Aspen Nutrition & Weight Loss

Vitamin D – Update

admin — Sat, 29 Oct 2011 15:56:44 +0000

Introduction
The term vitamin D actually refers to a pair of biologically inactive precursors of a critical micronutrient. They are vitamin D3, also known as cholecalciferol, and vitamin D2 also known as ergocalciferol. Cholecalciferol (D3) is produced in the skin by a photoreaction on exposure to ultraviolet B light from the sun (wavelength 290 to 320 nanometers). Erogcalciferol (D2) is produced in plants and enters the human diet through consumption of plant sources. Once present in the circulation, both D2 and D3 enter the liver and kidneys where they are hydroxylated to form both 25-hydroxyvitamin D and 1, 25 dihydroxyvitamin D. 25-Hydroxyvitamin vitamin D3 is the major circulating form of vitamin D3 in human blood, and therefore, it is the form measured by physicians to evaluate vitamin D status in people worldwide. It has recently been shown that there is no difference in circulating blood levels of Vitamin D when people take D3 as compared to D2 despite some current published opinions. Knowledge of the role of vitamin D metabolic activity, its role in human health and identification of the forms and metabolic pathways for vitamin D had been building for many decades but only became fully elucidated during the 1970s. Thanks in part to Dr. Holick from Boston University Medical School, who has been leading this research scince that time. While nutrition is fundamental in human health, understanding of nutritional metabolism has generally lagged behind the pace of medical investigation and practice focusing on factors external to the host such as infectious micro-organisms.
The first major functions of vitamin D to be recognized were (1) enhancement of calcium absorption from the diet through the intestine and (2) mobilization and re-absorption of calcium from bone which represents the major store of calcium (or “calcium bank”) in the body. Calcium in turn is critical for cellular metabolism and membrane actions, enzymatic reactions, muscle function, skeletal structure and a host of activities needed to sustain life and maintain homeostasis. Since vitamin D has long been recognized for its role in calcium metabolism it has long been used to treat patients with renal failure and bone diseases. It is also important in postmenopausal osteoporosis for the current epidemic of bone fractures in the elderly
However, in 1979 DeLuca found that vitamin D is actually recognized by every tissue in the body. Every cell has receptors for vitamin D. Since then it has been used to treat hyperproliferative skin diseases such as psoriasis.
For the immune system, the large white blood cell macrophages activate vitamin D. The activated vitamin D in turn causes macrophages to make a peptide that specifically kills infective agents such as tuberculosis mycobacteria. Vitamin D also has a role in autoimmune diseases such as multiple sclerosis, rheumatoid arthritis and diabetes type. Given vitamin D’s long recognized activity in the kidney it was also found to effect renin/angiontensin production in the kidney, the major regulators of blood pressure. There is a direct correlation between higher (more northern) latitudes and higher blood pressure (where both sunlight and vitamin D levels are lower) in both northern and southern hemispheres of the earth. People at high latitudes with high blood pressure experience a return to normal blood pressure levels following UVB light exposure, and restoration of active vitamin D levels, in a tanning bed three times per week for three months (and you thought it only worked if the sunlight was captured on a beach in the Bahamas!). Multiple sclerosis also shows a marked association with higher latitudes worldwide and there may be a similar role for protection by vitamin D.
Vitamin D is also thought to have an important role in cancer. As early as the 1940s it was noted that living at higher latitudes is associated with a higher incidence of several cancers (while only skin cancer specifically has a lower incidence at higher latitudes). Recent epidemiologic observations have continued to bear out this association.

Benefits of Sunlight/Vitamin D
• Improves Bone Health
• Improves Mental Health
• Improves Heart Health
• Prevents Many Common Cancers
• Alleviates Skin Disorders
• Decreses Risk of Autoimmune DIsorders
• Decreases Risk of Multiple Sclerosis
• Decreses Risk of Diabetes

There is essentially little or no active vitamin D available from regular dietary sources. It is principally found in fish oils, sun-dried mushrooms, and fortified foods like milk and orange juice. However, many countries worldwide forbid the fortification of foods. There is potentially plenty of vitamin D in the food chain because both phytoplankton and zooplankton exposed to sunlight make vitamin D. Wild caught salmon, which feeds on natural food sources, for example, has available vitamin D. However, farmed salmon fed food pellets with little nutritional value have only 10% of the vitamin D of normal fish. The “perfect storm” of photophobia, lack of exposure to sunlight, and insufficiency of available dietary vitamin D has led to a national and worldwide epidemic of vitamin D deficiency.
It is estimated that at least 30% and as much as 80% of the US population is vitamin D deficient. In the US, at latitudes north of Atlanta, the skin does not make (photoconvert) any vitamin D from November through March (essentially outside of “daylight saving time”; so while we shift the clock around, it does not salvage vitamin D synthesis). During this season the angle of the sun in the sky is too low to allow ultraviolet B light to penetrate the atmosphere and it is absorbed by the ozone layer. Even in the late spring, summer and early fall, most vitamin D is made between 10 AM and 3 PM when UVB from the sun penetrates the atmosphere and reaches the earth’s surface. It might be expected that vitamin D deficiency would be a problem limited to northern latitudes.
However, vitamin D deficiency is also a national problem. The US Centers for Disease Control and Prevention completed a national survey at the end of winter and found that nearly 50% of African-American women ages 15 to 49 years were deficient. These represent the critical childbearing years. A growing fetus must receive adequate vitamin D from the mother, especially since breast milk does not provide adequate Vitamin D. A study of pregnant women in Boston found that in 40 mother-infant pairs at the time of labor and delivery, over 75% of mothers and 80% of newborns were deficient. This observation was made despite the fact that pregnant women were instructed to take a prenatal vitamin which included 400 IU vitamin D and to drink two glasses of milk per day.

Vitamin D Dose and Toxicity

It has been well established that giving 100 IU of vitamin D daily to children will prevent rickets.
As with most of established thinking about RDAs the doses are those that prevent the development of frank nutritional deficiencies and associated pathology. The idea of levels for optimal health does not enter the picture. Even the capricious RDA process raised the recommendation from 200 IU to 400 IU per day in 1997 (although technically it is not an “RDA” but an “IA”- or adequate intake). Currently, those more knowledgeable about human nutrition than the outdated RDA/IA process, recommend 1000 IU daily for both children and adults in order to maintain blood levels of 25-hydroxyvitamin D above 30 ng/ml. It is now recognized that each 100 IU of vitamin D ingested raises blood levels by only 1 ng/ml.
Although a typical recommendation is in the range of 1000 – 2000 IU per day, it is a reasonable recommendation to take up to 5000 IU per day.

The Evolving Picture of Vitamin D Daily Intake Daily Intake Associated Effects
100 IU
Prevents rickets, frank nutritional disease
Amount in one glass of milk, or fortified orange juice
200 IU
“Adequate intake” per RDA pre-1997
400 IU
“Asequate intake” per RDA post-1997 Reduces risk of rheumatoid arthritis in women by 50%
1000 IU
Reduces risk of cancer (breast, colorectal, ovarian, prostate) by 50%
2000 to 5000 IU
Reduces risk of Type 1 diabetes by 80% Reduces upper respiratory tract infections in elderly by 90%
30,000 IU
Minimum to develop toxicity over several months/years

It is not easy to become vitamin D intoxicated. Sunlight actually destroys any excess vitamin D that is made in the body, so it is not possible to become vitamin D intoxicated from too much sunlight alone. In a world where dangerous and expensive drugs are doled out like candy, it is ironic to witness the degree of concern in the medical establishment over exposures to physiologic levels of natural substances such as vitamins, and even sunlight!
Nonetheless a medical lore has developed over the possible risks of excess vitamin D intake although vitamin D intoxication is one of the most rare medical conditions in the world. If vitamin D were considered as a drug it demonstrates a remarkable therapeutic index of at least 300 for disease treatment (minimum toxic dose/dose to treat rickets) and at least 20 for chronic disease prevention.
Despite the inadequacy of the RDA/IA process there is ample evidence and clinical experience indicating that vitamin D blood levels and daily intakes should be much higher than they are not only for prevention of bone diseases but for optimal health and helping reduce the risk of many common chronic diseases, disorders and medical conditions. Together with healthy sun exposure Vitamin D supplementation can be accomplished safely and effectively and should be a first line consideration in any clinical practice and for the general population.

See larger image

The Vitamin D Solution: A 3-Step Strategy to Cure Our Most Common Health Problems (Paperback)

By (author) Michael F. Holick Ph.D. M.D.

List Price:	$16.00 USD
New From:	$4.88 In Stock
Used from:	$3.17 In Stock
Release date February 22, 2011.

What’s Up With HCG?

admin — Wed, 19 May 2010 06:44:00 +0000

I have been asked many times over the past few weeks “what’s up with the HCG diet?” Well, let me give you some facts regarding the current hype about HCG. This long-ago discredited fad diet has been getting recent attention, thanks to web chatter and the claims of a “bestselling” author. The so-called “HCG diet’s” recent popularity is a bit surprising to me — and not just because research suggests it doesn’t work.

Most of today’s popular diets call for reducing sugar while consuming whole grains, dark vegetables, fruits, and appropriate amounts of protein. The HCG diet, in contrast, calls for eating just 500 calories a day while taking daily injections of human chorionic gonadotropin (HCG), a hormone produced by the placenta during pregnancy and excreted in pregnant women’s urine. According to the hype, HCG suppresses the appetite and prevents dieters from feeling weak or woozy on the low-calorie diet.

More than 50 years ago, Dr. Albert T. Simeons, a British-born physician, contended that HCG injections would enable dieters to subsist comfortably on a 500-calorie-a-day diet. He claimed that HCG would mobilize stored fat; suppress appetite; and redistribute fat from the waist, hips, and thighs [1]. There is no scientific evidence to support these claims. Moreover, a 500-calorie (starvation type) diet is likely to result in loss of protein from vital organs. As a matter of fact in the original study by Simeons his patients did not lose any weight. The claim was the hormone moved fat away from the places where it was traditionally deposited and rendered it available for metabolism.

In the decades that followed, researchers continued to study the diet and to show that the hormone added little to no benefit over the low-calorie regimen [2-6]. In 1995, Dutch researchers reviewed the results of the 24 studies that had been conducted on the HCG diet, in the years ranging from 1963-1995. Only 12 of them were well-designed, the scientists found; of those 12, 11 reported that HCG was ineffective in treating obesity. The Dutch team published their results in the British Journal of Clinical Pharmacology [7].

Despite these decades of negative study findings, the HCG diet was given new life by bestselling author Kevin Trudeau’s 2007 book, “The Weight Loss Cure ‘They’ Don’t Want You to Know About.” Giving credit to Simeons, Trudeau recommended a multi-phase approach in his diet, including a phase of daily HCG injections. There are unusual things about the book’s success. Mr. Trudeau, 42, a publishing novice, is not a doctor or scientist, and has had some run-ins with the law. In the early 90′s, he served two years in federal prison for credit-card fraud. He was later sued by the Illinois attorney general over an alleged pyramid marketing scheme, and he has been in court twice with the Federal Trade Commission over claims that he made in infomercials. In 2004, the commission barred him from selling products through infomercials, except books. In his 2007 infomercials, Trudeau falsely claimed that the book’s weight-loss plan is easy to do, can be done at home, and ultimately allows readers to eat whatever they want. The 2004 order also specified that he not misrepresent the content in his books. In 2008, the Court ruled that Trudeau had violated the previous order and ordered him to pay more than $37 million [8].

In 1976, the FTC ordered the Simeon Management Corporation, Simeon Weight Clinics Foundation, Bariatrics Management Corporation, C.M. Norcal, Inc., and HCG Weight Clinics Foundation and their officers to stop claiming that their HCG-based programs were safe, effective, and/or approved by the FDA for weight-control. Although the order did not stop the clinics from using HCG, it required that patients seeking this treatment be informed in writing that:

THESE WEIGHT REDUCTION TREATMENTS INCLUDE THE INJECTION OF HCG, A DRUG WHICH HAS NOT BEEN APPROVED BY THE FOOD AND DRUG ADMINISTRATION AS SAFE AND EFFECTIVE IN THE TREATMENT OF OBSITY OR WEIGHT CONTROL. THERE IS NO SUBSTANTIAL EVIDENCE THAT HCG INCREASES WEIGHT LOSS BEYOND THAT RESULTING FROM CALORIC RESTRICTION, THAT IT CAUSES A MORE ATTRACTIVE OR “NORMAL” DISTRIBUTION OF FAT OR THAT IT DECREASES THE HUNGER AND DISCOMFORT ASSOCIATED WITH CALORIE-RESTRICTIVE DIETS.

In that same year the FDA required a similar statement to be included in all labeling and advertising for HCG used in weight loss, which many clinics now ignore.

This position statement was made by the American Board of Bariatric Physicians in December of 2009, which stated:

Numerous clinical trials have shown HCG to be ineffectual in producing weight loss. HCG injections can induce a slight increase in muscle mass in androgen-deficient males. The diet used in the Simeons method provides a lower protein intake than is advisable in view of current knowledge and practice. There are few medical literature reports favorable to the Simeons method; the overwhelming majority of medical reports are critical of it. Physicians employing either the HCG or the diet recommended by Simeons may expose themselves to criticism from other physicians, from insurers, or from government bodies [9]. read more…

THE BOTTOM LINE: A 500-calorie per day diet is severely restrictive! In fact, it is not enough calories to support normal brain function. Your body will compensate by using stores of glycogen, protein (muscle) and some fat, which lowers your resting metabolism. Your body will think that it is starving and will down regulate energy expenditure to protect the vital organs and as a result you will burn less energy. You can lose weight at 500 calories a day with or without HCG but it will be done at the cost of losing lean mass, increased body fat percentage and decreased basal metabolic rate all of which will make it very difficult to maintain weight loss. Remember, if it sounds too good to be true, it usually is. Weight loss comes from hard work as well as lifestyle and behavioral modifications. Successful weight loss is sustainable because you are living a new way that is healthy, not forcing a diet that you cannot maintain for life. There is no magic potion, patch, or injection that will change that- although, if one is discovered I promise to let you know!

Simeons ATW. The action of chorionic gonadotrophin in the obese. Lancet 2:946-947, 1954
Craig LS and others. Chorionic gonadotrophin in the treatment of obese women. American Journal of Clinical Nutrition 12:230–234, 1963.
Frank BW. The use of chorionic gonadotrophin hormone in the treatment of obesity. A double-blind study. American Journal of Clinical Nutrition 14:133–136, 1964.
Miller R, Schneiderman LJ. A clinical study of the use of human chorionic gonadotrophin in weight reduction. Journal of Family Practice 4:445–448, 1977.
Stein MR and others. Ineffectiveness of human chorionic gonadotrophin in weight reduction: a double-blind study. American Journal of Clinical Nutrition 29:940–948, 1976.
Young RL and others. Chorionic gonadotrophin in weight control. A double-blind crossover study. JAMA 236:2495–2497, 1976.
Lijesen GK and others. The effect of human chorionic gonadotrophin (HCG) in the treatment of obesity by means of the Simeons therapy: a criteria-based meta-analysis. British Journal of Clinical Pharmacology 49:237–243, 1995
FTC: Marketer Kevin Trudeau violated prior court order. FTC news release, Sept 14, 2007.
American College of Bariatric Physicians. Position statement: Use of HCG in the treatment of obesity. Approved Dec 2009.

Water and Weight Loss

admin — Mon, 10 May 2010 22:44:00 +0000

Study Shows Water Consumption Increases Weight Loss During Diet Intervention

A study Published in Obesity Feb 18, 2010 looked a men and women 55-75 years of age and a BMI of 26-40 all who were on a low calorie diet. Here is my summary of this study which I found to be very good.

Dieters drinking 16oz of water prior to each meal increased their weight loss by 4.4 pounds and fat loss by 4.6 pounds in a 12-week period. This would be equivalent to an average size glass, or 2 cups. Prior to a meal was defined as 30 min or less.
Those in the water group lost an average of 11.9 pounds of body fat versus 7.3 pounds for those in the non water group. The non-water group still consumed the required 8- 8oz servings per day just not prior to meals.
They found that water intake prior to meals reduced calorie intake and is accompanied by increased sensation of fullness.

In conclusion, drinking 2 cups of water before meals increased weight loss when combined with a low calorie diet. Also, body fat loss was seen to increase as compared to those dieting and drinking the correct amount of water. Dieters drinking 16oz of water prior to each meal ate roughly 225 calories a day less over all. This is just another very good reason to get your water daily and work hard to drink before each meal– It will help you lose body fat!

Dr. Hempel

Get Cultured with yogurt

admin — Wed, 05 May 2010 06:51:00 +0000

Yogurt has always, as long as I can remember been a staple diet food, it can make a great snack and is high in protein. But watch the sugars as manufacturers continue to increased sugars to flavor yogurts. Here are some great benefits and thing to look for when buying yogurt.

Yogurt can help you lose weight, a study from University of Tennessee, Knoxville showed people who at 18 ounces of yogurt a day in conjunction with a low calorie diet lost 21 % more weight that those who did not. Why the big change? The lead author sites the high protein content and amino acids, helps us burn more fat by conserving lean body mass. Belly fat produces a hormone called cortisol, which signals the body to make more belly fat. Calcium in the yogurt signals out fat cells to put out less cortisol, theoretically making it easier to lose weight.
Probiotics. Look for the words “live and active cultures” the good bacteria found in yogurts are called probiotics. These helpful microorganisms are good for our digestive tract and help support our immune system.
Yogurt is loaded with vitamins. One serving is a great source of potassium (better than that banana which is all sugar and no protein), phosphorous, riboflavin, zinc,vitamins B5 and B12.
yogurt can help you recover after a workout. With the right protein to carbohydrate ratio, yogurt particularly Greek yogurt, makes an excellent post-workout snack. The best time is 45-60min after a work out, the amino acids from the protein help muscles repair, and the right amount of carbohydrates provide the energy the muscles need for recovery. If you do this snack with 8-16 oz of water the probiotics help your intestines increase the amount of water absorbed, improving hydration.

What to look for

I certainly do not endorse any brands, and forget the fancy promises made by manufacturers, you really need to look at the labels on these guys. To find good yogurt, that is low in calories, sugar and high in protein follow these guidelines:

Traditional serving size 6 oz.

Calories: 100 to 150 this is in the snack range, a serving a yogurt alone wont make a meal.

Fat: Ideally 4 grams or less.

Protein: At least 10 grams and even better would be 15 grams like that seen in Greek yogurt.

Sugar: 15 grams or less would be ideal but could go as high as 20

Here are some local brands that fit the profile:

Dannon and Yoplait both make a Greek yogurt that good and meets the nutritional requirements.

Plain — Yoplait Greek, Dannon Greek is very similar in nutritional content. See below.

Calories 100

Total Fat 0g

Saturated Fat 0g

Potassium 310mg

Total Carb 10g

Sugars 9g

Protein 14g

Try to stick to the plain yogurt as it is generally higher in protein and lower in carbs, although there are flavored yogurts would work, just check the labels.

Another good brand this can be found here in town at Albertson’s and Fred Meyer is Chobani, it is good, and tends to be lower in carb’s, of course the plain is always better. Take plain yogurt and add frozen berries, the taste is much better than sweetened and is much better for you.

Enjoy!

Dr. Hempel

Vitamin D – The Sunshine Vitamin

admin — Sun, 02 May 2010 08:28:00 +0000

It’s the beginning of May and as I was working outside on one of warmer (high of 50, low 29) days that we have had this spring, I cant help but think “what happened to spring and where is summer”. Now I am not complaining because the sun was shining and it felt nice to get out and work in the yard. I did make me think about something I have been talking to my patients a lot about this last winter and now spring, vitamin D. Vitamin D has been called the “sunshine” vitamin by many because exposure to the sun has historically given us all the vitamin D we need. With the attention now to skin cancer, and photo-aging of the skin from the rays of the sun the use of sun screen and protective clothing have decreased our sun exposure. Also we eat much less foods that are high in vitamin D as this is an oil based vitamin that is found in fats, such as egg yolk, tuna, sardines, liver, beef, and salmon.
New research is emerging on the essential role of vitamin D plays in our health. A recent study of almost 60,000 people found a 7% reduction in mortality in people who took vitamin D supplements in the range of 500 – 1000 IU daily. In addition to healthy bone development, vitamin D or 1,25-dihydroxyvitamin D, the active form in out bodies, controls over 200 genes including those that control cell division, growth of new blood vessels, and apoptosis (a programmed signal from our bodies to tell a cell to KILL itself). It appears that vitamin D may reduce the risk of many chronic illnesses, like auto-immune disease, MS, Crohn’s disease, diabetes, heart disease, as well as, colon, breast, and prostate cancers. A lesser known health problem is vitamin D deficiency associated with obesity. In 2000, a research group found that obese individuals had lower blood concentrations of vitamin D as a group. In their study of 19 obese and 19 non-obese women they concluded that the deficiency was most likely due to increased deposition of dietary vitamin D into fat cells. Another group a few years later found that those with higher body fat % had lower vitamin D levels again supporting excessive storage of vitamin D in fat tissue. Additional studies have shown a association with low vitamin D and metabolic syndrome, so everyone overweight and trying to lose it, needs good levels of vitamin D.
When we check vitamin D levels in the clinic we are checking 1,25-dihydroxyvitamin D. There is still some controversy as to what in the “normal” level in the blood. Historically, a level below 27.5 nmol/L (don’t worry about the units nmol/L it’s just “nerd talk”) was considered as a risk factor for the development of rickets. However studies now are showing that maybe levels 80 nmol/L are needed to avoid long latency diseases such as cancer and diabetes. Given these risks and the fact that people overweight have lower levels, it is recommended that we increase vitamin D, now I do not recommend sun tanning, and not using your sun screen, that’s a whole other lecture. Currently the USDA recommendation for vitamin D is still 400 IU daily even with mounting pressure to change them. It really should be about 800 IU daily for children, and adults should get 1000-2000 IU daily to avoid deficiency. Now unless you are out there turning your skin to leather with tanning and eating sardines, liver and egg yolks, you should probably take a supplement. Now here is where I need to apologize to all my grandparents, when I said, “you are crazy…there can’t be anything good about cod liver oil… well I am wrong, I admit it there is one thing, it contains 1360 IU of vitamin D per tbsp, for me I will stick with my very small, flavorless “sunshine pill” each morning.
If you have any questions about how much vitamin D you should take please talk to your doctor about it and see if you need to get your blood drawn to find out what your level is. This can be said though, it is nearly impossible to get a toxic dose of vitamin D if you take 1000-2000 IU daily in the form OTC supplementation. As for me who started taking vitamin D 1000 IU daily this winter, I feel much better even with this long drawn out winter/spring.

Welcome to Aspen Nutrition

admin — Sat, 01 May 2010 08:39:00 +0000

Hello world, my name is Dr. Eric Hempel.
I have decided to start a blog to discuss weight loss and nutrition. I have a few reasons for starting this blog: 1) I am continuing my own weight loss journey and feel that this might inspire me to be better 2) I have a medical weight loss program at my clinic, Aspen Family Medicine & Aesthetics, and in my discussions with my patients come across great ideas that I would like to share with others and 3) I love to research and talk about nutrition, prevention, weight loss, and wellness. A few things that you should know about me: I am not the best writer and as you may guess, being a doctor, I am all about getting the information out in as few words as possible. This will be a good challenge for me to continue to post fun and interesting blog entries so please bare with me on this venture. Please check back often as I hope to have many great ideas, tips, and helpful hints that might inspire us to continue to eat well, live healthy, and be well. Please share this blog with others and make comments often. If you would like to know more about our practice you can visit our web site at aspenfamilymedicine.com.