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Vitamin D – A Review

September 21, 2023
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by Dr. Bauer
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By Dr. Meghan Bauer ND

Vitamin D has a chemical structure like a hormone yet it’s classified as a vitamin.  We can make it from a reaction in our skin with the sun and we can eat it as a nutrient (food and supplement).  If this sounds like a riddle it’s because it is.  Vitamin D has long been known for its necessity in absorption and retention of calcium and phosphorus for our bones but we find receptors for the vitamin throughout our bodies.

In recent years, researchers have been trying to unravel the full picture of Vitamin D and what we need it/use it for. So far we know that it is involved in cardiovascular health, cognitive health, bone health, cancer survivorship, improved outcomes in individuals with diabetes type II, autoimmune diseases like MS, control of inflammation and in general immune health.

A large scale review of all of the literature on Vitamin D was done in 2014 and the authors concluded that “Despite a few hundred systematic reviews and meta-analyses, highly convincing evidence of a clear role of vitamin D does not exist for any outcome, but associations with a selection of outcomes are probable” [10].

One area where the research is more robust and conclusive is with Vitamin D and our immune system, in particular it’s been well studied for its relationship with the common cold and the flu. Here’s a brief run down of the connections we have evidence for as it relates to the role of Vitamin D and the common cold and flus:

  • Vitamin D levels are lowest in the winter months [1].
  • The active form of vitamin D, D3, tempers the damaging inflammatory response of some white blood cells, while it also boosts immune cells’ production of microbe-fighting proteins [1].
  • Children who have vitamin D-deficiency rickets are more likely to get respiratory infections, while children exposed to sunlight seem to have fewer respiratory infections [1]. 
  • Adults who have low vitamin D levels are more likely to report having had a recent cough, cold, or upper respiratory tract infection [2].
  • A large meta-analysis of individual participant data indicated that daily or weekly vitamin D supplementation lowers risk of acute respiratory infections. [4] This effect was particularly prominent for very deficient individuals.
  • The findings from this large meta-analysis have raised the possibility that low vitamin D levels may also increase risk of or severity of novel coronavirus 2019 (COVID-19) infection. Although there is no direct evidence on this issue because this such a new disease, avoiding low levels of vitamin D makes sense for this and other reasons [4].
  • A Systematic Review in October, 2022 concluded that: “Vitamin D supplementation is effective in reducing the COVID-19 severity. Hence, vitamin D should be recommended as an adjuvant therapy for COVID-19.However, more robust and larger trials are required to substantiate it further” [9].

An interesting randomized controlled trial in Japanese school children tested whether taking daily vitamin D supplements would prevent seasonal flu.  The trial followed nearly 340 children for four months during the height of the winter flu season. Half of the study participants received pills that contained 1,200 IU of vitamin D; the other half received placebo pills. Researchers found that type A influenza rates in the vitamin D group were about 40% lower than in the placebo group; there was no significant difference in type B influenza rates.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. The American journal of clinical nutrition. 2010 May 1;91(5):1255-60.

Even without all of the details of how Vitamin D is working we have been able to understand that avoiding a vitamin D deficiency is key for overall health. Vitamin D is often the most common supplement that I see patients taking however I routinely see low levels of Vitamin D on testing. Make sure to get your levels tested and supplement accordingly.

The recommended daily intake is 600 – 800 IU’s/day however more is often needed to climb out of a deficiency. Please check with your health care providers for your best dosing strategy!

References (some of many!)

  1. Cannell JJ, Vieth R, Umhau JC, Holick MF, Grant WB, Madronich S, Garland CF, Giovannucci E. Epidemic influenza and vitamin D. Epidemiology & Infection. 2006 Dec;134(6):1129-40.

2. Ginde AA, Mansbach JM, Camargo CA. Association between serum 25-hydroxyvitamin D level and upper respiratory tract infection in the Third National Health and Nutrition Examination Survey. Archives of internal medicine. 2009 Feb 23;169(4):384-90.

3. Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. The American journal of clinical nutrition. 2010 May 1;91(5):1255-60.

4. Martineau AR, Jolliffe DA, Hooper RL, Greenberg L, Aloia JF, Bergman P, Dubnov-Raz G, Esposito S, Ganmaa D, Ginde AA, Goodall EC. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ. 2017 Feb 15;356:i6583.

5. Zasloff M. Fighting infections with vitamin D. Nature medicine. 2006 Apr;12(4):388-90.

6. Nnoaham KE, Clarke A. Low serum vitamin D levels and tuberculosis: a systematic review and meta-analysis. International journal of epidemiology. 2008 Feb 1;37(1):113-9.

7. Autier P, Gandini S. Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Archives of internal medicine. 2007 Sep 10;167(16):1730-7.

8. Holick MF. Vitamin D: importance in the prevention of cancers, type 1 diabetes, heart disease, and osteoporosis. Am J Clin Nutr. 2004; 79:362-71

9. Shah K. Does Vitamin D Supplementation Reduce COVID-19 Severity?: a systematic review. QJM. 2022 Oct 25; 115(10): 665 – 672.

10. Theodorateu E. et al. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomized trials. BMJ. 2014 April 1; 348.

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“Immune Debt”? “Immune Robbery”? Why Are Our Children so Sick?

January 17, 2023
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by Dr. Bauer
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By Dr Meghan Bauer ND
December 16, 2022

Children's Immune Health

My kids have been sick since September, or have they? Are their never-ending drippy noses, dry coughs, and dark circles under their eyes an actual illness?  I’ve noticed a difference in the way they are getting sick.  Could this be related to a ‘post COVID’ factor and if so, what’s happening?  Are children who had mild infections with COVID 19 and who do not have Long COVID seeing changes to their immune systems?

Thanks to recent and somewhat controversial discussion about the possibility of post COVID immune changes as well as warranted concern and alarm about the ‘triple-demic’ of respiratory viruses (COVID, Influenza and RSV) I’ve been able to explore this idea with some expert opinions and recent studies. 

“Immunity Debt”

A speculative theory that pandemic restrictions and lockdowns have created a harmful “immunity debt” for children because of decreased exposure to regular viral infections. “There is no evidence that an individual is worse off for having avoided earlier infection” states Anjana Ahuja, author of a recent and strongly held opinion piece in the Financial Times called “’Immunity debt’ is a Misguided and Dangerous Concept.”

Deborah Dunn-Walters, professor of Immunology at the University of Surrey, says “Immunity debt as an individual concept is not recognised in immunology,” “The immune system is not viewed as a muscle that has to be used all the time to be kept in shape.” She says it’s important to distinguish between individual and population immunity (herd immunity) when assessing how pandemic measures may have altered the spread of non-COVID diseases.

Is COVID 19 Dysregulating our Immune System?

A recent and well rounded debate on TVO’s The Agenda explores this question with a panel of experts.

“If you look at certain immune markers in our blood there are changes that are long lasting.  It’s not full recovery as of yet.” says Baltimore, Maryland’s, T cell Immunologist Anthony Leonardi about post COVID changes to our immune system.

Colin Furness, infections control epidemiologist at the University of Toronto coined the theoretical term “Immunity robbery” on Twitter. “When a virus harms your immune response, making you more susceptible to subsequent infections.” He warns that “Recent data about kids with RSV suggests that maybe some kids are having a really bad immune suppression problem. Immune harm would help to explain some of these observations.” “I hope I’m wrong” he adds.

Dr. Allison McGeer, Medical biologist, and Infectious disease specialist at Mt. Sinai Hospital cautions that it’s difficult to tease out the impact on individuals who had mild omicron infections.  And hypothesises that it is unlikely that there’s going to be a long-term impact that is clinically significant for most people.

What this says about our children’s health and possible immune changes I’m not sure.  With an unlikely immune debt and a potential for some immune change after infection with COVID 19 I’m left with more questions than answers and a familiar feeling of the liminal COVID experience. Hopefully with continued, open-minded debate and focused research we will be able to gain increased clarity on what and how exactly this impactful virus continues to affect us.  In the meantime, I’m thankful that at least my husband has sick days available and that we’ve become unwilling experts at juggling kids and work and life, or have we?

*** Consider a naturopathic consultation for strategies to improve immune health.  We might not understand yet how COVID is affecting us in the long term but we do know how to help support our immune system in general. Naturopathic Dr’s use evidence-based strategies to help support our immune system from different angles such as fostering a healthy microbiome, improving our stress response, and optimizing vitamins and nutrients like Vitamin D.

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Best Nutritional Sources of Magnesium – The Relaxing Mineral

January 19, 2018
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by Dr. Bauer
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Best Nutritional Sources of Magnesium – The Relaxing Mineral
By: Dr Meghan Bauer BSc ND

Magnesium is readily available in food yet most people still have a deficiency.  You know those twisting foot or calf cramps in the middle of the night? They’re trying to tell you something.  Actually, they’re trying to tell us something – I get them all the time!  I’ve been getting the toe scrunching, tightening, overlapping type as long as I can remember.  I used to swim competitively and my coach didn’t believe me when I had to stop every workout (x3) and stretch out my toes.  All I needed was a little magnesium, or likely a lot of magnesium.

Magnesium is necessary for over 300 functions in the body; it is involved in protein synthesis, muscle and nerve function, bone formation, energy production, sugar balance and maintenance of a healthy heart among many other functions. (nih.gov, 2014)  With intense workouts I was likely monopolizing my circulating magnesium for energy production at the expense of muscle relaxation.  Hence the cramping muscles.

Magnesium makes us feel relaxed on all levels; mind and body.  It relaxes our muscles, it relaxes our bowels, and it relaxes our mind.  A perfect combination for a good night’s sleep.  Although, do watch out for that second one as there is such a thing as taking too much magnesium and reaching what is called “bowel tolerance.” With that said optimizing magnesium with diet or a supplement is an easy, safe and effective way to calm before bed and make for a deep, relaxing and restorative sleep.

With relaxation, energy, muscles, nerves, sugar balance, heart function and bone growth as magnesium’s top priorities the symptoms of a deficiency can be unclear and easily undiagnosed.  Here’s a list of the top symptoms associated with a mild to moderate magnesium deficiency:

  • Hyper-excitability
  • Muscle symptoms; cramps, tremors, twitches, spasms, weakness, (eye twitches!)
  • Fatigue
  • Loss of appetite
  • Confusion
  • Apathy
  • Difficulty sleeping
  • Irritability
  • Poor memory

As well as specific symptoms that speak to a magnesium deficiency there are a host of conditions that have been associated with a magnesium deficiency:

  • Anxiety & Depression
  • Insomnia
  • Hormone imbalance and PMS
  • Chronic fatigue syndrome
  • Constipation
  • Tension and/or migraine headaches
  • Osteoporosis
  • Type II diabetes
  • Heart attack

Often times a magnesium supplement is needed to optimize healthy levels if a deficiency state with symptoms has been reached.  Ideally though, we get all the magnesium we need from our diet.  Enter, leafy green vegetables and chocolate.

Here’s a list to support the last two lists.  These magnesium rich foods will do the trick if eaten regularly; 2-3 servings/day.

(Men RDA 400 milligrams and Women RDA 310 milligrams a day)

  • Spinach — 1 cup: 157 milligrams (40% DV)
  • Chard — 1 cup: 154 milligrams (38% DV)
  • Pumpkin seeds — 1/8 cup: 92 milligrams (23% DV)
  • Yogurt or Kefir — 1 cup: 50 milligrams (13% DV)
  • Almonds — 1 ounce: 80 milligrams (20% DV)
  • Black Beans — ½ cup: 60 milligrams (15% DV)
  • Avocado — 1 medium: 58 milligrams  (15% DV)
  • Figs — ½ cup: 50 milligrams (13% DV)
  • Dark Chocolate — 1 square: 95 milligrams (24% DV)
  • Banana — 1 medium: 32 milligrams (8% DV)

Luckily for us this list is full of some delicious foods!  Do you need to optimize your magnesium and how are you going to do it?  Please feel free to share any magnesium rich recipes!  Does chocolate, avocado ice cream exist?

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The Importance of Sleep

March 10, 2016
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by Dr. Bauer
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Is it possible for something as routine as sleep to be trendy? I’m announcing 2016 as the year of sleep. Well, maybe Arianna Huffington tipped me off but I’m corroborating her observation. I’ve been helping people sleep naturally for almost a decade now, and something has changed in the past short while – we have started to think about sleep as important. We’ve started to prioritize it. What’s changed? And now that it’s trendy are there more or better solutions for a good night’s sleep?

 

Arianna Huffington’s post for LinkedIn in December 2015 speaks to the need for this change. She states,

“We’re in the middle of a sleep deprivation crisis, with devastating effects on our health, our job performance, our relationships, and our happiness.”

Although all important, my suspicion is that the effect of sleep deprivation on job performance is really pushing sleep health to the top of the charts. Recent large-scale studies on productivity certainly help us to prioritize sleep. One led by Harvard Medical School researcher Ronald C. Kessler demonstrates that insomnia costs the average American worker 11.3 days and $2,280 in “lost productivity” each year.

 

According to a GALLUP poll conducted in 2013, in 1942 only 11 percent of Americans were getting less than six hours of sleep a night. Today, 40 percent are getting less than six hours. This likely accounts for an increase in prescription sleeping pills and for the influx of individuals seeking natural support for sleeping well. In my clinical practice I am seeing a decrease in the amount of hours people are allocating to sleep as well as an increase in sleep disorders like insomnia – a recipe for sleep deprivation.

 

Anyone who has experienced sleep deprivation knows that it is all consuming and often carries a pattern, both physiologically and mentally, that is hard to break. Research has shown poor sleep to affect our weight, mood, memory retention, productivity, immune system, detoxification, and how we handle and respond to stress.   However, it is stress that instigates a Catch 22; the less sleep we have the more stressed we are and the harder it is to sleep.

 

Our physiological way of adapting to stress is to increase levels of stress hormones, like cortisol, that help us to stay alert and “run away from the bear.” When the stressor is lack of sleep this response doesn’t make as much sense. Sleeping and waking are at different ends of the physiological spectrum and they often get a little mixed up; alert and on at night and sleepy and shut down during the day. The support we often reach for to cope like coffee, sugar and other stimulants during the day and alcohol and sleeping pills at night have a spill over effect and end up affecting sleep quality at night and alertness during the day. Not an ideal solution.

 

So, what do we do about it? The answers are usually found in the roots of the problem and sleep is no exception. In the case of sleep, this means a complex solution and often a multi faceted approach:

 

  • Set aside time each day to slow down. At least for an hour or two before bed and ideally at some other points throughout the day. Slow down physically but also mentally with tools like yoga, mindfulness meditation, deep breathing and exercise on a routine basis. There’s reason yoga, and now mindfulness practices have sprouted in North America – we need them!
  • Support your stress response and nervous system. See tip #1. Consume a healthy and whole foods diet with as little sugar as possible. Take a B complex vitamin for stress and nervous system support and provide yourself with as much rest and routine as possible. Treat yourself like a baby; eat and sleep on a schedule to provide your body with a reliable and stress-free experience.
  • Avoid sleep & wake cycle disrupters. Limit or avoid sugar, coffee, alcohol and other stimulants. It will take some time to break the cycle but with the other supports in place it will be much smoother. For at least one hour before bed turn off all electronic devices such as TV, computers, tablets and cell phones. The blue light emitted from electronic devices inhibits our necessary sleep hormone, melatonin. Inversely, sleeping in complete darkness will stimulate the production of melatonin and support a clear sleep cycle.
  • Address other areas of your life that might be causing stress. A big one but one where we need to be honest and make real choices; are you happy in your job? Relationship? On a creative level? Without changing and creating our best course, most other efforts will be constantly pushing uphill. You don’t have to solve it all over night but work on listening to yourself and your body. The nagging repetitive thought in the middle of the night might be trying to tell you something!
  • Seek professional help. If the above doesn’t feel like enough consult a health care provider for more tools and support to regulate the stress response, quiet the mind, and for other health concerns that may be affecting your sleep (hormones, sugar balance, chronic pain, respiratory concerns or allergies), and generally someone to help you stick with it!

 

Sleep might be trendy right now but ultimately it’s reliant on your overall health and wellbeing throughout your life. Take care and sleep well!

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What’s the Beef? A Discussion About Processed Meat & Cancer

November 19, 2015
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by Dr. Bauer
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What’s the Beef? Taking a naturopathic look at the recent report put out by the WHO classifying processed meat as a cancer-causing agent.

By Dr. Meghan Bauer ND

 

Processed Meat

In October 2015, 22 scientists from ten countries met at the International Agency for Research on Cancer (IARC) in Lyon, France, to evaluate the carcinogenicity of the consumption of red meat and processed meat. The Working Group assessed more than 800 epidemiological studies that investigated the association of cancer with consumption of red meat or processed meat in many countries, on several continents, with diverse ethnicities and diets. The Working Group classified consumption of processed meat as “carcinogenic to humans” (Group 1) on the basis of sufficient evidence for colorectal cancer. They classified consumption of red meat as “probably carcinogenic to humans” (Group 2A).

What does this report mean for our shopping lists and best health strategies? I’ve prepared a list of questions and answers to get to the bottom of it!

 

What is red meat and what is processed meat?

 Red meat is any meat that comes from a mammal. That means meat from cows, pigs, sheep, horses, goats and bison all count as red meat.

Processed meat includes any meat that isn’t fresh. This category can include processed red meat as well as poultry and fish. Processed meat according to the panel, has been modified from its natural state either “through salting, curing, fermentation, smoking, or other processes to enhance flavour or improve preservation”.

 

What is the risk of developing cancer from eating red and processed meat?

It is important to understand that this report is focussed on association between processed meat and cancer and does not clarify risk. For example, cigarettes and asbestos are also classified in Group 1 as carcinogenic to humans but they have a stronger risk of developing cancer. Eating processed meat is not as harmful as smoking cigarettes although they are both carcinogenic. The IARC looks at strength of evidence and they have found enough evidence to say with certainty that processed meat can cause cancer and that red meat can probably cause cancer.

With this said, a meta analysis of colorectal cancer in ten of the cohort studies reported a statistically dose-response relationship, with a 17% increase risk per 100g per day of red meat and an 18% increase per 50g per day of processed meat (about 2 slices of bacon!). This is a population-based risk to dose relationship and not a personal one, however; it does give us some parameters to understanding what we are actually talking about.

 

Are organic meats as dangerous?

 According to this report, yes! The danger posed by processed meat and red meat comes from chemical properties inherent to the meat. Organic meat that is raised with out antibiotics and hormones has many other health advantages but falls outside the context of this report.

 

What about nitrate-free meat?

As I understand it and according to the Working Group definition of processed meat the “naturally” processed meat, found increasingly in supermarkets, that claim no added nitrates or preservatives are included as processed meat as they use naturally occurring nitrates from sea salt and celery root to alter the meat all the same. It is not the added chemicals that are carcinogenic, it is the way the altered meat reacts with our cells and genes that is carcinogenic.

 

How do red meat and processed meat cause cancer?

Although this report was focused on determining the strength of cancer causing evidence, there are some studies included in the report that speak to the mechanistic evidence for carcinogenicity of red meat including; gene mutation, oxidative stress, and increased chemicals in our digestive systems like N-nitroso-compounds and polycyclic aromatic hydrocarbons (PAH). Even though there was stronger evidence found for processed meat causing cancer there was less understanding of why.

 

What is our best approach? Should we stop eating red and processed meat?

 There is no question that decreasing or eliminating red and processed meat will decrease your associated risk of cancer. The relationship between our diets and disease is real and diet is an important place to focus our energy to optimise preventative health and live well day-by-day.

One group of foods that help to prevent against cancer are foods that have the ability to act as antioxidants in our body. Antioxidants help to restore stability and health to our cells that have been or are at risk of being oxidized – as seen with the consumption of red meat. Try and pair your intake of red meat with foods high in antioxidant potential like Rosemary, Green tea and berries as they are powerful antioxidants.

One study in 2012 showed a 90% reduction in the formation of aromatic hydrocarbons in pan-fried beef with the addition of a marinade rich in antioxidants. The greatest antioxidant potential was found in a marinade of wine and rosemary -two powerful and delicious antioxidants!

 

 

For a detailed review of the IARC report and details about the included studies and findings:

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(15)00444-1/abstract

 

To read the IARC monographs and WHO Q&A on the report:

http://www.iarc.fr/en/media-centre/iarcnews/pdf/Monographs-Q&A_Vol114.pdf

 

A link to the referenced study about the antioxidant potential of a rosemary and wine marinade:

http://www.ncbi.nlm.nih.gov/pubmed/22642699

 

“What’s the Beef?” title credit to Dr. Katherine Kremblewski J

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Top 3 Botanical Prescriptions for Stress Support

November 13, 2015
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by Dr. Bauer
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Top 3 Botanical Prescriptions for Stress Support

by Dr. Meghan Bauer ND

As many of my patients will attest to I love giving support against stress whether it is real or perceived, in the past, present or future.  Helping our body to adapt to stress is paramount in maintaining a healthy endocrine system and health in general.

Some common symptoms that might indicate a stress response under pressure include; low energy, difficult sleep, a compromised immune system (i.e. frequent colds, and infections), changes in mood (anxiety, depression), increased weight, and an increased inflammatory response and allergies.

Along with some key nutraceuticals, botanical medicine is the mainstay of stress response restoration and truthfully I wouldn’t be able to practice the way I do without them.  Here are my top three.

1) Eleuthrococcus, commonly know as Siberian Ginseng
Although not a true ginseng Eleuthrococcus shares the ability of ginseng to improve strength and vitality.  It is best taken for physical stress, fatigue, convalescence and mild depression.  It is great for debility, chronic immune deficiency and as a tonic for the elderly. As well, it can be used to improve physical, exercise and mental performance and concentration.  Eleuthrococcus is safe although best to avoid during acute phases of infections and to use it in recovery instead.

2) Rodiola rosea
Rodiola has a similar efficacy as Eleutrococcus with particular support for endurance.  It is excellent support for fatigue, physical stress, convalescence, failure to thrive as well and to improve mental performance, concentration and memory when under stress.  I tend to find Rodiola specifically helpful for people who tend to get irritable and angry when under stress (e.g.”road rage”).  Rodiola is safe to take although should be taken away from mineral supplements for best absorption.

3) Ashwaghanda (Withania somnifera) (the image above)
Ashwaghanda is a traditional Ayurvedic plant from India that has been shown to help the stress response system restore unlike many other plants.  It has an action that is tonifying, adaptogenic, relaxing, anti-inflammatory and antitumour.  With these actions it is very helpful to improve energy, vitality, balance weight, help to calm the nervous system, improve immune health and restore post stress or infection.  There are no known adverse effects of taking Ashwaghanda and it can be used with the elderly and during pregnancy.

Despite the safe nature of thees three plants it is still advisable to talk to your naturopathic doctor before taking them.

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