Supplement Detective

By Curtis Alexander, Pharm.D.
America’s Natural Pharmacist

Summary: Vitamin D side effects are rare and often cases are sensationalized by the media.  The risk of vitamin D deficiency side effects is a greater threat.  However, like any supplement, the side effects of vitamin D are real and can happen.

Dear Curtis: I’ve read recently that D Vitamin side effects are becoming more and more common.  I’m a little worried as I supplement with an over-the-counter preparation of vitamin D (400 International Units).  Do you think I should be concerned and should I change anything?

My Answer: I think the claims of vitamin D side effects have been overblown and sensationalized.  Can you get toxic from too much vitamin D?  Of course.  You can get toxic with too much water if you try hard enough.  But, vitamin D toxicity takes a long time to happen and is frankly difficult to do.  But, it can happen.  Here are some risk factors and a little background to help you decide.

Do You Need a Vitamin D Supplement?

Before I get started let’s establish two things:

1. Vitamin D is really important for a number of functions in your body (including maintaining calcium balance which can help control osteoporosis risk, improving your immune system, help protect against uncontrolled cell proliferation, blood pressure regulation, improving muscle strength, playing a role in diabetes and in preventing cancer).
2. From my personal experience and opinion, most Americans have a higher risk of vitamin D deficiency that vitamin D toxicity due to decreased exposure to the suns UV rays which are required for natural vitamin D production.

But, that doesn’t mean everyone should start supplementing with vitamin D.  Where do you live?

For me, vitamin D supplementation is a near requirement as I live in Montana.  Generally, from November to March or April the only sun exposure I get is behind a pane of glass.  Which, in case your wondering, is not effective for synthesizing vitamin D.

Also, what is your skin color?  I’m a fair skinned person with Scandinavian and Northern European ancestry.  I’m not going to be the posterboy for sun tan lotion anytime soon.  So, I don’t need as much sun exposure to get my share of natural vitamin D.  During the summer I personally aim for 15 minutes a day of full body (I am wearing shorts of course, I don’t want the neighbors staring) exposure.

For dark skinned people they’ll need more.  Probably like 30 minutes.  Higher exposure is also needed the older you get as your ability to synthesize vitamin D from the sun decreases.

You should know that adequate sun exposure during the summer allows excess vitamin D to be stored in your fat reserves.  But, for obese people they have a harder time accessing those stores do to their high body fat composition.  Also, there has never been any evidence to suggest that you can get vitamin D toxicity from too much sun exposure.

So, if you can’t get good skin exposure to the sun at least two to three times a week as I’ve described above, supplementation is not only recommended…it’s probably needed.

**SIDENOTE** Remember when I was talking about how vitamin D improves immune function.  Well, I haven’t been doing my usual cod liver oil supplementation during the winter months.  I’ve now had my first serious cold for nearly 3 years.  Perhaps a coincidence…perhaps not?

Vitamin D From Food

Yes, some foods contain vitamin D and yes, some foods are fortified with vitamin D.  But, my mantra is if it’s not natural try not to eat it.  In other words, if it’s in a box or package, avoid it if you can.  This limits a lot of the fortified foods including orange juice, cows milk and oatmeals.

There are a limited number of naturally occurring foods with vitamin D in them including cold water fatty fish like salmon, sardines and mackerel.  On average, you can expect around 200 to 300 IUs (International Units) for sardines and mackeral (canned).  Salmon will likely give you the biggest vitamin D bang for your buck coming in at around 500 IUs for a 3 ounce serving of canned salmon.

As an aside, egg yolks can provide around 20 IUs but that is pretty minimal.

In short, yes you can get vitamin D from foods – but it’s not as much as you might expect.

Vitamin D Supplements

If you are supplementing it is likely the vitamin D3 form (cholecalciferol) which is more potent than ergocalciferol (vitamin D2).

Most over the counter supplements will contain 400 IUs of vitamin D3 per serving.

Vitamin D Recommendations

Right now, the general consensus with vitamin D intake is that there is no consensus.

Because vitamin D from the skin confounds so many studies and is hard to measure most experts have tried to come up with a tolerable upper level for vitamin D supplementation.  Unfortunately, this is where a lot of the vitamin D toxicity worries arise from.

For example, recently the Amercian Academy of Pediatrics recently doubled their old vitamin D recommendation from 200 IU/day to 400 IU/day.  Why?  Mounting evidence that vitamin D might reduce risks for cancer, diabetes and heart disease.

But what about adults?

Right now the medical mainstream says 400 IUs/day would be sufficient for most adults (aside from sun exposure) and offer a more liberal 600 IU/day for people older than 71 years of age.

Most experts (myself included) feel the governments vitamin D recommendations are too conservative.  In fact, if pediatric patients need 400 IU/day it stand to reason that adults could use more than that.  In fact, there have been studies in pediatric patients (if memory serves me correctly the study was done on children in poorer countries who may have been malnourished) and showed no side effects from 2,000 IU’s a day.

Everyone Is Different: Here’s What I Do

Personally, I think a vitamin D intake of 1000-2,000 IU/day is sufficient.  Notice I said intake – that is not all in supplement form.  I do NOT supplement during the summer months and I don’t think it is needed if you are getting adequate sun exposure (for me 15 minutes a day).  So, for me, some cod liver oil during the winter months and an occassional 2,000 IU vitamin D3 tablet.  Then, when spring comes around I rely solely on my diet and sun exposure.

Risk Factors

I don’t want to pretend that everyone can do this.  There are some people who are naturally at higher risk for vitamin D side effects even at lower doses.  And, rather than a true vitamin D toxicity presenting with nausea, vomiting and so forth – they actually exhibit signs and symptoms of too much calcium as calcium and vitamin D are very interrelated in your body.

For example, people with primary hyperparathyroidism, sarcoidosis, tuberculosis, and lymphoma can develop hypercalcemia related to increases in vitamin D intake.  If you have any of these conditions it’s very important you consult your health care provider prior to taking any vitamin D supplements.

Vitamin D Measurements

If you are truly concerned about suffering from vitamin D toxicity the best way to find out is to have your blood levels measured.

Your doctor or lab will likely suggest conservative numbers.  But this could be a mistake based on the most recent research.

It is generally accepted that clinical vitamin D deficiency (rickets and osteomalacia) occur at blood levels less than 8-10 ng/mL.  While some doctors suggest a low range of 20 ng/mL it appears that calcium absorption is not optimized until 32 ng/mL.  Therefore, I would shoot for blood levels of 30-50 ng/mL.

By Curtis Alexander, Pharm.D.
America’s Natural Pharmacist

Summary: Sominex® is an over the counter drug to help sleep.  It can help you fall asleep but often makes you groggy the next day.  This is probably due to it’s effects on your REM cycle.

Dear Curtis: I’ve been taking Sominex® sleep aid because I can’t sleep at night.  I fall asleep better but I wake up groggy and feel pretty sluggish for the rest of the day.  I’m not taking anything else.  What’s wrong?

My Answer: Trust me.  Your story isn’t unusual at all.  In fact, I’d call it common.

The basic pattern: You have trouble falling asleep.  You get something over-the-counter that is suppose to help.  You then fall asleep but are groggy all day.  Now, in most situations this is the point in the story where someone would look for a prescription drug to do the job.  But, Sominex® actually carries a prescription drug (diphenhydramine) just in a lower dose.

Sominex Background

Have you heard of Benadryl®?  The active ingredient in Benadryl®is diphenhydramine.  That is the same ingredient in Sominex®.  And they are using it because diphenhydramine is an anti-histamine.

Histamine has a whole host of effects in your body.  It’s released in many cases when someone has a mild or serious allergy attack (i.e., hives).  This is how they market Benadryl®.  Histamine also is released as a neurotransmitter.  In short, when you are sleeping normally your histamine cells essentially stop firing.  So, Sominex® is marketed as a sleep agent because it blocks histamine which should make you fall asleep.

But there in lies the rub.

I learned early on in pharmacy school that if you want to pick a poor sleep agent pick the antihistamines like Benadryl® and Sominex®.  Why?  Because they never fully allow your body to get it’s deepest, most restful sleep called REM (Rapid Eye Movement).  This is the biggest problem of Sominex® use.

So yes, you technically fall asleep but it’s not very restful sleep.  This probably explains why you are actually feeling groggy the next day.

In my opinion, I don’t think Sominex® will offer you any more help.  The good news is you can generally drop Sominex® without any sort of rebound effects like the jitters or inability to fall asleep.

Sominex® Should Be Short, Short Term

That’s doesn’t mean Sominex® doesn’t work or can’t help in certain cases but when it comes to helping you sleep in should be an extremely short term fix.

I know you may not like hearing this but I’m going to say it anyway.  Most of the time when you have trouble sleeping the answer isn’t in a pill – even in a prescription drug.  It’s in lifestyle modification.  In my opinion and experience, that is the most effective long-term and the safest.

Of course the problem is it’s not a quick fix.

I’d really encourage you to read an article I wrote on how to sleep better naturally.  Again, it’s not a quick fix but it’s based on personal experience and really helped me.

By Curtis Alexander, Pharm.D.
America’s Natural Pharmacist

Summary: You can learn how to sleep better and do it naturally.  But not all the experts advice may be right for you.  Here are two natural and simple steps I took to gain back my quality sleep.  Instead of basing it on a one-size-fits-all rule it is based on what works best for you and listening to your body and what it wants.

Dear Curtis: Do you have any natural advice on how to get better sleep?  I have a hard time falling asleep at night which leads to me sleeping in and feeling groggy every morning even though the clock says I’ve been in bed for 9 hours.  I don’t want to end up taking a sleeping pill but I don’t know what else to do.

My Answer: Believe it or not, at one time I had the same problem you did.  So know these two things:  Yes, there are natural things you can do but they probably aren’t what you are expecting.  Secondly, they will take some time and discipline to put into effect.  But I’ve had great results with them and I can show you how to sleep better at night.  And it’s all about using common sense and listening to your body.

My Sleep History

Like you I’m sure, I lived by the mantra that you should get a good solid 8 hours of sleep a night.

So, come hell or high water, I was determined to get my 8 hours.  And, because I was a working stiff who had to make it in the door by eight that generally meant I had to be up and functioning around the 6AM mark.  Count back 8 hours, carry the one, divide by pi and I was trying to get to bed about 9:30PM so I could actually be asleep by 10PM.

It was a heck of an idea if I don’t say so myself.  The only problem was…

…it didn’t work.

First of all, for some reason, eight hours felt like WAY more than what I needed.  If I had a good nights sleep I automatically woke up around the 7 hour mark.  So I’d lay in bed until I felt like I had met my quota of 8 hours.  Never mind the fact that I had no idea where this little jewel of 8 hours had come from.  But I felt like I was cheating if I did anything less.

So, for me, my first lesson was not everybody is hard-wired for 8 hours of sleep.  In fact, I don’t think most people are.  Furthermore, I think we may sleep too much.  But that’s another article for another time.

Difficulty Falling Asleep

The other problem was that when I went to bed I would toss and turn for what seemed like hours.  I can clearly remember going to bed at 9:30PM – tossing and turning – and then looking at the clock only to see it was after 11PM and I still hadn’t fallen asleep.

Yes, on occasion I would get up and go read like the experts say.  But there was a problem, by that time I was really frustrated.  Anxious even.  So reading was not relaxing for me at that particular time.  It was just something that reminded me I had sleep problems.

After a while, my frustration grew into almost anger.  Which made it even more difficult for me to fall asleep.  This seemed to effect my sleep pattern even more.

The results?  I’d wake up in the morning exhausted.

What was wrong?

Sleep Disorders are Generally Behavior Disorders

As I said, after a while this became very frustrating.  And even more so because I was following all the ‘rules’ set out by the sleep experts.  Namely:

• Nothing exciting before bed
• No alcohol before bed
• No reading in bed or watching TV in bed (we don’t even have a TV in our room or upstairs for that matter).
• Our room was quiet and dark

Finally, after being fed up with my lukewarm results I decided to take a step back and do something I recommend all the time to people who are having other problems with their health.  Namely, listen to your body and do what it is asking you to do.  Here are the two simple steps I implemented that allowed me to kick my personal sleep disorder.

My Personal Two-Step Program for Better Sleep

1. Stop going to ‘bed’ at any particular time:  This is huge.  Instead of treating 8 hours of sleep a night as gospel I started to question that maybe my body knew better than the experts.  For example, it just didn’t seem like my body needed 8 hours of sleep.  Maybe 7 was enough?
   So, I tried something crazy.  Something that would infuriate the ‘experts’.  I started going to bed when I was actually tired.  I know, it sounds crazy.  But it seemed to work.  The best gauge for when I was truly tired seemed to be when I was reading and my eyes started to get really heavy.  In fact, when I caught myself ‘nodding off’ I knew it was time for me to go hit the hay.  I’ve tried other indicators like meditating and writing.  But they seemed to be a little too ‘active’ to allow me to relax.  You should experiment but I think you’ll find that reading is a good relaxing activity and offers a good gauge of when you are truly tired.
   Do be careful of what you read, though.  While my preference for reading material leans towards non-fiction and autobiographies, I would suspect that reading a terror or suspense novel would not classify as a ‘relaxing’ read.  So use your common sense and personal preference when selecting something to read.  Will your bedtime be the same every night?  Not in the beginning.  But eventually, yes.  It will probably fall into a half hour time period
   **SIDENOTE:** Make sure all your evening ‘chores’ are taken care of before you begin reading.  The last thing you should be doing is reading.  Not checking the doors, putting the kids to bed, adjusting the blinds or going to the bathroom.  Get all of that stuff taken care of before you start reading.  Otherwise, you’ll start nodding off and decide to go to bed.  But before you actually go to bed you’ll have to check the doors and do your night routine and eventually wake yourself back up.  Defeating the whole purpose.
2. Wake up the same time everyday (Yes…even weekends):  For many people this is hearsay.  After all, the weekends are built for relaxation and sleeping in.  But, the only problem is when you sleep in, it screws up your ‘cycle’.  The later you wake up the later you’ll go to bed.  Keep that up for any length of time and pretty soon you’ll be going to bed at 1 AM.  So, even though you may be tempted to sleep in try to resist that urge and get up when you’re alarm goes off.  Eventually this too will become a habit and you’ll likely wake up at the same time everyday without the aide of an alarm clock.

My Sleep Patterns Now

The end result of all this experimenting and listening to my body is this:  I went from unsuccessfully trying to sleep 8 hours a night to sleeping my natural seven.  I wake up at about 4:45AM every morning, seven days a week.  I go to bed when I’m tired.  That usually ends up being between 9:30PM and 10PM.  Sometimes later.

My only fault is that I don’t always rely on reading as my indicator to go to bed.  I’ve been doing this long enough now that I can usually tell when I’m tired.  But sometimes I’ll get into bed even though I was yawning as I was getting the kids ready for bed and still won’t fall asleep for a 1/2 hour or so.

**Bonus Tip**: For the last four days or so I have been breaking the second rule about getting up at the same time everyday.  Why?  I started to feel like I was coming down with something.  A lot of colds and flu’s have been going around and I almost felt (even though I rarely get ill anymore) like I had a touch of it.

Like I said above, one of the best things I did, and that I recommend to you, is to listen to your body.  And my body was telling me to get some sleep so it could fight off whatever it was that was trying to get a hold of me.  It seems to have worked.  I never did get sick.

It is going to be a bit of a struggle to get back on a schedule of getting up at my regular time because I’ve essentially been staying in bed until between 6:30AM and 7AM.

Summary: Many women are told to buy Revitol Stretch Mark Cream once they become pregnant.  It contains all natural ingredients and appears to be safe during pregnancy – but you should talk to your doctor first.  Many of the reviews of Revitol are very positive.  It may also help the appearance of existing stretch marks.

Dear Curtis: I’m pregnant and only about two months along but I know that one of the things I want to avoid is stretch marks.  I’d like to buy Revitol – which claims to prevent stretch marks.  But, if I buy Revitol cream I want to make sure of two things: do you think it can really help and is it safe during pregnancy?

My Answer: First of all, congratulations on your pregnancy.  Secondly, having known many women who have had children I can tell you that your concerns are shared by a lot of other women.  I don’t know any women who are OK with stretch marks – which explains why Revitol will likely have a HUGE market.

What is Revitol Cream?

Revitol isn’t actually just a stretch mark cream – it’s a line of skin care products from hair removal to wrinkle creams.  Now, the important thing to look into before you buy Revitol stretch mark cream is to consider what causes stretch marks.

As an aside, stretch marks during pregnancy are extremely common – upwards of 90% of women claim to have some degree of new stretch marks after pregnancy.  But your chances of the stretch marks being bad or high in number increase as the elasticity, collagen structure and overall skin strength decrease.  In short, you want to make sure that your skin has the nutrients it needs to stay strong and elastic so it can expand without causing unsightly stretch marks.

Revitol Ingredients

Revitol stretch mark cream contains a number of natural ingredients designed to improve the elasticity and strength of your skin including squalene oil, vitamin E, vitamin A palmitate, vitamin D3, dl-penthenol (is converted to vitamin B5), aloe vera extract and grapefruit seed extract.

You can see the main ingredients in Revitol are natural.  Which is really nice.  A lot of the other stretch mark creams on the market that I saw contain more harsh chemicals.

Now, as to whether or not it is safe during pregnancy I can’t say for certain because no company ever designs a product (that includes prescription drug companies) and then decides to test it in pregnant women – that’s obviously unethical.  So, we don’t have any data on that.  The only evidence we have is that the company itself mentions use in pregnancy in a lot of it’s literature and there are a lot of reviews online from women who used it during pregnancy with no problems.  Finally, as I mentioned the ingredients in Revitol are natural and, this isn’t usually mentioned in a lot of places, it’s a topical drug.  So the amount of drug actually absorbed and passed onto the baby shouldn’t be anything to worry about.  But, this is a decision that you must make with your doctor.

Does Revitol Stretch Mark Cream Work?

In short, it looks promising to me and I would recommend it.  It does contain a number of natural ingredients that have shown promise in improving the appearance and function of the skin.  I would also recommend it because of the feedback from satisfied users about the results they achieved.  To my surprise, there were even women who claimed that it did improve the appearance of existing stretch marks as well (rather than just preventing them).

Bare in mind that Revitol isn’t completely natural as it does contain other preservatives like glycerin, caprylic trigylceride, dimethicone and stearic acid.

Revitol Cost

Revitol Stretch Mark Cream runs about $60 for a 3 month supply.  That’s not bad, considering how important it sounds like the appearance of your skin is to you.  I definitely think Revitol would be worth a try.

By Curtis Alexander, Pharm.D.
America’s Natural Pharmacist

Summary: There is a guaranteed athletes foot cure and it will cost you nothing.  It does take some time to work.  In the meantime, the best products I’ve seen to treat athletes foot symptoms are not the popular creams.  They may actually slow down the healing process.

Dear Curtis: Do you know of a cure for athletes foot?  My son continually gets it.  We treat it.  It goes away.  But comes back.  Why?  And what can we do to get rid of it (if anything)?

My Answer: Believe it or not I use to get athletes foot the worst before I was ever in sports heavily – about age 9 or 10.  Ironically, my oldest son was getting it by age 6.  So the name itself is a bit of a misnomer and I mention it because people seem to think that if they avoid the showers at the gym they won’t get it.

Not true.

How to Cure Athletes Foot

First understand that athletes foot (tinea pedis) is a fungal infection.  One of my first on-the-job trainings involved working with an old-school pharmacist who saw a lot of fungal infections.

His advice? A fungal infection needs a couple of things to ever get going: heat and moisture.

Take one away and the fungus can’t survive.

In my case and my sons our feet sweat more than the average person.  He loves to wear socks or shoes everywhere he goes.  He’d even wear socks to bed if we let him.  I’ve only noticed outbreaks when we let him wear socks.  Again…the socks are essentially locking in the moisture and heat.

Once we let his feet air dry the infection goes away.  Incidentally, the socks keep his feet warmer also – the other ingredient for a fungal infection.

I’ve yet to see this not work.  The best part is, this is a completely natural cure for athletes foot.

Various Athletes Foot Treatments

The downside is that it will take a few days for the lack of heat and moisture to get to work on the fungal infection.  So, what can you do in the meantime?

One of my favorite treatments that I never see mentioned is a diluted solution of Tea Tree Oil.  I mix a small amount (say 1 teaspoonful) 50/50 with some tap water and apply it directly to the infection.

I’ve applied the tea tree oil without mixing in the past but some people don’t like the strong scent that the oil gives off.  The only downside, buying the tea tree oil solution can be a bit pricey.

Another option that has always worked and is dirt cheap is Absorbine Jr.

I know, it’s for sore muscles but it is essentially alcohol which will kill the fungus.

One warning though: if there are any open sores or cracks (particularly between the toes which is where they always seem to end up) you’re going to get pain from the alcohol.  It won’t last long but it will hurt.  Actually, the tea tree oil can do the same just not as intense in my experience.

But, short term pain long term gain in my opinion.

What About Athlete Foot Creams?

Athlete foot creams can help but the one reason I don’t recommend them is probably one you can guess: the cream has a tendency to lock in and promote moisture.  Then why are they recommended?  They work because they contain an anti-fungal (likely clotrimazole, etc).

I’ve always seen quicker results with something that has an anti-fungal but also keeps the feet dry.

Spreading Athletes Foot

One concern some folks have is that if you live with someone who has athletes foot and they are walking around barefoot won’t you get the infection?

Not likely.  Remember…heat and moisture.  Your body is bombarded daily by bacteria, virus and fungi and a million other things.  They are opportunistic meaning they have to have conditions right for them and when they do they wreak their havoc.

Simply put, I walk around barefoot all the time when my son has had outbreaks and we make him go barefoot and I, my wife or my other son have ever got an athletes foot infection even though we are all walking around barefoot and using the same bathrooms.