Questions from Our Readers
As the editor of New England Health Advisory, I receive many questions from my readers and I want to share some of them here. If you have any questions, don’t hesitate to write to me at neha@nehealthadvisory.com or by commenting below.
Vitamin D and osteopenia
I have osteopenia and I’m particularly interested in vitamin D3 and the recommended dosages. I probably take about 1500 Mg per day in supplements along with Citrical and saw from your article that I should be up to 5000 mgs. I would like to see some solid research that I can forward to my physician regarding increasing the dosage. Anything you can add would be appreciated.—D.T.
Inger: Dr. John Cannell and the Vitamin D Council is a great reference for your physician. Your doctor has so much new research to try to keep track of, he/she will most likely not be familiar with the new recommendations for higher dosages. There is research on the site confirming why we need to reach 5000 IU as well as addressing toxicity concerns or any other question your doctor may have.
Here is a link to the site:
http://www.vitamindcouncil.org/health/deficiency/am-i-vitamin-d-deficient.shtml
As you know, I support higher vitamin D levels for a variety of reasons. With respect to osteopenia/0steoporosis, there is new research indicating the importance of vitamin D in this regard. Increasing calcium for bone health is a common strategy, but the body requires vitamin D to absorb it. Yet another reason why vitamin D is important!
But in addition to vitamin D, the body also requires collagen to hold the calcium: it’s like the glue that binds the calcium to the bone. Without it, the calcium just passes through.
Many people lack adequate collagen. And to further complicate the matter, because so many things in our bodies are interconnected, collagen cannot be created without adequate levels of vitamin C. Vitamin C is a vitamin that we cannot make so we must ingest our body’s requirements on a daily basis. New research shows that Vitamin C may also be a big contributing factor to osteopenia, and we’ll be talking more about that soon.
Vitamin D and sun exposure
First, you mentioned that twenty minutes in the sun per day would provide ample Vitamin D. Does a certain amount of skin need to be exposed in order to achieve that? Would only having your face and hands exposed work or does a person need to be in shorts with a short sleeve shirt?
Second, will 20 minutes of sun during the winter months when the sun isn’t as strong be effective? You mentioned that those with paler skin create Vitamin D more readily and people are typically paler during the winter months. Therefore, would less exposure during the winter when pale be comparable to more exposure during the summer when tan?
Finally, we are constantly told to wear sunscreen on our faces in order to prevent aging. Will wearing say spf 15 inhibit the production of Vitamin D?—S.C.
Inger: To get adequate vitamin D in only 20 minutes, you need to have a good portion of your body exposed, which means arms and legs too. If less of your body is exposed, you’ll require longer exposure time.
In the winter months, unless you are near the equator, you simply cannot get enough exposure to manufacture adequate vitamin D, as the sun ray’s are not strong enough at that time of year. November to March, you’ll require supplementation in most all parts of the U.S., and in northern states, that’s probably true for longer periods of time.
It’s more about the intensity of the rays and their ability to penetrate the atmosphere in enough intensity to stimulate production at the various times of year than it is the skin color, though in general paler skinned people will make vitamin D more readily because of their genetics and darker skins require more exposure time.
Wearing sunscreen will prevent vitamin D production; the only way you will produce vitamin D is exposure without sun screen. We will be talking further about the many myths around sunscreen use that are causing us health concerns. I never use it unless I am going to be out all day or on the water and in danger of a sunburn due to long exposure times. My face gets as much sun exposure as I can give it and many people tell me I look much younger than I am.
If you feel you must protect your face with sunscreen or a hat, then allow your arms and legs to be exposed and increase your exposure time slightly… For example, if you are out with arms and legs and no face exposed, perhaps you go for 30 minutes. If it’s just arms working in the garden and face and legs are covered, perhaps you work for an hour…. Again, this is summertime exposure and it will take more in the off seasons to get what you need. It’s not a science, because each individual’s needs and vitamin D production capabilities vary, but you get the idea. Experiment and then test to see where you are and adjust accordingly.
Beef alternatives
While I understand that not everyone has the opportunity, your article is why I eat venison and ONLY venison.—P.S.
Inger: Yes, venison is a good choice but as you pointed out, one not everyone can make. And for some, it is an acquired taste. Bison is another good option for those looking for a safer alternative to beef.
High cholesterol and cinnamon
With extremely high total overall cholesterol (313), an article in the L.A. Times about cinnamon being good for blood sugar levels and lowering cholesterol caught my eye. I began to take six caps each AM and six caps each PM. Since I made the capsules from containers of Saigon Cinnamon from Costco, I can’t tell you the mg. In less than six months, my overall cholesterol dropped to 227. What I considered a huge drop and my HDL improved significantly. Are there any medical studies re this?—BBG
Inger: Cinnamon is a known anti-inflammatory which is a critical part of lowering cholesterol levels. In addition it helps regulate blood sugar levels and it contains anti-oxidants.
As for testing, most tests are funded by pharmaceutical companies, who only test things they could patent, so there is not a lot of research out there. But there was a study done on cinnamon and its impact on blood glucose that was published in the Journal of the American College of Nutrition. I have been told that the USDA did a study on 49 herbs and their health benefits in which the previous stated benefits were confirmed that was also published there, but I have not been able to track that down yet.
Congratulations on taking control of your own medical situation and making such great progress!
Cod liver oil and vitamins D and A
When using cod liver oil to increase vitamin D, where do you draw the line to prevent overdosing on vitamin A?—A.F.
Inger: While a tablespoon or two of cod liver oil will deliver some vitamin D, it will not deliver enough; you’ll need to supplement with additional vitamin D3.
The problem with high doses of cod liver oil is the ratio of vitamin D to vitamin A. You’ll need to look at the label of the brand you are using and its dosage levels to determine safe amounts. But as an example, I have some super 1000 mg cod liver oil in my house. One pill delivers 2000 IU of vitamin A and 250 IU of vitamin D. To get to the 5000 IU of vitamin D, I’d need to take 20 pills. First of all that would be impractical. But more importantly, 20 pills would result in 40000 IU of vitamin A, which would exceed the recommended limit substantially.
Right now 5000 IU of vitamin A is considered safe and while you can probably go a little beyond that safely, there are concerns at levels of 10,000 or more.
You’ll want to consider vitamin A from all sources, so for example, if you take a good multi-vitamin you may already be getting up to 5000 IU of vitamin A in that alone.
My kids and I take a cod liver oil supplement (my son likes a pill, my daughter prefers a tablespoon of the liquid form with lemon flavor added) every day because I think it provides a good baseline. We supplement beyond that with a good multi and additional vitamin D3.
Sugar alcohols
What are sugar alcohols that are showing up on labels and how do they fit into your analysis of sugars?—N.
Inger: Sugar alcohols are neither sugar nor alcohol but rather a combination, as part of their chemical structure resembles sugar and part resembles alcohol. They are actually carbohydrates called polyols that occur naturally in plants. Because they are not fully absorbed by the small intestine, they can be good for diabetics because you don’t get the full sugar absorption. However, because they are not fully absorbed, many people can experience diarrhea, gas or bloating. Some people will react to even a small amount, others can handle small doses and can slowly build up a tolerance to higher amounts.
Because of that, they are good for candy and mints in small amounts, (sugar alcohols also do not cause tooth decay), but they are not so good for baking or consumption in larger amounts.
Of the sugar alcohols, xylitol is the best choice. It is sweetest and seems to have the least gastro intestinal impact reports. Using small amounts (or more if you can tolerate it) of xylitol is a good choice for a natural sugar substitute.
Sources for glycemic and carbohydrate content in foods
We are with you all the way, Inger. Your article on Sugar was very helpful. Can you direct me to a good source for both the glycemic content and carbo content of all foods. I found some sources but none of the lists were complete. Thanks.—J.M.
Inger: I probably work with the same web sites you found. There is no one fantastic Web site out there. I tend to use http://www.glycemicindex.com because it has a good search tool that allows you to search for whatever you want. For general sites, the following are decent:
http://www.southbeach-diet-plan.com/glycemicfoodchart.htm
http://www.glycemicedge.com/glycemic-index-chart/
Keep in mind, however, that foods with little or no carbohydrates such as meat, fish, eggs, avocado, wine, beer, spirits, most vegetables cannot have a GI value. No carbs means no GI. So possibly some of the items you are searching for do not appear for that reason.
Are all oatmeals equal?
I eat a combination of instant oatmeal and oat bran as a hot breakfast cereal. I have high cholesterol and take 5mg of Crestor daily. I also grind flax seed and put it on my cereal and take Omega-3. My cholesterol total is 160 and the HDL is 60, so the combination is working.
But, I’ve read that rolled oats or steel cut oaks are better. Is this just marketing or are these better to lower cholesterol? Can you offer an explanation?
Inger: Many “instant” oatmeals are highly processed and contain sugar or sugar substitutes and other preservatives which should be avoided. So you’ll want to take a look at your label and see if there is added sugar or high fructose corn syrup or any natural or artificial flavorings dyes or preservatives added. If so, those are not the best nutritional options because the other things you are taking in will offset the benefits of the oat fiber.
Steel cut oats are less processed than rolled oats, and I am always in favor of eating foods closer to their original form and so the least processed form is always my choice.
Beyond the processing, however, there really is not much documentable difference between rolled oats and steel cut oats in terms of nutrition; they are both good options. Many people find, however, that they prefer the taste and texture of steel cut oats because it has a fuller flavor and texture. Choosing steel cut oats for most is a question of flavor.
Is maple sugar good for you?
This is a really good idea. Kudos for you and Tim. Regarding sugar, I have thought for a long time that maple syrup is good for you. But, I don’t have any information re: science. Would you please comment on this?
Inger: The main sugar in maple syrup is sucrose, though the darker versions especially Grade B contain small amounts of glucose and fructose as well. Syrup is very high in sugar, but since it isn’t fructose laden, a little in moderation is fine. Just make sure it’s real maple syrup and not the imitation pancake syrups that are made out of high fructose corn syrup.
Where does PureVia rank in the sugar equation?
Have read the Cabot newsletters for years and their foray onto health could not have come at a better time for me as orthopaedic surgeries have taken me down the last 3 years and a 50 pound weight gain while I couldn’t walk is proving much more difficult now that I have hit 60 than it did at 30. … Read with interest your article on sugar as I am working with a program called Fitness Together, which is also coupled with Nutrition Together and looking at how we eat. After reading your sugar article, as I was discarding the Sweet ‘n Low, etc., I found a box of PureVia. Your article did not mention that one.
Have tried to determine where PureVia sweetener ranks in the sugar equation. Can you help?
Inger: First of all, I applaud you for taking action to try to make some changes. It IS hard; I broke my wrist a few years ago and gained some weight. And losing it in your 40s is a totally different experience than in your 20s or 30s. So I’m with you! There is an article on how to make lasting change posted on the website. It follows basic life and health coaching processes and may help you in your efforts. I think it’s called Resolve to Be Successful This Year, and it’s in the Recent Posts section.
As for Pure Via, it is a stevia-based sweetener. But it also has two other sweeteners in it: erythritol and isomaltulose. Neither one of these has been studied well. They are both supposedly safe, but that doesn’t mean much these days with the marketing power of food companies like Pepsi. The truth is, we don’t know much about their potential impact and because they are relatively new, neither has been studied over time.
I don’t think any real harm can come from finishing out the box you already have. But next time you shop, look for pure stevia as it is a better choice going forward.
Corn syrup vs. high fructose corn syrup?
Can you tell us if “Corn Syrup” is the same or different from “High Fructose Corn Syrup” on ingredient labels?
Inger: High fructose corn syrup is a more highly processed form of corn syrup. As I have shared in the report, for a number of reasons, it should be avoided. Corn syrup, if it were 100% pure, would be glucose and might be acceptable in small doses as a sweetener. However, today as corn syrup is processed, other sugars are added. For example, according to the Karo brand website, corn syrup contains between 15% to 20% dextrose (glucose) and a mixture of various other types of sugar. They don’t provide the breakdown, but as you can see, 80-85% is NOT glucose. For that reason, as well as the fact that it evolves from corn and corn is something that is far too prevalent in the American diet, I avoid traditional corn syrup as well.
Side effects of aspertame?
I was recently told by one of my co-workers about the many adverse reactions and side effects of aspartame. When I went online to do some research on Aspartame I was shocked at the many possible serious side effects. Is this information true? If it is, why isn’t this information being given to the public?
Inger: Sadly, the information is true. Aspartame is connected to over 92 health symptoms and is responsible for 75% of all food additive reaction reports to the FDA. This information has been public for awhile, but the food companies do their best to keep it under wraps. And of course, they do their own testing to say it’s just fine. The major supplier of aspartame is about to re-brand the product and give it a new name, AminoSweet, in order to try to overcome marketing objections. I am going to be writing more about this in the future.
SUSTA versus Stevia?
I just read your report on sugar and sugar alternatives. You comment on Stevia being the best alternative to sugar. I have been using SUSTA as an alternative to sugar, I really like it. I want to know what your opinion is on SUSTA.
Inger: SUSTA has been flying under the radar and not getting much buzz. I love the idea of adding a probiotic and fiber to the sugar; those are two things most people need more of, and that can be helpful to mitigating the effect of sugar in the body.
I do question whether you ingest enough of either to make a measurable difference, but the concept is intriguing. The problem I have with SUSTA, however, is that it is a fructose sugar, which is just what we take in too much of and should try to avoid. So despite the interesting add-ons, I have to say that SUSTA is a sugar substitute that I would avoid.
Truvia versus Stevia?
I know you recommended Stevia to replace the other sweeteners. It seems it has five calories, but Truvia has none. Any comments on the difference with reference to taste?
Inger: I have heard that Truvia (made by Coca Cola) and PureVia (made by Pepsi Co) taste sweeter than Stevia, as they were created to counter the sometimes bitter aftertaste that Stevia can leave. Personally, I cannot comment on the taste, as I have never tried either of those. I can, however, comment on some concerns I have about these two products.
Both products contain erythritol (PureVia also contains isomaltulose). Erythritol is a sugar alcohol and sugar alcohols are not all absorbed by the body. While this may seem good calorically, the down side is that because it is not all absorbed, it can cause gas, bloating and diarrhea upon initial consumption or after more substantive doses. There have been numerous complaints of these side effects associated with these two products.
At the same time, even if your body does not react to the sugar alcohol concern, the truth is we do not know much about the potential effect of these other sweeteners because they are both relatively new. Neither has been well studied, nor are there any studies to monitor the effect of long-term consumption.
Given all of these concerns, I would stick to pure Stevia.
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