November 2010 Archives

Vitamin D Q&A from my Readers:

I did get a few questions about the Vitamin D recommendations after last week's article.

Q: Is it ok to give kids supplements of Vitamin D?
A: Of course, always check with your child's doctor before starting supplementation. They know the child's medical history and lab work to make sure there aren't any contraindications. In terms of the recommendations for Vitamin D and kids, the review article that I talked about last time (Click here to read Part I) states recommended daily intake and maximum amounts by age. For most children the recommended intake is 600 IU and after the age of 9, the upper limit is 4000 IU.

Q: My brother had a lot of back pain and they found out he was deficient in Vitamin D. He took 50,000 IU of Vitamin D for deficiency, and that after taking it he felt much better. Does this article suggest that maybe he wasn't deficient?
A: There definitely are people who are deficient in Vitamin D, many who may not be diagnosed. Therefore it's important to talk with your doctor if you think you might be deficient and have a blood test done. Also, you want to make sure that you understand how they will determine if you are deficient, since there isn't agreement on what level is recommended. For many people who are deficient, a prescription level of Vitamin D is needed, which is typically found in a once a week, 50,000 IU form. Almost as important is to make sure that you have follow up labs done to determine when your levels have come back to normal.

I also had another reader share a really easy recipe that I will post in my next article, so you can look forward to that!

The Evidence for Vitamin D and Cancer Prevention

I wanted to make sure that I addressed the most current information regarding Vitamin D and cancer prevention as there have been claims that low levels of Vitamin D can increase risk for cancer. There are also some reports that cancer survivors have a higher incidence of deficiency than the average public.

The report that I reviewed in my last post, New Vitamin D and Calcium Recommendations Part I reports that there was not evidence to support the role of Vitamin D and reducing risk of any disease except for bone health. There was also a great review done by the National Cancer Institute in June 2010 regarding Vitamin D and cancer prevention.

Basically, their summary agrees with the Institute of Medicine review that there isn't enough evidence right now to confirm a link between low vitamin D levels and increased cancer risk. However, they do report that laboratory studies (which are studies not done on humans) have shown that vitamin D promotes healthy cell growth, decreases cancer cell growth, and stimulates cell death in unhealthy cells. And, of course, they also report that there are other ways by which vitamin D could affect cancer risk that is not fully understood.

National Cancer Institute Conclusions: 

Here are the main conclusions that they reported:

1. Vitamin D is essential for the formation, growth, and repair of bones and for normal calcium absorption and immune function. It is obtained primarily through exposure of the skin to ultraviolet radiation in sunlight, but it can also be obtained from some foods and dietary supplements.
2. Some studies suggest that higher intakes of vitamin D from food and/or supplements and higher levels of vitamin D in the blood are associated with reduced risks of colorectal cancer; however, the research results overall have been inconsistent.
3. Whether vitamin D is associated with reduced risks of other cancers, including breast, prostate, and pancreatic cancers, remains unclear.
4. The National Cancer Institute (NCI) does not recommend for or against the use of vitamin D supplements to reduce the risk of colorectal or any other type of cancer.

Another point I thought was interesting is that they report blood levels of Vitamin D vary by race, with the season, and possibly with gene activity. These variations complicate the interpretation of studies that measure the concentration of vitamin D at a single point in time.

I think this drives home the point that it is important to actually monitor your vitamin D levels if you are going to be taking high doses as a supplement or for treatment for deficiency. Who knows if your levels might be changing and you would want to decrease the amount you are taking!

If you want to read more on this, check out this fact sheet: http://www.cancer.gov/cancertopics/factsheet/prevention/vitamin-D

The Bottom Line:
Unfortunately, there is not a clear right and wrong here. That often seems to be the case, doesn't it??! Basically, we need more evidence to be able to judge what levels of vitamin D are adequate, what portion of the population is deficient and how a low or deficient level of vitamin D affects risk for cancer.

Reading through an email discussion about this topic among other oncology dietitians also makes it clear that there isn't one obvious answer to this issue. There was much discussion among everyone on both sides of the issue of supplementation. And a response posted by the vitamin D council sites many studies showing the benefit of higher doses of vitamin D.  

Until we have more consistent data, we'll just have to make due with the information we have! I guess we should make sure to get in the sun in the middle of the day for vitamin D production. But don't stay too long to increase risk for skin cancer. Supplement, if you think you need it and make sure to be in touch with your doctor about it. Life is such a juggling act!

- Julie
 

There's no doubt you've heard about Vitamin D here and there recently. It is the most popular and definitely receives the most attention from health advocates of all the vitamins currently.

The recommended daily allowance as of a 1997 review was for 400 IU per day of vitamin D with most people saying there was no risk of taking high levels of supplements. Many health experts were saying that 400 IU was not enough and that there was a large portion of Americans who had low levels of vitamin D.

There are also a lot of claims out there about how vitamin D levels may influence risk for disease, including cancer. Therefore, the Canadian and American Governments asked the Institute of Medicine to do a comprehensive review of all the evidence to date regarding Vitamin D and make some recommendations. Here's what they came out with last week:

New Vitamin D and Calcium Recommendations

Remember that these recommendations are based on all the evidence to date. That doesn't mean that in 5 years after more research, they won't find something different. That's why it's so important to have these reviews regularly. They also function as a great place to identify gaps in knowledge where future research needs to be done.

Here are the new recommendations put out this past week. (You can read a summary of the report here: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx).

"Overall, the committee concludes that the majority of Americans and Canadians are receiving adequate amounts of both calcium and vitamin D. Further, there is emerging evidence that too much of these nutrients may be harmful."

"Kidney stones have been associated with taking too much calcium from dietary supplements. Very high levels of vitamin D (above 10,000 IUs per day) are known to cause kidney and tissue damage."

The new recommended intake levels for Vitamin D and Calcium are the following:

RDI (Recommended Dietary Intake) for Vitamin D
600 IU 19-70 year old adults
800 IU 71+ year old adults

Upper Limit for Vitamin D
4000 IU for 19+ year old adults

RDI for Calcium
1000mg 19-70 year old adults
1200 51+ year old women
1200 71+ year old adults

Upper Limit for Calcium
2500mg 19-50 year old adults
2000mg 51-70 year old adults

The report also found that there was not consistent agreement among experts about what the cutoff level should be to define someone's level as low. They report that:

"Before a few years ago, tests for vitamin D were conducted infrequently. In recent years, these tests have become more widely used, and confusion has grown among the public about how much vitamin D is necessary. Further, the measurements, or cut-points, of sufficiency and deficiency used by laboratories to report results have not been set based on rigorous scientific studies, and no central authority has determined which cut-points to use. A single individual might be deemed deficient or sufficient, depending on the laboratory where the blood is tested."

They conclude that:

"The number of people with vitamin D deficiency in North America may be overestimated because many laboratories appear to be using cut-points that are much higher than the committee suggests is appropriate."

What does this mean for you?

There are some good practical things you can take from these recommendations and there are also some very ambiguous parts that you might not be sure what to do with! So here's my take on it.

First off, if you choose to take supplements of Vitamin D and Calcium, we know for sure that adequate levels will be beneficial for bone health. However, if you take levels that are too high, you may be putting your body at risk for adverse health effects, which is definitely not what you want!

Be sensible with your supplementation. And make sure that you pay attention to all of your sources of Vitamin D and Calcium. Now that many foods have fortification, and some bone health medications include vitamins and minerals in them, you might be getting more than you think.

And as always, understanding and interpreting your labs is something that is important for you to do with a trusted health provider who can evaluate your entire health history. For most people, this would be your physician. If you are deemed low or deficient in Vitamin D, you may need a very high supplement dose. As long as you are on those high doses, regular lab tests are necessary to know when your levels are back to normal.

What will Julie do?

I will stick to the current supplementation that I am on, which is nothing other than an 800 IU Vitamin D pill here and there, when I remember! Most of the time, for the general public or cancer survivor who has normal labs, I recommend 1000 IU of vitamin D daily, if they want to take a supplement.

And of course, make sure that you are eating a balanced diet that will give you all the complementary health promoting nutrients. It doesn't make much sense to take supplements if you aren't going to focus on the foods that you are eating!

In the next post, I will focus on what we know specifically about Vitamin D and cancer prevention and survivorship. Email me or post your questions on www.CancerDietitian.com and I will do my best to address them!

- Julie 

Happy Thanksgiving!

I hope you all have a wonderful Thanksgiving Celebration! It's always nice to have a time to be thankful for all of our many blessings. There are so many things that I have to be thankful for that I often don't even think about.

As the holiday season kicks off, I thought I would share a compilation of a few of the holiday recipes that I have shared with readers over the last 3 years. I hope you enjoy some of them as much as I do! If you made them all, I think your side dishes would be covered!

Citrus Ginger Cranberries

This recipe can be prepared 3 days ahead. Be sure to cover it and refrigerate.

Ingredients:

1. 2 12-ounce bags cranberries
2. 1 1/2 cups sugar
3. 1 cup orange juice
4. 1 cup water
5. 1 tablespoon grated orange peel
6. 1 teaspoon ground ginger
7. 1/2 cup (about 2 ounces) minced crystallized ginger
   

Preparation:

1. Combine first 6 ingredients in heavy medium saucepan.
2. Bring to boil, stirring until sugar dissolves.
3. Boil until cranberries pop, stirring occasionally, about 5 minutes.
4. Cool (I let it cool overnight)
5. Mix in crystallized ginger.
   

For more on the health benefits of cranberries, click here.

Down Home Green Beans

Ingredients
•    10 oz. frozen green beans
•    Red wine vinegar
•    Cooking Oil
•    One onion, diced
•    Cajun or Creole seasoning

Instructions:
1.    Heat pan with oil in it
2.    Sauté onion for 5 minutes
3.    Add green beans to pot and mix with onions
4.    Add vinegar and a little olive oil to cover bottom of pan
5.    Let the green beans boil in the vinegar for at least 5- 8 minutes or until hot.
6.    Add Cajun or Creole seasoning to taste
7.    Serve and enjoy!

Candied Yams

Ingredients: 
•    4 cups sliced sweet potatoes or yams - precooked in the microwave until soft
•    2 apples, sliced
•    1/3 c. pecans
•    1/4 C brown sugar, packed
•    1 tsp flour, sifted
•    1/4 tsp salt
•    1/4 tsp ground cinnamon
•    1/4 tsp ground nutmeg
•    1/4 tsp orange peel
•    1/2 C orange juice 

Directions:
1.    Preheat oven to 350
2.    Toss apples and nuts with combined sugar, flour, salt, cinnamon, nutmeg, and grated orange peel.
3.    Place half of sliced yams in medium-size casserole dish. Sprinkle with spiced apple mixture.
4.    Add second layer of yams, using the rest of the ingredients in the same order as above. Add orange juice.
5.    Bake uncovered for 30-45 minutes

Dad's Stuffing

Ingredients:
•    Stuffing mix (whole wheat bread mix if possible)
•    egg (beaten in a cup)
•    chicken broth or bullion
•    celery
•    onion
•    sliced black olives (can use the juice with the broth if desired)
•    Cooking oil
 
Instructions:
1.    Preheat oven to 350
2.    Sauté the onion and celery in a pan with olive oil
3.    Add stuffing mix, egg, black olives and any other additions to the onion and celery
4.    Continuously add broth until desired consistency is achieved
5.    Place in a covered dish
6.    Cook stuffing for 30-45 minutes

Possible additions: cooked brown rice, fresh apples, dried cranberries or mushrooms - just mix in before baking!

Aunt Donna's Garlic Mashed Potatoes

Ingredients:
•    8-10 potatoes (Russet - or equivalent volume of red)
•    8 oz fat free cream cheese
•    1 cup fat free sour cream
•    5 garlic cloves
•    chives
•    salt
•    pepper
Instructions:
•    Scrub, wash and boil the potatoes
•    Mash them along with all other ingredients.
•    Add skim milk if needed to make creamier
•    Place all ingredients in a 2 qt. casserole dish and bake at 350 degrees for 30 minutes.[If you want to make them a day ahead, put potatoes in dish and refrigerate. Simply increase the baking time to 45 minutes].


Tasty Kale
(For other tips on cooking kale and other vegetables, check out Vegetables Made Easy)
 
Ingredients:

• 1-2 bunches of Kale
• 1 medium Onion
• Canola Oil
• Water
  
• Salt

Instructions:

1. Rinse and dice onion.
2. Rinse kale and cut into strips (lengthwise across the leave and stem)
   
3. Place oil in a pan with onions and turn on medium high. (Use as much oil as you need to cook the onions).
4. Let the onions cook in the oil until they begin to turn transparent.
5. Add the kale to the pan stirring until onions, oil and kale are mixed.
6. Let cook for 1 minute.
7. Add enough water to coat the bottom of the pan.
8. Cover and let steam. Add water if it dries up.
9. Cook for 12-15 minutes or until kale is tender to eat.
10. Add salt to taste.
11. Eat immediately, keep warm covered in oven or refrigerate until reheated before eating.

Stuffed Baked Sweet Potatoes with Pecans
(from http://allrecipes.com )

For information on the health benefits of sweet potatoes, click HERE.

Serve it with a salad and some chicken or black beans, and you have a healthy dinner!

Ingredients

• 6 medium sweet potatoes, washed and scrubbed
• 2 tablespoons margarine, softened
• 1 (8 ounce) can crushed pineapple, drained
• 1/2 cup pecans, chopped

 
Directions

1. Preheat oven to 375 degrees F (190 degrees C).
2. Arrange the sweet potatoes on a baking sheet, and bake in preheated oven for 1 hour.
3. Cut a slit into the top of each potato.  Make sure you protect your fingers; the potatoes will be hot! Carefully scoop out the pulp from the potato, leaving the skins intact; place the potato in a large bowl. Add the margarine and pineapple to the potato and stir together. Stuff the potato mixture back into the reserved potato skins. Sprinkle the pecans over each potato.
4. Return the stuffed potato skins to the oven; bake another 12 minutes.

Cranberry Muffins

Preheat your oven to 400 degrees.

Ingredients:

• Non-stick canola oil spray
• 3/4 cup whole-wheat flour
• 3/4 cup all-purpose flour
• 1/2 cup fine yellow cornmeal
• 1/2 cup sugar
• 4 tsp. baking powder                                      
• 1/2 tsp. salt
• 1/4 tsp. baking soda
• 1 cup nonfat plain yogurt
• 1/2 cup skim milk
• 4 Tbsp. canola oil
• 1 egg, lightly beaten
• 1 tsp. vanilla
• 1 cup fresh or frozen cranberries

Instructions:

   1. Spray a 12-cup muffin tin with non-stick cooking spray.
   2. In a large bowl, combine flour, cornmeal, sugar, baking powder, salt and baking soda.
   3. In a medium bowl, combine the yogurt, milk, oil, egg and vanilla extract.
   4. Add the yogurt mixture to the flour mixture. Stir until just combined. (Don't overmix.)
   5. Stir in cranberries. (Note: I added crushed walnuts - about 1 cup - at this point).

Spoon the batter into the prepared muffin tin cups and bake for 20-25 minutes, until a toothpick inserted in the center of a muffin comes out clean.

Have a wonderful Thanksgiving weekend!
- Julie

Winter Veggie Recipes

I received some good feedback on the last few recipes. My friend Kelly said the butternut squash enchiladas were awesome! And my co-worker, Melissa said that her family really enjoyed the pumpkin pancakes, These are two great ways to get in the winter veggies, so if you haven't tried them, it is definitely worth it! And I LOVE hearing feedback from people on the recipes, so please share!!

Start Your Holiday Eating Off Right!

Most of the time when people talk about holiday meals, they usually comment about how unhealthy the meals are or how they eat too much. Personally, I think that one or two days of overeating on high calorie foods is not going to throw off a healthy lifestyle. I think the major problem with holiday times is that the eating NEVER STOPS!

Many people have so many leftovers that they keep eating them for multiple days. Then there are cookies, pies and desserts everywhere you go! And most people fill up on all the desserts and therefore aren't eating a lot of the foods that are so good for you - fresh fruits and veggies, whole grains and beans.

Here's my tip for this year's Thanksgiving celebration. Try making something that will be healthy for breakfast. The following is a recipe you can try. It came from the Whole Foods Market blog and was actually advertised as a dessert recipe. Since all the ingredients are unprocessed real food, you can make it on a regular basis and I decided it would be great for breakfast!

For information on different types of apples, check out this blog: http://ouichefcook.com/?p=4770.

Breakfast No Bake Apple Crisp

Serves 8

Ingredients

• 4 Honeycrisp apples (or other baking apple), cored and chopped
  
• 1/4 cup orange juice
  
• 3/4 cup pecan halves
  
• 3/4 cup hazelnuts
  
• 3/4 cup raisins
  
• 3/4 teaspoon ground ginger
  
• 3/4 teaspoon ground cinnamon

Instructions

Put apples in an 8-inch square baking dish or 2-quart casserole dish. Drizzle with orange juice, toss until the fruit is coated and smooth the top. In a food processor, combine pecans, hazelnuts, raisins, ginger and cinnamon and pulse just until chopped. Spoon the nut mixture over the apple mixture and serve.

Let me know what you think!
- Julie