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New Recommendations For Vitamin D

Vitamin D has been talked about as the vitamin — the one that might help fend off everything from cancer to heart disease to autoimmune disorders, if only we were to get enough of it.

“Whoa!” is the message from a committee of experts assembled by the Institute of Medicine (IOM) to update recommendations for vitamin D (and for calcium).

The IOM committee’s report, released this morning, says evidence for many of  the health claims for vitamin D is “inconsistent and/or conflicting or did not demonstrate causality.” The exception is the vitamin’s well-documented (and noncontroversial) benefits on bone growth and maintenance.

The IOM panel’s report also says most North Americans (Canadians as well as Americans) have more than enough vitamin D in their blood to achieve the desired effect on bone. The committee said a blood level of 20 nanograms per milliliter (ng/mL) is sufficient for most people.

The panel set 600 International Units (IU) as the recommended daily intake for children and for adults ages 19 to 70. People ages 71 and older are supposed to get an additional 200 IU, or 800 IU a day.

That’s a fairly sizable increase over the previous recommendations of 200 IU per day through age 50, 400 IU for people ages 51 to 70, and 600 IU for people ages 71 and older. Read more »

*This blog post was originally published at Harvard Health Blog*

Dental Fillings And Birth Defects: What Moms-To-Be Should Know

Although the first trimester of pregnancy is sacred, there will be patients who will encounter problems at that time. During the first trimester, the brain and the central nervous system develops from 6 to 10 weeks, a time period commonly known as organogenesis. To minimize the risk of developing birth defects, medications and invasive procedures are usually postponed until the arrival of the second trimester.

A recent article in the October 2010 issue of Ob.Gyn. News reported some disturbing findings: Dental fillings in the first trimester were linked to the development of a cleft palate. A cleft palate is a birth defect that has a slit in the roof of the mouth because it failed to close during the first trimester.

The article by Susan London described a study in Norway where pregnant women had dental filings in the first trimester and their babies subsequently developed cleft palates. Ideally, dental problems should be addressed prior to becoming pregnant, however that is not always an option. Dental problems can occur during pregnancy because of the increased calcium requirements of the fetus as well as hormonal changes of the pregnancy. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Hormonal Contraception And An Under-Appreciated Effect

Ask any third-year medical student how hormonal contraception prevents pregnancy, and they’ll probably tell you it prevents ovulation. What they won’t tell you is that this effect is variable and dose-dependent, and if we depended on it alone, hormonal contraception would be much less effective.

That’s because of the very important, and in my opinion, much under-appreciated effect of hormonal contraception on cervical mucus.

A Cervical Mucus Primer

Fertile cervical mucus — which forms under the influence of rising estrogen levels in the first half of the menstrual cycle and is maximal around ovulation –- is thin, watery, clear and easy for sperm to traverse.

Non-fertile mucus — which forms after ovulation and also in pregnancy under the influence of progesterone –- is the exact opposite: Thick,tacky, non-distensible and impossible for sperm to penetrate. (It’s not called the mucus plug for nothing.) Read more »

*This blog post was originally published at tbtam*

Pregnancy After 45: A High-Risk Dilemma

As more older women attempt to beat the biological clock and conceive, they are at greater risk for developing birth-related complications. For women over 45, there is less than a 1 percent chance of getting pregnant using their own eggs. Successful pregnancy for women over 45 is nearly always the result of in-vitro fertilization (IVF) and the use of an egg donor.

Researchers at Tel Aviv University reviewed birth records from 2000 to 2008, specifically looking at the records of 177 women who gave birth at the age of 45 and beyond. The majority of the women had IVF and received donor eggs, and 80 percent of the babies were delivered via cesarean section (C-section).

Despite their celebrity, Kelly Presley (age 47), Celine Dion (age 42), and Mariah Carey (age 40), are older pregnant women who are at risk. The premature birth of Celine Dion’s twin sons did not surprise me at all. Women over 35, and especially those over 45 with underlying medical problems, should be treated prior to becoming pregnant. I cannot emphasize this enough. Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Doctors, Voicing Concerns, And Fear Of Retaliation

Shouldn’t it be possible to voice a concern about a medical treatment, procedure, or claim without the fear of retaliation? If the claims are backed by science, then simply addressing my concerns would be enough.

Fear of retaliation silences discussion. Fear of retaliation makes it difficult to do the “right thing” when the public or an individual patient is at risk.

This incidence involves a British plastic surgeon threatened with libel action by the ‘Boob Job’ cream’s manufacturer after she voiced concerns/doubts of its effectiveness. Sense About Science has a great summary of the entire affair: “Plastic surgeon threatened for comment on ‘Boob Job’ cream.” Read more »

*This blog post was originally published at Suture for a Living*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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