Vitamin D is an essential nutrient for overall health. Our bodies produce vitamin D when our skin is exposed to ultraviolet (UV) rays in sunlight. And vitamin D occurs naturally in some foods, is added to others, and is available as a supplement in the form of a pill or a drop. In order to use vitamin D, our bodies must first process it: first in the liver into 25-hydroxyvitamin D [25(OH)D], also known as calcidiol, and then in the kidneys into 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.
Vitamin D is very important for our health. It helps the gut absorb calcium, and the two together promote bone health and help prevent osteoporosis. It also helps with cell growth, neuromuscular and immune function, and reduces inflammation.
25(OH)D is the form of vitamin D that can be measured in the blood to identify deficiencies. The experts haven’t yet completely agreed on the levels that are associated with deficiency. But they have determined that persons are at risk of vitamin D deficiency if the level of 25(OH)D is below <30nmol/L. This blood test is very expensive in Canada and not routinely done unless there’s a suspicion of a deficiency. Testing should be done in people who are home-bound, those living in a long-term care facility (e.g., nursing home), persons with a medical condition that increases the risk of vitamin D deficiency or insufficiency, and those with osteoporosis, a history of a low-trauma fracture (e.g., fracture after fall from standing), or low blood calcium.
Intake of Vitamin D
Sun exposure
Even though most people produce some vitamin D from sun exposure, in Canada we don’t get enough sun to produce adequate levels of vitamin D. Factors affecting UV radiation exposure and vitamin D synthesis include:
- a person’s age (as we grow older our skin becomes less able to make vitamin D);
- the season (which determines both the hours and intensity of sunlight);
- the time of day;
- cloud cover (clouds reduce UV rays by 50%, shade by 60%);
- smog levels;
- skin melanin content; and
- the use of sunscreen. As we know, science is always evolving: In May, 2019, a British Journal of Dermatology study found an increase of vitamin D in participants during a week of cloudless weather in Tenerife, with a very high UV index, even when sunscreens were used properly and prevented sunburn. Sunscreens are necessary to prevent sunburn and skin cancer but I do not wear them in the early morning or late afternoon when the sun’s rays are less intense. I hope I get my dose of vitamin D for the day this way!
Food
There aren’t many food sources of vitamin D, so Osteoporosis Canada recommends supplementations for adults all year long.
Recommended doses of vitamin D:
- 400 – 1,000 IU daily for healthy adults 19-50 years of age
- 800 – 2,000 IU daily for healthy people over 50 or those younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption)
This table from Osteoporosis Canada lists some good food sources and their vitamin D content:
Food Serving Size IU's per Serving
Swordfish, Baked or Broiled 75 g 761
Salmon, pink, Canned, Drained with solids and bones 75 g 435
Cod Liver Oil 5 mL/1 tsp 426
Salmon (Sockeye), Baked or Broiled 75 g 394
Snapper, Baked or Broiled 75 g 392
Milk (all types) 1 c/250 mL 103-105
Soy Beverage, Enriched 1 c/250 mL 86
Yogurt, Plain, Vitamin D Added 175 g 82-113
Egg Yolk, cooked 2 Large 64
Tuna, canned in water, drained unsalted 75 g 60
Orange Juice, Fortified 1/2 c/125 mL 50
Margarine, fortified 5 mL/1 tsp 25-36
Mushrooms, white 125 mL/ 1/2 c 4
Supplements
In supplements and fortified foods, vitamin D is available in two forms, D2 (ergocalciferol) and D3 (cholecalciferol). Some experts recommend vitamin D3 rather than vitamin D2 because it is the naturally-occurring form and it may be more effective at raising vitamin D levels in our bodies.
The amount of vitamin D in multivitamins varies so read the labels carefully to ensure you’re getting the amount you need. And add up all the sources of vitamin D you ingest in a day to avoid taking too much. Just because some is good for you doesn’t mean 10 times more is even better! It is hard to overdose on vitamin D but very elevated levels of 25(OH)D can cause complications such as high blood calcium levels and can increase the risk of developing kidney stones.
Vitamin D Deficiency
Rickets (softening of the bones during childhood) and osteomalacia (softening of the bones in adults) are less common nowadays since many foods are now fortified with vitamin D. But deficiencies can result from certain diets (dairy allergy, lactose intolerance, ovo-vegetarianism, and veganism), not taking enough supplements, limited exposure to sunlight, poor absorption of vitamin D by the gut, and kidneys that cannot convert vitamin D to its active form.
Who’s at risk of vitamin D deficiency:
- Older adults and persons with dark skin – they have less ability to synthetize vitamin D from sunlight;
- People spending long periods of time (living or working) indoors with consequent limited exposure to sunlight;
- Persons with inflammatory bowel disease, celiac, ulcerative colitis, or Crohn’s Disease – they may have impaired gut absorption of vitamin D;
- People who are obese or who have undergone gastric bypass surgery.
Can we prevent diseases with vitamin D supplementation?
There’s good evidence that vitamin D helps prevent and treat bone-related disorders, but there’s now some conflicting evidence on the role of vitamin D in the prevention of falls and fractures.
Our bone isn’t static: at any given moment old bone cells are being broken down and new ones are being formed. As we age, and especially in women in postmenopause with decreased estrogen levels, the rate of bone breakdown is higher than the rate of bone formation. This can lead to low bone density (weak bones) and osteoporosis (porous bones), which in turn increases the risk of fractures.
Osteoporosis is most often associated with inadequate intake of calcium, but since vitamin D is needed to help calcium absorption into the bones, insufficient vitamin D also contributes to osteoporosis.
Vitamin D was thought to prevent fall and fractures in the elderly but this finding is being contested by the Health Research Council of New Zealand which has been looking at the literature published in the past on the role on vitamin D in fall and fractures. The authors say
Our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health…
These results aren’t being accepted by all in the field. Some say that “The results of the new meta-analysis do not contradict the beneficial effects of combining vitamin D with calcium supplementation for older patients”, and that “Bolland and colleagues included studies that used very high bolus doses of vitamin D, which are known to increase the risk of fractures or falls, also biasing the results”.
It is unclear if taking vitamin D supplements reduces the risk of cancer or cardiovascular disease. Dr. JoAnn Manson and her VITAL (VITamin D and OmegA-3 TriaL) research group conducted a trial that examined the effects of 2000 IU of vitamin D3 with or without 1000 mg of marine omega-3 fatty acids compared with placebo in over 25,000 people made up of men 50 and over and women 55 and over. The authors conclude that “Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo”.
Diabetes is a disease caused by the body’s not being able to produce insulin, or to utilize properly the insulin it does produce, resulting in high blood sugar (glucose) levels. Recently, a study in Brazil suggested that vitamin D may promote insulin sensitivity (the increased ability of the body to utilize insulin) and possibly lower blood sugar levels. In this trial, low levels of vitamin D were not proven to cause diabetes but may play a role in diabetes (type2). According to Dr. JoAnn Pinkerton, former Executive Director of NAMS (North American Menopause Society), my certifying body, “Vitamin D supplementation may help improve blood sugar control, but intervention studies are still needed”.
As a healthcare professional who believes in preventive care, I strive to provide advice based on the latest and most accurate evidence-based medicine, including for vitamin D and your health. With ongoing research sometimes what to recommend isn’t all that clear. For now I follow the advice of the Canadian Osteoporosis Society: “[vitamin D] …It helps build stronger bones by increasing the absorption of calcium. It also improves the function of muscles, which can improve your balance and decrease the likelihood of falling and suffering a fracture.”
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
References for “Vitamin D and Your Health: What is Vitamin D Good For?”
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
https://www.menopause.org/docs/default-source/press-release/vitamin-d-lowers-diabetes-risk-1-30-19.pdf
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30348-6/fulltext
https://www.sciencedaily.com/releases/2019/06/190619130303.htm
The yummy Mediterranean-style diet
/in Diet, Osteoporosis/by Teresa Isabel DiasI don’t know about you, but I don’t like fad diets, especially if they eliminate certain foods, because I like a variety of foods, that’s why I like the yummy Mediterranean-style diet!
My love for many types of foods may have originated in my being raised on the Mediterranean-style diet and this way of eating has served me well all my life. I’ve never been overweight (reasonable portions and regular exercise also help to keep an ideal weight), and I usually don’t crave anything. And, when I do crave something, I usually eat it and get it out of the way! That’s because I usually eat healthily and when I indulge I regard it as a treat not a sin.
When I speak (write!) about diet I don’t mean diet in the sense of eating a predetermined and limited number of calories, or a certain type of food only, or the exclusion of whole food groups, or avoiding ice cream and other delicious treats. To me diet is the way of eating. Diet is nutrition. Diet is eating healthy foods most of the time and eating something less healthy when I feel like it because I’m human.
I eat my vegetables and fruits happily and eagerly. I have some delicious salad recipes that are a whole meal in themselves, are very nutritious, and fill me up. It you are interested in some of these recipes look up lentils.org. I rarely eat red meat and I don’t miss it or crave it. I use very little added sugar and don’t buy processed foods. Meaning, I buy most of my food from the outer aisles of the supermarket (fresh produce, frozen veggies and fruits, cheese, milk). I don’t buy food that is packaged in boxes (which often has been processed in some way). I cook from scratch 3-5 times a week and eat leftovers often. I make a pot of soup every week and take a bowl to work for my lunch. I know what you’re thinking! OMG, that’s crazy, too much work, too much time, I can’t do that (even if I wanted to!).
But if you eat properly you feel better!
The Mediterranean-style diet is characterized by a high intake of plant-based foods—vegetables, fruits, whole grains, legumes, and nuts. Olive oil and some canola oil are the main fats and these are healthy unsaturated fats (think of healthy fats as those that remain liquid even at low temperatures, as at fridge temperature). Include a high intake of fish (it’s getting harder to eat good sustainable fish these days, though) and poultry (chicken and turkey—the lean meats) and limited red meat. And I saved the best for last—one glass of red wine.
Let me tell you what science is saying about the Mediterranean-style diet:
When you plan what you eat carefully (I make a weekly menu and shopping list) you are aware of what you’re eating and consciously include nutritious and healthy food in your meals and snacks.
This diet doesn’t have any negative side-effects and it will give a lot of pleasure to your taste buds!
But remember to mind how much you eat (portion size) because too much of a good thing is still bad.
Happy Fall, season of bounty. Enjoy the harvest and go for a walk after a wonderful Mediterranean-style diet dinner!
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Are you aging well?
/in Diet, Exercise/by Teresa Isabel DiasAre you aging well? A long time ago I worked in a pharmacy and many of my patients were senior citizens. They often told me “Oh dear! You don’t want to get old!” to which I always replied, “Yes I do. The alternative isn’t very good!”
Aging isn’t appealing and in a society that seems to value looking young over wisdom and experience we try to hide our aging in many ways. (BTW, I stopped colouring my hair!) The reality is, we can’t stop aging. Don’t let the anti-aging commercials for expensive products trick you into thinking that you can. We can’t stop aging but we can choose how we age.
Our choices include the food we eat, how much we move, how long we sleep, what thoughts we put into our heads, and how much stress we allow in and out of our lives.
A healthy lifestyle before old age helps us to age well. Proper nutrition, enough sleep, and exercise on a regular basis are for our senior health what RRSPs are for our retirement income, an investment.
The earlier we start investing the better the benefits. But it’s never too late to adopt healthy lifestyle habits. Habits are hard to form but if you keep at it you’ll get into the habit. Do you ever have to force yourself to brush your teeth before bed? No! Because your parents, probably, instilled that habit in you when you were young and now it’s routine, you don’t even have to think about it, you just do it. Many other good habits can become as regular as brushing your teeth. You just have to repeat them often enough until you do them naturally.
Eating nutritious food, exercising, and even positive thinking can be learned and incorporated into your lifestyle slowly and steadily until they become…a habit, a part of your daily and weekly life.
I’m not saying it’s easy. I’m saying it’s possible, if you want it to be! If you put in the effort. It’s an investment you can choose to make now in order to live better later.
To find out more about what you should be doing to age well, join me and Dr. Vivien Brown on Tuesday, September 17, at 6:30 PM. Dr. Brown will be talking about her book “A Woman’s Guide to Healthy Aging – Seven essential ways to keep you vital, happy and strong”. You can learn more and register here.
Dr. Vivien Brown is a family physician in Toronto, a well-known national and international speaker, and author of A Woman’s Guide to Healthy Aging – Seven essential ways to keep you vital, happy and strong. Dr. Brown is past President of the Federation of Medical Women of Canada, Former Chair of the Consumer Education Committee for the North American Menopause Society, board member of the Women’s Brain Health Initiative, and Health Choices First.
Let’s break the menopause taboo. Let’s talk about menopause.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Tips to improve hot flashes in hot weather
/in Hot flashes/by Teresa Isabel DiasI hope you are healthy, safe, content, and enjoying summer, wherever you are! If you are in a hot and humid place like I am—I’m in southern Ontario—you may find your hot flashes have become worse since the temperature has gone up because slight increases in body temperature can trigger hot flashes. It happens to me every summer. When I think my hot flashes are over, along comes the hot weather…
Here are some tips to improve your vasomotor symptoms (hot flashes and night sweats) in hot weather:
Wear layers
When you walk outside or ride the subway the heat can become stifling and you need to bare as much as is decent! If you work in an office the AC cools you down, sometimes too much, and it feels good to cover up with a light cardigan or a shawl (I even have a pair of stockings/knee highs in my desk to keep my feet from freezing at work). Wear loose-fitting clothes that allow air circulation.
Drink cold water
Use an insulated container to keep your water cold, and carry it with you. Drink often; this prevents dehydration and cools you down.
Cold water wash/spray
Washing hands and wrists in cold water is helpful in hot weather. Often! Applying cold water to the back of the neck and the forehead is also helpful. When I hike or paddle in hot weather, I use a headband soaked in cold water around my neck to keep from overheating. Carry a spray bottle with water and mist your face, chest, and neck when needed (more convenient to use on make-up free days!)
Carry a fan
Battery-operated fans are small and easy to carry, and they may give you the breeze you’re hoping for.
Cool your night
Taking a cold or lukewarm shower before bedtime washes away the sweat accumulated during the day and lowers your body temperature. We sleep better when our bodies are cooler, that’s why exercising just before bedtime isn’t recommend, since exercise increases your core temperature. Air conditioning—or a fan if AC isn’t available—during the night is essential if you suffer from night sweats (hot flashes that happen during sleep). You’ll sleep better in a dark, quiet, and cool room. I recommend sleeping with a sheet only (no duvet or blanket) and wear a loose nightgown that’s made of light and breathable material that doesn’t get soaked in case you sweat. Or wear nothing at all—very sexy and less laundry! If you have long hair, tying it up may keep your neck cooler. Try a silk pillow case. If your pillow gets hot during the night then store an ice pack under it and turn the pillow around often to cool your face. Keep icy water near your bed and sip on it. Keep a facecloth wrapped in an ice pack within reach and apply it to your forehead, back of the neck, and chest during a night sweat.
Whatever you do, don’t get frustrated or allow your mind to start thinking. Once you get anxious or upset about your night struggles you stimulate your brain and it’s harder to get back to sleep. Stay positive and mind your breath (just focus on your breath, no other thoughts) to fall back to sleep.
Exercise regularly
I know, exercising in hot weather can trigger hot flashes, but for some women—me included—lack of exercise (and too much sugar) makes hot flashes worse.
Avoid triggers
A cold beer or a glass of icy white wine feels great on a summer evening, but alcohol can worsen hot flashes. Caffeine and spices may also trigger hot flashes. And sugar….
Reduce stress
One of the worst hot-flash triggers for me is anxiety. Any little thought that causes even the slightest doubt in my mind—did I lock the front door this morning?—triggers a hot flash. (I was on vacation in a cold climate recently and I didn’t have a single hot flash for 11 days!) Yes, anxiety is hard to avoid in our stressful modern world. But Cognitive Behavioural Therapy (CBT) has been proven in trials to be helpful, and it has no adverse effects. In fact, once you learn it you can apply it in many other situations in life!
I read the book “Managing Hot Flushes and Night Sweats: A cognitive behavioural self-help guide to the menopause” written by two female doctors from the UK, Dr. Myra Hunter and Melanie Smith, and my hot flashes have never bothered me as much ever since. And I know of a few other women who benefited greatly from it as well. If you would like to buy a copy from me, email me. If you are not the type that can stick with a self-help program and prefer a coach or a group, there are many CBT specialists in the city. Not cheap, but your work insurance may cover it.
Hormone therapy (HT) is the most effective treatment for hot flashes, but if you can’t or don’t want to use HT there are a few non-hormonal treatments available too. The problem with the non-hormonal treatments is that they haven’t been studied to a great extent and some work better than others.
I hope these tips to improve hot flashes in hot weather help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Why Don’t Women Talk About Urinary and Vaginal Health?
/in Menopause, Sexual Health/by Teresa Isabel DiasAs a healthcare professional specializing in women’s health in midlife, I wonder – why don’t women talk about urinary and vaginal health?
It’s a really important question – why don’t women talk about urinary and vaginal health? We don’t mention it to our friends, partners, or even to our doctors, and the result is that women with symptoms suffer alone, and needlessly. The vagina and bladder are parts of the body, just like the nose and the fingers, yet somehow it’s OK to discuss a runny nose and manicure but no one talks about leaky bladders, dry vaginas, or painful sex.
With age, estrogen declines and because it is the main female hormone it has a big effect on the tissues, organs, and systems specific to women: breasts, uterus, ovaries, bladder (men have one too but the anatomy of their pipes is different!), vagina, and vulva.
I recently wrote a blog about this for Mompreneurs, which delves deeper into this topic. You can read the whole post here.
I want women who need treatment to get it.
You shouldn’t be inconvenienced by your bladder or vagina, or give up sex because it hurts. There are things you can do to improve your urinary and vaginal health.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Are you apple-shaped or pear-shaped?
/in Diet, Exercise/by Teresa Isabel DiasWomen come in all shapes and sizes. A new study found that postmenopausal women with normal weight have a higher risk of cardiac disease if they are apple-shaped rather than pear-shaped.
During the menopause transition when estrogen levels fluctuate and decline, weight gain is common and changes in body shape occur – fat tends to migrate to the middle of the body and deposit around the waist.
BMI or Body Mass Index is a tool that checks your weight against your height and is used by healthcare practitioners to determine if a woman is underweight, normal weight, overweight, or obese.
BMI Underweight Below 18.5 Normal 18.5–24.9 Overweight 25.0–29.9 Obesity 30.0 and AboveIt is known that the higher the BMI the higher the risk for certain diseases such as heart disease, high blood pressure, type-2 diabetes, gallstones, breathing problems, and certain cancers.
The total body fat in women with normal BMI isn’t associated with a higher risk of cardiovascular disease (CVD) but where these normal-weight women store their fat may determine their risk of heart attacks and strokes.
Results from research led by Dr. Qibin Qi, an associate professor at the Albert Einstein College of Medicine, New York (USA), on US postmenopausal women (predominantly white) found that higher belly fat (apple-shaped) was associated with increased risk of cardiovascular disease while higher leg fat (pear-shaped) had a lower risk of CVD. Women with high belly fat and high leg fat had a three-times increase of CVD.
Are you apple-shaped or pear-shaped?
Why is accumulation of fat around the belly (apple-shaped rather than pear-shaped) detrimental for heart health of postmenopausal women?
Because fat stored around the belly is not only skin deep, it is also inside the body covering the organs. Fat stored around the organs in the abdomen increases risk of certain diseases such as diabetes, higher cholesterol levels, inflammation, and heart disease. The reason why fat accumulated around the legs may protect women from disease isn’t completely understood but it may be because it doesn’t cause problems in other parts of the body.
Science shows that being overweight and obese is detrimental to your overall health, but so is being apple-shaped without being overweight. Where does that leave you if your body weight, BMI, and body-shape put you at increased risk for disease?
Dr. Qui said “While there have been some large studies of genetic determinants of upper- and lower-body fat, fewer large studies have focused on lifestyles factors, though modifiable factors such as physical activity and dietary intakes are thought to play key roles in determining an individual’s fat distribution”.
That means that the food you eat and the amount and type of physical activity you do play an important role in how much and where you accumulate fat.
You can’t change your genes but what you eat and what you do in terms of physical activity are yours to choose. Some choices are easier than others. But if you are apple-shaped and not doing anything it may cost you your life. So why not try something?
I know it isn’t easy. I work at it every day. Due to family history I have a higher risk of diabetes and my hips are narrow, making me a good candidate for being apple-shaped if I don’t watch what I eat and what I do.
The most helpful thing, I believe, is to make good choices a habit in your life. Because once you’re doing something by habit you aren’t struggling to do it. Do you huff and puff and complain every time you brush your teeth? No, it’s been a long habit.
Until good nutrition and proper exercise become part of your daily or weekly routine—until they become a habit—it will be hard to keep at it. But if you stick with it for 3 months, at least, the more likely you are to succeed.
Here are some tips for good nutrition and physical activity:
Eat wisely:
Be physically active:
Be kind to yourself:
Don’t do it alone:
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
What is Vitamin D Good For?
/in Diet, Osteoporosis/by Teresa Isabel DiasVitamin D is an essential nutrient for overall health. Our bodies produce vitamin D when our skin is exposed to ultraviolet (UV) rays in sunlight. And vitamin D occurs naturally in some foods, is added to others, and is available as a supplement in the form of a pill or a drop. In order to use vitamin D, our bodies must first process it: first in the liver into 25-hydroxyvitamin D [25(OH)D], also known as calcidiol, and then in the kidneys into 1,25-dihydroxyvitamin D [1,25(OH)2D], also known as calcitriol.
Vitamin D is very important for our health. It helps the gut absorb calcium, and the two together promote bone health and help prevent osteoporosis. It also helps with cell growth, neuromuscular and immune function, and reduces inflammation.
25(OH)D is the form of vitamin D that can be measured in the blood to identify deficiencies. The experts haven’t yet completely agreed on the levels that are associated with deficiency. But they have determined that persons are at risk of vitamin D deficiency if the level of 25(OH)D is below <30nmol/L. This blood test is very expensive in Canada and not routinely done unless there’s a suspicion of a deficiency. Testing should be done in people who are home-bound, those living in a long-term care facility (e.g., nursing home), persons with a medical condition that increases the risk of vitamin D deficiency or insufficiency, and those with osteoporosis, a history of a low-trauma fracture (e.g., fracture after fall from standing), or low blood calcium.
Intake of Vitamin D
Sun exposure
Even though most people produce some vitamin D from sun exposure, in Canada we don’t get enough sun to produce adequate levels of vitamin D. Factors affecting UV radiation exposure and vitamin D synthesis include:
Food
There aren’t many food sources of vitamin D, so Osteoporosis Canada recommends supplementations for adults all year long.
Recommended doses of vitamin D:
This table from Osteoporosis Canada lists some good food sources and their vitamin D content:
Supplements
In supplements and fortified foods, vitamin D is available in two forms, D2 (ergocalciferol) and D3 (cholecalciferol). Some experts recommend vitamin D3 rather than vitamin D2 because it is the naturally-occurring form and it may be more effective at raising vitamin D levels in our bodies.
The amount of vitamin D in multivitamins varies so read the labels carefully to ensure you’re getting the amount you need. And add up all the sources of vitamin D you ingest in a day to avoid taking too much. Just because some is good for you doesn’t mean 10 times more is even better! It is hard to overdose on vitamin D but very elevated levels of 25(OH)D can cause complications such as high blood calcium levels and can increase the risk of developing kidney stones.
Vitamin D Deficiency
Rickets (softening of the bones during childhood) and osteomalacia (softening of the bones in adults) are less common nowadays since many foods are now fortified with vitamin D. But deficiencies can result from certain diets (dairy allergy, lactose intolerance, ovo-vegetarianism, and veganism), not taking enough supplements, limited exposure to sunlight, poor absorption of vitamin D by the gut, and kidneys that cannot convert vitamin D to its active form.
Who’s at risk of vitamin D deficiency:
Can we prevent diseases with vitamin D supplementation?
There’s good evidence that vitamin D helps prevent and treat bone-related disorders, but there’s now some conflicting evidence on the role of vitamin D in the prevention of falls and fractures.
Our bone isn’t static: at any given moment old bone cells are being broken down and new ones are being formed. As we age, and especially in women in postmenopause with decreased estrogen levels, the rate of bone breakdown is higher than the rate of bone formation. This can lead to low bone density (weak bones) and osteoporosis (porous bones), which in turn increases the risk of fractures.
Osteoporosis is most often associated with inadequate intake of calcium, but since vitamin D is needed to help calcium absorption into the bones, insufficient vitamin D also contributes to osteoporosis.
Vitamin D was thought to prevent fall and fractures in the elderly but this finding is being contested by the Health Research Council of New Zealand which has been looking at the literature published in the past on the role on vitamin D in fall and fractures. The authors say
Our findings suggest that vitamin D supplementation does not prevent fractures or falls, or have clinically meaningful effects on bone mineral density. There were no differences between the effects of higher and lower doses of vitamin D. There is little justification to use vitamin D supplements to maintain or improve musculoskeletal health…
These results aren’t being accepted by all in the field. Some say that “The results of the new meta-analysis do not contradict the beneficial effects of combining vitamin D with calcium supplementation for older patients”, and that “Bolland and colleagues included studies that used very high bolus doses of vitamin D, which are known to increase the risk of fractures or falls, also biasing the results”.
It is unclear if taking vitamin D supplements reduces the risk of cancer or cardiovascular disease. Dr. JoAnn Manson and her VITAL (VITamin D and OmegA-3 TriaL) research group conducted a trial that examined the effects of 2000 IU of vitamin D3 with or without 1000 mg of marine omega-3 fatty acids compared with placebo in over 25,000 people made up of men 50 and over and women 55 and over. The authors conclude that “Supplementation with vitamin D did not result in a lower incidence of invasive cancer or cardiovascular events than placebo”.
Diabetes is a disease caused by the body’s not being able to produce insulin, or to utilize properly the insulin it does produce, resulting in high blood sugar (glucose) levels. Recently, a study in Brazil suggested that vitamin D may promote insulin sensitivity (the increased ability of the body to utilize insulin) and possibly lower blood sugar levels. In this trial, low levels of vitamin D were not proven to cause diabetes but may play a role in diabetes (type2). According to Dr. JoAnn Pinkerton, former Executive Director of NAMS (North American Menopause Society), my certifying body, “Vitamin D supplementation may help improve blood sugar control, but intervention studies are still needed”.
As a healthcare professional who believes in preventive care, I strive to provide advice based on the latest and most accurate evidence-based medicine, including for vitamin D and your health. With ongoing research sometimes what to recommend isn’t all that clear. For now I follow the advice of the Canadian Osteoporosis Society: “[vitamin D] …It helps build stronger bones by increasing the absorption of calcium. It also improves the function of muscles, which can improve your balance and decrease the likelihood of falling and suffering a fracture.”
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
References for “Vitamin D and Your Health: What is Vitamin D Good For?”
https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/
https://www.menopause.org/docs/default-source/press-release/vitamin-d-lowers-diabetes-risk-1-30-19.pdf
https://www.thelancet.com/journals/landia/article/PIIS2213-8587(18)30348-6/fulltext
https://www.sciencedaily.com/releases/2019/06/190619130303.htm
Teresa on Living a Better Life Podcast with Madelaine Golec
/in Menopause/by Teresa Isabel DiasRecently I was the featured guest on the podcast Living a Better Life with Madelaine Golec.
At my first Mompreneurs Conference in 2019, Madelaine was one of the women listening to me talk about menopause (what else?). She is a Registered Physiotherapist/ Pelvic Floor Physiotherapist who graduated from the McMaster University Physiotherapy Program in 2012. As a pelvic floor specialist she sees and helps many women in menopause and wanted to learn more about what women go through during this phase of life.
I, on the other hand, having counselled many women with urinary incontinence, organ prolapse, and other genitourinary problems, was very interested in knowing more about how Madelaine helps women improve their symptoms.
We had a very interesting conversation which led to my being her guest on her podcast, Living a Better Life with Madelaine Golec . You can listen to our conversation here: Episode 6- Perimenopause and Menopause, which aired in May 2019 but is timeless. It is timeless because all women will go through menopause, a natural and normal stage of life. As timeless as the many physical, cognitive, and emotional changes of the menopause transition are.
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Teresa speaking about menopause at PxP2019
/in Menopause/by Teresa Isabel DiasLast week I enjoyed speaking about menopause at PxP2019 —on demystifying hormone therapy (HT)—to pharmacists from across Canada. Pharmacy Experience Pharmacie (PxP2019) is joint Canadian Pharmacists Association and Ontario Pharmacists Association conference.
I also wrote a blog for the Ontario Pharmacists Association last year in which I explained the misconceptions about HT:
About 80 per cent of women report vasomotor symptoms (VMS) such as hot flashes and night sweats, and other symptoms. Menopause not only impacts women, but also their partners, children, family, friends and co-workers. Hormone therapy (HT) is the most effective treatment for menopausal symptoms such as hot flashes, night sweats and vaginal dryness, so why are there so few women on HT?
The Women’s Health Initiative (WHI) Trial aimed at supporting observational data that demonstrated that estrogen alone or estrogen plus a progestin may have a preventative effect on heart disease, hip fracture and colon cancer among other conditions. The trial of the estrogen plus progestin arm was stopped early due to an increase risk of heart disease, stroke, blood clots, and breast cancer. The way the results were announced in July 2002, and the media, helped to propagate the fear that HT increased the risk of breast cancer and heart attacks without explanation of the magnitude of the risks. This was a big disservice for menopausal women. Women and healthcare providers weren’t advised properly on how to interpret the results of the trial and abandoned HT altogether.
One of my customers literally dumped her estrogen tablets in the toilet and came to see me in the pharmacy three days later with severe menopause symptoms. If I knew then what I know now, and if my scope of practice at the time had permitted, I would have renewed her prescription!
With all the emphasis on the risks of HT, the benefits of HT for the relief of VMS and the treatment of vaginal atrophy were largely ignored. The positive effects of HT on the prevention of certain diseases like osteoporosis and osteoporotic fractures, diabetes, and, in women on the estrogen plus progestin arm, colon cancer, were insufficiently acknowledged.
Not surprisingly, women’s decisions regarding HT are surrounded by anxiety and confusion and new medical graduates lack appropriate training in the management of menopausal symptoms and HT. Many menopausal women are untreated, some are undertreated, and too many suffer needlessly.
My aim in speaking about menopause at PxP2019 was to educate pharmacists so they can help their female patients.
You can read more on this important topic in the blog that I wrote for the Ontario Pharmacists Association, here.
And remember, there’s help, I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Teresa’s interview with Mompreneurs
/in Menopause/by Teresa Isabel DiasMompreneurs® is a group dedicated to supporting, educating, and empowering moms in business. I’m a Mompreneurs member and their website features an interview they did with me. My interview with Mompreneurs allowed me to expand on the reasons that I became interested in promoting menopause education:
I was in my mid 40’s when I started experiencing perimenopause… I was irritable, impatient…and…yelling at my kids… One day my older son asked me if I was bipolar. I wasn’t, but that made me seek help. I started looking on the internet. With my training as a pharmacist I knew what a science-based website was supposed to teach but most of what I found was marketing disguised as information.
And why I became an entrepreneur:
I became an entrepreneur so I can run a business according to the needs, values, and expectations of my clients. Doctors have, on average, 8 minutes to talk to their patients, and pharmacists don’t have a lot of time either, nor privacy in the pharmacy, to talk about intimate issues like menopause with women. Menopause education can’t be done in a few minutes in front of a lineup of people. It’s a personal, private matter.
You can read the full interview with Mompreneurs here.
And remember, there’s help, I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.
Who should know about the hormonal changes of midlife?
/in Hormone therapy, Menopause/by Teresa Isabel DiasMost women are not prepared for the hormonal changes of midlife.
Women in their late–30s and early–40s who have not yet experienced any changes will benefit from knowing what to expect. Understanding what the body and mind will go through when hormones start fluctuating reduces anxiety and confusion and increases wellbeing.
Women going through the menopause transition, 40+, benefit from knowing that this is a normal and natural phase of life and if their quality of life, relationships, and work is negatively affected it is reassuring to know there’s help. I can help you! If I cannot help directly, I can still save women angst, time, and money by directing them to the most appropriate healthcare providers that will take care of their needs.
Women postmenopause, 50+, benefit from knowing that reduced estrogen increases their risk for certain diseases (such as heart attacks, osteoporosis, and dementia) and that they should adopt healthy lifestyles (including proper nutrition, sleep, and exercise) to prevent disease and to stay engaged, vital, and active.
Older woman on a park bench
Employers of women 40+ benefit from knowing that even though not every woman has a hard time during the menopause transition, the 80% who do experience changes will benefit from education and support. Most women do not connect their experiences with hormonal changes and do not receive optimal support and care during this natural and normal phase of life. With awareness and education about menopause in the work place (i.e. Lunch & Learns and Wellness Clinics), employers can help midlife women reduce absenteeism and improve quality of life and work. It’s a win-win situation for employers and employees.
Women with breast cancer and other cancers may suffer induced menopause due to certain cancer treatments and experience severe symptoms due to the sudden decrease in estrogen that greatly affect their quality of life. Being deprived of estrogen under 40 also increases the risk for certain diseases such as heart attacks, osteoporosis, and dementia.
Partners, offspring, family, friends, and co-workers of women 40+ benefit from knowing that all women go through menopause and that the hormonal changes of midlife can cause mood swings, anxiety, crying spells, irritability, brain fog, etc., which may affect their quality of life, relationships, and work.
And remember, there’s help, I can help you!
Teresa Isabel Dias is a pharmacist and Certified Menopause Practitioner (NCMP) who provides education and support on symptom management for women at work and at home so they’ll feel like themselves again and enjoy a vibrant and productive life.
Grab a quick guide and subscribe to the MenopausED Newsletter on the MenopausED home page.
If would like to know how Teresa can improve your menopause transition then schedule a complimentary Discovery Call at MenopausED.org.