Vitamin C, also known as ascorbic acid, is a water-soluble vitamin. Unlike most mammals and other animals, humans do not have the ability to make ascorbic acid and must obtain vitamin C from the diet.
Food Sources of vitamin C
Vitamin C can be found in vegetables and fruits. Citrus fruits are especially high in vitamin C, but leafy greens and many other fruits and vegetables are also excellent sources. Choose fresh foods as your source of vitamin C as heat can destroy this vitamin.
Foods that provide vitamin C include: orange juice, grapefruit juice, kiwi, strawberries, broccoli, grapefruit, baked potato, tomato, spinach
Do you know that one medium orange gives you about 70mg of Vitamin C?
Why you need vitamin C during pregnancy
Both you and your baby need vitamin C daily because it's necessary for the body to make collagen, a structural protein that's also a component of cartilage, tendons, bones, and skin. Based on animal studies, some researchers believe that vitamin C deficiencies in newborn babies can impair mental development. (1)
Other than that, Vitamin C is also essential for healthy skin, tissue repair, wound healing, bone growth and repair. Vitamin C helps your body fight infections, improves your immune system and acts as an antioxidant, protecting cells from damage.
Vitamin C also helps your body absorb iron, especially from vegetarian sources. One tip will be to take Vitamin C together with iron supplements during pregnancy.
How much vitamin C do you need?
Pregnant women age 18 and younger: 80 milligrams (mg) per day
Pregnant women age 19 and older: 85 mg per day
Breastfeeding women age 18 and younger: 115 mg per day
Breastfeeding women age 19 and older: 120 mg per day
Nonpregnant women age 18 and younger: 65 mg per day
Nonpregnant women age 19 and older: 75 mg per day (2)
What are the signs of a vitamin C deficiency?
Signs include fatigue, muscle weakness, joint and muscle aches, bleeding gums, and leg rashes. Prolonged deficiency can cause scurvy, a rare but potentially severe illness.
Are there any risks associated with too much vitamin C?
Vitamin C is generally regarded as safe. Side effects are rarely reported, but may include diarrhea, nausea, abdominal cramps, and other gastrointestinal symptoms.
For most healthy individuals, the body can only hold and use about 200-250 mg of vitamin C a day, and any excess is lost though urine. At times of illness, during recovery from injury, or under conditions of increased oxidative stress (including smoking), the body can use greater amounts. High doses of vitamin C (greater than 2,000 mg/day) may contribute to the formation of kidney stones, as well as cause severe diarrhea, nausea, and gastritis. (3)
1. Tveden-Nyborg P, Lykkesfeldt J. Does vitamin C deficiency result in impaired
brain development in infants? Redox Rep. 2009;14(1):2-6.
During prenatal care, you will be reminded to take folic acid and calcium, but what about vitamin B2?
Vitamins in the B complex play an important role in supporting a healthy pregnancy and to the health of breastfeeding mothers.
Vitamin B2, part of the vitamin B complex is also known as Riboflavin. it is water soluble, which means that your body doesn't store it. You must replace them through your diet or prenatal vitamins.
Why vitamin B2 during pregnancy?
In general, there are many health benefits of vitamin B2:
• Headaches - Vitamin B2 can prevent headaches and treat migraine headaches. It reduces the pain you feel during a migraine attack and stops them from lasting too long.
• Energy - Vitamin B2 is an important part of the metabolic process. The body uses it to properly digest food to give us the energy we want. So without it, we don't process food properly and end up gaining weight and not having the energy to get through the day. Vitamin B2 breaks proteins down into their amino acid bases, fats and carbs by converting them into glucose; the main fuel of the body.
• Cancer - Vitamin B2 is responsible for the production of glutathione which removes these free radicals from breaking down our bodies and keeps the liver clean. Free radicals do a lot of damage to the body and are the main reason you get sick. (1)
During pregnancy, consumption of vitamin B2 lowers the risk of developing preeclampsia, a pregnancy complication. It also promotes the healthy development and growth of baby's bones, muscles and nerves. For moms, vitamin B2 helps your skin look glowing and refreshed! Don't you want to look radiant even when you are pregnant? This is also because vitamin B2 increases blood circulation for mother and foetus and helps prevent pregnancy-related anaemia.
Not only that! Breastfeeding mothers need even more vitamin B2 than pregnant mothers. Some women need up to 50% more daily intake of riboflavin than they did before pregnancy. To provide for the hungry baby, breast milk absorbs much of the vitamin B2 than the mother ingests.
How do you know if you are riboflavin deficient?
Anemia, magenta (dry and red tongue), skin rash, dermatitis, dryness and cracking around mouth, nose and lips are all signs of riboflavin deficiency (2). If you are on a special diet due to lactose intolerant, vegetarian or anorexia, then you are at higher risk of riboflavin deficiency. (3)
What dietary sources contains vitamin B2?
The best sources of riboflavin are almond, mushrooms, wild rice, milk, yogurt, eggs, broccoli, brussels sprouts, spinach and whole grains. Flours and cereals are often fortified with riboflavin.
However, riboflavin can be destroyed by light. So food should be kept away from light to protect its riboflavin content. Although riboflavin is not destroyed by heat, it can be lost in water when foods are boiled or soak. The best way is to roast or steam the foods to preserve more riboflavin rather than frying or scalding your food.
Should you take a supplement?
YES - Although you can get enough riboflavin from a diet that includes grains, fairy products, meats, green vegetables and eggs, your doctor will advise you to take a prenatal supplements which provide the dietary reference intake (DRI) for riboflavin.
The recommended daily dietary intake for riboflavin (4)
• Women, 19 years and older: 1.1 mg (RDA)
• Pregnant women: 1.4 mg (RDA)
• Breastfeeding women: 1.6 mg (RDA)
Alzheimer's Disease is the number one cause of dementia (70% of cases). Causes include cardiovascular events whereby there is reduced blood flow to the brain, aging, genetics, etc. Risk factors include older age, family history, having Apolipoprotein E (ApoE), abnormal MRI, history of cardiovascular disease.
Associated with multiple changes including:
- Cognitive Differences ( difficulty finding words, disorientation, forgetfulness etc)
- A reduction in Daily Functioning ( getting lost, neglecting self care)
- Personality Changes ( social withdrawal, disinterest, easy frustration)
- Problem Behaviors ( obsessive/compulsive behavior, nightime restlessness)
- Mental Health Issues ( depression, paranoia, abnormal beliefs, anxiety etc)
To slow the disease:
1. Vitamin E (as dl-alpha-tocopheryl acetate) 1000IU twice a day
Based on a large clinical trial published in Journal of the American Medical Association (JAMA), a 5 year study with more than 600 participants showed that the Vitamin E group, taking 2000IU of Vitamin E per day, experienced significant delay of more than 6 months in progression of the disease (1). On top of that caregiver time also decreased by 2 hours each day which means better quality of life for both the patient and the caregiver.
2. Panax Ginseng or Korean Red Ginseng
The primary active ingredients in ginseng are ginsenosides and there are 7 main ones found in dietary supplements namely Rb1, Rb2, Rc, Rd, Re, Rf and Rg1. Some of them have been shown in laboratories to be able to reduce levels of a compound called amyloid beta peptide which is found in brains of Alzheimer's patients. Moreover it also improves blood flow.
3. Omega-3 Supplements
May improve the appetite and weight gain in Alzheimer's patients. They might even help with reducing depressive symptoms.
4. Lifestyle Changes
This includes finding the right protein, fat, and carb balance. Studies have shown that diet high in lean protein and healthy fats may protect against mild cognitive impairment. On top of that, more exercise not just physically but also mentally are really important. Play more crossword puzzles and reading will reduce the risk of AD. Lastly, make sure to take time to de-stress as chronic stress can increase the amount of stress steroids in your body and this can block brain activities as well as increase risk of AD.
It is important to remember in Alzheimer that heart healthy = brain healthy so prevention is extremely important.
1. Dysken MW, Sano M, Asthana S, et al. Effect of Vitamin E and Memantine on Functional Decline in Alzheimer Disease: The TEAM-AD VA Cooperative Randomized Trial. JAMA.2014;311(1):33-44. doi:10.1001/jama.2013.282834.
Bloating and distension have been reported in up to 96% of patients with irritable bowel syndrome (IBS) and in 20% to 30% of the general population, In fact, more than 50% of persons with bloating and distension report a significant impact on quality of life. In general, the term bloating refers to the subjective sensation of increased abdominal pressure without an increase in abdominal size, whereas distension describes the same subjective sensation but with a corresponding objective increase in abdominal girth.
Patients who are constipated commonly report bloating and more than 80% describing severe symptoms. The pathogenesis of bloating in patients with constipation is likely multifactorial. First, the direct mechanical effects of fecal impaction and colonic loading can mimic bloating. Second, colonic stasis may cause increased fermentation of the colonic contents by intestinal bacteria and, therefore, increased gas production. Other than that rectal hypersensitivity is also a common scenario found in IBS and patients with constipation. Interestingly, alterations in visceral sensitivity may explain why symptoms of bloating and distension may be worse in women during the perimenstrual phase as visceral sensitivity varies throughout the menstrual cycle and is generally most acute in the perimenstrual phase (1)
The most significant advance in the treatment of bloating has been the identification of a group of poorly absorbed short-chain carbohydrates (FODMAPs) and individually, these carbohydrates have been considered to be potential triggers of IBS symptoms for decades. In well controlled dietary trials, modification in diet to a low-FODMAP diet can decrease symptoms in at least 75% of IBS patients (2).
If there is severe constipation, laxatives can be used as initial treatment to ensure that constipation is aggressively managed. On top of that, consider using probiotics. A systematic review concluded that bloating is significantly reduced by the probiotic Bifidobacterium infantis 35624 (3).
There is emerging evidence that kiwifruit is effective in the treatment of constipation and bloating. Although the mechanisms remain unknown, kiwifruit appears to promote both laxation and gastric motility.
In conclusion, bloating and distension are highly prevalent symptoms with a marked effect on health status and quality of life. Emerging evidence indicates that targeting colonic motility, gut flora, visceral sensitivity, and dietary intake is helpful in controlling such symptoms.
1. Altman G, Cain KC, Motzer S, Jarrett M, Burr R, Heitkemper M. Increased symptoms in female IBS patients with dysmenorrhea and PMS. Gastroenterol Nurs. 2006;29(1):4-11.
2. Halmos EP, Power VA, Shepherd SJ, Gibson PR, Muir JG. A diet low in FODMAPs reduces symptoms of irritable bowel syndrome. Gastroenterology. 2014;146(1):67-75.e5
3. Brenner DM, Moeller MJ, Chey WD, Schoenfeld PS. The utility of probiotics in the treatment of irritable bowel syndrome: a systematic review. Am J Gastroenterol. 2009;104(4):1033-1049; quiz 1050.
Meet Ernestine Shepherd, The world's oldest female bodybuilder. I was super inspired after I saw a video of her and her bodybuilding journey being shared on Facebook. She is a living proof that fitness is for everybody, no matter what age. She quoted 'discipline, determination and good old fashioned hard work' is what is takes for her to achieve this.
In medical research, there is evidence to suggest that physically fit elderly adults experience less profound declines in cognitive performance that thier less-fit contemporaries (1). It is evident in this study done in 1988 where reaction time and its fractionated components were studied in two groups of older women who differ in their level of regular aerobic exercise. Significant group differences were found in all dependent variables indicating that in older women regular aerobic exercise is an important factor influencing the speed of their reactions to simple and discriminatory stimuli, and in the accompanying premotor time, contractile time, and speed of movement following the reaction response (2).
I am a big believer of you are what you eat and if fitness is your priority, you will work hard to get it, Check out her inspiring video below.
1: Chodzko-Zajko WJ. Physical fitness, cognitive performance, and aging. Med Sci Sports Exerc. 1991 Jul;23(7):868-72. Review. PubMed PMID: 1921681.
2: Baylor AM, Spirduso WW. Systematic aerobic exercise and components of reaction time in older women. J Gerontol. 1988 Sep;43(5):P121-6. PubMed PMID: 3418038.
I am a medical doctor and a researcher hence I believe in evidence based medicine. I was very shocked to find this article recently (by accident) titled " A Nutritional-Toxicological Assessment of Antarctic Krill Oil versus Fish Oil Dietary Supplements ". This article was published in 2014 in Nutrients Journal by researchers from Griffith University and CSIRO Food and Nutrition in Tasmania. This research is also funded by ARC Discovery Grant DP666891.
So here comes the shocking part. They actually tested multiple readily available fish oils on the market and found that the DHA content in particularly 2 products fell below (~10%–30%) the manufacturer specifications namely Nature’s Way Kidsmart (133 mg specified vs. 95 mg observed) and Blackmores Pregnancy and Breastfeeding Gold (125 mg specified vs. 85 mg observed).
When I shared this piece of article with my friends they asked me how could the manufacturers be so misleading and why is this even allowed? To be absolutely honest, I am not here to judge or comment on different brands but merely sharing what I found published in the medical research world.
The next table below is where the researchers did an analysis of the contamination level of all the products. Even though they found that none of the products analysed in the current study (at their highest recommended dosage) came close to fulfilling tolerable daily intake (TDI) levels for any single analyte, they have listed the top five products with the greatest contaminant burden for five key compound groups, plus TEQ values, ranking them from 1–5 with the sample containing the highest concentrations receiving a score of 5.
Bioceuticals Omegasure liquid fish oil and Blackmores 1000 mg both carried a cumulative score of 16, Blackmores Pregnancy and Breastfeeding Gold formula and Nature’s Own 1000 mg each received a score of 12.
According to the researchers, Blackmore’s Pregnancy and Breastfeeding Gold formula incorporates tuna oil, sourced from northern hemisphere oceans, thereby likely contributing to the higher contaminant burdens found in this formulation, despite its lower oil content.
This again highlights that translational research is very important. What is translational research? In a medical research context, it aims to "translate" findings in fundamental research into medical practice and meaningful health outcomes. It is very common in medical research where great amount of research work and funding has been put in but there is lack of dissemination of information to the public. This is a gap that needs to be bridged and my blog is all about this. In regards to this article, it was an accidental find for me, to better educate myself (and definitely to warn all my pregnant friends to not take the particular product mentioned) and the public.
The researchers in the article has concluded that ongoing monitoring of the pollutant content of fish and krill oil products will become increasingly important as food authorities seek
regulatory overview of this rapidly expanding industry.
Make sure you know what you are taking and whether you are really paying for the quality.
Bengtson Nash SM, Schlabach M, Nichols PD. A Nutritional-Toxicological Assessment of Antarctic Krill Oil versus Fish Oil Dietary Supplements. Nutrients. 2014;6(9):3382-3402. doi:10.3390/nu6093382.
Menstrual cramps, otherwise known as dysmenorrhea is thought to affect about 50% of the women. Doctors tend to deal with it by either dismissing the pain as a psychological problem or prescribing painkillers. Today researchers have come a long way toward a better understanding of menstrual cramps.
There are 2 types of dysmenorrhea:
- Primary dysmenorrhea: Dysmenorrhea not caused by any physical abnormality of reproductive organs. Characterised by sharp, spasmodic pains in your lower abdomen OR dull ache in your lower back at the beginning of your period, or a day or two earlier, and it lasts two to three days.
- Secondary dysmenorrhea: Dysmenorrhea marked by pelvic and lower-back pain in which the pain is a symptom of another disease or condition that may require treatment such as endometriosis, pelvic inflammatory disease, uterine fibroids, and adenomyosis.
Main cause of dysmenorrhea:
- Dysmenorrhea happens when your uterus contracts to push out the menstrual blood. Imbalances between the hormones progesterone and estrogen worsen menstrual cramping. Hormone-like substances (prostaglandins) involved in pain and inflammation trigger the uterine muscle contractions and higher levels of prostaglandins are associated with more-severe menstrual cramps (1).
- Warm bath or lying down with a heating pad or hot-water bottle on your lower abdomen
- Exercise, take a walk around the block or a few sit-ups will stimulate your muscles to release feel-good endorphins
- Birth control or estrogen pills to decrease your body's production of prostaglandin.
- Calcium 1000mg daily has been found to reduce both premenstrual and menstrual symptom scores (2). In fact high intake of calcium and Vitamin D may reduce risk of premenstrual syndrome (PMS) (3).
- According to Christiane Northrup, M.D in her book 'Women's Bodies, Women's Wisdom (Revised Edition): Creating Physical and Emotional Health and Healing', she suggested getting plenty of essential fatty acids (salmon, flaxseed oil etc); take extra magnesium and a multivitamin-and-mineral supplement; take extra vitamin E during your menstrual cycles; eliminate trans-fatty acids from your diet; cut down on stress and consider yoga or massage.
1. Mayo Clinic http://www.mayoclinic.org/diseases-conditions/menstrual-cramps/basics/causes/con-20025447
2. Thys-Jacobs S, Ceccarelli S, Bierman A, Weisman H, Cohen MA, Alvir J. Calcium supplementation in premenstrual syndrome: a randomized crossover trial. J Gen Intern Med. 1989 May-Jun;4(3):183-9. PubMed PMID: 2656936.
3. Bertone-Johnson ER, Hankinson SE, Bendich A, Johnson SR, Willett WC, Manson JE. Calcium and vitamin D intake and risk of incident premenstrual syndrome. Arch Intern Med. 2005 Jun 13;165(11):1246-52. PubMed PMID: 15956003.
When I first heard about cases where people refused vaccination for their kids, kids who can't even decide for themselves yet, I honestly didn't think much of it. Then I found out it was because there might be a link between vaccination and autism which is why parents are making the decision to not vaccinate. At that time I was still a medical student so my thinking was sort of 'each to their own' and then few years down the line I started realising this silly decision is no longer 'each to their own' but really affecting a whole lot of other people (eg. the immunocompromised ones who need heard immunity) other than just putting their own kids at risk.
As my classmates turned interns, they started seeing really really sad cases where young infants die of whooping cough or meningitis (cased by haemophilus influenza). Each of the stories were pretty similar, the parents of these poor kids are either uneducated or have a false belief. The worst bit - is when the doctor tells these parents they could have PREVENTED the kid's death. Just imagine the guilt.
To me the logic is pretty simple, without vaccination, you won't even be born because small pox would have taken over the world (Note: small pox vaccine is the first successful vaccine developed back in 1796 and has successfully eradicated the disease). Just ask yourself, did your parents vaccinate themselves and you too? So why would you choose not to vaccinate your kids?
Apart from the fact that the original research about vaccination and autism was totally made-up plus a lot more money spent on properly researching this link and found no link at all, if you still think you are more educated than the world and that pharmaceutical companies are out to get your money, at least consider the fact that you are part of the human race and you should do the right thing and let your kids contribute to herd immunity to help those who can't vaccinate for medical reasons (seriously don't be so selfish). I once saw a comment in a forum where a lady said she would rather have an autistic kid than a dead kid so she chose to immunise her kids. Anti-vaxxers, you should really think hard on that and please enjoy the video below.
Several studies have demonstrated that vegetarians and vegans have much lower plasma concentrations of omega-3 fatty acids (DHA and EPA) when compared to those who eat fish. A recent study published in Clinical Nutrition showed low blood omega-3 levels in vegans and the fatty acid analysis data was presented on more than 160 vegans who were not supplementing with DHA and EPA (1). The result of the study showed the average omega-3 index of the vegans in the study was 3.7% with a total of 64% of the vegans having levels lower than 4%; 27 percent had levels lower than 3%; and a small number (about 1%) had very low levels (lower than 2%). It is also important to note that omega-3 index of lower than 4% has been known as a risk factor for heart disease.
As you may already know, omega-3 fatty acids are crucial components of cell membranes in the human brain (2) and I have highlighted in my previous posts that it could even potentially reverse ageing by affecting the telomere lengths.
It is understood that many vegans probably consume a huge amount of flax seeds, walnuts, chia seeds etc to try and boost their omega-3 fatty acid levels. However, what they are actually consuming is actually ALA (Alpha-lipoic-acid) which is the plant based omega-3 fatty acids which then converts to EPA and DHA. This conversion actually varies with different individuals and factors involved includes genetic factors (3). So eating plenty of ALA-rich foods is simply not enough for many people to achieve sufficient DHA and EPA levels—supplementation is often necessary.
In conclusion, if you are vegan (which means you are more prone to omega-3 fatty acid deficiency), please check your levels with a blood test to assure that you are sufficient, or take the supplement as a preventative measure.
1: Sarter B, Kelsey KS, Schwartz TA, Harris WS. Blood docosahexaenoic acid and eicosapentaenoic acid in vegans: Associations with age and gender and effects of an algal-derived omega-3 fatty acid supplement. Clin Nutr. 2015 Apr;34(2):212-8.
2. Higdon J: Essential Fatty Acids. In An Evidence-Based Approach to Dietary Phytochemicals. New York, NY: Thieme; 2006: 78-99
3. Davis BC, Kris-Etherton PM. Achieving optimal essential fatty acid status in vegetarians: current knowledge and practical implications. Am J Clin Nutr. 2003 Sep;78(3 Suppl):640S-646S. Review.
Parabens are widely used as preservatives in cosmetic and pharmaceutical products which can be absorbed through the skin. They have also been known as xenoestrogens (synthetic estrogens) which can mimic the female hormone oestrogen and there are concerns that they may be linked to breast cancer. Parabens are.common ingredients in cosmetics, shampoos, body lotions and sunscreens where they are used to prevent microbial growth and prolong shelf life.
The breast on the other hand has been known as the 'dustbin' for environmental chemicals because it's a very fatty part of the body so any fat soluble chemicals that are absorbed from the environment can linger in the tissues. On top of environmental chemicals, estrogen has been linked with promoting breast cancer.
The latest, a study in cells, not humans, from the University of California Berkeley and funded by the California Breast Cancer Research Program found that even at low levels parabens could stimulate the growth of breast cancer cells when they interact with a growth factor that's naturally produced in a woman's body (1).
Another study of 160 tissue samples from 40 mastectomies for Primary Breast Cancer in England between 2005-2008 has detected the presence of paraben esters in 99 percent of breast cancer tissues sampled (2).
Although further research will be required to clearly linked paraben to breast cancer and it will take even more years to spread the word and for policies to be implemented, it is safe to say that I myself will be choosing products that are paraben-free (better safe than sorry). Avoiding parabens and other harmful chemicals requires becoming an avid label reader. Beware that products boasting "all-natural" labels which can still contain harmful chemicals, including parabens, so make sure to check the list of ingredients.
1: Pan S, Yuan C, Tagmount A, Rudel RA, Ackerman JM, Yaswen P, Vulpe CD, Leitman DC. Parabens and Human Epidermal Growth Factor Receptor Ligands Cross-Talk in Breast Cancer Cells. Environ Health Perspect. 2015 Oct 27.
2. Barr L, Metaxas G, Harbach CA, Savoy LA, Darbre PD. Measurement of paraben concentrations in human breast tissue at serial locations across the breast from axilla to sternum. J Appl Toxicol. 2012 Mar;32(3):219-32. doi: 10.1002/jat.1786. Epub 2012 Jan 12.
Dr Nicole Ng (MBBS) is a medical doctor with a passion in women's health and medical research