Am I Getting Enough Vitamin D?

Vitamin D plays a crucial role in calcium absorption and bone health. Because we get most of our vitamin D from the sun, many people develop an insufficiency in the colder months. For older women at risk for osteoporosis, it is vital to ensure you are getting enough of this nutrient.

In this Q&A, Christopher Anthony Gold, DO, Assistant Professor, Medicine (General Internal Medicine), Icahn School of Medicine at Mount Sinai, explains why vitamin D is important and how to make sure you are getting enough.

Why is vitamin D important?

Vitamin D helps calcium absorb into your bones, which keeps them strong and healthy. This prevents bone diseases like osteoporosis, especially in menopausal and postmenopausal women. Vitamin D plays other important roles, such as assisting with your immune system and muscle function, and protecting the brain and central nervous system. It has some anti-inflammatory effects, and there is some small evidence that suggests high levels of vitamin D may decrease your risk for insulin resistance, potentially decreasing your risk for prediabetes or diabetes.

How much vitamin D do I need?

Vitamin D deficiency is not as common in the United States, though some studies suggest up to 25 percent of certain patient populations can be deficient. Vitamin D insufficiency, however, is more common, and can be seen in up to 30-40 percent of the population in some studies. To prevent this, the National Academy of Medicine recommends getting at least 600 international units (IU), or 15 micrograms (mcg), a day for adults under age 70, and 800 for those over age 70, through sun exposure, food, and/or supplements. If you live in a region with less sunlight, you should get at least 600 and up to 1,000 IU (15-25 mcg) of vitamin D a day. Menopausal and postmenopausal women should aim for at least 800 IU (20 mcg) a day and should pair vitamin D with 1,000 to 1,200 milligrams of calcium.

Keep in mind that too much vitamin D can lead to toxicity, but this is rare. The safe upper limit is defined as 4,000 IU a day (100 mcg).

What causes vitamin D insufficiency?

Lack of sunlight is the main cause in most cases. It can also be caused by not getting enough vitamin D-rich foods and supplements, especially in the winter. Aging also increases your risk because your skin has more difficulty synthesizing vitamin D from sunlight as you get older. Certain medical conditions, such as obesity, also increase your risk.

What are the symptoms of vitamin D insufficiency and deficiency?

Many people with vitamin D insufficiency do not have any symptoms, but some people may experience muscle weakness, bone pain, and fatigue. These could be signs that you have developed a vitamin D deficiency, which leads to bone disorders.

Quick tips to get more vitamin D:

  • Get 600 to 1,000 IU/15-25 mcg of vitamin D a day (depending on your age, medical conditions, and region)
  • Spend between 5-30 minutes a day in the sun between 10 am and 4 pm without sunscreen
  • Eat vitamin D-rich foods like wild salmon and foods that are fortified
  • Take vitamin D supplements

Who is most at risk?

Those most at risk include:

  • Older people
  • People with darker skin
  • People who live in northern regions with less sunlight
  • People with obesity
  • People who spend a lot of time indoors
  • People with certain medical conditions, such as osteoporosis, hyperparathyroidism, celiac disease, and inflammatory bowel disease

One serving of wild salmon meets the daily requirement of vitamin D for most adults under age 70

How can I make sure I’m getting enough vitamin D, especially in the winter?

The National Institutes of Health suggests getting 5-30 minutes of sun exposure a day between 10 am and 4 pm without sunscreen. Keep in mind that getting too much sun can damage your skin and increase your risk for skin cancer.

In terms of diet, there are foods that are naturally higher in vitamin D. These include fatty fish, such as salmon, tuna, and mackerel. One serving of wild salmon—about three and a half ounces—contains about 600 IU, or 15 mcg, of vitamin D, which meets the daily intake requirement for most adults under age 70. Other sources include mushrooms and eggs, especially in the yolks. Some foods are supplemented and fortified with vitamin D in the United States, including milk, orange juice, yogurts, and some cereals. In terms of supplements, vitamin D2 and D3 are both great. Some research suggests that vitamin D3 may be a little more beneficial.

What should I do if I suspect my vitamin D levels are low?

If you suspect you are insufficient in any nutrient, you should talk to your primary care provider.

Three Healthy Holiday Dessert Recipes

The holidays are a time to enjoy some sweets with friends and family. These festive dessert recipes include some nutritious ingredients for those who want healthier alternatives. Enjoy!

Gozinaki, Georgian Honey Walnut Brittle

Ingredients:

3 cups of raw walnuts (or other nuts, such as hazelnuts)
1 cup of good quality natural honey
1 tablespoon of sugar

Preparation:
Toast the walnuts in an ungreased pan on low heat. Stir them occasionally to avoid burning until the edges become a golden color. Set aside. When cool, remove husks by hand and chop the walnuts into very small pieces. Set aside.

Pour the honey into a thick-bottomed pan on low heat, stirring a few times with a wooden spoon. Bring to a boil and stir constantly to avoid burning. The honey should boil for 8 to 10 minutes before adding the sugar for texture. Continue stirring for an additional 2 to 3 minutes to reduce and thicken slightly.

Turn off the heat and add the chopped walnuts. Mix to fully incorporate the walnuts.

Moisten a wooden cutting board and wooden spoon with water. Pour the honey-walnut mixture onto moist board. Using the moist spoon, spread the mixture into a half-inch rectangular. Let it cool for 10 to 15 minutes. Cut the brittle into 2-inch diamond shapes or other shapes. Do not refrigerate the brittle; keep at room temperature. The brittle is best if eaten within a week.

25 servings, approximately 2” each
105 calories per piece

Gozinaki is a traditional dessert and snack from the country of Georgia. My mom made this for us on New Year’s Eve to symbolize the hopes and wishes for a sweet and healthy new year ahead. She instilled in me the love for cooking and appreciation for good quality ingredients. Now I make and enjoy Gozinaki all year round and I serve it on both the January first New Year’s day and the “old” New Year, celebrated on January 14 in Georgia.
– Ekaterine, Senior Immigration Specialist

Date and Nut Rolls—No Sugar Added

Ingredients
1 teaspoon butter, plus more for hands
1 cup dates, pitted and chopped
1/2 cup almonds, chopped
1/2 cup cashews, chopped
1/4 cup pistachios, shelled and chopped
Pinch of cardamom powder (optional)
Pinch of saffron (optional)
2 tablespoons coconut, coarsely chopped

PREPARATION

Place the butter and chopped dates into a frying pan over medium heat. Mix continuously until soft. Remove from the heat. Add the almonds, cashews, pistachios to the dates along with the cardamom and saffron to enhance the flavor if you are using. Mix well while dates are still warm. You may use your hands for the best results. Once mixed, divide the mixture in half with your hands coated with a bit of butter. Place the two halves on a cutting board and roll into two long logs.

Spread the coconut on the cutting board and roll each long in the coconut to cover. Wrap each in plastic and refrigerate for 2 hours. Once chilled, unwrap, place on the cutting board and slice each log into half-inch slices.

Nutritional Information for Entire Recipe
Approximately 1,431 calories
Carbohydrates: 144.8 grams
Fat: 78.6 grams
Protein: 33 grams

When we celebrate Diwali, I make these rolls as it is a sweet with simple and natural ingredients that gets its sweetness from the dates and no sugar. Our guests as well as my family members love them.
–Punita, Finance Manager, Network Operations, Corporate Office

Avocado Chocolate Cake

Ingredients:

1 cup of whole wheat pastry flour
6 tablespoons of cacao or unsweetened cocoa powder
1/2 teaspoon of baking soda
1/2 teaspoon of salt
3/4 cup of granulated sugar
1/2 cup of mini chocolate chips, optional
1/4 cup of yogurt
3/4 cup of water
1/4 cup of avocado, mashed
2 teaspoon of pure vanilla extract

Preparation:

Preheat oven to 350°F.

Grease an eight-inch square or round pan. Set aside.

In a large bowl, combine the flour, cocoa powder, baking soda, salt, sugar, and chocolate chips if using, and stir very well.

In a separate bowl, whisk together all remaining wet ingredients.

Pour wet into dry, and stir until just combined, being sure not to over-mix. Pour the batter into the greased pan.

Bake 25 minutes or until batter has risen and a toothpick inserted into the center of the cake comes out clean.

Refrigerate for at least 30 minutes before serving.

Makes 8 Servings
221 calories per serving

Recipe submitted by Jane Maksoud, Senior Vice President, Chief Human Resources Officer, Mount Sinai Health System

Your Guide to Helping Kids Manage Diabetes

Just because your child has diabetes doesn’t mean they can’t live a normal life.

Diabetes is a chronic disease in which the body cannot regulate the amount of sugar in the blood. In the United States, about 30 million people, or 9 percent of the population, has been diagnosed with diabetes, which includes about 350,000 children and adolescents under 20 years old, according to the U.S. Centers for Disease Control and Prevention.

Meredith Wilkes, MD

There are two types of diabetes. In type 1 diabetes, the pancreas doesn’t make insulin, and in type 2 diabetes, the pancreas makes insulin, but the cells don’t respond to it as they should, meaning there is insulin resistance.

No matter the type of diabetes your child may have, there are many steps you can take to help them manage their condition and support, according to Meredith Wilkes, MD, Medical Director of Pediatric Diabetes at the Comprehensive Diabetes Care Clinic at Mount Sinai Kravis Children’s Hospital. She shares her key tips and insights.

A Checklist: Eight Ways You Can Help Your Child Manage Diabetes:

  • Check their blood sugar levels daily at mealtime and at bedtime.
  • Maintain a healthy diet and weight.
  • Exercise and participate in physical activity.
  • Make sure to administer insulin injections or other diabetes medicines as needed.
  • Eat main meals on time and eat snacks at certain times, and make sure to have plenty of time to finish each meal or snack.
  • Keep an eye out for high or low blood sugar and treat the level as needed.
  • Have them drink water regularly and have access to water.
  • Always have access to a bathroom and make time for bathroom breaks.

Together with family, friends, teachers and others in your community, there are ways you can support your child. Here are some tips from Dr. Wilkes:

Be positive. Although diabetes is a chronic disease, it should not define your child. Keep a positive mindset and allow your child to learn about the condition as they grow and develop. Let them play with friends and attend birthday parties. Let them grow and aspire from the situation and turn the challenges into great possibilities and opportunities. Don’t let diabetes impede their future and their dreams.

Ask siblings, family members, and teachers to help. Educate those who offer care to your child and make sure they understand your child’s condition, treatment plan, and what do to in case of an  emergency. When everyone in your circle understands and is educated about your child’s condition, you will feel comfortable and more relieved when they are taking care of your child. Engaging siblings, especially with simple tasks, will help empower them and help them feel closer to their brother or sister.

Embrace technology. The technology available today to treat diabetes is there to make your life easier, to help you and your child feel more at ease, and to offer flexibility to help you live a normal life. Keep an open mind and enjoy the positive features. For example, the insulin pump offers improved blood sugar control, and eliminates manual injections and finger pricks.

Connect with others and participate in support groups. Try to connect with other families who have kids living with diabetes so you can share experiences. This can provide a support circle for you and your family, which can help reduce stress, and allow you to learn and share information with others.

If you have questions or if you are concerned that your child may have diabetes, call 212-241-6936.

The Comprehensive Diabetes Care Center at Mount Sinai Kravis Children’s Hospital is designed to provide families with the tools and support to help navigate life with diabetes. The Center cares for children with all forms of diabetes including type 1 diabetes, medication-induced diabetes, atypical diabetes, and cystic fibrosis-related diabetes. The Center’s multidisciplinary team of providers consists of pediatric endocrinologists, nurse practitioners, a social worker, a dietician, a psychologist and an ophthalmologist. Patients are encouraged to see multiple providers at each visit, ensuring you receive individualized care for your child. The Center cares for children with type 2 diabetes who require insulin, however, parents are encouraged to take their children with type 2 diabetes to the Healthy Lifestyle Clinic

 

How to Deal With Stress and Anxiety During Challenging Times

Life can get messy, and it’s natural to feel stressed out and anxious. Thankfully, there are many things you can do to alleviate those unsettling feelings.

“You might feel a sense of anxiety, dread, uncertainty, disillusionment, or a little bit of fear—all of those things make sense in times of stress, and all of those feelings are within the range of normal emotions,” says Jonathan DePierro, PhD, Associate Director of the Center for Stress, Resilience, and Personal Growth at Mount Sinai, which provides services that support the resilience and mental health of health care workers, first responders, and the general public.

Actions that help you feel better do not have to be big undertakings—you can begin with something as simple as a breathing exercise, says Dr. DePierro, who is also Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai.

For those who might feel overwhelmed when the going gets tough, Dr. DePierro shares some pointers on getting past those hurdles and being resilient.

First things first: Have self-compassion

Sometimes people kick themselves or blame themselves for having certain reactions, but those reactions make sense, and it is OK to be in those states.

“For example, today I am not feeling my best, and I may not feel my best tomorrow. I may not even feel my best next week,” says Dr. DePierro, “but cutting yourself a break and not expecting the best out of yourself or out of the people around you during trying times is a good way to start.”

It is important to take time to acknowledge and engage your feelings. Avoiding them isn’t going to make you feel better, he adds.

Jonathan Depierro, PhD, Associate Director of the Center for Stress, Resilience and Personal Growth, and Associate Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai.

Don’t avoid doing things

Sometimes, when people get really stressed, they stop doing the things that make them feel less stressed because they don’t have the energy and don’t feel like it anymore, says Dr. DePierro.

“That is not great, because it cuts off that source of stress relief,” he notes. If you have routines to destress, like yoga, exercise, spiritual practices, hobbies, or hanging out with friends, it is even more important to do those things when you’re feeling demotivated.

“If you catch yourself not wanting to do them, do them anyway,” he says.

Not all relief has to involve big gestures—some can be quick and accessible, such as breathing exercises. A simple thing to try is “box breathing,” which involves taking a deep breath for four seconds, holding it in for four seconds, exhaling for four seconds, and then pausing for another four.

“The idea is that this can function as a reset button to our fight-or-flight response,” says Dr. DePierro. “This reminds your body that in this moment, you are safe. You might not know what will happen in the next week or 10 years from now, but right at this moment, you can remind yourself through changing your physiology that you are safe.”

Helping your friends helps yourself

Putting calendar reminders or alarms to do joyful things can be helpful, but so is telling a friend about your action plan.

“You might tell a friend, ‘Hey, I’m going to get on the bike at 2 pm, can I call you while I’m on the bike? Or can we do it together, either next to each other or virtually?’ and that can be really meaningful,” says Dr. DePierro. If both individuals are struggling, having each other for accountability helps pick both of you up.

You can start that by checking in on your friends, especially if you feel they might be going through similar stressors.

“It could be an unhappy face or waving hand emoji, and that initiates a conversation,” says Dr. DePierro. “It doesn’t have to be something elaborate.”

It requires a little bit of bravery and vulnerability to tell somebody you trust that you are suffering and not doing well, but if you do, they can try to understand what’s going on with you and support you, he adds.

Checking in on your friends is good for your friends, but it’s also good for you. Acting altruistically and offering support activates the positive emotion centers of our brain, notes Dr. DePierro. Sometimes, when people go through difficult times, they lose their sense of meaning and purpose, but it’s really important to recommit to one’s core values, and to align daily actions, even in very tiny ways, to those core values.

Use tools to place limits

It is very easy to “doomscroll” and be caught in a loop of negative news through social media and the internet.

There aren’t a lot of guardrails on some of these platforms, and strong emotions, misinformation, and conflicting information can come through unfiltered and unmoderated. “These can trigger a fight-or-flight response, enough to make the heart race and incite feelings of nausea or being tense,” says Dr. DePierro. These are not helpful states to be in, especially right before bed.

If you have to check the news or social media, don’t do it right before sleeping, and especially not while in bed, he points out. These can impact your quality of sleep.

Setting screen time limits can help too—just as a parent might set them for kids, adults can benefit from them, and nowadays there are built-in tools and applications that can help.

Part of why doomscrolling is bad is that the act is without intention and becomes a negative feedback loop, where the bad thing reinforces the bad. “It’s easy to keep scrolling and only see nothing good,” says Dr. DePierro. “In those instances, I might suggest a ‘palate cleanser’ instead on those platforms. Is there something you can watch that makes you feel good? Videos of puppies, perhaps? Or something inspiring.”

Being intentional about finding content that gives a sense of joy helps break the cycle of doomscrolling. Flagging, bookmarking, and favoriting those uplifting pieces of content so you can always return to them is helpful. “Think of it as a virtual shoebox of things that make you feel good, which you can use,” he adds.

Learn when to seek professional help

If the feelings of unease and anxiety persist for weeks or even months, or especially if they disrupt your daily life, it might be time to seek professional help. This could include a primary care provider or a therapist.

It’s important to note that a singular feeling, while distressing, does not necessarily indicate a psychiatric disorder. “Just feeling sad alone does not make a depressive episode, or having a bad memory does not make post-traumatic stress disorder,” says Dr. DePierro. It usually has to be a cluster of symptoms occurring over weeks to months for it to be considered a mental health disorder, and this is where professional help can make that determination, he says.

How Can I Protect My Eyes From Diabetic Macular Edema?

Beyond causing elevated levels of blood sugar, diabetes can cause other serious complications, including poor vision or blindness. The leading cause of blindness in the working population in the United States, diabetic macular edema (DME) can cause an inability to read, drive, and perform daily activities. According to the Centers for Disease Control and Prevention, diabetic macular edema can affect up to 28 percent of people diagnosed with diabetes.

Nazanin Barzideh, MD, FACS, FASRS

In this Q&A, Nazanin Barzideh, MD, FACS, FASRS, ophthalmologist and retina specialist at New York Eye and Ear Infirmary of Mount Sinai at Mount Sinai Doctors-Carle Place, and Assistant Professor of Ophthalmology, Icahn School of Medicine at Mount Sinai, explains what diabetic macular edema is, signs and symptoms to look out for, and why it’s important to get diagnosed and be treated early.

What is Diabetic Macular Edema?

DME is the most common cause of vision loss in people with diabetic retinopathy. Diabetic macular edema is due to leakage of fluid and accumulation in the macula (or the central area that is responsible for fine detail vision) from vascular damage due to diabetic damage. As fluid collects in this nerve tissue, it causes swelling and disrupts anatomy of the fovea. The macula is the central part in the retina that is in the back of the eye and where vision is the sharpest. Typically, vision loss from DME develops over time as the disease becomes more advanced, and makes it impossible to focus clearly.

What are signs of DME?

It’s important to know that DME may cause a spectrum of changes from mild blurry vision to significant vision loss, and it can affect daily functions such as reading, writing, and driving.

Some common symptoms include:

  • Blurry or distorted vision
  • Blind spots
  • Squinting
  • Double vision
  • Floaters
  • Colors appear dull or grayish
  • Difficulty reading, driving, or doing other activities
  • Difficulty seeing when there is bright light or a glare
  • Trouble with recognizing faces or objects

How is DME diagnosed?

Diagnostic tests ensure an accurate assessment of DME and may include the following:

  • Comprehensive dilated eye exam.
  • Fluorescein angiography (FA): A diagnostic imaging technique where a dye is injected to identify abnormalities in the retinal blood vessels.
  • Optical coherence tomography (OCT): A non-invasive imaging technique that shows cross-sectional images of the retina, helping to detect inflammation and fluid accumulation in the macula.
  • Optic coherence tomography angiogram (OCTA): A non-invasive imaging technique that maps out and identifies retinal vascular abnormalities without using a dye.

Why is it important to get diagnosed and treated early?

Early detection of and prompt intervention in DME are essential to preserve vision in diabetic patients. The sooner a diagnosis can be made, the sooner a personalized treatment plan can be put in place to take care of the eyes and manage DME so it doesn’t progress to more advanced stages.

It’s also important to understand that eye conditions related to diabetes like retinopathy and macular edema are impacted by the longevity of the elevated blood sugar levels. The highs and lows through time really affect long-term prognosis, which is why it’s critical to control glucose levels from the day of diagnosis and to maintain that control throughout the years.

How is DME treated?

  • Control blood sugar levels on a regular basis.
  • Eye drops in some cases.
  • Anti-VEGF, a group of medications known as vascular endothelial growth factor treatments, that block the hormone VEGF, which can cause abnormal blood vessel growth in the eyes. They are injected directly into the back of the eye.
  • Corticosteroids that reduce inflammation and fluid leakage, and help to improve and sustain vision and slow down the disease progression.
  • Laser therapy where a focused laser beam is used to seal blood vessels in the eyes to stop fluid leakage that leads to DME.

How can we prevent DME and protect vision?

  • Get a comprehensive dilated eye exam yearly at minimum, or as directed by your ophthalmologist or retina specialist.
  • Control diabetes and maintain good blood sugar, blood pressure, and cholesterol levels, monitoring them regularly.
  • Manage other conditions associated with diabetes like heart disease, kidney disease, and obesity, for example.
  • Stay active, exercise regularly, eat healthily, drink plenty of water, and maintain a healthy lifestyle.

Please call 516-408-4900 to schedule an appointment.

Exercise May Give Your Immune System a Boost

Vaccines and nutrition strengthen your immunity to viruses and other harmful pathogens—exercise may give it an even bigger boost. In this Q&A, Christine Schindler, MD, Assistant Professor of Medicine (General Internal Medicine), Icahn School of Medicine at Mount Sinai, explains why exercise likely helps strengthen the immune system and how much you need to reap the benefits.

How does exercise strengthen my immune system?
Exercise causes useful inflammatory responses in the immune system. With moderate exercise, these inflammatory effects can strengthen the immune system. Short bursts of high-intensity exercise are also quite beneficial to your health. One note of caution: According to research, more than 90 minutes of high intensity exercise in a single session is probably bad for your immune system. However, few people exercise at high intensity for that long.

What qualifies as moderate versus high intensity exercise?
A power walk or slow bike ride qualify as moderate intensity. You’re a little out of breath, but not too winded; you can speak in full sentences but not sing. High intensity exercise includes more vigorous activities like running, jumping rope, and tennis—you are getting your heart rate up, working up a real sweat, and are too out of breath to have a conversation.

Can exercise boost vaccine efficiency and reduce the risk of severe illness, especially in older adults?
The most recent studies suggest that exercise does boost vaccine efficacy for people of all ages. One study looked at people who got the flu and COVID-19 vaccines, then performed light to moderate intensity exercise for 90 minutes. About a month later, there was still a higher antibody response to those vaccines. In other studies, the immune response to the flu vaccine was found to be more robust in people who exercised regularly. In older adults, studies suggest that exercise leads to a longer antibody response that may offer more protection throughout the flu season.

These results are promising but not the last word, since researchers are also studying the effects of metrics such as age, gender, and the effect of daily exercise routines. However, the most probable answer is that moderate intensity exercise is beneficial for vaccine response. Exercising the day you get the vaccine also likely has some benefit.

How much, and how often, do I need to exercise to strengthen my immune system?
There is no specific number. Generally, the recommendation for all adults is to get 150 minutes of moderate intensity exercise a week, or 30 minutes a day, five days a week. Or get around 75 minutes of vigorous activity, or 15 minutes a day, five days a week. Strength training at least twice per week is also beneficial. There is evidence that walking 6,000 to 8,000 steps per day has positive health effects. In terms of benefits for your immune system, a power walk is going to be more effective.

What types of exercises do you recommend, especially for someone older or with mobility issues?
It’s important for older adults to walk if they can. Walking amongst nature decreases stress hormone levels and blood pressure and is beneficial for mental health. Joining a walking or exercise group can be very motivating. Senior centers and places like the YMCA often have exercise classes for older adults. It’s beneficial to work out in groups, whether walking around with friends, or going to a class. The team mentality helps people stay motivated. Regardless of your age, if you are new to exercise, it’s best to start slowly.

If you struggle with mobility, there are good beginner YouTube videos that show different ways to exercise: exercises you can do from the chair and exercises you can do in a small apartment space or without exercise equipment, such as using cans of beans instead of weights.

How can I get more exercise without joining a gym?
There are easy ways to incorporate exercise into your daily routine without a gym membership. For example, if you are a commuter, you can walk for part of your commute instead of taking the bus, and you can take the stairs at work instead of the elevator. If you don’t live in a neighborhood where you feel safe or the weather is bad, try walking up and down the stairs of your building or walk in a mall. Get creative with strategies that work for you and your schedule.

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