Showing posts with label dairy. Show all posts
Showing posts with label dairy. Show all posts

Sunday, April 25, 2010

Time for some Vitamin D (part 2) Que FLAN-TASTICO!



In my last post, I admitted that I’m not only pale, but a failure.  Well, these two things are about to change.  Sun is coming my way, and my second attempt at flan unveiled a beautiful, creamy delight.  In the last post, I also discussed how vitamin D deficiency and insufficiency are much more common than previously thought.

So what is vitamin D anyway? And why could deficiency affect your health?  Vitamin D, a hormone, can be formed in skin exposed to sunlight or through ingestion.  Vitamin D is involved in an intricate hormonal pathway that helps the body absorb calcium and phosphorus in the gut.  Metabolic derivatives of vitamin D also increase kidney absorption of calcium and promote bone formation. 

Vitamin D is a hot topic in research right now.  Vitamin D is very important in bone health and deficiency is thought to contribute to low bone mineral density and osteoporosis.  Recent studies, including a meta-analysis by the Cochrane review show that supplementation of vitamin D alone cannot prevent fractures in postmenopausal women, but vitamin D taken with calcium can have an effect in preventing bone breaks [1].  A recent randomized control trial of post-menopausal women who were given dietary supplementation of calcium and vitamin D rich foods had less frequent bone breaks than those who were not part of the intervention [2]. A study of women given vitamin supplementation of calcium and vitamin D had decreased bone fractures compared to those untreated [3].

Other effects of vitamin D seem to be less well supported by well designed, randomized controlled trials.  Vitamin D, along with bone health, is although thought to be associated with pain control, muscle health and strength [4].  The Cochrane Review of effects of vitamin D in chronic pain shows that most research is inconclusive [5].  As for muscular integrity, in a small, retrospective study of pelvic floor disorders (urinary incontinence and organ prolapse) in post-menopausal women, those with pelvic floor disorders had a significantly higher rate of vitamin D deficiency, even when controlled for age, race and number of babies born [6].  The proposed mechanism for this finding is related to muscular health. 

There is an incredible amount of research looking at vitamin D deficiency and its effects on various diseases.  It will definitely be an interesting field to follow, so keep your eyes open!  As for my opinions on this, I think little harm can come from increasing vitamin D and calcium intake and supplementation can improve general health, especially if you live somewhere cold.   Eggs and milk are a great way to get some vitamin D, and this flan which I copied exactly from Julia Child has LOTS of both.  I went straight for the fat after my attempts at a healthier, less lipid laden attempt at flan that was ugly and boring and broke like stink.  So, if you want a yummy flan, don’t cut corners, just cut little pieces and share with lots of friends. 




Que Flan-tastico ! Julia Child’s Flan from The Way to Cook with an Elizabethan kick

(left my cookbook back in Cleveland so these are my abbreviated instructions)

For caramel sauce
¾ cups sugar
3 tbsp water

For flan
6 whole eggs
5 egg yolks
¾ cups sugar
4 cups whole milk
1 cinnamon stick
½ vanilla bean scraped and added to milk
1 tsp ground cinnamon
¼ tsp ground nutmeg
Pinch salt

Preheat oven to 350.  For caramel sauce. Over low heat in heavy bottomed sauce pan, swish around pan without stirring until sugar is dissolved.  Once sugar is dissolved, increase heat to medium high, cover and cook until sugar is dark, about 5 minutes.  In 4 inch deep dish or soufflĂ© pan, add half of caramel sauce to bottom of dish and swirl around bottom and sides until coated.  To other half of caramel sauce, add ¼ cup water and reserve for top of flan. 




In saucepan, over medium heat up milk with vanilla bean, cinnamon and nutmeg until steaming.  In large bowl, mix together eggs and sugar until well mixed but not foamy.  Slowly add milk to egg mixture, and whisk until mixed.  Strain mixture over dish.  Put dish in casserole dish in oven and add boiling water to about halfway up the flan dish.  Bake for about 1 hour to 1 hour 15 minutes or until flan is formed but still wiggles in the middle.  Remove from water and allow to cool.  Run sharp knife around edge of flan and invent carefully onto a large plate.  Serve with extra sauce and enjoy!!



1. Avenell, A.; Gillespie, WJ.; Gillespie, LD.; O'Connell, D. “Vitamin D and vitamin D analogues for preventing fractures associated with involutional and post-menopausal osteoporosis.” Cochrane Database Syst Rev, issue 2, 2009, p. CD000227.

2. Moschonis, G.; Katsaroli, I.; Lyritis, GP.; Manios, Y. “The effects of a 30-month dietary intervention on bone mineral density: The Postmenopausal Health Study.” British Journal of Nutrition,, 2010, p. 1-8.

3. K, et al. “Effect of calcium and vitamin D supplementation on bone mineral density in women aged 65-71 years: a 3-year randomized population-based trial (OSTPRE-FPS).” Osteoporosis International,, 2010.

4. Venning, G. “Recent developments in vitamin D deficiency and muscle weakness among elderly people.” BMJ: British Medical Journal, v. 330 issue 7490, 2005, p. 524-6.

5. Straube, S.; Derry, S.; Moore, RA.; McQuay, HJ. “Vitamin D for the treatment of chronic painful conditions in adults.” Cochrane Database Syst Rev, issue 1, 2010, p. CD007771.

6. Badalian, SS.; Rosenbaum, PF. “Vitamin D and pelvic floor disorders in women: results from the National Health and Nutrition Examination Survey.” Obstetrics and Gynecology, v. 115 issue 4, 2010, p. 795-803

Tuesday, April 20, 2010

Time for some Vitamin D (Part 1—with FLAN FAIL!)

Fiesta!  Time to celebrate!  I’m done with classes in medical school and just hanging out until graduation on May 16.  This includes some much needed sun in Mexico (we leave on Sunday) with my best friend from high school. 

When I went home last month to visit my mom, I had a skirt on to honor springtime.  She was aghast the pastiness of my white legs.  We went on a walk that night and my two stumps were aglow in the moonlight.  

While this complaint of lack of sun seems vain, it elucidates the negligible amount of time I’ve spent in the sun in the past three years.  Not only have I lived in Cleveland, voted by Forbes to have the worst winter weather in America, but seemingly, for the past two summers, I have done my absolutely hardest rotations during peak summer sun hours.  Going into the hospital before the sun’s up and catching only the twilight zone at the end of the day just does not help. 

Even though basking in the sun puts people at increased risk for deadly skin cancers, one benefit from our favorite burning ball of gas, besides sanity, is that the skin reacts with sunlight to produce vitamin D.  Vitamin D, if you haven’t noticed, is all the rage right now.   A quick literature search reveals research blaming vitamin D deficiency for everything from heart disease to diabetes, low birth weight babies, chronic pain, pelvic floor disorders and neurologic deficiencies. 

Obviously this is a rapidly growing area of interest, but is the hype real?  Even three years ago in my first year of medical school I was taught the vitamin D deficiency was quite rare and remember the lecturer saying that “only some old lady who doesn’t eat anything and is locked up in her bedroom all year” could lack this essential nutrient. 

Vitamin D deficiency is actually much more prevalent than once previously thought.  When I did an endocrinology rotation all of the fellows who are young and healthy tested their vitamin D blood levels.  They were all insufficient.  In the National Health and Nutrition Examination Survey from 2001-2004 of 6275 nationally represented children from ages 1-21, 9% were deficient and 61% were insufficient [1].  A study of 2500 mothers and infants in urban Boston showed that 58% of infants and 35.8% of mothers were severely deficient [2].  People of darker skin color and colder climates are at the highest risk.

In the next post, I’ll discuss the role of vitamin D in the body, and review some of the literature about the health effects of deficiency.  I’m sure you’re wondering how you can boost your own vitamin D levels.  Get outside and get some sun.  Supplemental tablets  (the Institute of Medicine is about to release new dosage guidelines) and foods with vitamin D such as fortified milk products, eggs and fish, are also good sources. 

To prepare for my Mexican adventures and to boost all of our vitamin levels with eggs and milk in a sweet way, I tried to make some cinnamon infused flan.  I just love anything custardy.  In fact, my very first memory wasn’t of my parents or our cats but of custard that our neighbor made.  And the donuts we ate at the beach.  I’ve been a life-long food lover, and now I want to share it with you. 

Well, you see, I wrote this post and had a FLAN FAIL!  It looked great until I tried to flip it and it turned into a puddle of soupy caramel egg mush.  So, for the next post, I’ll try a new recipe that is guaranteed to succeed.  For now, I give you my stages of flan grief. 







1.  Kumar, J., et al. “Prevalence and Associations of 25-Hydroxyvitamin D Deficiency in US Children: NHANES 2001-2004.” Pediatrics, 2009.
2. Merewood, A., et al. “Widespread vitamin D deficiency in urban Massachusetts newborns and their mothers.” Pediatrics, v. 125 issue 4, 2010, p. 640-7.