What Do You Lack? Probably Vitamin D

Vitamin D promises to be the most talked-about and written-about supplement of the decade. While studies continue to refine optimal blood levels and recommended dietary amounts, the fact remains that a huge part of the population — from robust newborns to the frail elderly, and many others in between — are deficient in this essential nutrient.   

If the findings of existing clinical trials hold up in future research, the potential consequences of this deficiency are likely to go far beyond inadequate bone development and excessive bone loss that can result in falls and fractures. Every tissue in the body, including the brain, heart, muscles and immune system, has receptors for vitamin D, meaning that this nutrient is needed at proper levels for these tissues to function well. 

Studies indicate that the effects of a vitamin D deficiency include an elevated risk of developing (and dying from) cancers of the colon, breast and prostate; high blood pressure and cardiovascular disease; osteoarthritis; and immune-system abnormalities that can result in infections and autoimmune disorders like multiple sclerosis, Type 1 diabetes and rheumatoid arthritis. 

Most people in the modern world have lifestyles that prevent them from acquiring the levels of vitamin D that evolution intended us to have. The sun’s ultraviolet-B rays absorbed through the skin are the body’s main source of this nutrient. Early humans evolved near the equator, where sun exposure is intense year round, and minimally clothed people spent most of the day outdoors. 

“As a species, we do not get as much sun exposure as we used to, and dietary sources of vitamin D are minimal,” Dr. Edward Giovannucci, nutrition researcher at the Harvard School of Public Health, wrote in The Archives of Internal Medicine. Previtamin D forms in sun-exposed skin, and 10 to 15 percent of the previtamin is immediately converted to vitamin D, the form found in supplements. Vitamin D, in turn, is changed in the liver to 25-hydroxyvitamin D, the main circulating form. Finally, the kidneys convert 25-hydroxyvitamin D into the nutrient’s biologically active form, 1,25-dihydroxyvitamin D, also known as vitamin D hormone. 

A person’s vitamin D level is measured in the blood as 25-hydroxyvitamin D, considered the best indicator of sufficiency. A recent study showed that maximum bone density is achieved when the blood serum level of 25-hydroxyvitamin D reaches 40 nanograms per milliliter or more.
“Throughout most of human evolution,” Dr. Giovannucci wrote, “when the vitamin D system was developing, the ‘natural’ level of 25-hydroxyvitamin D was probably around 50 nanograms per milliliter or higher. In modern societies, few people attain such high levels.”

A Common Deficiency
Although more foods today are supplemented with vitamin D, experts say it is rarely possible to consume adequate amounts through foods. The main dietary sources are wild-caught oily fish (salmon, mackerel, bluefish, and canned tuna) and fortified milk and baby formula, cereal and orange juice. 

People in colder regions form their year’s supply of natural vitamin D in summer, when ultraviolet-B rays are most direct. But the less sun exposure, the darker a person’s skin and the more sunscreen used, the less previtamin D is formed and the lower the serum levels of the vitamin. People who are sun-phobic, babies who are exclusively breast-fed, the elderly and those living in nursing homes are particularly at risk of a serious vitamin D deficiency.
Dr. Michael Holick of Boston University, a leading expert on vitamin D and author of “The Vitamin D Solution” (Hudson Street Press, 2010), said in an interview, “We want everyone to be above 30 nanograms per milliliter, but currently in the United States, Caucasians average 18 to 22 nanograms and African-Americans average 13 to 15 nanograms.” African-American women are 10 times as likely to have levels at or below 15 nanograms as white women, the third National Health and Nutrition Examination Survey found. 

Such low levels could account for the high incidence of several chronic diseases in this country, Dr. Holick maintains. For example, he said, in the Northeast, where sun exposure is reduced and vitamin D levels consequently are lower, cancer rates are higher than in the South. Likewise, rates of high blood pressure, heart disease, and prostate cancer are higher among dark-skinned Americans than among whites. 

The rising incidence of Type 1 diabetes may be due, in part, to the current practice of protecting the young from sun exposure. When newborn infants in Finland were given 2,000 international units a day, Type 1 diabetes fell by 88 percent, Dr. Holick said. 

The current recommended intake of vitamin D, established by the Institute of Medicine, is 200 I.U. a day from birth to age 50 (including pregnant women); 400 for adults aged 50 to 70; and 600 for those older than 70. While a revision upward of these amounts is in the works, most experts expect it will err on the low side. Dr. Holick, among others, recommends a daily supplement of 1,000 to 2,000 units for all sun-deprived individuals, pregnant and lactating women, and adults older than 50. 

The American Academy of Pediatrics recommends that breast-fed infants receive a daily supplement of 400 units until they are weaned and consuming a quart or more each day of fortified milk or formula. 

Given appropriate sun exposure in summer, it is possible to meet the body’s yearlong need for vitamin D. But so many factors influence the rate of vitamin D formation in skin that it is difficult to establish a universal public health recommendation. Asked for a general recommendation, Dr. Holick suggests going outside in summer unprotected by sunscreen (except for the face, which should always be protected) wearing minimal clothing from 10 a.m. to 3 p.m. two or three times a week for 5 to 10 minutes. 

Slathering skin with sunscreen with an SPF of 30 will reduce exposure to ultraviolet-B rays by 95 to 98 percent. But if you make enough vitamin D in your skin in summer, it can meet the body’s needs for the rest of the year, Dr. Holick said.

Can You Get Too Much?
 
If acquired naturally through skin, the body’s supply of vitamin D has a built-in cutoff. When enough is made, further exposure to sunlight will destroy any excess. Not so when the source is an ingested supplement, which goes directly to the liver. 

Symptoms of vitamin D toxicity include nausea, vomiting, poor appetite, constipation, weakness and weight loss, as well as dangerous amounts of calcium that can result in kidney stones, confusion and abnormal heart rhythms. 

But both Dr. Giovannucci and Dr. Holick say it is very hard to reach such toxic levels. Healthy adults have taken 10,000 I.U. a day for six months or longer with no adverse effects. People with a serious vitamin D deficiency are often prescribed weekly doses of 50,000 units until the problem is corrected. To minimize the risk of any long-term toxicity, these experts recommend that adults take a daily supplement of 1,000 to 2,000 units.

10 Bipolar Disorder Myths

By Tom Scheve, HowStuffWorks.com

The word "bipolar" is often used during casual and joking diagnosis of someone who's happy one minute and sad the next, but the real thing, bipolar disorder, is a serious mental illness that's wrecked lives. There's still much that remains unknown about the disease, but knowledge of it is growing, and great strides have been made in its treatment. However, there are many misperceptions about the condition, and a lot of things that even researchers and doctors used to believe about bipolar disorder have been scrapped.

So what are 10 myths about bipolar disorder that continue to misinform? Keep reading to find out.

10: There's Only One Type of Bipolar Disorder

A common -- but mistaken -- belief is that there is only one type of bipolar disorder, but there are actually several:

• Bipolar I disorder is distinguished by its inclusion of a full-blown manic episode at some point in the person's life.
• A person with bipolar II, a milder form of the disorder than bipolar I, goes back and forth between periods of depression and periods of elevated moods, but not actual mania.
• Cyclothymic bipolar disorder is similar to bipolar II, but less severe.
• Several periods of mania and/or depression in a single year indicates rapid cycling bipolar disorder.
• If highs and lows coexist or occur quickly back-to-back, this is mixed bipolar disorder.

9: Mania Sounds Like Fun

A surface understanding of manic episodes -- or their occasional representation in movies or TV shows -- makes them seem like a good time. You get lots done, you have endless energy, you're highly extroverted -- why wouldn't you be on top of the world?

Some people with bipolar disorder do experience happiness when in a manic state, but often, the reins of life can slip out of their hands. They become highly excitable, anxious and irritable. Their minds careen from one seemingly grand idea to the next, and their sleep rhythms fall apart. They may begin making bolder and risky decisions when it comes to sex, and may overindulge on alcohol or drugs. Some people start gambling or racking up huge shopping tabs. Mania can also cause psychotic thoughts and actions.

So there you have it -- another reason not to believe everything you see about mental illness in the media

8: Very Few People Actually Have Bipolar Disorder

While most of us know about or have heard of bipolar disorder or manic depression, it's easy to think that it doesn't affect that many people. After all, many patients don't disclose their condition to co-workers or acquaintances, and the casual observer may not detect anything more significant than an especially good mood or a person having a bad day. But almost 6 million Americans are affected each year by bipolar disorder, according to WebMD.

Bipolar disorder doesn't discriminate based on gender or race, and seems to affect all groups evenly across the board. While most often symptoms present themselves in young adulthood (late teens to early 20s), older adults are susceptible as well as young children.

7: Children Can't Get Bipolar Disorder

Life for many families would be easier if this next myth were indeed true. However, children as young as 6 can develop bipolar disorder, and the disease can prompt children to attempt suicide. When bipolar disorder presents itself at a young age, there's often a corresponding family history of mood disorders. Children who develop it can experience many periods of depression before the first manic episode, making it harder to diagnose. Sometimes, these depressions are accompanied by psychotic thoughts and behaviors, and children are more likely to experience mixed states -- that is, having mania and depression at the same time.

While lithium is often less effective in children (and the side effects are worse), advancing research and knowledge of adolescent bipolar disorder -- when matched with early detection and treatment -- offers more hope each day to families with bipolar children.

Did You Know?
Early-onset bipolar disorder (bipolar disorder in children) can be more severe than the adult version, according to the National Institute of Mental Health. Symptoms and changes in mood occur more frequently in bipolar children than they do in adults.

6: It's Just a Dramatic Term for Mood Swings

We've all experienced mood swings, so it's easy to think bipolar disorder is just a fancy name for one.

When most people feel in the dumps or on top of the world, it's usually a short-term feeling that fades away along with the reasons that prompted the feeling, or as a result of a gradual adjustment to the new circumstances.

Bipolar mood swings are different, and they can last for weeks or months. Up mood swings often lead to dangerous lifestyle choices, racing thoughts that refuse to be corralled and out-of-ordinary behaviors that can damage careers and family lives. Down mood swings for a bipolar person lead to excessive sleep and lethargy, uncontrollable crying and even thoughts of (and attempts at) suicide.

So when we're talking about bipolar disorder, we're not talking about good moods and bad moods. There's no "snapping out of it" when it comes this condition.

5: Bipolar Disorder Means High Highs or Low Lows

When most of us hear the words bipolar or manic depression, we think of very high highs and very low lows. Additionally, we think that people with bipolar disorder simply go from one to the other, with no stop in between.

While severe cases can involve such features, most people don't careen from high to low and back again. Patients may be in state of mania or depression for a while, or they may be in between the two. They may even show signs of both simultaneously. Some people go months or even years with bipolar disorder in regression, only to have it rear its ugly head again. Some people cycle quickly between high and low, while others only experience a full-blown manic state once every few years.

Regardless of frequency, the intensity is highly variable as well. Many people with bipolar disorder have more mild highs and lows and cycle between these states.

4: Bipolar Disorder Only Affects Mood

While the best known symptoms of bipolar disorder are mood related (and the disease itself is a mood disorder), bipolar disorder affects a person in many other ways as well.

When people with bipolar disorder experience highs or lows, they experience problems with overall cognitive functions as well as mood. A person may one day have a razor-sharp mind and sharpened intellect, and the next day have muddled thoughts and a sluggish thought process.

It also messes with sleep patterns. While experiencing a "high," someone with bipolar disorder won't sleep as much (sometimes hardly at all), and seemingly won't be the worse for it during the day. In fact, lack of sleep is often a precursor to a manic episode that hasn't presented itself yet. When experiencing a "low," a person will oversleep and never feel fully rested and alert.

Highs and lows also contribute to bad lifestyle choices like smoking, drinking, poor diet and drug use.

3: Alcohol and Drug Abuse Can Cause Bipolar Disorder

Many people with bipolar disorder are also frequent or heavy users of alcohol and nonprescription drugs. This in part has led to a belief that substance abuse -- offering its own often unpredictable highs and lows -- can cause you to snap and become bipolar.

While there is increased use of alcohol and drugs for people with bipolar disorder, it's not a contributing factor. A healthy person without bipolar disorder can't "crack" through alcohol or drug use and develop it.

People with bipolar disorder are more prone to engaging in risky, dangerous behaviors, and many also attempt to self-medicate in hopes of decreasing mood swings, getting sleep and dealing with anxiety. Though many people find short-term success or results, over the long haul these behaviors take their toll.

2: All You Need are Meds

Modern medications have made a wonderful difference and vast improvement in the lives of many people with bipolar disorder. But while lithium, anticonvulsants, antidepressants and other drugs are very important in the treatment of the condition (especially when first treated during a full-blown high or low), it's now commonly accepted that long-term success is best attained when treatment doesn't rely on medications alone.

Instead, treatment should include regular counseling from a trained mental health professional and a treatment support network consisting of family, friends, counselors or group-therapy sessions. It's also important to maintain a steady and healthy lifestyle -- that means proper sleep, diet, exercise and sobriety.

People will be most successful in dealing with bipolar disorder by developing a treatment plan that manages the issue through a variety of different means, and not just with medication alone.

1: Meds Will Turn You into a Zombie

Bipolar disorder is usually treated through some combination of drugs like lithium, anticonvulsants, antipsychotics and antidepressants, but pills often have side effects. Lithium in particular has a reputation for turning patients into zombies. It's not totally undeserved, but side effects usually fade away after a few months of use, and the remaining side effects can often be alleviated through dosage adjustment.

The same holds true for anticonvulsants and antipsychotics. Dosages may be higher than usual at first, especially when dealing with extreme mania or depression. However, once the crisis has passed, the dosage is generally lowered to facilitate a stable, happy and productive life. Lithium or any other specific drug may just not be right for you, but by working with your doctor, a better option can be found.

Negaholics

Negativity

We all know someone who constantly seems like a downer. You know, those glass-half-empty people? The people who can always seem to find a downside for everything that's positive? Well it turns out that some people can actually become addicted to negativity and self-doubt -- a situation that's sometimes referred to as "negaholism."

People who are addicted to negativity see everything in a negative light -- the outlook is always bleak. They find fault in most things and never seem to be satisfied. What's more, negativity addicts might actually seek out negative situations and criticism or be preoccupied with past negative experiences. Negaholics also tend to complain about a problem, rather than try to fix it.

So what's addictive about being negative? Well, like most addictive behaviors or substances, negativity gives you a mental stimulus. And our brains actually react more strongly to negative stimuli than to positive stimuli, so negative thoughts and feelings are more stimulating than positive ones. What some people become addicted to is the surge of brain activity happening when they think negatively .

Negativity addiction can be deep-rooted and can result from emotional trauma or dysfunction at an early age. It's kind of like a build up of negative emotions that paints everything else in a negative light, sometimes making it difficult to overcome .

More Exercise

t's basic physiology -- when you feel sluggish, unmotivated and fatigued, getting up and doing some exercise causes changes in your body that boost your energy. Exercise also releases endorphins in the brain, and endorphins are great pain killers. So when people say those of us with fibromyalgia and chronic fatigue syndrome would feel better if we got "more exercise," there's something to it, right?

Actually, no. In normal, healthy people, yes -- exercise creates energy. Problem is, we're not normal and healthy.

Exercise is a tough subject, whether you have fibromyalgia or chronic fatigue syndrome. However, it's not the same for both groups, so let's look at them separately.

Fibromyalgia & 'More Exercise'

This myth is compounded by numerous studies showing that exercise lowers our pain levels and does in fact give us more energy. Doctors glance at the titles of these studies and tell the next fibromite who walks through the door to go to the gym. What they're missing is that the amount and type of exercise we need is far from what most people would even consider exercise.

If we exert ourselves to the point of exhaustion, we're probably going to trigger a major flare that lands us on the couch for days or even weeks. We all have different fitness levels so the exact amount of exertion we can handle varies greatly, but generally speaking, we should exert moderate effort for just a few minutes on a regular basis. There's ample clinical and anecdotal evidence to support that regular exercise, done with extreme moderation, helps us. That means, for us, an exercise regimen might consist of 2 minutes of gentle yoga per day. If you're in better shape, maybe you can handle a 10-minute walk or 20 minutes of aquatic exercise to start with.

I consider myself in moderately good shape for someone with fibromyalgia -- I can go grocery shopping, clean the kitchen and do a couple loads of laundry in the same day (most of the time, anyway.) I can also get through a 30-minute yoga routine without wiping myself out or having nasty repercussions. I couldn't do that a year ago, though, and if I'd tried, I would have crashed afterward. Two years ago, I would have crashed 10 minutes in; and three years ago, just getting into the first pose would have done me in on bad days. While I'm not the most consistent about exercise, I have worked hard to slowly and steadily increase my activity level.

That slow, steady pace is what we need. If all you can do is 2 minutes, try to be consistent about your 2 minutes. Eventually, you'll be able to handle 4. The key is not pushing yourself too far too fast, and expecting setbacks along the way.

Chronic Fatigue Syndrome & 'More Exercise'

A key symptom of chronic fatigue syndrome is post-exertional malaise. It's a period of intense, often debilitating symptoms that follows any kind of exercise or exertion and lasts for a day or more (usually more.) Research actually shows abnormalities in the blood chemistry of people with chronic fatigue syndrome after they exercise, and those abnormalities could very well provide the long-awaited diagnostic test for this condition. Some preliminary research also shows abnormal heart rhythms during exercise, which could mean that exercise is actually damaging your health.

For years, some chronic fatigue syndrome doctors and researchers have touted a treatment called graded exercise therapy (GET). It's controversial to say the least, and while some studies have shown that it can help some people, the methods used to arrive at that conclusion are frequently called into question. Looking over the available research, it seems to me that GET is only recommended because it's more effective than most treatments that have been studied -- and that's not saying a lot. However, it does help some people, as evidenced by the comment below from Dr. Donnica Moore, a well-respected expert who just signed on to work with the Whittemore Peterson Institute.

So what does all this mean about exercise and chronic fatigue syndrome? It really depends. There's clearly a reduced exercise tolerance, but you're the only one who can determine exactly what your body can tolerate. It all depends on your current fitness level and severity of your illness. We all know that being sedentary increases muscle aches and pains, so at the very least you might want to learn some simple stretches you can do while laying in bed. Because of the evidence suggesting heart abnormalities, you should talk to your doctor about testing your heart to make sure exercise is OK -- here's a link to studies you can show your doctor, and they contain testing information: Cardiac Involvement in Chronic Fatigue Syndrome.

What If You Have Both?

If you're diagnosed with both fibromyalgia and chronic fatigue syndrome, you're in a particularly difficult situation -- the right kind of exercise may relieve some symptoms while exacerbating others. Again, you're the only one who can figure out the right level of exertion for yourself.

The Persistent Myth

The exercise myth is one that's not likely to go away -- it's pretty firmly entrenched in the medical establishment, and a consequence of an uninformed public. What we need to do is know our own bodies, try to educate those who are receptive, and ignore those who aren't. We're not doing any good for anyone by over exerting ourselves and winding up in bed for a week.

What is the MyFi Study?

What is the MyFi Study?

The main purpose of the MyFi clinical research study is to find out if the study drug called milnacipran is safe and effective in helping young people manage their fibromyalgia.

• Researchers want to learn more about fibromyalgia and how it affects adolescents
• Researchers want to learn more about treatment options that may benefit adolescents with fibromyalgia
• About 300 teenagers will participate in this study nationwide
• Milnacipran has been approved by the U.S. Food and Drug Administration (FDA) in adults for the management of fibromyalgia. However, the use of milnacipran in this study is experimental because it has not been approved by the U.S. FDA for use in pediatric (children and adolescents) patients.

How does the study drug work?

The study drug falls into a class of drugs known as serotonin and norepinephrine reuptake inhibitors (SNRIs).

• Serotonin and norepinephrine are substances made by the brain that influence how the brain sends messages to the body and in turn how the body responds to pain
• Researchers think that the study drug may help serotonin and norepinephrine to work better on the central nervous system, which serves as the body’s main message "processing center"

How long will the study last?

The study may last up to 21 weeks and involve 8 or more study visits after the Screening Visit.

• During the Screening Period, which lasts 1–4 weeks, the study doctor will determine if your child is eligible to participate in the MyFi study
• After the Screening Period, all participants will take the study drug for 8 weeks
• If your child tolerates the study drug and qualifies to continue on in the study, he or she will be assigned by chance to a study group either taking the study drug or taking placebo (a tablet that looks like the study drug but has no active medication in it) twice a day, for another 8 weeks

Your child will be closely supervised by the study doctor during his or her participation. The study doctor can tell you more about what will happen at each visit.

What are the risks and benefits?

There is no guarantee that being in the study will help your child. Your child’s fibromyalgia may or may not get better while in this study.

All drugs have some risk of side effects.

• Some adults who have taken milnacipran have experienced nausea, headaches, dizziness, and other symptoms
• All SNRIs carry a risk of increased suicidal tendencies in children

The study doctor can talk to you about all of the side effects people have reported after taking milnacipran.

What is my role as caregiver?

As parent or caregiver, you will participate and oversee all aspects of your child’s involvement in the MyFi study.

• There is no cost to you for the study drug, study visits, or any tests or procedures that are part of the study

Who can participate in the study?

To be eligible to participate in the MyFi study, your child must be 13 to 17 years old and:

• Receive a diagnosis at the first study visit or already have a diagnosis of fibromyalgia
• Have had unsatisfactory results after trying other non-drug treatments for fibromyalgia (e.g., diet, exercise, acupuncture)
• Be willing to take a drug screening test
• Be willing to discontinue certain medications, if required
• If female, be willing to take a pregnancy test

Additional study requirements can be reviewed with site study staff.

Participation in the MyFi study is completely voluntary.

Your child can leave the study at any time and does not have to participate in the study to receive treatment for fibromyalgia.

Before deciding to participate in the MyFi study, you and your child should ask questions and discuss the study with your own doctors, family members, friends, and the clinical research staff.

For more information.

http://www.myfiresearch.com/fibromyalgia.aspx?vendor=nfaemail