‘Science Says’ Sunday – Vitamin D Deficiency

Three years ago, I experienced tiredness like never before. There were days where I could barely manage to get off the couch on the weekend, because the fatigue was simply so overwhelming. I finally decided to go to the doctor and requested they run some labs. Because my fatigue was so significant, they also ran a vitamin and hormone panel. The results were astounding. While the Institute of Medicine recommends that Vitamin D levels fall between 20-40 ng/dL, mine was 12 ng/dL. TWELVE! One week of intensive vitamin D supplementation and I was back to feeling like myself again.

I’m not certain that the Vitamin D supplementation alone was responsible for my fatigue. I was a mom of two under 7, it was a very busy/stressful time for me on the faculty, etc etc. It could have very well been a placebo effect (ie, “a beneficial effect produced by a placebo drug or treatment, which cannot be attributed to the properties of the placebo itself, and must therefore be due to the patient’s belief in that treatment”), given that a big study in the New England Journal of Medicine (one of the premier journals in academic medicine) published a study indicating that a more appropriate cutoff might be closer to 12.5 mg/DL, based on the analysis of blood samples from hundreds of thousands of individuals. 

So why is it possible that my potential vitamin D deficiency may have led to such extreme tiredness??

Well, Vitamin D is not frequently found many of the foods humans consume. Furthermore, we typically get Vitamin D from the SUN! So, if you don’t consume many of the foods that contain vitamin D, or consume them in quantities large enough to provide the Vitamin D levels your body needs, AND/OR you don’t get a lot of sun exposure, then it possible you could be vitamin D deficient. Since I wasn’t getting Vitamin in my food and getting very little sun exposure, it’s likely that the combination of those two things led to my deficiency.

So, what are some of the foods that contain Vitamin D naturally??

  • Fatty fish, like tuna, mackerel, and salmon
  • Foods fortified with vitamin D, like some dairy products, orange juice, soy milk, and cereals
  • Beef liver
  • Cheese
  • Egg yolks

At that time in my life, I didn’t eat eggs, I didn’t drink milk at all, I rarely ate salmon or tuna, definitely did NOT eat beef liver (although no judgement of those who do!!), and didn’t consume orange juice fortified with Vitamin D. Furthermore, this time of year three years ago also meant that I had been wearing lots of layers, and likely hadn’t spent much time outside because it’s winter. Also, it’s flu season and hello! Best to stay indoors. 😀 All that to say, I now consume a lot more salmon, and definitely take the Vitamin D dosage my physician prescribed.

Studies suggest that people most at risk for Vitamin D include:

  • people with anorexia nervosa
  • people who have had gastric bypass surgeries
  • people who suffer from other malabsorption syndromes like celiac sprue
  • people who have dark skin
  • people who wear total skin covering (and therefore absorb less sunlight even when they are outdoors for extended periods of time) 

 What are some of the symptoms of Vitamin D deficiency??

Some people have no symptoms at all. Others experience tiredness or fatique (like I did), others experience muscle aches. Extreme and prolonged (that lasts a long time) vitamin D deficiency can lead to brittle or misshapen bones.

If you have vitamin D deficiency, and have questions about what to do or what to take, definitely consult with your healthcare provider about an appropriate dosage if you’re not already getting it in your diet or you’re not in the sun a lot. Oh, but don’t forget, if you’re in the sun, WEAR SUNSCREEN because, hello, skin cancer. 😦

For more information, visit the following sites which include significant information about this topic!

https://www.health.harvard.edu/blog/vitamin-d-whats-right-level-2016121910893

https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/

https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

JoAnn E. Manson, M.D., Dr.P.H., Patsy M. Brannon, Ph.D., R.D., Clifford J. Rosen, M.D., and Christine L. Taylor, Ph.D. Vitamin D Deficiency — Is There Really a Pandemic? New England Journal of Medicine

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. Evaluation, treatment, and prevention of vitamin D deficiency: An Endocrine Society clinical practice guideline. Journal of Clinical Endocrinology & Metabolism 2011

Heaney RP, Holick MF. Why the IOM recommendations for vitamin D are deficient. Journal of Bone and Mineral Research

Bouillon R, Van Schoor NM, Gielen E, et al. Optimal vitamin D status: A critical analysis on the basis of evidence-based medicine. Journal of Clinical Endocrinology & Metabolism.

Cauley JA, Greendale GA, Ruppert K, Lian Y, Randolph JF Jr, Lo JC, Burnett-Bowie SA, Finkelstein JS. Serum 25 hydroxyvitamin D, bone mineral density and fracture risk across the menopause. Journal of Clinical Endocrinology & Metabolism, May 2015.

‘Science Says’ Sunday – HPV and the HPV Vaccine


Another ‘Science Says’ Sunday is here and this one came HIGHLY requested, so here’s some info about the Human Papillomavirus (HPV) and the HPV vaccine you will want to read!
First, let’s start with what HPV is and what it does:

What: HPV is one of THE most common sexually transmitted infections in humans. Since there are often no symptoms, it’s difficult to know whether the person is infected or not. A person can be infected with the virus for years and not have symptoms until years later. There are different types of HPV (just like the different strains of the flu virus we talked about last week, remember??), and the different types can result in different outcomes (see the What does HPV do? below).

Who, What, and When: It can be transmitted during any sexual encounter that involves vaginal, anal, or oral sex with someone who has the virus. Anyone can get it, even if the person has only had sex with one single person.

What does HPV do? In most people, the virus ‘goes away’ on its own, much like the body would clear a cold virus. However, in some cases, the virus remains ‘hidden’ or ‘sleeping’ in the body. When that happens, it can lead to things like genital warts, cervical cancer, or mouth/throat cancer, specifically cancer in the back of the throat, including the base of the tongue and tonsils. It can also cause other cancers like cancer of the vulva, vagina, penis, or anus. The strains that cause cervical cancer are not the same as the ones that cause genital warts.

What can you do to prevent infection?? I know that vaccines can be scary and there was A LOT of interest about the HPV vaccine, specifically when I asked about topics to cover for this series. I totally get it. This vaccine was not around when people my age (late 30s-40s) were growing up, and much like any new thing, there is a lot of talk about it. Peer-reviewed studies (those that have super strict guidelines for assessing how valid a study is and who funded it and whether the results can be generalized to all populations affected, for example), show that the vaccine is SAFE and helps PREVENT the diseases caused by HPV infection.

Who should get the vaccine and when: Current guidelines recommend that the vaccine for those who are ages 11 or 12 (or you can start at 9 years old) for both boys and girls. Adults aged 27-45 who have not been vaccinated can speak with their healthcare provider about their risk for new infections and consideration about whether or not to get the HPV vaccine. Scientific evidence does suggest that the HPV vaccine provides less benefit when people have a higher likelihood of having been already exposed to HPV. People used to think that HPV only lead to cervical cancer and if cervical cancer is a woman’s disease, then why do boys need the vaccine too. Here’s where we get into what ‘herd immunity’ is and WHY vaccines are SO IMPORTANT for the general population. The ONLY way to fully eradicate (get rid of complete) a disease, is to have everyone – or as close to it – free of disease. So herd immunity works by making sure that a large enough proportion of the population is vaccinated so that the majority can protect the few people who can’t be vaccinated (like babies, older individuals who are sick, people with cancer, people getting chemotherapy, etc). So, in order to prevent cancer and all the other diseases caused by HPV, we need to get the HPV vaccine and both boys and girls need to get it before the first time they have sex. It doesn’t mean that getting the HPV vaccine will make them ready to have sex (especially at 9-11 years of age) it just means they will be protected when they do, even if the first time isn’t until they are 30. 🙂

HPV vaccine risks: This is a point of contention for many and there is so much mis-information about this out there. Here is what we know: We have now had data on the vaccine that spans 12 years. In that time, clinical trials, use by many in the general community, reports to the Food and Drug Administration (FDA) all agree that the vaccine is SAFE TO USE with MINIMAL risks. Overwhelming data suggests that the most frequent side effects include dizziness after getting the vaccine and something called syncope (fainting), which sometimes happen to people generally when getting any shot, the HPV shot included. While blogs and the anti-vax community has stated that the HPV vaccine leads to adverse effects such as death, there is no evidence to suggest that the HPV vaccine has been directly responsible (ie, no evidence to suggest HPV is causal for death as an outcome) for any deaths in individuals who have gotten the vaccine to date.
This summary comes from evidence provided by the Centers for Disease Control (CDC) and highly reviewed, scientifically regarded studies published in peer-reviewed journals with no conflicts to declare.

For more information and to peruse the sources for today’s post, please visit:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511986/#__ffn_sectitle
https://www.ncbi.nlm.nih.gov/pubmed/26908690
https://www.cdc.gov/hpv/parents/vaccinesafety.html
https://www.cdc.gov/std/hpv/stdfact-hpv.htm

‘Science Says’ Sunday – The Flu Shot

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There are so many questions out there about science and health, and so many people willing to share misinformed and/or non-evidence based information, that I decided to create a ‘Science Says’ Sunday series. I polled the Instagram Community and came up with this series to share evidence-based information with you on a number of science and health-related topics. There will be one posted every Sunday, so stay tuned!

In today’s post, we are talking about the flu and the flu shot. Lots of misconceptions out there, so here are some myths and facts:

MYTH: You can get the flu from the flu shot/vaccine.

  1. You CANNOT get the flu from the flu vaccine. People who get sick after the flu vaccine were going to get sick anyway. It takes 1-2 weeks to be fully protected from the flu after getting the vaccine, so it is still possible to get sick during that time. That’s why it’s important to get the flu shot as early as possible when it’s offered every fall (usually Sept/Oct).

 

MYTH: Getting the flu is better than getting the flu vaccine.

False. The flu a serious viral infection and can be especially serious in children and older adults, not to mention people who are immunocompromised (eg people undergoing chemotherapy) or babies who are too young to be vaccinated against the flu. The vaccine works best if everyone gets it; it minimizes the amount of people who get sick and can transmit disease to others.

 

MYTH: The flu shot contains harmful ingredients.

Vaccine skeptics have centered on this and cited Thimerosal (preservative) and formaldehyde (used to kill the virus) among the harmful chemicals used in the making or preservation of the flu vaccine. REPEATED, peer-reviewed studies have shown that these substances are not harmful in the tiny amounts contained in flu vaccines.

 

MYTH: You don’t need to get a flu shot every year.

The influenza virus changes (mutates) each year. So getting vaccinated each year is important to make sure you have immunity to the strains most likely to cause an outbreak. Getting the flu vaccine has also been associated with less severe symptoms even if you do end up getting the flu, so it’s worth getting it either way.

 

MYTH: It’s too late to get your flu shot this year.

Though flu season is well underway, it is NOT too late to get your shot, since the season typically continues into February or beyond.

Other concerns:

The flu vaccine can cause severe side effects. The flu vaccine has been associated with the onset of Guillain-Barré Syndome (GBS), in very rare cases. It has been reported in 1 in 1 million people who get the flu vaccine. The exact cause of Guillain-Barré syndrome is unknown. But it is often preceded by an infectious illness such as a respiratory infection or the stomach flu. It is possible that cases associated with the flu would have developed even in the absence of getting the flu vaccine.

Information for this post was sourced from the Centers for Disease Control, The World Health Organization, the Harvard Health Blog, and Dr. Andrea Carcelen of John Hopkins University. Thanks for reading and look forward to sharing more with you this year!

yours truly, dr. b