Talking about trauma with kids; PTSD, neural mapping, EMDR and reframing

/This article was originally posted on March 21, 2011. It is still important to have open conversations with children about traumatic events or other information they may find confusing, troubling or frightening. EMDR therapy can be helpful for adults with PTSD./
We all need comfort and we gain it from sharing our burdens, talking about troubles and letting out worries. Listening is more important than talking – let kids talk to you about trauma – we don’t know what they are thinking or are worried about until we let them talk it out. Don’t worry too much about “how to talk about it“, pause, listen, and accept – “yes, there are worries but we’ll stick together and work through it“, is a strong message for all of us to hear.
Children and all of us have “hot” emotional memories centered in the amygdala and milder long term factual memories stored more generally throughout the neocortex. Electrical activity of the brain can be recorded and associated with the topic being considered. The amygdala centered emotional memory can be tied to smells, sounds, places or people and can be unexpectedly triggered leaving the person with panic attack type symptoms unique to the individual’s memories of the early traumatic event.

Neural connections in the brain can be flexible or can be linked together in behavior patterns that might be described as being a bit like playing with a line of toy dominoes. The designers spend hours placing the dominoes in line, each the perfect distance and angle from the last, carefully balanced on end and poised for any slight shock to send the entire chain tumbling down. Emotional memories may be triggered by something like a car door slamming shut. A toddler memory may be submerged regarding something as trivial as mom and dad fighting over who has to carry in the groceries and the car doors were slammed shut violently. To a toddler the words may not mean as much as the tone and the violent sounds. A description of brain cell connections without the dominoes analogy is available on ScienceDaily: Brain pattern flexibility and behavior, (ScienceDaily)

 

After the event, immediately, and maybe later that day, the next day, the next week – the toddler may pester with questions of what is wrong and what did I do to cause that fight? The child’s world is centered around themselves – natural while young but prone to self blame. The memory can be stored with feelings of “I caused that arguement – I am a bad person – I don’t deserve attention or explanation” and so on. If their worries are left unanswered or are denied as real then the hot memory is ignored and is left unprocessed, instead it is pushed down and forgotten at the daily level. A car door slamming with a combination of shouting voices might trigger a panic attack though.

 

The hot memory can be toned down and moved to long term storage if time is allowed to discuss the event – and more than once. It might pop up in the toddler’s chit chat daily, and then weekly, monthly, and maybe even over the years if it was bad enough triggering event. Once the connection is made though, (negative event associated with a negative symptom) and discussed, usually the power of the slamming/shouting sound is reduced and similar events in the future may not trigger a panic attack or it might  be a milder reaction.

 

Children are absorbing knowledge and building their neural pathways – good habits and bad habits are learned by watching the people they love and trust. Spending a few minutes whenever possible to listen to children share their worries allows them to move the memories from the ‘hot’ button zone of the amygdala, to the mellower long-term storage of the neocortex.

 

Symptoms of PTSD, Post Traumatic Stress Disorder, can be effectively reframed  and reduced using cognitive therapy techniques like EMDR. A problem or trigger event is visualized and then a state of deep relaxation is reached and the memory is discussed or pondered with guidance from the therapist. New insights from the perspective of the adult framing of the situation can be considered and then the relaxation method is repeated using the new perspective.  The neural maps of the traumatic events can be reached  from a deeply relaxed state of theta waves. EMDR, attempts to help the patient reach the theta state with rapid stimulation of the right side then left side of the brain, either visually with a moving hand or object, or with sound or a vibration buzz in the palm of the hand. Children under seven are already living in this more meditative level of consciousness. In the zone – flow time – playing like a child – we could all use a little relaxed theta time these days and a chance to free a little worry from the hot zone of the amygdala.

 

The world is changing but denying reality never solves problems it only pushes them down to a submerged hot zone. When we talk about our troubles then we can look for solutions and change. Denying problems, denies a chance for change.

 

Art therapy can be a useful way to give children and anyone freedom to explore feelings – color to feel not to produce. Playdough and other free form play can help reach a relaxed state where gentle talk about hot topics can be released  as they surface. Picking at the problem with needling questions may not be as quick as open ended play time. Adults may find a walk or bike ride their ticket to free flow brain time.

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Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

  1. Terrorism, and talking to kids about catastrophic mass violence, guidance sheets from The National Child Tramatic Stress Network [nctsnet.org/trauma-types/terrorism]
  2. by Carol Boulware, MFT, PhD, “EMDR Therapy, EMDR Therapists, EMDR information, PTSD,” [emdr-therapy.com/].
  3. by Carol Boulware, MFT, PhD, “EMDR-Breakthrough Therapy for Overcoming Anxiety, Stress,Trauma and Self-Sabotage,” [emdr-therapy.com].
  4. by Carol Boulware, MFT, PhD, “Do I Have Anxiety Needing Therapy?” a discussion about anxiety and PTSD focused on adults [emdr-therapy]
  5. The National Child Traumatic Stress Network [nctsnet.org/]
  6. Trauma and Your Family – a guidance factsheet from The National Child Traumatic Stress Network pdf: [nctsn.org]
  7. by Tanya Anderson, PTSD in Children and Adolescents, Great Cities Institute, GCP-05-04, November, 2005  pdf: [uic.edu]
  8. This website is a non-profit 12 step based program for the Adult Children Of Alcoholic (or Dysfunctional) Families. PTSD and neural mapping aren’t discussed but the symptom list includes similar problems: The Laundry List – 14 Traits of an Adult Child of an Alcoholic (or Dysfunctional Family) ,  [adultchildren.org]

Alp Luachra, an old name for edematous malnutrition

Alp Luachra is a Celtic fairy with a pet newt. It was considered dangerous to fall asleep near a stream. Alp Luachra might climb into the victim’s mouth along with his pet newt. They would live in the stomach and gobble up nutrients while the rest of the accursed person shriveled away. No matter how much the victim would eat they would eventually starve – because Alp Luachra leeches all the nutrition away. I learned of him from my new book, Tarot of the Celtic Fairies. The picture on the Tarot card does resemble edematous malnutrition with a very round belly and thin, starved looking arms and legs. Maybe it does exist outside of the tropics. (The 9 of Cauldrons card from  Tarot of the Celtic Fairies 14)

Kwashiorkor, (that rare tropical form of malnutrition in toddlers weaned from breast feeding too rapidly, and/or from lack of introduction of insects to the diet at the appropriate stage), has been in the news. An insurance billing watch dog group found an increased use of the diagnosis code for kwashiorkor/malnutrition in a group of California hospitals. Prime Healthcare Service’s response to the allegations that a diagnosis of malnutrition was used to increase reimbursement states that the facts were distorted in order to mislead the public and gain concessions. It continues that the “relevant (i.e., where the diagnosis affected reimbursement) malnutrition rate at all Prime Healthcare hospitals was 3.6%,which is much less than the rates referenced in the article. For example, their relevant malnutrition rate at Huntington Beach hospital was 5.3% rather than the 39% reported by California Watch.”

That seems reasonable to me. It continues to review the disturbing prevalence of malnutrition and their screening program that Prime Healthcare hospitals use for improving patient care and decreasing morbidity and mortality rates a nutritional screening for their elderly patients is part of their routine care.

Published studies estimate that up to 15% of ambulatory elderly patients, up to 44% of homebound elderly patients, up to 65% of hospitalized elderly patients, and up to 85% of nursing home patients are malnourished. Hajjar, R.R., Kamel, H.K., Denson, K., Malnutrition In Aging, The Internet Journal of Geriatrics and Gerontology, Volume 1, Number 1 (2004); Chen, C.C-H, Schilling, L.S., Lyder, C.H., A Concept Analysis of Malnutrition In The Elderly, Journal of Advanced Nursing, Volume 36(1) (2001).

** Prime Healthcare sounds like a good place for dietitians to work. A nutrition screening by a Registered Dietitian is vital for quality preventative health care. A multidisciplinary team allows a thorough assessment from multiple viewpoints – a stethoscope or a microscope or a little Celtic sparkle – who knows the health solutions that teamwork can bring. However, I was just reading about albumin on RD411, an information website, today [16]. I learned that low albumin is not considered useful to tell if a patient is malnourished because it is easily influenced by many factors besides dietary protein intake. However, at the same time I learn that it is associated with increased mortality and morbidity – so I am left to assume that  I needn’t consider the elderly person with an albumin of 7 or 8 as ‘malnourished’ but just to consider them at increased risk of morbidity and mortality instead. The recommendation is to continue dietary calculations as normal, but instead of pouring another Health Shake to add to the malabsorbtion mess I would rather consider what is causing the shift in fluid and what might be better absorbed than what we already have been trying.

In research by Yi-Chia Huang et al, the elderly Taiwanese population had an intake range of 573.9 to 3191.9 kcal/day and no association between functional status and intake could be made.  Intake of at least 55 grams protein per day was associated with better function but higher levels of protein intake again could not be correlated to improved status. [7] In cases of malabsorption we can pour in 3000 calories per day and there will be no guarantee that it will be more helpful than 573. It would probably be more harmful than low intake. Anything that passes through the body has to be brought into safe balance with the chemical needs of the intestinal lining. Magnesium is a buffer that is taken from the bones to “fix” over acidic conditions. High protein, dairy and sugar intakes add to acidic conditions and coffee, carbonated beverages, black tea, and fruit juices can be very acidic. For strong bones try choosing an herbal or green tea and pass on the extra large glass of pop or milk and the triple shot of alcohol too probably.

There is controversy over using just the albumin level for a diagnosis of malnutrition and it is true that short term edema – puffiness – will cause low albumin levels while puffy. With less fluid in the blood and more fluid in the spaces between cells and organs there will be less albumin. It is a blood protein that acts a little like a sponge to attract and keep fluid around it but where the fluid goes it is also attracted to follow. Circular paths are the way of nature. The albumin level that remains low for months – rather than during an acute week of an illness – I would strongly consider the possibility that an underlying malnutrition problem is the cause of puffiness and low albumin, the reasons for the initial malnutrition can vary but once the poor absorption starts the problems picks up pace and the body deteriorates from feeding on itself – there isn’t a newt but there is a brain, heart and lungs as long as the fingers, toes and remaining peripherals hold out (reminder Buerger’s vasculitis disease [15]).

One lab test can be supported by other labs and observed signs and symptoms of health or weakness. Several studies have found that assessing frailty factors seems more correlated with a variety of quality of life factors and improved surgical recovery rates than BMI. More than 3 of 5 of the following – unintentional weight loss, weakness, self-reported poor energy, slow walking speed, and low physical activity  was found associated with risks of falls and fractures. Hand grip strength, and calf muscle to fat area, mid arm circumference, sarcopenia were mentioned as measurements of improved muscle mass with improved health status. Sit ups and leg lifts or just a walk in the woods – better muscle mass is associated with longer life.

Based on the sensitivity of the autoimmune gut and my review of kwashiorkor research, I would surmise that a gluten free, lactose free, low calcium to magnesium ratio with an increase in glucosamine and other essential sugars (super starches) and plenty of B vitamins, C, A, zinc, selenium might help the catabolic patient with edema. We need to provide building blocks that readily make a strong glycocalcyx to reduce the leakiness of the intestinal lining.

I am glad that Prime Healthcare has had to stand up for malnourished patient’s rights – the right to a diagnosis that is accurate. An albumin of 7 or 8 is tragic and just because it is from excessive dilution due to malabsorption/mal-retention and not due to lack of protein in the diet – doesn’t mean it isn’t leading to cell starvation. Just because we don’t quite understand edematous malnutrition and don’t seem to know how to stop it, doesn’t mean that it doesn’t exist and isn’t killing people in a very costly and agonizingly slow way.

Names matter and the tropics and kwashiorkor is simply where the problem was studied most. Edematous malnutrition is a better name for the condition in my opinion than protein calorie malnutrition. Over the long term edema means that the cells aren’t being well fed or well detoxified. During edema the movement of fluid is reduced and the movement of nutrients and toxins is slowed. Over the long term edema leads to dysfunction and malnourishment. If the fluid in our toilets backed up regularly we would expect the plumber to repair it not just measure the dysfunction. Puffy abdomen and ankles = overflowing waste = better call a doctor on the Prime Healthcare team in case malnutrition is involved (and remember to ask for a referral to a Registered Dietitian); maybe repair is still in the future but recognition is at least a first step.

Kwashiorkor occurs on the same diet as marasmus malnutrition but the children have different metabolic reactions. Recent infection may be associated with the kwashiorkor susceptible population. Their intestinal lining lacked glucosamine and excess fluid movement both directions was the result. An enzyme deficiency for the conversion of glucose or galactose into glucosamine seemed to be a significant difference between the two groups of children and aldosterone levels were also abnormal in the kwashiorkor children but not the maramus group. Edematous malnutrition exists outside of the tropics.
Glucosamine supplements may be crucial for heart disease and other leaky membrane problems (dementia). Zinc and selenium are low in heart disease and B6 and all of the B vitamins are essential for cell growth and energy demands. Vitamin C is also depleted rapidly. Our “health supplement shakes” and complete feeding formulas are not based on ratios that the critically ill can tolerate – they are more harmful than helpful. We need research and development of an isotonic formula with high levels of beneficial nutrients and low levels of a few things that add to the body burden .

In the meantime more magnesium, B complex, zinc, selenium, iodine, glucosamine, taurine, vitamin C, and beta carotene rich dark green and deep orange fruit and vegetables may be helpful to the chronically ill and obese. Mushrooms, aloe vera, fenugreek, slippery elm powder and ginger also have essential sugars – super fiber for building a strong glycocalyx. The intestinal lining is an organ that protects and nourishes our bodies for miles – literally – do we want junk food littering the way or a strong yet fluid, free-form matrix of super starches, trace mineral ions lighting up the place and plenty of strong white blood cells patrolling for trouble.  Cancer wouldn’t stand a chance – or at least reduced chance.

***11-7-11 BTW I figured out what’s happening with the leaky membrane problem – its complicated – call me or read the [bazillion words, “Cantaloupe, listeria, and sea squirts, oh my,” Oct. 5, 2011]

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 /Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./
  1. Olubukola O. Nafiu et al., “The Association of Body Mass Index to Postoperative Outcomes in Elderly Vascular Surgery Patients: A Reverse J-Curve Phenomenon,” Anesthesia & Analgesia 112, no. 1 (January 1, 2011): 23 -29.
  2. Ian M Chapman, “Obesity paradox during aging,” Interdisciplinary Topics in Gerontology 37 (2010): 20-36.
  3. S L Miller and R R Wolfe, “The danger of weight loss in the elderly,” The Journal of Nutrition, Health & Aging 12, no. 7 (September 2008): 487-491.
  4. Ian Janssen, “Morbidity and mortality risk associated with an overweight BMI in older men and women,” Obesity (Silver Spring, Md.) 15, no. 7 (July 2007): 1827-1840.
  5. Kristine E. Ensrud et al., “Frailty and Risk of Falls, Fracture, and Mortality in Older Women: The Study of Osteoporotic Fractures,” The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 62, no. 7 (July 1, 2007): 744 -751.
  6. Meei-Fang Lou et al., “Nutritional status and health outcomes for older people with dementia living in institutions,” Journal of Advanced Nursing 60, no. 5 (December 2007): 470-477.
  7. Yi-Chia Huang et al., “Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan,” J Am Coll Nutr 20, no. 2 (April 1, 2001): 135-142.  (free article)
  8. Matteo Cesari et al., “Frailty syndrome and skeletal muscle: results from the Invecchiare in Chianti study,” The American journal of clinical nutrition 83, no. 5 (May 2006): 1142-1148.  (free article)
  9. H K Vincent, K R Vincent, and K M Lamb, “Obesity and mobility disability in the older adult,” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 11, no. 8 (August 2010): 568-579.
  10. Heppenstall, et al, “Frailty: dominos or deliberation?,” N Z Med J. 2009 Jul 24;122(1299):42-53. http://www.nzma.org.nz/journal/122-1299/3710/.
  11. Fred Chau-Yang Ko, “The clinical care of frail, older adults,” Clinics in Geriatric Medicine 27, no. 1 (February 2011): 89-100.
  12. Stephane M Schneider et al., “Lack of adaptation to severe malnutrition in elderly patients,” Clinical Nutrition (Edinburgh, Scotland) 21, no. 6 (December 2002): 499-504.
  13. Lilian Liang et al., “Nutritional issues in older adults with wounds in a clinical setting” 1: 63-71.
  14. McElroy, Mark, Tarot of the Celtic Fairies, artwork by Eldar Minibaev, (2010, Lo Scarabeo, Via Cigna 110 – 10155 – Torino- Italy _www.loscarabeo.com_ (I hope this will be viewed as a brief extract and recommendation rather than copyright infringement.  I find Tarot cards a meditative cognitive therapy aid – solitaire for the brain.)
  15. http://www.hopkinsvasculitis.org/types-vasculitis/buergers-disease/ ***I discussed it in my article Vasculitis – Withering from Within.The main cause of this type is smoking and the best treatment is to quit smoking. Smoking depletes oxygen and antioxidants and magnesium – malnourishment from within – second best to quitting smoking would be of course to replenish with extra vitamin C and magnesium supplements and foods and some oxygen would help also vitamin A foods – supplements have not been helpful but the food has helped . . . carrots, peaches, sweet potatoes, tomatoes, broccoli and V8, mangos, apricots and cantalope.
  16. http://www.rd411.com/index.php?option=com_content&view=article&id=393:albumin-as-an-indicator-of-nutritional-status&catid=105:professional-refreshers&Itemid=400
  17. see my previous blogs Angelina please don’t risk the knife, and We are what we eat, for more Bibliography on kwashiorkor, insects and perimenopause.
  18. see my previous blogs on the glycocalyx and Electrolytes R Us, for more on leaky membranes and hydration.
  19. http://www.highbeam.com/doc/1G1-250812435.html . “Prime Healthcare Services Review of State Health Data Confirms Normal Malnutrition Rates Among Its Medicare Patients; Recent Studies Debunked.(Clinical report).” PR Newswire. PR Newswire Association LLC. 2011. HighBeam Research. 9 Apr. 2011 http://www.highbeam.com.

From a different list of reading:
7. Yi-Chia Huang et al., “Nutritional Status of Functionally Dependent and Nonfunctionally Dependent Elderly in Taiwan,” J Am Coll Nutr 20, no. 2 (April 1, 2001): 135-142.  (free article)

Excerpt from Conclusions section:
“There were approximately 36% of functionally dependent subjects who consumed energy less than 75% of the Taiwan RDNA in our study. The elderly with functional dependence might have more difficulties in accessing food. However, we could not find an association between energy intake and functional status. This might be due to large variations of energy intake among individuals ranging from 573.9 to 3191.9 kcal/day.
Consistent with Payette and Gray-Donald [24], the elderly had sufficient mean protein intake, but these authors’ association between protein intake and serum albumin concentration was not found. Morgan et al. [6], however, indicated a positive relationship between protein intake and serum albumin concentrations. It is worth noting that the association was valid only up to protein intake of 55 g/day. Since our subjects had a varied protein intake ranging from 23 g/day to 122 g/day and half of the subjects had a protein intake .55 g/day, the dietary protein intake might no longer have an effect on serum albumin concentration. Another possibility was that chronic conditions play a determinant role in affecting the albumin concentration.”

***Note on vitamin D – The chronically ill may have depressed 25-D levels because they have elevated 1,25 D levels resulting in more than enough of the active hormone for preventing fractures even though the vitamin level seems insufficient for the average person.

The enzyme to activate the vitamin to the steroidal hormone is made by white blood cells as part of the stress/inflammation response and in some cancer cell strains. An active D level above 45 means the bones are losing calcium stores. My five year 1,25-D average, while actively avoiding vitamin D foods, supplements and much time in the sun, was 59 pg/ml and my five year average 25-D was 20 ng/ml. The range was 51-71 pg/ml, 1-25-D and 8.0-26.7 ng/ml for 25D. Ex: 3-31-2009 25-D of 9.0 and 1-25D of 53 pg/ml. If I spend a day on the beach I am hurting two days later from the calcium that is drawn out of the bones – muscle spasms, fatigue and irritability symptoms primarily for me but ringing in the ears and a twitching eyelid have been reduced with magnesium. B vitamins and zinc tend to be involved to – magnesium rich foods would provide those as well as iron and iodine only if it was grown in iodine rich soil.

Kwashiorkor Bibliography

  1. http://www.ajcn.org/content/89/2/592.long ***Reduced production of sulfated glycosaminoglycans occurs in Zambian  children with kwashiorkor but not marasmus also good –
  2.  http://www.icmr.nic.in/ijmr/2009/November/1128.pdf  Tahmeed Ahmed, Sabuktagin Rahman and Alejandro Cravioto, Oedematous malnutrition,  Indian J Med Res 130, November 2009, pp 651-654
  3.  http://www.pe.com/localnews/stories/PE_News_Local_D_malnutrition20.27e2afa.htmlWilliams, L., Jewett, C., and Doi, S. K., Hospital chain, under scrutiny, reports rare illness (The Press Enterprise Local News)
  4. http://www.pe.com/localnews/opinion/editorials/stories/PE_OpEd_Opinion_D_op_27_ed_primehealth.1816fbc.html  Shady billing? (The Press Enterprise)
  5. http://www.sacbee.com/2011/02/20/v-print/3414850/medicare-billed-for-exotic-illness.html
  6. Prime Healthcare Should Be Denied New Hospital Licenses Until Federal, State Investigations into Extraordinarily High Septicemia, Malnutrition Rates and Risk to Patients are Complete.Business Wire. Business Wire. 2011. HighBeam Research.
  7. http://online.wsj.com/article/SB10001424052748703293204576106072340020728.html  Marcel Dicke, Arnold Van Huis are professors of entomology at Wageningen University in the Netherlands.  (2-19-11, The Wall Street Journal, pC3)  The Six-Legged Meat of the Future
  8. http://onlinelibrary.wiley.com/doi/10.1111/j.1525-139X.2010.00705.x/abstractEffect of Diabetes Mellitus on Protein–Energy Wasting and Protein Wasting in End-Stage Renal Disease, Nazanin Noori1, Joel D. Kopple1,2Article first  published online:13 APR 2010DOI: 10.1111/j.1525-139X.2010.00705.x
  9. http://www.ncbi.nlm.nih.gov/pubmed/19121473  Semin Nephrol. 2009 Jan;29(1):39-49. Causes and prevention of protein-energy wasting in chronic kidney failure. Dukkipati R, Kopple JD. Division of Nephrology and Hypertension, Los Angeles Biomedical  Research Institute at Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
  10. http://www.ncbi.nlm.nih.gov/pubmed/19121477 Semin Nephrol. 2009 Jan;29(1):75-84. Nutrition support for the chronically wasted or acutely catabolic chronic kidney disease patient.Ikizler  TA.Department of Medicine, Division of Nephrology, Vanderbilt University School of  Medicine,Nashville, TN 37232-2372, USA.
11. http://www.ncbi.nlm.nih.gov/pubmed/16129200Am J Kidney Dis. 2005 Sep;46(3):387-405. Multinutrient oral  supplements and tube feeding in maintenance dialysis: a systematic review and meta-  analysis. StrattonRJ, Bircher G, Fouque D, Stenvinkel P, de Mutsert R, Engfer M, Elia  M.Instituteof Human Nutrition, University of Southampton, UK.

12.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2891019/?tool=pubmed New Insights into the Role of Anabolic Interventions in Dialysis Patients with Protein Energy Wasting Jie Dong and T. Alp Ikizler1 Curr Opin Nephrol Hypertens. Curr Opin Nephrol Hypertens. 2009 November; 18(6): 469–475.doi: 10.1097/MNH.0b013e3283 31489d.

 “Economic Implications of Nutritional interventions It is also important to assess the impact of nutritional supplements not only in terms of changes in nutritional parameters, but to extrapolate these observations to potential improvements in hospitalization, mortality, and cost-effectiveness. In a recent study, Lacson et al showed that a hypothetical increase in serum albumin concentration in the order of 2 g/L in 50%  of the United States dialysis population would be associated with  projections of approximately 1400 lives saved, approximately 6000 hospitalizations  averted, and approximately $36 million in Medicare cost savings resulting  from a reduction of approximately 20,000 hospital days over one year[68]. This is a reasonable estimation since 2 g/L increase in serum albumin is the average improvement reported in most nutritional intervention studies.”

***The above paper is suggesting that giving them growth hormones  and other anabolic steroids along with protein will help them to stop catabolizing and start building albumin. They have had success with the strategy, but wouldn’t magnesium plus protein (ideally combined within the same magnesium foods) be cheaper than hormones and protein?

Dietitian Recommends less Vitamin D and Calcium

We can cure the epidemic of ill health and obesity that has seized our nation and the world. The food supply is low on some important nutrients and has too much focus on calcium. Calcium is important but health is built on a variety of essential nutrients, and clean air and water of course.
We can have health if we seek to rebuild instead of hunt for a disease to name and for a magic bullet cure. There will always be a need for acute care but we are overloading the medical system with chronic degenerative disease. Chemotherapy kills and so do corticosteroids. They are powerful drugs that are aimed at the disease but our bodies get in the way. Food that nourishes with a full range of essential nutrients in forms that can be absorbed and used can help us heal ourselves from within.
We are designed to fight cancer and to rebuild organs using our own stem cells and white blood cells but we can only do that if they are working right. White blood cells protect us by patrolling for old, pre-cancerous or infected cells. The bad cells can be mercy-killed in a process called apoptosis. We grow new skin cells every day and new intestinal cells weekly. New cells of whatever type we need can be rebuilt from our own stem cells. Any organ can be ours for the making – if we have the essential nutrients in our food supply in a mixture that we can absorb.
Our food supply isn’t providing us with the variety of nutrients that we need, in ratios that we can absorb well. Our nutrient guidelines were developed in the 1940’s to help make K-rations that could keep our soldiers strong and healthy under conditions of war.  The original work has been reviewed and modified by the Institute of Medicine. The calcium guidelines were increased in 1997 and while they have been reviewed they haven’t been changed since. The increase was based on an estimation of how much calcium might be needed for better bone absorption.
Do we have stronger bones now as a nation then we did in 1996? That is a simple question with a simple answer – no.Our nation’s diet was changed in 1997 and since then chronic illness, obesity and osteoporosis rates have been expanding quicker than our budgets or belts.
We can’t grow strong bones out of excessive calcium and vitamin D supplements. Bones do require some vitamin D and calcium but we also need magnesium, strontium, vitamin K, and water to name a few essential nutrients.
Calcium is being consumed at levels that our bodies are not able to excrete. The kidneys actively save calcium and use magnesium to remove acidic wastes and some of the excess calcium. Diuretics and alcohol use also increase magnesium losses. Magnesium is lost in sweat but many brands of electrolyte beverages don’t contain it. Our food supply is low in magnesium and high in calcium from dairy products, fortified foods, and supplements.
The dairy products available in our U.S. food supply in the year 2007 provided 716 milligrams of calcium in just 351 calories of cheese and milk per day. Many people eat more than 351 calories of dairy products daily. On average we are consuming more cheese and less milk than we did prior to 1970. Cheese is a more concentrated source of fat and calcium than liquid milk.
Toddlers (n=925) usual intakes from food, beverages, and supplements as reported in FITS 2008 provided on average 892 mg/day of calcium and 160 mg/day of magnesium.
The abnormal vitamin D levels have been misunderstood. Low lab values are linked to ill health and obesity but more of the vitamin won’t fix the underlying problem. The mega-dose is a short term fix but not a long term cure for chronic illness and cancer. It is considered safe for everyone but it is only safe for those with healthy kidney control over the activation of vitamin D to hormone D. High levels of the active hormone D can cause health problems to worsen over time, adding to chronic degeneration.
Vitamin D has two forms and two lab tests of interest, and one test is more expensive. The cheap lab test for 25 hydroxy D (Dᴣ), is what most of the research is based on. It is the inactive form of the vitamin and is available as a supplement. It is considered safe at higher doses because it is assumed that all people, not just healthy people, have very good kidney control over the activation of the vitamin to the hormone. The enzyme needed for activation to 1,25 dihydroxy D is being produced uncontrollably by inflammatory white blood cells and it has been shown to be produced by some cancer cell strains as well.
We are not deficient in vitamin D and haven’t been since milk fortification was begun. The average American’s serum 25-D levels were normal, above 20 ng/ml and Canadian’s had average levels around 24 ng/ml, also normal, from a 2009 Institute of Medicine report. An increased risk of fractures has not been observed at these levels. [4]
Lack of sunlight is not a problem either, according to the research by Dr. James Norman. He has put together a database of over 10,000 patients with hyper-para-thyroidism from around the world who live under a wide range of sunlight conditions. Their vitamin 25-D levels average 19.4 ng/ml, but their active hormone, 1-25 D levels and calcium levels are very high no matter where they live. As soon as their para-thyroid tumor is removed their bodies’ 25-D and 1-25 D balance normalize, no matter where they live.
Dr. Norman, does not recommend supplementing with vitamin D. The supplements push the patient’s lab values for 1-25 D and calcium even higher. He has multiple case examples where stroke or sudden illness occurred after vitamin D supplementation was begun by the patient’s endocrinologist. His seminar about it is on Youtube, listed under ParaThyroid TV, and is posted on my webpage.
I recently started working at an assisted living facility and many of the residents were started on high doses of vitamin D by their individual doctors about a year ago when this research was first getting popular. I read charts cover to cover – and I saw their quality of life deteriorate, their pain levels increase, and worsening of their weakness, cardiac symptoms and dementia, and one death. High doses of vitamin D may not be safe for unhealthy people.
Our public health initiatives have been successful at preventing rickets in the majority; we already won the battle against vitamin D deficiency. Many foods are now fortified with vitamin D not just milk. I met about 4000 babies in fifteen years as a WIC dietitian and only one showed early symptoms of rickets. He was exclusively breast fed and he and his mother both had severe milk protein allergies. They both took to sardines which are an excellent natural source of vitamin D, and supplements were never even needed for the little boy.
We are not vitamin D deficient but we do have a sub-population of chronically ill and obese people with depressed levels of the inactive form of the vitamin. The inactive vitamin Dᴣ is being activated at an unlimited rate in some cancer cells and by white blood cells in wound and inflammatory conditions, resulting in elevated levels of the active hormone form.
Increased levels of the active hormone cause movement of calcium and magnesium out of the bone which eventually leads to osteoporosis of the bone and calcification of everything else. It increases intestinal absorption of calcium and it can increase levels of cortisol, the stress hormone. [39] Too much cortisol can increase abdominal weight gain but it also acts like corticosteroid drugs on the immune system.
Activated hormone D leads to increased cortisol and a short term reduction in inflammatory symptoms because it kills off the overactive white blood cells. However it also kills off the healthy ones. Mega doses of vitamin D are being used in a way similar to corticosteroids. Ultimately the immune system is functioning even worse. The current increase in allergic sensitivities to foods like gluten and peanut butter is due to the over active white blood cells. If we kill off the white blood cells then we won’t get the allergic symptoms as bad but we may get more colds, skin infections, and other illnesses.
Mega-dosing with vitamin D is like paying for Prednisone, if we’re sick and for an expensive cholesterol supplement if we’re healthy. 
Vitamin D is actually a very powerful steroidal hormone based on cholesterol. The average American is making enough vitamin D from their stored cholesterol. Vitamin D is an expensive cholesterol supplement if you don’t need it.[1]  If you are worried about whether you need a supplement or currently are supplementing with vitamin D, then ask your medical provider for both lab tests, cheap and expensive, 25 hydroxy D and 1, 25 dihydroxy D.  The good news is that the combined test result comparison will serve as a biomarker to show who does have chronic inflammatory conditions – proving that fibromyalgia isn’t all in our heads.
Low levels of 25-D combined with high levels of 1,25 D is an abnormal balance that is not seen in the healthy person with good kidney control.It occurs due to the increased production of the activating enzyme in the cancer cells or infected cells. Autoimmune disease may be due to a variety of chronic infections that are not readily identifiable by today’s standard lab tests.
Excessive levels of the active vitamin D cause the bone to lose calcium and magnesium. Too much calcium can cause muscle cramps, increase pain, and can cause anxiety, irritability and headaches.
We need less calcium then we are getting on average and more magnesium. If we limit our intake to 800 mg calcium we should absorb magnesium better, but we still need about twice as much magnesium as we are currently getting. Nuts, beans, seeds and greens are all excellent sources of magnesium and so is chocolate. Just two and a half dairy servings per day, about what is recommended already, would provide adequate calcium for strong bones without overloading our intestines. Too much calcium is causing magnesium to be poorly absorbed in the intestines and to be wasted in urinary losses.
Magnesium blocks calcium channels in cell membranes and would protect the brain cells from being over-flooded with calcium and being overworked to the point of cell death. The over-excitation of the brain cells causes anxiety and irritability and may be underlying the increase in rates of bullying and violence. PMS is another name for magnesium deficiency that is associated with excessive irritiability and chocolate cravings (a good source of magnesium).
Magnesium provides power inside of the cell – fatigue is a common symptom of magnesium deficiency. Anemia and edema are early symptoms of magnesium deficiency. It is essential for the growth of mature red and white blood cells in bone marrow. It is used by over 300 enzymes and it is essential for apoptosis – the mercy killing of infected and precancerous cells. Hypertension and increased serum cholesterol and insulin are also symptoms. If I were writing the books, then Metabolic Syndrome would be called magnesium deficiency and so would pre-eclampsia.
We can heal ourselves, if we learn how to feed ourselves better and repair the food supply and nutrient guidelines.I recommend stopping the push to supplement with vitamin D and calcium and instead I would encourage trying the DASH diet plan. It was a primary education tool that I used successfully to prevent pre-eclampsia reoccurrence in high risk women. The DASH diet provides a good supply of magnesium from the Bean, Nut and Seed food group. The plan has been found helpful for weight loss as well as reducing hypertension.
I propose ten steps for turning around our epidemic of chronic illness and obesity
  1.  Look for health in Food First, treating symptoms does not restore function.
  2. Increase Magnesium in water and other electrolyte beverages. Softened water adds salt to our daily intake and sucks magnesium from our bones.
  3.  Increase magnesium rich foods. They also give us fiber that builds a healthy glycocalyx lining and stronger immune system. Beans, nuts, seeds, greens, whole grains and chocolate are good sources and there is a little in everything else.
  4. Sub-populations need to be identified and informed about their individual nutrient needs, whether increased or decreased from the average person’s to promote optimal health and quality of life.
  5. Poor intestinal absorption of magnesium is part of the problem. We can deliver nutrients from other directions. Skin lotions and Epsom salt (MgSO4) baths are low budget, low risk and very effective methods. [35, 36, 37]
  6.  Nutrients can be delivered by inhalation in an aerosolized  form that would be safer than intravenous magnesium use. [30, 31]
  7.  Limit calcium intake – more is not better. We will retain more when we consume less. The research on strong bones and calcium supplements were for people whose native diet averaged 300 mg calcium per day – not our current RDA of 1000 mg.
  8. Don’t worry about D deficiency and if you are worried then ask for both tests, the inactive and active form of the most powerful hormone in our body.
  9. Ask your government representatives to support food labeling reform. Neotame and free amino acids may be causing migraines, seizures and lead to dementia.
  10. We need our Nutrient Guidelines – the math – checked by a multi-disciplinary team of scientists who use the numbers – food scientists, dietitians, and biochemists should be involved. The math makes our infant formulas and cafeteria menus and when it is wrong then we all suffer.
All nutrients are equally essential. Currently our food supply and health care messages are over-loaded with calcium and vitamin D and it is hurting us. Draining the magnesium from our bones is draining the energy and fluid from our cells and leaves us puffy and pale from anemia. Without magnesium we can’t grow proper blood cells and without healthy white blood cells we can’t protect ourselves from infections and we can’t breakdown decaying, pre-cancerous cells for normal recycling.
Cancer occurs from old cells mutating. Healthy white blood cells can kill the active cancer too. The Linus Pauling Institute successfully treats tumors with high doses of vitamin C. The Gerson Clinic successfully uses a raw foods approach and detoxification with coffee enemas Not too pretty sounding but chemotherapy isn’t pretty either. Why do we continue to hurt people with harsh chemicals when nature gave us what we need in whole foods and the potent herbs and spices. Cinnamon, oregano and rosemary have shown promise in chronic illness. Spice up your lives and enjoy.
Our bodies can do it, we just have to feed ourselves an absorbable balance of a wide variety of essential nutrients.

See Bibliography on the page with this title. I will continue to add to it as I get it organized .

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. Please see an individual health care professional for individualized health care services. If you have questions or comments please contact me at: jenniferdepew@jenniferdepew.com