Vitamin D deficiency: Should we use supplements?
For years, it has been widely accepted by scientists that vitamin D deficiency is a longstanding health problem, with implications on health and wellbeing. While there are a wealth of reasons for vitamin D deficiently, inadequate skin synthesis due to restricted sunlight, limited food fortification and lack of vitamin D from natural food sources are confirmed contributing factors. Here, we discuss how certain health conditions can further enhance the risk of vitamin D deficiency and ways to increase its consumption. The levels of vitamin D deficiency In the UK, currently, Reference Nutrient Intakes (RNI) for vitamin D are only set for children aged 1.5-3 and adults over 65 years of age. Using the average intakes for each of these age groups, data from the latest UK National Diet and Nutrition Survey (NDNS) revealed that intakes of vitamin D from food sources are just 27% of the RNI for children and 33% for adults, showing significantly low vitamin D levels from food sources. When it comes to assessing blood biomarkers in relation to vitamin D levels, plasma vitamin D levels of <25 nmol/L are used to identify a deficiency. Using this as an indicator, it was revealed that on average, 19.7% of boys and 24.4% of girls aged 4 to 10 had levels less than 25 nmol/L, while 24% of men and 21.7% of women aged 19 to 64 has plasma vitamin D levels below this. The survey also revealed that when averaged out across the year, 40% of young people and adults were deficient between the months of January and March. Health conditions which can increase the risk of vitamin D deficiency Malabsorption, coeliac disease, cystic fibrosis, short bowel syndrome and inflammatory bowel disease (IBD) can all increase the risk of vitamin D deficiency. Amongst adults, an Irish study involving 81 patients with Crohn’s disease (CD) revealed that 63% were vitamin D deficient. Furthermore, a study of patients with coeliac disease in the US showed that 25% had vitamin D deficiency. Common signs of deficiency When it comes to symptoms of vitamin D deficiency, these tend to vary across the lifespan and with the level of deficiency. During adolescence, symptoms typical of severe deficiency include muscle cramps, pain in weight-bearing joints and problems walking, running or climbing stairs. In adults, a mild lack of vitamin D may present itself as general aches and pain, while more severe deficiency is associated with osteomalacia and post-menopausal increased fracture risk. Furthermore, suboptimal vitamin D levels are associated with an increased risk of severe infections and sepsis amongst those that re critically ill. Vitamin D supplements When it comes to supplementing vitamin D levels, we must first ascertain whether it is to maintain and prevent deficiency or to treat a diagnosed deficiency. In the care of maintaining levels, The European Food Safety Authority (EFSA) proposed an adequate intake of 15 µg/day for adults. In the UK, while RNIs are not available, it has been suggested that 10 µg/day for those aged 11 to 65 is suitable. In the situation of vitamin D deficiency, such as in cases of patients with diagnosed bone diseases, it has been advised by the National Osteoporosis Society that levels are increased rapidly with doses of up to 7500 µg. So, for example, taking 20 µg/day capsules, five times a day for 10 weeks could be used to rapidly correct low levels, and following this, levels should be maintained. When it comes to which form of vitamin D supplementation to take, evidence suggests that vitamin D3 (cholecalciferol) is effective at raising levels. Here at 121 Dietitian we support all the evidence regarding Vitamin D deficiency and the importance of correcting low levels. However the safety of increasing levels and continued maintenance of these levels are of concern, and so we prefer to guide our patients with a safe combination of a whole food diet rich in Vitamin D foods and natural supplementation of key nutrients. Why? Many of the general population are correctly taking action and looking after their own health, and over the counter supplementation has been around for a long time, nothing new there. The issue is the toxic levels of Vitamin D supplementation that people are taking and the length of time they are taking them for with no monitoring. Hypervitaminosis D is a rare but potentially serious condition. It occurs when you take in too much vitamin D. It’s usually the result of taking high-dose vitamin D supplements without checking your status. Too much vitamin D can cause abnormally high levels of calcium in the blood. This can affect bones, tissues, and other organs. It can lead to high blood pressure, bone loss, and kidney damage without treatment. Vitamin D can also affect Vitamin A, Vitamin K and magnesium levels and if the ratio is not maintained then you may experience further unpleasant side effects. As of the past number of years GP’s in Northern Ireland are unable to routinely measure peoples Vitamin D levels. This for me as a health professional is disappointing and worrying as we are frequently seeing cases of severe deficiency and many with long term excessive use and negative consequences. Monitoring needs to happen. In summary, Vitamin D deficiency is common in the UK, particularly during the winter months and notably in vulnerable populations. While symptoms can be hard to spot, tiredness and general fatigue are common and may suggest your levels should be assessed by your GP or through a simple blood test where possible. Action should be taken based on these findings and current health status. If you are unsure of how to change your eating habits, or need help optimising the foods you eat please do contact us. We would love to help you or your family and friends with any nutrition related queries big or small. In the meantime do please check out our 121Dietitian Shop If you have enjoyed this blog we would love you to share this with your family and friends on your social
Hashimoto’s and me – part 2…
For me I could not imagine how I would be coping if I had not been able to recover my health after my Hashimoto’s Hypothyroidism diagnosis. Well sorry for the very long pause, things always happen when you least expect them. My mother who is disabled with MS was in a car accident and badly broke her leg in June. This meant all my extra time outside of work and family was directed at her care and attention and to keep her mentally strong. It is an ongoing slow process but she is getting there. To get to the level I am at now did take a big decision as I was, pre 2010, not an ‘elimination of foods’ Dietitian! My motto was to increase food choice and enhance variety in all my patients diets (obviously not those with allergies and specific ill health but the people who required help with healthy eating). The big leap was that I removed gluten from my diet, and I can only say I am happy I did. My symptoms like constipation and skin irritation did not change greatly but I knew it was scientifically worth the change – even if removal was to prove it was the wrong path, I could save my patients from possibly making the decision. It is 2 years since I made the change and I am continuing with this. I feel the scientific evidence is there and unfolding at present there is not enough research written up and so I will continue this route while I await further results to unfold. If you are unsure of how to change your eating habits, or need help optimising the foods you eat please do contact us. We would love to help you or your family and friends with any nutrition related queries big or small. In the meantime do please check out our 121Dietitian Shop If you have enjoyed this blog we would love you to share this with your family and friends on your social media channels. Why not visit our YouTube Channel for more on keeping your health optimal. How can a Dietitian help Book a consultation via our Online Portal About Gillian Killiner Check out our tailored dietary programmes Gillian x [instagram-feed] Information checked & correct on 16th May 2018.
“Healthy working Lives” NI 2015 – how are we shaping up??
Healthy working lives. Well, that was a morning I wasn’t expecting, all in a good way that is. I was invited to speak at a Business in the Community event for improving employee health and wellbeing in the workplace on Tuesday. I had my hat on as nutrition specialist as part of the Support 2 Perform team human performance specialists. My plan was to dip in and present the exciting and important need to using wearable technology for staff health, and then head away to attend to my business demands and what comes with that, however I was drawn in to stay by the programme line-up and the venue, and I am glad I did! I must congratulate the Business in the Community team who arranged an excellent set of speakers all of whom were informative and had fresh ideas and information. I hope I can include myself in this line-up! Minister Wells MLA set the scene with Dr Carolyn Harper providing informative stats. It was then the break out session and my turn under the spot light. Thanks to Dr Jonathan Bloomfield’s information the presentation I felt was extremely well placed, allowing the audience of HR from the public and private sectors to understand and realise the opportunities for their staff with a real return of investment – long term. The next sessions were close to my heart with the 12 week weight loss programmes presented by Tanya Kennedy and Dr Declan Bradley. A great idea and an excellent starting point for business to test the water with staff health and weight loss. Progression then to the niche and real long term effective programmes like Counterweight weight management, stress, mental health and nutrition, firstbeat, garmin would then be understood and appreciated for adding value when costing long-term staff health benefits. It was great to see some of the companies that 121 Dietitian have worked with at the event, chatting to these key influencers their feedback made it clear how valuable the advice Dietitian’s provide the quote “best received” “most talked about by staff ” and looking to rebook soon again. The final speaker of the event was Susan Hayes Cullerton, an economist from Cork (a place of my family origins) had passion, drive and great humour and she stole the show. She spoke in real terms of her feelings, experiences and future plans on health and wellbeing for herself, her workforce and her future. As a non-health professional she was a breath of fresh air, she had researched intensively and presented the hard core details effortlessly with a real magnetic charm. I will even forgive her for not promoting those hard working companies who pick up from the free services she mentioned! As a specialist dietitian I too am passionate, driven and determined and share Susan’s transparency. I don’t shy away from looking in the mirror regularly. Susan pushed home the importance of needing to look at ones self before being able to advise others. She discussed 5 key areas that she found important to ask herself and she challenged the audience to answer them too. To rise to this challenge and be transparent, confirming the deep commitment I have to helping and treating people, here are my questions and answers: 1) Is my health good? Yes; I monitor it closely: I eat healthy, exercise, drink water, take supplements based on my bloods. I am unfortunate to have an auto-immune disease, but the positive I draw from living with this is having been a patient I know how difficult and lonely it can be……Do I eat ‘bad’ foods – yes sometimes. It is important to have balance. I am a scientist, cook, business owner, food experimentalist, mother of 3, wife, work long hours but I also LOVE Food. I have thus spent the past 20 years creating very clever tasty fast meals, recipes and snacks to allow all the flavours, tastes and enjoyment and variety of food to be had using the healthiest combinations possible. I educate to eat clever: nutrient focus not kcals focus. I find people judge me as a Dietitian’s assuming that I do not know what it feels like to be faced with unhealthy eating dilemma’s, or they feel that I maybe judgemental towards them because I am slim. If only they could realise that all I ever hope for is that they are inspired to make a change. Dietitian’s can’t win: If we are thin we are not accepted if we are overweight we are not credible! But for the majority of people interested in us it is thankfully often as simple as wanting to know what is in MY fridge and My cupboards!!! 2) The changes I have made to improve my overall health and well being for 2015 is to unsubscribe from unnecessary websites, take up ice-skating with my kids, switch off from work at 10:30pm/11pm at the latest and not the 12pm+ as in previous years. ( I work now 9am-3pm in the office and clinic, pick up the kids 3pm answer emails and calls while homework’s and sporting activities and food cooking takes place and then return to the office/clinic 8pm – 11pm, then its back to unpack the dishwasher, sandwiches and sleep….. 3) I go to bed extremely satisfied and wake up raring for the day ahead. 4) My commitment long term, so as not regret anything when I am 80; is that I have helped many people in my job, raised my kids to do their best and be humble. I also have for many years now look after (with great time and energy) my mother who is my inspiration to keeping focused and happy. Incapacitated with MS for 40 years she never complains and always has a smile on her face despite her pain and suffering. I can switch off like Susan when I take the 3 hour trip to visit my parents and although it is a full time job, those memories I have stored
Salt – Sea salt & rock salt -healthier options?
What is salt? Have you ever considered certain salt e.g Sea Salt or Rock Salt, may be better for you than others? At 121 dietitian we have been asked this very question. So you can see why we came to our conclusion we have provided some background info first. What is salt made from? Salt is made up of two minerals (sodium & chlorine). Sodium naturally occurs in many plant and animal foods but for most of us it is the salt in our diets which is our main source of sodium. 1g of sodium is the equivalent to 2.55g of salt. If you see sodium on a food table the easiest way to decide how much salt the food contains is to multiply the sodium by 2.5. Sodium x 2.5 = Salt in grams Why do we use salt? Salt is used in cooking to add flavour to foods, boost the flavour of other ingredients and to act as a preservative. Most of the salt we eat comes from pre-prepared foods (75%) rather than the salt we add at the table. Sea salt, rock salt or table salt is there a difference & which is better? Sea salt, rock salt and table salt all contain around 100% sodium chloride which means that too much of any of them will have a negative effect on your health. However rock salt & sea salt are often marketed as being a healthier or tastier option than table salt. Both are considerably more expensive than table salt. Sea salt is produced by the evaporation of sea water. It is argued that sea salt contains more minerals than table salt so is better for your health. However, just because it may contain extra minerals does not mean it is good for you. It would better to get these minerals from a balanced diet containing lots of fruit and vegetables than to consider sea salt as a healthy food. Rock salt is also known as halite. It is different to sea salt because it is already found in a solid form and then mined. Table salt (refined salt) can also be produced from solid salt which is found underground and then refined to remove any impurities. When the salt is being refined minerals such as calcium and potassium are often considered as impurities and so are removed in the refining process. Since 75% of the salt we eat is already in the foods we buy and no salt is a “healthy” option, we here @ 121 Dietitian suggest the cheapest and best decision you can make is to not add any extra salt at all. Instead try experimenting with other flavours such as herbs, spices, garlic, chillies, lemon & ginger. Which foods contain high levels of salt? We mentioned that 75% of the salt we consume is already in the foods we buy. Foods which often have a high salt level include bacon, cheeses, ready-made stocks, soy sauce, tomato ketchup, mustard, ham and ready-made sauces. Try to limit how often you use these products and where possible choose the reduced salt options. You can also use nutrition labels to compare salt content when no reduced salt options are available. What are the health effects of salt? In the body sodium is actually essential, it is required to maintain fluid balance and for nerve signalling. Despite this, as a nation we needn’t worry about deficiency. It is recommended that adults have no more than 6g salt per day. But the average intake shown in the last national diet & nutrition survey was 8.6g per day (with many people consuming more than this). Really all we need to maintain our health is only around 1g of salt (a pinch). Getting too much salt can be bad for our health. High intakes of salt are linked to increased blood pressure, which in turn can increase the risk of stroke and heart disease. Salt has also been linked to other conditions including osteoporosis, stomach cancer, kidney disease, kidney stones and obesity. It may also exacerbate the symptoms of asthma, Alzheimer’s and Diabetes. How much salt is too much? Recommended maximum salt intakes Age Maximum Salt Intake 0-6 months Less than 1g / day 6-12 months 1g / day 1-3 years 2g / day 4-6 years 3g / day 7-10 years 5g / day 11 years and above 6g / day If you found this article interesting you can find more information on the Action Salt website www.actionsalt.org.uk or chat to us @ 121 Dietitian: info@121dietitian.com Make sure you have the correct nutritious foods to get you off to a great start. Check out the 121Dietitian Shop Please visit my YouTube Channel. If you have enjoyed this blog we would love you to share this with your family and friends on your social media channels. Instagram Facebook Youtube X-twitter Linkedin
Have you heard about our mini assessment sessions?
We all know everyone likes to receive helpful advice, especially in terms of improving our diet, health and lifestyle. Check out 121Deititian mini sassessment sessions. Here at 121 Dietitian we provide this at various levels daily; to many clients who maybe in need of a little dietary direction, to business’ wishing to improve productivity and health in the workplace, to patients who have debilitating medical conditions, or to our media associates, food companies, nursing homes…. We realise however that even when interested, not everyone knows what they may need or has the time, money or medical condition to feel they require a visit to a Dietitian. We are now able to help with this dilemma … 121 Dietitian have set up a service just for this reason and we have been delighted with its success. Our specialist assessment sessions have gone from strength to strength, and it couldn’t be simpler. STEPS TO TAKE for a Mini Assessment: Download and complete the food diary and questionnaire found on the contact us page. Use the contact us page and request a mini Clinic appointment. When your appointment date and time is confirmed bring your food diary and questionnaire with you to the appointment. A Dietitian will assess your details, take some body composition measurements and then identify key positive changes that you may require. The clinic chat takes 20 minutes with a follow up email bringing the total time spent to 1 hour. The changes for you to consider making will be life long. If during the consultation you are suspected to have a undiagnosed medical condition or require blood tests we will direct you to your GP for these and review you. The cost of this consultation will be deducted from further appointments if required to attend for further personalised advice. Information checked & correct on 16th May 2018.
This valentine’s day take care of your heart!
Its national heart month and Valentine’s day so what can you do to help your heart? You may be taking a medication to lower your cholesterol or perhaps wishing to avoid the risk. By following some key advice it might be possible to manage your cholesterol reducing the need for medication. If you have high cholesterol, it is of concern, because over time plaque build up can lead to a blockage resulting in a heart attack or stroke. Test results should be broken down as follows: • HDL – “good” cholesterol. Aim to have a good level as HDL works to clean up your blood vessels. • LDL – “bad” cholesterol. Should be low. High levels can cause arterial plaque build up. • Triglycerides – You want this number to be low. Research has shown the following dietary changes to be effective in improving cholesterol levels . . . If your HDL cholesterol is too low you need to: • Exercise regularly, Eat monounsaturated fats and Omega-3’s: olive oil, almonds, walnuts, fatty fish, avocado, and flaxseed, Maintain a healthy body weight, Incorporate colourful fruits and vegetables such as beets, plums, red cabbage, and red grapes, Quit smoking, Limit simple carbohydrates such as white flour, sugar, and fizzy drinks, choose wholegrain foods, fruits and vegetable, pulses. If your LDL cholesterol is too high: • Limit your intake of saturated fats, Avoid hydrogenated oils (trans fat), Get adequate fibre from whole grains, legumes, fruits, and vegetables, Incorporate food high in antioxidants: rich colourful diet, Incorporate more healthy fats listed above. If your Triglycerides are too high: • Limit simple carbohydrates as above, Eat oily fish, Limit alcohol. Unsure what to eat? A Dietitian can create a personalised plan to assist you further. Pancake Day Of course at 121 Dietitian it hasn’t skipped our notice that today also happens to be pancake day. In honour of the occasion we’d also like to share with you an alternative pancake recipe! Apple & Cinnamon Batter Puddings. 55g plain wholemeal flour 25g light soft brown sugar 11/2tsp ground cinnamon 1 large egg 125ml semi skimmed milk 2 small apples 2 tsp sunflower oil Prep time 15 mins Baking time 20 mins Serves 4 Set oven to 220◦C and allow to preheat. Mix the flour, cinnamon & sugar in a bowl. Make a well in the centre of the flour. Add the egg to the well with a little milk & whisk together with the flour. Gradually whisk in the remaining milk. Make sure to draw the flour in from the sides of the bowl to mix into a smooth batter. Pour batter into a jug & set aside. Peel core & cut the apples into 8 wedges. Add 1/2tsp into each well of a Yorkshire oudding tin. Heat the tin in the oven for 2-3 mins. Remove the tin from the oven & place 4 apple wedges into each well ( be careful of hot oil splashes!) Stir the batter again before pouring it evenly into the wells over the apple wedges. Bake in the oven for around 20 mins or until the puddings are cooked, have risen and are nicely browned. Remove puddings & serve immediately. Information checked & correct on 16th May 2018.
