If you’ve watched the Katz’s Delicatessen scene in the movie “When Harry Met Sally,” you can’t help but ardently admire Meg Ryan’s acting ability as Sally.  She is sitting at a deli table with ‘Harry’ (Billy Crystal) and proceeds to fake an orgasm right there in the restaurant to prove a point to Harry that women can and do indeed, with great gusto and authenticity, really fake orgasms from time to time.  The middle-aged woman sitting across from her table watches with great fascination as Sally enacts this sexual scenario with great abandon and noisy, breathless exclamations.  When the waitress reaches the other woman’s table with an order pad, the gray-haired lady quickly exclaims, pointing in Sally’s direction, “I’ll have what she’s having!”  This customer undoubtedly made an unquestioning conclusion that there was a connection between something Sally ate and the spontaneous occurrence of what from all appearances certainly seemed to be a genuine and well above-average orgasm!  If such a menu item or diet was actually in existence in the real world today, no doubt, every woman would be saying, “I’ll have what she’s having!” 

Well, while we may have enjoyed that movie scene, we know that there is no specified diet or food which magically increases sexual desire and sensitivity to the point of spontaneous orgasm (although I have read an article where a woman claimed that)!  However, from ancient times until now, many cultures have touted certain foods purported to enhance sexuality.  Many of these aphrodisiacs were rooted in superstition, and when modern human beings use them today they produce little or no effect.  However, there are some foods which the ancient peoples cultivated and ate which are still in existence today, and do indeed seem to have a libido-enhancing effect.  While ancient peoples often did not know the scientific reasons behind the aphrodisiac properties of the food, scientists today are able to break down the chemical composition of the food and make a scientific connection between certain chemical components and a rise in sexual desire or potency.  Foods that tend to produce a libido-enhancing effect usually contain compounds that improve one of three things:  (a) blood flow (b) brain or nerve circuit function or (c) hormonal balance. 

Fish and seafood are one of the main dietary components in the “great sex diet,” mainly because of their higher concentrations of omega-3 fatty acids, essential for cellular diffusion and brain and nerve cell health.  Omega-3’s are also a precursor of  prostaglandins, hormone-like substances that play a large role in sexual health.  Walnuts and almonds are another major source of essential fatty acids.  Almonds in particular are vital to the production of male hormones (which are present in both males and females) and help to regulate sex drive.  Other foods aid in sexual function by enhancing blood flow because they contain arginine, an amino acid the body uses to synthesize nitric oxide within the endothelium (lining) of the blood vessels.  Nitric oxide causes blood vessels to expand, increasing blood flow and inducing engorgement of the sex organs to facilitate intercourse.  Some foods in which arginine occurs naturally are granola, oatmeal, peanuts, cashews, walnuts, dairy, green vegetables, root vegetables, garlic, ginseng, soybeans, chickpeas and seeds.  Foods containing anti-oxidants are also important for sexual health and stamina, as anti-oxidants neutralize free radicals, harmful molecules produced in a process called oxidation.  Some common anti-oxidant fruits and vegetables are tomatoes, red peppers, garlic, and spinach.

Other miscellaneous foods which by virtue of one or more chemical compounds they contain may support a healthy sex life are celery, pumpkin seeds, avocados, asparagus, figs, chili peppers, basil, cardamom (a spice),  and garlic. 

Last but not least, a tuber root vegetable grown for centuries in Peru, called maca root contains a combination of starches, amino acids, minerals, fatty acids, and vitamins which is nature’s perfect formulation for balancing hormones.  It works better for menopausal women than HRT, since rather than supplying hormones for the body, it works on the pituitary and hypothalamus glands and stimulates them to make endogenous hormones in the appropriate amounts within the body itself.  It is actually consumed as a food in Peru, and the dried root can be purchased from health food vendors in other countries including the U.S.  

While we don’t know what Sally was eating in the aforementioned movie other than a deli sandwich and a piece of pie, if her diet included any foods with omega-3’s, arginine, vitamin E, soy, or even Maca, well, then, I’ll have what she’s having!

Years ago over lunch, a close young female friend of mine who had been married only a short while asked me if having sexual intimacy twice a week was “normal,” or in other words, comparable to the number of times weekly my husband and I made love.  I gathered that she was trying to gain some idea of what frequency of sexual relations other couples had, so that she would have a benchmark by which to measure the health of her own sex life with her husband.  Although I did divulge to her the average frequency of my own sexual activity with my husband (since she was a close and trusted friend), I also explained to her that the best measure of the health of any woman’s sex life is not the comparative frequency she and her partner have sex in relation to other couples, but rather the balance between her sexual desire and that of her partner.  There are two and only two significant participants (at least, one would hope!) in a couple’s life both in and out of the bedroom, and what contributes most to the “normalcy” of their sex life is the amount of satisfaction and fulfillment they are both experiencing with their love-making and sexual union in general.  It takes two satisfied partners to constitute a good sex life, which is built upon the levels of desire and satisfaction which each individual possesses.  I also explained to her what my mother once told me, that men’s brains are wired to be more preoccupied with intercourse than the female brain, and that they need it more on a purely physical level than we as women do.  Thus, the balance of desire may sometimes appear to be skewed, and a woman may begin to feel that she is abnormal simply because her mind is not on sex as much as is her partner’s (and an insensitive husband may sometimes blurt out this opinion in the heat of the moment).  I explained to her that while this discrepancy is really normal rather than abnormal, that we as women needed to work at bridging that gap and finding ways to enter a man’s mental and sexual world while at the same time inviting him to visit ours.  Thus what really matters is coming closer to understanding and accommodating one another’s sexual needs, and finding common ground in order to gain a balance in satisfaction.  It just will not do to have one partner jacked up all the time, feeling short-changed and resentful, with the other partner feeling put-upon and pressured to perform.  That would be like when as a child I sat on a see-saw on the playground, with a much heavier child on the other end.  Try as I might, we couldn’t get the see-saw to balance or to go back and forth, and I usually ended up having to jump off and hit the ground hard!  But as long as a sort of loving compromise can be reached which allows both partners to have their felt needs met, a state of balance has been achieved which is irrelevant to the number of times a week they actually have sex.  In short, I told her that sexual balance superceded sexual frequency in importance!  But I’m also here to tell you that there are lifestyle changes which, when adopted by both partners, can help both you to desire and enjoy sex more frequently and more passionately. 

If you are experiencing an almost total loss of sexual desire or have pain during sex, this constitutes a sexual dysfunction.  In order to qualify as a real sexual dysfunction, one or both partners would be dissatisfied with the state of their sex life, and there would be an imbalance in sexual desire and interest, with one partner’s desire far outweighing that of the other, creating intense unhappiness for one or both partners.  Know this, if you have a sexual dysfunction which prevents mutual satisfaction and fulfillment in your relationship, there are definite causes for the dysfunction which, when properly addressed, can restore the sensuality and sizzle to your relationship.  First of all, your psychological history contributes to your sexual functionality.  No matter how we learned about sex, in the process of learning we picked up more than bare facts – we also picked up emotional, moral, and cultural associations to sex.  If your psychological history includes anything with a negative connotation associated with sex, chances are you have retained some of those negative sexual connotations to this day.  The key to changing this is honesty, first with yourself and your partner, and then possibly talking about it with a therapist or close friend.  If you have positive psychic vibes regarding sex but your physical desire is low, the first positive step towards changing this is to transform your diet and lifestyle to follow healthy guidelines.  Improving dietary intake and exercising will improve self-image and help to balance our hormones naturally, which will often improve the libido as well. 

If you are eating a healthy diet and exercising regularly and still experiencing low libido, a visit to your gynecologist which includes an honest assessment and a thorough lab work-up is in order.  There are many bio-identical hormone treatments today with a variety of routes of administration available.  Make sure, however, that the gynecologist with whom you consult is knowledgeable and qualified in the area of hormone therapy.  Not just any OB/GYN who claims to specialize in HRT will necessarily be of help for your specific problem, but with some determined research and seeking, you can find the right practitioner to help with your problem.

When a couple’s sexual balance is out of whack, a frequent by-product is resentment, no matter how much they love each other.  One all-important deterrent to the forming of resentment is honest communication.  Men, you need to know that a lower-than-desired libido in your woman is not to be viewed as a defect, but rather the result of very real physical and psychological causes which, although beyond her control in the past, can be remedied in the future.  Ladies, be certain of this, your man is just being a man when he communicates his urgent need for sex, and that with some work on altering psychological attitudes and presuppositions as well as finding medical and non-medical ways to improve your general and sexual health, the two of you can ride that sexual see-saw together (hmm, I just had a vivid mental image of a very kinky sexual encounter involving a see-saw!).  No seriously, by paying heed to these real time-tested truths regarding the complicated but beautiful gift of sex, the “see-saw” may go up and down, but a healthy balance will be achieved!

When you looked at the title of this article, did you get the impression that the author did not recognize the proper use of hyphenation?  Why in the world would anyone hyphenate the word ‘foxy’?  Well rest easy, there’s a very good reason the author inserted the hyphen, to emphasize the latter part of the word, ‘oxy’!  ‘Oxy’ in ancient Greek meant ‘sharp, swift, or keen.’  And in a little bit you will see how that ancient word root figures significantly into a hormone that influences the health and well-being of every human alive. 

In listening to Dr. Cabeca’s teleconference entitled “Feel Good, Look Good Secrets”, I was especially fascinated with the seven ways she outlined in which we as women can balance our hormones.  And I guess the idea that 7 as a number has mystical significance (the ‘perfect’number) must have subconsciously influenced my choice to fixate upon the seventh point in her list of healthy hormone-balancing practices!  Her seventh point is, specifically, the importance of exercise to hormonal balance.  And somewhere right in the middle of her treatise on the benefits of exercise for women, she mentioned the release of the hormone oxytocin into the bloodstream as a benefit of exercise. 

Most women who have ever given birth were informed early on by nurses and lactation experts in the hospital about the importance of breast-feeding for maternal bonding and for the health and well-being of both mother and child, and were informed that oxytocin production both stimulates and is stimulated by lactation in a kind of cyclical fashion.  If you were one of those mothers who had enough leisure time every day to breastfeed (back when I gave birth my employer provided no breast-feeding rooms or extra breaks from work for that purpose), you can attest to the wonderful feelings of closeness and affection, relaxation, and general well-being you felt every time your child snuggled close to you and nursed. 

It wasn’t until considerably later, though, when my children were nearly grown, that I began to encounter some writings on the subject of oxytocin that were not specifically related to childbirth and breastfeeding.  I began to read more about the far-reaching effects of this hormone and discovered that the derivation of the word is very likely from Greek, meaning ‘swift birth.’  This corroborates my initial knowledge of the word, that it stimulates uterine contractions during labor and expression of milk during breast-feeding, and apparently for quite some years this is about all that was known about this hormone.  However, more recent writings indicate that although oxytocin is not an endorphin per se, when oxytocin is released by the posterior pituitary gland, that in turn stimulates the production of endorphins, the “feel-good” hormones of which most of us have already heard.  Males as well as females produce oxytocin, and it has beneficial effects in both sexes.  Some of its many documented benefits are feelings of connectedness and closeness to loved ones, lessening of cravings and addictions, increased sexual receptivity, facilitation of learning, faster wound healing, diminished sense of pain, lessened feelings of stress, lowered cortisol levels, and lowering of blood pressure.  So from what is now known about oxytocin, it is indeed very important to social interactions of all kinds and especially to close familial bonding including sexual.  So if you really do want to be ‘foxy’, then you should consider ways to produce more ‘oxy’! 

And up until I heard Dr. Cabeca’s teleconference, I was not aware that oxytocin was generated through exercise.  Of course we all know that endorphins are a beneficial byproduct of exercise.  However, I wonder how many of us know that powerful feelings of closeness and bonding to our families, our co-workers, our fellow human beings, and the universe in general are byproducts of exercise as well, due to that ‘foxy oxy’ that we are manufacturing as we exercise!  I certainly was not aware of this fact until now, but now that I think about it, when I am exercising regularly, I do find that some very good things are facilitated, more so than when I am not exercising!  Although I knew this in a very general sense to be true, I find it fascinating that oxytocin is one spoke in the wheel of life, the one that starts turning with our birth and continues throughout life as we relate to all other living things in a continuous cycle.  Of course movement is another spoke in the wheel and one phase of our continuous journey through the universe.  We are not still and static beings, and exercise in a sense “shakes up” and activates the release of oxytocin, which in turn energizes us to move even more, in all kinds of healthy and loving ways!

Ever since physical education classes in 7^th grade (square dance class was my favorite) I have known that getting up and moving is healthy and beneficial.  Apparently dancing, running, and other forms of “bouncing” exercise release more oxytocin than other milder forms of exercise.  Long-distance marathon runners have the ability to run through pain largely due to the pain-mitigating effects of the oxytocin which is continuously being released into their systems. 

So, shake it up, Baby!  If you want to be foxy, shake up your oxy!  You know it feels good, so get up and dance to the music.  In my case, I make sure no one is watching because my rhythm is terrible, but I dance anyway.  If you have a sedentary job, make the time to get up, go someplace where you feel good, and make that body move – because your oxytocin will thank you for it!

Sexual dysfunction often has deep psychological roots. This is not to say those afflicted by sexual dysfunction are imagining everything; it just means that our beliefs and attitudes truly do affect our reality. There are most certainly physical causes for the disorder as well, since often sexual dysfunction in an individual is caused by several different factors which interact to produce the difficulty. Treating sexual dysfunction is definitely a multi-faceted approach, but understanding the deeply held emotional reactions of a patient toward sex can be the key to unlocking their difficulties in the bedroom.

 Sexual dysfunction can often be traced back to a patient's upbringing. Religion and culture play a very important role in defining who we are as we develop, and those raised in very strict religious families, or in cultures with punitive attitudes toward sex, often suffer from problems related to sexual functioning in adulthood. If we hold a very deep-set belief that what we are doing is wrong or dirty, then how can we possibly find enjoyment in that activity? If sex has always been associated in the mind with deviant behavior or punishment, it will be difficult to engage in sexual activities without a deep sense of guilt and shame - let alone actually enjoy it. For victims of sexual abuse, these beliefs can be particularly hard-wired and damaging. It is important to seek therapy and heal from past events, and learn to accept sex as a loving and nurturing behavior rather than a traumatic and abusive experience.

Treating sexual dysfunction often involves confronting these beliefs and changing attitudes toward sex so that it is viewed in a positive light, as a reflection of the love and intimate bond between a couple. These beliefs can function as an emotional wall in your relationship, separating you both psychologically and physically from your partner. My Sexual CPR course will give you all the tools you need to tear down that wall once and for all, and embark upon a journey of redisovery together as a couple.

Sexual dysfunction affects millions of couples, and can be destructive to your self esteem as well as the intimate bond in a relationship. When couples begin to have problems within their relationships, trouble in the bedroom is one of the most common complaints and sources of stress.

Sexual dysfunction can manifest in several ways. Basically, there are four distinct areas of sexual functioning that can go awry: A lack of interest in sex, having interest but being unable to achieve arousal, lacking adequate vaginal lubrication, and being unable to achieve orgasm. All of these problems can seriously disrupt your sex life, which can in turn disrupt your entire relationship.

Treating sexual dysfunction involves looking into three key areas of the patient's overall health. Medical health, for example, can affect your sex life. There may be a hormone imbalance, diet and exercise concerns, pain from childbirth, or other physical trauma that is impacting you sexually.

Also, emotional health is another key element to sexual health. There are many different ways that your emotional state can affect your sex life, and emotional healing can make an enormous difference in treating sexual dysfunction. This is not to say, “It's all in your head”, because that is not the issue here. The truth is that the mind/body link is indeed very powerful, and to treat many physical problems we need to start with emotional or psychological healing.

The last key area that can impact your sex life is the health of the relationship. Sexual dysfunction can be just as much a symptom of relationship problems as it is sometimes  the cause. They really do go hand-in-hand much of the time, so treating sexual dysfunction can involve treating the couple's relationship as a whole.

Luckily, sexual dysfunction is treatable. By paying attention to the importance of the problem, you have taken the first step to solving it. Before long you can get your sex life on track again, and enjoy those great intimate bonds you have been missing in your relationship.

In a well-known proverbial fairy tale, Snow-White is blessed with the assistance of seven dwarfs with dubious names like Grumpy, Sleepy, and Dopey.  While in the story these diminutive creatures are friendly and helpful with their magic, some of their names bring to mind the “bewitching” that can change an energetic, easy-going, quick-thinking woman into someone who is often “Grumpy”, “Sleepy”, or “Dopey” – not to mention “Sweaty” and “Moody” – when she goes through menopause.  

I believe many a woman experiences alarm and not a little consternation concerning the changes she perceives in herself both as menopause approaches and after it has already occurred.  No matter how much information she has read about menopausal changes and how to be prepared for them, it is still difficult for her to recognize her usual self with the frequent hot flashes, forgetfulness, fatigue, irritability, and drop in sexual desire which often accompany menopause.  It is easy for her to feel that she has irrevocably changed for the worse, and almost to mourn the loss of her familiar former persona.  In spite of the irritability and sadness, though, she often tells herself that this is a “normal” state for her age, and that she will just have to learn to deal with and accept a less energetic, less sociable, and less sexual/sensual state of affairs, because it is the hand her body has dealt to her at this stage in life – after all, she is getting older!

“Baloney!” exclaim seven squeaky voice all at once, voices of the “dwarfs” who can help women to emerge on the other side of menopause with more cognitive, sensual, sexual, and physical resources than they have ever before possessed.  These seven new dwarfs are named Lively, Healthy, Cheerful, Amorous, Contented, Sensual, and Happy (while that last dwarf shares a name with one of Snow White’s dwarfs, this is not the same Happy, but rather one far more attuned to helping a woman achieve happiness after menopause)!  And a beautiful kind of magic occurs when these elves are summoned to help restore normalcy to the life of a menopausal woman, because they can transform her into a lady we can call “Ms. Know-Right” (hey, it rhymes with Snow-White)!

What are some of the means that these “dwarfs” use to maximize a woman’s biological, sexual, and psychological health after menopause?  Well, if I remember right, Snow White used to cook for the seven dwarfs.  And in our real-life story, Ms. Know-Right cooks healthy meals and make appropriate food choices for herself and her family.  After all, food is one of the first sensual pathways via which courtship and romance are initiated between a man and woman.  Along the same lines, a healthy diet rich in amino acids, omega-3 fats and alkaline foods which contain beneficial minerals and vitamins nourishes the brain as well as the body, and the human brain is actually the most important sex organ we possess.  The pleasurable sensations of orgasm and of eating tasty foods are both rooted deeply in the limbic system, a network of small organs buried deep in the center of the human brain which contains the so-called “reward centers,” nerve endings which fire rapidly and repeatedly when a fundamental need is met.  This process is facilitated by the flow of neurotransmitters (chemical messengers which travel along nerve pathways and flow across the gap at the end of the pathway to the target cell or receptor).  Dopamine, one of numerous human neurotransmitters, is the one most closely connected to sexual desire and arousal.  Dopamine levels tend to drop after menopause, probably as a result of an estrogen/progesterone (or even testosterone) imbalance.  So when we summon the Healthy dwarf to remedy the situation by way of diet, exercise, and appropriate hormone replacement therapies, the Amorous, Sensual, and Contented dwarfs are right on his heels because better hormonal balance usually means normal dopamine levels.  It should be noted that prescription anti-depressant medications increase the neurotransmitter serotonin in the brain, which actually inhibits the production and circulation of dopamine and consequently decreases sexual desire.  So Healthy, Amorous, Sensual, and Contented are more often the result of natural treatments (giving your body and brain what they need) than of psychotropic medications, which can balance one neurotransmitter but upset the balance of another.  So summon the Healthy Dwarf and his sidekicks to help you be aware of how to naturally regain equilibrium and wholeness after menopause.  And when you feel Healthy, Amorous, Sensual, and Contented, of course you’ll feel more Cheerful, Lively and Happy as well!

B12 deficiency is rampant and Dr OZ is waking America up to this fact! These links have segments from his show that are useful to help patients learn that there are so many symptoms associated with suboptimal B12 intake for which most people wind up getting a useless drug that will cause more harm than good. It is always best to fix the problem not live on a drug! We need to find a method whereby FACT members get all of their patients email addresses and share some of this kind of vital information with your entire patient list.

However, we know that the bigger issue is really that patients are in danger with Folic Acid and that it can cause cancer whereas the Folate treats cancer. Just taking B12 without Folic Acid is unwise but with the toxins found in everyone today, there is a provable methylation epigenetic change that means approximately 40% of all patients must take the methyl form of B12 (more expensive) and the methyl form of Folate ( again more expensive but VITAL over their lifetime).

Patients must not rely just on the cheap synthetic form of Folic Acid found in their multiple supplements if they are to avoid the complications of Folate deficiency, which include Cancer, premature aging, Alzheimer's etc.

Dr. Garry F. Gordon, MD, DO, MD(H)
President, Gordon Research Institute
www.gordonresearch.com

“To everything – turn, turn, turn – there is a season – turn, turn, turn – and a time for every purpose under Heaven.” (song written by Pete Seeger, 1960s)

Pete Seeger wrote this song during the rapidly changing times during the 60s, the words echoing a familiar Old Testament Scripture passage.

Both the Scripture and the song lyrics are very pertinent, as there are distinct times when circumstances dictate a certain policy or practice, while at a different juncture in a day or in a life, circumstances may call for very different course of action.  Thus the key to happy and healthy living is to be alert to the “time,” or to the emotional context of what is occurring at a particular moment in one’s life.  This is a skill, which when keenly developed, greatly enhances ones’s satisfaction with his or her personal and family life.  Nowhere is this more true than in the area of a couple’s sex life. 

Two loving sexual partners must be aware of the supreme importance of each moment in their love-making sessions, purposefully putting aside their awareness of other pressing matters at that time to be fully present in that moment.  It is not that they are actually unaware of other momentous occurrences surrounding that moment in time, but that they realize that the cosmic connection they are making in that moment has over-riding significance.  The physiologic make-up of the human body aids in this awareness, as the abundance of certain neurotransmitters (dopamine in particular) in the brain at the time of sexual orgasm spikes dramatically.  Then following orgasm, although dopamine levels drop back sharply, another neurotransmitter called oxytocin rises to higher levels.  This chemical messenger, when it travels the nerve pathways in the brain, produces the urge for skin-to-skin cuddling, closeness, and bonding.  Oxytocin levels after orgasm tend to be higher for women than for men, hence the common female complaint that when she wants to cuddle and talk for a few minutes after sex, all her man wants to do is go to sleep!  However, both sexes do experience an elevation in oxytocin levels to some extent after orgasm.

Herein lies an example, then, of the salience of a moment in time to be seized for a particular purpose – since the man and woman are experiencing elevated oxytocin levels in their brains, the emotional context of that few minutes following intercourse is already primed for eye-to-eye contact and communication about their shared sexual experiences and preferences.  A profoundly heart-felt “Thank you” should be the first sentiment uttered by each partner, accompanied by a caress or pleasurable touch.  Then some positive “I-statements” about what sexual practices makes each one happy can easily be exchanged between them so that they can be remembered and applied the next time.  The chemistry of the body after sex provides a natural environment for closeness and communication, and lovers are wise to seize this few moments to take advantage of it. 

This is an especially important skill to practice when a couple still has young children at home, because while of necessity they give their children huge chunks of time and attention, it is still extremely important to the ongoing health of their own relationship not only to maintain a good sexual relationship but to keep the lines of communication open.  After all, before they know it their children will be out of their house attending college or establishing their own jobs and families. 

By the time a couple all of a sudden finds themselves entering this unfamiliar “empty-nest” world with so much more time available in a day, chances are they are entering middle age.  They have the advantage of more time to devote to their emotional and physical relationship, but they are also entering a different stage or season of their life when hormonal or health issues may be begin to manifest themselves.  But not to worry, in today’s world there is an abundance of information available about healthy lifestyle, diet, exercise, and even bio-identical hormone therapy that can help keep men and women younger and healthier for much longer, and keep the effects of aging at bay.  So, this time or “season” needs to be internally recognized as a context for self-care, for slowing the pace of life somewhat in order to accommodate both one’s partner and one’s self individually.  It is not a time to despair over lost youth or lower libido or menopausal symptoms.  It is a time for celebrating in each individual life and in the life of the couple what they still possess and share, and even what can be re-claimed by renewal of healthy life choices such as diet and sound medical advice. 

We are not “stuck” in one particular time or season if we remain flexible to what is occurring in our lives and alert to the physical and emotional climate of each moment, each hour, and each day, enabling us to make healthy and happy choices at that point in time.

From Dr. Cabeca to Dr. Richard:

Hi Richard,

Do you think that all the Vitamin D replacing will have adverse consequences? and what do you think of replacing D2 vs D3?

Thanks for your thoughts as always!

Best regards,

Anna

Dr. Richard replied:

Hello Anna,

Not at all! Many people are in chronic Vitamin D deficiency, and they are very likely to benefit in multiple ways from oral replacement therapy. On the other hand, I have great concern over the current rush to use 50,000 IU doses without evidence of need for such aggressive replacement. Many people have perfectly adequate Vitamin D without any supplementation, and they can develop vitaminosis D. The problem here is that we know little about how to detect the less-than-overtly toxic excessive D state from clinical observations. The main known issue is lack of adequate viatmin K to allow the chauffer network to move the extra calcium to sites needing deposition (primarily Bone). The long term outcome of this scenario tends to be soft tissue calcifications.

Another area of concern over excess states is that of the other 1, 25-OHD hormone effects being overdone. This involves the immune cell responses where the dance of interactions is complicated and not yet fully understood. The situation here is reminiscent of that for excessive fish oils and, more recently, potentially excessive folic acid. I think we are entering into a new era of nutritional science where some essential nutrients are becoming recognized to be limited in the diet for good reason. If I'm right, then we may start to hear more about heightened awareness of the need to do status assessment before proceeding with aggressive supplementation regimens

The general consensus at this point still holds that the D2 and D3 isomers both act equally to augment circulating 25-hydroxycholecalciferol. A few reports contend to find some differences in utilization efficiencies from oral cholesterol dosing.I find it fascinating that the skin quickly darkens and shifts reaction rates to reduce conversion of cholesterol to D3. That speaks to the importance of normal mechanisms to prevent overrunning optimal circulating levels of pre-hormone. 

Kind regards,

Richard

One of my specialties is helping women balance their hormones so they can feel better, look younger, and even lose weight.

How do you know if YOUR hormones are out of whack?

Well, a sure sign is if you experience any of the following symptoms:

* Your mood changes unpredictably or you're depressed

* You've gained weight over the years and it's extremely hard to lose (diet and exercise don't do the trick like they once did)?

* You're tired most of the time and you use caffeine or sugar to help you get through the day

* You experience sleep problems such as difficulty getting to sleep or waking up in the wee hours of the night

* Your interest in sex is lackluster (or nonexistent)?

* Your mind feels hazy or scattered and you have difficulty concentrating?

* You're experiencing obvious hormonal issues such as PMS or hot flashes

When I see a patient in my practice with any constellation of these symptoms, I know we’ve got some "hormone work" to do. I also know there are probably some baseline nutritional and other lifestyle factors that we need to work on too.

Because the foundational fixes to these issues are the same for all women, I created a mini course so I can teach you the KEY tips I have learned about getting rid of these annoying hormone-related symptoms. I invite you to learn from me on a no-cost teleclass I'm hosting next week:

"Feel Good, Look Good Secrets for the Woman Over 35: ?Why You’re Feeling Fat, Fatigued and Frumpy and How ?to Feel FABULOUS Again!"

FR*EE Teleclass with Women’s Health Expert Dr. Anna Cabeca?

Tuesday, April 26 at 5 pm Pacific / 8 pm Eastern

Reserve your spot here:
http://www.cabecahealth.com/feel-fabulous

(Be sure to register to receive the recording even if you can't make the live call.)

On the teleclass, you’ll learn:

* 5 obstacles to achieving optimal health (and how you can overcome them)?

* The true underlying causes behind your symptoms?

* How conventional treatments for these symptoms often mask the problems rather than fix them?

* The most common type of hormonal imbalance that I see in my practice every day, and how to identify if you have it?

* 7 ways to balance your hormones to lose the moodiness, clear your brain, and have more energy?

* 6 steps you can take right now to make an immediate impact on how you feel?

* And much, much more...

Ladies, please don't miss out on this opportunity to learn my secrets to regaining the vitality of your youth. I’m so happy to share them with you because I believe all women deserve to live with optimal health and vitality. Do it for yourself, and do it for your family. They want to see you live this way too!

Here's that link again:
http://www.cabecahealth.com/feel-fabulous

To your health,

Anna Cabeca, DO, FACOG, ABAARM

P.S. It’s easy to think that these symptoms are just a part of normal aging, but they aren’t. If your hormones are balanced and your body healthy, there’s NO reason why you shouldn’t have abundant energy, a svelte body, and look and feel fantastic for decades to come.

I’ll be sharing more of my personal story on the call, but I went from being seriously depressed to losing over 50 pounds, conceiving a healthy baby at 41 (after being diagnosed with irreversible infertility) and in love with my life again. If I can do it, you can too! I’ll show you how.

Register right now before you forget:
http://www.cabecahealth.com/feel-fabulous

P.P.S. Please feel free to let your friends know about this teleclass, but be sure to reserve your spot here first! http://www.cabecahealth.com/feel-fabulous

Ladies, lots of us spend big bucks on facial creams and other lotions and potions that promise to minimize crow's feet, lip creases and other wrinkles.

Problem: The latest research shows that our skin would benefit more if we focused on what we put in our mouths rather than in our cosmetics cases.

Alan C. Logan, ND, of Harvard's School of Continuing Medical Education, explained to me, “The same metabolic factors that contribute to chronic illnesses such as heart disease and diabetes also can damage the skin's cellular structures, leading to wrinkling. Those factors are highly influenced by the nutrients we ingest.” Here's what really keeps skin looking young...

ANTIWRINKLE FOODS

Among the chief metabolic factors that harm skin (as well as other body tissues) are chronic inflammation... oxidation (a kind of biological rust)... and high blood sugar. Certain foods help prevent such damage—other foods make it worse.

Evidence: Australian researchers studied the skin of 453 seniors and, in an article in the Journal of the American College of Nutrition, posed the question, “Skin Wrinkling: Can Food Make a Difference?” Their answer, an emphatic yes, identified specific foods and food groups associated with the least and the most wrinkling. According to the study...

Wrinkle preventers : Eggs... fish... fruits (especially apples, cherries, melons and pears)... legumes (especially fava beans and lima beans)... low-fat dairy foods (skim milk, low-fat yogurt)... olive oil and other monounsaturated fats (avocados, nuts)... tea... vegetables (especially dark leafy greens and asparagus, celery, eggplant, garlic and onions)... whole-grain breads and cereals. These foods are high in antioxidant vitamins and phytochemicals that protect skin.

Wrinkle promoters : Butter and margarine... cakes and pastries... high-fat dairy foods (whole milk, ice cream)... potatoes... red meat (particularly processed meats)... and soft drinks (the study did not distinguish between sugar-sweetened and diet soda). Researchers found that these foods were associated with a high degree of photoaging (sun damage).

Another nutritional factor that ages skin is the advanced glycation end-product—with the apt acronym AGE. Dr. Logan explained, “Collagen and elastin are fibrous proteins that help maintain the skin's firm, supple structure. AGEs are sugar molecules that bind with collagen and elastin, weakening and warping those fibers. AGEs also inactivate enzymes that protect against UV rays.”

To reduce AGEs in your skin...  

Avoid sugar. The number-one dietary source of damaging AGEs is sugar—so cut down on candy, cookies, ice cream and other sugary foods.
Cook right. When certain food is cooked using high heat (above 375°F) and no water - for instance, oven-roasted, baked, grilled or fried - AGEs form. "All foods can form AGEs, even vegetables, though the highest levels occur when protein and carbohydrates are combined, such as in baked goods made with eggs and flour," said Dr. Logan. Best:Steam, boil, stew, use a slow cooker or roast at 350°F or lower.
Add spice. Turmeric, garlic, cinnamon and ginger inhibit AGEs' ability to bind with collagen and elastin—so use these liberally. You'll add flavor to your food... and subtract years from your skin.

SKIN-SMOOTHING SUPPLEMENTS  

Even if you are conscientious about your diet, it can be hard to get sufficient amounts of the most powerful skin-protecting nutrients from food alone. That's why Dr. Logan and I recommended taking any or all of the following supplements daily (with your doctor's OK), continuing indefinitely.

Alkalinizing your body and giving it antioxidents definately promotes healthy aging of the skin.  We use in my practice Mighty Maca Greenswhich has many health benefits and helps you beautify and energize from the inside out!

Multivitamin/mineral. Choose a brand that includes 100% of the recommended daily value for vitamin A, which helps prevent dryness...vitamin C, vitamin E and selenium, essential for the manufacture and function of collagen... and zinc, which protects against the sun's damaging UV rays.
Fish oil. This is rich in omega-3 fatty acids that shield skin from UV rays... protect against oxidation... and improve skin elasticity. Take a daily fish oil supplement that supplies 1,000 mg to 2,000 mg ofeicosapentaenoic acid (EPA), the omega-3 that best protects collagen. We use Vitality Packs which contain a fantastic multivitamin formulation, omega-3's, calcium and an additional antioxidant in a handy packet.  

Gamma-linolenic acid (GLA). This fatty acid enhances EPA's skin-saving effects. Dosage: 250 mg to 500 mg of GLA from borage oil or evening primrose oil, taken along with your fish oil.

Probiotics. These “friendly” intestinal bacteria not only support digestive health, they also combat inflammation and oxidation throughout the body—including in the skin. Dr. Logan explained, “Probiotics help prevent certain harmful substances from passing through the gut wall and entering the bloodstream, where they could provoke a systemic inflammatory response and contribute to oxidative stress.”  

Wishing you health and happiness and beautiful skin!
Anna Cabeca, DO, FACOG, ABAARM

Source: Alan C. Logan, ND, is a board-certified naturopathic physician and an invited faculty member in Harvard's School of Continuing Medical Education in Boston... and author or coauthor of four books, including Your Skin, Younger and The Clear Skin Diet (both from Cumberland House).

Ok, I am having this moment when I am standing in front of my pantry thinking that I can keep going through my favorite foods but nothing is quite lifting me up, duh! So I am on the phone with my brother Robert and he reminds me to recite the serenity prayer: “God grant me the serenity to accept the things I can not change, courage to change the things I can, and wisdom to know the difference, Thy will not mine be done“. What do you do when seeking comfort?

Dr. Cabeca,

I recently heard you speak at the IFM Symposium on Advanced Women’s Health. Thank you, it was a great presentation. I am a registered dietitian in my own private practice. I see many women with PCOS. I believe I understood you to say that the PCOS patients should not follow a typical DM diet balancing carbs through out the day...with 5-6 meals.  I believe you said to have them consume only 3 meals a day????

I have a client that has PCOS, has had children successfully, has very elevated blood glucose levels. I do not believe her insulin levels were measured. She is on metformin and is following a DM diet. Her levels are  not under control yet. Do you recommend only 3 meals a day?    

For the clients w/o PCOS but high levels of insulin, again do you recommend 3 meals a day and not the 5-6 in a typical DM diet?  Thank you for your input and a great presentation.

Sue

Susan T. Anthony, RD

Dear Sue,

Thanks very much for your compliment and attending my lecture at the Integrative Healthcare Symposium in New York City on polycystic ovarian syndrome, metabolic syndrome and insulin resistance. This is a fascinating topic and understand that it goes against basic nutritional guidelines of three meals and three snacks per day, however this does not work on the insulin resistant patient. Two hours or even three hours after she has eaten her insulin levels may still be above 50 and we want them to be nice and low otherwise they are storing glucose and storing fat and it continues to propagate insulin resistance, and metabolic syndrome, as well as the sequelae of the disease such as high cholesterol, high triglycerides, hypertension, increased abdominal obesity diabetes, infertility, etc.

Therefore in my patients I recommend that they keep an alkalinizing diet with a good amount of protein at each meal at lease 25 to 35 g of protein and a low glycemic index, and at least 4 to 5 hours between meals. As you know they‘re getting healthy fats and protein. Your not going to make them hypoglycemic with this regimen whether or not their on a sulfonurea or metformin.

Additionally, I recommend the mighty Maca greens because it is alkalinizing and it has insulin sensitizing herbals and it is a very good way to bring nature back into the body. She should also be on high quality of Omega threes with a high level of EPA/DHA in addition to a diet high in cruciferous vegetables, greens and low glycemic index.

Thanks for your question, and complement and look forward to hearing from you againycystic ovarian syndrome, metabolic syndrome and insulin resistance. This is a fascinating topic and understand that it goes against basic nutritional guidelines of three meals and free snacks per day, however this does not work on the insulin resistant patient. Two hours or even three hours after she has eaten her insulin levels may still be above 50 and we want them to be nice and l low otherwise they are storing glucose and storing fat and it continues to propagate insulin resistance, and metabolic syndrome, as well as the sequelae of the disease such ashigh cholesterol, high triglycerides, hypertension, increased abdominal obesity diabetes, infertility, etc.

Therefore in my patients I recommend that they keep an alkalinizing diet with a good amount of protein at each meal at lease 25 to 35 g of protein and a low glycemic index, and at least 4 to 5 hours between meals. As you know they‘re getting healthy fats and protein. Your not going to make them hypoglycemic with this regimen whether or not their on a sulfonurea or metformin.

Additionally, I recommend the mighty Maca greens because it is alkalinizing and it has insulin sensitizing herbals and it is a very good way to bring nature back into the body. She should also be on high quality of Omega threes with a high level of EPA/DHA in addition to a diet high in cruciferous vegetables, greens and low glycemic index.

Thanks for your question, and complement and look forward to hearing from you again.

Best regards,

Anna

How much vitamin D is enough?

Over the past decade, rickets has re-emerged as a noticeable public health issue in some areas (Lanham-New et al, 2010) and many physicians have been ordering lab values of blood vitamin D levels on their patients and prescribing large doses of the vitamin for the patients whose levels seemed low: <20-30 ng/ml. However, the accuracy of serum vitamin D assessments, the need for the vitamin D supplementation, and efficacy of the supplements have not been clear. Now, the Institute of Medicine recommends tripling the daily intake for most children and adults to 600 IU per day, up from 200 IU/day (Institute of Medicine, 2011. This recommendation is not without controversy.)

Clinically, the level of 25-OH vitamin D is assessed because it is the major form of the vitamin and is readily converted to the active form, 1,25 [OH]2 vitamin D (also called vitamin D3 or calcitriol) by CYP27B1, primarily in the kidney. A quick scan of PubMed and internet health sites makes clear that there are wide-ranging opinions about how much vitamin D is enough to maintain growth and skeletal health and the role of vitamin D in a broad spectrum of diseases from the common cold and flu to cancer. Mechanistic research on actions of vitamin D in simple cell systems and rodents provides ample evidence of roles for vitamin D in gene regulation; thus, we know that vitamin D can modulate proliferation, differentiation, and apoptosis of many cell types (e.g., Anet al., 2010; Eganet al., 2010), and have effects on immune function, among others. The precise roles of vitamin D in human health, especially those effects not associated with calcium metabolism, and concentration-response curves of the effects in humans are, however, harder to define, especially since well-controlled, randomized in vivo studies in humans are difficult and expensive. The non-calcemic effects of vitamin D may occur along different concentration-dependence curves and require a re-evaluation of what defines adequate daily intake (Bikle, 2010). At present, however, much of what we think about vitamin D requirements and effects in humans is based on epidemiologic data.

How much vitamin D does a human need every day? The answer is not clear, although most current suggestions agree within a factor of ~3-4. As with many dietary components, and especially for vitamin D, which the human body can make upon exposure to sunlight, serum levels vary widely, probably reflecting genetic background, diet, latitude, time spent out-of-doors, body size, developmental stage, and state of health, as well as plasma levels of vitamin D binding protein. The actions of vitamin D could also vary with the expression of various isoforms of the vitamin D receptor and of the activating and inactivating CYPs, and with the presence of various nuclear co-activators. Because rigorous and well-controlled dietary studies are often lacking in humans, recommended daily intakes for vitamins are sometimes as much matters of opinion as of fact, or are extrapolated from studies in model systems. In practice, most urban dwellers do not get much exposure to sunlight and diet generally does not supply sufficient amounts of vitamin D: a serving of fish may contain 200-500 IU; a cup of a fortified dairy product (cow’s milk, yogurt, soy milk) supplies 100 IU. Thus, for many of us, supplementation is required.

The range of scientific opinion favoring increased vitamin D supplementation is well represented by two papers from a 2009 symposium-in-print: Garland et al. (Garland et al., 2009) used epidemiologic data to argue for increasing the average serum levels of vitamin D to 40-60 ng/ml (100-150 nM), a level that they suggest could be achieved by an intake of 2000 IU/day (50 µg/day) and which might decrease the rate of a number of cancers. Vieth (Vieth, 2009) argues that any benefit of vitamin D needs to be balanced by consideration of the toxicity of vitamin D and the related hypercalcemia, that 2000-4000 IU/day is generally satisfactory, and that toxicity should not be expected below 10,000 IU/day.

A prominent proponent of increasing vitamin D intake is Dr. Michael Holick, an endocrinologist at Boston University Medical Center. Holick summarizes his views and research in a recent review (Holick, 2011) and a book (Holick, 2010). To quote from his review:
"Vitamin D deficiency and insufficiency have been defined as a 25-hydroxyvitamin D <20 ng/ml and 21-29 ng/ml respectively. For every 100 IU of vitamin D ingested the blood level of 25-hydroxyvitamin D, the measure vitamin D status, increases by 1 ng/ml. It is estimated that children need at least 400-1000 IU of vitamin D a day while teenagers and adults need at least 2000 IU of vitamin D a day to satisfy their body's vitamin D requirement." (Holick, 2011)

Endocrinology Clinics of North America recently published a compendium of articles by researchers who work on aspects of vitamin D metabolism and action (Multiple Authors, 2010). In general, these authors recommend maintenance of plasma levels of 25-OH-D ≥30 ng/mL, requiring a daily intake of ≥1000 IU for most children and adults, and twice that for pregnant and lactating women. Others argue that in special cases, such as that of pregnant women, up to 6000 IU/day are needed (Hollis, 2007).

The recommendations of the Institute of Medicine fall short of the values advanced by these proponents, but do advise higher daily intakes than previously indicated for both calcium and vitamin D, as discussed below. Thus, the recommended daily allowance of vitamin D will continue to be controversial; happily, proponents of greater increases in vitamin D intake generally recommend an amount at or below what the IOM considers the upper limit of 4000 IU/day.

The Linus Pauling Institute at Oregon State University maintains a well-informed website on vitamin D (Higdon and Drake, 2010).

Overview
A report issued on 30 November 2010 by the Institute of Medicine (IOM) of the National Academy of Sciences provides new guidelines for daily vitamin D and calcium supplementation (Institute of Medicine, 2011). These recommendations, referred to as Dietary Reference Intakes (DRIs) are the reference values used for nutrition standards for school meals, food labeling, and are widely employed for assessing vitamin D and calcium sufficiency. These values are more commonly known as the Recommended Dietary Allowance (RDA). The recommendations, new and previous, are shown in Table1.

]

Table 1. 
The IOM evaluation focused on three central issues:

• the health outcomes influenced by vitamin D and calcium;
• the vitamin D and calcium requirements to achieve the desirable health outcomes;
• adverse actions arising from over medication.
  

Background for IOM Study
Increasing medical and public interest over the last 10 years focused on claims of enhanced benefits of vitamin D and calcium on human health. It is also commonly believed that there is negligible risk associated with taking vitamin D and calcium supplements, which are widely available in North America. Scientific research suggested relationships between vitamin D intake and cancer prevention, increased immunity; and possible roles in preventing diabetes or preeclampsia. These findings come on a background of clinical findings that many adults and children may be deficient in vitamin D. Based on this array of issues and several preceding comprehensive reviews (Cranney et al., 2007) [summarized in (Cranney et al., 2008)] and (Chung et al., 2009), the IOM was approached by the U.S. and Canadian governments to conduct a review of data pertaining to calcium and vitamin D requirements and to identify DRIs based on current scientific evidence about the roles of calcium and vitamin D in human health. Health outcomes considered bone and skeletal health, physical performance and falls, cancer and site-specific neoplasms (breast, colorectal, prostate), cardiovascular diseases and hypertension, type 2 diabetes and metabolic syndrome (obesity), falls, immune disorders and infectious diseases, neuropsychological functioning (autism, cognition, and depression), and disorders of pregnancy (preeclampsia).

Summary of IOM Findings
Using an evidence-based approach, the review committee found compelling support favoring a role for calcium and vitamin D in sustaining skeletal health. This, along with analysis of parameters regulating mineral ion homeostasis were used to generate the new DRIs. Evidence for a role of supplemental vitamin D or calcium on non-skeletal outcomes was inconclusive.
The IOM determined that the extent of vitamin D deficiency among the North American population has been overestimated because of inflated cut-points for serum 25(OH) vitamin D. The IOM recommendations now suggest that persons are at risk of deficiency at serum 25(OH) vitamin D levels below 30 nmol/L (12 ng/mL). Some, but not all, persons are potentially at risk for inadequacy at serum 25(OH) vitamin D levels between 30 and 50 nmol/L (12 and 20 ng/mL). Practically all persons are sufficient at serum 25(OH) vitamin D levels of at least 50 nmol/L (20 ng/mL). Serum 25 (OH) vitamin D concentrations above 75 nmol/L (30 ng/mL) are not consistently associated with increased benefit. Serum 25-OH D levels above 125 nmol/L (50 ng/mL) are a cause for concern.
Potential toxicities of vitamin D and calcium were also assessed and revised Upper Limits (UL) for daily supplementation were issued. The UL is the level above which the risk for adverse actions begins to increase. The UL is the highest average daily nutrient intake level likely to pose no risk of adverse health effects for nearly all people in a particular group. The revised ULs are based on increased fortification of foods with nutrients and the use of larger doses of dietary supplements. In general, the risk of adverse effects for vitamin D begins when intake surpasses 4,000 IUs per day. The risk of harm for calcium begins when intake surpasses 2,000 milligrams per day. Side effects of excess vitamin D or calcium most immediately include hypercalcemia and hypercalciuria.

Pharmacology Summary
Serum calcium levels are tightly regulated at 2.2-2.6 mmol/L (9-10.5 mg/dL) for total calcium and 1.1-1.4 mmol/L (4.5-5.6 mg/dL) for ionized calcium. When serum calcium falls, parathyroid hormone (PTH) secretion increases. PTH exerts direct effects on the kidney to retain calcium and on bone, where it mobilizes calcium. PTH also induces the expression of renal 1α vitamin D hydroxylase (CYP1α), which converts 25(OH) vitamin D to its active form, 1,25[OH]2 vitamin D (calcitriol). Vitamin D, in turn, stimulates intestinal calcium absorption. The major therapeutic uses of vitamin D include treatment of nutritional or metabolic rickets; osteomalacia, particularly in the setting of chronic renal failure; hypoparathyroidism; and osteoporosis. Vitamin D supplementation may help prevent fractures, but the relationship between blood vitamin D concentrations and fracture risk is unclear (Cauley et al., 2008). The IOM investigation failed to find evidence indicating a significant reduction in risk of falls that was related to vitamin D intake or blood levels (Institute of Medicine, 2011). Calcium is used in the treatment of calcium deficiency states and as a dietary supplement. The role of supplemental calcium in supporting skeletal integrity is controversial.
Gender, age, diet, and health impact the requirements for calcium and Vitamin D. Milk, yogurt, cheese, and foods and juices fortified with calcium and vitamin D remain the best dietary sources of calcium and vitamin D. If these do not provide the desired RDA, supplements can be used to supply the balance of recommended daily amounts. A one-cup serving of most dairy products contains 200-300 mg of calcium.

By: Peter A. Friedman; Laurence L. Brunton
AccessMedicine from McGraw-Hill © 2011 The McGraw-Hill Companies

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References
1.     An BS, Tavera-Mendoza LE, Dimitrov V, et al. Stimulation of Sirt1-regulated FoxO protein function by the ligand-bound vitamin D receptor. Mol Cell Biol 2010;30:4890-4900.
2.     Bikle DD. Vitamin D: newly discovered actions require reconsideration of physiologic requirements. Trends Endocrinol Metab 2010;21:375-384.
3.     Cauley JA, Lacroix AZ, Wu L, et al. Serum 25-hydroxyvitamin D concentrations and risk for hip fractures. Ann Intern Med 2008; 149:242-250.
4.     Chung M, Balk EM, Brendel M, et al. Vitamin D and calcium: a systematic review of health outcomes. Evid Rep Technol Assess (Full Rep) 2009:1-420.
5.     Cranney A, Horsley T, O'Donnell S, et al. Effectiveness and safety of vitamin D in relation to bone health. Evid Rep Technol Assess (Full Rep) 2007:1-235.
6.     Cranney A, Weiler HA, O'Donnell S, et al. Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr 2008;88:513S-519S.
7.     Egan, JB, Thompson PA, Vitanov MV, et al. Vitamin D receptor ligands, adenomatous polyposis coli, and the vitamin D receptor FokI polymorphism collectively modulate beta-catenin activity in colon cancer cells. Mol Carcinog 2010;49:337-352.
8.     Garland CF, Gorham ED, Mohr SB, et al. Vitamin D for cancer prevention: global perspective. Ann Epidemiol 2009;19:468-483.
9.     Higdon J, Drake VJ. Vitamin D. Linus Pauling Institute. 2010.
10.  Holick MF. The vitamin D solution: a 3-step strategy to cure our most common health problem. New York: Hudson Street Press; 2010, p. 336.
11.  Holick MF. Vitamin D: evolutionary, physiological and health perspectives. Curr Drug Targets 2011;12:4-18.
12.  Hollis BW. Vitamin D requirement during pregnancy and lactation. J Bone Miner Res 2007;22 Suppl 2:V39-44.
13.  Institute of Medicine. Dietary reference intakes for calcium and vitamin D. Washington, DC: The National Academies Press; 2011, p. 1015. Full Report: http://books.nap.edu/openbook.php?record_id=13050. Brief Report: http://www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D/Report-Brief.aspx.
14.  Lanham-New SA, Buttriss JL, Miles LM, et al. Proceedings of the Rank Forum on Vitamin D. Br J Nutr 2011;105(1):144-56. Epub 2010 Dec 7.
15.  Multiple Authors. Vitamin D. Endocrinol Metab Clin North Am 2010;39:243-479.
16.  Vieth R. Vitamin D and cancer mini-symposium: the risk of additional vitamin D. Ann Epidemiol 2009;19:441-445.