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You have most likely heard Vitamin D discussed in the media and other heath news sources, but have you heard the most recent news? After years of questioning, the Institute of Medicine (IOM) recently reviewed the Dietary Reference Intakes for Vitamin D and Calcium. The IOM was encouraged to do this because of new research suggesting that the previous guidelines, set in 1997, were outdated. In addition, it has come to light over the past several years, that a good majority of Americans are either Vitamin D deficient or insufficient. A 2009 report (Arch Intern Med 2009;169(6):626-632) found 3/4 of US teens and adults to be deficient. In addition, Vitamin D deficiency disproportionately affects races with darker skin colors: only 3% of African-Americans sampled in 2004 had Vitamin D levels in the recommended range (down from 12% two decades earlier). Most labs indicate that a Vitamin D (OHD2) of less than 30mg/dL is considered deficient, however the IOM considers deficiency to be a level of less than 11 ng/mL. Using the IOM threshold for deficiency, a study published in the American Journal of Clinical Nutrition last November found that about 10% of the population is deficient. The Vitamin D Council recommends that blood levels measure between 50 and 80 ng/dL for optimal health and disease prevention. 

Vitamin D Sources: Vitamin D is converted to its active form in the skin with the contact of UV light. According to the Vitamin D Council, Caucasian skin produces approximately 10,000 IU vitamin D in response to 20–30 minutes of summer sun exposure. However, darker skin colors need up to six times more sun exposure to get this amount and using a sunscreen with as little as 15 SPF can block the skin's Vitamin D production up to 99%. In addition, there are few sources of the vitamin in our diets. Some of the few food sources include salmon, tuna, mackerel, and vitamin D fortified products, such as milk. Thus, because most people aren't getting enough sun exposure and/or dietary intake of Vitamin D, a supplement is necessary for many people. 

How much Vitamin D?  This is where it gets controversial. Many health care professionals expected the IOM substantially increase the recommendation for Vitamin D in their newest report, but the IOM failed to do so. The new IOM report can be found here. Basically, the IOM committee concluded that the majority of Americans and Canadians are receiving enough Vitamin D and calcium, despite a volume of research suggesting otherwise. Dr. John Cannell, Executive Director of the Vitamin D Council, issued a scathing response to the IOM's revision, or lack thereof, to the current standards. In his response, Cannell outlines the many reasons (with supporting research) that the Vitamin D recommendation should have been substantially increased. Additional statements have been made by William B. Grant, PhD, Bill Sardi, investigative journalist, and Joel Fuhrman, MD & Mark Hyman, MD for the Huffington Post. Additionally, an action alert by the Alliance for Better Health recently questioned whether the IOM may have ties to big Pharma, thus influencing their decision to leave Vitamin D recs basically unaltered from their 1997 state.

What to do now? Well, if you haven't had your Vitamin D levels tested, get them tested. How much Vitamin D to take will be based on your lab results. You can either ask your physician to order this lab test for you or you can order a Vitamin D test kit and do it yourself. Below are some guidelines for supplementation as recommended by Michael F. Holick, MD, PhD published in the New England Journal of Medicine (NEJM 2007; 357: 266-81): 

Children who have been breastfeeding without vitamin D supplementation (up to 1 year):

• Preventive & Maintenance Measures: 400 IU Vitamin D3/day, sensible sun exposure, 1000-2000 IU vitamin D/day is safe, maintenance dose is 400-1000 IU per day.
• Treatment of Deficiency: 200,000 Vitamin D3 once every 3 months or 1000-2000 IU of Vitamin D2 or D3 per day with calcium supplementation

• Preventive & Maintenance Measures: 800-1000 IU vitamin D3/day, 50,000 IU Vitamin D2 every 2 weeks or every month, sensible sun exposure, or use of tanning bed or other UVB radiation device, up to 10,000 IU Vitamin D3/day is safe for 5 months, maintenance dose is 50,000 IU every 2 weeks or month
• Treatment of Deficiency: 50,000 IU Vitamin D2 every week for 8 weeks; repeat for another 8 weeks if blood levels still less than 30 ng/mL

Adults who are pregnant or lactating (fetal utilization, inadequate sun exposure or supplementation): 

• Preventive & Maintenance Measures: 1000-2000 IU vitamin D3/day, 50,000 IU Vitamin D2 every 2 weeks, up to 4,000 IU Vitamin D3/day is safe for 5 months, maintenance dose is 50,000 IU every 2 weeks or month
• Treatment of Deficiency: 50,000 IU Vitamin D2 every week for 8 weeks; repeat for another 8 weeks if blood levels still less than 30 ng/mL

Adults with Obesity 

• Preventive & Maintenance Measures: 1000-2000 IU vitamin D3/day, 50,000 IU Vitamin D2 every 1-2 weeks, maintenance dose is 50,000 IU every 1, 2, or 4 weeks 
• Treatment of Deficiency: 50,000 IU Vitamin D2 every week for 8-12 weeks; repeat for another 8-12 weeks if blood levels still less than 30 ng/mL

*NOTE: Always consult with your Physician, Registered Dietitian, or other licensed healthcare professional before starting treatment. 

Want to schedule a nutrition consultation, but running low on funds? Hershey's has agreed to pay for 1,994 appointments with Registered Dietitians valued at $250 each! Beginning today, there's a fantastic new resource available. The Hershey Center for Health and Nutrition and the American Dietetic Association are launching Moderation Nation, a program featuring lots of helpful tools and a national initiative to cover the cost of ADA registered dietitian visits. Click here to download your certificate to connect with an RD. You must use the certificate within 45 days. You can find details regarding rules and stipulations here. Contact me if you are ready to redeem your certificate! What an amazing opportunity! 

Have you heard? The FDA may approve a genetically engineered salmon that will grow to full size in 18 months instead of 3 years. Safety data is limited, but regardless, this may end up in our restaurants, grocery stores, and ultimately on our plates.

The FDA has scheduled meetings September 19-21 to hear advice about whether the agency should approve GM (genetically modified) salmon. These are Atlantic salmon bioengineered by AquaBounty Technologies.   Atlantic salmon only grow for a few months per year; they do not produce growth hormone in non-growth months.  AquaBounty scientists combined growth hormone genes from an unrelated Pacific salmon with DNA from the anti-freeze genes of an eelpout fish. The result is that the GM salmon produce growth hormone throughout the year and grow at twice the rate of non-GM salmon.

What do you think about this? Food & Water Watch, a non-profit consumer food safety advocacy group, suggests 10 reasons these so-called "Frankenfish" should be rejected. 

I am excited to announce that the SoCal Nutrition & Wellness Blog is now a member of the Nutrition Blog Network! The Nutrition Blog Network is a collection of blogs written by registered dietitians.  It’s a site you can turn to for trusted advice from nutrition experts.  

If you want to learn how you can safely lose those last 5 pounds, find healthy recipes for your family, lower your cholesterol, jumpstart a healthy lifestyle, seek solutions for your picky preschooler or learn what to eat when you’re pregnant, you can find what you’re looking for in the Nutrition Blog Directory.

Every five years, a group of experts from around the country get together to debate the science behind nutrition recommendations for the general United States Public. The last Dietary Guidelines, released in 2005, included a major change to the food guide pyramid and new a website where an individual could get more personal recommendations, hence the name MyPyramid (www.mypyramid.gov). When I teach college nutrition students, most of them say they have never seen this 2005 pyramid:

Instead, most students claim to be more familiar with this  1995 food guide pyramid:

 Which are you most familiar with?

On June 15, 2010, the most recent suggestions for dietary guidelines revisions were released and will be open for public comment through July 15th. The new nutrition communication tools have not yet been released, but it will be interesting to see what shape they take this year. Some of the major changes to the dietary guidelines include:

• Reducing the recommended daily sodium intake from 2300 mg to 1500 mg per day
• Reducing the recommended percentage of calories coming from saturated fats from 10% to 7%
• Reducing the recommend trans fat daily limit from less than 1% to less than 0.5% of total calories.
• Expanding nutrition education to improve nutrition literacy and cooking skills
• Increasing availability of fresh produce to consumers
• Increasing the emphasis placed on health, nutrition, and physical education in schools

The new sodium recommendation will likely be one of the most challenging for Americans to meet. Most Americans currently consume anywhere from 3000 to 8000 mg of sodium each day, so getting down to 1500 mg will prove significantly challenging. For example, many restaurant meals pack in at least 1000 mg or more of sodium. To keep sodium in check, the food industry and restaurants will need to start cutting back and consumers will need to consume more whole, unprocessed foods. Fortunately, many food manufacturers have agreed to scale back over the next several years. 

To read the dietary guidelines committee report in its' entirety and/or to submit a comment, visit: http://www.cnpp.usda.gov/dietaryguidelines.htm 

Below is a list of nutrition, wellness, fitness, and health articles of interest that were published in the popular press over the past 2 weeks. Nutrition and wellness information is flooding the media as usual. Take a peak to see which topics interest you. Happy reading!

• E. coli cases down in 2009, CDC says
• Eating well on $68.88 a week: That's the food stamp budget for a family of 4
• LAX hopes to give taste buds quite a ride. The airport plans to upgrade concessions to reflect the diverse, top-drawer cuisine of L.A. New shops and other services are all part of the plan too. 
• Cooking at home can save money, calories
• Registered Dietitians Play Essential Role In Management Of Gastric Bypass Patients
• An Insurer’s New Approach to Diabetes
• School nutrition and gardening classes aim to grow healthy eating habits
• Pushing Kids To Play Outside
• Anorexia, bulimia definitions hinder treatment, study says
• Child Obesity Soaring in Rural America; In one Louisiana community, one in two kids is now overweight or obese, study finds
• Diet can sharply cut Alzheimer’s risk. Study: Olive oil, nuts, fish, poultry among best brain boosters
• Growing concern over marketing tainted beef
• What is your nutritional carbon footprint?
• Preventing Type 2 Diabetes: Launch Of Europe-Wide Recommendations
• Raiding the Refrigerator, but Still Asleep
• Sleep's role in weight loss remains a mystery
• How Much Exercise Prevents Weight Gain?

Irritable bowel syndrome (IBS) is a disorder characterized by abdominal pain or discomfort, and altered bowel habit (chronic or recurrent diarrhea, constipation, or both – either mixed or in alternation).

• IBS affects between 25 and 45 million people in the United States (10 to 15% of the population). 
• The exact cause of IBS is not known. Symptoms may result from a disturbance in the way the gut, brain, and nervous system interact. This can cause changes in normal bowel movement and sensation. Stress does not cause IBS. However, because of the connection between the brain and the gut, stress can worsen or trigger symptoms.
• The impact of IBS can range from mild inconvenience to severe debilitation. It can control many aspects of a person's emotional, social and professional life. Persons with moderate to severe IBS must struggle with symptoms that often impair their physical, emotional, economic, educational and social well-being.
• IBS is unpredictable. Symptoms vary and are sometimes contradictory. Diarrhea can alternate with constipation. Long-term symptoms can disrupt personal and professional activities, and limit individual potential.
• Although IBS is common in the general population, few seek medical care for their symptoms.

Diet plays a large role in IBS symptom severity, but is also highly individual. If you have or think you may have IBS, working with a registered dietitian can help you to improve your diet and reduce your specific IBS symptoms. 

For more information about IBS, please visit: http://www.aboutibs.org/

Did you know that the health care reform bill signed into law yesterday also requires menu labeling? Enactment of federal menu labeling was the result of a seven year effort that included passage of menu labeling laws in California, Maine, Massachusetts and Oregon and adoption of policies in several cities including New York. The federal policy will require chain restaurants with 20 or more outlets nationally to provide calorie labeling on menus, menu boards, and drive-through displays and also requires calorie labeling of alcoholic beverages. The law also pertains to vending machines. The U.S. Food and Drug Administration is required to propose regulations no later than one year from today. Those regulations will be finalized through a formal notice and comment rulemaking process. With the enactment of the bill, California’s menu labeling law is preempted; however, the federal provisions are stronger than the California law and menu labeling will be required throughout the country. 

Next month, committees of the California Legislature will debate and vote on four bills designed to improve beverage environments in California:

• SB 1210 (Florez), a soda tax to fund childhood obesity prevention
• SB 1255 (Padilla), a ban of the sale of electrolyte replacement beverages in public schools
• SB 1413 (Leno), the requirement that schools provide free drinking water in school food service areas

AB 2084 (Brownley), nutrition standards for beverages in licensed child day care facilities. 

To learn more about these bills and/or see where they are in the legislative process, please visit: http://www.leginfo.ca.gov/bilinfo.html

Information courtesy of California Center for Public Health Advocacy: http://publichealthadvocacy.org/

The nutrition and wellness world is fast-paced. There are constantly new studies being published, new fitness gadgets being created, and new headlines. Here are some of the major nutrition and wellness headlines for the week of March 15th through 19th:

• Mass. Senate passes bill limiting junk food at schools
• Vitamin D linked to lower heart disease risk: by raising low levels of the vitamin to normal levels, patients reduce their risk of heart disease by about 30%, an observational study finds (Announced at the American College of Cardiology annual meeting)
• Michelle Obama takes campaign to end childhood obesity to the country's largest food makers
• Taking the Bake Out of Bake Sale: A new rule in NYC schools, which officials say is aimed at tackling obesity, restricts student bake sales
• FDA considers spice supply safety
• U.S. health survey: Too few exercise, too many smoke
• Kraft to cut salt in its North American foods
• New York's Restaurants to Get Graded Under New System
• U.S. kids even fatter than believed: Study shows many face chronic health problems, shorter life spans
• Lifestyle And Diet Still Best Ways To Help Prevent Type 2 Diabetes
• Lawmaker confident US food safety law will pass in 2010
• FDA seeks permanent injunction against Louisiana sprout grower

Surgeon General Regina M. Benjamin, MD, MBA just released her first position paper, calling for a nationwide grassroots effort at the neighborhood level to address the obesity epidemic. Her paper can be found here.

Here's a sample of her suggestions for creating Individual Healthy Choices and Healthy Home Environments:

• Reduce consumption of sodas and juices with added sugars.  
• Reduce consumption of energy dense foods that primarily contain added sugars or solid fats.  
• Eat more fruits, vegetables, whole grains, and lean proteins. 
• Control your portions. 
• Drink more water. 
• Choose low-fat or non-fat dairy products. 
• Limit television viewing time and consider keeping televisions out of children’s rooms. 
• Become more physically active throughout the day. 
• Breastfeed exclusively for 6 months.

Sounds like everything I discuss with my clients!