Summer 2008 marks a milestone in my medical career. As I celebrate the 20th anniversary of completing medical school (Boy, does time fly!), I am fulfilling a lifelong dream. This summer I have the privilege of participating in a medical humanitarian trip to a small village in the mountains of Mexico.

 

I can't tell you how excited I am about this trip. I hope it is the first of many. Every July, a group of doctors, nurses and other medical workers travel to rural Mexico and set up a M.A.S.H. unit, serving 3,000 patients in under two weeks. The patients walk from miles away and spend the night outside, lined up waiting for the clinic to open. They are triaged and referred to the specialists as needed. I will be operating along with several other surgical specialists in a makeshift operating room.

 

I go with the goal of serving others. I am told that I will recieve much more than I give. I ask for your thoughts and prayers as I embark on this mission. I am sure I will have stories to tell upon my return.

 

Fondly,

Dr. V

The Skinny on Vitamin D and UV

 

Are you confused about all the (mis)information about Sunscreen and Vitamin D? Well, frankly, so was I. So, I decided to delve a little deeper into the controversy to educate myself, and my patients.

 

First of all, why do we need Vitamin D? Well, for one it is essential for bone health, as is calcium. Adequate levels of both can help prevent osteoporosis, a disease that causes bones to become fragile and easily fractured. Osteoporosis affects 55% of people over the age of 50, and is a "silent disease", that is, until a fall results in a fracture.

 

According to the National Osteoporosis Foundation, there are several recommendations that patients may follow to reduce the risk of fractures from osteoporosis. These include an adequate intake of both calcium and Vitamin D, lifelong program of weight-bearing and muscle-strengthening exercises, avoidance of tobacco, and limited alcohol consumption.¹

 

 

Adequate Intake of Calcium and Vitamin D

At least 1200 mg of Calcium per day, in diet and supplements, is recommended. If we don't consume enough, we start resorbing calcium stores from our skeleton, leading to osteoporosis. The NOF recommends an intake of 800 to 1000 international units (IU) of vitamin D3 per day for adults over age 50. This is substantially higher than previous recommendations. The following table from the National Osteoporosis Foundation's website gives a quick estimate of your daily calcium intake¹:

 

TABLE 6. Estimating Daily Dietary Calcium Intake¹

STEP 1: Estimate calcium intake from calcium rich foods*

Product Servings/Day Calcium/Serving, mg Calcium, mg

Milk (8 oz) _______ X 300 = _______

Yogurt (8 oz) _______ X 400 = _______

Cheese (1 oz, or 1 cubic inch) _______ X 200 = _______

Fortified Foods or Juices _______ X 80-1000 = _______

STEP 2: Total from above + 250 mg for nondairy sources = total dietary calcium

 

 

Calcium rich foods: fortified milk, yogurt, cheese, tofu, almonds, beans (white, navy, black), fortified orange juice, sardines, broccoli, dried figs

 

Vitamin D may be found in vitamin D-fortified milk (400 IU per quart) and cereals (40 to 50 IU per serving), egg yolks, salt-water fish, and liver. Some calcium supplements and most multivitamin tablets also contain vitamin D. There is new evidence that Vitamin D may reduce the risk of other types of cancer-this is inconclusive at present, but promising.

 

Vitamin D and sun exposure

While it is true that the sun stimulates the synthesis of Vitamin D in our bodies, it is important to balance that against the importance of skin protection from damaging UV rays. As little as 10 minutes of sun exposure a day may be all that it takes for adequate Vitamin D synthesis. However, in March 2005, a study of 93 adults in Hawaii were assessed as to sun exposure, skin type and Vitamin D level (25(OH)D). Despite abundant sun exposure, 51% had low Vitamin D levels. 2   So, don't rely on sun exposure, do eat a healthy diet with foods rich in Vitamin D, and take a supplement.

 

Consider your body as a whole, protect your skin from the sun by avoiding sun exposure during the highest intensity of UV rays, between 10 am and 4 pm. Wear an SPF 15 or higher on your face and other exposed skin on a daily basis. Wear a hat and sunglasses when outside in the daylight. Remember UV comes through car windows, house and office windows, and clouds. Also, there is no safe tanning bed. You do not have my permission to tan!

 

Yours in healthy skin,

Michelle B. Vessely, M.D.

 

1.  Clinicians Guide to the Prevention and Treatment of Osteoporosis. 2008. 1232 22nd Street NW, Washington, D.C. 20037-1292

2.  J Clin Endocrinol Metab. 2007;92:2130-2135.

 

 

 

Call 503-692-1190 for details.