1-818-812-7222 Office Hours: 8:00 AM to 5:00 PM
10 Congress St., Suite #300
Pasadena, CA 91105

Results for : "vitamin d"

Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

September 04, 2014 3:08 pm

Nycalopia or Night Blindness is a side effect of Vitamin A deficeincy. Vitamin A is a fat soluble vitamin that occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Beta carotene and other carotenoids, yellow and red carotenoid pigments, can be changed to vitamin A in the liver.

A number of functions for vitamin A have been found, including immune mechanisms, maintenance of healthy epithelial tissues,  facilitates the mobilization iron from stores to developing red blood cells, and most importantly, a function in the visual system. Vitamin A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle. Zinc works with Vitamin A by converting retinol to retinal and also protects from toxicity of Vitamin A. Vitamin A deficiency can worsen Iron Deficiency Anemia. It has been shown that treatment for Iron Deficiency Anemia responds better when Vitamin A and Iron are supplemented together.

Vitamin A deficiency may also represent a decreased visual acuity, more specifically, night blindness. Night Blindness was found in a patient who reported that they were unable to read a particular sign at night while driving, but was able to read it during the day. The body uses Vitamin A to make retinal, part of a molecule called rhodopsin. Rhodopsin is found in the rods of the eye.  The rods are the cells of the retina that allow you to see in low light conditions. Here is a video of a patient exhibiting the effect of night blindness.

Night blindness Video

If Vitamin A deficiency is left untreated at the stage of night blindness it can progress to Xerophthalmia.  Xerophthalmia is also caused by Vitamin A deficiency. The symptoms of Xerophthalmia is lack of tear production which are the lubrication of the eye. This leads to corneal and conjunctiva inflammation and thickening. The cornea can become cloudy and foamy spots (Bitot’s spots) leading to scarring and damage that effect the sight.

Over the last few decades, the incidence of vitamin A deficiency in the general population of the United States has significantly decreased. It is only when a patient shows signs and symptoms associated with malabsorption of fat soluble vitamins that he or she may be diagnosed with a vitamin A deficiency.
Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video
Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

When a patient is diagnosed with vitamin A deficiency, the treatment will require aggressive oral supplementation.  Duodenal Switch patients will only respond to “Dry” water miscible form of Vitamin A, which is pictured below/right. This “Dry” water miscible form is a powder which is designed to dissolve in water without the addition of bile for absorption. When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” water miscible form of vitamin A. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.

For cases in which vitamin A levels do not respond to “Dry” water miscible Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage of vitamin A is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize the vitamin A level, as well as resolving the symptom of night blindness.

Nyctalopia (Night Blindness) An Early Sign of Vitamin A Deficiency with Video

Patch or Spray Vitamins

August 15, 2014 10:37 pm

At the last group meeting, there were several questions whether vitamin D and other vitamins would be absorbed via patch (transdermal) and spray (buccal/sublingual) routes.  After reviewing several resources, the only article I could find was for transdermal Vitamin D absorption.  However, if we look at the mechanism for each route we can make an educated assumption.

Transdermal route of absorption (without additional absorption enhancers) (ref) requires a molecular mass less than 500 g/mole, high lipophilicity (affinity to fat or lipids), and low required daily dose (less than 2mg). The fat-soluble vitamins are definitely lipophilic, all of them have molecular weights less than 500 g/mole and daily dose is under 2mg. It seems that hydrophilic medications (that have an affinity to water) may have less ability to be absorbed with this route unless a chemical enhancer is added to the product. Most vitamins and minerals have lower molecular weights except Vitamin B12 which has too high of a molecular weight unless an enhancer is added. The transdermal route has slower absorption than buccal (oral mucosa) but faster than usual tablet oral route. The down side to transdermal route is possible skin issues due to medication, adhesives, and also different rates of absorption due to skin thickness and condition.

Buccal/sublingual route of absorption is dependent on lipid solubility, oil to water partition coeffincient, saliva pH, small to moderate molecular weight, and oral mucosa thickness. The mechanism of action is osmosis, which means items that readily dissolve in water are easily absorbed. Unlike orally ingested medicates, that take time to absorb and need to be filtered and/or processed in the liver, sublingual route is fast absorbing and the liver is bypassed. The down side to this route is it disrupts eating and drinking and is not efficient with smoking due to vasoconstriction.

An e-mail was sent to the companies inquiring about the outcomes of their products with people with malabsorption issues.  No response was received from the spray vitamin companies.A request was also sent to obtain any research articles they may have but a response has not been received at this time. The following is the response I received from the maker of Patch MD.

“I am the president and founder of Patch MD. We design Patch MD to help people that have digestive issues and malabsorption. Our whole premise is to avoid the digestive track, by doing so we avoid dealing with conditions such as short bowel syndrome, acid reflux, and bariatric surgery to name a few. People also with Crohn’s disease and iliac disease are challenged with digestion and absorption every day of their life. Our patches are designed specifically to pass nutrition through the skin into the bloodstream. We get letters every day from people that have had bariatric surgery and were unable to get vitamin D, calcium, the B’s and Vitamin A and K, our product works because we use the skin as our delivery system, absorption is through the skin, avoiding all digestive potential issues. The only problem that we may have is we tell our customers to use no lotions or cream in the patch application area, as you may understand it will prevent absorption. We are going to be at a national convention this weekend in Manhattan Beach California to take part and display our products at the ObesityHelp conference. They ask us to take part as they were getting great reviews from their members that are using the patch. All were improving their blood work after taking Patch MD patches.”

Earl Hailey, President Patch MD

In light of the review of data, it would seem that the transdermal route would be beneficial to people who are having issues maintaining blood levels of fat-soluble vitamin levels.  The other vitamins also have a good prospect of absorption via transdermal route.  Buccal or sublingual (sprays) would seem to have a better outcome for water-soluble vitamins unless there is an additive added to the product to increase the solubility of the fat-soluble vitamins and make them water miscible.  We must realize that there is no data for Duodenal Switch patients and very little data regarding these routes of absorption with vitamins specifically.  If you are going to try these types of vitamins you should be extremely diligent in following your laboratory studies for vitamin levels with greater frequency until it is determined they are maintaining your blood levels.

Also, it should be noted that water miscible (dry) Vitamin A, D, E, K are the only type of these vitamins a DS patients should be taking.  Over the counter Vitamin A, D, E, K are fat-soluble and due to the fat malabsorption after DS these type of vitamins are not appropriate to maintain blood levels.  Water miscible (dry) vitamins should NOT be taken with fatty or oily foods and should also be taken 30 minutes prior or 30 minutes after eating.  The water miscibility makes them water soluble and therefore will not have optimal absorption if taken with fat. Fat also increases the rate of digestion through the small bowel after DS and decreases the amount of time the vitamin has in the bowel and therefore, decreases absorption. They are best absorbed when taken on their own.

The good news patches and spray routes of administering medications and supplements is an up and coming area of research.  There are several ongoing research studies and new developments on the horizon for increasing absorbability of transdermal route with different types of additives and techniques. 

Vitamin’s Physical State And Solubility are Two Different Things.

March 29, 2014 6:11 pm

One of the most common misconceptions regarding vitamins is that its physical shape and state (liquid versus solid) defines its solubility.  Water-soluble vitamins may be found in dry powder form (solid) or may be a form of liquid.  Fat-soluble vitamins may also be found in both solid and liquid form.  It is important to appreciate that one cannot assume that if a fat soluble vitamin is in liquid form in a gel cap it will be absorbed.  What makes a fat-soluble vitamin absorbable is not its liquid, physical state, but rather it’s molecular structure, which makes it possible to be absorbed.  When purchasing vitamins that are fat-soluble, labels such as “dry”, “water-soluble” are indications that it is water-soluble more important than its shape, size or the nature of the vitamin itself.
A liquid form of vitamin A and D may be less soluble than a dry powder form.  This is because it dry powder form may be chemically structured so that it is soluble in water versus a liquid form that is not.  An analogy will be the mixing of olive oil (liquid) with vinegar (liquid).  Olive oil will stay separated because it is not water-soluble even though it’s a liquid state.

Vitamins And Minerals

March 29, 2014 5:26 pm

Vitamins -Minerals
Function
Source
Problems with deficiency 
B1 (Thiamine)
Carbohydrate conversion, breaks down fats and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, immune system
Pork, organ meats, whole grain and enriched cereals, brown rice, wheat germ, bran, brewer’s yeast, blackstrap molasses
Heart, age-related cognitive decline, Alzheimer’s, fatigue
B2 (Riboflavin)
Metabolism, carbohydrate conversion, breaks down fat and protein, digestion, nervous system, skin, hair, eyes, mouth, liver, antioxidant
Brewer’s yeast, almonds, organ meats, whole grains, wheat germ, mushrooms, soy, dairy, eggs, green vegetables
Anemia, decreased free radical protection, cataracts, poor thyroid function, B6 deficiency, fatigue, elevated homocysteine
B3 (Niacin)
Energy, digestion, nervous system, skin, hair, eyes, liver, eliminates toxins, sex/stress hormones, improves circulation
Beets, brewer’s yeast, meat, poultry, organ meats, fish, seeds, and nuts
Cracking, scaling skin, digestive problems, confusion, anxiety, fatigue
B5 (Pantothenate)
RBC production, sex and stress-related hormones, immune function, healthy digestion, helps use other vitamins
Meat, vegetables, whole grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ, salmon
Stress tolerance, wound healing, skin problems, fatigue
B6 (Pyridoxine)
Enzyme protein metabolism, RBC production, reduces homocysteine, nerve and muscle cells, DNA and RNA, B12 absorption, immune function
Poultry, tuna, salmon, shrimp, beef liver, lentils, soybeans, seeds, nuts, avocados, bananas, carrots, brown rice, bran, wheat germ, whole grain flour
Depression, sleep and skin problems, elevated homocysteine, increased heart disease risk
B12 (Cobalamin)
Healthy nerve cells, DNA/RNA, RBC production, iron function
Fish, meat, poultry, eggs, milk and milk products
Anemia, fatigue, constipation, loss of appetite, weight, numbness and tingling in the hands ad feet, depression, dementia, poor memory, oral soreness
Biotin
Carbs, fat, and amino acid metabolism (the building blocks of protein)
Salmon, meats, vegetables, grains, legumes, lentils, egg yolks, milk, sweet potatoes, seeds, nuts, wheat germ
Depression, nervous system, premature graying, hair, skin
Folate
Mental health, infant DNA/RNA, adolescence and pregnancy, with B12 to regulate RBC production, iron function, reduce homocysteine
Supplementation, fortified grains, tomato juice, green vegetables, black-eyed peas, lentils, beans
Anemia, immune function, fatigue, insomnia, hair, high homocysteine, heart disease
Eyes, immune function, skin, essential cell growth and development
Milk, eggs, liver, fortified cereals, orange or green vegetables and fruits
Night blindness, immune function, zinc deficiency, fat malabsorption
Calcium and phosphorus levels, calcium absorption, bone mineralization
Sunlight, milk, egg yolk, liver, fish
Osteoporosis, calcium absorption, thyroid
Vitamin E
Antioxidant, regulates oxidation reactions, stabilizes cell membrane, immune function, protects against cardiovascular disease, cataracts, macular degeneration
Wheat germ, liver, eggs, nuts, seeds, cold pressed vegetable oils, dark leafy greens, sweet potatoes, avocado, asparagus
Skin, hair, rupturing of red blood cells, anemia, bruising, PMS< hot flashes, eczema, psoriasis, cataracts, wound healing, muscle weakness, sterility
Calcium
Bones, teeth, helps heart, nerves, muscles, body systems work properly, needs other nutrients to function
Dairy, wheat/soy flour, molasses, brewer’s yeast, Brazil nuts, broccoli, cabbage, dark leafy greens, hazelnuts, oysters, sardines, canned salmon
Osteoporosis, osteomalacia, osteoarthritis, muscle cramps, irritability, acute anxiety, colon cancer risk
Chromium
Assists insulin function, increased fertility, carbohydrate/fat metabolism, essential for fetal growth/development
Supplementation, brewer’s yeast, whole grains, seafood, green beans, broccoli, prunes, nuts, potatoes, meat
Metabolic syndrome, insulin resistance decreased fertility
Magnesium
300 biochemical reactions, muscle/nerve function, heart rhythm, immune system, strong bones, regulates calcium, copper, zinc, potassium, vitamin D
Green vegetables, beans & peas, nuts and seeds, whole unprocessed grain
Appetite, nausea, vomiting, fatigue, numbness, tingling, cramps, seizures, personality changes, heart rhythm, heart spasms
Selenium
Antioxidant, works with vitamin E, immune function, prostaglandin production
Brewer’s yeast, wheat germ, liver, butter, cold water fish, shellfish, garlic, whole grains, sunflower seeds, Brazil nuts
Destruction to heart/pancreas, sore muscles, fragility of red blood cells, immune system
Zinc
Supports enzymes, immune system, wound healing, taste/smell, DNA synthesis, normal growth & development during pregnancy, childhood adolescence
Oysters, red meat, poultry, beans, nuts, seafood, whole grains, fortified breakfast cereals, and dairy
Growth retardation, hair loss, diarrhea, impotence, eye & skin lesions, loss of appetite, taste, weight loss, wound healing, mental lethargy
COQ10
Powerful antioxidant, stops oxidation of LDL cholesterol, energy production, important to heart, liver, and kidneys
Oily fish, organ meats, and whole grains
Congestive heart failure, high blood pressure, angina, mitral valve prolapsed, fatigue, gingivitis, immune system stroke, cardiac arrhythmias
Carnitine
Energy, heart function, oxidize amino acids for energy, metabolize ketones
Red meat, dairy, fish, poultry, (fermented soybeans), wheat, asparagus, avocados, peanut butter
Elevated cholesterol, liver function, muscle weakness, reduced energy, impaired glucose control
N-Acetyl Cystein (NAC) & Glutathione
Glutathione production, lowers homocysteine, lipoprotein, heal lungs, inflammation, decrease muscle fatigue, liver detoxification, immune function
Meats, ricotta, cottage cheese, yogurt, wheat germ, granola, and oat flakes
Free radical overload, elevated homocysteine, cancer risk, cataracts, macular degeneration, immune function, toxin elimination
Alpha Lipoic Acid
Energy, blood flow to nerves, glutathione levels in brain, insulin sensitivity, effectiveness of vitamins C, E, antioxidants
Supplementation, spinach, broccoli, beef, brewer’s yeast, some organ meats
Diabetic neuropathy, reduced muscle mass, atherosclerosis, Alzheimer’s, failure to thrive, brain atrophy, high lactic acid

Vitamin A

May 17, 2011 7:20 pm

Vitamin A occurs in animal tissue as retinol. There are a number of different provitamins in food of vegetable origin. Disorder yellow and red carotenoid pigments can be changed to vitamin A in the liver.

A number of functions for vitamin A have been found, including defense mechanisms, maintenance of healthy epithelial tissues, and most importantly, a function in the visual system.  A deficiency may manifest itself by: 1.) A scale-like appearance in the skin and occasional acne, 2.) A failure of growth in young animals, including C. station of skeletal growth, and 3.) A failure of reproduction associated with atrophy of the epithelial cells of the testes and interruption of the female sexual cycle.  A deficiency may also represent a decreased visual acuity, and more specifically, night blindness. This was found in a patient who complained that they were unable to read a particular sign at night while driving, but was able to read it during the day

Over the last few decades, the incidence of vitamin A deficiency in the United States has significantly decreased. It is only when the patient shows signs and symptoms associated with the malabsorption of fat soluble vitamins that he or she may be diagnosed with a deficiency.

Vitamin A Deficiency Treatment

IMG_5427
Injectable Vitamin A

When a patient is diagnosed with a deficiency, the treatment will require aggressive oral supplementation. For cases in which vitamin A levels do not respond to “Dry” Vitamin A oral supplementation, intramuscular injections may be required. The usual injected dosage is between 25,000-50,000 international units. Repeated injections in a 3-month interval have been required in some patients to normalize their level, as well as resolving the symptom of night blindness.

When taking oral vitamin A, it is important for patients who have had the Duodenal Switch operation to specifically look for a “Dry” or water miscible form. This is to maximize the amount of vitamin A that can be absorbed even in the presence of reduced fat absorption.

Overfed But Undernourished

October 01, 2019 11:27 am

Obesity is related to as many as 400,000 deaths each year in the US and it has increasingly been recognized as a risk factor for several nutrient deficiencies. This may seem surprising given the likelihood of over consumption of calories, however these additional calories are not from nutritious sources. One of the main reason for these nutritional deficits is the greater availability of inexpensive foods that are rich in calories and are nutrient deficient. This has led some medical professional to conclude that there is a certain group of people who are overfed but undernourished.  Even with the epidemic of the obesity, there is significant nutritional deficiencies noted.

Obese subjects have increased blood volume, cardiac output, adiposity, lean mass and organ size all of which can influence volume of distribution, in addition, treatment for severe obesity involving surgical procedures can worsen these nutrient deficiencies and in some cases may cause new ones to develop.

This table shows the percentage of population below the estimated average requirement (EAR) by body weight status in adults more tan 19 years old, showing that almost 90 to 100 percent of people including normal weight (NW) are below the EAR of vitamin D and Vitamin E.

Nutrition TableNutritional deficiencies in obese patients may promote the development of chronic diseases including increased insulin resistance, pancreatic B-cell disfunction and diabetes, this is because specific micronutrients are involved in glucose metabolic pathways; There are other chronic diseases related to obesity that are being investigated such as decrease in focal grey matter volume and cognitive impairment or inadequate sleep due to low intake of antioxidant vitamins.

We would like to thank Miguel Rosado, MD for his significant contribution provided for this Blog.

Sunscreen

June 27, 2019 3:03 am

Recently there has been some research and concern regarding sunscreen and the chemicals within them. This has led to findings that can be concerning but that need further research.

Post weight loss surgical patients, and in general patients who suffer with obesity, before or after weight loss surgery, have low vitamin D level. This may be caused by a number of factors. One such factor may be the reluctance to get skin exposed to sunlight in order for the bodies natural Vitamin D pathways functioning.

The recommendations are for daily exposure to sun. This not only is critical to the vitamin D metabolic pathways, but also help with bone health, immune function, mood, counteracting depression.

In a recently published online article, concerns were raised that some of the ingredients of some of few sunscreens are absorbed in the blood stream. This is a small study, and as the results indicates, it is not recommending to stop using the sun screens. Be aware of your sun exposure, timing exposure, and the ingredients in your sunscreen.

You can find past blog posts on Vitamin D, Bone health, etc here

Osteoporosis Medications, Action and Side Effects

May 25, 2019 3:40 pm

Recently I had a short live presentation on the subject of osteoporosis, osteoporosis medications, and the treatment options of this deteriorating bone condition. A patient who has had a bone scan may be diagnosed with Osteopenia and/or Osteoporosis. This information is usually conveyed by the forms of a Low T score. Both of these indicated demineralization of the bones, and the end result is  worsening of the bone structure. This leads to weaker bones and higher chance of fracture due to stress or trauma.

Treatment options should be approached is a global and systemic fashion. It is critical that the nutritional status is at its best possible and optimized for important healthy bone vitamins and minerals. Low protein needs to be corrected. Special attention should be given to nutrients, minerals and vitamins. These include ProteinCalcium, Magnesium, Vitamin D, and Vitamin K1/K2to name a few.

Healthy bones require ongoing and routine force in the form of exercise to remain health. Just as exercise improves muscle strength, it also improves bone health. Exercise is also critical in improving bone structure and density. Ideally, exercise should be weight bearing and resistance.  Examples include: hiking, walking, jogging, climbing stairs, playing tennis, and dancing. Resistance type exercise is weight lifting and resistance bands.  These exercise work by creating a pull or force on the bone either by gravity, movement or weight.  Always check with your physician before beginning an exercise routine, start slowly and building up to longer periods of time.  The ideal goal would be at least 30 minutes a day, every day, if you are able.

We frequently see patients immediately started on osteoporosis medications without checking or improving some of the nutritional markers noted above or without looking at exercise history. In some case, the medication recommended are contraindicated due to nutritional status.

The medications can be grouped in to those  that help with new bone formation (Anabolic agents) or those that help by suppressing the bone breakdown phase (Antiresorptive agents).

Groups of Medication

 

National Osteoporosis Foundation has an exhaustive list (below) of medications for treatment of Osteoporosis.

The table below outlines the side effects and mechanism of the actions of the common medications used for treatment of  osteoporosis which was published by the University Health News Publication on August of 2014.

Mechanism Of Action And Side Effects

 

With all this information, the few points to remember is that the most important factors in healthy bone structure are the nutritional status Protein, Calcium, Magnesium, Vitamin D, and Vitamin K1 levels.

This is an animation of normal bone Metabolism. It shows how bone structures is taken down and rebuilt continuously. This allows for a healthy bone maintainence as we age. The key is the balance of breakdown (osteoclast) and the build up (osteoblast) activity is regulated. Osteoporosis develops when there is more breakdown that build up.

With permission of Dr. Susan Ott of University of Washington.

Additional information available on her site.

Past blogs on Bone Health.