Friday, December 14, 2007


Winter months feature lack of sunlight – and Vitamin D

There is probably a reason why this time of year is loaded with holidays and activities. The days are shorter, it gets darker earlier and every one is just a little bit cranky. Looking forward to Thanksgiving, Christmas, Hanukkah, New Years and even Valentines Day gives us a reason to get up on a cold dark morning.

Because of the shorter periods of sunlight in New England and colder weather keeping some of us inside more, we are also producing less Vitamin D. Vitamin D is a fat soluble vitamin that is produced when our skin is exposed to ultraviolet light (sunshine). It is also found in fortified foods, such as milk, orange juice, soymilk and breakfast cereals. Fatty fish, egg yolk and mushrooms are also sources of the vitamin.

Vitamin D is most well known for promoting bone health by increasing the body’s ability to absorb calcium and phosphorous. It also helps to promote bone formation. Low amounts of Vitamin D in the diet increases risk of the bone disease, Osteoporosis. Prior to the 1930’s, rickets was a major public health problem for children, until milk began to be fortified with Vitamin D. Low blood levels of Vitamin D are also associated with high blood pressure, some types of cancer (skin and colon), depression and autoimmune diseases.

Recommended Daily Intake (RDI) for Vitamin D is 200 International Units (IU) for children and for men and women under 50 years of age. Recommendations go up for people over 50 to 400 IU daily and to 600 IU for those over age 70. Needs increase with aging because the skin makes less pre-vitamin D as it ages and the liver and kidney convert less pre-vitamin D to the active, useful form of the vitamin. An 8-ouce glass of fortified milk contains 100 IU of vitamin D, and 3 ½ ounces of cooked salmon provides 360 IUs. Mushrooms are an excellent source for vegans.

During the months of November through February, the New England sun is an insufficient source of Vitamin D. If outdoor exposure to sunlight is limited and getting away to southern climates is not an option, it becomes important to obtain Vitamin D through foods or supplements. Using sunscreen, which is recommended to prevent skin cancers, also limits ultraviolet light exposure, reducing the production of Vitamin D. During the spring and summer months adequate Vitamin D can be obtained by exposure to sunlight for 10-15 minutes daily.

As I write this column, the view out my window is dreary, with a few snow flurries. A little salmon for dinner and some mushrooms in the salad might be a good idea. Then I think I’ll book a little Island getaway. All for the sake of my bones, of course.

Mary Beth Dahlstrom Green is a dietitian at The William W. Backus Hospital. This column should not replace advice or instruction from your personal physician. E-mail Green and all of the Healthy Living columnists at


Many factors dictate brain hemorrhage treatments

Bleeding anywhere in the brain is life threatening. Physics dictates that adding volume to a closed container will result in increased pressure. When blood accumulates in the skull, it puts pressure on the brain causing severe damage.

The location of the blood within the brain is often an indication of the source of hemorrhage and the cause of bleeding.

An intracerebral hemorrhage occurs when a blood vessel in the brain ruptures, resulting in bleeding within the substance of the brain. This type of brain hemorrhage is most commonly seen and causes a hemorrhagic stroke. This differs from an ischemic stroke, which is typically caused by a blocked blood vessel as opposed to leakage. It is often the result of chronic high blood pressure, malformed blood vessels, or both. A substance known as beta-amyloid is deposited in the walls of blood vessels during the normal aging process. The accumulation of beta-amyloid weakens the vessel walls, thus making intracerebral hemorrhage more likely in older people.

Sub-arachnoid hemorrhage occurs as the result of a ruptured aneurysm beneath the arachnoid tissue surrounding the brain. An aneurysm is a weakening of an arterial wall resulting in the formation of a berry-like deformity. It is very similar to a bulging bubble seen on the inner tube of a bicycle tire. Aneurysms are usually present at birth and are commonly seen as a family trait.

Subdural hemorrhage occurs beneath the dura mater or the outermost covering of the brain. It typically results from trauma to the veins bridging the subdural space.
Epidural hemorrhage occurs outside the dura mater. This type of hemorrhage is caused by trauma to the middle meningeal artery. Since it is arterial in nature, it produces a large amount of blood very quickly and many times results in sudden death.
There are different treatments for brain hemorrhage. The type of treatment depends on the location of the bleeding and the amount of blood that accumulates.

Neurosurgeons often open the skull and mechanically stop the bleeding and repair the damaged blood vessel. Recent studies have shown that in smaller hemorrhages, the risk of further injury is greater with surgery and it is best to medically support the patient. Medications lower blood pressure, shrink brain swelling, and prevent seizures. Rehabilitation in the form of intense physical, occupational, and speech therapy can lead to a full recovery for many patients.

Anthony G. Alessi, MD, is Chief of Neurology at The William W. Backus Hospital with a private practice at NeuroDiagnostics, LLC in Norwich. This column should not replace advice or instruction from your personal physician. E-mail Alessi and all of the Healthy Living columnists at

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