Vitamin D Deficiency

I remember in high school my doctor told me I was low on Vitamin D and to try to go out in the sunlight more. It wasn't suggested that I start taking a Vitamin D supplement until about a year ago when I complained of my struggle with my chronic fatigue to my adult GI doctor. He decided to draw lab testing various elements other than just my Iron and B12. This time he checked my Folate, Vitamins K and D to be on the safe side. Following the results, I was directed to start taking Folate and Vitamin D to bring them back into range and help combat my chronic fatigue. I was started on a high dose of 50,000 IU a week of Vitamin D for a couple of months with my level to be rechecked. With improvement to my Vitamin D level, I was able to change to 1,000 IU daily to maintain my level improvement and I was able to find this amount over the counter at a local grocery store in the pharmacy section.


It seems as though it is a lot easier to be deficient on Vitamin D than one may realize. We process Vitamin D through sunlight, diet, and supplements but we often are not in the sun enough to maintain adequate Vitamin D due to a variety of reasons such as season, cloud cover, air pollution, skin color, and location to equator and there are a limited number of foods with Vitamin D. There is also the risk of skin cancer with prolonged sun exposure to consider. So it may be likely that a supplement needs to be added to one's daily regiment in order to maintain an appropriate Vitamin D level.


Vitamin D acts as a hormone that functions in the intestine, kidneys, and bone to help stimulate transport of calcium and phosphorus to reduce the release of the parathyroid hormone that reabsorbs bone tissue. Both functions help us to build and maintain strong and healthy bones. Calcium and Phosphorus are both minerals that serve important functions and can be dangerous at too high or too low of levels. Calcium also needs Vitamin D for proper absorption. Vitamin D also helps maintain our muscle function and immune system to fight off illness and infection. Some studies suggest Vitamin D may also help to prevent cancer as well as other diseases such as diabetes, heart disease, high blood pressure, dementia, and multiple sclerosis. Vitamin D is essential to help protect bones from becoming too thin, brittle, or misshapen as children are at risk of rickets and adults are at risk of osteomalacia and adequate Vitamin D can help prevent osteoporosis in adults as well.


Infants who are only breastfed are at risk of Vitamin D deficiency as breast milk contains a small amount of Vitamin D. Therefore, the American Academy of Pediatrics recommends breastfed infants be given a liquid multivitamin or 200 IU daily for their first two months of life and 400 IU afterwards until they are drinking formula or milk that are fortified.


The highest diet source for Vitamin D is cod liver oil followed by sources such as Swordfish, Salmon, Tuna, Fortified Orange Juice and Milk. Other sources at smaller amounts include Fortified Yogurt and Margarine, Sardines, Beef Liver, Egg Yolk, Fortified Cereals, and Swiss Cheese. Vitamin D is fat soluble therefore opting for fat free or low fat with Vitamin D options will result in poor absorption.


Your doctor can easily check your Vitamin D level with a simple blood test and recommend if you need higher or lower amounts of Vitamin D. The Institute of Medicine recommends for the average adult under the age of 70 to intake 600 IU a day and 800 IU a day if over 70. Some professionals suggest these recommendations remain too low for what is actually needed.


The body may have difficulty absorbing or processing Vitamin D due to issues such as:

• Kidney or Liver Diseases
• Cystic Fibrosis
• GI diseases/conditions
• Gastric Bypass Surgery
• Obesity

There are medications that may also lower Vitamin D level such as:

• Laxatives
• Steroids
• Cholesterol Lowing Drugs
• Seizure Control Drugs
• Rifampin
• Orlistat

Signs of low Vitamin D include:

• Frequent illness or infections due to lowered immunity, particularly respiratory tract infections
• Fatigue
• Bone and Back Pain
• Depression
• Impaired Wound Healing
• Bone Loss
• Hair Loss
• Muscle Pain

It's important to have your doctor monitor your Vitamin D level not only to ensure that you're obtaining enough Vitamin D but also to prevent too high of a Vitamin D level.
High Vitamin D can cause:

• Nausea, Vomiting, Constipation, Poor Appetite
• Itching
• Increased Thirst and Urination
• Weakness
• Weight Loss
• Confusion
• Heart Rhythm Problems
• Kidney Damage
• Pancreatic Cancer
• Ataxia - a condition that can cause word slurring, stumbling

Vitamin D supplements come in two forms - D2 and D3. D2 comes from plants and requires a prescription whereas D3 is the form that is made by the body when the skin is in contact with the sun and is found in animal sources. D3 is available over the counter and is more easily absorbed and lasts longer in the body from dose to dose.


Even if you are not exhibiting signs of Vitamin D deficiency it can be helpful to request a Vitamin D level check just to be on the safe side.

Balancing Chronic Illness and Socializing

Belongingness is a hierarchical, psychological need and socializing is an important part of that for everyone regardless of health. But that doesn't mean we have to be in a near constant state of socializing with others, does it?

I'm a bit of an introvert myself so I need time to myself to recharge after extensive socialization and on top of that, I don't feel well a lot of the time due to my chronic illness. Additionally, in order to support myself my priority is maintaining full time employment. To do so, this requires my constant attention to my health needs so that I may recover from the last week of work so that I may work the next week. It is an ever-present cycle of care that I must balance and protect for my livelihood.


My work as a social worker involves talking to chronically ill patients all day long 5 days a week. Between providing care to my patients and maintaining my relationships with my co-workers, I'm often exhausted upon my return home and I don't necessarily want to socialize with anyone else. I want to recover from the day. I am emotionally and physically drained by this near daily ritual that is employment. And if I am going to socialize on most days, I prefer messaging versus verbal communication except on rare occasions and of course during in-person interactions. I'm also not one for spontaneous social activities - I like to plan ahead so that I may prepare myself to be able to attend and participate as well as I possibly can. The unpredictable nature of chronic illness does not always allow for activities or socialization even with the best intentioned plans.


Balancing a social life and chronic illness is a common struggle. Too little socialization fosters isolation and depression but too much socialization drains us of our reserves to maintain our physical health. We often pay the following day or days after extending ourselves beyond our physical limits. An occurrence we often push ourselves to do on particularly good health days as we want to leave our homes, our routines, and rejoin the world and our loved ones in activity and socialization. Thus, it is far too easy to isolate ourselves away but then the double edge sword of trying to protect our physical health can also cause damage to our mental health at the same time. Maintaining friendships amidst chronic illness can be quite the challenge as well.


My best relationships with others, platonic or romantic, are those with individuals who not only take an interest in understanding and respecting my daily health struggles but also do not take my at times lack of presence personally. I don't require nor desire constant communication and because of my health, I am not always the most reliable for being able to keep scheduled activities. Even if that activity may be a friend coming to my home while I lie in bed in my pjs, that doesn't mean I will physically feel up to a visit even in the most conducive of situations for my health. Sometimes I feel more comfortable being along than in the presence of others.


Nevertheless, in spite of all the challenges and personal preferences, socialization is important for our well-being. Fortunately, with today's technology it is easier and faster to be able to communicate with others than it has ever been before. In person socialization can't be replaced but we can still develop meaningful, deep friendships with others through the phone and social media. We can receive and give comfort to others through these interactions as well. It may not be the same as the physical touch and care of another but it is not something to be dismissed either. Regardless the format, we must continually strive to balance our social needs and our health needs for the best outcomes for ourselves.

Keeping it Simple

A few years ago I underwent an intensive transformative time as I was separating from the love of my life and in the midst of this heart wrenching, soul destroying period I was also losing others in my life I hadn't expected.


It was at this time that I wrote the following revelations in Let the Fire Burn :

"No longer care what others think of you. When you lose respect for someone, that person's opinion no longer means anything anyway. Don't waste yourself on those who have already lost your respect. Cherish those who are true to you - those who are supportive, loving, caring, and there with you through the brightest and darkest times of your life - not those who try to create dark times, tear you down, harm you with their malicious intent and manipulations, leave you without explanation. Don't let yourself succumb to the power of others, especially when it is a harmful power. You don't have time for that nor should you.

Don't take the dangerous, personal issues of others on as your own. People will attempt and succeed at betraying, manipulating, deceiving, and harming you. The reasons for others to inflict such pain on another is deep seated within them. Stop trying to decipher the reasons behind their actions. Their reasons don't need to make sense. Their reasons are just that, theirs. Not yours. Do not take on more pain simply because another is engaging in harmful behavior towards you."

That year I learned a multitude of lessons, none of which were easy. Not only was I having to cut ties with others of my choosing but I also had others choose to cut their ties with me. I felt abandoned and betrayed by those I held close for so many years, individuals who I had bared my soul to. It had all been in vain. It didn't matter how much I had cherished individuals in my life, nothing could stop what was being set in motion.


And so while in my own depths of depression, I had to learn to let go. Letting go didn't come easy to me but at some point that changed. Instead of holding onto feelings of abandonment and betrayal, I focused on the freedom from drama. My life was chaotic enough as it was, I certainly didn't need added drama. I stepped away and allowed others to do the same and when I accepted that I was able to let go of the stress caused by others.

Nowadays I keep my circle tight. Outside of work, there are few who I deeply engage myself with. It's not anything against others, it's a matter of simplification. With fewer people, there is less stress and mess. Those I remain close to also accept that I may not talk or visit them for long stretches of time. We both know though that the other is just a call away if one of us is needed for anything. We don't take things personally with each other and we don't create drama for the other. These are deep, meaningful yet simple friendships that sustain us. These are the type of friendships I not only want but also need.

It's okay to take a step away from someone or something. Sometimes it is necessary for our mental health. Learning to step away has taught me not to take the actions of others personally even if it was meant to be personal. It no longer matters. What does matter is self care and happiness. These are things that are within our own hands and others cannot take it away from us without our permission. I stopped giving my power over to others and I've never looked back.

Anemias and Bowel Disorders

Anemia is a common disorder for those of us without a colon, particularly if we are also missing a part of our small intestine.
Anemia occurs when a person doesn't have enough healthy red blood cells to carry adequate oxyen throughout the body. This condition can cause:

• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Headaches

It's important to catch anemia early as the symptoms can worsen with prolonged anemia and there are increased risks to the heart. There are two types of anemia common for those with bowel disorders:

• Iron Deficiency Anemia

This occurs when there is a deficiency of iron. This lack of iron makes it difficult for the hemoglobin to be produced which enables red blood cells to carry oxygen. In addition to the common symptoms of anemia, a person may also experience:

• Inflammation or soreness of the tongue
• Brittle nails
• Unusual cravings such as ice, dirt or starch
• Poor appetite

For those with GI issues, simply increasing food intake of iron rich foods is not typically enough to correct the iron deficiency anemia. Iron pills and iron infusions are common to help manage iron deficiency anemia. Iron pills can be Ferrous Sulfate, Ferrous Fumarate, or Ferrous Gluconate with the latter being easier on the stomach than the former. Vitamin C (250 mg daily) can also help with iron absorption. It is important not to drink tea within two hours of taking iron supplements as the tannins in tea can interfere with iron absorption. It's important to consult your doctor regarding how much iron to take as at high doses iron is toxic.


Try incorporating these iron rich foods into your diet:

• Red meat, pork, poultry
• Seafood
• Beans, lentils and peas
• Dark green leafy vegetables
• Dried fruit
• Iron fortified cereals, breads and pasta

• Vitamin Deficiency Anemia

This occurs when the body doesn't have enough Folate, Vitamin B12 and Vitamin C that's needed to produce enough healthy red blood cells. This also is called Megalobalstic Anemias.

In addition to the common symptoms of anemia, Vitamin Deficiency Anemia can also cause:

• Weight loss
• Numbness or tingling in hands and feet
• Unsteady movements
• Personality changes
• Mental confusion or forgetfulness

It is common for those with bowel disorders to also be low on folate and Vitamin B12.


Folate is also known as B9 and is found in fruits, leafy green vegetables, nuts, and enriched grain products. Folate can also be taken as a supplement, commonly in a daily multi-vitamin.


Vitamin B12 is found in meat, shellfish, eggs, and dairy products and can be taken via an injection, oral solution or in a pill form. Cyanocobalamin is the synthetic form of Vitamin B12. Vitamin B12 also needs to be monitored as too high of a level can cause inflammation to occur.


Vitamin C can be found in broccoli, citrus fruits, strawberries, sweet peppers and tomatoes and can help with the absorption of iron.


To help manage both my iron and vitamin deficiency anemias, I take several medications:

• Ferrous Gluconate 28 mg from Puritan Pride - I take 2 pills every time I eat something but I allow a 2 hour window between consumption of tea and these pills
• B12 Microlozenge 5000 mcg from Purtain Pride - I take one pill three times a week. I take the microlozenge with food and let it melt under my tongue before swallowing for best results. I've found that if I chew it and don't take it with food then it isn't absorbed and taking it three times a week helps keep my B12 level below an inflammation level.
• Vitamin C - I cut a 500 mg tablet in half so that I'm taking the recommended 250 mg a day to help with iron absorption and thereby stretching my supply of Vitamin C. I found that 250 mg tablets are more expensive than the 500 mg tablets.
• Multi Vitamin with Folate - I take one daily to help maintain my folate level.

For your best functioning, it's a good idea to have your doctor monitor your iron levels and vitamin levels to determine if you are low on any levels and to develop a plan to treat any deficiencies. 

No, My Food Choices Aren't The Problem

I have a long history of chronic pain caused by eating and no, it isn't my food choices that are the culprit. I appreciate others being concerned about my well-being but unsought advice gets to be tiresome, particularly when I've been dealing with my health issues since I was 9 and the particular issue of pain when I eat since I was 15. I think I have a good understanding of my own health issues and symptoms.


A lot of people are quick to tell me "It's what you ate", "You shouldn't eat so much" or "You have an allergy, try this diet". I have been tested for food allergies and intolerances, they were all negative. And the pain happens with everything I eat and even a gulp of water is enough to cause excruciating pain and stomach cramps at times. The only things that sometimes don't cause me pain are saltines, tamales, and Arby's Roast Beef Sandwiches and even then I'm sure if I ate enough of them, they would cause pain too. Sure, over eating causes me pain but the pain is just worsened by quantity. Even small meals or snacks cause me pain and discomfort. Reducing my intake of filling foods such as pasta, rice, and bread do help to reduce my pain but I still have pain regardless. I have some level of discomfort with everything I eat - it just varies on severity. And there are times that I can eat something and have one level of pain and eat it again the next day and the pain level is something different.


I started experiencing excruciating pain every time I ate after I had my ostomy reversed via a straight pull thru. I required another surgery within a year to remove adhesions that were causing a stricture of my small intestine. It took several years after this last surgery in 2002 before my body was better able to tolerate food. The pain never fully went away although it did significantly lessen - that is until 2015. With my hospitalization in 2015, I started having chronic pain and nausea when I eat and the nausea occurs sporadically throughout the day and night as well. Additionally, my adhesions now cause me a higher risk of intestinal blockage and now I'm unable to eat raw or undercooked vegetables or I will have a blockage. This makes it harder to eat light, healthy foods in an attempt to further reduce my pain.


Since 2015, I've undergone various procedures and tests and the conclusion is that my chronic pain and nausea are a result of my adhesions worsening again. They're just not to the point of requiring surgery. During a period of testing in 2017, it was discovered that I had C-Diff and that was the cause of worsening my GI symptoms as my stomach and intestine were inflamed and irritated from the infection that was wreaking havoc on my body. I remember during this time I was being told by others to "try this diet, you have food allergies". I held off from trying the diets these individuals suggested because I wanted to give all the testing I was completing a chance to identify a source and for treatments to be tried before I changed my diet. I'm glad I didn't jump on the diet bandwagon as it turned out my weight loss and severe pain were actually due to the infection I didn't realize I had.


I'm glad to hear that certain diets have really helped others and I wish everyone the best of luck but a diet isn't always the answer for everyone's health issues. It certainly isn't the answer for my symptoms.