Tips To Protect Yourself From the Heat This Summer & Recognizing Heat Related Illnesses

Dear Dr. Deena,
Any tips on how to prevent heat related sickness this summer?
Jay


What a great question, Jay! With the heat wave upon us, here are some tips to stay cool this summer:

1. Drink plenty of water, even if you don't feel thirsty! I would recommend avoiding alcohol or caffeinated drinks, as these can lead to dehydration.

2. Avoid being outdoors during the hottest/sunniest times of the day, which is between 10 am and 4 pm. If you need to be outside, avoid strenuous activities outdoors which lead to increased sweating and ultimately dehydration. If you wish to perform strenuous activities during the day (exercise, gardening, etc.), do them indoors instead. 

3. Spend more time in air-conditioned areas to keep your body temperature cooler. If you don't have access to air conditioning, visit your nearest government cooling center. They can be found online, like this one for my New York followers: http://www.nyc.gov/html/oem/html/hazards/heat_cooling.shtml

4. Summer is the perfect season for fresh, and delicious fruits. Make use of this by eating light, well-balanced meals consisting of more fresh fruits and vegetables. Avoid eating too many high protein foods, like meats, as these foods increase our metabolism which ultimately leads to increased body temperature and heat production.

5. Wear sunscreen to protect yourself from sun burn and skin cancer.

6. Wear light-weight, light colored clothing to keep cool and reflect the sun.

7. Wear a wide-brimmed hat that will provide shade over most of your face like this one:


8. Be aware of some of the symptoms of heat related illness. These include:

-Heat cramps: increased sweating with muscle cramps which are mainly in the legs

-Heat exhaustion: increased sweating, dizziness, nausea, vomiting,  and/or increased weakness

-Heat stroke: body temperature > 103 degrees Fahrenheit, rapid pulse, confusion, loss of consciousness, extreme headache, and/or difficulty breathing. This is a medical emergency and if you are concerned about these symptoms please call 911!

Hope this information will keep you safe and healthy this summer. As always please feel free to leave comments below and email all questions to DoctorDeenaMD@gmail.com

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

The Causes of Lupus & Other Forms of Lupus Beyond Systemic Lupus Erythematosus!

Dear Dr. Deena,

What is the cause of lupus?

Regards,
Anonymous

Thanks for another great question, Anonymous. To continue with the questions you have asked, below I have addressed what the causes of SLE might be, including other forms of lupus that exist. It is important to differentiate between these forms because treatment is quite different for each.

For more information on Systemic Lupus Erythematosus, visit my previous post: What is SLE?

The cause of SLE is unknown. It is most commonly seen in woman of child-bearing age and is generally diagnosed between age 20-40. Some researchers believe that development of SLE can be hereditary, but recent studies have found that less than 3% of children develop SLE if their mother has SLE. 

Lupus is more common among African Americans, Asians and Latinos – this may be due to certain genes that are present in these communities; however, research is currently being performed to truly prove the genetic risk factors for development of SLE.

SLE is usually diagnosed when a patient develops symptoms after being exposed to a certain trigger. These triggers might include: increased sun exposure, certain antibiotics, a recent infection, a major emotional or stressful event, pregnancy, sleep deprivation and/or exhaustion.

There are 2 additional forms of lupus in adults that must be differentiated from SLE. These include Drug-Induced Lupus and Cutaneous Lupus Erythematosus.

“Drug-Induced Lupus” is a disease where a patient develops symptoms  similar to SLE, that are caused by the body’s reaction to certain medications. Once the medication is stopped, the patient’s lupus-like symptoms improve and disappear over weeks to months. There are at least 40 medications that are associated with Drug-Induced Lupus, the most common ones known to cause lupus-like symptoms include: procainamide (used to treat abnormal heart rhythms) and hydralazine (used to treat high blood pressure).

Cutaneous Lupus Erythematosus (CLE) is a form of lupus that ONLY affects the skin. Roughly 10% of those with CLE will go on to develop SLE. Rashes related to CLE are called “discoid rashes” because they are circular and look like discs. See image below:

 image taken from http://hardinmd.lib.uiowa.edu/ui/tray/DLE-003.html

Patients with CLE may also develop a “butterfly rash” with redness over the nose and cheeks. Many patients with CLE will notice that their symptoms are worse with exposure to the sun. Below is the pattern of a butterfly rash:



Hope these posts were helpful! In the upcoming week I will talk about one of the lifesaving drugs that is used to treat symptoms of SLE - Steroids.

As always please feel free to leave comments below, and continue to email your questions to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

The Effects of Systemic Lupus Erythematosus aka "Lupus" and Inflammation on the Body

Dear Dr. Deena,
 I have a family member who was diagnosed with Lupus and I wanted to make more sense of it. What is it really doing to the body? 
Regards,
Anonymous

Thank you for your question, Anonymous. I am so sorry to hear about your family member who was recently diagnosed with Lupus. I hope that this blog can help you and your family better understand this disease.

Systemic Lupus Erythematosus (commonly known as “SLE” or “Lupus”) is an autoimmune inflammatory disease. In SLE, the patient’s immune system recognizes healthy tissues as "foreign". These tissues may include organs (like the kidney, lungs or heart), joints, ligaments, bone, etc. SLE can ultimately attack any tissue in the body which leads to inflammation that may cause pain, swelling, and/or inability for an organ to function properly.

In order to fully understand SLE, one must first understand  what an autoimmune disease is and the process of inflammation.

Our immune system is developed to help protect us against anything that is foreign to the body. These “foreign” things can include bacteria, viruses, parasites, splinters, dirt, pollen, etc. Normally our immune system produces chemicals to help destroy these “foreign” substances.

 In an "autoimmune" disease the body mistakenly recognizes its own healthy cells as foreign and begins to destroy them. This process of destruction of healthy cells leads to a great deal of inflammation.

The process of inflammation is very complex. I will briefly describe this to you in the following steps, so you can better understand what is happening in the body in patients with SLE.  

As an example, let's imagine a patient with SLE who is experiencing symptoms in their knee joint. (Remember the process that I am describing to you, is what happens in ANY tissue that is affected by SLE. I chose to focus on the knee joint because its easier to visualize the ultimate effects of inflammation on the knee)

1. Since SLE is an autoimmune disease, the immune system mistakenly recognizes the healthy knee joint tissue as "foreign".

2. An immune cell, called the macrophage, releases chemical signals to increase blood flow  towards the knee. As the blood flow increases to the knee joint it appears more red and warm.

3. The chemical signals released by the macrophage, also cause the blood vessels to become porous. These pores allow red blood cells, white blood cells, and fluid to exit freely into the space surrounding the knee tissue. This leads to swelling of the knee joint.

4. White blood cells also recognize the chemical signals sent out by the macrophage and enter into the space surrounding the knee joint.

5. The white blood cells begin to attack the healthy knee tissue cells that it mistakenly recognizes as "foreign"  and consumes all destroyed cells in a process called "phagocytosis".

6. As the immune system continues to attack more and more healthy knee tissue, this inflammation continues to destroy the knee joint. This process can ultimately lead to thickening and scarring of tissue (“fibrosis”) and loss of function of that knee joint (leading to inability to move knee, bare weight, etc.).


Here is a picture of what you might have pictured the knee to look like during a SLE flare of the knee. Now you can understand why the knee appears red, warm, swollen, and tender --> the classic signs of inflammation! (left knee is abnormal and right knee is normal).


                   image from http://kneeswellingnopainsrgl.wordpress.com/


Now that you understand what is happening to the body with SLE, let's discuss the symptoms.

Every SLE patient is different - some might have disease that is mild and some might have disease that is life-threatening. Some patients might have symptoms every day, and some might have symptoms only a few times in their lifetime after which they go into remission ("a symptom free period").

As mentioned before SLE symptoms are caused by inflammation, which can affect the whole body or any individual part of the body.

When SLE affects the whole body symptoms might include fatigue, fevers, and changes in weight.

When SLE affects the joints this may result in pain, swelling, stiffness, and difficulty with walking. The most commonly affected joints include the fingers, wrists, and knees.

SLE can affect the kidneys causing problems in filtering waste products from the blood stream. If kidney disease is left untreated. the patient may require dialysis or kidney transplantation.

When SLE affects the digestive system, patients may experience abdominal pain, nausea, vomiting, and/or diarrhea.

SLE can affect the lungs in a variety of ways leading to shortness of breath and pain with breathing ("pleurisy").

SLE can affect any part of the heart leading to chest pain, shortness of breath, and  increases the patient's risk for having a heart attack.

Some of the most common problems affecting the nervous system in patients with SLE include difficulty concentrating, memory loss, depression and anxiety, headaches, pain in the hands or feet (called peripheral neuropathy), weakness or numbness, or even stroke.

Skin changes associated with SLE include a rash, hair loss, ulcerations in the mouth, and "Raynaud's Phenomenon". Raynaud's Phenomenon occurs when blood vessels in the fingers and toes narrow in response to cold temperatures, stress, cigarette smoking, and other triggers.
 As the blood vessels narrow, less blood flows to the area, causing the fingers or toes to become pale and then blue, purple, and/or red. Below is an example of how Raynaud's Phenomenon progresses as the fingers turn from pale to blue/purple:

image taken from wikimedia.org

I hope you now feel comfortable understanding what the body is experiencing during a SLE flare and how this inflammation can affect any organ in the body leading to the symptoms discussed above.

As always please feel free to leave comments below, and continue to email your questions to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Understanding Multiple Sclerosis

Dear Dr. Deena,

I am 26 years old, and was just diagnosed with Multiple Sclerosis. What is this disease? 

AG

AG, I am so sorry to hear about your diagnosis. Luckily modern medicine has many treatment options for you that can slow down progression of this disease!

Multiple Sclerosis, commonly known as “MS”, is a disease that effects the central nervous system (which consists of the brain and spinal cord). MS effects  90 in 100,000 individuals. These individuals are mostly young women, with the usual age of onset between 24 and 30 years of age.

To better understand MS, let us look at the structure of a nerve cell (see image the below). The nerve cell is composed of 2 distinct parts: the cell body (outlined by the red square) and the axon (circled in blue). The cell body receives information and nerve signals from other nerves. The axon transmits information to other nerves, muscles and glands.  

Axons are coated by myelin.  Myelin is a fatty substance that protects the nerve cell and allows for proper nerve signal transmission and functioning.   In fact the more myelin that coats the axon, the faster that a nerve signal can be transmitted to other nerves, muscles, and glands.

The CNS is composed of 2 types of matter: white matter and gray matter. Gray matter consists of the cell body and dendrite portion of the nerve cell. White matter consists of the axons of the nerve cell and appears white because of the myelin sheaths covering the axons.

MS is a “demyelinating” disease which means that it damages “myelin” and thus mostly effects the “white matter” of the CNS.

The actual cause of MS is unknown.  Many researchers believe that it is an autoimmune disease (where the body’s immune system attacks itself); however, the true cause for MS is still uncertain. What we do understand is the pathogenesis of this disease- meaning how the disease injures nerves and how the disease might progress overtime if untreated.

The main mechanisms of disease in MS are quite complex. To break it down simply for all of you, the disease begins with inflammation surrounding the nerve cell which leads to demyelination (damage and destruction of myelin)  which then leads ultimately to “sclerosis” (or scarring) of the nerve cell which can ultimately lead to loss of function of that nerve.  

As the myelin is damaged by inflammation, the axon can no longer transmit nerve signals properly, leading to a variety of symptoms that can occur. These symptoms depend on the location of the nerve affected and the degree of damage to that nerve.  

Remember, every MS patient has different symptoms!

Sensory symptoms are very common among MS patients, and symptoms may be described as numbness, tingling, pins-and-needles, coldness, or swelling of the limbs or trunk. 

Motor symptoms can include difficulty with walking, balance and motor coordination. Muscle weakness, tremor, and spasms may also be seen.

Bowel, bladder, and sexual dysfunction can also been seen in patients with MS. The extent of bowel and sexual dysfunction often parallels the degree of motor impairment in the lower extremities. Constipation is quite common among people with MS.

When MS effects the nerves supplying the eye (known as the optic nerve), one might develop “optic neuritis” which can cause eye pain and partial blindness. Luckily this condition can easily be reversed with high dose steroids.

Fatigue is a characteristic finding in MS, usually described as physical exhaustion that is unrelated to the amount of activity performed. MS patients are at risk for development  of depression and changes in cognition (i.e. the brain's ability to process and understand information).

If you are concerned that you might have symptoms similar to MS, contact your MD. Luckily there are many medications available that can slow down the progression of disease, though there still remains no definitive treatment. Depending on the type of MS you have, there is always the possibility to go into remission for years with no substantial change to your quality of life.

I hope this information helps, AG. Thanks for visiting my blog. Once again if you have any new comments or questions, please email them to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Facts about the Bird Flu: Avian Influenza A, H7N9

Dear Dr. Deena,
I keep hearing about the Bird Flu in China. What is this? How can I prevent this?
AJ

Thank you for a great question AJ! Avian influenza also known as the "bird flu" is caused by a virus called Avian Influenza A. Most avian influenza viruses only effect birds; however, there are some rare forms which can infect both humans and birds. 


There are several subtypes of avian influenza infection that  have been reported to effect humans since 1997. None of these cases have been reported in the USA, and have mainly been found in Asia and Africa.

In April 2013 the World Health Organization reported 3 human infections with a new avian influenza A virus known as H7N9 in China.  Since this time more cases of H7N9 infections have been reported, and all have been isolated to China.

Most of the cases of the bird flu in humans have resulted from human contact with infected poultry (specifically domesticated chicken, ducks, and turkeys) or surfaces contaminated with the secretions (saliva, mucous, tears), feathers, or excretions (feces) from infected birds. 


The most important thing to know is that there has been NO sustained person-to-person spread of the H7N9 virus detected at this time. Ongoing (sustained) person-to-person spread is necessary for an epidemic to occur, and currently we are not at the risk for this. 

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (difficulty breathing, respiratory failure, acute respiratory distress syndrome), and even death. 


The best way to prevent infection with avian influenza A viruses is to avoid sources of exposure. Most human infections with avian influenza A viruses have occurred following direct or close contact with infected poultry. 

If you are traveling to Southeast Asia consider avoiding places where domesticated birds might be present, i.e. farms, rural areas, open markets.  I would recommend wearing a mask throughout Southeast Asia (since all birds that you come in contact with have the potential of being infected) and make sure to wash your hands throughout the day (especially after handling poultry, meats, or touching public surfaces).

According to the Food and Drug Administration, bird flu cannot be transmitted by eating properly cooked poultry meat or eggs from infected birds. Poultry meat is safe to eat if it's been cooked to an internal temperature of 165 F (74 C). Eggs should be cooked until the yolk and white are firm.

Seasonal influenza vaccination will not prevent infection with avian influenza A viruses, but can reduce the risk of co-infection with human and avian influenza A viruses. There is currently no vaccination for H7N9, but researchers are currently working towards one.

I hope this information was helpful! Let's continue to hope for the best as China struggles to find the right answers.

Please continue to email me your questions at DoctorDeenaMD@gmail.com.


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Welcome to Spring! A Guide to Allergy Symptoms

Dear Dr. Deena,

Thank you for all your help.

How do I know if I have allergies? 

Debra

This is a great question, Debra, especially because we are entering into Spring! Spring is the most common season to develop allergies due to increased pollens in the air, as our trees and grasses begin to blossom once again!

Allergies affect roughly 30-40% of the population, which is likely an underestimation since many people don't even realize they have allergies.

Allergies occur when your immune system mounts a response against a foreign substance, known as an "allergen." Common allergens include pollen, dust, molds, certain foods, and animal dander (material shed from the bodies of animals).
Every individual has different sensitivities to these foreign substances, which is why not everyone develops or has the same types of allergies. 

The area of the body that is exposed to the allergen, is the area where symptoms will most likely occur. For example - if you are allergic to pollen and you breathe it in -- your symptoms will mostly be isolated to the airways (nose, sinuses, mouth, throat, lung) causing runny nose, itchy nose/throat, increased post nasal drip, difficulty breathing, wheezing, sinus congestion, etc. 
If pollen comes in contact with your eyes -- your symptoms will be isolated to the eyes causing itchy, watery, and/or red eyes. 

Allergic reactions can range from minor to severe. Symptoms develop based on the type of allergen, the areas of the body which are exposed to the allergen, and our own immune systems.

Here is a list of different types of allergies, along with their symptoms:

Seasonal Allergies: are generally caused by small airborne particles of pollens from trees, grasses, and weeds, as well as spores from fungi and molds. 

Symptoms of seasonal allergies may include:

-Sinus congestion

-Itchy nose

-Runny nose

-Itchy eyes

-Watery eyes

-Itchy throat

-Sneezing

-Increased post nasal drip (increased mucous production at the back of the throat or nose)

-Itchy ears

"Atopic Dermatitis" aka "Eczema": a type of rash which is very common among infants and generally outgrown before adulthood (See image below)

Symptoms of eczema include: 

- A red, itchy rash, +/- peeling and flaking of the skin

-Most commonly affected areas include face, neck, elbows, wrist, knees, and/or ankles

(courtesy of uptodate.com)

Food allergies:  caused by certain food proteins. Symptoms related to food allergies are dose dependent (meaning the more food that you eat which you are allergic to, the more severe your symptoms will be). 

Symptoms of food allergies may include:

-Tingling sensation of the lips and/or inside the mouth after eating a certain food

-Swelling of the tongue, lips, face or throat after eating a certain food. Which may look like this:

(courtesy of dxline.com)

-Development of "hives" which are raised, flat, red skin rashes that are generally itchy and look like this:

Anaphylaxis: is the most severe form of an allergic reaction and is LIFE THREATENING! 
It happens within minutes of exposure to an allergen

Symptoms of anaphylaxis may include:

-Most commonly patients will develop hives (generally all over their body)

-Difficulty breathing

-Chest tightness

-Increased wheezing

-Loss of consciousness

-Low blood pressure

-Dizziness

-Fast heart rate

-Nausea

-Vomiting

-Diarrhea

**If you are concerned with anaphylaxis, call 911!**

If you develop any of the above symptoms (especially during the spring and summer months) OR if you notice certain environmental triggers (food, dust, pollens, animals, etc.) always produce symptoms -- you may want to visit an Allergy specialist for evaluation. Luckily there are treatment options out there for you!

Here's a question for all of you -- what's another name for "Seasonal Allergies"? Leave your answers below!

Hope this information was helpful! As always, leave comments below and email all questions to DoctorDeenaMD@gmail.com. Happy Spring and I hope it's allergy free for all of you!!

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Tips To Adjust to Daylight Savings Time!

Do you find yourself even more tired now that daylight savings time is in effect? 

If yes - don't worry because this is completely normal! The first few days after the initiation of daylight savings are quite difficult since our body's natural rhythm is disrupted. 

According to the New England Journal of Medicine -traffic accidents are 8.6% more common on the first Monday of daylight saving time, according to an analysis of Canadian data from 1996.  

Here are some tips on how to adjust to daylight savings!

-- Avoid caffeine after lunchtime

--Eat dinner 3 hours prior to bedtime

--Avoid lying in your bed, until it is time to sleep

--Avoid taking naps during the day if possible

--Do not do any work in your bed, your bed should only be for sleep and sex

--Avoid dim lighting during the day, let as much bright light into your home or workspace as possible

--Exercise at least 3 times a week, but not before bedtime

--Play relaxing music to help soothe your mind and clear your thoughts while lying in bed before sleeping

--Find relaxation techniques that work for you - like deep breathing, stretches, or meditation that can be performed when you have difficulty sleeping

--Make sure that your room is dark when it's time for bedtime!

--Avoid alcohol before bedtime (tip: "nightcaps" might make you sleepy but alcohol decreases your quality of sleep)

Hope this helps to improve your sleep and your mood! 

Please email me at DoctorDeenaMD@gmail.com for any medical questions.

Sweet dreams everyone!


**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

All You Need To Know About Vitamin C!

Lets talk about Vitamin C!

Vitamin C is also known as L-ascorbic acid. It is very important for the functioning of our immune system and in the formation and maintenance of bones, teeth, cartilage and blood vessels. Vitamin C is an important factor in wound healing.

What Foods Contain Vitamin C?

It is important to make sure that our diet is rich in Vitamin C, since this vitamin is not stored or produced in our bodies.  Vitamin C can be found in many fruits and vegetables.  Although vitamin C is not naturally present in grains, it can be found in some fortified breakfast cereals. The vitamin C content of food may be reduced by cooking because ascorbic acid is water soluble and is destroyed by  high heat. Steaming or microwaving may lessen cooking losses. Fortunately, many of the best food sources of vitamin C, such as fruits and vegetables, are usually consumed raw.

 According to the Institute of Medicine - citrus fruits, tomatoes and tomato juice, and potatoes are major contributors of vitamin C to the American diet. Raw red peppers, orange juice and oranges have the highest amount of Vitamin C. 

Fruits containing Vitamin C include:
Cantaloupe
Citrus fruits and juices, such as orange and grapefruit
Kiwi fruit
Strawberries
Watermelon

Vegetables containing Vitamin C include:
Green pepper
Broccoli
Brussels Sprouts
Cabbage
Cauliflower
Spinach
Green peas

What Are The Symptoms of Vitamin C Deficiency?

-Poor wound healing
-Easy bruising
-Fatigue
-Mood changes (depression, easily irritability, etc)
-Bleeding gums
-Painful joints and muscles
-Nose bleeds
-Dry skin
-Dry, brittle hair
-Decreased ability to fight off infections leading to increased colds or other infections

Who is at risk for Vitamin C deficiency?

-Smokers (including those subject to second-hand smoking)
-Those with poor nutrition (the very poor, elderly, alcoholics, those with eating disorders, etc.)
-Those with severe intestinal malabsorption due to inflammatory bowel disease or who have had surgical resection of the intestines require higher amounts of Vitamin C
-Cancer patients require higher amounts of Vitamin C
-Patients on dialysis require higher amounts of Vitamin C

How Much Vitamin C Is Enough According to the NIH:

Infants:
0 - 6 months: 40* milligrams/day (mg/day)
7 - 12 months: 50* mg/day
*Adequate Intake (AI)

Children:
1 - 3 years: 15 mg/day
4 - 8 years: 25 mg/day
9 - 13 years: 45 mg/day

Adolescents: Age 14-18
Girls: 65 mg/day
Boys: 75 mg/day

Adults: Age 19 and older
Men: 90 mg/day
Women: 75 mg/day

Smokers or those who are around secondhand smoke at any age should increase their daily amount of vitamin C an additional 35 mg per day.

Women who are pregnant or breastfeeding and those who smoke need higher amounts of vitamin C. Ask your doctor what amount is best for you.


Fun fact: 
Did you know that Vitamin C deficiency was the leading cause of death among sailors between the 1500s and 1800s? 

After the 14th century, more and more sailors began to explore the Indian and Pacific Oceans -- leading to longer duration of voyages overseas. On these long voyages, a sailor's diet consisted largely of salted meat and biscuits made from flour. Since there was no way to preserve fruits and vegetables, these were never consumed while at sea.

Vitamin C deficiency first came into the public eye in Britain during the 1740s, after Commodore George Anson led 6 ships into the Pacific to raid Spanish shipping. He returned back to Britain with only 700 of his 2000 sailors, and it appears (from what has been described in stories and drawings) that most died from "Scurvy" , which is the most severe form of Vitamin C deficiency. Their symptoms were vividly described by Richard Walter: "skin black as ink, ulcers, difficult respiration,s, teeth falling out and, perhaps most revolting of all, a strange plethora of gum tissue sprouting out of the mouth, which immediately rotted and lent the victim's breath an abominable odour."  

This disease affecting only sailors was a true medical mystery at first, and  many physicians believed that the symptoms might be related to syphilis, dysentery or psychosis. What people did recognize; however, was that once on land the sailor's symptoms completely resolved as they resumed a normal diet. This made more physicians and sailors pay special interest to the foods on board the ship. 

In the 1760's the British used trial and error to research which foods might prevent this disease. They focused their interests on portable soup (a preparation of dried vegetables), malt, sauerkraut, concentrated lemon and lime juice (called "rob"), vinegar, mustard, molasses and beans. Different voyages sent out to sea took a different set of foods, and sailors were monitored for their symptoms. It turns out one group of sailors under Captain Cook was very lucky in preventing scurvy for three successive voyages, with the help of lemon and lime!

I hope you enjoyed my tips for Vitamin Week! Especially the little history about Vitamin C!

Please continue to email your questions/comments to DoctorDeenaMD@gmail.com.

**PLEASE REMEMBER IF YOU HAVE ANY QUESTIONS OR CONCERNS ABOUT YOUR HEALTH AND/OR BEFORE STARTING OR STOPPING ANY TREATMENT OR ACTING UPON INFORMATION CONTAINED ON THE SITE, YOU SHOULD CONTACT YOUR OWN PHYSICIAN OR HEALTH-CARE PROVIDER**

Vitamin Week Continues with Vitamin B-12 aka Cobalamin

Today I will discuss Vitamin B-12. This is a very important vitamin to know about because many of us will need supplementation after age 65!

Vitamin B-12 exists in many different forms and contains the mineral cobalt, which is why it is also known as "cobalamin."  Vitamin B-12 plays a very important role in the development and maintenance of our nervous system, red blood cell formation, and the synthesis of DNA.

B-12 is found in all animal products, dairy products, and fortified cereals. Cooked clams and liver are known to have the highest amounts of B-12.

According to the NIH - recommended intake of B-12 is the following:

Table 1: Recommended Dietary Allowances (RDAs) for Vitamin B12

Age	Male	Female	Pregnancy	Lactation
0–6 months*	0.4 mcg	0.4 mcg
7–12 months*	0.5 mcg	0.5 mcg
1–3 years	0.9 mcg	0.9 mcg
4–8 years	1.2 mcg	1.2 mcg
9–13 years	1.8 mcg	1.8 mcg
14+ years	2.4 mcg	2.4 mcg	2.6 mcg	2.8 mcg

* Adequate Intake

 In a well-balanced diet, a person obtains approximately 5 to 15 mcg of vitamin B12 daily, which is much more than the recommended dietary allowance noted above. This is why it takes years to develop true B-12 deficiency! For a healthy, young, individual - it takes anywhere between 3 to 5 years to develop B-12 deficiency since we have a huge reserve of B-12 stored in the liver.

Symptoms of B-12 Deficiency

Symptoms of B-12 deficiency can be divided into different categories as B-12 plays an important role in the formation of red blood cells and the functioning of our nervous system (nerves and brain).

The clinical manifestations of B-12 deficiency on the blood include anemia leading to feeling tired, weak, and/or short of breath. 

The clinical manifestations of B-12 deficiency on the nerves include:
-feeling numbness or "pins and needles" in your hands and/or feet
-loss of sensation in the hands and/or feet
-inability to walk
-inability to sense ones feet on the ground

The clinical manifestations of B-12 deficiency on the brain include:
-confusion
-change in mental status
-personality changes
-difficulty with memory
-depression

Who is at Risk for B-12 Defiency?

1) The malnourished

Those with limited access to foods containing B-12 (vegetarians) or who do not follow a well-balanced diet (such as the elderly or alcoholics) or at risk or B-12 deficiency. 

2) Those with diseases effecting intrisic factor production in the stomach such as pernicious anemia 

3) Those with decreased acid production in the stomach due to:
- medications for GERD/Acid Reflux (like "H-2 blockers" (i.e. Zantac) or "Proton Pump Inhibitors" (i.e. Nexium, Protonix, Prilosec))
-surgical resection of parts of the stomach (such as weight loss surgeries) 

Acid in the stomach helps to breakdown B-12 so that it can bind to intrinsic factor and be absorbed. If there is less acid in the stomach due to the conditions above, one might develop B-12 deficiency.

4) Older individuals

Older individuals are at risk for B-12 deficiency due to limited nutritional intake of B-12 and development of atrophic gastritis. Many elderly patients are predisposed to atrophic gastritis, since acid production decreases with age as the stomach lining begins to thin. 

5) Individuals with diseases effecting absorption of nutrients in the intestines such as celiac disease, inflammatory bowel disease, and those who have undergone intestinal surgeries

6) Those taking medications such as: Metformin, cephalosporins, aminoglycosides, etc.

Who Needs To Be Taking B-12 Supplements?

I would recommend having your B-12 levels checked if:

-you are experiencing any of the symptoms that I have mentioned above

-you consider yourself in one of the groups outlined above who are "at risk" for B-12 deficiency

-you are older than 65 years of age

Treatment of B-12 deficiency is quite common and curable, so be sure to ask your doctor if you need further supplementation! 

Please continue to email your questions/comments to DoctorDeenaMD@gmail.com


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