You Ask, I Answer: Depression & Vitamin D

I just got my blood labs done to test for vitamin D deficiency.

My doctor said that my recent depression symptoms and joint pain could be resulting from that.

I knew about rickets and vitamin D deficiency in children, but what is this chronic pain/fatigue/depression stuff in adults?

How does vitamin D deficiency play a role in that?

-- Christine (last name unknown)
Via the blog

Thanks to more funding -- which means more research -- we are finally getting a glimpse at all of Vitamin D's important functions.

Many people don't realize that the term "vitamin" isn't even 100 years old (that anniversary will occur in 2012).

Vitamin D, meanwhile, wasn't discovered until 1922.

In any case, recent research on vitamin D status, depression, and joint pain appears promising (more studies are needed before any of this can be established as fact, though).

As far as depression is concerned, this is the reasoning:

* Blood samples of individuals experiencing clinical depression show lower levels of
25-hydroxyvitamin D (the active form of vitamin D measured in blood).

* The brain contains vitamin D receptors, which vitamin D uses in the synthesis of vital peptides and compounds.

* Recent studies on individuals suffering from Seasonal Affective Disorder (SAD) concluded that those who supplemented 600 International Units of vitamin D reported feeling better more quickly than those who did not supplement. It is worth noting that neither group used special UV lamps for the study.

This is not to say that vitamin D "cures" depression. The current line of thinking is that low vitamin D status can exacerbate some types of depression, and that correcting this inadequacy may be one factor than can help speed up recovery.

As for the second half of your question -- since Vitamin D is tightly linked with calcium and phosphorus in bone metabolism, it only makes sense that inadequate levels could have an effect on joints.

The latest studies theorize that deficiencies of vitamin D make it more difficult for the body to repair cartilage and joint damage from arthritis.

I completely side with scientists and researchers who recommend daily supplementation of 2,000 International Units of vitamin D for the following groups of people:

* Dark-skinned individuals
* Adults over the age of 65
* Anyone living north of Atlanta (from October to April)
* Anyone with limited sun exposure

Numbers Game: Answer

92 to 98 percent of peak bone mass (the period by which all bone formation occurs) is achieved by age 20.

High peak bone density is one factor that helps decrease the risk of osteoporosis and bone fractures later in life.

This is precisely why having adequate intakes of calcium -- as well as being physically active -- during childhood and adolescence is crucial.

The more "bone healthy" the diet is during childhood and adolescence (particularly by consuming sufficient amounts of calcium, vitamin K, vitamin D, phosphorus, and magnesium), the higher peak bone mass levels are.

This is not simply a matter of having your child pop a Flintstones chewable vitamin, though. Whole foods containing these nutrients are far superior sources.

You Ask, I Answer: Vitamin D/Sunshine

Can we synthesize D with sunblock on? Doctors these days recommend NO unprotected sun exposure.

How much sun exposure is required for our daily dose of Vitamin D? If I take a 30 minute walk outside every day is that sufficient or do I still have to supplement?

How much skin has to be available to the sun to do the job?

I always wear sunblock on my face, and at this time of year (in upstate NY) that's the only skin that sees sunshine.

The rest is sunblocked, windblocked, coldblocked, snowblocked with multiple layers of clothing!

-- Jennifer Armstrong
Saratoga Springs, NY

We are unable to synthesize vitamin D with sunblock on because all products on the market act as barriers against either solely UVB rays or, if advertised as "full spectrum," both UVA and UVB rays.

Remember -- only UVB rays are associated with Vitamin D synthesis.

From an exposure standpoint, all you need is 10 minutes a day, three days a week, when the sun is at its highest point in the sky.

Even though these 10 minutes are without sunblock, it is believed that the benefits of adequate vitamin D levels outweigh the risks of soaking up sunrays without protection for such a short amount of time.

That said, people who live north of Florida -- like you, Jennifer -- must supplement from October to March, as the sun is too low in the sky for its UVB rays to penetrate the atmosphere.

Although current Vitamin D Daily Values for adults are set at 400 International Units, it is becoming increasingly clear that people should be supplementing with approximately 800 IUs a day.

Since the elderly and darker-skinned individuals synthesize lower amounts of this vitamin from the sun, it is recommended they supplement even during Summer months so as to not expose their unprotected skin to the sun for longer amounts of time.

Our Bodies Are Smart: Example 1,456,973

As anyone with basic nutrition knowledge is aware, humans can synthesize Vitamin D from sunlight.

Specifically, UVB rays convert a cholesterol precursor on the skin known as 7-dehydrocholesterol into previtamin D3.

Previtamin D3 is then converted into Vitamin D3 -- the active form -- with the simple "application" of heat (luckily, sunlight takes care of that!)

As with other vitamins and minerals, there is an tolerable upper limit for the "sunshine vitamin."

The latest data considers daily intakes higher than 10,000 International Units a day to be excessive, as they can result in nausea, fatigue, high calcium levels in blood, and calcinosis (a condition in which calcium deposits form in soft tissue).

Which begs the question: do humans run the risk of making too much Vitamin D if they are exposed to sunlight for hours with no protection?

Not at all, thanks to our incredibly smart bodies.

Turns out the cutaneous photoactivation and synthesis of vitamin D (that's a lofty way of saying "the process by which we create vitamin D from sunlight") is self-regulating.

Consistent exposure to heat photodegrades, or destroys, previtamin D3.

Therefore, once sufficient amounts of D3 have been created, subsequent amounts of previtamin D3 turn into inactive metabolites that are not converted into vitamin D3.

You Ask, I Answer: Vitamin D Fortification

I have seen some foods fortified with Vitamin D2, and others with Vitamin D3.

Which is better?

-- Tom (last name withheld)
(City withheld), TX

From a fortification standpoint, they are both equal.

Ergocalciferol ("vitamin D2") is a vitamin D precursor that extracted from a yeast sterol, while cholecalciferol ("vitamin D3") is usually synthesized from fish oils or lamb's wool.

Not surprisingly, you will find that vegan alternatives tend to be fortified with the former, while other foods usually rely on the latter.

Both D2 and D3 raise vitamin D levels in the blood equally, although there was always conflicting research on whether or not their half-lives (how long their effects last) are the same.

However, the latest research (a 2008 study out of Boston University) found that doses of both D2 and D3 took the same amount of time to plateau to baseline levels.

Regardless, if you consume Vitamin D on a daily basis (and get some exposure to the sun), half-lives become rather irrelevant.

You Ask, I Answer: Almond Milk

I am trying out almond milk and wondering why calcium is listed [on the nutrition label] as 0% [per serving] when it is made from almond base made from almonds.

What are your thoughts about almond milk, anyway?

-- Dennise O'Grady
Bay Head, NJ

"Almond base" is basically a combination of almonds and water.

In order to save money, many companies that sell almond milk use a pretty high water to almond ratio.

Consider the following: 23 almonds contain 7% of the Daily Value calcium.

Thereby, if your brand of almond milk contains zero percent of the calcium Daily Value per serving, it's fair to conclude that each serving probably contains two or three actual almonds (eleven almonds provide 3.3 percent of the Daily Value, 6 almonds provide 1.82 percent, and three almonds provide .91 percent.)

Almond butter, meanwhile, lists almond as its sole ingredient.

It is no surprise, then, to see that two tablespoons provide ten percent of the calcium daily value (this means that it takes approximately 35 almonds to make two tablespoons of almond butter!)

My thoughts on almond milk aren't particularly strong either way.

I enjoy the taste quite a bit myself, but I wouldn't suggest that anyone specifically seek it out or avoid it.

I do, however, recommend that people choose varieties fortified with calcium and vitamin D, particularly if they are vegan.

You Ask, I Answer/In The News: Vitamin D requirements

I read today that the recommended amount of vitamin D has doubled due to a new study.

I thought most people get enough of it.

How much vitamin D do we get from dairy as compared to being out in the sun?

--Hemi
Via the blog

The issue of Vitamin D requirements being too low has been a hot topic in the nutrition field for years.

According to current recommendations, children and adults up to the age of 50 should get at least 200 International Units, adults 50 to 71 years of age should aim for 400 IUs, and anyone above the age of 71 should be taking in 600.

The new guidelines you are referring to bump up the 200 IUs figure to 400 IUs.

Even so, many researchers think everyone should aim for 1,000 IUs a day!

The best source of Vitamin D is the sun, but this can get complicated.

After all, we get this vitamin from exposure to UVB rays, which are not as powerful in winter months and have a harder time getting through on cloud-covered days.

Additionally, the massive use of moisturizers and creams that block out UVB rays prevents many people from absorbing a good deal of "solar powered" vitamin D.

Some fortified foods (i.e.: cereals, soy milks, and dairy milk) provide vitamin D, while others (tuna, salmon, and... ugh, cod liver oil) do so naturally.

Despite this, it can be very difficult to meet the Vitamin D recommended intakes without some sort of supplementation.

For example, a cup of fortified dairy milk provides a quarter of a day's worth of Vitamin D (using 400 IUs as the goal).

Not bad, but unless you're planning on downing four glasses of milk a day, you will come up short.

Keep in mind, too, that many dairy products (like yogurt, cottage cheese, and ice cream) are NOT fortified with vitamin D.

Going back to the sun, the general recommendation is that 30 minutes of exposure to sunlight twice a week provides sufficient levels vitamin D.

Interestingly, research studies earlier this year concluded that individuals living in countries near the equator tend to have higher vitamin D levels than their counterparts to the North and South.

You Ask, I Answer: Calcium Supplements

I take a pill that [contains] 600 mg Calcium and 400 IU vitamin D.

I'm a 26 year old female. Is this a good decision?

-- Anonymous
Via the blog

If you find that your diet does not provide sufficient calcium, then supplementing it is certainly a good decision.

Having Vitamin D in the same pill as calcium is particularly smart, as this helps facilitate absorption.

However, 600 milligrams is too much for the body to absorb at once. I recommend a supplement containing no more than 500 milligrams.

Also, be sure to check your supplement’s bottle for the amount of “elemental calcium” – this tells you how much of the calcium in the supplement is “up for grabs.”

Some not-so-trustworthy companies advertise themselves as offering large amounts, but read the fine print and you'll see that each pill doesn't offer that much absorbable calcium.

Speaking With...: Milton Stokes

Milton Stokes, MPH, RD, CDN is the owner of One Source Nutrition, offering a variety of private counseling and media consulting services.

He is also an American Dietetic Association National Media Spokesperson who has been featured in a plethora of publications, including Self, Cooking Light, Men’s Health, Fitness, and the New York Daily News.

I first met Mr. Stokes in January of 2007 when he served as an adjunct professor for New York University’s Department of Nutrition, Food Studies, and Public Health.

He is an intelligent, sharp, and charismatic entrepreneur who is a wonderful asset to the field of nutrition and dietetics and communicates his nutrition knowledge in a most effective manner.

On with the interview:

What shifts, if any, have you noticed with your clients over the past decade? Is nutrition education really more widespread?

Most people come to my office well-educated on nutrition and health.

They develop admirable knowledge from websites, like anything associated with NIH.gov, and certain consumer publications, like Eating Well and Cooking Light. Clients know all about MyPyramid and reading food labels. So it's not a knowledge gap.

Instead, the problem is that gray area of disconnect, that missing spark to motivate clients to implement their knowledge.

A lot of what we do in the practice is boost a client's self-efficacy. We simply point out "You say you want to achieve health, but you continue with this behavior."

From there we proceed by encouraging them to start with a specific change today or this week. Showing clients we believe they can do it helps enhance their sense of self belief, which is what self efficacy is all about.

What do you perceive as two of the most important behavioral modification changes people who are looking to lose weight can do?

Step one is getting proof of what a client's eating and drinking. Proof in the form of a simple food journal. It's amazing what a difference seeing food consumption on paper really makes. Subtle, but significant, patterns start to emerge.

Usually those patterns are enough to guide future work with the client. We work with eating disorders mostly, and as I said earlier, our patients are extremely educated in nutrition. But they do things, like sabotage themselves with unhealthy environments at home.

Premium ice cream and other binge foods don't crawl into the kitchen without help. With exercise, owning a treadmill is a good start, but you can't use it as a wardrobe station in the basement. Take those clothes off of it--or whatever items reside there--and have it ready.

This leads me to the next tip: plan. If you don't plan to exercise, you probably won't. Your sneakers and workout clothes won't magically appear if you don't take them out. Furthermore, take them with you in the morning. After work it's a little easier to get to the gym when you don't have to come home to change.

Once home, it's like pulling teeth to go back out. Home has dishes to be done, laundry to fold, mail to open, and so forth. Those are common distractions that become excuses. So I say bypass those and do the exercise first.

Planning is applicable to food as well.

Do most of your clients share a common obstacle/hurdle in reaching their health/nutrition/weight goals?

We see mostly females in our practice. And the adult women tend to prioritize everything but their health.

For one of many examples: They shop for food, they cook the food, and they clean up after it's all over. I say, "Hold up, why can't you farm out some of this work?" Give the list to your spouse; assign your 10-year-old the task of tearing lettuce for the salads and setting the table; each person clears his own dishes and loads the washer.

That the woman has to do all this is really old fashioned. And it's a common barrier to putting health first. If you aren't healthy, how can you take care of your family?

Finding ways to earn back 5 minutes here, 5 minutes there will add up. Soon you're at 20 minutes, which is enough for a brisk walk and some alone time to clear your head.

Are there two or three popular nutrition myths that most of your clients have interpreted as "truth"?

Eating breakfast makes me gain weight.

Stop eating after 6 pm or all the food turns to fat. But digested food isn't like Cinderella's carriage: at the stroke of midnight (or whatever time) it doesn't turn into a pumpkin....or into fat.

Holy grail of nutrition and feeding is some secret or mystical concoction. What's the minute, teeny tiniest thing I'm missing to make me whole?

Exogenous digestive enzymes....we would've died out ages ago.

As a nutrition educator, are there certain inaccurate messages in the mainstream media regarding nutrition that especially frustrate you?

In general, a lot of marketing jumps the gun on real benefits of specific nutrients or foods. This promotes adult food jags of sorts.

One day dried plums or blueberries or tomatoes are the rage. The next, it's some hideously bitter juice designed to extend life by 7 years.

Then just a pill crammed with all the nutrition of 10 fruits and vegetables. There is no secret or miracle to losing weight or preventing disease. Eating real food does the trick--but that message isn't sexy or provocative or profitable.

Having said that, let me also pause to recognize the work of researchers.

Nutrition is an evolving science, so what we know today may change tomorrow as research is completed. And that's okay. There's nothing wrong with continuing to pursue new findings.

I do wonder, though, what would become of human health if we diverted some of those research dollars to subsidize fruits, vegetables and whole grains? We know that eating this way works. Do we need more research, or can we go ahead and pay farmers with research dollars to deliver their products to all neighborhoods?

People could go to market several times a week, or whenever, and stock up. Farmers could be paid to go door-to-door. Consumers wouldn't pay a thing.

What particular direction would you like the nutrition field to embark in over the next 10 - 15 years?

Stop putting everything under a therapeutic microscope.

Stop hanging on the latest research finding that says a certain micronutrient might do this or might do that. Nobody eats solo nutritients. Clients tire themselves by getting carried away over headlines without understanding the full scope of the study.

Studies isolate single nutrients without considering synergy or total nutrient packages in whole food. This relates to what we talked about earlier: the message to eat more fruits and vegetables isn't glamorous or trendy.

I am concerned with incessant food scares over pathogens and improper food handling.

I'd like to see nutrition researchers partnering with sleep experts. Who isn't sleep deprived? Without enough sleep we know it's quite difficult to lose weight, and you're more likely to reward yourself with high-carbohydrate foods as way to feel better.

Vitamin D [is another subject that we need to look into further].

I might get in trouble for this, but we may have missed out on the opportunity to consider low-carb diets. First of all, I believe no single diet fits every person. I also believe low-fat isn't necessarily top dog.

Researchers, like Jeff Volek, have shown low-carb diets promote fat loss, preserve lean muscle mass, and improve lipid profiles. Am I saying we all need to eat low-carb? No. But we could let the scientific process show us what low-carb eating can do.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * *
A huge thank you to Milton for participating in this interview.

If you enjoyed this interview, be sure to visit his new blog for more information and tips.

Say What?: The "Coo Coo" Diet

I am always fascinated by people who take nutrition to an extreme, ultimately putting their health at risk.

And so I present to you: fruitarians (exhibit A and exhibit B.)

That's right -- these people advocate eating nothing but fruit for optimal health.

(Insert "Twilight Zone" theme song HERE.)

It's worth pointing out that this includes "avocado, cucumbers, tomatoes, paprika, olives and squash."

Although some fruitarians start out eating nuts and seeds, the goal is to eventually cut those out as well.

Right, because nuts and seeds are behind all our health problems. UGH.

Despite clearly lacking a multitude of nutrients (Omega-3 fatty acids, zinc, calcium, and vitamin D, among others,) this movement has devout followers.

When it comes to dangerous diets such as fruitarianism, I leave political correctness at the door.

I am not going to sit here and say it's just a "different" diet that needs to be "carefully planned."

No. It's unhealthy, unbalanced, and as far as I'm concerned, an eating disorder disguised as a "natural" way to eat.

You Ask, I Answer: V8

Does a glass of V8 truly count as a serving of vegetables?

-- Greg M.
Los Angeles, CA

An 8-ounce glass of V8 -- a blend of tomatoes, carrots, celery, beets, pasley, lettuce, watercress, and spinach -- actually counts as two vegetable servings.

Well, at least technically it does.

If it comes down to having a V8 versus no vegetables at all, I would definitely suggest the V8.

However, I have a few issues with replacing actual vegetables with this beverage.

Firstly, the sodium content in standard V8 is moderately high -- 480 milligrams (approximately 25% of a day's worth) per 8 ounce glass.

The accompanying 480 milligrams of potassium -- one of two key nutrients in regulating blood pressure -- serves as some consolation, though.

My real concern with this drink comes from the absence of fat, which impairs the absorption of the fat-soluble vitamins (A, D, E, and K) and some antioxidants (i.e.: lycopene).

This can easily be remedied by accompanying your V8 with some fat, like a handful of nuts or a salad with avocado slices.

V8 also does not provide as much fiber -- or as many phytonutrients -- as actual vegetables.

It's a very middle of the road product, in my opinion. Nothing fantastic, but also not a heinous creation.

Checking in with Oprah

I recently told you about Oprah's 21-day vegan cleanse (which, apart from obviously shunning all animal-derived foods, also bans sugar, gluten, alcohol, and caffeine).

The talk show queen is blogging on her site and updating everyone on her progress.

Day 1 was fairly easy to traverse.

You certainly can't knock it as an unhealthy eating pattern.

That day alone includes standouts like oatmeal, blueberries, strawberries, wild rice, a baked potato, and olive oil.

As wonderfully whole as all those foods are, I have some concerns.

Despite providing sufficient calories (roughly 1,600), fiber, and protein, the total amounts of vitamin B12, vitamin D, and calcium do not meet requirements.

Additionally, such a heavy reliance on nuts (they are eaten at breakfast, lunch, dinner, and as a snack) really drives up the Omega-6 fatty acid content.

This is slightly troublesome because, apart from some walnuts at breakfast and olive oil as salad dressing, Omega-3 intake isn't that high.

Remember, the Omega-6 to Omega-3 ratio plays an important role in our health.

I would personally add flaxseed to breakfast and replace the pinenuts in the dinner salad with nori (or some other sort of seaweed, naturally rich in Omega 3 fatty acids.)

By the next day, things get interesting -- and a little unrealistic. Oprah and her exec producers (also doing this diet with her) get their very own vegan chef!

And, alas, I'm back to my original gripes with this entire "cleanse."

When you start banning multiple food groups and not allowing yourself to have gluten (the most bizarre part of this plan; there is no reason to give up gluten unless you have an intolerance to it) or sugar, you'll find that unless you are very experienced around a kitchen and alternative ingredients -- or hire a personal chef -- it is not easy to maintain a dietary lifestyle that is interesting, practical, healthy, and balanced.

For Oprah and her colleagues to go the personal chef route is a bit of a copout. They should attempt to do this on the average income of an adult in the United States.

Take this example -- on day two, Oprah and her fellow cleansers wake up to strawberry rhubarb wheat-free crepes.

Do you think that on a random Wednesday morning you'll find yourself concocting such a recipe in your kitchen at 7 AM? I doubt it.

A successful eating plan is not only nutritious and tasty, it also has to be convenient. What's so wrong about some whole or sprouted grain toast with peanut butter?

Or a bowl of whole grain cereal (slightly sweetened, say a measly 3 grams of sugar per serving) with soymilk and raisins?

In yesterday's blog entry, Oprah hints at another problem with these overly strict regimens (let me make something very clear: it is one thing to be vegan, but a whole other thing to be a vegan who abstains from sugar, coffee, alcohol, and gluten) -- they can render you defenseless outside the four walls of your home.

Oprah mentions flying to Las Vegas later this week and being slightly nervous about her choices.

I hope she prepares herself for an eye-opening experience.

Forget vegan-friendly, Vegas is barely vegetarian-friendly.

Even something as standard and semi fast food-ish as a veggie burger is hard to come by. The only place where I felt healthy cooking was a priority was the spa at the Venetian Hotel.

Otherwise, bring your own snacks!

I found today's entry to be cause for concern:

"I hit a wall today. Literally had to stand in my closet and bound the walls, the cabinets, the floor for a few minutes and take some deep breaths."

A well-planned, balanced, practical eating plan should not have you feeling like this on day four.

This is why I very much oppose overnight radical shifts. Not only is there no physiological benefit to banning things left and right from one day to the next, it also conjures up issues of self-flagellation and unnecessary deprivation that often accompany a lot of weight loss plans.

It particularly upsets me because it sends very erroneous messages: healthy eating is a chore, it involves giving up pleasures, it pushes your body to the limit.

Nonsense!

The path to healthy eating and smart choices is not always going to be smooth and easy -- it is perfectly common and understandable to have the occassional setback -- and extreme approaches such as this "cleanse" certainly don't help.

It's a shame that someone as influential and looked up to as Oprah isn't using her show as a platform to show that wellness and health can be achieved without personal chefs, swearing off foods, or feeling like the world is caving in on you.

Anyhow, Oprah has two more weeks to go. I'll be sure to follow her progress and keep you all in the loop.

You Ask, I Answer: Menopause

What nutritional requirements should I be on the lookout for as I go through menopause?

-- Lena Hill
Boca Raton, FL

Since menopause is a time when a woman’s body undergoes a number of changes (among them hormonal, since estrogen and progesterone production is halted), nutrition recommendations are slightly altered.

To begin with, there is a fairly decent body of research linking diets rich in phytoestrogens (plant versions of estrogen) with alleviation of some menopause symptoms.

It is worth pointing out that phytoestrogens are not as powerful as human estrogen, so in order for them to have any sort of therapeutic effect, they need to be consumed in fairly large quantities on a consistent (daily) basis.

Although there are approximately 30 different forms of phytoestrogens, isoflavones and lignans are the two most commonly cited as helpful with menopause symptoms.

Legumes (including lentils, chickpeas, and soybeans) are good sources of isoflavones, while flaxseeds and bran are the best sources of lignans.

Although there is some research showing no relationship between isoflavone consumption and menopause symptoms, it is worth pointing out that most of those studies only looked at soy intake, rather than a variety of phytoestrogens.

Additionally, I don't see the harm in trying to include phytoestrogen rich foods (like edamame, pictured alongside this post) in the diet, since they are good sources of fiber, healthy fats, zinc, and calcium.

Even if they don't help you specifically with symptoms, you are certainly getting a fair share of nutrition.

Menopause is also a time to increase the intake of specific nutrients.

First up – calcium. Once women hit 50 years of age, their calcium requirement returns to that of their adolescent years – 1,200 to 1,400 milligrams a day.

This is up to 40 percent higher than the 1,000 milligram requirement for women ages 18 - 49.

It is recommended to get as much as calcium as possible from food first, and resort to supplements to make up any lost ground.

Supplementation of Vitamin D is also encouraged.

Requirements increase from 400 International Units to 800, since older women can’t convert sunlight into vitamin D as efficiently as their younger counterparts.

Because aging is accompanied by a loss of muscle mass, metabolism also slows down.

By the time a woman reaches the age of 60, for instance, her calorie needs decrease 15 to 20 percent than when she is in 30.

This means that the hypothetical 2,000 calories required at age 30 to maintain weight turn into roughly 1600.

This is one reason why exercise is so crucial. Weigt bearing exercises help minimize muscle loss, thereby keeping metabolism slowdown to a minimum (assuming there are no other health problems).

You Ask, I Answer: Cow Or Soy Milk?

When it comes to milk, is soy milk better for kids than regular cow's milk?

-- Anonymous
Via the blog

I don't consider either "better" than other. This ultimately depends on personal preference and a few other factors.

I don’t have a problem with children drinking skim or low-fat milk, provided that they aren’t lactose intolerant, of course.

What disappoints me is that so many schools offer chocolate milk to children (and label it a "healthy" alternative simply because it contains calcium).

A single cup contains a tablespoon of added sugar. It's fine as a treat, but I don't find it to be the optimal beverage to accompany a meal on a daily basis.

Unfortunately, the majority of milk in the United States -- chocolate or not -- in the United States is produced by cows that chow on corn all day long and are injected with antibiotics and growth hormones.

Milk in and of itself is a nutritious beverage, though, providing high-quality protein, calcium, vitamin D, vitamin A, phosphorus, and potassium.

I would highly recommend opting for organic, grass-fed varieties.

Soy milk is a perfectly fine alternative.

Most varieties are fortified with vitamin D and provide a good amount of calcium, protein, and potassium.

I would be more concerned with what they're eating along with that cold glass of (dairy or soy) milk.

*UPDATE* Thank you to reader "gd" for pointing out that vanilla and chocolate flavored soy milks also contain quite a bit of added sugar.

I erroneously assumed everyone reads minds and would telepathically infer I was only referring to regular soy milk in this post.

So, if you are opting for soy milk, I suggest going for plain or unsweetened varieties.

You Ask, I Answer: Osteoporosis

I am a 56 year old woman diagnosed with osteoporosis.

I would like to know the best way to incorporate calcium [in]to my diet.

-- Maria Barbosa
Argentina

Before I answer your specific question, let's briefly discuss the larger issue.

Osteoporosis -- a condition in which bone tissue deteriorates and bone density decreases, thereby weakening the skeletal system (see accompanying illustration) -- is especially prevalent among women.

In the United States alone, it is estimated that approximately 10 million adults currently live with osteoporosis, and an astounding 75 percent of them are women.

In case you are wondering about the difference between these two groups, a decline in estrogen at menopause is associated with decreased bone density.

Men, meanwhile, are protected by testosterone. Although testosterone levels decrease with age, they are still at a sufficient range to guard against the onset of osteoporosis.

Since osteoporosis is “symptom free” (you don’t feel weak, bloated, tired, or get headaches), it is completely feasible to develop it and be completely unaware of this for years.

To discuss how osteoporosis starts – and how to make the necessary changes once diagnosed with it – let’s go back to the beginning.

Our bones are a vast storage unit for a handful of minerals, especially calcium.

It’s important to have a strong reserve of calcium because we lose it on a daily basis.

All bodily excretions (sweat, urine, and feces) contain calcium, and our nails require it for production and growth.

Calcium is also needed for a variety of bodily functions (i.e.: forming blood clots).

Consume adequate amounts of this mineral every day and you easily replenish any losses.

If calcium intake is insufficient, that’s where the problem begins.

The body, desperate for calcium, doesn’t find any circulating in the blood and goes to the trusted storage unit for some.

In turn, bones are demineralized and broken down.

Imagine this happening on a daily basis for ten, twenty, even thirty years!

By the time you hit the fifty or sixty year-old mark, your bones are -- not surprisingly -- quite fragile and acutely demineralized.

Although many people automatically equate osteoporosis with calcium, there are other factors to keep in mind.

A crucial one is Vitamin D, which helps our bodies absorb calcium (this is why you often see calcium supplements also containing Vitamin D).

As I have explained before, Vitamin D is not found in many foods (the best source is actually the sun).

If you live in an area of the world that does not receive much sunlight for five or so months of the year, or if your dermatologist has strongly recommended you always use UV-proof skin lotions, you run the risk of being significantly deficient.

The solution? Reach for a daily supplement! Aim for 1,000 International Units a day.

Protein also plays a role in preventing osteoporosis.

Both sides of the spectrum – not getting enough or getting too much – are problematic.

A lack of protein in the diet will hinder the body’s ability to repair and rebuild bone tissue.

An excess, meanwhile, results in urine outputs with higher calcium levels than normal.

Phosphoric acid is also worth paying attention to. Found in regular and diet sodas, it disturbs the body’s calcium balance mechanism, often resulting in calcium being leeched from bones.

Sodium – a mineral the majority of people in the United States overconsume– also plays a role in osteoporosis.

High sodium intakes increase calcium losses through the urine (a result of the body attempting to keep various mineral levels proportional).

With all that in mind, how can you be proactive about lowering your risk of developing osteoporisis (and maintaing what bone mass you do have at the time you are diagnosed with it)?

From a nutritional standpoint, make sure you get sufficient amounts of calcium and Vitamin D and that you do not surpass maximum recommendations for sodium and protein.

Aim for 800 – 1,200 milligrams of calcium a day.

To answer your question, all dairy products are a great source, as are tofu, almonds, oats, and any fortified products.

Spinach, however, is one food that gets way too much credit.

Although it offers substantial amounts of various nutrients, don’t put it in your osteoporosis defense kit.

Spinach offers significant amounts of calcium, but also contains high levels of oxalate, a compound that binds to calcium and greatly reduces its absorbability in our gastrointestinal tract.

The good news is that oxalates only affect calcium absorption of the food they are in.

So, if you’re having a spinach and tofu stirfry, only the dark leafy green vegetable's calcium will be practically rendered useless.

Aside from nutrition, one of the best things you can do to minimize your risk of developing osteoporosis (and prevent further bone demineralization if you have already been diagnosed) is weight-bearing exercises.

This does not mean you need to necessarily start lifting heavy weights or buildmuscles. It’s really just about performing physical activity in which the muscles have to resist weight.

Remember, bone strengthens up when stressed. Hence, challenging it with weights on a regular basis helps to maintain -- and even increase -- its density.

As you can see, there are helpful steps you can take at any stage of the game. There is no reason to give in to osteoporosis.

In The News: D-Mistifying D

Vitamin D -- affectionately called "Sunny D', since sunlight is our primary source-- is undoubtedly the hottest nutrient these days, so it is no surprise The New York Times is dedicating more space to it today.

Not only is its importance in a variety of body functions consistently becoming more clear, traditional recommendations suggesting a daily intake of 400 International Units are being questioned.

Recent research has led dietitians to establish a much-higher 1,000 International Units as the desired daily intake.

Since Vitamin D is found very scarcely in foods (a cup of fortified milk provides 100 IU's), it is one of the few nutrients I highly recommend people who do not get enough sun (either because of winters with little hours of sunlight or because of the use of UV protection creams) supplement in pill form.

Research studies showing the benefits of sufficient Vitamin D intake is a dime a dozen:

"A Swiss study of women in their 80s found greater leg strength and half as many falls among those who took 800 I.U. of vitamin D a day for three months along with 1,200 milligrams of calcium, compared with women who took just calcium. Greater strength and better balance have been found in older people with high blood levels of vitamin D."

And then there's this one:

"Researchers at Creighton University in Omaha conducted a double-blind, randomized, placebo-controlled trial... among 1,179 community-living, healthy postmenopausal women. They reported last year in The American Journal of Clinical Nutrition that over the course of four years, those taking calcium and 1,100 I.U. of vitamin D3 each day developed about 80 percent fewer cancers than those who took just calcium or a placebo."

According to current estimates, as much as 60 percent of the United States adult population is Vitamin D deficient -- and that's based on the starting-to-be-considered-low 400 IU figure!

In The News: Skim & Lowfat Milk: Waist-Friendly, Prostate-Attacking?

I can't wait to see how the National Dairy Council responds to this study.

I unfortunately do not have a working Internet connection at home at the moment, so I will not comment on this study until Friday afternoon. I want to read the research before posting any opinions.

For the time being, though, I suspect this might be a small molehill erroneously reported as an intimidating mountain.

More to come tomorrow...

You Ask, I Answer: Olestra

This situation is a little awkward but: I ate the Lay's light chips (the ones cooked with olestra) and [they] produced some rather unfortunate side effects the next morning, as you can imagine.

I checked but there was no warning on the packaging. How come they don't warn about the side effects of Olestra?

-- Bubbles (via the blog)

Welcome to nutrition politics! I'm getting ahead of myself, though.

Let's begin with some general information.

Olestra -- a calorie-free fat-substitute made by linking fatty acid chains to sucrose molecules -- was developed in 1996 by multinational consumer goods giant Proctor & Gamble.

I am sure many of you remember the popularity of "WOW!" chips in the late 90s. Those were fat-free thanks to the inclusion of Olestra.

At the time, two things stood out to people who read the nutrition label and ingredient list. First, vitamins A, D, E, and K were added into the product.

A "healthier" potato chip? No. Since Olestra inhibits the absorption of these vitamins, it was decided to fortify such fat-free products with them.

However, the statement following the ingredient list caught most people's attention: "Olestra may cause abdominal cramping and loose stools." Yum!

Why is this? Olestra travels through our bodies completely undigested. In turn, even not-so-large quantities result in less than pleasurable side effects.

Alas, time went on and the Food & Drug Administration received over 20,000 formal complaints from consumers. The overwhelming majority revolved around the consumption of Wow! chips and painful -- sometimes painfully embarrassing -- side effects.

This made Olestra the food additive with the most complaints in the history of the FDA.

Interestingly enough, Wow! chips were soon replaced by "light" varieties of popular snacks. The perfect marketing trick, if you ask me -- offer a product with a tarnished reputation under a different name.

Remember, this is Proctor & Gamble we are talking about here. A lot of money -- and corporate interest -- is at stake.

I should also mention that Proctor & Gamble is known for its overly generous contributions to the Republican Party. This nugget of information will come in handy in a about two seconds.

Fast-forward to October of 2003 when, magically, during a Republican presidency, the FDA announced that products containing Olestra no longer need to list warnings on their packages.

Their reasoning? The reported gastrointestinal side effects were "mild and rare."

In fact, one of their main arguments was that abdominal cramps and diarrhea are common, and Olestra was just getting a bad reputation.

I don't think Olestra is worth all the trouble. If you are looking for a lower fat conventional potato chip, try Baked chips (I personally think Baked Lay's taste like salted cardboard, but the new Kettle Baked Chips are tasty), which contain 85% less fat than their regular relatives and absolutely no Olestra.

Numbers Game: Answer

Which of the following provides the highest amount of omega-3 fatty acids?

a) 4 ounces of fresh cold-water salmon
b) 4 ounces of canned sardines (in oil)
c) 4 ounces of fresh lobster
d) 4 ounces of canned salmon
e) Trick question. They all provide the same amount!

The correct answer is "d" -- canned salmon. Four ounces pack in 2.2 grams of Omega-3 fatty acids!

The remaining fish?

4 ounces of fresh cold-water salmon provide 1.7 grams, sardines contribute 1.8 grams, and fresh lobster contains 0.1 grams.

Omega-3's are essential (meaning our bodies can not produce them) polyunsaturated fatty acids that have been linked in hundreds of studies to lower risks of heart disease, cancers, rheumatoid arthritis, and even Alzheimer's and Parkinson's.

Recommendations are currently set at 1 to 2 grams a day (or 7 - 14 grams a week).

Why does canned salmon edge out cold-water salmon? Simple -- all canned salmon is wild.

The figure for cold-water salmon, meanwhile, is an average that takes into account wild and farmed salmon.

Farmed salmon offers lower levels of Omega-3 fatty acids since they are fed grains (rather than subsisting on a natural diet of small marine creatures).

Although all salmon is a great source of Vitamin D (four ounces provide a day's worth!), canned salmon offers an additional bonus -- calcium. Turns out the cooking process softens the bones to such a degree that they can be eaten.

The result? A quarter of your day's calcium needs in a (lactose-free) four-ounce piece!

Elaine Was On To Something

Fellow Seinfeld fans must remember the infamous "muffin top" episode, in which Elaine opens a muffin top shop, arguning it is the only part of the baked good people enjoy.

Although success didn't follow, the folks over at VitaMuffin are having a much better run.

Their chocolate muffin tops -- found in the frozen section of your grocery store -- aren't just delicious (you know I don't recommend anything on my blog until I have tasted it), they also pack in their fair share of nutrition.

Let me be perfectly clear. This is not a "health" food. It is not meant to replace vegetables or fruits. It also does not give you license to eat an entire box in one day.

However, I think it's pretty nifty when a product delivers satisfying taste without going overboard on calories, fat, and sugar. After all, who CAN'T make something tasty with unlimited amounts of butter and sugar?

Each package contains four individually wrapped muffin tops. They make for an excellent dessert. So, if four of you happen to be sitting around the dining table, you won't be tempted to go back for more.

Here is the nutritional rundown per muffin top:

100 calories
1.5 grams fat
1 gram saturated fat
140 milligrams sodium
170 milligrams potassium
6 grams fiber
9 grams (slightly over teaspoons) of sugar
20% calcium
50% vitamin D

Try them out for yourself and let me know what you think.