also manifest as gas and bloating, belching, nausea or vomiting, bitter taste in the mouth, coughing, difficulty swallowing, hiccups, hoarseness or sore throat.

For some the symptoms of heartburn mimic the symptoms of a heart attack, if you are unsure at all, seek medical care.

There are many factors that contribute to heartburn including:

• certain foods lower esophageal sphincter tone and can irritate the esophagus including: alcohol, spicy and fatty foods, chocolate, citrus foods and juices, coffee and carbonated drinks.
• food allergies and food sensitivities can trigger or aggravate the symptoms.
• eating large meals or eating too close to going to bed increases the chance of heartburn.
• dehydration and heartburn tend to go hand-in-hand.
• improper breathing and chest breathing is associated with an increased risk of GERD.
• for many people heartburn is triggered due to increased levels of stress or specific types of stress.
• H. pylori infection can cause heartburn.
• smoking cigarettes reduces lower esophageal sphincter tone, prolongs acid clearance and has been related to increased numbers of reflux events.
• medications can initiate or exacerbate GERD symptoms: Anticholinergics, Beta-blockers, Bronchodilators, Calcium channel blockers, Dopamine-active drugs, Progestin, Sedatives, Tricyclic antidepressants.
• Obesity, pregnancy, asthma, ulcers and other conditions are associated with heartburn.

If you suffer from heartburn it is important to first identify the factor(s) that are contributing. If your heartburn is severe or chronic it is important to work with a naturopathic doctor to determine the best therapeutic approach.

General guidelines for acute heartburn include:

1. Address the dietary factors that are triggering or aggravating the symptoms.
2. Relax while consuming food: always sit down, eat meals slowly and deliberately, avoid doing other activities simultaneously.
3. Eat smaller, more frequent meals with low fat content.
4. Increase dietary fiber intake.
5. Ensure you drink adequate water, but not while eating.
6. Engage in regular exercise or movement. 
7. Address any postural issues. Standing and sitting up straight provides from more room in the abdomen.
8. Learn how to breath into the abdomen and back versus into the chest.

Naturopathic medicines are effective in the management and treatment of heartburn. 

• Liquid calcium magnesium can be used in place of antacids. It coats the esophagus which decreases the acute symptoms of heartburn.
• Some supplements work by neutralizing the stomach acid with a base such as sodium bicarbonate, others, such as glutamine, work by soothing the mucous membranes and healing the damage caused by the stomach acid.
• Herbs are effective in healing the lining of the esophagus, addressing inflammation and treating conditions such as h. pylori. Common herbs used in the treatment of heartburn include: Marshmallow root (''Althea officinalis''), Slippery Elm (''Ulmus rubra''), Chamomile (''Matricaria recutita''), Ginger (''Zingiber officinale'')
• Herbs are also used to manage stress and to decrease the occurrence of heartburn due to stress.
• Homeopathics can be helpful in the treatment of both acute and chronic heartburn.
• From a Chinese perspective heartburn is due to stagnation in the body. Acupuncture is effective in clearing stagnation.

For most people heartburn can effectively be treated by addressing the causal factors and using natural therapies. Prescription medication for heartburn may be needed in severe cases, but  one concern of most prescription medications for heartburn is that they often result in a condition referred to as hypochlorhydria (Low Stomach Acid).  Many people associate heartburn with high stomach acid, yet it is commonly caused by low stomach acid, especially as people getting older. Low stomach acid impairs digestion and is associated with a range of other health concerns.

For more information on heartburn and other common conditions check out www.ndhealthfacts.org. To learn more about how naturopathic medicine can assist you talk to one of our naturopathic doctors or contact us to book an appointment.