UVA Health System Blog

My little cousin John used to do it all the time: Bury his vitamins in the house plant behind the kitchen table. As an adult, John seems healthy enough. Was he really missing out?

In this Q & A with Angie Hasemann, registered dietitian at the UVA Children’s Fitness Clinic, she clarifies whether or not parents of kids like my cousin John need to stress out about their child’s nutrition.

Are supplemental vitamins necessary for kids?  

No — if your children eat a balanced diet (rich in fruits, vegetables, whole grains, lean proteins and adequate dairy), they’re likely getting the vitamins and minerals their body needs. If your child is a picky eater, leaving out an entire food group or often skipping meals, a multivitamin might be a helpful addition to her diet. Special vitamin and mineral supplementation might be necessary in some special health conditions; consult your doctor with questions. (more…)

Do you have problems controlling your asthma, or your child’s asthma?

It doesn’t have to be that way.

Asthma is controllable, according to Julia Wisniewski, MD, a junior investigator with UVA’s Division of Asthma, Allergy and Immunology.

“Not using the stairs, frequent visits to the emergency room or missing work or school because of your asthma is unacceptable,” she says. “Every person with asthma needs to know how to manage their asthma symptoms before they get out of control.”

When Should I See an Allergy and Respiratory Medicine Specialist?

If your asthma symptoms aren’t under control, even with medication, you need to see an allergy and respiratory medicine specialist. You should see a specialist if:

• You use your quick-acting rescue medicine (like albuterol) more than twice a week.
• You wake up with symptoms more than two nights a week.
• You’ve limited any of your daily activities, including exercise.

“Our goal is to control your asthma so you can be physically active and live a normal life,” says Wisniewski. (more…)

Multivitamins aren’t usually necessary, according to a UVA pharmacist. But if you’re thinking about getting pregnant, it’s a different story.

Women need extra calcium and vitamin D when pregnant, according to Mark Lepsch, MD. Infants in the womb “take what they need. Women’s calcium stores can drop significantly during pregnancy.”

What’s the big deal? Can’t a woman just drink a lot of milk or eat yogurt to build calcium back up after the baby is born?

Taking prenatal vitamins before you're pregnant is more beneficial than you'd think.

It’s not that easy. “Bone density peaks at age 30, decreasing afterwards,” explains Lepsch. It’s not something you necessarily replenish. And of course, a lack of bone density leads to osteoporosis.

Why the vitamin D? It absorbs calcium. “If you don’t take it, calcium isn’t absorbed in your body.”

And then there’s iron. As a pregnant woman’s body develops the placenta, she adds “50 percent more blood volume; if you don’t make any more red blood cells, you can become anemic.” Anemia, while extremely common in pregnancy, can result in undesirable exhaustion.

Build Up Your Stores

You may wonder why getting pregnant can deplete a woman to such extremes. The problem isn’t pregnancy in itself so much as what’s there to start with. Which is why you want to start taking prenatal vitamins even before you get pregnant.

“It takes time, if you’re low, to build up your stores. It takes months. It’s not like you can say, ‘I’m low in this’ and you take it and it replenishes your body. If you have heavy menstrual periods, for instance, and low feratin iron stores, it’s going to be a month or so into your pregnancy until your body builds up the blood supply.”

The baby will need extra blood volume and calcium, so taking iron, calcium and vitamin D on a regular basis ahead of pregnancy stocks your body with the resources you need to stay healthy.

Folic Acid

But taking prenatal vitamins isn’t just a measure to maintain the mother’s health.

Studies show that folic acid helps prevent neural tube defects, like spina bifida. Again, the ideal time to start taking extra folic acid is a few months before pregnancy. The first eight weeks or first trimester is the crucial period when all the baby’s organs develop – called organogenesis – and you need folic acid built up in your body to provide for the fetus during that time.

This is also why, Lepsch explains, “alcohol and smoking have their worst effects during the first eight weeks — that’s when the baby’s trying to form its lungs, etc. “

What About Morning Sickness?

There’s yet another reason to start taking prenatal vitamins before you’re pregnant.

Morning sickness.

A quick poll of mothers I know showed the one problem they all shared was taking a prenatal vitamin and keeping it down while having morning sickness — some women experience nausea throughout their whole pregnancy.

Again, the vitamins you need during the crucial first trimester come from stores built up in your body over time, not from a daily pill. “That way, if you get sick later, there’s enough in your body already,” advises Lepsch.

He adds, “The most important thing is nutrition and drinking fluids. You do the best you can.”

Some points to remember if your prenatal vitamins are making you sick:

• Never, ever take them on an empty stomach.
• It doesn’t matter what time of day you take them, so if you’re getting nauseous in the morning, try taking them at night.
• Try chewable children’s vitamins; that will be more helpful than taking nothing. They don’t have as much in them, so you can even take two.
• If the vitamin is making you sick, you might have to stop taking it.

If You Can’t Take Prenatal Vitamins?

Don’t be too discouraged. Lepsch has some comforting information if it turns out you can’t take prenatals.

1. You’re probably okay: “In this country, all our foods are fortified. It is very hard to be deficient in vitamins in this country.” We need extra vitamin D in part because of sunscreen and spending less time in the sun, and we need calcium because we’re living longer and therefore at risk of more bone fractures.

2. There’s more to you and your baby’s health than vitamins: “A healthy diet and regular exercise are probably still the most important factors in determining your health and your baby’s health. ”

Another great way to prepare for a healthy pregnancy: Get a checkup.

Need a doctor? You can find a UVA doctor or primary care provider at numerous locations in the region.

Did you have problems taking prenatal vitamins? What did you do? Tell us in the comments below.

“Bike helmets are for wimps.”

“This helmet makes me too hot.”

“Oh good, my mom’s not looking. I can take off my helmet.”

I heard these statements frequently when I was a kid. We all believed bike helmets were hot, stuffy and the ultimate in dork-dom. The notion that you could be riding your bicycle one moment and brain-injured the next was beyond us. Being cool was much more important than being safe.

But William J. Brady, MD, knows better. Brady, who works in UVA’s emergency room, recently saw two patients involved in separate bike accidents: an 8-year-old girl and a 35-year-old man. Both escaped with minor scrapes. Both were wearing helmets that cracked upon impact.

“I looked at them and said, ‘This helmet saved your life. That would have been your head and brain with a crack in the middle of it,’” Brady says. “And in general, brains don’t do well with cracks.”

That’s why our Community Outreach program teaches local third-graders about bike safety and fits them for helmets. This year, about 300 kids in Greene and Nelson counties benefited from the program, which also satisfies a physical education Standard of Learning (SOL) requirement for the schools. (Learn more about the bike safety program.)

Head Trauma: Don’t Crack the Egg

Community Outreach coordinator Angela Taylor begins each bike safety class by asking students if they already have helmets. In one class, she recalls, none of the students did.

Yet wearing a helmet can reduce the risk of head injury by up to 85 percent, according to Safe Kids.

“Something as simple as a fall off your bike in the driveway or street in front of your house, if you land on your head, can result in death or permanent injury,” Brady says. He gives the example of a kid’s head striking the curb. “Without a helmet, that can be a life-threatening injury. With a helmet, it’s a scraped elbow.”

Taylor uses an egg and a Mason jar to simulate a brain injury to her students. She shakes the egg inside the Mason jar to show how it cracks upon impact, then gives kids the chance to build something to protect the egg.

Buying a Bike Helmet

Bike helmets don’t have to be expensive, Taylor says, but parents should look for Consumer Product Safety Commission approval on the packaging.

Follow these tips to ensure a good helmet fit:

• Measure your child’s head with a tape measure before buying the helmet. Wrap the tape measure around the center of the head, about two inches above the eyebrow. It should be snug but not so tight it digs into the skin. Look for a bike helmet within the head size range. Most third-grade kids wear a size small or medium helmet, Taylor says.
• The helmet should sit no more than two fingertips above the child’s eyebrow.
• The straps of the helmet should form a V shape around the ears.
• The helmet shouldn’t slide around on the head or fly back when bike-riding. If it does, it’s too loose.

Kids shouldn’t wear a helmet that’s been in an accident involving the head, even if there’s no visible damage to the helmet.

Bike Safety: Beyond Helmets

Don’t assume the helmet means you’re immune to injury. “People do need to be careful of not being lulled into a false sense of security,” Brady says. “It might protect your head, but it’s not going to protect the rest of your body.”

Taylor gives her third-graders these bike safety tips:

• Wear sneakers or tennis shoes and socks, not open-toed shoes.
• Double-knot shoelaces and tuck them inside the shoes.
• Wear brightly colored clothes.
• Stop at intersections, get off the bike and walk with the bike through the intersection.
• Check your bike’s brakes and tires before riding.
• Make sure the bike is the right size: Straddle the bike with your feet on the ground. There should be 1-3 inches between your crotch and the center bar where it extends past the handlebars.

Keeping Kids Safe from Bike Injuries

Do your kids like wearing their helmets, or do they say the same things my friends did? Leave a comment and tell us how you help them stay safe. 

Recipe courtesy of Morrison Management Specialists

This dish is light but full of flavor, perfect for summer lunches. It was featured in our cafeteria recently.

Makes 6 servings

Ingredients

For the rice:

2 cups hot water

1/2 teaspoon low sodium vegetable base (no msg)

1 cup brown basmati rice (long grain, dry)

For the salsa:

1/2 cup fresh mango, peeled and diced

1 tablespoon red onion, finely chopped

1 tablespoon red bell pepper, diced, 1/4 inch

1/2 tablespoons fresh cilantro, chopped

1/4 cup canned black beans, drained and rinsed

1/2 teaspoon olive oil/canola oil 25/75 blend

1/4 teaspoon ground black pepper

For the chicken and vegetables:

1 1/2 cup hot water

1/2 tablespoon teaspoon low sodium vegetable base (no msg)

1/4 cup olive oil/canola oil 25/75 blend

1 1/2 pound white-meat chicken, diced

1 1/2 cup frozen whole kernel corn

1 1/2 cup frozen green peas

1 1/2 cup light coconut milk

1 teaspoon kosher salt

1/2 teaspoon ground black pepper

1 tablespoon cilantro

6 fresh lime wedges

Directions

Combine 2 cups hot water and 1/2 teaspoon vegetable base in a sauce pan, bring to a boil. While the water is heating, rinse the rice to remove excess starch and drain well. Add the rice to the vegetable base and water mixture, then bring to a boil. Reduce to a simmer, cover and cook for about 40 minutes or until the rice is tender.

Combine the mangoes, onions, peppers, cilantro, black beans, olive oil and pepper. Gently fold together until the oil and seasoning are well distributed. Reserve for later use.

Combine hot water with 1/2 teaspoon vegetable base and stir until dissolved. Reserve for later use.

Heat a sauté pan over medium high heat. Mist the pan with olive oil blend. To the pan, add cooked brown rice, vegetable stock, chicken, corn and peas. Heat to 165F, stirring constantly. Add the coconut milk and bring back to a simmer. Season with the salt and pepper.

For each serving, put 1 1/4 cups of chicken and rice into the center of a bowl, top with 2 tablespoons of mango salsa, 1/2 teaspoon cilantro and 1 lime slice.

Nutritional Facts

Calories: 421

Fat: 12 g

Sodium: 566 mg

Protein: 33 g

Vitamin A: 42% daily value

Recipe and picture courtesy of Morrison Management Specialists

In the mood for some Thai? This healthy recipe was featured in our cafeteria recently. It’s full of vitamins A, C and K.

Makes 1 serving

Ingredients

1 1/3 cup boiling water

1 1/3 cup ice cold water

1 1/4 oz dry rice noodles

1 1/8 teaspoon canola (Divide into 1 teaspoon and 1/8 teaspoon to use at separate times)

3 1/3 teaspoon vegetable demi glace

1/2 teaspoon low-sodium soy sauce

1/8 teaspoon granulated sugar

1/8 teaspoon fresh grated ginger root

1/8 teaspoon fresh peeled and minced garlic cloves

1/2 teaspoon 100% pineapple juice

1/8 teaspoon cornstarch

1/2 teaspoon water

1 egg

1 spray of oil (Pam or spray canola oil)

3 1/2 oz Chinese (Napa) cabbage, shredded

1/4 cup julienne-sliced zucchini

1/4 cup julienne-sliced yellow squash

1/4 cup julienne-sliced carrots

3 oz. cooked and diced chicken breast

Garnish

1 tablespoon diced scallions (green onions)

1 tablespoon chopped peanuts

1 fresh lime wedge

Directions

In large pot bring water to a boil. While water is heating make an ice bath using the cold water. When water has reached boil, drop noodles into water and cook 6 to 8 minutes or until tender. Remove noodles from boiling water and shock in ice bath. Once totally chilled remove from water, strain and spray with oil so noodles don’t stick together. Reserve for later step.

In sauce pot combine vegetable demi glace, soy sauce, sugar, grated ginger, garlic, and pineapple juice and bring to a simmer and cook for 5 minutes. While sauce mixture simmers combine ½ tsp of water and cornstarch in small separate bowl and make a slurry. Slowly whisk the slurry into the sauce mixture and continue to cook for 3-5 minutes until fully thickened.

Heat a pan over medium heat and spray with Pam/oil. Then add egg and stir constantly until the egg is fully cooked. Remove egg from pan and cool completely, then reserve for later use.

Heat sauté pan over medium-high heat and spray the bottom of the pan with Pam/oil. Add zucchini, yellow squash, carrots and Napa cabbage and stir fry for 1 minute. Then add cooked rice noodles, diced chicken, cooked egg and stir fry sauce. Heat until internal temperature is 165° F. Garnish with peanuts, green onion and lime wedge.

Nutritional Facts

Calories: 416

Total fat: 13 g

Saturated fat: 2 g

Carbohydrates: 42 g

Fiber: 4 g

Protein: 31 g

Sodium: 433 mg

Vitamin A: 325% Daily Value

Vitamin C: 70% Daily Value

Vitamin K: 54% Daily Value

We learned last week that it’s better to get your vitamins from food instead of pills.

But how do you do that? I figured there was no way to get enough of the recommended daily allowance from my diet. Don’t I need to eat a ton of vegetables to get all the vitamins I need?

I asked two of UVA’s experts, Wendy Phillips, clinical nutrition director, and Kendra Glassman, a clinical dietitian, for their advice.

It turns out, I can get everything I need if I follow one basic guideline: Eat right.

Put the Right Foods on Your Plate

Eat right? What exactly does that mean? According to Glassman, following the U.S. Department of Agriculture’s current nutrition guide, MyPlate, ensures you’ll get all the vitamins you need.

This means your daily diet should include:

• 50% fruits and vegetables
• 30% grains, especially whole grains
• 20% protein, like lean meats, nuts and beans
• Plus, a cup of dairy products

“If you’re following MyPlate, then you’re going to get a wide variety of foods that provide all the vitamins and minerals you need,” says Glassman.

Getting your vitamins from food also provides you with extras you just can’t get from a pill, says Phillips. Antioxidants and phytochemicals occur naturally in our food and may reduce our risk of cancers, heart disease and other conditions. Stanols and sterols found in plant-based foods lower cholesterol and reduce inflammation.

The fruits, vegetables and whole grains nature provides for us really are some of the best preventive medicine you can get.

“It is easier to pop a pill. But you’re not getting the same results,” says Phillips.

(more…)

May is National Physical Fitness and Sports Month, and there is no better time than now to dust off your running shoes and get active. From lowering your cholesterol and releasing stress, to keeping your family healthy and boosting confidence, exercise has countless benefits and should be at the top of all of our to-do lists.

Club Red, a UVA Heart Center initiative, is a great resource for all things fitness. Check out clubreduva.com for information about:

• Keeping your kids fit and healthy
• Staying hydrated before, during and after a workout
• Staying safe in the hot summer months
• Physical and mental benefits of regular physical activity
• Lowering cholesterol and reducing stroke risk with exercise

Summer is a great time to get outside and try new activities, but it’s important to stay mindful of proper hydration and protecting yourself during the hot months. Whether you’re new to exercise or a seasoned athlete, Club Red can help you stay in-the-know about safety and can provide ideas for new activities to work into your routine.

UVA Heart Center and Club Red support you in your journey to better health. Have fun, stay safe, and get out there!

“I don’t take vitamins — isn’t it better just to get your nutrients from food?”

My attempt to justify why I don’t pop a multivitamin every day is what started this whole series. My co-workers’ reactions were immediate and hysterical, as if they were shocked I hadn’t collapsed from rickets in front of them.

But that sparked a conversation, and we realized we really didn’t know much about vitamins. So I took our questions to UVA pharmacist Donna White.

What exactly are vitamins and minerals?

They’re basically nutrients that are required in small amounts for essential functions in our bodies. These functions maintain:

• Bone health
• Teeth
• Structural health
• Blood cells

Why do we need vitamins and minerals?

If we don’t get adequate amounts, we can get diseases like scurvy, which comes from a lack of vitamin C. We don’t see that anymore because we can easily get vitamin C through food sources. And there are actually foods that are fortified with vitamins that aren’t as easy to get.

For example, milk and cereal are fortified with vitamin D, but you can also get it from even small exposure to sunlight, as little as 15 minutes three times a week.

We see a lot of ads for multivitamins. Do we really need those?

A balanced diet provides us with the appropriate vitamins and minerals. The problem is whether we’re eating what’s necessary to obtain those minerals and vitamins. You should have three servings of fruits and five servings of vegetables per day, and pick bright colors. But in our daily routines, we might not be getting all of that.

There are some instances where some vitamins are needed in higher amounts. For example, higher doses of folic acid in pregnancy prevent birth defects.

Also, say somebody is on a very restricted caloric diet for weight loss or other reasons. They would certainly benefit from a multivitamin. And certain diseases cause absorption issues.

But for the regular person who should be eating a healthy diet, you can get what you need from food.

If you do take a multivitamin, does it matter if it’s name-brand or generic?

Yes and no.

We know brand names have been well studied and their ingredients have been verified in studies. Generics are OK as long as they’re verified by the USP (U.S. Pharmacopeial Convention.)

I think most places where you buy vitamins, like pharmacies and grocery stores, are going to be OK. A health food store may have some vitamins that aren’t USP branded.

What does “fat-soluble” and “water-soluble” mean?

Fat-soluble vitamins (A, D, E and K) are stored in the liver, whereas water-soluble vitamins (C and the B vitamins) pass through the system and leave through the kidneys.

You’ve probably heard the phrase: If you’re taking large doses of water-soluble vitamins, you have expensive urine. And with water-soluble vitamins, if you have poor renal function, anything that is excreted through urine could build up in the body.

Your liver is a great detoxifier, so you do process and excrete fat-soluble vitamins. But the process is different, so if you have something you’re taking too much of, your body has less ability to clear it.

Is it possible to get too much of a vitamin?

It shouldn’t be much of an issue if it’s just your food source plus a multivitamin. If you’re taking multivitamins and then additional singular vitamins on top of that, that could be a concern.

In particular, it’s the fat-soluble vitamins that can be problematic — in very very large doses — because they stay in your system and can become toxic.

If you were taking high, high doses of vitamin C, which is water-soluble, that could lead to kidney stones. The requirement for vitamin C is around 100 milligrams a day. But when people purchase Vitamin C for colds or whatever reason, the doses are 500 or 1,000 milligrams. When you get to doses above 2,000 milligrams, which is not that many if someone is thinking they’ll cure their cold by popping them in, there’s a risk of kidney stones.

Do fish oil supplements have enough mercury to cause harm?

They do not. There are several studies that have looked at that. Fish oil goes through a purification process. In some studies, there may have been the slightest amount of mercury. Some people tout that fish oil supplements are actually safer than eating the fatty fish, with regards to mercury.

Back to vitamin C. Is there any truth to the claim it can cure a cold?

No, not really.  If you’re susceptible to six colds a year and you took a high dose of vitamin C every day for a year, you might shorten the length of the cold from 10 days to nine days. And that’s if you’re taking it every single day.

So it really hasn’t borne out. And then you could get into the issues with kidney stones.

What about protein powder? Do people doing strength training need extra protein?

Proteins aren’t vitamins or minerals; they’re amino acids. You have to be careful about them, too. Increasing your protein like that has wear and tear on your kidneys. It’s not unusual to find someone who is young and who exercises a lot and also has a big body build, and they have increasing levels of muscle breakdown in their system.

Most of us need about a gram of protein per kilogram (2.2 pounds) of weight per day.

If you’re taking vitamin supplements and are on medication, do you need to worry about interactions?

There are certainly drugs that are affected by taking vitamins or minerals. It works both ways. Some drugs cause a depletion of vitamins and minerals. For example, Metformin, which is for diabetes, can cause a decrease in B12.

There are some antibiotics that, if they are given closely with a multivitamin with minerals, the antibiotic doesn’t work as well. That’s why you’ll see on the bottle to take on an empty stomach.

Most of the time, I think physicians are not telling patients to take a multivitamin. People get the idea from outside resources or seeing it on TV.  But also patients will come into the pharmacy and ask about multivitamins. When we ask patients, “Are you taking anything over-the-counter?” we ask specifically about multivitamins and minerals, because a lot of times patients don’t consider those medications.

I think it would be good to always bring up any change in your medication, including vitamins, with your doctor.

Want to know more? Don’t miss the series!

Now we know it’s possible to get the nutrients you need from food. Subscribe to this blog so you don’t miss the rest of our vitamin series, including vitamin-rich recipes, vitamins for kids and prenatal vitamins.

In my 20s, I kept a bottle of multivitamins in my kitchen cabinet. Every so often, I’d reach in there and grab a vitamin. More often than not, I ignored that bottle. Out of sight, out of mind. I started taking multivitamins more often once I reached my early 30s, assuming they would help with various health conditions.

Now, I take a multivitamin every night without fail. Plus, I was diagnosed with a vitamin D deficiency, so I take an additional supplement of that vitamin.

But do I really need to take those vitamins? Are they helping me — or could they be hurting me?

In the coming weeks, we’ll explore vitamins and supplements and clear up some of the mystery. You’ll get answers to these questions:

• Why do we need vitamins?
• What vitamins should I take if I’m pregnant?
• Do my kids need to take vitamins?
• How do I get vitamins in my daily diet?
• And lots more!

Plus, we’ll share some vitamin-rich recipes you can try at home.

Check back here on Thursdays to find out everything you ever wanted to know — and a little more — about vitamins and your health. And be sure to comment and share your ideas and questions with us!

Enjoy reading!