Interesting Facts About Vitamin A

When we think of food sources of vitamin A and what it does for the body we think of carrots and better vision. While this is true, there are some interesting and often overlooked facts about vitamin A.

What is vitamin A?

Vitamin A is a fat-soluble vitamin that is stored in the liver for up to 4 years. It is a subclass of retinoic acids, a family of lipid soluble compounds that includes retinols, beta carotenes and other carotenoids.

  • The active form of vitamin A is called preformed retinol It is found in fish, organ meats, dairy products, egg yolks and some fortified foods.
  • Provitamin A carotenoids are precursors to vitamin A. Foods containing carotenoids are converted through an enzymatic process into vitamin A. Carotenoids are a class of  compounds yellow, orange, or red fat-soluble pigments, including carotene, which give color to plant parts such as ripe tomatoes and autumn leaves: There are more than 600 known carotenoids. Carotenoids are found in fruits, vegetables and some fish, such as in the pink color of salmon. It is also found in supplement form. One such carotenoid is beta-carotene.
  • Beta-carotene converts to vitamin A and is an antioxidant. Antioxidants are manmade or natural substances that protect cells from damage caused by substances called free radicals. It is converted to retinol in the wall of the small intestine.

Function of vitamin A

Vitamin A plays many important roles in health. 

Preformed vitamin A – retinol is important for vision, especially night vision, anti inflammatory, enhances immune system function, important for developing fetal endothelial cell proliferation, produces pigments in retina, maintains healthy teeth, skeletal and soft tissue. In food form can be protective against some forms of cancer. 

Vitamin A deficiency- 

Vitamin A deficiency is considered to be rare except in premature infants, malnourished areas of the world, gastrointestinal disorders such as celiac, pancreatic insufficiency, bile duct disorder and those who cannot convert beta carotene to active vitamin A due to a BCMO1 gene variation– which results in a poor conversion from beta carotene to vitamin A. (It is estimated that approximately 45 percent of the population may have this conversion defect.

Symptoms of vitamin A deficiency:

Vitamin A toxicity

Most toxicity isa result of supplementation and not food sources. 

Symptoms of vitamin A toxicity:

  • drowsiness
  • irritability
  • abdominal pain
  • nausea
  • vomiting
  • increased pressure on the brain

Supplementation 

Seek advice of a qualified health professional before supplementing vitamin A or beta- carotene. Vitamin A is stored in the liver for up to four years so there is little chance of being deficient unless you have a pre existing condition that impairs vitamin A absorption or genetic impairment.  

In addition, a large scale study called the ATBC study— over 29,000 smokers who supplemented with beta carotene (the precursor to vitamin A) was stopped abruptly because of the high incidence of lung cancer that developed during the study.  The researchers concluded that all smokers should not use beta carotene supplements due to this increased risk of lung cancer. 

Measles management in children

Excerpt from Infectious Diseases in Clinical Practice:

“In November 2019, the National Foundation for Infectious Diseases convened a summit that included multidisciplinary subject matter experts from across the United States to discuss the use of vitamin A in US measles management. The resulting Summit recommendations include that all children in the United States presenting with measles should receive an age-appropriate dose of vitamin A as part of a comprehensive measles management protocol. Multiple studies in populations in which vitamin A deficiency is prevalent have shown that this simple, quick means of improving vitamin A status can dramatically reduce the risk of serious complications and death from measles, with minimal detectable incidence of adverse effects.”

- Brooke Lounsbury, RN

Medical Content Writer

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Vitamin E

Vitamin E is a popular over the counter vitamin supplement that has many uses. But just like any medication and supplement, there are a few things you should be aware of before supplementing.

Discovery of vitamin E

Vitamin E was discovered in 1922 by Bishop and Evans. However, it wasn’t until the 1940s when the use of vitamin E in the role of nutrition in premature infants was investigated. This led to examining intestinal absorption of vitamin E in premature infants to prevent intracranial hemorrhage, pulmonary oxygen toxicity, hemolysis and more. Since that time, the use of vitamin E in premature infants has helped save many lives.

There are eight different natural forms of vitamin E which can be subdivided into two separate groups: the tocopherols and the tocotrienols. Both are plant based and fat soluble and each of these have four separate analogues. Each analogue has a different potency and effect on health.

Tocopherols are the saturated form of vitamin E and contain the analogues alpha, beta, delta, and gamma. This form of vitamin E is the major source in the U.S. diet.

Food sources of tocopherols include oils derived from walnuts, hazelnuts, peanuts, sunflower oil.

Tocotrienols are the unsaturated form of vitamin E and contain same name but different types of analogues- alpha beta, delta and gamma.

Food sources of tocotrienols are palm and rice bran oil, wheat germ, barley, oats, grapefruit seed oil, and annatto oil.

Vitamin E

Synthetic vitamin E

Synthetic forms of vitamin E contain both tocopherol and tocotrienols and include the four analogs of each. However there is evidence to suggest that synthetic E isn’t  absorbed by the body as efficiently as natural forms.

How to tell if your vitamin E supplement is synthetic or natural

Most vitamin E supplements are derived from natural sources. The natural (D-α-tocopherol) contains the prefix “D”, the synthetic form (DL-α-tocopherol acetate) contains the prefix “DL”.

Vitamin E deficiency

Causes

Vitamin E deficiency is rare; however some causes are:

  • Some genetic disorders that can cause malabsorption of dietary fats
  • Cystic fibrosis patients have trouble absorbing the fat-soluble vitamins- ADEK
  • Malnutrition
  • Short-bowel syndrome patients
  • Surgical resection
  • Mesenteric vascular thrombosis
  • Crohn’s disease
  • exocrine pancreatic insufficiency
  • liver disease
  • Cigarette smoking depletes vitamin E

Symptoms vitamin E deficiency

  • Impaired balance and coordination
  • Muscle weakness
  • Retinopathy

Consult with your care provider before supplementing with vitamin E

Vitamin E toxicity

Vitamin E toxicity occurs by supplementation, not diet alone. Symptoms include excessive bleeding, nausea, vomiting and muscle weakness. If toxicity is suspected, discontinuation of vitamin E and administration of vitamin K may be initiated by your care provider.

Drug interactions and cautions when supplementing with Vitamin E

  • Vitamin E inhibits platelet aggregation and can disrupt vitamin K1 clotting. Use with caution when on anticoagulation and antiplatelet medications as there is the potential risk of bleeding when taken together.
  • Niacin: vitamin E supplementation can reduce effects of niacin

Medical conditions that may be contraindicated with vitamin E supplementation

  • History heart attack or stroke
  • Bleeding disorders
  • Diabetes
  • Vitamin K deficiency
  • Retinitis pigmentosa
  • Kidney disease
  • Anemia
  • Liver disease

- Brooke Lounsbury, RN

Medical Content Writer

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Vitamin D

Vitamin D is a steroid hormone, and sometimes called “activated vitamin D” or “calcitriol.” Steroid hormones are derived from cholesterol and are lipid-soluble molecules. Examples of steroid hormones include the sex hormones (androgens, estrogens, and progesterone) produced by male and female gonads and hormones of the adrenal glands (aldosterone, cortisol, and androgens). It is a fat-soluble vitamin that helps the body absorb and retain calcium and phosphorus. Both are necessary for building bone. Vitamin D also plays a role in bolstering the immune system to fight off viruses and bacteria. In addition, research suggests that vitamin D could play a role in downregulating autoimmune disease. In addition a randomized 5 year clinic trial of high vitamin D supplementation reduced the incidence of advanced cancer without a diagnosis of cancer at the beginning of the study. Much interest and research is ongoing in this promising field of study.

Vitamin D is found in two main forms:

Vitamin D2 (ergocalciferol) – The main source is from plants. Mushrooms, when exposed to UV light produce D2. Fortified cereals are usually fortified with vitamin D2

 

Vitamin D3 (cholecalciferol) – The main source is from animals- Sources of D3 are egg yolks, cod liver oil, fatty fish-salmon, sardines, herring, tuna, beef liver. In addition, when skin is exposed to sunlight vitamin D3 is produced. The body only produces enough vitamin D3 from sunlight as it needs then stops producing it.

The liver metabolizes vitamin D2 and vitamin D3 and form the active compound known as calcifediol. A study done by the National Institute of Health on post-menopausal vitamin D deficient women showed that vitamin D3 yielded twice more calcifediol than an equal amount of vitamin D2.

Excess Vitamin D3 is stored in the bodies adipose tissue and liver and is converted by the kidneys to the active form of vitamin. Excess vitamin D is almost exclusively from supplement sources.

According the NIH:

The amount of vitamin D you need each day depends on your age. Average daily recommended amounts are listed below in micrograms (mcg) and International Units (IU):

Life Stage Recommended Amount
Birth to 12 months 10 mcg (400 IU)
Children 1–13 years 15 mcg (600 IU)
Teens 14–18 years 15 mcg (600 IU)
Adults 19–70 years 15 mcg (600 IU)
Adults 71 years and older 20 mcg (800 IU)
Pregnant and breastfeeding teens and women

15 mcg (600 IU)

 

The 25-hydroxy vitamin D test (a blood test) is the most accurate way to measure how much vitamin D is in your body.

Factors affecting vitamin D deficiency

  • Older adults skin doesn’t absorb vitamin D as well as younger population. Dark skin also doesn’t absorb vitamin D very well either
  • Some diseases- celiac, Crohn’s disease, ulcerative colitits, limit absorption of fats and vitamin D
  • Obesity and gastric bypass may need more vitamin D

Signs of vitamin D deficiency- up to 42 percent of the US population is deficient

  • Rickets in children
  • Osteomalacia in adults
  • Not sleeping well.
  • Bone pain or achiness.
  • Depression or feelings of sadness.
  • Hair loss.
  • Muscle weakness.
  • Lowered immunity to infections-viral and bacterial

Signs of vitamin D toxicity

Vitamin D toxicity is not common, except when extremely high doses of vitamin D is taken in supplement form for a long time (months).

  • Hypercalcemia
  • Nausea, vomiting
  • Can progress to bone pain and kidney stones

How to Improve Your Vitamin D Status

In addition to adequate sunlight exposure, vitamin D requires other nutrients and minerals to work properly. It is always best to get your nutrition from food sources, however long winters and low sunlight may require supplementation. If supplementing with vitamin D, it is best to take with fat since it is a fat-soluble vitamin.

Vitamin K2(MK-7)- activates osteocalcin, which integrates calcium into the bone. Activates matrix GLA protein (MGP) to bind excess calcium and promote arterial flow and flexibility. Food sources include fermented foods, natto

Magnesium- helps convert vitamin D to active form. Food sources include leafy greens, beans, legumes, almonds, cashews

Zinc– synergistic effect- vitamin D enhances zinc action and homeostasis and zinc enhances vitamin D absorption. Food sources include oysers, red meat, poultry

Boron– increases vitamin D in the blood. Food sources include coffee, milk, apples, dried and cooked beans, and potatoes

Cold water fish– salmon, herring, sardines, tuna

- Brooke Lounsbury, RN

Medical Content Writer

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The Advantage of Telehealth During Bad Weather

The massive influx of historic, record-breaking weather that has swept the country has left many communities reeling. Power outages, impassable or treacherous road conditions illuminates how fragile our society is when infrastructure breaks down. Hopefully you have your basic over the counter medicines well stocked along with prescription medicines. You had topped off your preps, food, extra water, and a small indoor safe heater with fuel  in case of power failure.

If you haven’t considered or don’t have a generator check out the Jackery portable power station.. It has USB plug ins to keep cellphones recharged and can take care of basic electrical needs, such as keeping a min fridge cold, running small appliances and even your laptop. You can recharge it via AC outlet, solar panel or car outlet. This could prove invaluable during a power outage, by keeping your phone recharged to monitor weather, check in with family members and neighbors, and if needed, to contact your care provider in case of minor emergency or illness.

Medical preparedness

During inclement weather, you may not have access to in person, non-emergent health care. Power lines or trees may be downed and block the road, snow and ice storms can make a trip to the urgent care or clinic outright dangerous or impassable. Even Southern California experienced blizzard conditions and Portland, Oregon set a record for the second most snowfall to date.  In Oklahoma, tornados have left scores of communities homeless, many injured and without vital infrastructure needed to maintain adequate living conditions. During times such as these EMS workers are spread thin due to wrecks and other health emergencies, road crews can’t keep up with the massive amounts of snowfall and other road hazards. Staying home can be the safest and most prudent thing to do until after the storm passes and infrastructure is restored.

By now you should have medicines that you use on a regular basis, a well-stocked first aid kit and a Jase case (which covers a broad variety of infections) specifically for every member of your family.

Telehealth can help bridge the gap

Sometimes it only takes a phone call to the doctor’s office to answer a question or seek guidance for you or your loved one’s illness or injury. Other times a clinic visit would be preferable, however may not be immediately possible. Telehealth is an effective option for scenarios like this. For example, if your child had been exposed to strep throat while at school and has developed a sore throat while at home for snow days, a virtual visit via telehealth can determine if an antibiotic is needed. A virtual visit can keep you and your child safe, warm and not exposed to the elements.

Telehealth isn’t ideal for every injury or illness, however, if you are stuck at home with no availability to pharmacy or medical care, it is a valuable tool that has proven to be highly successful in diagnosing and resolving minor emergencies and illnesses.

Some common telehealth visits include:

  • Coughs
  • Colds and influenza symptoms
  • Earaches
  • Stomach aches
  • Diarrhea or constipation
  • Nausea and vomiting
  • Skin rashes
  • Sore throats
  • Conjunctivitis
  • Sprains or strains
  • Urinary tract symptoms (until you can get to the clinic for an urinalysis)
  • Food poisoning

Non emergent visits can  include chronic illness visits, prescription refills, weight checks, blood pressure checks and review labs.

How to access telehealth

While telehealth can be a valuable tool to access healthcare, nothing replaces the in person visit to your healthcare provider. Telehealth should be viewed as another valuable tool in your preparedness toolkit when healthcare isn’t accessible.

An increasing number of insurances are allowing telehealth visits. Even Medicare pays for telehealth visits. Check with your insurance company for a list of providers that offer telehealth as an option to in person visits.

Most all regions across the United States offer telehealth services as an alternative to in person visits. Check with your local health systems services, your care provider or health department.

- Brooke Lounsbury, RN

Medical Content Writer

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Vitamin K1 and K2, They Are the Same, Right?

There is confusion surrounding vitamin K. We know vitamin K as the clotting vitamin, found in large amounts in leafy green vegetables. When someone is on blood thinners they are usually cautioned about their intake of greens and how it can interfere with the effectiveness of the medication. But did you know there is a vitamin K1 and K2?

There are two forms of vitamin K, K1 and K2

Vitamin K is the generic name for a family of similar compounds that are fat soluble, are found in food and are also found in supplement form. These compounds include phylloquinone (vitamin K1) and a series of menaquinones also known as MKs (vitamin K2). Vitamin K2 can be divided into subtypes: short-chain (i.e., menaquinone-4; MK-4- most bioavailable) and long-chain (MK-7, MK-8, and MK-9)

Vitamin K1 is found in spinach, cabbage, and kale. K1 can also be found in fruits like avocado, kiwi and grapes. Absorption of K1 is increased when eaten with fat, such as butter or oils.

Vitamin k2 is found in fermented food (sauerkraut and vegetables), meat, and dairy. Other sources of K2 are chicken meat, egg yolks, beef and salmon. K2 is synthesized by bacteria, and a small amount is produced by the bacteria in the gut. Absorption is also increased when eaten with fats such as butter or oils.

Vitamin K1 is retained in the liver, where it assists with and works with other compounds to manufacture the body’s clotting factors. In contrast, vitamin K2, particularly long chain derivatives, are redistributed to the circulation and are available for other tissues, such as bone and vascular system.

Health benefits of both vitamin K1 and K2

Both vitamin K1 and K2 are vital to health. They work in drastically different ways and on different parts of the body. About 10-15% of vitamin K1 is absorbed by the body compared to 50% of vitamin K2. The Standard American Diet (SAD) intake of vitamin K1 is higher than K2.

Vitamin k1 health benefits

  • Assists with bleeding and bruising regulation in the body
  • Acts as an anti-inflammatory and protects against oxidative stress
  • Is a cofactor to make prothrombin ( clotting factors)
  • Precursor to K2
  • Bone health

Vitamin K2 health benefits

Factors that prevent absorption of vitamin K absorption

  • Health problems that can prevent your body from absorbing vitamin K, such as gallbladder or biliary disease, cystic fibrosis, celiac disease, and Crohn’s disease
  • Liver disease
  • Taking blood thinners, such as warfarin (Coumadin)
  • Long-term hemodialysis
  • Serious burns
  • Consumption of trans fats (k2 absorption)
  • Broad spectrum antibiotic use (k2 absorption)
  • Dilantin
  • Fat blocking medications such as Orlistat

- Brooke Lounsbury, RN

Medical Content Writer

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Seasonal Allergy Relief

As we emerge from the depths of winter and attention turns to the longer days that spring presents- more time outdoors, sports, gardening, outings to lakes and local parks can fill our leisure time.

Sunny days beckon us to spending more time outside, however many suffer from seasonal allergies. Seasonal allergies can make life perfectly miserable. Stuffy nose, swollen and teary eyes, clogged ears, sinus drainage, sneezing and cough add up to some allergy sufferers avoiding the benefits of being outdoors. In fact, seasonal allergies affect 19,2 million adults and 4.2 million children in the U.S.

What are seasonal allergies. And when ae they the most prevalent?

Seasonal allergies are also known as “hay fever” or seasonal allergic rhinitis. The immune system kicks into overdrive and overreacts to pollen or other substances. Symptoms happen during certain times of the year, when trees, grasses, and flowering plants  release tiny pollen particles into the air to fertilize other plants.

Spring allergies begin in February and last until the early summer. However, seasonal allergies can happen anytime, depending on where you live and what your body overreacts to.

What are common seasonal allergy symptoms?

  • Congestion
  • Sneezing
  • Itchy eyes, nose and throat
  • Runny nose and eyes
  • Puffy, swollen eyes
  • Postnasal drip (drainage in the throat)
  • Excessive sleepiness
  • Coughing
  • Brain fog

Some common seasonal allergens and when do they occur?

  • Tree pollen—May, June, July
  • Grass pollen—Depending on where you live – March through July
  • Ragweed- sage, mugwort, rabbit brush, etc- end of August through October
  • Mold—mostly in the fall, or in moist, warm environments and climates

How to control seasonal allergies

Environmental

Reduce your exposure to allergy triggers

  • Stay indoors on windy days during pollen season.
  • If the air in your home is humid, run a dehumidifier.
  • Remove clothes you’ve worn outside and shower to rinse pollen from your skin and hair. This is especially important after mowing lawn or working in the garden
  • Pollen can stick to sheets and towels, dry clothes inside.
  • Wear a face mask when outside.
  • Every city and area of the country has a pollen forecast. It can usually be found on weather apps on phone. In addition, your local tv or radio station may have pollen forecasts.
  • Keep doors and windows closed when pollen counts are high
  • Avoid outdoor activity in the early morning when pollen counts are highest.
  • Keep indoor air clean- portable Hepa filter devices can clear a room of allergens. These are very useful in the bedroom. Keep the unit on, even when not in the room to help keep air clean.
  • Use air conditioner in home, change filters on a regular basis
  • Damp mop all hard floor surfaces, thoroughly vacuum carpet with a vacuum equipped with a HEPA filter

Nonprescription medications that may help

Check with your care provider before using any over the counter or alternative treatments for allergy relief. Some over the counter medicines shouldn’t be used with high blood pressure patients, and there are interactions with any drug, over the counter or not.

Oral decongestants. Oral decongestants such as pseudoephedrine (Sudafed) can provide temporary relief from nasal stuffiness. Some allergy medications combine an antihistamine with a decongestant. Examples include cetirizine-pseudoephedrine (Zyrtec-D 12 Hour), fexofenadine-pseudoephedrine (Allegra-D 12 Hour Allergy and Congestion) and loratadine-pseudoephedrine (Claritin-D). Talk to your health care provider about whether the use of a decongestant is good for treating your allergy symptoms.

Oral antihistamines

Some oral antihistamines list sleepiness as a side effect (diphenhydramine and Chlorpheniramine for example. Be sure to read labels and precautions.

Antihistamines can help relieve sneezing, itching, a stuffy or runny nose, and watery eyes. Examples of oral antihistamines include loratadine (Claritin, Alavert).cetirizine (Zyrtec Allergy), Diphenhydramine (Benadryl) fexofenadine (Allegra Allergy) Chlorpheniramine (Chlor-Trimeton)

Corticosteroid nasal sprays. These medications improve nasal symptoms. Examples include and triamcinolone (Nasacort Allergy 24 Hour). fluticasone propionate (Flonase Allergy Relief), budesonide (Rhinocort Allergy) and triamcinolone (Nasacort Allergy 24 Hour. These are not recommended for long term use without medical supervision.

Cromolyn sodium nasal spray (Nasachrom). decreases inflammation in the nose and reduces substances in the body that release that cause allergy symptoms.

Try some home relief remedies

Neti pot

Neti pots can rinse sinuses out, clearing allergens in nasal cavity. They have a proven track record to relieve allergy symptoms. Use saline solutions from ready made pouches or if you use water, only use distilled /sterile water.  Do not use tap water, there have been rare cases of infections from bacteria or protozoa in tap water. It may be safe to drink because stomach acid will kill pathogenic bacteria, however sinuses don’t have that protection. Be sure to thoroughly clean and air dry neti pot after use.

Raw honey, royal honey, propolis

Raw honey has been proven to relieve seasonal allergy symptoms. Start honey before allergy season before allergy season starts. Do not use in children under a year old.

Natural antihistamines are found in:

  • Stinging nettle,
  • Butterbur, a marsh plant
  • Quercetin, found in citrus fruits, grapes, apples and onions along with other fruits and vegetables
  • Bromelain, found in pineapples

Probiotics

Probiotics have been studied and have shown to relieve allergy symptoms. L Casei is a probiotic demonstrated to relieve allergy symptoms, It is found in kefir, a cultured milk product and in a lesser extent yogurts(check labels). There are other probiotics that have been researched and have positive results, however there have been mixed results.

When home remedies aren’t enough, Seek help from your healthcare provider.

If you have bad seasonal allergies, speak with your health care provider if your seasonal allergies aren’t relieved by the above methods or your symptoms are bad. They may recommend skin tests or blood tests to find out what allergens trigger your symptoms. This will enable your care provider to target which treatments are likely to work best for you.

- Brooke Lounsbury, RN

Medical Content Writer

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