Give Me an "A!" The Benefits and Dangers of Vitamin A

This article was published recently in my company's wellness newsletter. It's the second installment in the vitamins and minerals series.

Many a parent has coaxed a child into consuming carrots and leafy greens with promises of eagle eyes or superhero vision. These claims are not entirely unfounded....

Carrots, leafy greens, and lots of other plant and animal foods contain Vitamin A—a fat-soluble nutrient that not only plays an important role in eye health, but also in cell growth and a variety of other important biological processes. While Vitamin A will never give you built-in binoculars or X-ray vision, it can help prevent dry eye and cataracts: conditions which can be linked to blindness later in life. It can also boost your immune system, helping your body prevent and fight off infections and diseases like the measles and even some types of cancer.

There are two basic types of Vitamin A:

• Preformed retinoids, a “processed” form of Vitamin A found in animal foods like dairy, liver, and eggs.
  


• Provitamin carotinoids, an “unprocessed” form of Vitamin A found in plant foods like carrots, leafy greens, and other colorful fruits and vegetables. The human body converts provitamin carotinoids into preformed retinoids.

Since Vitamin A is a fat-soluble nutrient, it’s often stored in your liver and other body tissues and does not pass out of your body easily. For this reason, you should avoid consuming excessive amounts of Vitamin A. Too much can lead to Vitamin A toxicity, which can cause headaches, dizziness, fatigue, blurry vision, and nausea. Severe toxicity can result in permanent eye and liver damage and even birth defects in pregnant women.

Getting the Right Amount in Your Diet
The best way to consume the right amount of Vitamin A is to eat a normal, well-balanced diet that includes lots of fruits and vegetables. The U.S. Institute of Medicine and the National Academy of Sciences have developed Vitamin A recommendations based on life stage and age. Recommended Dietary Allowance (RDA) represents the amount of Vitamin A needed to meet basic biological needs. Upper Limit (a.k.a. tolerable upper intake level) represents the highest amount of Vitamin A a healthy person can consume on a regular basis without risk to his or her health.

Sources of Vitamin A
Vitamin A comes from a variety of animal and plant foods, such as:

• Skim milk (1 cup) 150 μg


• Cheddar cheese (1 ounce) 75 μg


• Lowfat yogurt, plain (1 cup) 34 μg


• Eggs (1 large) 84 μg


• Beef liver (3 ounces) 6,450 μg


• Carrots (1 large) 433 μg


• Spinach (1 cup) 140 μg


• Mango (1 cup) 63 μg


• Tomato juice (1 cup) 56 μg


• Cantaloupe (1 cup) 264 μg

It’s fairly easy for most people to meet their daily requirements. However, some people on restrictive diets or those who suffer from medical conditions that interfere with fat absorption (like celiac disease, Crohn’s disease, or pancreatic disorders), may need to take a Vitamin A supplement.

Multivitamins often contain 60 percent or more of the Recommended Dietary Allowance. Check the label to make sure your supplement does not contain excessive amounts of Vitamin A. As we mentioned in the last issue of Alive & Well, make sure your supplement has the United States Pharmacopeia (USP) seal of approval. This means the supplement has been tested and contains the amount of vitamins and minerals shown on the label.

Handy Online Vitamin Gauge
Want to make sure you’re getting enough Vitamin A and other essential nutrients from the food you eat? Visit http://www.mypyramidtracker.gov/ and register to use the Assess Your Food Intake tool.

Vitamin A-Rich Menu
See how easy it is to get the Vitamin A your body needs. Try this sample menu:

• Breakfast: 1 cup plain oatmeal with ½ cup skim milk, 1 banana,1 cup orange juice (90 μg)


• Lunch: 1 cup vegetable soup, 1 cup romaine salad with ½ medium tomato (385 μg)


• Dinner: 1 broiled boneless skinless chicken breast, ½ cup green beans, 1 small roasted sweet potato (675 μg)
  
  Total = 1,150 μg

Sources: American Dietetics Association, the National Institutes of Health Office of Dietary Supplements, the Mayo Clinic

Vitamin A amounts calculated using the USDA Center for Nutrition Policy and Promotion Assess Your Food Intake tool.

The Red Stapler Statement

A few years ago I ordered myself the red stapler to use at work. Yes, “the” red stapler. You know the one I’m talking about.

I had just received my big promotion from a secretarial job in human resources to the professional position I’d been gunning for—a writer in the company’s marketing department. The new possibilities ahead thrilled me (when does a new job not make you feel prickly and shot full of vim?). But during my two-plus years shuffling paperwork in HR I’d picked up a friend, a cynical corporate imp, let’s call him Floyd.

Anyone who works for a large corporation for more than a few weeks makes friends with an imp. They thrive in close quarters under florescent lights. They feed on paper clips and legal pads from the supply closet. I sometimes suspect they’re addicted to toner.

Imps live to sow discontent. They whisper persuasive, subversive natterings: no one appreciates how hard you work, you deserve to park in visitor spots, that coworker saw you checking your gmail. We all become a little more paranoid. And we cling to our imps because they’re the only ones who can tell us the “truth” about what’s going on.

I think Rome fell because of the imps.

The red stapler was a statement. I placed it prominently on my desk—bright, red, and shiny. It’s my declaration of independence. My refusal to be sucked into the corporate morass unwitting. It’s a rallying cry for like-minded individuals. It says: “It’s ok, I know. You know I know. I know you know I know. And everyone knows we know it.” And as long as we “know” we are free.

Or possibly it’s just a cry for help. “I am Milton. I entered the corporate jungle in search of adventure and opportunity…but now I’m trapped, my map’s no good, and the tigers are after me.”

I’m not sure which one it is. But the weight of the stapler in my hand is comforting. It’s much nicer and more solid than the cheap Corporate Express stapler I found on my desk when I arrived.

But I worry that one day Floyd will kidnap my stapler. Its symbolism really goes against his grain. And then I’ll be reduced to wandering the building, asking each person I meet, “Pardon me, but have you seen my stapler?”

*Shudder*

How important is gender to a child?

In Salon today I read about a pair of Swedish parents who have made the decision not to tell their two-year-old whether it is a boy or a girl. I struggled with “it” just now. I felt, in using “it” that I was denying the child “its” personhood. And yet, is personhood defined by gender? Should it be? My gut ties them together in ways that are tough to explain. “It” makes me think of a chair or a bike.

In English, the definite and indefinite articles attached to these objects are gender-neutral, but in many other languages, like French, these objects have gendered articles attached to them: “la chaise,” “le velo.” And in vernacular English, we assign genders to objects constantly. But I digress.

I had a discussion with my coworker about the propriety of depriving a child of knowledge of his or her gender. Would it necessarily damage the child to go through its first few years of life as a socially genderless human being rather than as a little boy or little girl?

What does gender inform as a child grows up? Clearly, once the child encounters other children, in school or in play, the subject is bound to come up. And mutual anatomical comparisons will resolve the issue in fairly short order. But while the child is still young enough to be protected from the knowledge of its gender by its parents, how will it be affected by lack of that knowledge? Should this knowledge play into natural development of the mind, personality, and interests? If the child is given access to a wide variety of the cultural artifacts of gender, a neutral mix of clothes, toys, books, and media, will that produce an androgynous child? One who enjoys the loud clanking sounds of toy trucks and the colorful accouterments of dolls in equal measure? Will this change the way the child understand the world?

I think of some of the essays I’ve read by Ursula LeGuin about the role of gender in storytelling. Will this sort of early upbringing change the stories that the child makes up to understand its own existence and the world in which it lives? Personhood is made up of these “stories” that one tells about oneself. The whole field of psychoanalysis is based on “telling your story” and analyzing it to better understand the self. Do we deny the child an essential element of its early story? Or do we make more stories possible? Only time will tell. I would be very interested to see a follow up on the Salon article in a year or two.

Got Water?

Keep in mind as you enjoy the hot summer months that higher temperatures combined with outdoor activity can lead to dehydration. Knowing how to prevent dehydration and treat it in its early stages is the key to avoiding serious health consequences.

What is Dehydration?
Dehydration occurs when your body loses too much water. Your body reacts to fluid loss by redirecting blood flow to your two most important organs: your brain and heart. That means there’s less blood flow to other parts of your body and, after a while, you may start to feel the effects. The symptoms of mild or moderate dehydration often include:

• Thirst


• Dry, sticky mouth


• Sleepiness


• Decreased urine output


• Headache


• Few or no tears when crying


• Muscle weakness


• Dizziness or lightheadedness


• Decreased sweating


• Irritability

More severe dehydration can lead to serious symptoms such as anxiety and agitation, parched skin, or rapid heartbeat, and requires emergency treatment.

Who’s Most at Risk?
Any one can become dehydrated, but certain people are at greater risk. Infants and children can more easily become dehydrated due to their high metabolic rate and low body mass. Older adults are often more susceptible since their bodies are less able to conserve water and they tend to lose “thirst sense” as they age. People with chronic illnesses (such as diabetes) may become dehydrated due to disease symptoms, medications, or lack of appetite. In addition, endurance athletes and people living or working at high altitudes are at greater risk.

Medication Complications
Planning to take a cruise, go on a camping trip, or simply spend a lot more time outside than usual? If you take certain medications that can cause dehydration (or make it worse), you may need to adjust your dosage or alter your hydration strategy. Medications that can cause dehydration include:

• Antihistamines (e.g., Benadryl)


• Chemotherapy drugs (e.g., Cytoxan)


• Diuretics (e.g., Lasix)


• Laxatives (e.g., Correctol)


• Heart and blood pressure medicines (e.g., Digoxin)


• Psychiatric drugs (e.g., Seroquel)

Even over-the-counter drugs like Aspirin and Ibuprofen can affect your body fluid balance. If you take one of these types of drugs, contact your doctor before your next big outdoor excursion. He or she can tell you what you need to do to prevent dehydration.

Hydration Strategy

Everyday Prevention: Follow these tips to stay healthy and hydrated.

For everyone:

• Drink water every 15-20 minutes during exercise, and after.


• Avoid caffeine (it can accelerate dehydration).


• Eat fruits and vegetables, and consider taking a multivitamin to replace
  depleted vitamins and minerals .


• Wear light-weight, light-colored clothing outdoors.

For adults:

• Drink 8 to 10 cups of water each day.


• Pack a sports drink containing electrolytes (like salt and calcium) if you’ll
  be exercising longer than 60 minutes.


• Avoid alcohol (it can accelerate dehydration).


• On a high-protein diet? Drink more water.
  

For kids:

• Drink 4 to 10 cups of water each day (depending on age).


• Choose water or a kid’s oral rehydration solution (ORS) like Pedialyte.


• Avoid sports drinks, soda, and juice (these contain a lot of sugar, which can aggravate dehydration).


• For babies under 1 year, breast or bottle-feed often.

At-Home Dehydration Treatment
If you catch it early, you can often treat mild or moderate dehydration at home. If you notice symptoms of dehydration:

For everyone:

• Stop your activity and rest. Get out of sunlight and lie down in a cool spot indoors or in the shade.


• Prop up your feet.


• Remove excess clothing.

For adults and kids 12+:

• Drink water, juice, or a sports drink. Consume 8 cups of cool liquid over the next 2 to 4 hours.


• Rest and continue to drink lots of fluids for the next 24 hours.
  

For kids 1-11:

• Drink a kid’s ORS, half-strength orange juice, or plain water (if also eating food).
  

For babies under 1 year:

• Feed them an ORS via bottle, spoon, or dropper if dehydration develops.

The Good, the Bad, and the VLDL: Decoding Cholesterol

Too much cholesterol in your body and diet can put you at risk for heart disease and other health problems. However, as you’ve probably heard, there are different kinds of cholesterol, and not all of them are bad for you. It may seem complicated, but learning just a few key facts about cholesterol can help you control your risk.

What is Cholesterol?
Cholesterol is a waxy, fatty substance produced naturally in your liver and typically contained in foods derived from animal products (like meat and dairy). In healthy amounts, cholesterol performs vital body functions: it’s used to build cells and to make vitamin D, bile acids, and hormones. The problem is, you can easily have too much. When cholesterol levels are too high, it builds up on the walls of blood vessels to form plaque. These deposits can make it difficult for blood to flow, which deprives your body of oxygen and puts you at risk for heart disease.

How Can I Tell If I Have High Cholesterol?
There are no direct symptoms of high cholesterol; however, physicians can detect it using a special blood test called a lipid panel. Starting at age 20, you should have your cholesterol
tested at least once every five years; more often, if your physician recommends it. In general, you’re more likely to have high cholesterol if you can say “yes” to any of the following risk factors.

• I’m a smoker.
• I’m overweight.
• I don’t eat healthfully.
• I don’t exercise regularly.
• I have high blood pressure.
• I’m diabetic.
• I have a family history of heart disease.

The Cholesterol Code
Cholesterol travels through the blood attached to a protein. This combination of cholesterol (a lipid) and protein is called a lipoprotein. Lipoproteins are either high-density or lowdensity, based on how much protein and fat they contain.

• Low-density lipoproteins (LDL) are “bad” cholesterol. LDL contains mostly fat with only a small amount of protein. It can build up as plaque inside your arteries (atherosclerosis), which can lead to heart disease. If you have high cholesterol, your doctor will want you to lower your LDL.
• High-density lipoproteins (HDL) are “good” cholesterol. HDL contains more protein than fat. It functions as a “sweeper,” clearing out excess cholesterol in your blood and carrying it back to your liver. A high level of HDL can help prevent heart disease.
• Triglycerides are a common type of fat found in your blood. It’s used to store energy, but if levels are too high, and you also have high LDL, they can increase your risk for developing coronary heart disease (CHD).
• Very-lowdensity lipoproteins (VLDL), a precursor to LDL, are the type of lipoprotein containing the most triglycerides. If you’re taking an LDL-lowering medication, you may also need to take a separate medication for VLDL.

How’s My Cholesterol?
The American Heart Association has come up with optimal levels for total cholesterol and for each type of cholesterol. Compare your most recent test to their numbers to find out how you're doing.

Watch Out for Hidden Gluten

Some gluten foods are obvious (like bread and cereal). Others are harder to spot. Some foods that may contain hidden gluten include:

• Beer and other malt beverages (made from barley)


• Broth


• Imitation bacon and crab


• Luncheon meats


• Non-dairy creamer powder


• Salad dressings and marinades


• Soup


• Soy sauce (fermented with wheat)
  

Wheat-Free Doesn’t Always Mean Gluten-Free
Federal law requires all food labels to indicate if the food contains wheat. However, people with celiac disease also need to avoid barley, oats, and rye; the only way you can avoid those is by reading labels.


Basic Gluten-Free Flour Mix
Rice flour forms the basis for most gluten-free baking. A mixture often used as a direct substitute for wheat flour includes:

• 2 parts white rice flour


• 2/3 part potato starch


• 1/3 part tapioca starch

Plus, 1 tsp. xanthan gum per cup of flour mix.

Sources: Healthwise Knowledgebase, Mayo Clinic, Nemours Foundation, Orlando Sentinel

Hard to Digest: Understanding Celiac Disease

Pizza, sub sandwiches, and French fries. Gravy, stuffing, and pumpkin pie. All of these foods contain gluten, a protein found in wheat, barley, oats, and rye. These days, eating gluten-free is fast becoming a health craze, but for people with celiac disease, a digestive condition triggered by gluten, eating gluten-free is more than a diet fad, it’s a way of life.

What is celiac disease?
When a person with celiac disease eats foods containing gluten, it causes an immune system reaction that damages the surface of the small intestine and makes it unable to absorb nutrients
from food. Eventually, this can lead to malnutrition, anemia (due to lack of iron), and osteoporosis (due to lack of calcium).Research suggests that 1 in 133 people may have celiac disease, but the odds are 1 in 22 if you have a parent, sibling, or child with the condition. Certain environmental factors (such as viral or bacterial infections) or stressful life events have also been known to trigger celiac disease.

How can I tell if I have it?
People with undiagnosed celiac disease often experience intermittent diarrhea, abdominal pain, bloating, and weight loss. However, sometimes there are no gastrointestinal symptoms at all. You may simply feel tired, weak, or depressed; you may develop an itchy rash, joint pain, or tingling in the legs and feet. Celiac disease can often be mistaken for other health conditions such as irritable bowel syndrome (IBS) or Crohn’s disease. Only a doctor can tell you for sure if you have celiac disease:

• It starts with analyzing your medical history and your family medical history, plus a physical exam.
• If your doctor thinks you might have celiac disease, he or she will order a blood test to look for high levels of gluten anti-bodies.
• To confirm the diagnosis, your doctor will perform a biopsy of your small intestine.

How is celiac disease treated?
Celiac disease is a lifelong digestive disorder that can’t be cured, but can be managed by following a strict gluten-free diet. Once you remove gluten from your diet, you’ll start to feel better within a few days to several weeks. You may want to talk to a dietitian to help you get started with a gluten-free regimen.

Gluten-free for life.

Staying healthy means avoiding all foods and food ingredients made from wheat, barley, oats, and rye. But that doesn’t mean you have to give up all of your favorite foods. You can make gluten-free variations of almost any recipe. And, thanks to the recent gluten-free health fad, more restaurants than ever before now offer gluten-free dishes on their menus. People with celiac disease who don’t follow a gluten-free diet are more likely to develop gastrointestinal cancers and even neurological disorders.

Find alternatives. Look for foods and ingredients made with other types of flours and starches including: almond, arrowroot, bean flour, buckwheat, coconut, corn, potato,
quinoa, rice, sorghum, soy, tapioca, and teff. Read labels religiously and stock up on foods that are naturally gluten-free like plain meat and dairy, eggs, nuts, fruits, and vegetables.

Nix cross-contamination. Even tiny crumbs of gluten can affect you if you have celiac disease. Before you use any surface, plate, or utensil that might have come into contact with gluten, clean it thoroughly. Keep separate bottles of condiments and other foods for your use; even a separate toaster. When preparing food containing gluten for other people, make sure to wash your hands often.

Use restaurant cards. When you eat out, the easiest way to let your server know about your dietary needs is to give them a special card listing foods to avoid and instructions for preparing a safe meal. Celiac Travel (http://www.celiactravel.com/) offers restaurant cards you can download in 42 languages.

Strategize for the holidays. Your family and co-workers may have all the best intentions, but sometimes it’s easy to forget which foods and ingredients are on your “safe” list. Don’t hesitate to ask what’s in each dish. To make sure there’s always something you can eat on the table, bring a gluten-free offering of your own to pass.