If your bones, muscles or joints ache for no apparent reason, you could be suffering from vitamin D deficiency. This silent epidemic is spreading throughout the United States, because as Americans, we’re increasingly avoiding sun exposure and consuming fewer milk products.

Vitamin D is very important to our health. It helps the body absorb calcium and phosphorus, responsible for bone growth and density. Vitamin D also suppresses the release of a hormone that causes bone breakdown.

Vitamin D can also boost our immune systems and act as an anti-inflammatory. For this reason, it may help treat inflammatory diseases such as certain types of arthritis, dermatologic conditions, osteoporosis, cancers, autoimmune diseases and central nervous system diseases. It may also help prevent organ transplant rejection. Studies show that vitamin D may even play a role in cardiovascular health and the prevention of gum disease.

Vitamin D deficiency can affect anyone and is usually caused by poor diet, insufficient sun exposure or certain diseases that limit the body’s ability to absorb vitamin D. In rare cases, a person’s body absorbs vitamin D but is unable to process it.

Infants, children, the elderly and postmenopausal women are at the highest risk for vitamin D deficiency. Infants are at risk because human breast milk contains low levels of vitamin D, and most infant formulas do not contain adequate vitamin D. The elderly are at risk because they consume fewer vitamin D-rich foods, and their bodies are less able to absorb and store Vitamin D. Postmenopausal women with osteoporosis frequently have unrecognized vitamin D deficiency.

A recent study showed that more than 30 percent of healthy adults ages 18 to 29 had vitamin D insufficiency at the end of winter, falling to 4 percent by the end of summer. The amount of sun needed to synthesize vitamin D varies and depends on the person’s age, skin color, sun exposure and underlying medical problems.

Complications of vitamin D deficiency include low blood calcium, low blood phosphate, rickets (bone softening seen in childhood) and osteomalacia (bone softening seen in adults). Vitamin D insufficiency is also common and may or may not have visible signs or symptoms, but it can still lead to reduced bone density, mildly decreased blood calcium, and an increased risk of falls and fractures. Osteomalacia puts adults at a higher risk for pain and fractures. For these reasons, identifying and treating vitamin D deficiency or insufficiency is important to maintaining bone strength.
 
The daily vitamin D recommendation for infants and children is 400 international units (IU) per day. For adults, the recommendation is at least 800 IU per day. You can increase your vitamin D intake through diet, vitamin supplements and some exposure to ultraviolet (UV) light. However, using sun exposure or tanning beds as the primary source of vitamin D is not recommended due to the risk of skin cancer.

Sources of vitamin D include fortified dairy products such as milk (100 IU per cup), fatty fish such as tuna (200-400 IU per serving) or salmon (800 IU per serving), and cod liver oil (1,300 IU per tablespoon). Other good sources are green leafy vegetables and sundried food productsÑincluding mushrooms, peppers and tomatoes.

If you are diagnosed with vitamin D deficiency or insufficiency, you may also benefit from prescription vitamin D preparations.

Vitamin D deficiency is a commonly unrecognized and undiagnosed condition. If you experience unexplained aches and pains and believe you don’t get enough dietary vitamin D or sun exposure, ask your doctor to check your levels today to get the information or treatment you need to lead a healthier, longer and more comfortable life.

— By Sung Hui Knueppel, M.D.

— The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

We are in the middle of a busy cold and flu season. In addition to all the usual seasonal cold and flu viruses, we have the H1N1 virus, which has been circulating throughout the United States this fall.

The U.S. Centers for Disease Control and Prevention (CDC) reports that flu activity is already widespread in 46 states, and that flu-related hospitalizations and deaths are unseasonably high. Plus we still have more than 200 viruses that cause the common cold and the seasonal influenza viruses to look forward to this winter.

The cold and flu viruses cause a predominately respiratory illness, with a runny or stuffy nose, sore throat, cough, fever, body aches, headache and fatigue. In a healthy individual, these are temporary symptoms that last five to seven days. Individuals with heart or lung disease, such as asthma, often experience more severe symptoms.

While we have no vaccine against the common cold, the mainstay of preventing the seasonal flu has been the annual seasonal flu vaccine. This year we also have a vaccine against the H1N1 flu. Due to production delays and distribution problems, however, there is a nationwide shortage of both flu vaccines. So what else can we do to protect ourselves and our families against the flu?

Cold and flu viruses are spread from infected individuals in the droplets of a cough or sneeze, or in the discharge of a runny nose. If you are infected, you can help prevent spreading it to family and friends by doing the following:

• Always cover your nose and mouth with a tissue when coughing or sneezing, and then immediately dispose of the tissue after using it.
• If you have no tissue, avoid coughing or sneezing into your hand. Instead, cough or sneeze into your upper arm.
• If you do use your hand to cover a cough, wash immediately with soap and water or an alcohol-based hand cleanser.
• Do not carry a cloth handkerchief that you use repeatedly, because it is a haven for lurking germs. Use disposable tissue instead.
• If you get a fever, stay home until 24 hours after your fever is gone (without the aid of fever-reducing medications such as Tylenol) to avoid passing the virus to others. Keep warm, drink plenty of fluids and rest.

To best avoid getting infected with a cold or flu virus, remember the following:

• Avoid touching your eyes, nose or mouth, as these are the places where the viruses enter our bodies.
• If you need to rub your eyes or scratch your nose, either use a clean disposable tissue or wash your hands first.

If you are caring for a loved one with the flu, remind them of these tips to avoid passing the virus to family members. Follow the advice of public health authorities regarding school closures, and avoid crowded areas during the height of cold and flu season.

If you do get the flu-which is usually accompanied by a high fever, dry cough and body aches-there are prescription medicines to help reduce the duration and/or intensity of the illness. These work best if started within two days of the initial symptoms and are most often used for individuals with chronic illnesses who might have a more serious course. Your doctor may want to see you before prescribing these anti-flu medicines to assure you do not have pneumonia, a serious condition that may have symptoms similar to the flu but requires a very different type of treatment.

In general, avoiding colds and the flu involves following the advice we all received from our grandmothers-covering our coughs and sneezes and washing our hands. Follow this common-sense advice and the other tips outlined above, and have a happy, healthy holiday season.

Photo Caption: Dr. Bill Black is an internal medicine physician at the Palo Alto Medical Foundation (PAMF).Endnote: The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

Preventing Spread of Colds and Flu

By Bill Black, M.D., Ph.D.

We are in the middle of a busy cold and flu season. In addition to all the usual seasonal cold and flu viruses, we have the H1N1 virus, which has been circulating throughout the United States this fall.

The U.S. Centers for Disease Control and Prevention (CDC) reports that flu activity is already widespread in 46 states, and that flu-related hospitalizations and deaths are unseasonably high. Plus we still have more than 200 viruses that cause the common cold and the seasonal influenza viruses to look forward to this winter.

The cold and flu viruses cause a predominately respiratory illness, with a runny or stuffy nose, sore throat, cough, fever, body aches, headache and fatigue. In a healthy individual, these are temporary symptoms that last five to seven days. Individuals with heart or lung disease, such as asthma, often experience more severe symptoms.

While we have no vaccine against the common cold, the mainstay of preventing the seasonal flu has been the annual seasonal flu vaccine. This year we also have a vaccine against the H1N1 flu. Due to production delays and distribution problems, however, there is a nationwide shortage of both flu vaccines. So what else can we do to protect ourselves and our families against the flu?

Cold and flu viruses are spread from infected individuals in the droplets of a cough or sneeze, or in the discharge of a runny nose. If you are infected, you can help prevent spreading it to family and friends by doing the following:

• Always cover your nose and mouth with a tissue when coughing or sneezing, and then immediately dispose of the tissue after using it.
• If you have no tissue, avoid coughing or sneezing into your hand. Instead, cough or sneeze into your upper arm.
• If you do use your hand to cover a cough, wash immediately with soap and water or an alcohol-based hand cleanser.
• Do not carry a cloth handkerchief that you use repeatedly, because it is a haven for lurking germs. Use disposable tissue instead.
• If you get a fever, stay home until 24 hours after your fever is gone (without the aid of fever-reducing medications such as Tylenol) to avoid passing the virus to others. Keep warm, drink plenty of fluids and rest.

To best avoid getting infected with a cold or flu virus, remember the following:

• Avoid touching your eyes, nose or mouth, as these are the places where the viruses enter our bodies.
• If you need to rub your eyes or scratch your nose, either use a clean disposable tissue or wash your hands first.

If you are caring for a loved one with the flu, remind them of these tips to avoid passing the virus to family members. Follow the advice of public health authorities regarding school closures, and avoid crowded areas during the height of cold and flu season.

If you do get the flu-which is usually accompanied by a high fever, dry cough and body aches-there are prescription medicines to help reduce the duration and/or intensity of the illness. These work best if started within two days of the initial symptoms and are most often used for individuals with chronic illnesses who might have a more serious course. Your doctor may want to see you before prescribing these anti-flu medicines to assure you do not have pneumonia, a serious condition that may have symptoms similar to the flu but requires a very different type of treatment.

In general, avoiding colds and the flu involves following the advice we all received from our grandmothers-covering our coughs and sneezes and washing our hands. Follow this common-sense advice and the other tips outlined above, and have a happy, healthy holiday season.

— By Bill Black, M.D., Ph.D.Endnote: The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.

Running On Empty
The Truth About Children and ADD

Do teachers and family members comment on your child’s inability to follow directions or sit still? Is your child impulsive or disorganized? Do you feel your child is ignoring you, even when you try multiple times to get his or her attention? If so, your child may have attention deficit disorder (ADD). If the child has these symptoms plus hyperactivity, the culprit may be attention deficit hyperactive disorder (ADHD).

Most people are familiar with the terms ADD and ADHD, but the disorders are misunderstood. For example, many people believe they are not real medical disorders and are caused by poor parenting. Another misconception is that the disorders are limited to boys or that children always grow out of it. Girls also suffer from ADD and ADHD, and the disorders can plague individuals into adulthood – making it difficult to perform daily activities and responsibilities.

Children with ADD and ADHD are less likely to perform well in school, leading to higher dropout rates. Impulsive behavior can also lead to accidents, trouble with the law, sexual activity at a young age and other serious problems. Self esteem often suffers. For these reasons, the disorder should be taken very seriously.

One of the primary problems children with ADD and ADHD have is that they’re unable to focus on something they don’t f ind interesting. We all focus better for longer periods of time when we’re interested in a topic, and people with ADD or ADHD can often focus when they’re interested. It’s when things aren’t so interesting that they have bigger problems than others.

Children with ADD or ADHD don’t automatically focus in a classroom setting. They may see the teacher, but the teacher is no more important to their brains as 12 other thoughts at that time. Their brains don’t prioritize “teacher” over “other things,” such as “What will I have for lunch?” or “That picture is crooked.” Some may argue this thought process is evolutionarily adaptive – such as a hunter paying attention to many things in the environment at one time. Even if this is true, it makes school difficult.

Fortunately, ADD and ADHD are usually quite manageable and treatable. You and your child’s teacher may be able to manage symptoms with a positive reinforcement program in the class-room and at home. For example, it may help the child to sit close to the teacher, or wherever there are fewer distractions. At home, you can help your child focus on homework by establishing a clutter-free desk. While medications have sometimes received a bad reputation in the press, they can be quite effective. I’ve seen “F” students turn into “A” students when placed on medication.

Many parents fear labeling their child. But if your child does have ADD or ADHD, ignoring it will not make it go away. Untreated children are more likely to have problems at school and put themselves in dangerous situations. If you suspect your child has ADD or ADHD, please educate yourself on the symptoms and schedule an appointment with your child’s doctor right away.

Endnote: The Palo Alto Medical Foundation and column editor Arian Dasmalchi provide this monthly column.