Friday, December 23, 2016

Nutrition Puzzles

Written by  Dr. Eva Hersh, MD

Dear Dr. Eva,

I am curious about vitamin D. It seems like everybody I know who is been tested for vitamin D has been told their level was too low and put on supplements. If everybody’s level is too low, is there something wrong with the normal ranges?


Dear Scientist,

Vitamin D is necessary for good health, especially for healthy bones. As you may know, vitamin D is made in the skin in response to sunlight. Artificial light doesn’t cause vitamin D production. Most people get enough vitamin D from their bodies’ own production of the vitamin and from vitamin D that is added to milk products, cereals, some soy products, and other foods. Severe vitamin D deficiency causes rickets, softening of the bones, which in children causes curving of the lower legs. Prevention of rickets is the main reason that foods are supplemented with vitamin D.

Although it’s hard to find a source in medical literature that directly says so, many doctors think that the accepted lowest normal level for vitamin D, which is 20 to 30 ng/ml, may be too high. The fact that most people who are tested do have vitamin D levels below the currently accepted normal range does put into question what the real normal is. Until there is more consistent scientific data, a reasonable approach is for people with very low vitamin D levels, below 20 ng/ml, to take 800 unit vitamin D supplements daily long-term and consider also taking a 12-week course of prescription-level supplements that physicians can prescribe. The usual prescription dose is 50,000 units once a week for 12 weeks. People with vitamin D levels between 20 and 30 should make their own judgment call. Everyone with vitamin D deficiency should spend at least 20 minutes in sunlight in the middle of the day to help their body make the most vitamin D that it can.

Dear Dr. Eva,

A few years ago you used to hear and read a lot about saturated and unsaturated fats in health magazines. It doesn’t seem to be as popular a topic these days. Is this an important thing to think about? How do you know which fats are saturated, or not?

Lipid Lou

Dear Lipid Lou,

In general, saturated fats are solid, like butter, margarine and lard, and are more likely to be turned into cholesterol that sticks to the walls of blood vessels (arteries) and causes dangerous blockages to blood flow, which results in heart attacks, strokes, and peripheral vascular disease. Unsaturated fats are usually liquids, such as canola oil, olive oil, and other vegetable oils. Unsaturated fats are less likely to form cholesterol plaque in the arteries and cause disease.

Dear Dr. Eva,

Is honey better for you than sugar?


Dear Sweetie,

Honey is only better for you in a philosophical sense, not in a nutritional sense. Natural food advocates often recommend honey over sugar (sucrose). They believe that honey is natural and sugar is artificial. In fact, sugar is refined from sugarcane or beets by people, and honey is refined from pollen and nectar by bees. If you are looking for an unrefined, natural sugar, fructose, the sugar found in fruit, is a good choice.

Another sugar that you might hear mentioned is lactose, which is the sugar that is a natural part of milk. Quite a few people, especially those of Northern European ancestry, cannot digest lactose, which causes them to have diarrhea.

It’s important to know that children under one year old should not eat raw (unpasteurized) honey. This is because raw honey can contain botulin bacteria spores, which can cause paralysis in infants.

Eva Hersh is a Baltimore family physician. Send your comments and questions to her by email at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .


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