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Calcium and Vitamin D

Nutrition is a very dynamic science. I look back to the 90’s when everything in my household was “fat free” and thought I was eating right! Luckily, most of the population has turned away from the low fat frenzy where bagels and pasta were unlimited and realized that carbohydrates may be a target of dietary modification.

Two specific nutrients I get many questions on are calcium and vitamin D. Below you will find some thoughts on the utility of dairy products and sun exposure!

Myth: You must eat dairy products to get calcium and keep bones strong

Calcium is found in a wide variety of foods, including dairy products. The problem with dairy is that some people have sensitivities (can present as eczema, acne, IBS), it tends to be pro inflammatory/mucus producing (chronic sinus or respiratory issues) and many people do not have the enzymes (lactase) necessary to digest dairy. The belief that dairy prevents fractures and supports bone health has not been supported by research. The Harvard Nurses’ Health Study, followed more than 75,000 women for 12 years, showed no protective effect of increased milk consumption on fracture risk. In fact, increased intake of calcium from dairy products was associated with a higher fracture risk.

Calcium is a very important mineral, but choose your sources of calcium wisely. Try to get a variety of calcium containing foods in your daily diet:

  • Canned salmon or sardines: canned fish has steamed, edible bones that supply calcium, vitamin D and vitamin K. Also, these fish supply healthy omega-three fats and are my top pick for healthy calcium containing food. About 3 oz of fish will supply 300-400 mg of calcium.
  • Collard greens: also contain vitamin K, 1 cup will supply 200-300 mg of calcium. Try using collards as a wrap or chop and add to soup or marinara sauce. Other greens that also have similar calcium content per serving are spinach, beet greens, mustard greens and bok choy.
  • If you do tolerate dairy and choose to include it in your diet, the best forms to include for calcium benefits are organic, raw if available, unsweetened yogurt or kefir.

Bone strength depends on more than just calcium. Vitamin D, magnesium and vitamin K are also important for bone health.

Myth: You only need vitamin D supplementation in the winter.

It is true that our vitamin D levels can dip in the winter, which may be a cause for seasonal depression. When the sun is out in the summer months, are you getting enough D on a daily basis? Individual requirements for vitamin D vary widely, making follow up blood testing important to see if optimal blood levels are being achieved. Target blood values are usually > 70 on standard blood panels.

The ability to make vitamin D from the sun is dependent on our geographic location. In areas north of 35-37 degrees latitude, little to no vitamin D is made November to February. For reference, Chicago is at 41 degrees north and Phoenix is at 33 degrees. Also, any sunscreen over SPF 8 will block the sun’s ability to make vitamin D. Caucasians need approximately 20 minutes per day between 10 and 2pm of direct sunlight, most of skin uncovered (think bikini or swim trunks!), to make their daily dose of vitamin D. Darker skinned individuals need a longer duration in the sun to allow for absorption, approximately 40 minutes or more. During sunbathing, the body can make up to 20,000 units in this 20 minute time period.

Food sources that are high in vitamin D are fortified; therefore sun exposure and supplementation are critical.

Vitamin D is best absorbed and utilized with vitamin K (both K1 and K2), so I usually recommend supplementation containing D and K. Look for cholecalciferol (D3) which is the active form of D that you make from the sun!

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Is your gut leaky? Fix it!

Something called “leaky gut” could be the root cause of your health concerns.

Your gastrointestinal (GI) tract:

General function:

  1. ​Alter food by chemical and mechanical means into substances that can be absorbed. This involves the digestive enzymes secreted by the stomach, pancreas and gallbladder.
  2. Absorb nutrients in the small and large intestines
  3. Eliminate unused substances
  4. Keep a tight barrier from the outside world (food) and inside (blood)

Signs that general functions are not carried out properly:

  • ​Bloating and gas
  • Constipation or diarrhea
  • Undigested food in stool
  • Sensitivities to foods
  • Body aches and pains

Could leaky gut be the answer?
​In very simple terms, leaky gut may be the cause of some of the above listed symptoms. Leaky gut is when the barrier between the outside world (food, medicines, or supplements) you put into the body begin to “leak” into the bloodstream. Normally, the mucosa (lining of the digestive tract) has tight junctions between the cells that line the digestive tract. When these cells are no longer tightly lined up due to chronic inflammation, toxins, pathogens (bad bacteria or yeast), or stress, symptoms as listed above can occur. Sometimes a picture is worth a thousand words…
Leaky-Gut-Syndrome

Fix it!

  • Testing for leaky gut can be done with a simple at home test called the lactulose/mannitol test. Or can be considered when there are multiple food sensitivities or based on symptoms. Often, my recommendations may come from a presumed leaky gut situation, without testing.
  • Identify food sensitivities and remove them from your nutrition plan. This can be done with an elimination/challenge type diet (or cleanse) or can be done with an in office test for food sensitivity.
  • Replace good bacteria and kill off any pathogenic bacteria or yeast. This may involve herbs or supplements to kill bad bacteria (berberine, caprylic acid, grprefruit seed extract, etc. ) and replace with a high quality probiotic (25 + billion CFUs per cap and good mix of lacto and bifido bacteria)
  • Support normal digestive function with L-glutamine, DGL, slippery elm, and digestive enzymes
  • Heal the lining of the digestive tract to regenerate cells that are no longer performing optimally by removing triggers like stress and harmful medicines (especially antacid medications or NSAIDs)
  • Healing foods:
    • Bone broth
    • Fermented Foods: sauerkraut, kimchee, kefir
    • Coconut oil

As you know, health starts with the gut! Hope this finds you with a happy digestive system!

Water: How much is enough?

Your body is made up of about 60% water! We lose water via urine, perspiration, and respiration. Have you ever wondered how much water you should drink in a day? Is the recommended “8-glasses” enough? What about other beverages (coffee, tea, etc.)– do those count? Below are some tips on how to stay hydrated this summer and year round!

Water:

  • How much? If you were to follow general guidelines, you should get 8-8 oz glasses per day. That is a total of 64 oz per day. That might actually be okay for many people! My general rule is this: drink half your body weight, in ounces, per day. So, for a 150 pound woman, that is 75 oz of water per day. This recommendation goes for water only. It important to listen to our bodies and drink when thirsty. However, if we wait until our body tells us to drink, we are often already a bit dehydrated at that point. That is why it is best to sip on water throughout the day and never get to the point of real thirst. During exercise or hot weather (i.e. when we sweat) we need to make up for the lost water with extra hydration.
  • What form? Water seems to come in many forms these days– “smart” “zero” “sparkling” “naturally flavored.” I would consider any water-based beverage WITHOUT caffeine to count towards your total daily water intake. Caffeine has a slight diuretic effect, which may cause more water loss and no net hydration. See list below to see if your beverage counts towards your daily total:
    • Yes: water, sparking water, herbal tea, flavored water beverages, decaf coffee, electrolyte beverages, coconut water
    • No: coffee, green or black tea, cola, caffeinated sports beverages
    • Food: veggies and fruits have naturally occurring water. However, it’s hard to estimate how much and add that into the total. I’d suggest counting fruits and veggies as “bonus” and still targeting a specific pure water intake goal.
  • Do I have enough? Your urine should be straw colored. Very clear urine means you may be drinking too much water and very yellow urine means you are probably dehydrated. If you are taking vitamin supplements, beware that vitamin B2 (Riboflavin) will turn your urine bright, almost neon, yellow.
  • Benefits of drinking water: can help with constipation, improve skin (especially acne), may aid weight loss, and has been shown to help in those with chronic headaches.

 

​Fun water ideas:

  • Add in lemon, lime, mint leaves, or cucumber to water.
  • Make your own electrolyte beverage: take a pinch of sea salt, a splash of juice, and a squeeze of lemon or lime.
  • Sparkling water makes a meal fun! There are many flavored sparking waters or add any of the above to your sparkling. Adding bitters (herbs that support digestion) to sparking water is also a fun way to make water interesting. I also like to add Emergen-C packets to water to make “soda.” You can probably trick your kids into liking this too!
  • One of the most important aspects of ensuring hydration is routine. I’ve personally found that having a water bottle, toting it around with me, and tallying up the number of times I fill it in a day is the only way I can remember to get enough water (and keep tabs on the amount). Any other food or drinks on top of my daily water bottle tally are bonus! Try to get a glass, stainless steel or (at a minimum) BPA free plastic bottle to have on hand at your desk or as you go about your day.

Cheers to water!

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Healing Bone Broth Uses and Recipe

Bone broths are becoming a popular drink! It is especially great for those with digestive concerns (like food allergies) or inflammatory conditions (like arthritis or acute cold/flu).  Some of the benefits of bone broth include:

  • Good source of calcium, magnesium, and phosphorus therefore good for bones (kids, osteoporosis/osteopenia/healing bones)
  • Contains collagen that is supportive to skin, joints, hair, and nails
  • Can support digestive health with the gelatin in the broth, leading to decreased inflammation and repair of the cells that line the digestive tract (IBD- Crohns Colitis, IBS)

Mineral-Rich Bone Broth

Yield: Approximately 14 servings

Ingredients

4 quarts of filtered water

1.5- 2 lbs of beef knuckle bones or marrow bones (or any other kinds of bones – especially oxtail, which lends added gelatin and a delicious flavor). Chicken turkey or necks are inexpensive and also work great. You can get these by asking for them at the butchers counter.

Cloves from 1 whole head of fresh garlic, peeled & smashed

2 Tbsp apple cider vinegar (organic, unfiltered- I like Bragg’s brand)

1Tsp unrefined sea salt – or more/less to taste (I like Celtic Sea Salt)

Preparation

If you choose, you may brown or roast the bones in a separate pan/pot. If  you are using a crockpot, but this isn’t a necessary step. I usually just use leftover bones from a whole roasted chicken or a bone-in steak. If you don’t have enough bones for a batch, save the bones in a plastic bag in the freezer until you have accumulated enough to make the broth.

Place all ingredients in a 6 quart pot and set the heat to HIGH. Bring the stock to a boil, then reduce the heat setting to LOW. Allow the stock to cook for a minimum of 8 hours and up to 24 hours. The longer it cooks, the better!

(I really prefer the crockpot for this reason– set it and forget it!)

Turn off the pot or  crockpot and allow the stock to cool.

Strain the stock through a fine mesh metal strainer to remove large pieces. Discard bones, herbs, spices or veggies you used to cook with. Place the stock into glass or metal bowls and allow to cool completely in the fridge. After it cools, determine how much to leave in the fridge and how much to freeze. Store in the fridge in glass canning jars. I like to freeze in quart size bags and ice cube trays so I can have various quantities on hand.

You can drink stock any time of day, before or after meals, or use it as the base for soups and stews!

Perfect in any recipe that calls for broth. Keep in mind it will make your soup or stew thicker than using commercial pre-prepared broths.

 

Variations

Use any other kind of animal bones you like – chicken, in fact, will take less time due to the smaller pieces.

Add chopped veggies like carrots, celery and onions for more flavor or variety.

Add ginger for warming spiciness!

4 Easy Ways to Meditate

I have often recommended meditation to patients to help calm their mind and ease stress. Sometimes, I am met with puzzling looks: what does that mean? How do I meditate? Is it hard? Here are some simple ways to make meditation a part of your routine.

  1. Driving meditation: If you have a long commute to work, use that time to meditate! One of my favorites is quiet driving meditation. Turn off the radio, silence the phone, and just concentrate on your surroundings and your thoughts. Notice what comes to mind in the quiet of your car for the commute. Acknowledge thoughts and don’t judge them. Just like the cars passing by, so is your passing thought.
  2. Walking meditation: Take a moment to escape your desk at work or home, take a walk around the block without any other intention other than to be alone with your thoughts. As you walk, take slow, intentional, steps and notice your surroundings.
  3. Spiritual practice: Communicating with your higher spiritual connection is another great way to meditate. For some this means prayer, reading, or listening to music.
  4. Loving kindness: This is one of my favorite, easy mantras, to repeat under a social stressor when you may be faced with anger, unhappiness, or frustration toward another person. You can also repeat this mantra while thinking about loved ones near or far to send them peaceful energy: “May you be filled with loving kindness, may you be peaceful and at ease, may you be well.”

Give them a try and see which technique sticks for you!

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