What’s up with Vitamin D?!

Vitamin D has been getting a lot of hype lately.  It’s been in the news, docs are talking about it, and we at Student Health Services even offer an OIY (Order it Yourself) Vitamin D test.  Vitamin D is something that is made by our bodies from the sun, so why is there all this talk about vitamin D deficiencies?

It turns out that living in Ohio is not very conducive for vitamin D production, at least not in the colder months.  The amount of vitamin D you can get from exposing your bare skin to the sun depends upon 4 factors:

  • Time of day
  • Where you live
  • Color of your skin
  • Amount of exposed skin

Time of Day:  Think of the whole sun rising in the east and setting in the west thing.  When the sun is rising and setting it’s coming at us from an angle and it turns out that is not a good thing as far as vitamin D goes.  When the sun is angled the atmosphere blocks the UVB part of the rays which are what produces vitamin D.  The closer to midday the better the angle and the more vitamin D.

Where you live:  The closer to the equator the easier is it to produce vitamin D.  Again back to the angle thing – the further from the equator the greater the angle and the less UVB exposure.

So, consider Ohio in the winter.  Yeah.  Far from the equator and the sun is almost always angled which means rarely is there an opportunity for UVB exposure.

Color of your skin:  Melanin in our skin protects us from skin damage from too much UVB exposure.  As a result darker skin with more melanin allows less UVB to enter the skin, meaning less vitamin D is produced.  The darker the skin, the more time that must be spent in the sun to product vitamin D.

Amount of exposed skin:  It’s going to take a lot longer to made vitamin D if just your face and arms are exposed than if your back is exposed.

OK, so putting this all together, and assuming that 25% of your skin is exposed and its summer in Ohio, an individual with pale skin that tans fairly easily would need approximately 1 hour of exposure to the sun during midday to produce 1,000 IU.  An individual with dark skin would need approximately 2 hours of exposure to produce the same amount.  During the winter, it’s not possible to make vitamin D, regardless of skin type.

Oh and if you’re thinking that you can hang out in a nice air conditioned sun room and get your vitamin D through the glass – forget it!  Glass blocks all UVB.

So, how much vitamin D do you need?  The institute of Medicine recommends that adults ages 19-70 get 600 IU daily.  Not a problem if you spend time outside during the summer, but what to do in the winter?  Vitamin D can be obtained from foods, but it’s nearly impossible to get enough.  Foods that contain vitamin D are:

  • Fatty fish
  • Beef liver
  • Egg yolks
  • Fortified milk and orange juice
  • Fortified cereals

The only other option is supplements.  If you choose to take a supplement make sure that it is D3, not D2.  D3 is what would be produced by your body when exposed to sunlight.  The amount to take varies depending on where you look, but a good rule of thumb is 600 IU daily. 

If you have concerns about your vitamin D or believe that you might be deficient, come see us at Student Health or schedule an appointment with your primary care provider.  They can test your vitamin D levels and direct you as to your best course of action.

For more information on Vitamin D, check out the Vitamin D Council website.

Submitted by Tina Comston, M.Ed.

Reviewed by Mary Lynn Kiacz, M.D.

To supplement or not to supplement – Creatine


I grew up in the “No pain, no gain” era, meaning that if you wanted to become stronger, faster, whatever you had to work at it.  You had to do the reps, run the sprints, you had to sweat.  Now, however, it seems that more and more people want to skip the “pain”/sweat part of the equation and go right to the “gain” through supplementation.  One option people are considering for this short cut is creatine.

Creatine is something we already have.   It is a compound produced by the kidneys, pancreas, and liver and it plays a role in releasing energy when the body moves quickly or powerfully.  So, when you are sprinting or lifting weights creatine is involved.  It gives us the energy to do the lifting and sprinting and, like everything else, as we progress through our workout our creatine levels become depleted and our ability to keep pumping that iron or running those sprints diminishes.  In other words, we run out of energy.

The whole point of creatine supplementation is to allow the body to produce more energy and with more energy you will be able to complete another set of reps or run a few more sprints and with these additions you will become stronger and/or faster.  So, it’s not really a shortcut, it just gives you the energy to be able to put in some extra work and through that extra work you will see additional results.

Now, just because creatine is naturally produced by our bodies does not mean that taking it in supplement form is good for us.  As with any supplement you should talk with your doctor before taking it.  You should also be aware of potential side effects, such as:

  • Stomach pain
  • Nausea
  • Muscle cramping
  • Diarrhea

Patients with kidney disease should completely avoid using creatine, and caution is advised for diabetics and people taking blood sugar supplements.

If you chose to take creatine supplements, you should expect to gain weight.  Initially this will be due to retention of water, approximately 2 to 4 pounds in the first week, but after that it will be due to an increase in muscle as a result of being able to exercise longer and harder.

Submitted by Tina Comston, M.Ed.

Reviewed by Kendra McCamey, MD

An Apple a Day – Fact or Fiction

Last year I participated in a study here on campus regarding apples.  I had always wondered about the ‘Apple a day keeps the doctor away’ saying and I liked apples, so I thought, why not.  When I signed up for the study I was told that participants would be divided into four groups.  Group 1 would take a placebo each day; Group 2 would take a capsule each day containing polyphenols, a type of antioxidant found in apples; Group 3 would eat an apple each day; and Group 4 would not only eat an apple a day, but also apple sauce and drink a glass of apple juice.  Lucky me – I ended up in Group 4.  Let me just say, that was a lot of apple.

The study was held over a 4 week period.  Prior to starting the study a blood sample was taken and I was asked to spit in a cup.  After the 4 weeks another blood sample was taken and again I spit in a cup.  I wondered about the whole spitting in a cup thing, but having read the results of the study it now makes sense.

And the results, they were fairly significant.  Those individuals who consumed an apple a day for 4 weeks lowered by 40% the blood levels of oxidized LDL – “bad” cholesterol.  This is what contributes to the hardening of arteries.  As far as spitting in the cup, they also found that eating apples has some effect on the antioxidants in saliva which has implications for dental health.

It appears that ‘An Apple a Day’ could indeed keep the cardiologist away.  As for an apple, apple sauce, and apple juice – that was a bit much. 

To read more about this study:

Submitted by Tina Comston, M.Ed.

Have you found your “bliss point”? It’s not what you might think.



Obesity is all around us, and surveys reveal that more and more of us are endangering our future health through poor diet and lack of exercise.  It is our responsibility to control our appetites and activity.  Right?  Well, new information suggests that other forces are also at work. 

In the February 20 New York Times magazine, Michael Moss wrote about his research involving junk food, as part of an soon-to-be published book, “Salt Sugar Fat: How the Food Giants Hooked Us”.  Mr. Moss has uncovered some fascinating tactics used by food manufacturers to keep us hitting the snack aisle. 

  • Bliss point – optimizing each component in a product that the consumer likes to create the highest level of craving,  keeping the food good enough to want to eat, but not so good that you tire of the food.
  • Stomach share – how much each brand can dominate the market versus their competitors.
  • Sensory-specific satiety – design foods that taste good, but avoid any single distinct flavor that would tell you to stop eating.
  • Mouth feel – the positive interaction of food with the mouth in terms of moisture and texture (think chips).
  • Sweet range – the range of acceptable taste that may allow manufacturer to adjust costly ingredients to the lowest acceptable level in order to reduce cost
  • Vanishing caloric density  – ability of food to dissolve or shrink while eating, giving you the impression that you are eating less (Cheetos?)

Each of these factors is considered in the design and marketing of snack foods.  In this way, convenience foods like Lunchables end up including nearly a full day’s maximum amounts of fat, sodium and sugar.  Yogurt, which used to be considered a health food, has become a dessert given the amount of added sugar in each serving. 

For information about healthy eating, visit Student Health Services.  Our providers can advise you and refer you to nutrition services for further assistance. 

Roger Miller, MD  (OSU Student Health)

Why You Eat More Than You Think

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Is this your day?  Overslept for 9 AM class; jumped out of bed, threw on some clothes, brushed teeth and ran out the door to class.  Sat in class until 10:18 and ran to next class at 10:30.  Had a break from 1:00 until 1:30.  Grabbed lunch to go at Market Place.  Wanted to get the salad but had to take it to class so picked the Tuna melt, bag of chips and a diet pop (tuna is healthy, right!).  Ate lunch in class, which ended at 2:30.  Ran home to change- had to be at work at Buffalo Wild Wings by 5PM.  Worked from 5 until 11:00PM. At work, scarfed down some wings and fries and sipped on diet coke throughout the night.  Got home at 11:30, exhausted and starving and too hyped up to go to bed.  Relaxed on the couch with laptop (Facebook, emails). Scoured the refrigerator and found a yogurt.  Ate that first since it’s healthy and you’re trying to lose some of the 20 pounds you have gained in the past year.  Spied the leftover pasta from Noodles and Co. and finished it off while watching the episode of Lost you had taped but it’s OK since you haven’t eaten much all day. Went to bed at 2AM.

This type of routine is not an untypical schedule for many OSU students.  We have become the “Masters of Multi-tasking”, because there is always too much to do.  Unfortunately, this does not always serve us well when it comes to our relationship with food.  Often we are not “in the moment” with our food (or with many other things as well).  This lack of mindfulness prevents us from being aware of our body’s natural signals for hunger and fullness.  It is important to realize that we all came into world normal, intuitive eaters.  Babies are experts at eating; they cry when they’re hungry and they stop eating when they’re full.  They eat exactly what they need to grow and be healthy.  They do not count carbs, protein, fat or calories.  They just eat!

Our body’s natural systems would continue to manage our eating and meet our body’s needs if modern society did not mess with them.  Arbitrary schedules are set up that interfere with intuitive eating and we are constantly bombarded with external versus internal food cues. No wonder we “mess up.”

So what is “Mindful Eating” and how can you re-learn this healthy approach to eating?  Mindfulness is deliberately paying attention to how, what, where and when you eat in a non-judgmental way.  It is using all of your senses – seeing, hearing, tasting and feeling – when you eat.  I call it “yoga with food” – it requires eating without distractions (no TV, Computer, work, studying) in a calm environment, and it requires practice. 

Here are some guidelines to help you implement mindful eating in your life and some web sites with good information that will start you on the path to more natural, intuitive eating.

  • Make eating consistently a priority and give yourself permission to eat. Eat breakfast within 30 minutes of waking and pay attention to hunger cues-usually about every four hours.
  • Keep a food intake diary for a week noting what, where, and when you eat and how you feel when eating.
  • Eat sitting down without distractions, preferably in a calm environment.
  • Turn off the television, computer, or other distracting electronic devices. Music is fine.
  • Eat at a table if possible-not on the couch, easy chair, car or bed.
  • Try not to work or study while eating
  • Slow down! Practice putting down your fork or sandwich between bites. Time a typical meal and add 5 minutes the next time you eat. Enjoy the texture and flavor of the food. Pay attention to your body’s signal of fullness or satiety.
  • Eat when you feel comfortably hungry (not starved) and stop when you are comfortably full (not stuffed).
  • Be aware of emotional triggers for eating-a “craving” is often the result of emotional need.

Remember, food is not the enemy!  There is no such thing as perfect eating, but eating mindfully will make it more pleasurable and satisfying.

If you would like to discuss mindful eating, or any other nutritional questions you may have, call to make an appointment with the Student Health Center’s Registered Dieticians.

John A. Vaughn, MD
Student Health Services
The Ohio State University

Center For Mindful Eating

“Mindless Eating”

“Eating mindfully”

My doctor said that my vitamin D level is low. Is that really bad?


It’s well established that Vitamin D is important in the regulation of the body’s calcium levels and bone development.  If people don’t get enough, they are at risk of diseases like rickets and osteoporosis.  But researchers have more recently discovered that vitamin D receptors are found on almost all tissues of the body.  This has caused a “boom” in vitamin D research; scientists are investigating its role in everything from heart disease and diabetes to depression, cancer and the common cold. 

You get Vitamin D in two ways: by consuming it in foods or supplements, and by making it in your skin when sunlight hits it.  Vitamin D doesn’t occur naturally in a lot of foods – unless you’re a really big fan of cod liver oil or mackerel, you wouldn’t get nearly enough – so many foods are fortified with it.  Almost all of the milk sold in the U.S. is fortified with Vitamin D, as are many cereals, juices and yogurts. 

This time of year in Columbus ain’t exactly the most Vitamin D friendly environment – the sun seems to head south for the winter – so it’s not unusual for people around here to have a low Vitamin D level.  But what does that really mean?  How low is too low?  And does having a low Vitamin D level increase your risk for depression, high blood pressure, the flu?  We don’t know for sure.  There’s even a lot of debate going on right now about whether or not the current cut off for a “normal” Vitamin D level is too high and that a lot of people are being told they have a deficiency when they really don’t. 

That being said, people build up the majority of their bone density during their twenties so it wouldn’t hurt to take a daily adult multi-vitamin containing around 600 IU of Vitamin D to help prevent osteoporosis later in life.  It’s also a good idea to get some regular sunlight exposure whenever you can; even if it’s cold, it’ll turn on your skin’s Vitamin D factory.  But don’t overdo it – taking too much (over 4000 IU) can cause damage to the heart, blood vessels and kidneys.  And excessive uv radiation exposure can damage your skin and put you at risk for really bad things.   

The National Institutes of Health has a great site about Vitamin D supplements, and the Mayo Clinic also provides a lot of good information.  And of course, you can always make an appointment to see us if you’re worried about your Vitamin D level.   

John A. Vaughn, MD
Student Health Services
The Ohio State University

Everything you need to know about fish oil supplements


Ever since researchers discovered that Greenland Eskimos had really low rates of heart disease because of all of the fish they ate, fish oil has been a hot topic.  And once supplement manufacturers realized they could bottle and sell it, fish oil really took off. 

So let’s dish about fish – here’s everything you need to know about fish oil supplements.      

What conditions does fish oil really help?

It’s been proven that the Omega-3 fatty acids in fish oil – eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and alpha-linolenic acid – prevent heart disease, improve cholesterol by reducing triglyceride levels, and prevent heart attacks, stroke, and death in people who already have heart disease. 

While Dr. Google will tell you that fish oil will cure rheumatoid arthritis, high blood pressure, depression, bipolar disorder, menstrual pain, and certain kidney problems, there isn’t a lot of good evidence to back that up at this point.

Is taking a fish oil supplement the same as eating fish?

Obviously, the best way to consume fish oil is to eat oily fish.  The American Heart Association (AHA) recommends at least two servings per week for cardiovascular health.  A serving is 3 ounces (the size of a deck of cards, or ¾ of a cup).  So if you can afford, prepare and stomach salmon a couple times per week, you can skip the fish oil capsules.

How much fish oil supplement should you take?

A good target intake is between 250 and 500 mg per day of EPA + DHA.  You could get that in a daily 1 gram fish oil supplement, which contains between 200 and 800 mg of EPA + DHA, depending on the formulation and manufacturer.   

Do fish oil capsules have side effects?

The most common side effects are nausea, heartburn, a fishy aftertaste, and burping.  Taking them with food or refrigerating them helps a lot, but some brands can’t be refrigerated so be sure to check with your pharmacist.  In general, fish oil capsules have an “expiration date” of about 90 days after opening a new bottle.  Capsules with a very strong or spoiled smell should be thrown away.

Can you get mercury poisoning from taking fish oil supplements?

There’s been a lot of concern lately about mercury contamination in the world’s fish supply.  In general, this is more of a concern for pregnant women and young children, but it’s always a good idea to pay attention to what you’re eating.  Fish known to be low in mercury include shrimp, canned light tuna (not albacore), salmon, pollock, and catfish. 

Fish oil capsules are generally low in mercury and other pollutants.  But to be safe, only buy products with the “USP Verified Mark” on the label; these have been tested and found to contain acceptable levels of mercury.    

Jason Goodman, PharmD, RPh
Student Health Services
The Ohio State University

How much are you willing to pay per pound to lose weight?


The Food and Drug Administration (FDA) recently approved two new medications for weight loss.

Qsymia, is actually a combination of two older drugs – topiramate (Topamax), an anticonvulsant that helps increase satisfaction after eating, and phentermine, a psychostimulant and appetite suppressant. Using Qsymia combined with diet and exercise for a year led to an average weight loss of 8.4% of total body weight, or about 20 pounds.   

Qsymia is a controlled medication because it has a potential for addiction. Like other psychostimulants (think Adderall and Ritalin), it can cause a fast heart rate and a tingling sensation in the limbs. Other side effects include memory impairment and decreased concentration. Topiramate can cause birth defects as well.   

Belviq, is an entirely new class of medication called a serotonin 2C agonist.  It helps patients feel full sooner and eat less. Belviq was even less effective than Qsymia in helping with weight loss; it led to an average annual decrease of just 5% of total body weight, or about 7 pounds. The side effects from Belviq are minimal, but because older serotonin agents were associated with heart problems, everyone is keeping a close eye on it. 

Information about cost is hard to pin down exactly, but the best guesstimates are that Qysimia will cost about $6 a day and Belviq $8 a day.   

This made me wonder if we should approach these medicines as if they were in a refrigerator case at the grocery store and ask ourselves, “What am I paying per pound?”

When you look at it this way, these two new wonder drugs don’t look so great. Qsymia will run you about $109/pound of weight lost while Belviq will cost you about $417/pound.

To give you an idea of how that compares to other methods that have been around for a while:

  • Weight Watchers = $ 97/pound
  • Nutrisystem = $130/pound
  • Jenny Craig = $131-237.56/pound
  • Weight loss surgery = $235 – 400/pound
  • Diet and exercise = $0/pound!

As you can see, none of them are cheap, and the only one that doesn’t cost you any money costs you a little more in time and effort.  Unfortunately, it’s the only one that really works.  In fact, it’s the main ingredient in those super expensive drugs we’re talking about.  Read that description again – “using Qsymia combined with diet and exercise led to weight loss…”  The problem with diet pills is that not only do you gain the weight back as soon as you stop taking them, but without diet and exercise, they barely make a dent in your waistline.

Because of all of this – the cost, the side effects, the potential for addiction and the lack of any proven long-term benefit – we don’t even prescribe these medicines at the Student Health Center. We’d rather work with you one on one and help you take advantage of the resources available to you here at Ohio State.    

At Student Health Services, we can offer a “well person” exam with any indicated laboratory tests and refer you to one of our registered dieticians. Dining services offers some great online resources to help you keep tabs on your nutritional intake and Rec Sports has many facilities and programs to help you participate in any kind of exercise that you are interested in. 

We want you to succeed at getting to and maintaining your optimal healthy weight. As soon as it is as easy as taking a pill, we’ll let you know.  In the mean time, we’re here to help you do it the right way.

Jo Hanna Friend D’Epiro, PA-C, MPH
Student Health Services
The Ohio State University

How Healthy are Healthy Foods?

photo: ehow.com

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A recent WebMD report cited 23 “Food Frauds” that are suggested by advertising as being healthy food choices, but really contain lots of hidden bad stuff:

  • extra calories
  • fats
  • sugar
  • salt

or, they are just misleading:

  • 2% milk does not mean 2% of the fat in whole milk, but actually about 50%
  • “Zero trans-fat” may not truly mean there is no trans-fat in the food

Here are some of their list of frauds – are any of these on your menu for today?

  1. Fresh Smoothies
  2. Energy Bars
  3. Chicken Burrito
  4. Sugar-free Drinks
  5. 2% Milk
  6. Turkey Hot Dogs
  7. Low-fat Granola
  8. Added Omega 3
  9. Iced Tea
  10. Trans-fat Free Foods

Want to learn more about your diet and healthy food choices?  Both Student Health Services and the OSU Student Wellness Center have nutritionists on staff to assist you. 

Healthy Eating!

Roger Miller, MD (OSU Student Health Services)

Source: WedMD (Copyright ©2009, WebMD, LLC. All rights reserved)

Save a Million Hearts!

Million Hearts - Sodium?

Think you will have a heart attack or stroke in the next five years?  Well, of course, at 50, my chances are a lot greater than yours.  But even young adults can be at risk.  Is your cholesterol elevated?  How about your blood pressure? Do you smoke? 

Visit this link to try out a risk calculator for yourself

Ok, maybe you are reading this in the RPAC, after your intense daily workout, your pleasing weigh-in, and your fruit-n-bran smoothie.  If you are already doing the things you should, maybe you can spread the word to the people you care about.  (Think – Mom, Dad, Grandpa, Aunt, Neighbor, Friend):

Launched by the U.S. Department of Health and Human Services with several key partners, Million Hearts aims to prevent 1 million heart attacks and strokes over the next five years.

The first goal is to empower Americans to make healthy choices such as preventing tobacco use and reducing sodium and “trans” fat consumption. This can reduce the number of people who need medical treatment such as blood pressure or cholesterol medications to prevent heart attacks and strokes.

The second goal is improving care for people who do need treatment by encouraging a targeted focus on the “ABCS

  • Aspirin for people at risk,
  • Blood pressure control,
  • Cholesterol management and
  • Smoking cessation

These four items address the major risk factors for cardiovascular disease and can help to prevent heart attacks and strokes.  

If you want to learn more about your health and your heart attack and stroke risk, stop in at the Student Wellness Center, or come see us at Student Health.  We have the expertise and are here on campus for you. 

Students First!

Roger Miller, MD  (OSU Student Health Services)