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Chronic functional constipation is strongly linked to vitamin D deficiency

World J Gastroenterol. 2019 Apr 14; 25(14): 1729–1740.

Alba Panarese

Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. [email protected]

Francesco Pesce

Nephrology section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70013, Italy

Piero Porcelli

Department of Psychological, Health, and Territorial Sciences, D’Annunzio University of Chieti-Pescara, Chieti 70013, Italy

Giuseppe Riezzo

Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Palma Aurelia Iacovazzi

Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Carla Maria Leone

Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Massimo De Carne

Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Caterina Mammone Rinaldi

Department of Radiology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Endrit Shahini

Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy

Alba Panarese, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. [email protected];Author contributions: Panarese A has conceived the protocol; Shahini E and Panarese A drafted the initial and final manuscript; Panarese A enrolled patients; Panarese A, and Leone CM collected in a database the baseline and on-treatment information; Shahini E, Pesce F and Porcelli P systematically reviewed the data entries for completeness and consistency, checked for completeness of information and performed the statistical analysis; all the authors reviewed and approved the final draft.

Corresponding author: Alba Panarese, MD, Doctor, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Turi Street n. 27, Castellana Grotte (Bari) 70013, Italy. [email protected]

Telephone: +39-3471401487; +39-0804994251 Fax: +39-0804994250

Received 2019 Feb 16; Revised 2019 Mar 11; Accepted 2019 Mar 24.

Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

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Abstract

BACKGROUND

Few studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not well-defined.

AIM

To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.

METHODS

We performed a prospective case-control study, from May-June to November 2017. Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis were used to assess colonic and oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life (IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D).

RESULTS

We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests (IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group (P < 0. 001), which significantly correlated with low vitamin D levels (r = – 0.57, P < 0.001; r = 0.21, P = 0.01; r = – 0.48, P < 0.001; r = – 0.57, P < 0.001; r = – 0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).

CONCLUSION

Vitamin D deficiency, anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders. Vitamin D serum levels should be routinely measured in these patients.

Keywords: Chronic constipation, Intestinal motility, Vitamin D, Quality of life, Anxiety, Depression

Core tip: Intestinal motility disorders, which are disabling conditions associated with chronic constipation, have been examined in only A few studies. Patients with intestinal motility disorders are frequently affected by vitamin D deficiency, which is strongly associated to anxiety, depression symptoms and to severe impairment of quality of life. These data suggest that vitamin D serum levels should be routinely measured, and its supplementation should be evaluated in patients with intestinal motility disorders.

INTRODUCTION

The term “Constipation” has a broad definition both for physicians and patients[1]. The most common form is functional chronic constipation, which is a gastrointestinal disorder defined by symptom criteria, after the exclusion of secondary causes[2-4]. This clinical condition usually affects women, older subjects, particularly those of lower socioeconomic status[5], and has a prevalence ranging between 2% and 27% in western countries with a high burden on global health-care system[2,6,7]. The main symptoms of functional chronic constipation are difficulty with evacuation, bloating, abdominal pain, discomfort or hard stools that significantly impair health-related quality of life[2,8]. Since depression has been commonly observed in patients with the constipation variant of irritable bowel syndrome (IBS), specific questionnaires have been endorsed to evaluate some aspects of the quality of life of these patients, especially the IBS Quality of life (IBS-QOL), the Short Form Health Survey 12 (SF-12), and the Hospital Anxiety and Depression Scale 14 (HADS-14-A/D)[9-12]. Moreover, previous studies showed a possible role of vitamin D deficiency in the pathophysiology of IBS and depression, and also beneficial effects of vitamin D supplementation in alleviating depression and certain gastrointestinal symptoms in a population of study prevalently affected by diarrhea or by alternating subtype, and the minority by constipation symptoms[13-20]. Normal transit constipation is probably the most common form, and it frequently overlaps with the constipation variant of IBS[9].

Among patients with functional chronic constipation, intestinal motility disorders have been reported. Although the overall prevalence of intestinal motility disorders is not currently well-defined[2], it involves more commonly patients affected by slow transit constipation (STC)[2], and rarely subjects with delayed oro-cecal transit time[21], In addition, defecation disorders significantly overlap with normal and STC[9,22]. While STC is characterized by an altered colonic motor activity, and reduced reaction after a meal and when waking up, decreased “high amplitude propagated contractions”, which have been associated to altered regulation of enteric nervous system, reduction of neurons and axons in the myenteric plexus[2,22-24], delayed oro-cecal transit time could be partially associated with an underlying small-intestinal bacterial overgrowth (SIBO)[25].

Moreover, the most severe form of intestinal motility disorder may be considered chronic intestinal pseudo-obstruction, which is a symptomatic and disabling disease, related to a visceral myopathy or/and neuropathy[26]. Hence, colonic transit time could be objectively measured by radiopaque markers (single or multiple capsule techniques), and this diagnostic tool is also used to rule out dyssynergia defecation[2,23]. Radiopaque markers studies are useful, inexpensive and widely available[2,23]. In addition, even if not definitively recommended by guidelines, lactulose breath test (LBT) and glucose breath test (GBT), are commonly used in clinical practice to evaluate the presence of SIBO as well as small-bowel motility by estimating oral-cecal transit time[25,27]. Other expensive tests such as colonic scintigraphy and wireless ingestible motility capsule, measure more accurately overall transit time[23,27], whereas advanced physiologic tests identify anorectal dysfunctions in patients not responding to initial therapy[2,27]. In this paper we hypothesized that serum vitamin D deficiency could be associated with chronic functional constipation secondary to delayed intestinal transit time and consequently we investigated this relationship and the related psychological aspects.

MATERIALS AND METHODS

Study design

This case-control study was performed from May-June to November 2017, in the Outpatients Clinic of our Institution, in Apulia, a Mediterranean region located in southeast of Italy. As shown in Figure , we enrolled 86 subjects from a population of 152 consecutive constipated patients affected by intestinal motility disorders.

Flow diagram describing the process of patients’ selection. CT: Computerized tomography; ROM: Radiopaque markers.

Inclusion criteria were the following: Caucasian subjects ≥ 18 years old, body mass index (BMI) ≥ 18.5 kg/m2, affected by functional chronic constipation associated to delayed intestinal transit time, supported by Roma IV criteria[8,26,28]. Exclusion criteria were the following: Subjects > 75 years old, IBS, pregnancy, significant comorbidities such as cardiac, respiratory, chronic renal insufficiency, anorectal and pelvic floor dysfunctions, metabolic/endocrine (diabetes mellitus, hypothyroidism, hypercalcaemia, panhypopituitarism), medications (opiates, antihypertensive agents, iron preparations, anti-epileptic drugs, tryciclic antidepressants, anticholinergics or dopaminergics), organic (extra-intestinal mass, colorectal cancer, ischaemic or surgical stenosis, anal fissure, anal strictures, inflammatory bowel disease, intestinal malabsorption and diverticular diseases), neurological (Parkinson disease, multiple sclerosis, paraplegia, autonomic neuropathy, chronic intestinal pseudo-obstruction, gastroparesis, Hirschsprung disease and stroke), past psychiatric disease, and myogenic (scleroderma, amyloidosis and myotonic dystrophy dermatomyositis)[2,21,26]. In addition, we also assessed a control group of 86 healthy subjects (sex, age and BMI matched), recruited from a population-based cohort study of 150 healthy subjects, which underwent routine clinical exams in our Institute to check their healthy status, after excluding the presence of a functional chronic constipation during the clinical interview.

Our research was carried out in compliance with the Helsinki Declaration and procedures received approval by the Institutional review board of the National Institute of Gastroenterology “S. De Bellis” Research Hospital (0807/16) and by the Research Ethics Committee of the National Oncological Institute of Bari (CAAE:147/16) (Trial registration number: {“type”:”clinical-trial”,”attrs”:{“text”:”NCT03096704″,”term_id”:”NCT03096704″}}NCT03096704). Informed consent was obtained from all participants of the study. The statistical review of the study was performed by a biomedical statistician.

Definition of functional chronic constipation

All selected patients were inquired, before, for any possible secondary causes of functional chronic constipation, including alarm features, lifestyle factors and medical treatments and we also identified the response (or lack of) to previous treatment about constipation symptoms, by interviewing patients. Then, they were considered affected by functional chronic constipation only when they showed a frequency of evacuation less than twice a week with increased stool consistency[8,26,28]. All the selected patients underwent blood tests, colonoscopy, nutritional assessment (with daily food frequency questionnaires), stool frequency diary, LBT, GBT, wireless motility testing, radiopaque markers studies, and when required, tests for pelvic floor dysfunction, and psychological tests exploring patient’s quality of life.

Accordingly, when not eligible, patients were excluded (Figure ): 152 consecutive subjects affected by functional chronic constipation with intestinal motility disorders met the eligibility criteria, along with 150 healthy subjects. Patients and controls in each group were first randomly sampled from the pool of available individuals (152 with intestinal motility disorders and 150 controls) and, then matched for age, sex and BMI, using MatchIt[29]. This analysis resulted in 86 patients and 86 matched controls that were enrolled for the study. Our patients did not receive any pharmacological treatment before all evaluations.

Colonic transit time, breath tests and wireless motility analysis

The colon transit time was measured with radiopaque markers, using multiple capsule techniques (P and A Mauch CH-4142 Munchenstein). The patient ingested 1 capsule a day (at 9.00 am, during breakfast) for 3 consecutive days and each capsule with 24 different shaped radio-opaque polyurethane markers, and then performed abdominal x-rays (100KV) on day 7, at 9.00 am, to reconstruct the colon activity during the last week[30,31]. Normal transit time was considered about 30-40 h, whereas the upper limit, above 70 h. Markers scattered about the colon was due most likely to STC, whereas markers gathered in the recto-sigmoid tract was considered a defecatory disorder[5,27] (Supplementary material).

Moreover, LBT and GBT were used for measuring oro-cecal transit time. A rise in hydrogen of ≥ 20 ppm by 90 min was considered the cut-off value used to exclude SIBO for both tests[25]. Time to the second peak and rise of 5-10 ppm of hydrogen, or a level of positivity for methane ≥ 10 ppm on a breath test, were considered useful in estimating oro-cecal transit time[25,27,32] (Supplementary material). Wireless motility analysis was also used to quantify oro-cecal transit time (Smartpill, Medtronic, Sunnyvale, California, United States), in order to define the presence of a delayed small intestinal transit time. Normal small-bowel transit should be 6 hours or less[25] (Supplementary material). Finally, STC and/or delayed oro-cecal transit time were definitively endorsed when radiopaque markers and/or breath tests with wireless motility analysis identified a specific intestinal motility disorder[27].

Questionnaires for the evaluation of quality of life in patients with intestinal motility disorders

The IBS-QOL questionnaire is a 34-item tool validated to quantify quality of life in non-subtyped IBS patients, but also used to assess the severity of IBS-like symptoms, and psychological factors[10]. The SF-12 includes a subset of 12 items, used to assess the physical and mental health domain in many diseases. All these scores are converted into a standardized 0-100 score. Higher scores indicate a better self-reported health status[11]. Furthermore, the HADS-14 represents a global measure of psychological distress and includes 14 items, 7 of them evaluate anxiety symptoms, and 7 depressive ones. Each item is coded from 0 to 3. The total scores for anxiety and depression can range between 0-21, based on symptoms characteristics[12].

Vitamin D and parathyroid hormone levels measurement

Serum 25-hydroxyvitamin D [25-(OH)-D] (Supplementary material) and parathyroid hormone (PTH) levels were measured in patients and healthy controls within 1 hour from blood draw. Overall subjects were enrolled in the interval time of the year with major sunlight exposition, when 25-(OH)-D values are usually higher[13]. The 25-(OH)-D levels status was categorized as usually proposed by experts in literature: using a standardized cut-off (deficiency less than 20 ng/mL, insufficiency from 20 to 29 ng/mL and sufficient when equal or higher than 30 ng/mL)[13].

Statistical analysis

Screened patients and controls in each group were matched for age, sex and BMI using the nearest neighbor matching algorithm implemented in MatchIt[29]. Normal distribution of continuous variables was assessed with the Shapiro-Wilk test and data were expressed as mean and standard deviation and compared using Student’s t-test. Categorical variables were reported as percentages and compared using the Chi-squared test or Fisher’s exact test, when needed.

Spearman’s test was performed to evaluate possible correlations of vitamin D values with quality of life scores and psychological functions (IBS-QOL, SF12-PCS, SF12-MCS, HADS-14 A and HADS-14 D). The impact of the vitamin D levels on patient’s risk to have intestinal motility disorders was analysed using univariate and multivariate logistic regression analyses. The association between each explanatory variable and the outcome (intestinal motility disorders occurrence) was tested using the likelihood ratio test. We included in the multivariate model all explanatory variables showing a P < 0.05 at univariate analysis. For each variable included in the multivariate model, we calculated both unadjusted and adjusted odds ratios (OR), with their 95% confidence intervals (CI), and the level of significance (using the likelihood ratio test). Statistical significance was set at P < 0.05. All statistical analyses were performed using SPSS 23.0 software (SPSS, Chicago, IL, United States) and R version 3.4.3 (http://www.R-project.org/).

RESULTS

Characteristics of patients with intestinal motility disorders

As shown in Figure , 86 patients along with 86 healthy matched subjects, were finally enrolled. The characteristics of patients are shown in Table . About 85% of patients suffering from intestinal motility disorders were female, and mean age was 49.9 ± 17.4 years. Patients with intestinal motility disorders had significantly lower intermediate and bachelor schooling degree, as compared to the control group (P = 0. 001 and P < 0.001, respectively).

Table 1

Characteristics of patients with functional chronic constipation with intestinal motility disorders and of controls

Variables Intestinal motility disorders (n = 86) Controls (n = 86)
Age, mean ± SD , yr 49.9 (17.4) 50 (17.1)
Sex, n (%)
Male 13 (15.1) 13 (15.1)
Female 73 (84.9) 73 (84. 9)
BMI, mean ± SD, kg/m2 23.7 (2.8) 24.6 (3.4)
Education, n (%)
Primary 5 (5.8) 5 (5.8)
Intermediate 33 (38.4)a 14 (16.3)a
High school 38 (44.2) 37 (43)
Bachelor degree 10 (11.6)a 28 (32.6)a
No data 0 2 (2. 3)
Marital status
Single 30 (34.9) 22 (25.6)
Married 53 (61.6) 58 (67.4)
Widower 3 (3.5) 4 (4.7)
Divorced 0 1 (1.2)
No data 0 1 (1.2)
Symptoms
Constipation 78 (90.1)a 3 (3.5)a
Abdominal pain 73 (84. 9)a 2 (2.3)a
Swelling 79 (91.9)a 14 (16)a
IBS-QOL (total score) 108.4 (23.7)a 39.8 (7.7)a
Dysphoria 24.1 (7.7)a 8.7 (1.5)a
Interference 15.9 (5.5)a 8 (1.6)a
Body image 15 (2.1)a 4.8 (1.4)a
Anxiety health 13. 5 (1.8)a 3.7 (1.4)a
Food avoidance 13.6 (1.6)a 3.7 (1.4)a
Social reaction 10.8 (3.2)a 5 (1.1)a
Interpersonal relationships 6.3 (3.3)a 3.3 (0.6)a
Sexuality 4.6 (2.2)a 2 (0.1)a
HADS-14 A 14.6 (4.3)a 2.4 (1.8)a
HADS-14 D 14. 6 (3.1)a 4.5 (2.6)a
SF12-PCS 37.3 (9.8)a 47.2 (7.6)a
SF12-MCS 29.1 (7.4)a 56 (7.1)a
PTH, mean ± SD, 10-70 pg/mL 51.1 (12.1)
Vitamin D, mean ± SD, IU/mL 14.6 (7.7)a 28.4 (8.8)a

The proportion of patients with intestinal motility disorders was more affected by constipation, abdominal pain, swelling, anxiety and depression symptoms as well as by quality of life alterations, as compared to healthy subjects (P < 0. 001). The results of the various questionnaires compiled by patients (IBS-QOL, HADS-14 A, HADS-14 D, SF12-PCS and SF12-MCS) showed a significant impairment in all health-related domains (P < 0.001) (Table ). Patients with intestinal motility disorders had lower vitamin D serum levels, as compared to the control group (P < 0.001). Moreover, the poor results of psychological tests (IBS-QOL, SF12-PCS, SF12-MCS, HADS-14 A and HADS-14 D) significantly correlated with low vitamin D levels (r = – 0.57, P < 0.001; r = 0.21, P = 0.01; r = – 0.48, P < 0.001; r = – 0.57, P < 0.001; r = – 0.29, P < 0.001, respectively). Other parameters, such as the age, sex and marital status did not differ between the two groups (Table ).

In the groups with intestinal motility disorders, 32, 28 and 26 patients, after completing all diagnostic tests, received a diagnosis of delayed oro-cecal transit time (37. 2%), STC (32.6%) or delayed oro-cecal transit time with STC (30.2%), respectively. In the group with delayed oro-cecal transit time and with STC, the proportion of patients who suffered constipation, swelling, abdominal pain and vitamin D deficiency (< 20 ng/mL) was higher than groups with delayed oro-cecal transit time or with STC (P = 0.03, P = 0.02, P = 0.03 and P = 0.04 respectively) (Figure ). When we considered the three groups: subjects with delayed transit time in both intestinal tracts (26), to patients with delayed transit time in only one tract (60) and to controls (86), the quality of life showed worsening functions. Moreover, vitamin D and BMI were significantly reduced with decreasing values as following for the variables: delayed oro-cecal transit time with STC group less than delayed oro-cecal transit time or STC group, less than controls (P < 0.001, respectively) (Supplementary material).

Proportion of patients who suffered constipation, swelling, abdominal pain and vitamin D serum levels, in delayed small intestinal transit time, slow transit constipation, and delayed small intestinal transit time (with) slow transit constipation groups. STC: Slow transit constipation. Significantly different by aP < 0.05.

Patients with delayed transit time of both intestinal tracts, as compared to patients with delayed transit time involving only one tract, showed significantly reduced levels of vitamin D and higher PTH levels (for both P < 0.001), and showed worsening quality of life (P < 0.001) (Supplementary material). Patients with delayed transit time in both intestinal tracts showed significantly reduced serum levels of vitamin D and higher PTH serum levels (for both P < 0.001), and showed worsening quality of life (P < 0.001) than patients with delayed transit time in only one tract (Supplementary material).

Risk factors associated to intestinal motility disorders

Results from linear regression analysis are shown in Table . At univariate and multivariate analysis adjusted for BMI, vitamin D levels remained a significant independent risk factor for intestinal motility disorders occurrence (OR = 1. 19; 95%CI: 1.14-1.26, P < 0.001).

Table 2

Probability of intestinal motility disorder occurrence at the univariate and multivariate analysis

Variable Univariate analysis


Multivariate analysis


OR (95%CI) P value OR1(95%CI) P value
Age, yr 1.0 (0.98-1.01) 0.76
BMI, kg/m2 0. 91 (0.82-1.0) 0.04 0.98 (0.86-1.11) 0.72
Vitamin D, IU/mL 0.82 (0.78-0.87) < 0.001 0.83 (0.78-0.87) < 0.001

DISCUSSION

In this study, we demonstrated for the first time that serum vitamin D deficiency could be associated to functional chronic constipation induced by intestinal motility disorders. Furthermore, patients showing the latter clinical condition are frequently affected by anxiety and depression symptoms which severely impair their quality of life.

About 1 billion people have vitamin D insufficiency or deficiency[13]. Nowadays, this phenomenon is associated with significant disability and healthcare costs[14,15]. Several studies showed that hypovitaminosis D may be a risk factor for many chronic diseases and for mortality[16,33-36]. Notably, vitamin D deficiency has been involved in the pathophysiology of inflammatory bowel disease, IBS and also depression[13-17,19]

Some multicentric studies, reported a higher prevalence of hypovitaminosis D in the southern Europe[37,38]. Interestingly, Italian elderly subjects showed the lowest levels of vitamin D in Europe in the winter season[37,38]. In our study, we found low serum levels of vitamin D, mainly checked during the summer season, among patients affected by intestinal motility disorders during an interval time when vitamin D values are usually high, due to beta-ultraviolet rays exposition[13,36]. Moreover, our patients were prevalently female (84.9%) and relatively younger, although, vitamin D deficiency has not been limited to the elderly age[35-38]. While low levels of vitamin D have been also observed in winter in 33% of pre-menopausal women, especially if obese[39], in our study the majority of patients with intestinal motility disorders had normal BMI.

How vitamin D deficiency and intestinal motility disorders are linked remains an open question. One intriguing hypothesis may be that STC and/or delayed small intestinal transit time could negatively modify the gut microbiota[36], or conversely altered microbiome could primarily affect mucosal barrier and gut motility due to microbial-derived metabolites[40]. In addition, some studies suggested that vitamin D deficiency could predispose to gastrointestinal infections[16], which could be responsible of the “leaky gut” alteration and of loss of immune homeostasis[40,41]. However, in our patients we also performed LBT and GBT, to exclude SIBO. When the clinical suspicion of the latter condition remained, we treated them “ex juvantibus”, and we further excluded SIBO as the main cause of bowel symptoms, especially when they did not disappear after a gut-targeted antibiotic therapeutic cycle.

Anyway, the presence of vitamin D receptor on gut epithelial cells, macrophages and lymphocytes surface, has suggested a possible link between vitamin D deficiency, the dysfunction of its receptor and gut microbiota composition, leading to the onset of autoimmune diseases[40,42,43]. Finally, the influence of vitamin D deficiency on human immune system is also supported by its involvement in the development of multiple sclerosis[44]. As concerning this aspect, an interesting study supported a role of autoantibodies against enteric nervous system targets in B cell-deficient mice with experimental autoimmune encephalomyelitis model of multiple sclerosis, showing that serum immunoreactivity (idiopathically or secondary to another autoimmune disease), could be implicated in the induction of autoimmune gastrointestinal dysmotility[45]. In fact, in humans with multiple sclerosis, whose pathogenesis has been linked to vitamin D deficiency, a slow colonic motility in the proximal tract as well as autonomic rectal dysfunction has been observed[44-48].

We may suppose that the intestinal motility disorder could be the “primum movens” of an underlying autoimmune process in a specific genetic background and unmasked by chronic vitamin D deficiency, which could exert metabolic/immunologic damage on epithelial and neuromuscular structures of the gut. The latter alterations could include gut hyper-permeability and bacterial translocation, whose degree of injury and extension could be influenced by the severity of vitamin D deficiency[22,45]. This hypothesis may be supported by our results, which showed that levels of vitamin D were independently associated with intestinal motility disorders and by the fact that the prevalence of symptoms associated to functional chronic constipation grew up in concordance with the worsening of vitamin D levels, especially in patients involving more extensively the bowel tract. Furthermore, patients with intestinal motility disorders had high levels of psychological distress with impaired quality of life, and hypovitaminosis D significantly correlated with the worsening of the psychological functions. In our study, a potential bias could derive from disease misclassification, which could be a negligible factor since intestinal motility disorder was diagnosed following standardized criteria, and from the small sample size of our population. Moreover, we did not check fecal microbiota composition.

In conclusion, we demonstrated that vitamin D deficiency could be strongly related to intestinal motility disorders. Moreover, patients with intestinal motility disorders are very commonly affected by anxiety and depression symptoms which severely influence their quality of life. If the latter two psychiatric symptoms are caused by intestinal factors, it will be confirmed only through a cross-sectional study. Therefore, we suggest that vitamin D serum levels should be routinely measured and vitamin D supplementation should be considered, to better evaluate its effects on intestinal motility and quality of life of patients with intestinal motility disorders.

ARTICLE HIGHLIGHTS

Research background

Functional chronic constipation is a gastrointestinal disorder that affects more commonly women and older subjects, with a deep impact on global health-care system. Nowadays, only few studies have examined intestinal motility disorders, which are severe clinical conditions associated with chronic functional constipation, whose pathogenesis and prevalence are actually partially known. In this subgroup are inclued patients with slow transit constipation, as well as with slow oro-cecal transit time, whereas their extreme clinical form, could be considered chronic intestinal pseudo-obstruction, which has been related to the structural damage of neural and smooth muscle cells of gut.

Research motivation

Although some studies have shown a possible link between vitamin D deficiency and irritable bowel syndrome (IBS), as well as with depression (and with several other diseases), the same link has never been detected before in patients affected by intestinal motility disorders, and the indications to look for vitamin D in these patients relied only of opinions of experts in the field. Therefore we investigated this relationship and the psychological aspects in this subgroup of patients.

Research objectives

To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation linked to intestinal motility disorders.

Research methods

Herein, we applied rigorous statistical methods to elucidate this relationship. We performed a prospective case-control study, from May-June to November 2017. We used Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis to estimate both oro-cecal and colonic transit time. After receiving a diagnosis of intestinal motility disorders, patients underwent to blood sampling, for checking 25-hydroxyvitamin D levels. Furthermore, we evaluated for these patients the influence on psychological features and on their quality of life, which were estimated by using validated questionnaires, the IBS Quality of life (IBS-QOL), the Short Form Health Survey 12 (SF-12), and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D).

Research results

Our cohort included 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 age, sex, body mass index (BMI)-matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life domains and psychological tests (IBS-QOL, SF12-PCS, SF12-MCS, HADS-14 A and HADS-14 D), as compared to the control group (P < 0.001). Moreover, the latter tests significantly correlated with reduced vitamin D levels (r = – 0.57, P < 0.001; r = 0.21, P = 0.01; r = – 0.48, P < 0.001; r = – 0.57, P < 0.001; r = – 0.29, P < 0.001, respectively). In multivariate analysis, vitamin D low levels remained significantly associated with the occurrence of intestinal motility disorder, after adjusting for BMI (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).

Research conclusions

We demonstrated for the first time a strong association between vitamin D deficiency and intestinal motility disorders. Moreover, these patients are very commonly affected by anxiety and depression symptoms which deeply impact on their quality of life. These findings suggest that vitamin D serum levels should be routinely measured in this category of patients and consequently vitamin D supplementation could represent a further therapeutic aid for this clinical condition.

Research perspectives

Our findings may confirm how vitamin D deficiency could exert a wide spectrum of action in many gastrointestinal (or not) diseases, being highly associated with intestinal motility disorders and with certain neuropsychiatric symptoms, but remains unclear if it could have a causative role in this process, and for this reason, future cross-sectional studies are needed, also to investigate if anxiety and depression symptoms are caused by intestinal factors.

ACKNOWLEDGEMENTS

We thank to Vanessa Terenzio and Domenico Flavio Terenzio, native English speakers, for the language revision of this manuscript.

Footnotes

Institutional review board statement: National Institute of Gastroenterology “S. De Bellis” Research Hospital (0807/16) and by the Research Ethics Committee of the National Oncological Institute of Bari (CAAE:147/16) (Trial registration number: {“type”:”clinical-trial”,”attrs”:{“text”:”NCT03096704″,”term_id”:”NCT03096704″}}NCT03096704).

Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.

Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.

Manuscript source: Invited manuscript

Peer-review started: February 18, 2019

First decision: February 26, 2019

Article in press: March 25, 2019

Specialty type: Gastroenterology and hepatology

Country of origin: Italy

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P-Reviewer: Feretis M, Luthin DR, Negreanu L S-Editor: Yan JP L-Editor: A E-Editor: Song H

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Alba Panarese, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. [email protected]

Francesco Pesce, Nephrology section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70013, Italy.

Piero Porcelli, Department of Psychological, Health, and Territorial Sciences, D’Annunzio University of Chieti-Pescara, Chieti 70013, Italy.

Giuseppe Riezzo, Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Palma Aurelia Iacovazzi, Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Carla Maria Leone, Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Massimo De Carne, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Caterina Mammone Rinaldi, Department of Radiology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Endrit Shahini, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy.

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Chronic functional constipation is strongly linked to vitamin D deficiency

World J Gastroenterol. 2019 Apr 14; 25(14): 1729–1740.

Alba Panarese

Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. [email protected] abla

Francesco Pesce

Nephrology section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70013, Italy

Piero Porcelli

Department of Psychological, Health, and Territorial Sciences, D’Annunzio University of Chieti-Pescara, Chieti 70013, Italy

Giuseppe Riezzo

Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Palma Aurelia Iacovazzi

Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Carla Maria Leone

Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Massimo De Carne

Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Caterina Mammone Rinaldi

Department of Radiology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Endrit Shahini

Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy

Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy

Alba Panarese, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. [email protected];Author contributions: Panarese A has conceived the protocol; Shahini E and Panarese A drafted the initial and final manuscript; Panarese A enrolled patients; Panarese A, and Leone CM collected in a database the baseline and on-treatment information; Shahini E, Pesce F and Porcelli P systematically reviewed the data entries for completeness and consistency, checked for completeness of information and performed the statistical analysis; all the authors reviewed and approved the final draft.

Corresponding author: Alba Panarese, MD, Doctor, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Turi Street n. 27, Castellana Grotte (Bari) 70013, Italy. [email protected]

Telephone: +39-3471401487; +39-0804994251 Fax: +39-0804994250

Received 2019 Feb 16; Revised 2019 Mar 11; Accepted 2019 Mar 24.

Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.

This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial.

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Abstract

BACKGROUND

Few studies have examined intestinal motility disorders, which are disabling conditions associated with chronic functional constipation, whose pathogenesis is actually not well-defined.

AIM

To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation associated to intestinal motility disorders.

METHODS

We performed a prospective case-control study, from May-June to November 2017. Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis were used to assess colonic and oro-cecal transit time, after excluding small-intestinal bacterial overgrowth condition. Then, we measured 25-hydroxyvitamin D levels in patients with intestinal motility disorders and we further evaluated the influence of intestinal motility disorders on psychological symptoms/quality of life using validated questionnaires, the Irritable Bowel Syndrome Quality of life (IBS-QOL), the Short Form Health Survey 12, and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D).

RESULTS

We enrolled 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life and psychological tests (IBS-QOL, Short Form Health Survey 12-Physical Component Summary, Short Form Health Survey 12-Mental Component Summary, HADS-14 A and HADS-14 D), as compared to the control group (P < 0. 001), which significantly correlated with low vitamin D levels (r = – 0.57, P < 0.001; r = 0.21, P = 0.01; r = – 0.48, P < 0.001; r = – 0.57, P < 0.001; r = – 0.29, P < 0.001, respectively). At multivariate analysis vitamin D low levels remained a significant independent risk factor for the occurrence of intestinal motility disorder (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).

CONCLUSION

Vitamin D deficiency, anxiety and depression symptoms are commonly associated with chronic functional constipation induced by intestinal motility disorders. Vitamin D serum levels should be routinely measured in these patients.

Keywords: Chronic constipation, Intestinal motility, Vitamin D, Quality of life, Anxiety, Depression

Core tip: Intestinal motility disorders, which are disabling conditions associated with chronic constipation, have been examined in only A few studies. Patients with intestinal motility disorders are frequently affected by vitamin D deficiency, which is strongly associated to anxiety, depression symptoms and to severe impairment of quality of life. These data suggest that vitamin D serum levels should be routinely measured, and its supplementation should be evaluated in patients with intestinal motility disorders.

INTRODUCTION

The term “Constipation” has a broad definition both for physicians and patients[1]. The most common form is functional chronic constipation, which is a gastrointestinal disorder defined by symptom criteria, after the exclusion of secondary causes[2-4]. This clinical condition usually affects women, older subjects, particularly those of lower socioeconomic status[5], and has a prevalence ranging between 2% and 27% in western countries with a high burden on global health-care system[2,6,7]. The main symptoms of functional chronic constipation are difficulty with evacuation, bloating, abdominal pain, discomfort or hard stools that significantly impair health-related quality of life[2,8]. Since depression has been commonly observed in patients with the constipation variant of irritable bowel syndrome (IBS), specific questionnaires have been endorsed to evaluate some aspects of the quality of life of these patients, especially the IBS Quality of life (IBS-QOL), the Short Form Health Survey 12 (SF-12), and the Hospital Anxiety and Depression Scale 14 (HADS-14-A/D)[9-12]. Moreover, previous studies showed a possible role of vitamin D deficiency in the pathophysiology of IBS and depression, and also beneficial effects of vitamin D supplementation in alleviating depression and certain gastrointestinal symptoms in a population of study prevalently affected by diarrhea or by alternating subtype, and the minority by constipation symptoms[13-20]. Normal transit constipation is probably the most common form, and it frequently overlaps with the constipation variant of IBS[9].

Among patients with functional chronic constipation, intestinal motility disorders have been reported. Although the overall prevalence of intestinal motility disorders is not currently well-defined[2], it involves more commonly patients affected by slow transit constipation (STC)[2], and rarely subjects with delayed oro-cecal transit time[21], In addition, defecation disorders significantly overlap with normal and STC[9,22]. While STC is characterized by an altered colonic motor activity, and reduced reaction after a meal and when waking up, decreased “high amplitude propagated contractions”, which have been associated to altered regulation of enteric nervous system, reduction of neurons and axons in the myenteric plexus[2,22-24], delayed oro-cecal transit time could be partially associated with an underlying small-intestinal bacterial overgrowth (SIBO)[25].

Moreover, the most severe form of intestinal motility disorder may be considered chronic intestinal pseudo-obstruction, which is a symptomatic and disabling disease, related to a visceral myopathy or/and neuropathy[26]. Hence, colonic transit time could be objectively measured by radiopaque markers (single or multiple capsule techniques), and this diagnostic tool is also used to rule out dyssynergia defecation[2,23]. Radiopaque markers studies are useful, inexpensive and widely available[2,23]. In addition, even if not definitively recommended by guidelines, lactulose breath test (LBT) and glucose breath test (GBT), are commonly used in clinical practice to evaluate the presence of SIBO as well as small-bowel motility by estimating oral-cecal transit time[25,27]. Other expensive tests such as colonic scintigraphy and wireless ingestible motility capsule, measure more accurately overall transit time[23,27], whereas advanced physiologic tests identify anorectal dysfunctions in patients not responding to initial therapy[2,27]. In this paper we hypothesized that serum vitamin D deficiency could be associated with chronic functional constipation secondary to delayed intestinal transit time and consequently we investigated this relationship and the related psychological aspects.

MATERIALS AND METHODS

Study design

This case-control study was performed from May-June to November 2017, in the Outpatients Clinic of our Institution, in Apulia, a Mediterranean region located in southeast of Italy. As shown in Figure , we enrolled 86 subjects from a population of 152 consecutive constipated patients affected by intestinal motility disorders.

Flow diagram describing the process of patients’ selection. CT: Computerized tomography; ROM: Radiopaque markers.

Inclusion criteria were the following: Caucasian subjects ≥ 18 years old, body mass index (BMI) ≥ 18.5 kg/m2, affected by functional chronic constipation associated to delayed intestinal transit time, supported by Roma IV criteria[8,26,28]. Exclusion criteria were the following: Subjects > 75 years old, IBS, pregnancy, significant comorbidities such as cardiac, respiratory, chronic renal insufficiency, anorectal and pelvic floor dysfunctions, metabolic/endocrine (diabetes mellitus, hypothyroidism, hypercalcaemia, panhypopituitarism), medications (opiates, antihypertensive agents, iron preparations, anti-epileptic drugs, tryciclic antidepressants, anticholinergics or dopaminergics), organic (extra-intestinal mass, colorectal cancer, ischaemic or surgical stenosis, anal fissure, anal strictures, inflammatory bowel disease, intestinal malabsorption and diverticular diseases), neurological (Parkinson disease, multiple sclerosis, paraplegia, autonomic neuropathy, chronic intestinal pseudo-obstruction, gastroparesis, Hirschsprung disease and stroke), past psychiatric disease, and myogenic (scleroderma, amyloidosis and myotonic dystrophy dermatomyositis)[2,21,26]. In addition, we also assessed a control group of 86 healthy subjects (sex, age and BMI matched), recruited from a population-based cohort study of 150 healthy subjects, which underwent routine clinical exams in our Institute to check their healthy status, after excluding the presence of a functional chronic constipation during the clinical interview.

Our research was carried out in compliance with the Helsinki Declaration and procedures received approval by the Institutional review board of the National Institute of Gastroenterology “S. De Bellis” Research Hospital (0807/16) and by the Research Ethics Committee of the National Oncological Institute of Bari (CAAE:147/16) (Trial registration number: {“type”:”clinical-trial”,”attrs”:{“text”:”NCT03096704″,”term_id”:”NCT03096704″}}NCT03096704). Informed consent was obtained from all participants of the study. The statistical review of the study was performed by a biomedical statistician.

Definition of functional chronic constipation

All selected patients were inquired, before, for any possible secondary causes of functional chronic constipation, including alarm features, lifestyle factors and medical treatments and we also identified the response (or lack of) to previous treatment about constipation symptoms, by interviewing patients. Then, they were considered affected by functional chronic constipation only when they showed a frequency of evacuation less than twice a week with increased stool consistency[8,26,28]. All the selected patients underwent blood tests, colonoscopy, nutritional assessment (with daily food frequency questionnaires), stool frequency diary, LBT, GBT, wireless motility testing, radiopaque markers studies, and when required, tests for pelvic floor dysfunction, and psychological tests exploring patient’s quality of life.

Accordingly, when not eligible, patients were excluded (Figure ): 152 consecutive subjects affected by functional chronic constipation with intestinal motility disorders met the eligibility criteria, along with 150 healthy subjects. Patients and controls in each group were first randomly sampled from the pool of available individuals (152 with intestinal motility disorders and 150 controls) and, then matched for age, sex and BMI, using MatchIt[29]. This analysis resulted in 86 patients and 86 matched controls that were enrolled for the study. Our patients did not receive any pharmacological treatment before all evaluations.

Colonic transit time, breath tests and wireless motility analysis

The colon transit time was measured with radiopaque markers, using multiple capsule techniques (P and A Mauch CH-4142 Munchenstein). The patient ingested 1 capsule a day (at 9.00 am, during breakfast) for 3 consecutive days and each capsule with 24 different shaped radio-opaque polyurethane markers, and then performed abdominal x-rays (100KV) on day 7, at 9.00 am, to reconstruct the colon activity during the last week[30,31]. Normal transit time was considered about 30-40 h, whereas the upper limit, above 70 h. Markers scattered about the colon was due most likely to STC, whereas markers gathered in the recto-sigmoid tract was considered a defecatory disorder[5,27] (Supplementary material).

Moreover, LBT and GBT were used for measuring oro-cecal transit time. A rise in hydrogen of ≥ 20 ppm by 90 min was considered the cut-off value used to exclude SIBO for both tests[25]. Time to the second peak and rise of 5-10 ppm of hydrogen, or a level of positivity for methane ≥ 10 ppm on a breath test, were considered useful in estimating oro-cecal transit time[25,27,32] (Supplementary material). Wireless motility analysis was also used to quantify oro-cecal transit time (Smartpill, Medtronic, Sunnyvale, California, United States), in order to define the presence of a delayed small intestinal transit time. Normal small-bowel transit should be 6 hours or less[25] (Supplementary material). Finally, STC and/or delayed oro-cecal transit time were definitively endorsed when radiopaque markers and/or breath tests with wireless motility analysis identified a specific intestinal motility disorder[27].

Questionnaires for the evaluation of quality of life in patients with intestinal motility disorders

The IBS-QOL questionnaire is a 34-item tool validated to quantify quality of life in non-subtyped IBS patients, but also used to assess the severity of IBS-like symptoms, and psychological factors[10]. The SF-12 includes a subset of 12 items, used to assess the physical and mental health domain in many diseases. All these scores are converted into a standardized 0-100 score. Higher scores indicate a better self-reported health status[11]. Furthermore, the HADS-14 represents a global measure of psychological distress and includes 14 items, 7 of them evaluate anxiety symptoms, and 7 depressive ones. Each item is coded from 0 to 3. The total scores for anxiety and depression can range between 0-21, based on symptoms characteristics[12].

Vitamin D and parathyroid hormone levels measurement

Serum 25-hydroxyvitamin D [25-(OH)-D] (Supplementary material) and parathyroid hormone (PTH) levels were measured in patients and healthy controls within 1 hour from blood draw. Overall subjects were enrolled in the interval time of the year with major sunlight exposition, when 25-(OH)-D values are usually higher[13]. The 25-(OH)-D levels status was categorized as usually proposed by experts in literature: using a standardized cut-off (deficiency less than 20 ng/mL, insufficiency from 20 to 29 ng/mL and sufficient when equal or higher than 30 ng/mL)[13].

Statistical analysis

Screened patients and controls in each group were matched for age, sex and BMI using the nearest neighbor matching algorithm implemented in MatchIt[29]. Normal distribution of continuous variables was assessed with the Shapiro-Wilk test and data were expressed as mean and standard deviation and compared using Student’s t-test. Categorical variables were reported as percentages and compared using the Chi-squared test or Fisher’s exact test, when needed.

Spearman’s test was performed to evaluate possible correlations of vitamin D values with quality of life scores and psychological functions (IBS-QOL, SF12-PCS, SF12-MCS, HADS-14 A and HADS-14 D). The impact of the vitamin D levels on patient’s risk to have intestinal motility disorders was analysed using univariate and multivariate logistic regression analyses. The association between each explanatory variable and the outcome (intestinal motility disorders occurrence) was tested using the likelihood ratio test. We included in the multivariate model all explanatory variables showing a P < 0.05 at univariate analysis. For each variable included in the multivariate model, we calculated both unadjusted and adjusted odds ratios (OR), with their 95% confidence intervals (CI), and the level of significance (using the likelihood ratio test). Statistical significance was set at P < 0.05. All statistical analyses were performed using SPSS 23.0 software (SPSS, Chicago, IL, United States) and R version 3.4.3 (http://www.R-project.org/).

RESULTS

Characteristics of patients with intestinal motility disorders

As shown in Figure , 86 patients along with 86 healthy matched subjects, were finally enrolled. The characteristics of patients are shown in Table . About 85% of patients suffering from intestinal motility disorders were female, and mean age was 49.9 ± 17.4 years. Patients with intestinal motility disorders had significantly lower intermediate and bachelor schooling degree, as compared to the control group (P = 0. 001 and P < 0.001, respectively).

Table 1

Characteristics of patients with functional chronic constipation with intestinal motility disorders and of controls

Variables Intestinal motility disorders (n = 86) Controls (n = 86)
Age, mean ± SD , yr 49.9 (17.4) 50 (17.1)
Sex, n (%)
Male 13 (15.1) 13 (15.1)
Female 73 (84.9) 73 (84. 9)
BMI, mean ± SD, kg/m2 23.7 (2.8) 24.6 (3.4)
Education, n (%)
Primary 5 (5.8) 5 (5.8)
Intermediate 33 (38.4)a 14 (16.3)a
High school 38 (44.2) 37 (43)
Bachelor degree 10 (11.6)a 28 (32.6)a
No data 0 2 (2. 3)
Marital status
Single 30 (34.9) 22 (25.6)
Married 53 (61.6) 58 (67.4)
Widower 3 (3.5) 4 (4.7)
Divorced 0 1 (1.2)
No data 0 1 (1.2)
Symptoms
Constipation 78 (90.1)a 3 (3.5)a
Abdominal pain 73 (84. 9)a 2 (2.3)a
Swelling 79 (91.9)a 14 (16)a
IBS-QOL (total score) 108.4 (23.7)a 39.8 (7.7)a
Dysphoria 24.1 (7.7)a 8.7 (1.5)a
Interference 15.9 (5.5)a 8 (1.6)a
Body image 15 (2.1)a 4.8 (1.4)a
Anxiety health 13. 5 (1.8)a 3.7 (1.4)a
Food avoidance 13.6 (1.6)a 3.7 (1.4)a
Social reaction 10.8 (3.2)a 5 (1.1)a
Interpersonal relationships 6.3 (3.3)a 3.3 (0.6)a
Sexuality 4.6 (2.2)a 2 (0.1)a
HADS-14 A 14.6 (4.3)a 2.4 (1.8)a
HADS-14 D 14. 6 (3.1)a 4.5 (2.6)a
SF12-PCS 37.3 (9.8)a 47.2 (7.6)a
SF12-MCS 29.1 (7.4)a 56 (7.1)a
PTH, mean ± SD, 10-70 pg/mL 51.1 (12.1)
Vitamin D, mean ± SD, IU/mL 14.6 (7.7)a 28.4 (8.8)a

The proportion of patients with intestinal motility disorders was more affected by constipation, abdominal pain, swelling, anxiety and depression symptoms as well as by quality of life alterations, as compared to healthy subjects (P < 0. 001). The results of the various questionnaires compiled by patients (IBS-QOL, HADS-14 A, HADS-14 D, SF12-PCS and SF12-MCS) showed a significant impairment in all health-related domains (P < 0.001) (Table ). Patients with intestinal motility disorders had lower vitamin D serum levels, as compared to the control group (P < 0.001). Moreover, the poor results of psychological tests (IBS-QOL, SF12-PCS, SF12-MCS, HADS-14 A and HADS-14 D) significantly correlated with low vitamin D levels (r = – 0.57, P < 0.001; r = 0.21, P = 0.01; r = – 0.48, P < 0.001; r = – 0.57, P < 0.001; r = – 0.29, P < 0.001, respectively). Other parameters, such as the age, sex and marital status did not differ between the two groups (Table ).

In the groups with intestinal motility disorders, 32, 28 and 26 patients, after completing all diagnostic tests, received a diagnosis of delayed oro-cecal transit time (37. 2%), STC (32.6%) or delayed oro-cecal transit time with STC (30.2%), respectively. In the group with delayed oro-cecal transit time and with STC, the proportion of patients who suffered constipation, swelling, abdominal pain and vitamin D deficiency (< 20 ng/mL) was higher than groups with delayed oro-cecal transit time or with STC (P = 0.03, P = 0.02, P = 0.03 and P = 0.04 respectively) (Figure ). When we considered the three groups: subjects with delayed transit time in both intestinal tracts (26), to patients with delayed transit time in only one tract (60) and to controls (86), the quality of life showed worsening functions. Moreover, vitamin D and BMI were significantly reduced with decreasing values as following for the variables: delayed oro-cecal transit time with STC group less than delayed oro-cecal transit time or STC group, less than controls (P < 0.001, respectively) (Supplementary material).

Proportion of patients who suffered constipation, swelling, abdominal pain and vitamin D serum levels, in delayed small intestinal transit time, slow transit constipation, and delayed small intestinal transit time (with) slow transit constipation groups. STC: Slow transit constipation. Significantly different by aP < 0.05.

Patients with delayed transit time of both intestinal tracts, as compared to patients with delayed transit time involving only one tract, showed significantly reduced levels of vitamin D and higher PTH levels (for both P < 0.001), and showed worsening quality of life (P < 0.001) (Supplementary material). Patients with delayed transit time in both intestinal tracts showed significantly reduced serum levels of vitamin D and higher PTH serum levels (for both P < 0.001), and showed worsening quality of life (P < 0.001) than patients with delayed transit time in only one tract (Supplementary material).

Risk factors associated to intestinal motility disorders

Results from linear regression analysis are shown in Table . At univariate and multivariate analysis adjusted for BMI, vitamin D levels remained a significant independent risk factor for intestinal motility disorders occurrence (OR = 1. 19; 95%CI: 1.14-1.26, P < 0.001).

Table 2

Probability of intestinal motility disorder occurrence at the univariate and multivariate analysis

Variable Univariate analysis


Multivariate analysis


OR (95%CI) P value OR1(95%CI) P value
Age, yr 1.0 (0.98-1.01) 0.76
BMI, kg/m2 0. 91 (0.82-1.0) 0.04 0.98 (0.86-1.11) 0.72
Vitamin D, IU/mL 0.82 (0.78-0.87) < 0.001 0.83 (0.78-0.87) < 0.001

DISCUSSION

In this study, we demonstrated for the first time that serum vitamin D deficiency could be associated to functional chronic constipation induced by intestinal motility disorders. Furthermore, patients showing the latter clinical condition are frequently affected by anxiety and depression symptoms which severely impair their quality of life.

About 1 billion people have vitamin D insufficiency or deficiency[13]. Nowadays, this phenomenon is associated with significant disability and healthcare costs[14,15]. Several studies showed that hypovitaminosis D may be a risk factor for many chronic diseases and for mortality[16,33-36]. Notably, vitamin D deficiency has been involved in the pathophysiology of inflammatory bowel disease, IBS and also depression[13-17,19]

Some multicentric studies, reported a higher prevalence of hypovitaminosis D in the southern Europe[37,38]. Interestingly, Italian elderly subjects showed the lowest levels of vitamin D in Europe in the winter season[37,38]. In our study, we found low serum levels of vitamin D, mainly checked during the summer season, among patients affected by intestinal motility disorders during an interval time when vitamin D values are usually high, due to beta-ultraviolet rays exposition[13,36]. Moreover, our patients were prevalently female (84.9%) and relatively younger, although, vitamin D deficiency has not been limited to the elderly age[35-38]. While low levels of vitamin D have been also observed in winter in 33% of pre-menopausal women, especially if obese[39], in our study the majority of patients with intestinal motility disorders had normal BMI.

How vitamin D deficiency and intestinal motility disorders are linked remains an open question. One intriguing hypothesis may be that STC and/or delayed small intestinal transit time could negatively modify the gut microbiota[36], or conversely altered microbiome could primarily affect mucosal barrier and gut motility due to microbial-derived metabolites[40]. In addition, some studies suggested that vitamin D deficiency could predispose to gastrointestinal infections[16], which could be responsible of the “leaky gut” alteration and of loss of immune homeostasis[40,41]. However, in our patients we also performed LBT and GBT, to exclude SIBO. When the clinical suspicion of the latter condition remained, we treated them “ex juvantibus”, and we further excluded SIBO as the main cause of bowel symptoms, especially when they did not disappear after a gut-targeted antibiotic therapeutic cycle.

Anyway, the presence of vitamin D receptor on gut epithelial cells, macrophages and lymphocytes surface, has suggested a possible link between vitamin D deficiency, the dysfunction of its receptor and gut microbiota composition, leading to the onset of autoimmune diseases[40,42,43]. Finally, the influence of vitamin D deficiency on human immune system is also supported by its involvement in the development of multiple sclerosis[44]. As concerning this aspect, an interesting study supported a role of autoantibodies against enteric nervous system targets in B cell-deficient mice with experimental autoimmune encephalomyelitis model of multiple sclerosis, showing that serum immunoreactivity (idiopathically or secondary to another autoimmune disease), could be implicated in the induction of autoimmune gastrointestinal dysmotility[45]. In fact, in humans with multiple sclerosis, whose pathogenesis has been linked to vitamin D deficiency, a slow colonic motility in the proximal tract as well as autonomic rectal dysfunction has been observed[44-48].

We may suppose that the intestinal motility disorder could be the “primum movens” of an underlying autoimmune process in a specific genetic background and unmasked by chronic vitamin D deficiency, which could exert metabolic/immunologic damage on epithelial and neuromuscular structures of the gut. The latter alterations could include gut hyper-permeability and bacterial translocation, whose degree of injury and extension could be influenced by the severity of vitamin D deficiency[22,45]. This hypothesis may be supported by our results, which showed that levels of vitamin D were independently associated with intestinal motility disorders and by the fact that the prevalence of symptoms associated to functional chronic constipation grew up in concordance with the worsening of vitamin D levels, especially in patients involving more extensively the bowel tract. Furthermore, patients with intestinal motility disorders had high levels of psychological distress with impaired quality of life, and hypovitaminosis D significantly correlated with the worsening of the psychological functions. In our study, a potential bias could derive from disease misclassification, which could be a negligible factor since intestinal motility disorder was diagnosed following standardized criteria, and from the small sample size of our population. Moreover, we did not check fecal microbiota composition.

In conclusion, we demonstrated that vitamin D deficiency could be strongly related to intestinal motility disorders. Moreover, patients with intestinal motility disorders are very commonly affected by anxiety and depression symptoms which severely influence their quality of life. If the latter two psychiatric symptoms are caused by intestinal factors, it will be confirmed only through a cross-sectional study. Therefore, we suggest that vitamin D serum levels should be routinely measured and vitamin D supplementation should be considered, to better evaluate its effects on intestinal motility and quality of life of patients with intestinal motility disorders.

ARTICLE HIGHLIGHTS

Research background

Functional chronic constipation is a gastrointestinal disorder that affects more commonly women and older subjects, with a deep impact on global health-care system. Nowadays, only few studies have examined intestinal motility disorders, which are severe clinical conditions associated with chronic functional constipation, whose pathogenesis and prevalence are actually partially known. In this subgroup are inclued patients with slow transit constipation, as well as with slow oro-cecal transit time, whereas their extreme clinical form, could be considered chronic intestinal pseudo-obstruction, which has been related to the structural damage of neural and smooth muscle cells of gut.

Research motivation

Although some studies have shown a possible link between vitamin D deficiency and irritable bowel syndrome (IBS), as well as with depression (and with several other diseases), the same link has never been detected before in patients affected by intestinal motility disorders, and the indications to look for vitamin D in these patients relied only of opinions of experts in the field. Therefore we investigated this relationship and the psychological aspects in this subgroup of patients.

Research objectives

To investigate the relationship between serum 25-hydroxyvitamin D levels and functional chronic constipation linked to intestinal motility disorders.

Research methods

Herein, we applied rigorous statistical methods to elucidate this relationship. We performed a prospective case-control study, from May-June to November 2017. We used Glucose/lactulose breath tests, radiopaque markers (multiple capsule techniques) and wireless motility capsule analysis to estimate both oro-cecal and colonic transit time. After receiving a diagnosis of intestinal motility disorders, patients underwent to blood sampling, for checking 25-hydroxyvitamin D levels. Furthermore, we evaluated for these patients the influence on psychological features and on their quality of life, which were estimated by using validated questionnaires, the IBS Quality of life (IBS-QOL), the Short Form Health Survey 12 (SF-12), and the Hospital Anxiety and Depression Scale 14 (HADS-14 A and HADS-14 D).

Research results

Our cohort included 86 patients with chronic functional constipation associated to intestinal motility disorders and 86 age, sex, body mass index (BMI)-matched healthy subjects. Patients with intestinal motility disorders had lower 25-hydroxyvitamin D levels (P < 0.001), and they showed a significant impairment of all health-related quality of life domains and psychological tests (IBS-QOL, SF12-PCS, SF12-MCS, HADS-14 A and HADS-14 D), as compared to the control group (P < 0.001). Moreover, the latter tests significantly correlated with reduced vitamin D levels (r = – 0.57, P < 0.001; r = 0.21, P = 0.01; r = – 0.48, P < 0.001; r = – 0.57, P < 0.001; r = – 0.29, P < 0.001, respectively). In multivariate analysis, vitamin D low levels remained significantly associated with the occurrence of intestinal motility disorder, after adjusting for BMI (odds ratio = 1.19; 95% confidence interval: 1.14-1.26, P < 0.001).

Research conclusions

We demonstrated for the first time a strong association between vitamin D deficiency and intestinal motility disorders. Moreover, these patients are very commonly affected by anxiety and depression symptoms which deeply impact on their quality of life. These findings suggest that vitamin D serum levels should be routinely measured in this category of patients and consequently vitamin D supplementation could represent a further therapeutic aid for this clinical condition.

Research perspectives

Our findings may confirm how vitamin D deficiency could exert a wide spectrum of action in many gastrointestinal (or not) diseases, being highly associated with intestinal motility disorders and with certain neuropsychiatric symptoms, but remains unclear if it could have a causative role in this process, and for this reason, future cross-sectional studies are needed, also to investigate if anxiety and depression symptoms are caused by intestinal factors.

ACKNOWLEDGEMENTS

We thank to Vanessa Terenzio and Domenico Flavio Terenzio, native English speakers, for the language revision of this manuscript.

Footnotes

Institutional review board statement: National Institute of Gastroenterology “S. De Bellis” Research Hospital (0807/16) and by the Research Ethics Committee of the National Oncological Institute of Bari (CAAE:147/16) (Trial registration number: {“type”:”clinical-trial”,”attrs”:{“text”:”NCT03096704″,”term_id”:”NCT03096704″}}NCT03096704).

Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.

Conflict-of-interest statement: All authors declare no conflict of interest related to this publication.

Manuscript source: Invited manuscript

Peer-review started: February 18, 2019

First decision: February 26, 2019

Article in press: March 25, 2019

Specialty type: Gastroenterology and hepatology

Country of origin: Italy

Peer-review report classification

Grade A (Excellent): 0

Grade B (Very good): B, B

Grade C (Good): C

Grade D (Fair): 0

Grade E (Poor): 0

STROBE statement: The guidelines of the STROBE Statement have been adopted.

P-Reviewer: Feretis M, Luthin DR, Negreanu L S-Editor: Yan JP L-Editor: A E-Editor: Song H

Contributor Information

Alba Panarese, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. [email protected]

Francesco Pesce, Nephrology section, Department of Emergency and Organ Transplantation, University of Bari, Bari 70013, Italy.

Piero Porcelli, Department of Psychological, Health, and Territorial Sciences, D’Annunzio University of Chieti-Pescara, Chieti 70013, Italy.

Giuseppe Riezzo, Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Palma Aurelia Iacovazzi, Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Carla Maria Leone, Department of Clinical Pathology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Massimo De Carne, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Caterina Mammone Rinaldi, Department of Radiology, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy.

Endrit Shahini, Department of Gastroenterology and Digestive Endoscopy, Scientific Institute for Digestive Disease “Saverio de Bellis” Hospital, Castellana Grotte (Bari) 70013, Italy. Department of Emergency and Organ Transplantation, University of Bari, Bari 70124, Italy.

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Altered gastrointestinal motility involving autoantibodies in the experimental autoimmune encephalomyelitis model of multiple sclerosis. Neurogastroenterol Motil. 2018;30:e13349. [PMC free article] [PubMed] [Google Scholar]46. Chia YW, Gill KP, Jameson JS, Forti AD, Henry MM, Swash M, Shorvon PJ. Paradoxical puborectalis contraction is a feature of constipation in patients with multiple sclerosis. J Neurol Neurosurg Psychiatry. 1996;60:31–35. [PMC free article] [PubMed] [Google Scholar]47. Li Q, Michel K, Annahazi A, Demir IE, Ceyhan GO, Zeller F, Komorowski L, Stöcker W, Beyak MJ, Grundy D, Farrugia G, De Giorgio R, Schemann M. Anti-Hu antibodies activate enteric and sensory neurons. Sci Rep. 2016;6:38216. [PMC free article] [PubMed] [Google Scholar]48. De Giorgio R, Bovara M, Barbara G, Canossa M, Sarnelli G, De Ponti F, Stanghellini V, Tonini M, Cappello S, Pagnotta E, Nobile-Orazio E, Corinaldesi R. Anti-HuD-induced neuronal apoptosis underlying paraneoplastic gut dysmotility. 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4 vitamins and supplements for constipation

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Increasing dietary fiber and taking over-the-counter (OTC) laxatives are conventional treatments for constipation, but some people also choose to take supplements.

Constipation is a common medical problem. In the United States, people make 2.5 million visits to the doctor for constipation every year.

Apart from OTC medications, people can try eating foods high in fiber, such as:

  • vegetables
  • fruits
  • whole grains
  • bran

While some vitamins and minerals might help relieve constipation if a person has a deficiency, others can cause it.

In this article, we explore vitamins and supplements for constipation. We take a look at the effects of different vitamins on digestive health.

The authors of an earlier study from 2008 noticed that children with constipation had lower levels of vitamin C, folate, and magnesium.

These children also ate lower amounts of dietary fiber, fruits, and plant foods. Not consuming enough fiber can cause constipation. Fruits and vegetables, which are high in fiber, are often high in vitamin C as well.

Some possible side effects of taking vitamin C include abdominal pain, nausea, vomiting, and diarrhea. The larger the dose, the more likely it is that a person may experience these symptoms.

Doctors do not recommend that people take large doses of vitamin C to help them pass stool, but a daily vitamin C supplement may help.

Research from 2019 found a strong association between chronic constipation and vitamin D deficiencies.

The participants with intestinal disorders that cause constipation had lower levels of vitamin D. These findings do not suggest that increasing vitamin D will relieve constipation, however, as the low vitamin D levels may be a consequence of chronic constipation.

Some people take vitamin D supplements, especially if they live in northern countries since sunshine is a vital source of vitamin D.

People with a vitamin B-12 deficiency may experience :

  • constipation
  • fatigue
  • weakness
  • loss of appetite
  • weight loss

While taking vitamin B-12 supplements may not help those without a deficiency, correcting the deficiency may relieve symptoms in those who do.

Groups of people that are most at risk of developing a vitamin B-12 deficiency include people with:

  • pernicious anemia
  • poor absorption of vitamin B12 from food
  • poor absorption of vitamin B12 following an operation
  • dietary deficiencies

Taking too many magnesium supplements can cause loose stools, diarrhea, nausea, and cramps. Magnesium has an osmotic effect, which means it draws water into the intestine, which is one of the causes of loose stools or diarrhea.

A common laxative that people can buy at the pharmacy is Milk of Magnesia. The main medicinal ingredient is magnesium hydroxide.

While there is little research to suggest that magnesium supplements can treat constipation, of all the supplements listed in this article, it is the most commonly used mineral supplement to address the problem. It is likely a safe option to try, as long as a person sticks to the recommended dose.

Although some vitamins and minerals can help people with constipation, others may cause it or make it worse.

Calcium

Calcium is essential for maintaining strong bones and carrying out functions in the muscles, heart, brain, and other body systems.

Calcium is in:

  • dairy products
  • kale
  • broccoli
  • fish with soft bones, such as canned sardines
  • fortified cereals, fruit juice, and soy and rice milk

While it is unlikely that a person would consume too much calcium from food alone, those taking supplements might. Too much calcium can cause constipation.

Some people need to continue taking calcium supplements, however. To reduce the risk of constipation from supplements, doctors recommend taking calcium throughout the day.

Taking calcium with meals or changing the brand or form of calcium can sometimes help.

Iron

Iron is another mineral that can cause digestive issues if a person is taking supplements.

Too much iron can also cause:

  • black stool
  • constipation
  • nausea
  • abdominal pain
  • vomiting

To reduce constipation, people can try taking lower doses at first and slowly increasing their dose if necessary.

A doctor may recommend taking the iron pill with food, although some foods reduce iron absorption.

If a person is having hard or infrequent bowel movements and has tried increasing dietary fiber and taking OTC products, they should speak with their doctor.

The doctor might be able to prescribe stronger laxatives or recommend other treatments.

In some cases, frequent or persistent constipation can be a sign of an underlying condition, so a doctor may ask about a person’s other symptoms.

Anyone who needs to take laxatives regularly to pass stool should let their doctor know. Treating constipation when it is a symptom of another condition can hide dangerous warning signs.

The most common treatments for constipation include dietary changes and OTC laxatives. Vitamins and minerals do not have a major role in treating constipation.

However, some people may experience constipation as a result of a vitamin deficiency, such as vitamin B-12 deficiency. In those situations, a vitamin supplement may help relieve constipation.

Some vitamins and minerals can cause loose stools or diarrhea, including magnesium and vitamin C. Other supplements, such as calcium and iron, can cause constipation.

People should speak with a doctor before starting or stopping a vitamin or mineral supplement.

SHOP FOR VITAMINS AND SUPPLEMENTS

The vitamins and minerals in this article are available to purchase in drug stores and online

4 vitamins and supplements for constipation

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Increasing dietary fiber and taking over-the-counter (OTC) laxatives are conventional treatments for constipation, but some people also choose to take supplements.

Constipation is a common medical problem. In the United States, people make 2.5 million visits to the doctor for constipation every year.

Apart from OTC medications, people can try eating foods high in fiber, such as:

  • vegetables
  • fruits
  • whole grains
  • bran

While some vitamins and minerals might help relieve constipation if a person has a deficiency, others can cause it.

In this article, we explore vitamins and supplements for constipation. We take a look at the effects of different vitamins on digestive health.

The authors of an earlier study from 2008 noticed that children with constipation had lower levels of vitamin C, folate, and magnesium.

These children also ate lower amounts of dietary fiber, fruits, and plant foods. Not consuming enough fiber can cause constipation. Fruits and vegetables, which are high in fiber, are often high in vitamin C as well.

Some possible side effects of taking vitamin C include abdominal pain, nausea, vomiting, and diarrhea. The larger the dose, the more likely it is that a person may experience these symptoms.

Doctors do not recommend that people take large doses of vitamin C to help them pass stool, but a daily vitamin C supplement may help.

Research from 2019 found a strong association between chronic constipation and vitamin D deficiencies.

The participants with intestinal disorders that cause constipation had lower levels of vitamin D. These findings do not suggest that increasing vitamin D will relieve constipation, however, as the low vitamin D levels may be a consequence of chronic constipation.

Some people take vitamin D supplements, especially if they live in northern countries since sunshine is a vital source of vitamin D.

People with a vitamin B-12 deficiency may experience :

  • constipation
  • fatigue
  • weakness
  • loss of appetite
  • weight loss

While taking vitamin B-12 supplements may not help those without a deficiency, correcting the deficiency may relieve symptoms in those who do.

Groups of people that are most at risk of developing a vitamin B-12 deficiency include people with:

  • pernicious anemia
  • poor absorption of vitamin B12 from food
  • poor absorption of vitamin B12 following an operation
  • dietary deficiencies

Taking too many magnesium supplements can cause loose stools, diarrhea, nausea, and cramps. Magnesium has an osmotic effect, which means it draws water into the intestine, which is one of the causes of loose stools or diarrhea.

A common laxative that people can buy at the pharmacy is Milk of Magnesia. The main medicinal ingredient is magnesium hydroxide.

While there is little research to suggest that magnesium supplements can treat constipation, of all the supplements listed in this article, it is the most commonly used mineral supplement to address the problem. It is likely a safe option to try, as long as a person sticks to the recommended dose.

Although some vitamins and minerals can help people with constipation, others may cause it or make it worse.

Calcium

Calcium is essential for maintaining strong bones and carrying out functions in the muscles, heart, brain, and other body systems.

Calcium is in:

  • dairy products
  • kale
  • broccoli
  • fish with soft bones, such as canned sardines
  • fortified cereals, fruit juice, and soy and rice milk

While it is unlikely that a person would consume too much calcium from food alone, those taking supplements might. Too much calcium can cause constipation.

Some people need to continue taking calcium supplements, however. To reduce the risk of constipation from supplements, doctors recommend taking calcium throughout the day.

Taking calcium with meals or changing the brand or form of calcium can sometimes help.

Iron

Iron is another mineral that can cause digestive issues if a person is taking supplements.

Too much iron can also cause:

  • black stool
  • constipation
  • nausea
  • abdominal pain
  • vomiting

To reduce constipation, people can try taking lower doses at first and slowly increasing their dose if necessary.

A doctor may recommend taking the iron pill with food, although some foods reduce iron absorption.

If a person is having hard or infrequent bowel movements and has tried increasing dietary fiber and taking OTC products, they should speak with their doctor.

The doctor might be able to prescribe stronger laxatives or recommend other treatments.

In some cases, frequent or persistent constipation can be a sign of an underlying condition, so a doctor may ask about a person’s other symptoms.

Anyone who needs to take laxatives regularly to pass stool should let their doctor know. Treating constipation when it is a symptom of another condition can hide dangerous warning signs.

The most common treatments for constipation include dietary changes and OTC laxatives. Vitamins and minerals do not have a major role in treating constipation.

However, some people may experience constipation as a result of a vitamin deficiency, such as vitamin B-12 deficiency. In those situations, a vitamin supplement may help relieve constipation.

Some vitamins and minerals can cause loose stools or diarrhea, including magnesium and vitamin C. Other supplements, such as calcium and iron, can cause constipation.

People should speak with a doctor before starting or stopping a vitamin or mineral supplement.

SHOP FOR VITAMINS AND SUPPLEMENTS

The vitamins and minerals in this article are available to purchase in drug stores and online

4 vitamins and supplements for constipation

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Increasing dietary fiber and taking over-the-counter (OTC) laxatives are conventional treatments for constipation, but some people also choose to take supplements.

Constipation is a common medical problem. In the United States, people make 2.5 million visits to the doctor for constipation every year.

Apart from OTC medications, people can try eating foods high in fiber, such as:

  • vegetables
  • fruits
  • whole grains
  • bran

While some vitamins and minerals might help relieve constipation if a person has a deficiency, others can cause it.

In this article, we explore vitamins and supplements for constipation. We take a look at the effects of different vitamins on digestive health.

The authors of an earlier study from 2008 noticed that children with constipation had lower levels of vitamin C, folate, and magnesium.

These children also ate lower amounts of dietary fiber, fruits, and plant foods. Not consuming enough fiber can cause constipation. Fruits and vegetables, which are high in fiber, are often high in vitamin C as well.

Some possible side effects of taking vitamin C include abdominal pain, nausea, vomiting, and diarrhea. The larger the dose, the more likely it is that a person may experience these symptoms.

Doctors do not recommend that people take large doses of vitamin C to help them pass stool, but a daily vitamin C supplement may help.

Research from 2019 found a strong association between chronic constipation and vitamin D deficiencies.

The participants with intestinal disorders that cause constipation had lower levels of vitamin D. These findings do not suggest that increasing vitamin D will relieve constipation, however, as the low vitamin D levels may be a consequence of chronic constipation.

Some people take vitamin D supplements, especially if they live in northern countries since sunshine is a vital source of vitamin D.

People with a vitamin B-12 deficiency may experience :

  • constipation
  • fatigue
  • weakness
  • loss of appetite
  • weight loss

While taking vitamin B-12 supplements may not help those without a deficiency, correcting the deficiency may relieve symptoms in those who do.

Groups of people that are most at risk of developing a vitamin B-12 deficiency include people with:

  • pernicious anemia
  • poor absorption of vitamin B12 from food
  • poor absorption of vitamin B12 following an operation
  • dietary deficiencies

Taking too many magnesium supplements can cause loose stools, diarrhea, nausea, and cramps. Magnesium has an osmotic effect, which means it draws water into the intestine, which is one of the causes of loose stools or diarrhea.

A common laxative that people can buy at the pharmacy is Milk of Magnesia. The main medicinal ingredient is magnesium hydroxide.

While there is little research to suggest that magnesium supplements can treat constipation, of all the supplements listed in this article, it is the most commonly used mineral supplement to address the problem. It is likely a safe option to try, as long as a person sticks to the recommended dose.

Although some vitamins and minerals can help people with constipation, others may cause it or make it worse.

Calcium

Calcium is essential for maintaining strong bones and carrying out functions in the muscles, heart, brain, and other body systems.

Calcium is in:

  • dairy products
  • kale
  • broccoli
  • fish with soft bones, such as canned sardines
  • fortified cereals, fruit juice, and soy and rice milk

While it is unlikely that a person would consume too much calcium from food alone, those taking supplements might. Too much calcium can cause constipation.

Some people need to continue taking calcium supplements, however. To reduce the risk of constipation from supplements, doctors recommend taking calcium throughout the day.

Taking calcium with meals or changing the brand or form of calcium can sometimes help.

Iron

Iron is another mineral that can cause digestive issues if a person is taking supplements.

Too much iron can also cause:

  • black stool
  • constipation
  • nausea
  • abdominal pain
  • vomiting

To reduce constipation, people can try taking lower doses at first and slowly increasing their dose if necessary.

A doctor may recommend taking the iron pill with food, although some foods reduce iron absorption.

If a person is having hard or infrequent bowel movements and has tried increasing dietary fiber and taking OTC products, they should speak with their doctor.

The doctor might be able to prescribe stronger laxatives or recommend other treatments.

In some cases, frequent or persistent constipation can be a sign of an underlying condition, so a doctor may ask about a person’s other symptoms.

Anyone who needs to take laxatives regularly to pass stool should let their doctor know. Treating constipation when it is a symptom of another condition can hide dangerous warning signs.

The most common treatments for constipation include dietary changes and OTC laxatives. Vitamins and minerals do not have a major role in treating constipation.

However, some people may experience constipation as a result of a vitamin deficiency, such as vitamin B-12 deficiency. In those situations, a vitamin supplement may help relieve constipation.

Some vitamins and minerals can cause loose stools or diarrhea, including magnesium and vitamin C. Other supplements, such as calcium and iron, can cause constipation.

People should speak with a doctor before starting or stopping a vitamin or mineral supplement.

SHOP FOR VITAMINS AND SUPPLEMENTS

The vitamins and minerals in this article are available to purchase in drug stores and online

4 vitamins and supplements for constipation

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Increasing dietary fiber and taking over-the-counter (OTC) laxatives are conventional treatments for constipation, but some people also choose to take supplements.

Constipation is a common medical problem. In the United States, people make 2.5 million visits to the doctor for constipation every year.

Apart from OTC medications, people can try eating foods high in fiber, such as:

  • vegetables
  • fruits
  • whole grains
  • bran

While some vitamins and minerals might help relieve constipation if a person has a deficiency, others can cause it.

In this article, we explore vitamins and supplements for constipation. We take a look at the effects of different vitamins on digestive health.

The authors of an earlier study from 2008 noticed that children with constipation had lower levels of vitamin C, folate, and magnesium.

These children also ate lower amounts of dietary fiber, fruits, and plant foods. Not consuming enough fiber can cause constipation. Fruits and vegetables, which are high in fiber, are often high in vitamin C as well.

Some possible side effects of taking vitamin C include abdominal pain, nausea, vomiting, and diarrhea. The larger the dose, the more likely it is that a person may experience these symptoms.

Doctors do not recommend that people take large doses of vitamin C to help them pass stool, but a daily vitamin C supplement may help.

Research from 2019 found a strong association between chronic constipation and vitamin D deficiencies.

The participants with intestinal disorders that cause constipation had lower levels of vitamin D. These findings do not suggest that increasing vitamin D will relieve constipation, however, as the low vitamin D levels may be a consequence of chronic constipation.

Some people take vitamin D supplements, especially if they live in northern countries since sunshine is a vital source of vitamin D.

People with a vitamin B-12 deficiency may experience :

  • constipation
  • fatigue
  • weakness
  • loss of appetite
  • weight loss

While taking vitamin B-12 supplements may not help those without a deficiency, correcting the deficiency may relieve symptoms in those who do.

Groups of people that are most at risk of developing a vitamin B-12 deficiency include people with:

  • pernicious anemia
  • poor absorption of vitamin B12 from food
  • poor absorption of vitamin B12 following an operation
  • dietary deficiencies

Taking too many magnesium supplements can cause loose stools, diarrhea, nausea, and cramps. Magnesium has an osmotic effect, which means it draws water into the intestine, which is one of the causes of loose stools or diarrhea.

A common laxative that people can buy at the pharmacy is Milk of Magnesia. The main medicinal ingredient is magnesium hydroxide.

While there is little research to suggest that magnesium supplements can treat constipation, of all the supplements listed in this article, it is the most commonly used mineral supplement to address the problem. It is likely a safe option to try, as long as a person sticks to the recommended dose.

Although some vitamins and minerals can help people with constipation, others may cause it or make it worse.

Calcium

Calcium is essential for maintaining strong bones and carrying out functions in the muscles, heart, brain, and other body systems.

Calcium is in:

  • dairy products
  • kale
  • broccoli
  • fish with soft bones, such as canned sardines
  • fortified cereals, fruit juice, and soy and rice milk

While it is unlikely that a person would consume too much calcium from food alone, those taking supplements might. Too much calcium can cause constipation.

Some people need to continue taking calcium supplements, however. To reduce the risk of constipation from supplements, doctors recommend taking calcium throughout the day.

Taking calcium with meals or changing the brand or form of calcium can sometimes help.

Iron

Iron is another mineral that can cause digestive issues if a person is taking supplements.

Too much iron can also cause:

  • black stool
  • constipation
  • nausea
  • abdominal pain
  • vomiting

To reduce constipation, people can try taking lower doses at first and slowly increasing their dose if necessary.

A doctor may recommend taking the iron pill with food, although some foods reduce iron absorption.

If a person is having hard or infrequent bowel movements and has tried increasing dietary fiber and taking OTC products, they should speak with their doctor.

The doctor might be able to prescribe stronger laxatives or recommend other treatments.

In some cases, frequent or persistent constipation can be a sign of an underlying condition, so a doctor may ask about a person’s other symptoms.

Anyone who needs to take laxatives regularly to pass stool should let their doctor know. Treating constipation when it is a symptom of another condition can hide dangerous warning signs.

The most common treatments for constipation include dietary changes and OTC laxatives. Vitamins and minerals do not have a major role in treating constipation.

However, some people may experience constipation as a result of a vitamin deficiency, such as vitamin B-12 deficiency. In those situations, a vitamin supplement may help relieve constipation.

Some vitamins and minerals can cause loose stools or diarrhea, including magnesium and vitamin C. Other supplements, such as calcium and iron, can cause constipation.

People should speak with a doctor before starting or stopping a vitamin or mineral supplement.

SHOP FOR VITAMINS AND SUPPLEMENTS

The vitamins and minerals in this article are available to purchase in drug stores and online

4 vitamins and supplements for constipation

We include products we think are useful for our readers. If you buy through links on this page, we may earn a small commission. Here’s our process.

Increasing dietary fiber and taking over-the-counter (OTC) laxatives are conventional treatments for constipation, but some people also choose to take supplements.

Constipation is a common medical problem. In the United States, people make 2.5 million visits to the doctor for constipation every year.

Apart from OTC medications, people can try eating foods high in fiber, such as:

  • vegetables
  • fruits
  • whole grains
  • bran

While some vitamins and minerals might help relieve constipation if a person has a deficiency, others can cause it.

In this article, we explore vitamins and supplements for constipation. We take a look at the effects of different vitamins on digestive health.

The authors of an earlier study from 2008 noticed that children with constipation had lower levels of vitamin C, folate, and magnesium.

These children also ate lower amounts of dietary fiber, fruits, and plant foods. Not consuming enough fiber can cause constipation. Fruits and vegetables, which are high in fiber, are often high in vitamin C as well.

Some possible side effects of taking vitamin C include abdominal pain, nausea, vomiting, and diarrhea. The larger the dose, the more likely it is that a person may experience these symptoms.

Doctors do not recommend that people take large doses of vitamin C to help them pass stool, but a daily vitamin C supplement may help.

Research from 2019 found a strong association between chronic constipation and vitamin D deficiencies.

The participants with intestinal disorders that cause constipation had lower levels of vitamin D. These findings do not suggest that increasing vitamin D will relieve constipation, however, as the low vitamin D levels may be a consequence of chronic constipation.

Some people take vitamin D supplements, especially if they live in northern countries since sunshine is a vital source of vitamin D.

People with a vitamin B-12 deficiency may experience :

  • constipation
  • fatigue
  • weakness
  • loss of appetite
  • weight loss

While taking vitamin B-12 supplements may not help those without a deficiency, correcting the deficiency may relieve symptoms in those who do.

Groups of people that are most at risk of developing a vitamin B-12 deficiency include people with:

  • pernicious anemia
  • poor absorption of vitamin B12 from food
  • poor absorption of vitamin B12 following an operation
  • dietary deficiencies

Taking too many magnesium supplements can cause loose stools, diarrhea, nausea, and cramps. Magnesium has an osmotic effect, which means it draws water into the intestine, which is one of the causes of loose stools or diarrhea.

A common laxative that people can buy at the pharmacy is Milk of Magnesia. The main medicinal ingredient is magnesium hydroxide.

While there is little research to suggest that magnesium supplements can treat constipation, of all the supplements listed in this article, it is the most commonly used mineral supplement to address the problem. It is likely a safe option to try, as long as a person sticks to the recommended dose.

Although some vitamins and minerals can help people with constipation, others may cause it or make it worse.

Calcium

Calcium is essential for maintaining strong bones and carrying out functions in the muscles, heart, brain, and other body systems.

Calcium is in:

  • dairy products
  • kale
  • broccoli
  • fish with soft bones, such as canned sardines
  • fortified cereals, fruit juice, and soy and rice milk

While it is unlikely that a person would consume too much calcium from food alone, those taking supplements might. Too much calcium can cause constipation.

Some people need to continue taking calcium supplements, however. To reduce the risk of constipation from supplements, doctors recommend taking calcium throughout the day.

Taking calcium with meals or changing the brand or form of calcium can sometimes help.

Iron

Iron is another mineral that can cause digestive issues if a person is taking supplements.

Too much iron can also cause:

  • black stool
  • constipation
  • nausea
  • abdominal pain
  • vomiting

To reduce constipation, people can try taking lower doses at first and slowly increasing their dose if necessary.

A doctor may recommend taking the iron pill with food, although some foods reduce iron absorption.

If a person is having hard or infrequent bowel movements and has tried increasing dietary fiber and taking OTC products, they should speak with their doctor.

The doctor might be able to prescribe stronger laxatives or recommend other treatments.

In some cases, frequent or persistent constipation can be a sign of an underlying condition, so a doctor may ask about a person’s other symptoms.

Anyone who needs to take laxatives regularly to pass stool should let their doctor know. Treating constipation when it is a symptom of another condition can hide dangerous warning signs.

The most common treatments for constipation include dietary changes and OTC laxatives. Vitamins and minerals do not have a major role in treating constipation.

However, some people may experience constipation as a result of a vitamin deficiency, such as vitamin B-12 deficiency. In those situations, a vitamin supplement may help relieve constipation.

Some vitamins and minerals can cause loose stools or diarrhea, including magnesium and vitamin C. Other supplements, such as calcium and iron, can cause constipation.

People should speak with a doctor before starting or stopping a vitamin or mineral supplement.

SHOP FOR VITAMINS AND SUPPLEMENTS

The vitamins and minerals in this article are available to purchase in drug stores and online

90,000 Vitamin D. To drink or not to drink, that is the question. (Or a story about how I passed the test, which was not prescribed to me)

Background

In November 18, I accidentally passed an analysis for vitamin D. (I was not assigned to check it, the fact is that in the laboratory there was a discount on a package of tests, which included the ones I needed, plus a couple more in addition to it.) The result surprised me somewhat. The required tests were normal, but vitamin D was in short supply.

“Figovo”, I thought, and decided to study this issue a little.As it turned out, now the overwhelming majority of this vitamin is deficient, since over the past hundred years we have left sunny fields and moved to offices with artificial light. But this is not a problem, the standards are known and with low levels of this vitamin, it makes no sense even to go to the doctor. Having calmed down on this, I visited iHerb and after three months brought my result to a “worthy” 79 ng / ml.

I also decided that I would take an analysis for this vitamin D once a year, just in case, for control.

This would be the end of the story, but just recently I was asked to translate an article by a German doctor entitled “The Dangers of Vitamin D Treatment.” The article argued that the current norms of vitamin D are overestimated, and taking this vitamin in excess of the norm, even in small quantities, does more harm than good. On the one hand, the article was written by a practicing doctor with over 30 years of experience, and on the other hand, it was a little strange and the author was an anthroposophical (i.e.e. non-standard) medicine.

Usually, when mainstream science shows the results of double-blind, placebo-controlled studies, and it is opposed by a strange loner who says that everything is not so, we believe the majority. And this is usually justified. Nevertheless, since the matter with this vitamin touched me personally, I became interested and I decided, as far as possible, to sort out the discovered contradiction.

As you probably already guessed, everything turned out to be not at all as unambiguous as we would like.

Is it possible to believe the official science only on the basis of the fact that it is official? (lyrical digression)

Several centuries ago, official science argued that the Earth is flat and rests on three whales, and the guy who dared to deny it and explain something there was burned at the stake so as not to muddy the water. And the fact that this happened a long time ago does not mean that the situation has somehow changed now. Just look at the history of lobotomy or thalidomide. This I mean that at all times humanity has been subject to massive delusions on certain issues and there is no guarantee that now “all delusions are in the past.”Someone might argue that in those days there was no blind placebo-controlled study yet. On the one hand, this is so, but on the other hand, financial interest at all times made it possible to get the necessary figures on paper, and now this financial side is stronger than ever before. Even today, every year some drugs are withdrawn from circulation, because despite all the studies and tests that have passed, “suddenly” it turns out that the harm from their use is greater than the benefit.

Do you still trust double-blind, placebo-controlled trials? Me not!

Okay, just kidding.I believe this kind of research is a wonderful methodology. But I don’t really trust the people who conduct this research and the conclusions they draw from it. The fact is that such research costs a lot of money, which the state (we are not talking about ours), can spend more profitably, and therefore most of such research is carried out with the money of commercial organizations. And commercial organizations, of course, do not give money just like that, and it is quite understandable that they want some kind of “return” from their investments.This is where data manipulation begins.

For example, here is one very interesting study that concluded that beef lowers cholesterol levels. How? Elementary! You just need to properly load the control group with cholesterol from other sources (pork, poultry, fish, eggs and fatty milk) and reduce the amount of fiber, and in the right groups, on the contrary, remove all these foods and add fiber.

All this leads to the conclusion that “These results … provide support for the inclusion of lean beef in a diet that is good for the heart.”At the same time, for some reason, they do not write in the conclusion that beef is useful only as a substitute for pork. After a careful study of the study, there is every reason to conclude that the same diet (BOLD +), but without beef in general, would be much healthier for the heart. However, after reading only the conclusion, it is logical to assume that it would be more beneficial to simply ADD beef to your diet.

And, unfortunately, there are a lot of such studies. Let’s get back to vitamin D.

A course of vitamins or hormone therapy?

The first and most important thing to know about vitamin D is that it is not a vitamin, but a prohormone.Initially, it was mistakenly ranked as a vitamin, and when its true nature was revealed, which happened much later, it was already known to the whole world as a vitamin and (for some reason I do not understand) did not rename it.

Tellingly, this is not some kind of scientific super-discovery. There is no disagreement among scientists on this issue – everyone who is interested in the issue has known this for a long time. (Although, unfortunately, doctors are not always interested).

Nevertheless, it was a super discovery for me personally.If I had honestly written “D-hormone” on my bottle, my attitude would be completely different. It is one thing to prescribe a course of vitamins for yourself in the dose recommended by the manufacturer, and it is completely different for hormonal therapy. Yes, I understand perfectly well that it is stupid to think that my health is of interest to the state or some pharmaceutical companies, and it is quite understandable that if the packaging said “hormone” sales would drop several times, but it was still unpleasant. I confess that, in my naivete, I expected more honesty in this matter.

Standards

The second thing I wanted to check was the norms. Who measured D-hormone levels in people getting enough sun and what were the results?

On this topic, there were 100,500 scientific publications of varying degrees of authority, but oddly enough, they did not echo each other at all, confirming the current norms. So, for example, one of the most authoritative sources – the US Institute of Medicine (since 2015 – the US National Academy of Medicine) published in 2011 the “Calcium and Vitamin D Diet Guidelines”.To quote from the chapter “Conclusions on Vitamin D Deficiency in the United States and Canada”:

“… Vitamin D limits for determining deficiency in laboratory interpretation and for use in clinical practice are outside the purview of this committee. However, the committee noted with some concern that serum vitamin D thresholds, defined as signs of vitamin D deficiency, have not been systematically and scientifically developed.

From the committee’s point of view, there is currently a 90,050 significant overestimation of the vitamin D deficiency rate of in the North American population due to 90,050 use of cut-off values ​​well above the levels defined in this report based on available data. Earlier reports reported that serum vitamin D concentrations above 11 ng / ml are indicative of adequate vitamin D levels for children from birth to 18 years of age, while concentrations above 12 ng / ml correspond to adequate vitamin D levels for adults aged 19 to 18 years. 50 years.In recent years, other thresholds have been proposed for defining deficit and what has been termed “deficiency”. In the current literature, they include values ​​in the range from above 20 ng / ml to values ​​above 50 ng / ml. Using higher cut-off values ​​would be expected to artificially increase estimates of the prevalence of vitamin D deficiency.

… Data analysis by this committee suggests that people are at risk of vitamin D deficiency for bone health at levels below 12 ng / ml.Some, but not all, people are potentially at risk at levels between 12 and 20 ng / ml. For almost all people, a vitamin D level above 20 ng / ml is sufficient. Serum vitamin D concentrations above 30 ng / mL are not always associated with increased benefit. Readings above 50 ng / ml may be cause for concern. Given the concern about high serum vitamin D levels, and the desire to avoid misclassifying vitamin D deficiency, there is a strong public health and clinical need for a consensus to define both vitamin D deficiency and excess vitamin D levels.The current lack of evidence-based guidance is a concern and concern as serum vitamin D levels above 20 ng / ml can sometimes be classified as deficient and treated with high doses of vitamin D, many times the intake levels recommended by this report. ”

Then where did the current norms come from?

Later that year, a certain “Endocrine Society” published a report in which, without a shadow of embarrassment, wrote literally the following:
“Vitamin D deficiency has been historically identified and recently recommended by the Institute of Medicine as less than 20 ng / ml…. “

In response, several leading epidemiologists and endocrinologists on the original committee of the Institute of Medicine published an article in the New England Journal of Medicine” Vitamin D Deficiency: Is There Really a Pandemic? ” This article argues for lowering the currently accepted cut-off level of 20 ng / mL, and states that the level they rated as acceptable was never intended to be used to determine vitamin D. over-screening for vitamin D deficiency; and over-treating people who are already okay.

After reading these materials, I considered it inappropriate to further study the issue, for the following reasons:

  • Despite the complexity of the issue for me, as a layman, it seems to me that for scientists this is not rocket science at all. In other words, I strongly doubt that modern scientists are really unable to determine the rate of any hormone. And to put it even simpler, both sides know the answer to the question, but one of them is disingenuous.
  • The history of recent decades suggests that if scientists cannot agree on a relatively simple issue, then you need to look for who will benefit from certain results.There are only two options:
    1. Perhaps we all really need to catch up with the artificially synthesized D-hormone, and a group of scientists from the Institute of Medicine decided to publish deliberately incorrect data. But why? For the sensation? Their work is not sensational at all. Who can benefit if everything remains as it is and the population does not spend money on the purchase of the medicine they need? I have not been able to come up with an answer to this question.
    2. Perhaps the opposite is true, and we do not need to take a certain hormonal drug, and in this case, the guys from the endocrine community, and, perhaps, some other “experts” artificially inflate the norm.Who can benefit from this? Considering that the global D-hormone market was estimated at $ 130 million in 2018, and the fact that the cans with this drug are still labeled “vitamin”, I can quite clearly imagine who benefits from this alignment.

This concludes my story, and as a result I would like to say that I am not agitating anyone to drink vitamin D , D-hormone, or not drink. Of course, there are states of the body in which it is necessary to artificially add this hormone to the diet, but at the same time, everything is not at all as unambiguous as it is written in the decoding of the results we receive from medical laboratories.90,000 Does Vitamin D Cause Constipation?

Does Vitamin D Cause Constipation?

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Excessive intake of certain vitamins and minerals supplements causes constipation. Here we will see whether vitamin D is related to constipation or not. Vitamins are essential for the human body to perform various functions in the body. All vitamins are needed in small quantities, but essential for the prevention of various diseases and disorders.Vitamin D is also one of the most important vitamins that the body needs for a variety of purposes. This vitamin is essential for the proper absorption of calcium and phosphate. Secondly, vitamin D is also essential for maintaining healthy bones and teeth. However, if you are not getting enough vitamin D from food, he advised using vitamin D supplements. However, there are several claims that vitamin D causes constipation. Let us know more about it.

Vitamin D

Vitamin D is obtained from various foods like milk, eggs, fish, cheese, shellfish, soy, etc.Secondly, exposure to direct sunlight also helps in the synthesis of vitamin D under the skin. Thus, vitamin D deficiency is a rare disease. However, having an unhealthy diet, does not receive sunlight, or suffers from any health condition, etc. are some of the causes of vitamin D deficiency. Vitamins and mineral supplements are usually intended for people who suffer from vitamin D deficiency. Second, vitamin D supplements may also be prescribed if the person suffers from any calcium deficiency disorder.

Vitamin D Supplements and Constipation

First, it should be noted that most vitamin and mineral supplements do not cause side effects when taken in the right amounts. Therefore, it is important to consult with your doctor and only take supplements in specific amounts and for the prescribed period of time. Therefore, if you suffer from side effects such as constipation, weakness, nausea, vomiting, etc. then it may be due to excess vitamin D in your body. It should be noted that vitamin D overdose can be dangerous.In order to prevent this, as mentioned above, vitamin D deficiency must be properly diagnosed and supplements should be taken with the advice of a doctor.

Secondly, as mentioned above, vitamin D is necessary for the absorption of calcium in the body. In fact, vitamin D is involved in the absorption of calcium in the body. On the other hand, excess calcium in the body can lead to side effects like drowsiness and constipation. A combination of calcium and vitamin D taken together to treat calcium deficiency.However, if the level of calcium in the body rises above normal, the person may suffer from constipation. Apart from this, the build-up of calcium and phosphate in the liver is also one of the side effects of vitamin D.

Vitamin D supplements are usually taken in the form of D3. It is a fat-soluble vitamin that is easily absorbed by the body. However, when taken in excess, it can lead to toxicity and symptoms like a metallic taste in the mouth. And as vitamin D is related to constipation, it is recommended that you consult your doctor immediately if you suffer from constipation or any other side effects associated with vitamin supplementation.Although constipation can be treated with medications and home remedies, your doctor will adjust the dosage of the supplement to avoid side effects.

Summarizing the above, we can say that constipation can only occur due to an excess of vitamin D or calcium in the body. Finally, to be on the safe side, inform your doctor about any side effects you are experiencing on taking supplements. Take care of yourself!


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Constipation

Constipation – prolonged delay in bowel movements, bowel movements from feces.

Causes of constipation

Among its causes, neurogenic factor may prevail, associated with various disorders in the central nervous system (stressful situations), conscious suppression of the reflex under certain living conditions and working conditions (traveling work, lack of a toilet). With proctological diseases, accompanied by painful defecation, reflex constipation occurs. They can also be a consequence of 90,050 chronic poisoning with lead, morphine, nicotine and other toxic substances, disruption of the endocrine glands – ovaries, pituitary gland .At the present time, constipation of alimentary origin is quite common – with insufficient intake of fiber of vegetable fiber or constipation associated with a sedentary, sedentary lifestyle.

The mechanisms of such constipation are quite complex. Intestinal peristalsis (muscle contractions) is stimulated by mechanical action on the intestinal wall of coarse and indigestible fibers of plant fiber, contained in natural food in sufficient quantities.These are the shells of grains in cereals, a certain content of bran in plain wheat flour, in vegetables and fruits. But in recent decades, the diet of the modern city dweller has undergone significant changes. In his diet, semi-finished and deeply refined products began to prevail – premium flour and products made from it (white bread, pasta), refined cereals, rice with an almost complete absence of fiber, and so on. Vegetables also began to be classified as low-calorie foods, and, therefore, with low nutritional value, and they began to be partially replaced by food concentrates and flavors.Chronic low fiber content in the digestible food of a modern person leads to a slow movement of food in the gastrointestinal tract and has a number of negative consequences in the development of chronic atonic constipation. Fiber loosens food masses in the intestinal lumen and thereby improves access to food lumps of intestinal juice, which, along with normal peristalsis, ensures optimal food breakdown and absorption. The absorption of food in the intestine is also facilitated by the mechanical cleansing of the fibers of the fiber of the villous inner surface of the intestine.With its deficiency, a film forms over time on the surface of the intestinal wall, which prevents the absorption of nutrients into the blood, primarily those having large molecules (protein, vitamin complexes and polysaccharides). In the lumen of the intestine, areas of accumulation of dense undigested food are formed, and putrefactive processes intensify in the large intestine, poisoning the body with absorbed toxins, non-excreted “fecal heaps” and “stones” are formed. Fiber, due to its poor digestion, in the last stages of digestion is involved as a filler in the formation of bulk feces and thereby stimulates the urge to empty the intestines in time.

Calcium deficiency in the diet of modern humans also has a negative effect on intestinal motility and absorption processes.

Calcium is necessary for the process of contraction of muscle fibers, including smooth muscles, presented in the intestinal wall, as well as for direct participation as a conductor in the process of absorption of nutrients through the intestinal mucosa into the blood. With a lack of calcium, these processes are suppressed.Calcium deficiency is also associated with a change in the nature of the diet – the use of refined products (yoghurts, low-fat kefir), in which the calcium content is 3-4 times lower in comparison with natural dairy and fermented milk products, neglect of dishes with bone broths. Chronic calcium deficiency (and thus alimentary constipation) is especially common among women over 35. On the one hand, this is due to the reproductive function they perform. Fetal formation, birth and breastfeeding require significant amounts of calcium, which the mother’s body receives from its reserves stored in the bones.With the modern diet, this deficit persists and increases with each subsequent birth. On the other hand, calcium metabolism also decreases during the period of fertility extinction, as a result of a decrease in the secretion of certain female hormones by the ovaries. The calcium content in bones decreases to a critical level – osteoporosis (loosening, rarefaction) of bones, and as a result, along with long-term constipation and chronic poisoning from the large intestine, leading to malnutrition of the skin, hair and other tissues and organs, increased fragility of bones occurs, the likelihood of their fractures with minor trauma.

Quite rarely, there are constipation associated with the anatomical features of the large intestine – lengthening of its sections or excessive narrowing.

With atonic form of constipation , the delay in emptying is associated, as noted, with the relaxed state of the smooth muscles of the intestinal wall as a result of a decrease in motor function (peristalsis) – muscle contractions of the intestine. The feces in this case are abundant, dense, sausage-like.Defecation is painful, carried out with great difficulty, sometimes with microcracks in the mucous membrane of the anal canal, manifested by streaks of blood on the surface of the stool.

At spastic constipation , a long delay in defecation, on the contrary, is associated with an increased tone of intestinal smooth muscles and is most often the result of a neurogenic reaction of the whole organism to a prolonged stressful situation, mental trauma. It should be noted that the stress reaction indirectly negatively affects the state of the intestinal microflora.Feces in this form take the form of “sheep feces” – dense, small separate lumps, sometimes accompanied by a meager liquid fraction. Spastic constipation is characterized by flatulence, a feeling of fullness in the abdomen, pains of a spastic nature that spread to the upper abdomen.

Treatment of constipation

Treatment for constipation is directed at the underlying cause. For atonic constipation, gastroenterologists recommend a gradual increase in the diet of foods containing a sufficient amount of vegetable fiber – cereals, vegetables, fruits, certain types of bread.You should also regularly consume natural fermented milk products, cheese, bone broth. A prerequisite is the restoration of an active lifestyle – daily walks, exercise, water procedures, massage of the abdomen. From medicines, long-term intake of calcium preparations is recommended, preferably of natural origin or in combination with vitamin D (calcium gluconate and analogues can contribute to the formation of kidney stones). Herbal laxatives can be used to facilitate bowel movements.Periodic bowel irrigation and cleansing enemas are also useful.

With spastic constipation, first of all, it is necessary to normalize the state of the nervous system. For this purpose, tranquilizers, adaptogens are recommended (eleutherococcus, lemongrass, preparations of Rhodiola rosea, ginseng). Food should be gentle, mostly boiled. For spastic manifestations, antispasmodics are used (no-shpa, baralgin, etc.), thermal procedures and pine baths have a positive effect to reduce intestinal spasms.

90,000 Why is vitamin D overdose dangerous for children?

Vitamin D overdose leads to changes in bone metabolism, osteoporosis and bone demineralization. Resorption of the bone marrow stroma occurs, vascular hardening, which further contributes to the development of atherosclerosis. Excess vitamin D in the body causes increased deposition of calcium salts in the internal organs, which disrupts their function, especially of the kidneys. Joint pains appear.
Symptoms:
In acute hypervitaminosis D, the child’s behavior changes dramatically: at first he is restless, capricious, and then inactive, lethargic.The skin is pale, appetite is sharply reduced, the liver increases, persistent constipation appears, less often diarrhea. The child begins to drink a lot and urinate frequently. With the progression of the disease, persistent vomiting, developmental delay, and weight loss appear. Blood pressure may rise. In severe cases, breathing becomes difficult, the pulse is rare and weak, convulsions appear, the reaction to the environment becomes slower or sharply reduced.
In chronic hypervitaminosis D, all changes increase gradually and begin to appear no earlier than a month after the start of vitamin D intake.The earliest and most characteristic sign is loss of appetite, weight loss (in children, body weight ceases to increase). Nausea, vomiting, constipation, irritability, thirst, frequent urination, pallor, fever appear. Gradually, the condition worsens, there may be excitement or lethargy, constipation or diarrhea, appetite sharply decreases, thirst increases.
Hypervitaminosis D can most often occur during self-medication, when the child’s parents believe that he has rickets, or they themselves prescribe vitamins for prophylactic purposes.It is especially easy to get an overdose of the drug in infants: they are given only one drop, 2 – already an overdose, 3 – hypervitaminosis.
If a child has the above phenomena, you should immediately consult a doctor, stop taking the drug, exclude cottage cheese, eggs, cow’s milk from food – foods richest in vitamin D. Treatment of this condition should be carried out only under the supervision of a doctor.
It should be remembered that vitamin D is produced in the skin under the influence of ultraviolet radiation.15-20 minutes of exposure to the sun is enough for the body to produce a daily dose of vitamin D.
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Vitamins for winter

Winter has come and our body needs help to maintain health.

What vitamins are especially necessary for us during this period?

Vitamin A – in fact, this is the name for a whole group of chemicals that are similar in chemical structure, which includes retinol (vitamin A1, axeroftol) and other retinoids that exhibit similar biological activity: dehydroretinol (vitamin A2), retinal (retinene, aldehyde of vitamin A1), retinoic acid.Retinoids are found in animal products such as fish oil, beef liver, cottage cheese, cheese, butter, and caviar.

Provitamins A – carotenoids are metabolic precursors of vitamin A, that is, retinoids are formed from carotenoids in the body. The most important of these is β-carotene. Carotenoids are found in plant foods such as carrots, pumpkin, spinach, broccoli, green onions, legumes (soy, peas), peaches, and apples.

One of the earliest signs of vitamin A hypovitaminosis is the development of “night blindness” – a violation of dark adaptation.

Vitamin A hypovitaminosis also causes growth retardation at a young age, follicular hyperkeratosis (increased keratinization of the skin), dry mucous membranes (including the intestines, bronchi, urinary tract, which can lead to the development of inflammatory processes, including of an infectious nature), xerophthalmia (dryness of the conjunctiva of the eye), keratomalacia (clouding and softening of the cornea of ​​the eye), impaired fertilizing activity of sperm.

Vitamin E – also represent a group of compounds – derivatives of tocol, of natural origin.The most important of these are tocopherols and tocotrienols. The main sources of vitamin E are vegetable oils (soybean, cottonseed, sunflower), nuts (almonds, peanuts), green leafy vegetables, cereals, legumes, egg yolk, milk.

Lack of tocopherol – vitamin E hypovitaminosis – often occurs in people living in areas exposed to radionuclide or chemical contamination.

Lack of vitamin E leads to impaired visual acuity, dry skin, anemia, muscular dystrophy, degenerative changes in the heart muscle, impaired reproductive abilities.

B vitamins is a large group of water-soluble vitamins that take an active part in cellular metabolism. Includes thiamine – vitamin B1, riboflavin – vitamin B2, nicotinic acid, niacin – vitamin B3 (or PP), pantothenic acid – vitamin B5, pyridoxine, pyridoxal and pyridoxamine – vitamin B6, biotin – vitamin B7 (or H), folic acid, folacin – vitamin B9 (or Sun, or M), cyanocobalamin – vitamin B12.

Foods rich in B vitamins include pine and walnuts, pistachios, peanuts, lentils, buckwheat, corn, pork, liver.

Lack of B vitamins leads to the development of rapid fatigue, insomnia, apathy, up to depression, dermatitis and allergies, dry skin, constipation, dizziness, memory impairment.

Vitamin C – L – ascorbic acid – organic compound, one of the most important in the human diet.

Contained in fruits and vegetables (rose hips are the richest in vitamin C. Also found in large quantities in sea buckthorn, sweet (Bulgarian) pepper, black currant, kiwi, dried white mushrooms, parsley and dill, Brussels sprouts, broccoli.

With a lack of vitamin C, symptoms such as dry skin, hair loss, brittle nails, tooth loss, bleeding gums, poor wound healing, decreased immunity, joint pain, increased fatigue and irritability are observed.

Vitamin D is also a group of biologically active substances, which includes cholecalciferol and ergocalciferol.

Cholecalciferol (vitamin D3) is synthesized under the action of ultraviolet rays in the skin, and also enters the human body with food.

Ergocalciferol (vitamin D2) comes exclusively from food.

The main function of vitamins D2 and D3 is to ensure absorption of calcium and phosphorus from food in the small intestine.

The formation of the vitamin cholecalciferol in the skin requires exposure to ultraviolet rays. When in the shade or cloudy weather, the synthesis of the precursor cholecalciferol can be reduced by 60%.

Food sources of vitamin D are some algae, fatty fish, fish oil, chanterelle mushrooms.

Vitamin D deficiency causes rickets, heart disease and hypertension, brittle bones, periodontitis, muscle pains, cramps, headaches, fatigue and insomnia, can worsen the condition in rheumatoid arthritis, asthma, diabetes, multiple sclerosis.

In order to prevent the development of hypovitaminosis in winter, you should, after consulting your doctor, take complex dietary supplements containing the above vitamins.

Vitamin therapy

Vitamins are substances without which human life is impossible. However, even a full-fledged diet, which includes a large amount of fresh fruits and vegetables, cannot provide us with the necessary amount of vitamins. This is due to a number of reasons, the description of which would take more than one page. Let’s name only the main ones: fruits and vegetables do not contain the whole complex of vitamins in the quantities necessary for a person; during storage and cooking, a significant part of them is destroyed.In addition, an unfavorable environmental situation, significant physical and psycho-emotional stress, various diseases, prolonged use of antibiotics can significantly increase the need for vitamins.

When the body does not receive the required amount of vitamins for a long time, the phenomenon of vitamin deficiency develops, which, depending on the severity, have the character of hypo- or avitaminosis. The most often observed is the so-called subnormal supply of vitamins, which is not accompanied by a vivid clinical picture of vitamin deficiency, but nevertheless has a negative effect on the general condition: the state of health worsens, the body’s resistance to infectious diseases and working capacity decreases.

AGE DISEASES

Symptoms: attacks of dizziness, imbalance, feeling of exhaustion, weakening of memory and attentiveness, anxiety, decreased performance.
Causes: metabolic disorders, decreased lung and heart function, oxygen starvation, lack of nutrients.
How vitamins can help. Vitamin E is an essential protective factor for brain and nerve cells. It prevents the destructive process in which neurons in the brain die and seals are formed from dead waste and oxidized cholesterol.Vitamin A protects the mucous membranes, vitamin C strengthens the walls of blood vessels and makes them smoother, eliminating vein diseases and improving blood circulation.
Our advice. In the morning before breakfast, take a tablespoon of vegetable oil (contains a lot of vitamin E). Drink fresh squeezed lemon juice (vitamin C) twice a day. Serve dark green vegetables, salad, or carrots once a day.

EYE DISEASES

Symptoms: weakening of visual acuity, redness of the eyelids, burning and itching in the eyes, lack of tear fluid.
Reasons: dry air, draft, harmful substances, stress, too long stay at the TV screen.
How vitamins can help. The eyes require five times more vitamins A, C and E than any other organ. Therefore, this sense organ has a particularly rich and extensive network of the finest blood vessels. Thus, it is supplied with a large amount of essential nutrients. But even this is not enough for nature. Through the lacrimal fluid, vitamins A, C and E enter the eye, protecting it from free radicals.
Our advice. Eat fresh fruit three times a day (1 apple, 1 kiwi, southern fruit), when preparing meals, use only fresh vegetable oil that covers the deficiency of vitamin E. To meet the need for vitamin A, it is necessary to take fish oil.

Bloating

Symptoms: bloated abdomen, flatulence, intestinal colic.
Causes: Eating foods that cause bloating (legumes, cabbage, black bread), low acidity of gastric juice, poor chewing, bile deficiency, consumption of carbon dioxide-containing drinks.
How vitamins can help. B vitamins – essential for maintaining muscle tone in the gastrointestinal tract. They normalize appetite and digestion. Vitamin A – protects the sensitive mucous membranes of the stomach and intestines from drying out and restores their functions. At the same time, the mucous membrane of the stomach again begins to produce a sufficient amount of gastric juice and enzymes, preventing putrefactive processes in the intestines.
Our advice. Take a vitamin B complex daily, in the form of brewer’s yeast.Increase your intake of vitamin A, which vegetables are especially rich in (the greener the better). There are a lot of carrots, add vegetable oil to salad and vegetables. B vitamins and vitamin A normalize the functions of the gastrointestinal tract.

BLOOD CIRCULATION DISORDERS

Symptoms: varicose veins, hemorrhoids, leg edema, cold limbs, dizziness attacks.
Reasons: in the arteries with their elastic walls (through them the blood from the heart disperses throughout the body) deposits are formed – most often from calcium and cholesterol crystals, which causes narrowing of the blood vessels.Veins with weaker walls (through which blood flows to the heart) dilate when there is a lack of nutrients. Small venous valves do not do their job well, and there is a reverse flow of blood, forming sinuses and vermiform branches due to excess pressure. In addition, blood enters the surrounding tissues through the thinned walls of the veins.
How vitamins can help. Bioflavins, which give the berries a blue-violet color, together with vitamin C, strengthen the walls of blood vessels.In the arteries, a form of vitamin C dissolves the dangerous calcium phospholipids that are circulating in the blood and tend to accumulate. When they interact in the blood and on the inner walls of blood vessels, calcium ascorbate and sodium phospholipids are formed. Both of these substances are easily excreted in the urine.
Our advice. Several times a day there are blue and red fruits and berries, as well as citrus fruits, apples, apricots, etc. Instead of rice and pasta, it is more common to serve buckwheat, which is very rich in bioflavin, a routine that strengthens the capillary walls in plants.Additionally, take up to 3 grams of vitamin C (from a pharmacy), preferably sodium ascorbate, not ascorbic acid. Once a day, prepare a grout from self-milled wheat grains, which contain a large amount of zinc, which is necessary to strengthen the walls of blood vessels. To avoid circulatory disorders, you need to eat citrus fruits, apples and apricots every day.

Diarrhea

Symptoms: pain and cramps in the intestines, frequent watery stools.
Causes: stress, overexcitation, infections, inflammation of the small intestine, food allergies, deficiency of enzymes, especially necessary for the digestion of carbohydrates.
How vitamins can help. Niacin (vitamin B 3) stimulates the production of hydrochloric acid in the stomach, strengthens the autonomic nervous system and normalizes bowel function. Vitamin A helps with diarrhea caused by inflammation and infections, strengthening the immune system and the intestinal mucosa.
Our advice. Eat foods containing a large amount of so-called ballast substances. They absorb gastric juices containing pathogenic bacteria, decay and fermentation products, and remove them from the body. Particularly effective help in such cases is provided by fruits and vegetables containing a lot of pictin – apples, citrus fruits, carrots, tomatoes, as well as potatoes (be sure to eat unpeeled!). Pectin together with water forms a colloid that covers the intestinal mucosa with a protective film.For the intake of niacin, it is necessary to eat wheat germ or brewer’s yeast. To restore the immune defenses of the mucous membranes, a two-week course of fish oil treatment is recommended. If diarrhea is combined with fever, you should consult your doctor.

ECZEMA

Symptoms: A rash on the skin that causes itching and burning, sometimes with watery discharge and redness.
Causes: caused by bacteria or allergic factors.There are eczema caused by inadequate protein absorption. In this case, undigested and perishable proteins are excreted from the body through the skin. All eczema are of a different nature and therefore their treatment is individual. But most of them are caused by food allergies associated with low acidity of gastric juice. Most eczema sufferers have high levels of antibodies in their blood, indicating an allergy. At the same time, white blood cells (defenders of the immune system) often have painful changes and do not provide the body’s defense against bacteria that tenderly multiply in the skin tissue.
How vitamins can help. Vitamin A is the most effective skin protection against infections. Eczema is difficult to treat, so to be successful it is necessary to build up an increased concentration of vitamin A in the blood. The best home remedy is fish oil. The substances contained in it can restore the dry, shriveled and keratinized intestinal mucosa, increase its total weight by 15 percent and thus significantly improve its protective properties to resist food allergies.Vitamin E, which protects fatty acids from oxidation, will not cure eczema, but it will counteract its spread.
Our advice. Buy fish oil in the pharmacy. Eat a cup of wholemeal grout daily. The zinc contained in it not only helps to release vitamin A from the liver, but in itself is the best remedy for skin diseases. For cooking (such as salads), use unrefined vegetable oil that is high in vitamin E.Fish oil and wholemeal grout can help relieve eczema.

COLD

Symptoms: inflammation of the mucous membrane of the throat, hoarseness, fever, cough, runny nose, pain in the limbs and increased fatigue.
Reasons: viral infection against the background of a weakened immune system as a result of hypothermia (dampness, cold, draft, etc.).
How vitamins can help. Vitamin C is the best prophylactic against colds, its molecules penetrate into white blood cells and make them invincible against viruses and bacteria of all kinds.At the same time, bioflavins increase the effectiveness of vitamin C tenfold. Vitamin A “specializes” in providing immunity to mucous membranes (eg, throat, nose, mouth) often prone to infections.
Our advice. Fresh juice of 1 lemon is enough to provide the body with a daily dose of vitamin C. To meet the need for vitamin A, you need to eat dark green vegetables (spinach, broccoli), lettuce, carrots or other yellow, red and green vegetables once a day …If the cold is already in full swing, then even vitamins will not be able to help right away.

INCREASED FATIGUE

Symptoms: constant sleepiness, a state of weakness, indecision, sensitivity to weather changes, irritability, nervousness and insomnia.
Reasons: most often the cause of this malaise is the concentration of sugar in the blood (a new “fashionable disease” – hypoglycemia).
How vitamins can help. When blood sugar levels are too low, the cells in the brain and nerves are not supplied with enough energy.The consequence is that they switch their work to an economical mode, which causes increased fatigue and nervousness. The best way to increase the concentration of sugar in the blood is B vitamins, in combination with the trace element chromium (all this is found in brewer’s yeast).
Our advice. Take brewer’s yeast every day and avoid sugar, sweets and sugary drinks, and flour products. Only complex carbohydrates are recommended (products from unrefined wheat grains, unprocessed rice, vegetables, potatoes).

FEMALE DISEASES

Symptoms: absence or irregularity of menstruation, weak libido, hardening in the chest, urinary retention, irritability, depression.
REASONS can be very different. Most often these are hormonal changes and low blood sugar concentration.
How vitamins can help. Vitamin B6 (pyridoxine) in most cases relieves the symptoms of premenstrual syndrome. But this vitamin is ineffective in isolation.Its action is activated by vitamin B2 (riboflavin). Vitamin E helps prevent hardening in the breasts. Women with premenstrual syndrome often have low blood magnesium levels, leading to irritability and a high sensitivity to pain.
Our advice. Use B vitamins in combination. A week before menstruation, additionally take magnesium tablets, and in addition, once a day – a tablespoon of vegetable oil (contains vitamin E).Vitamins B6 and B2 are especially useful for women. They help with irregular periods, hardening in the chest, urinary retention and depression.

FORGETTING

Symptoms: absent-mindedness, difficulty in perceiving educational material, inability to remember events in a certain period of time.
REASONS. Most often it is the atrophy of the thinly branched endings of brain cells and nerves. Insufficient glucose supply to brain cells.
How vitamins can help. To refresh memory, you need B vitamins – choline and inositol, as if created by nature specifically for this purpose. The complex of other B vitamins will help normalize digestion and absorption of carbohydrates, thereby improving the supply of glucose to brain cells.
Our advice. Take a month of treatment with lecithin, which is high in choline and inositol. To supply glucose, it is enough to eat a cup of grout from hand-milled grains once a day, which contains enough B vitamins.It is recommended to exclude sweets from the diet.

PAIN IN THE JOINTS

Symptoms: Constant pain in the joint capsules, most often in the shoulder joint.
Causes: injuries (bruises). Cartilage wear due to a large one-sided load, rheumatic inflammatory processes (including due to hypothermia, dampness, drafts).
How vitamins can help. Vitamin E is effective in bone tissue atrophy and has the ability to stimulate the reproduction of cartilage cells.At the same time, it closely interacts with vitamin C, strengthening the sulfur-containing proteins in the cartilage. Vitamin C, as well as vitamins A, B6 and the trace element zinc activate protein synthesis in cartilage tissues.
Our advice. Carry out a four-week course of treatment with vitamins C (2-3 grams of ascorbic acid daily) and E. Brewer’s yeast is indispensable to fill the lack of vitamin B6 and zinc. The daily diet should contain a lot of green, yellow and red vegetables rich in vitamin A. It is recommended to cook well-mashed carrots with the addition of a small amount of fat.For joint pain, you should pay attention to vitamins C, E, B6 and A.

HEMORRHOUS

Symptoms: itching in the anus, bleeding, pain, induration in the anal region.
Causes: Weakened veins, increased stress on the blood vessels when straining (in many cases caused by constipation), pregnancy.
How vitamins can help. Vitamin C and bioflavins, especially rutin, which are rich in buckwheat, give the vein walls strength.(The weakening of blood vessels is most often explained by a lack of vitamin C.) Substances that are found in blue and purple berries increase muscle tone in veins and protect vascular cells from atrophy and destruction.
Our advice. Provide an enhanced two-week course of treatment with bioflavins and vitamin C, which will stop the development of hemorrhoids and the process of thickening of the veins. Eat as many fresh fruits as possible, preferring such as kiwi, lemons, grapefruit, oranges, currants, etc.n. Citrus fruits must be eaten whole to ensure the intake of bioflavins, which are contained in the pulp of citrus fruits. Additionally, take ascorbic acid purchased at the pharmacy (2-3 grams daily).

THROAT PAIN

Symptoms: burning and shortness of breath, dry throat, pain when swallowing.
Causes: inflammation of the larynx and nasopharynx due to a viral infection.
How vitamins can help. Vitamins A and C have a strong antiviral effect and are effective in preventing almost any viral infection.At the same time, vitamin A? Specializes? on the mucous membrane of the larynx, and vitamin C enhances the effectiveness of white blood cells – the guardians of our immunity. If the inflammation of the larynx has gone far, then with the help of vitamins and other nutrients alone, it cannot be cured.
Our advice. Prevent illness by regularly consuming fresh fruit, and in the autumn and winter months – fish oil, which contains a lot of vitamin A. If inflammation of the larynx has already begun, you should drink diluted vegetable juices, light soups, herbal tea.Observe rest. Heat (including increased body temperature) promotes healing. Viruses die faster when the temperature rises, so heat during illness performs a natural protective function.

ALLERGY (HAY FEVER)

Symptoms: Watery, reddened eyes, continuous sneezing and headaches.
Reasons: allergic hypersensitivity to pollen from flowering grasses and trees, as well as dust, molds, mites, etc.p.
How vitamins can help. The main culprit? allergies – histamine. Molecules of this substance in large quantities enter the bloodstream when, for example, plant pollen provokes an immune response. The consequences of this are obvious: vasodilation, secretion of fluid from small vessels, redness of the skin (the same process in the brain leads to headaches). This process intensively affects the mucous membranes of the nasopharynx, a runny nose and sneezing begin. Vitamin C controls the concentration of histamine in the body and breaks down its excess into neutral acids.
Our advice. Before the plants begin to bloom in spring, take vitamin C vigorously for 4-6 weeks. If possible, eat fresh fruit and additionally take 1 gram of ascorbic acid twice a day. If in the spring before the beginning of flowering of plants there are fresh vegetables three times a day and additionally take one gram of ascorbic acid twice, you can avoid allergies.

LUMBAGO

Symptoms: sudden onset of severe pain, usually in the lower back muscles, involuntary hardening of the muscles.Bending and walking are usually accompanied by severe pain.
Reasons: the attack is often preceded by hypothermia. With awkward movement or heavy lifting, the vertebrae shift.
How vitamins can help. Vitamin C, an essential nutrient for our skeletal system, speeds up the healing process, relieves pain and strengthens the back muscles. It is essential for the synthesis of keratin, a muscle vitamin that supplies energy to muscle cells. That is why the first symptoms in patients with scurvy, caused by a lack of vitamin C, are bleeding from the gums and muscle weakness.Sometimes treatment with vitamin C relieves the patient from vertebral surgery.
Our advice. In addition to the usual treatment (improvement of blood circulation, massage, heat, compresses, etc.), four times a day, take one gram of ascorbic acid (vitamin C). For an upset stomach, the dose can be halved.

COUGH

Symptoms: dry or hoarse cough, chest pain, fever.
Causes: Mucus production as a defense against viral infection.
How vitamins can help. In a severe attack of coughing, viruses and bacteria are expelled from the body at the speed of a bullet. For treatment, warmth, rest and plenty of drink are prescribed. If the cough is accompanied by hemoptysis, fever, or lasts more than eight days, you should see a doctor. The best preventive measures are vitamins A and C, which strengthen the immune system and make the mucous membranes more resistant to bacteria and viruses.
Our advice. At the beginning of the rainy autumn and winter months, treat with fish oil (2-3 weeks). Also, eat more fresh fruits, salads and vegetables. To protect against coughing, it is necessary to take a course of treatment with fish oil and eat more fruits, salads and vegetables.

WEAK IMMUNITY

Symptoms: Feeling unwell throughout the body. Each deterioration in well-being can be the result of lowered immunity.
Reasons: lack of nutrients, especially vitamins.Because of this, the immune system, consisting of the pineal gland, lymphatic system and white blood cells, cannot successfully fight off pathogens (viruses, bacteria, fungi, etc.).
How vitamins can help. Carotenes, from which vitamin A is synthesized, and vitamin E are the best protection for pineal gland cells. The higher the concentration, the more successfully this white blood cell-producing immune organ is able to fight microorganisms. The spleen also produces protective bodies and must be protected from harmful substances by antioxidants such as vitamins A, C and E.Vitamin C improves metabolism and protects white blood cells from many enemies. It also increases the amount of interferons, the body’s protective substances.
Our advice. Regular consumption of tomato juice increases the concentration of carotenes in all cells. As for vitamin E, its deficiency in the body is easy to overcome if you take a tablespoon of vegetable oil daily (in pure form or in salads). In addition, you need a lot of fresh fruit (vitamin C).Other important bio – substances for the immune system: zinc (in unrefined grains, brewer’s yeast) and selenium (in unrefined grains, meat, garlic, brewer’s yeast, and also in fish, although in this case it is absorbed somewhat worse).

CARIES

Symptoms: dark spots and holes in the teeth, hypersensitivity to toothache.
Causes: Exposure to teeth and tooth enamel of acid produced by bacteria and fungi from sugar residues.
How vitamins can help. A prerequisite for improving the disease state should be the rejection of sweets and flour products. These fast-dissolving carbohydrates disrupt the balance of calcium and phosphorus in the body, which poses a danger of tooth decay. In addition, sugar that comes into direct contact with tooth enamel poses a danger to teeth. With a healthy diet, there are enough immune substances in saliva to prevent tooth decay.
Our advice. Eat at least 100 grams of cottage cheese twice a day with fresh lemon juice.To strengthen teeth and gums, a lot of vitamin C is required. Another ally in this matter is vitamin D, which ensures that the calcium content in the blood remains constant. But only in combination with vitamin C, it works most effectively (this is very important for women during the climatic period!). Therefore, twice a day you need to spend at least 10 minutes in the fresh air in daylight, preferably in the sun, and every three days take a tablespoon of fish oil rich in vitamins A and D.The easiest way to prevent tooth decay is to eat 100 grams of cottage cheese daily and wash it down with freshly squeezed lemon juice. In addition, you need to be in the sun at least twice a day for ten minutes.

PAIN IN BONES

Symptoms: aching, pressing or sharp pain in bones, deformation and fragility of bones.
Causes: Deficiency of certain nutrients, primarily calcium and phosphorus.
How vitamins can help. In menopause, women lose up to one and a half percent of bone mass annually.It doesn’t have to be. With proper nutrition and physical activity (gymnastics, tennis, jogging, etc.), women under 70 can keep their skeletal system as healthy as at 30 – all kinds of special drugs that doctors are so willing to prescribe.
Our advice. To prevent this ailment, one liter of milk per day or twice 100 grams of cottage cheese is enough. For the rest, you need good nutrition with a high phosphorus content. Long walks are recommended for women in menopause.It is necessary to include fish in the menu, as well as liver, eggs. You should not take fish oil for a long time as a source of vitamin D. It is advisable to always have fresh vegetables on the table, and eat half an apple or kiwi before bed. To provide quick relief to weakened bones, you can take 2-3 grams of ascorbic acid daily for three weeks. It is important to consider that our bones do not have permanent strength. It depends on how much calcium and vitamin C comes into our body with nutrients.

LESS ATTENTION

Symptoms: distraction, forgetfulness, poor academic performance.
Reasons: Insufficient supply of nutrients to brain cells.
How vitamins can help. For normal life, 100 billion of our brain cells need a substance, the main part of which is the B-group vitamin – choline. Without it, we constantly forget where we put the key to the apartment and cannot remember either phone numbers or names.If the deficiency of this substance becomes permanent, it can lead to Alzheimer’s disease, accompanied by massive decay of brain cells.
Our advice. Eat unprocessed cereals, including brown rice, wheat germ, bran, and liver and eggs. Sitting in front of the TV, you can nibble on sunflower seeds, nuts and fruit pits. This will supply your brain with choline. For an emergency supply of nutrients to hungry brain cells, you can take a four-week course of treatment with brewer’s yeast, which are saturated with a wide variety of vitamins.Eating unprocessed cereal grains, brown rice, sprouted wheat, bran, and liver and eggs can help you relieve distraction, forgetfulness, and achieve academic success.

Varicose veins dilatation

Symptoms: dilated, worm-like sinuous thickened veins of blue-violet color, protruding from under the skin. Swelling and induration in the calf muscles.
Causes: Poor supply of nutrients to the blood vessel walls and increased pressure in the veins of the legs.
How vitamins can help. People with varicose veins have too much fibrin in their blood, which causes blood to clot. This is dangerous, since the body sounds the alarm if the already weak walls of the veins become thinner, and, just in case, increases the concentration of fibrin in these places. If there is a breakthrough of the veins, then the blood in this place instantly coagulates.
Our advice. To prevent veins from expanding, you need to strengthen their walls with vitamin C and bioflavins contained in the pulp of fresh fruits.It is recommended to additionally take one gram of ascorbic acid twice a day. This also prevents rupture of small vessels. Substances contained in garlic and onions interfere with the formation of the clotting prostaglandin thromboxane and increase blood flow. The same goes for ginger and pepper. Vitamin C, bioflavins and ascorbic acid prevent varicose veins.

CARDIOVASCULAR DISEASES

Symptoms: Headaches, fatigue, lack of appetite, indigestion, numbness of the limbs, difficulty urinating, painful periods and heart pain.
CAUSES can be very different – from stress and nervous disorders to infections and allergic reactions. Unhealthy lifestyles, such as alcohol, nicotine or medication abuse, as well as unhealthy diet and associated high blood cholesterol levels are the most common causes of cardiovascular disease.
How vitamins can help. With the help of unsaturated fatty acids and vitamin E, you can lower blood cholesterol. Both are found in vegetable oil, as well as in wheat germ and in all seeds.Linolenic acid, which contains cholesterol in an assimilable form, helps very well in such cases and helps its delivery to the cells of the body so that it does not accumulate in the blood. In this way, atherosclerosis and associated circulatory disorders can be prevented. An absolute prerequisite for successfully combating this ailment is the transition to good nutrition. Circulatory disorders are an alarm signal to which one cannot remain indifferent!
Our advice. Light gymnastics has a beneficial effect on the heart and circulatory system, activates the function of vitamins in intracellular metabolism.Jogging or exercising for five minutes can increase the effectiveness of vitamin C by about 15 times. Therefore, it is recommended that you drink a glass of lemon juice or eat an apple before starting your workout.

STRESS

Symptoms: fatigue, exhaustion, lack of goals and aspirations, poor concentration of attention.
Reasons: most often mental and physical stress in combination with a catastrophic lack of nutrients.
How vitamins can help. Stress depletes the nutrients the body needs. In conditions of their deficiency, the nervous system and muscles go into an economical mode. To restore body functions, you need protein, as well as vitamins B1 (thiamine), B5 (pantothenic acid), B6 ​​(pyridoxine), B12 (cobalamin) and vitamin C.
Our advice. It is best to immediately buy a complex of B vitamins at the pharmacy, and after two weeks switch to food rich in B vitamins (dishes made from unrefined bread grains and rice).Brewer’s yeast is an optimal addition to the diet. To strengthen the heart and muscles, it is necessary to increase the efficiency of fat burning with vitamin C and quasi-vitamin carnitine. It is also recommended to consume heavily meat (preferably lamb), as well as fresh fruits and salads for two weeks. In the future, you can reduce the proportion of consumed protein and switch to a healthy nutritious diet. With fatigue, poor concentration and stress, vitamins of group B and vitamin C can help.

REDUCING SEXUAL LUSK

Symptoms: weak erotic or sexual desire, coldness of feelings, lack of orgasm.
Reasons: is almost always a lack of nutrients in gonadotropic hormonal metabolism.
How vitamins can help. Our pituitary gland weighs no more than 0.5 grams and nevertheless regularly supplies sex hormones that provide arousal during sexual intercourse. Since this gland must produce eight more hormones, it must be supplied in abundance with nutrients: niacin (B3), pantothenic acid (B5), vitamins C, E and the trace element zinc.Protein is essential for the production of sex peptides and histamine for orgasm.
Our advice. Eat protein-rich foods for breakfast and dinner (cold roasts, fish, white poultry, etc.) with plenty of fruit. It is best to buy vitamin C from the pharmacy. Ideal is blood dishes (blood sausage), which contain large amounts of histidine. From it in the process of metabolism, the sex hormone histamine is produced. Cheese also contains a lot of histidine.To supply the body with niacin, brewer’s yeast is recommended, containing, along with zinc, pantothenic acid and many other vitamins and microelements.

PAIN IN THE STOMACH

Symptoms: pressing painful sensations in the stomach, often in combination with heartburn, sour belching, nausea.
Reasons: most often excess acidity of gastric juice due to stress and malnutrition. Stomach pain can be caused by food allergies or poisoning.
How vitamins can help. Under stress, the gastric mucosa intensively produces hydrochloric acid. Gastric juice with high acidity burns the already inflamed or even bleeding mucous membrane. Carotenes and vitamin A repair damaged areas of the mucous membrane, and the increased production of hydrochloric acid caused by stress cannot harm them. B vitamins choline, inositol help to relax during stress and maintain a calm, even mood.
Our advice. A three-week course of fish oil treatment, will supply the mucous membranes of the stomach with vitamin A. It is recommended to take brewer’s yeast or molasses daily. These products are exceptionally rich in B vitamins.

MIGRAINE

Symptoms: paroxysmal headaches in the eyes or temples, accompanied by blurred vision, dizziness, sweating, increased sensitivity to light, nausea.
Reasons: Most often, spasm of blood vessels leads to migraine.First, the arteries supplying the brain narrow, resulting in impaired circulation. In the subsequent phase of the headache, the vessels dilate and stretch, especially in the cerebral cortex. At the same time, their permeability increases, and blood enters the adjacent tissues. In addition, histamine is intensively produced in the walls of blood vessels, leading to inflammatory processes.
How vitamins can help. People with migraine are most often the victims of metabolic disorders leading to increased production of prostaglandins and leukotrienes – the main culprits? headache.In such cases, vitamins have an effective effect, suppressing the formation of pain pathogens in the tissues.
Our advice. For a month, try to do without meat, completely replacing it with fish. A two week treatment with vitamin E will help normalize metabolism. It is also recommended to take brewer’s yeast daily.

REDUCED BLOOD PRESSURE

Symptoms: fatigue, exhaustion, attacks of dizziness, increased sensitivity to weather changes, drowsiness, pale skin and headaches.
Causes: Dysregulated processes that maintain normal blood pressure, low blood sugar, stress, lack of exercise, lack of nutrients.
How vitamins can help. A complex of B vitamins (primarily niacin and vitamin B3) in combination with the trace element chromium plays an important role in maintaining optimal blood sugar concentration. In this case, the body responds to stress not with fatigue (a decrease in blood sugar), but with the release of glucose from the muscles and liver, caused by certain stress hormones, such as glucagon.By stimulating the sympathetic nervous system, the blood pressure rises slightly, which reduces stress on the heart.
Our advice. Serve more chromium-rich foods such as liver, meat, wholemeal bread, mushrooms. It is even better to supplement food with molasses or brewer’s yeast, which contain all the essential B vitamins. A rare trace element chromium activates vitamin C in the pituitary gland and adrenal glands and thus contributes to the production of vital hormones. Liver, meat, wholemeal bread, mushrooms, molasses and brewer’s yeast help with low blood pressure.

PARADONTOSIS

Symptoms: bleeding and festering gums, gum atrophy, tooth loss.
Reasons: weakened immunity, the action of toxic substances, free radicals, enzymes that destroy tissue, bacteria.
How vitamins can help. White blood cells are the main defense against periodontal disease. Accordingly, their deficiency, often caused by age-related reasons, inevitably leads to this disease.Patients with periodontal disease often have an increased concentration of the protective substance of immunoglobulin E in the gum tissues, which indicates an allergic reaction. The increased production of the inflammatory substance histamine in the walls of the gum capillaries also has an allergic cause.
Our advice. Immediately switch to a nutritious diet to treat food allergies. Bioflavins and vitamin C found in fresh fruits, especially pulped lemons, strengthen the walls of blood vessels in the gums and stop bleeding.Additional doses of calcium (200 grams of cottage cheese daily) stabilize teeth and jaw bones, especially if you take calcium along with vitamin C. In advanced periodontal disease, it is recommended to take ascorbic acid three times a day, eat foods and meals made from wholemeal flour, and molasses or brewer’s yeast.

BLADDER INFLAMMATION

Symptoms: persistent urge to urinate (especially with hypothermia), burning sensation when urinating, weakened control of urination.
Causes: most often bacteria penetrate through the urethra into the bladder (women suffer from this more often than men).
How vitamins can help. Vitamin C has an antiseptic effect on inflammatory processes in the bladder and kidneys. In addition, vitamin C enhances the process of urination and thus activates the functions of the kidneys and bladder, which leads to the release of bacteria from the body. By increasing the acidity of urine, vitamin C makes it difficult for bacteria to multiply in the body.
Our advice. Take ascorbic acid three times a day. Avoid hypothermia of the genitourinary organs.

RHEUMATISM

Symptoms: pain in muscles, joints, ligaments, connective tissues.
CAUSES can be very different: inflammatory, allergic, caused by wear and tear of cartilage or due to digestive disorders.
How vitamins can help. Vitamin A strengthens the intestinal mucosa, which prevents allergic reactions.An adequate diet, containing a large amount of fiber (fruits, vegetables, lettuce, potatoes), regulates the state of the intestinal flora. Fats of animal origin (meat, sour cream, cheese, etc.) should be avoided, since the fatty acids they contain are raw materials for the production of substances in the body that cause inflammatory processes.
Our advice. Revise the structure of food, replacing meat dishes with fish. It is best to eat fish that lives in cold water.An effective substitute for fish dishes is fish oil, which contains the most essential nutrients for the body. For pain in muscles, joints, ligaments, connective tissues and other symptoms of rheumatism, it is recommended to replace meat in your diet with fish or take fish oil instead.

NASMORK

Symptoms: Increased secretion of mucus in the nasal cavity, watery eyes, sneezing, fatigue, sometimes a slight increase in temperature.
Reasons: droplet viral infection.
How vitamins can help. The moist and warm environment of the nasopharynx encourages the proliferation of viruses. To combat this common disease, warmth, rest, profuse sweating (viruses cannot stand high temperatures), hot baths are recommended. Inhalation is helpful. Vitamin C, found in fresh fruit, is recommended as a prophylactic agent. Fruit is a must on the menu, especially during the cold and damp seasons.This vitamin will also help people around you to avoid infection.
Our advice. Drink plenty of fluids (fruit and vegetable juices, herbal infusions, etc.) to prevent dehydration. It is recommended to purchase a humidifier. Aerosol inhalers, which often dry out the sensitive mucous membrane of the nasopharynx, are of less benefit.

PSORIASIS

Symptoms: white or silvery-white plaque on the skin of elbows, knees, hands, under the hair, often with red outlines.
Causes: weakening of the immune system.
How vitamins can help. In psoriasis, skin cell death occurs many times faster than in healthy skin. This is due to a deficiency in certain chemicals that are involved in regulating cell proliferation. With insufficient assimilation of proteins, intestinal bacteria convert protein residues into toxic substances. Their content in the body of patients with psoriasis, as a rule, is increased. Through the blood, they enter the skin, where they produce their destructive effect.
Our advice. Vitamin A (1 tablespoon of slave fat daily) prevents the production of toxic polyamines in the intestines. But it is even more important to ensure the normal assimilation of dietary protein so that it participates in metabolism, and does not turn into poison in the digestive tract. Bromelain, an enzyme found in fresh pineapple juice that breaks down proteins, is very useful. This enzyme and substances of a similar effect are part of medicines that can be obtained from a pharmacy with a doctor’s prescription.For lichen and psoriasis, it is best to take one tablespoon of vitamin A-rich fish oil daily.

Heartburn

Symptoms: burning sensation in the upper stomach, often accompanied by sour belching.
Causes: increased acidity of gastric juice, in which acid enters the esophagus and causes a burning sensation there, or low acidity, in which fermentation begins, caused, in particular, by lactic acid.
How vitamins can help. In both cases, it is necessary to normalize the acidity of the stomach. For this, a varied, nutritious diet is recommended, and food should be taken in small portions, evenly distributed throughout the day. We strongly advise you to abandon the well-known vaunted theory of separate feeding. It is often the first step towards chronic stomach ailments. Vitamin A (in liver, fish, butter, egg yolk, fish oil) promotes the synthesis of so-called glycoproteins in the gastric mucosa and thereby protects it from the destructive action of the acid contained in gastric juice (it can be so high concentration that it can burn holes in your carpet!).
Our advice. If possible, serve dark green vegetables or carrots cooked with a small amount of fat every day. Vitamin A is produced from the carotenes they contain. For variety, it is recommended to eat fish more often instead of meat.

SUNBURN

Symptoms: Reddened, painful skin that subsequently begins to flake off or form blisters.
Causes: Excessive sun exposure or overheating of UV lamps in tanning salons.
How vitamins can help. Para-aminobenzoic acid (PABA), a B-group vitamin found in the liver, kidneys, heart, seeds, nuts, wheat germ, bran and brewer’s yeast, provides excellent protection against ultraviolet radiation. If the burn has already occurred, PABA soothes the pain, as does vitamin E in vegetable oil. Vitamin C (in fresh fruit) and zinc (in bran bread) accelerate the healing and formation of healthy cells in the affected skin tissue.
Our advice. Use cooling compresses, wear light clothing that allows good skin ventilation. Leave scalded skin exposed overnight. Take brewer’s yeast (containing PABA and zinc), as well as vitamin C (twice a day, 1 gram of ascorbic acid) as a dietary supplement, and one tablespoon of vegetable oil daily. Babies with sunburn should be seen by a doctor. Sunburn is especially dangerous for babies.At the first symptoms of this condition, the child must be shown to the doctor.

DISEASES OF VEN

Symptoms: varicose veins, ulcers in the lower legs, swelling, feeling of heaviness in the legs, hemorrhoids, pain in the calf region.
Causes: Insufficient blood supply, weak vein walls.
How vitamins can help. Our veins are often weakened from poor nutrition. Healthy blood vessel walls contain a large amount of a substance that prevents blood clotting and ensures normal blood circulation.In weak veins, this substance is absent, the blood thickens, fibrins mix with fats and form seals.
Our advice. Avoid straining the walls of the veins (straining during bowel movements, crossing the legs when sitting, too tight clothes). It is recommended to lead an active lifestyle. Food should contain a lot of ballast substances (this will prevent constipation). Garlic, onions, peppers, and ginger naturally thin the blood. Bioflavins contained in fruit pulp and vitamin C in combination with zinc strengthen the porous walls of blood vessels.The best source of zinc is a daily grout made from wholemeal flour. Foods rich in ballast substances, daily grout from wholemeal flour, garlic, onions, peppers, ginger are very helpful for varicose veins, leg ulcers, leg swelling, hemorrhoids and pain in the calf region.

DIGESTIONAL DISORDERS

Symptoms: bloating, diarrhea, constipation, heartburn, sour belching, nausea, abdominal pain.
Reasons: lack of enzymes, increased or decreased acidity of gastric juice, unhealthy diet, destroyed intestinal flora.
How vitamins can help. Any natural complete food promotes good digestion, and sugar, sweets, fried potatoes, pasta, too fatty sausage, canned foods, etc. are relentlessly destroying our sensitive gastric and intestinal flora.
Our advice. Be sure to switch to foods rich in fiber. Thanks to this, the acidity of the stomach is normalized, which is a necessary prerequisite for the assimilation of proteins, which transport minerals into the blood.To ensure normal absorption of carbohydrates, you need to take brewer’s yeast daily for three weeks (this eliminates bloating and constipation). When cooking, use more vegetable oil to stimulate the absorption of fats.

CONSTRUCTION

Symptoms: hard stools, long absence of stools.
Reasons: Incorrect power supply .
How vitamins can help. Those who use laxatives for constipation are themselves to blame for this ailment.Nature has a much better solution to your problem – foods rich in fiber. Fibrous substances, which make up the basis of fruits, vegetables, lettuce, potatoes, absorb gastric juice and facilitate the passage of feces through the intestines.
Our advice. Buy ascorbic acid (vitamin C) at the pharmacy and take one teaspoon dissolved in water two to three times a day. It is an excellent remedy for constipation.

DISEASES OF THE CLIMACTERIC PERIOD

Symptoms: irregular periods, sudden flushes of heat to the skin, migraine, dizziness, heart palpitations, difficulty urinating.
Reasons: A decrease in the content of the hormones estrogen and progesterone in the body with attenuation of the cyclic functions of the ovaries leads to changes in the autonomic nervous system.
How vitamins can help. Vitamin E prevents the destruction of the sex hormone progesterone and can thus replace estrogen therapy. Therefore, in the climacteric period, the need for vitamin E increases. If the production of estrogen in the ovaries decreases, the adrenal cortex comes into play, which takes over the synthesis of estrogen and androgens.Many women who suffer from nutritional deficiencies have a depleted adrenal gland. As a result, in the morning they feel tired, in the evening they cannot sleep for a long time. Vitamins B2 (riboflavin), B5 (pantothenic acid), B12 (cobalamin) and folic acid stabilize the adrenal glands. Vitamin C and zinc help with hormone production. In addition, vitamin D and magnesium are required for optimal calcium absorption to maintain healthy bones and teeth.
Our advice. Use the hand mill to make 1 cup of wheat grout (contains all the B vitamins) for your breakfast daily. To meet your vitamin C needs, it is recommended that you eat plenty of fruit. When cooking, always use vegetable oil containing vitamin E. Dark green vegetables supply magnesium to the body, and cheese (150 grams or 1 liter of milk daily) provides the necessary amount of calcium. Spend at least 20 minutes in the sun or fresh air twice a day so that vitamin D is synthesized in the skin using ultraviolet rays.

GINGUAL BLOOD

Symptoms: increased bleeding of the gums for no apparent reason.
Causes: Inflammation and infectious diseases of the gums, almost always caused by a lack of vitamin C.
How vitamins can help. Human and animal gums contain particularly strong connective tissue, which must be strengthened with zinc, protein and vitamin C.
Our advice. Eat a whole lemon twice a day (and not just drink juice!).In 95 percent of cases, bleeding from the gums stops. If there is no effect, additionally take brewer’s yeast to meet the need for zinc. It is necessary to give the jaws an increased load from time to time. Stale bread works well for this. To counteract gum inflammation, you need to eat whole lemon twice a day and additionally take brewer’s yeast.

Health care institution “4th city polyclinic”

Why vitamin D is important for an infant and a nursing mother

Why Vitamin D is Important for Infant and Nursing Mother

Vitamin D plays a key role in metabolic processes in bone tissue.In the body of a newborn child, there are no reserves of it, and the metabolism is imperfect. This is why walking in the sun and breastfeeding are so important. But it happens that a family lives in a region with predominantly cloudy weather, and mother’s milk does not contain the required amount of vitamin D. Then the deficiency must be replenished with appropriate supplements.

Benefits of Vitamin D for Nursing

Lactating women have an increased need for vitamins and microelements, a significant amount of these substances, together with milk, are passed on to a newborn child.Therefore, it is necessary to replenish their stocks daily. Studies show that, on average, a breastfeeding mother loses 4 times more vitamin D than during pregnancy.

The benefits of the vitamin for women is to maintain bone mineral density. After the birth of a child, the secretion of the hormone prolactin increases in a nursing mother. It suppresses ovarian function and the production of estrogens, which are involved in maintaining calcium in the bones. At the same time, prolactin stimulates the synthesis of parathyroid hormone.It activates osteoclast cells in tubular bones and increases the flow of calcium into the blood by destroying tissue.

Women who take vitamin D in the daily dosage recommended for nursing maintain the physiological concentration of calcium and can avoid the appearance of pain in the extremities, deterioration of the condition of the teeth.

The role of vitamin D in infant development

The required concentration of this substance in the body is reached a few months after birth.Premature babies have even less of it, so it takes more time to recover.

Sufficient vitamin D content provides:

  • normal calcium-phosphorus metabolism;
  • growth and development of bone tissue;
  • muscle development;
  • strong immunity;
  • support of the thyroid gland;
  • normal blood clotting;
  • regulation of heart contractions.

It also prevents the occurrence of autoimmune diseases.It is also important for mental development. Vitamin D is responsible for the development of cognitive functions and their further maintenance. If, during the period of active growth, the body does not receive this substance, the child will suffer from rickets. This is a violation of osteogenesis (bone development) associated with a lack of minerals – mainly calcium and phosphorus.

Symptoms appear at three to four months of age. Parents pay attention to:

  • general restless behavior;
  • sleep disorders;
  • heightened reactions to loudness and brightness;
  • skin redness;
  • sweating;
  • itching of the scalp;
  • decreased appetite;
  • digestive disorders.

Launched rickets slows down the development of the musculoskeletal system. A child later than his peers begins to hold his head, sit and walk. Teething is delayed. The disease is reflected in the appearance of the baby. The most famous symptom is the fontanel not overgrowing in time. A child may have a flat back of the head and a wide forehead, crooked legs, thickening of the arms, and a deformed rib cage.

The norm of vitamin D

The need for vitamin varies depending on its initial blood level, type of food and time spent in the open sun.It is recommended to take 400 mg per day for infants up to 6 months, but the maximum allowable dose is 1000 mg. Children after 6 months. The recommended dose of the vitamin does not change, but the maximum amount is increased to 1500 mg. For lactating women, 800 mg is considered normal, the maximum dosage per day, bordering on toxic, is 4000 mg.

To determine the need for calciferol, you can take a special blood test. The normal indicator for the content of vitamin D for an adult is 60-100 ng / ml, when using other methods of measurement – 150-250 nmol / l.If you do not adhere to the recommended norms, the child will suffer first of all in a nursing woman. The consequences of the rickets suffered will remain for him for life.

The musculoskeletal system of a matured person will be fragile and weakened. This causes difficulty in walking, pain in the limbs, brittle bones. Rickets is also reflected in body complexion:

  • low growth;
  • incorrect posture;
  • Pronounced parietal and frontal tubercles;
  • laterally flattened chest;
  • narrowed pelvis.

Lumps in the wrist may disappear as they heal. Mobility problems, on the other hand, can only get worse with age. In severe cases, patients stop walking due to severe pain. Untreated rickets is fraught with seizures in adolescence and adulthood. Sometimes they cause respiratory arrest.

When to take vitamin D

A pregnant woman needs to take at least 800 IU of vitamin D per day to ensure an adequate supply for her baby.But not everyone has this opportunity. The reasons may be different:

  • there is little sun in the region;
  • dark skin, immune to its rays;
  • gestational diabetes;
  • overweight;
  • malnutrition.

Breastfeeding should be continued as long as possible. If a baby is diagnosed with vitamin D deficiency, the pediatrician will prescribe an additional intake. Most often, the vitamin is obtained from fish oil or milk mixtures.A nursing mother should contact a therapist to select the necessary dosage for herself.

A pediatrician may prescribe an aqueous solution of a vitamin to a newborn if he notices the first signs of calciferol deficiency. This can be done without testing. It is recommended to drink drops when a child starts to sweat, the fontanelle closes at a slow rate, which does not correspond to age, and the baby’s irritability is manifested.

Better when your baby gets it naturally.His body produces a beneficial substance on its own when the skin comes into contact with the sun’s rays. Therefore, you need to walk with babies every day for at least an hour.

There is no need to hide your baby’s face and hands from the sun. But at the same time, it is impossible to allow overheating and go out in the summer afternoon under direct rays. Full body sunbathing is recommended at a comfortable temperature.

The second natural source of vitamin D is mother’s milk. But there should be enough of it in a woman’s body to provide for both herself and the child.You need to take care of this even during pregnancy:

  • walk in the sun;
  • eat fish, cereals, eggs, cheese;
  • drink milk and orange juice;
  • take fish oil.

It is better for a woman to start from the very first trimester, while all the main body systems of the future baby are being laid. By the third trimester, his skeleton will actively accumulate calcium – you need to be prepared for this. Otherwise, a deficiency of vitamin D will be created in the mother’s body.This is dangerous not only for the child, but also for herself.

How to take vitamin D while breastfeeding

Vitamin D is sold as a fat and water solution. It can have a different structure, which determines its lipid solubility. Vitamin D2 is predominantly fat-soluble, so it can be taken in the form of fish oil. But this form of the drug can be dangerous. In a solution of fats, the vitamin enters the liver, where it can be deposited and gradually released into the blood.Sometimes its concentration reaches its limiting values, it is impossible to control this process. Therefore, symptoms of overdose easily occur.

Lactating women and young children are advised to take vitamin D3 in the form of an aqueous solution or in the form of Aquadetrim tablets. For some women with calcium deficiency, the doctor may prescribe a special complex.

Take vitamin in daily dosage 1 time per day. It can be taken by all women who live in the middle climatic zone from September to April.During this period, the sun’s rays are not enough, and the activity of the sun is low, so that its own calciferol is synthesized in the skin.

It is allowed to take the vitamin complex in the summer, if there are changes in the analyzes of the cut or other signs of shortage. But in this case, careful monitoring of the dosage is necessary so as not to cause complications and side effects.

Contraindications and side effects

A nursing mother must comply with the vitamin dosage prescribed by the doctor.Otherwise, its excess can lead to side effects or toxic effects on the newborn. It is imperative to discuss the need to take the drug if there are the following contraindications:

  • according to a blood test, the concentration of calcium is increased;
  • in the analysis of urine increased calcium excretion;
  • hypersensitivity to the drug or its individual components was observed;
  • diagnosed with urolithiasis, especially oxalate stones;
  • there are acute or chronic diseases of the liver and kidneys;
  • confirmed renal failure, regardless of form;
  • diagnosed with sarcoidosis – non-infectious inflammation of muscle tissue;
  • a nursing woman has pulmonary tuberculosis or other localization in an active form.

But even adherence to the dosage does not guarantee that side effects of the drug will not appear. Some women may have an intolerance to auxiliary components, which manifests itself in allergic reactions. Most often these are rashes on the skin of the face, neck, elbows, abdomen.

In case of hypersensitivity to the drug or hypervitaminosis, appetite may disappear, nausea and vomiting appear. The woman feels headaches and muscle pains, discomfort and aching joints. Stool disorders often appear in the form of prolonged constipation.Hypervitaminosis causes dry mouth, thirst, and excess urine flow. Large amounts of calcium are lost with urine.

High doses of the vitamin damage the kidneys, protein appears in the urine, as a reaction to inflammation – leukocytes, and in severe cases – blood. If the drug is not canceled, body weight decreases, sleep disorders, depression and other mental disorders occur. Increased calcium concentrations can cause calcification of blood vessels, lungs and kidneys, which further worsens the condition of the body and requires emergency medical attention.

Vitamin D is vital for a developing fetus, a newborn baby and his mother. But it must be taken with caution and only after consulting a doctor.