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GoodWellness Website: http://wellness.circ9.dcn

HEALTHThe Ninth Circuit Wellness Committee Newsletter

SUMMER 2021

The summer months always serve as a good reminder to stay properly hydrated. But as much as we understand the need to drink plenty of fluids to avoid the dangers of severe dehydration and heat exhaustion, the potential health impacts of mild dehydration, especially as it relates to brain health, may be less understood.

Dehydration is one of the most common and preventable medical conditions in the world, yet studies have found that more than 70% of Americans – from young children to older adults – are chronically dehydrated. And researchers are now learning how even mild levels of dehydration prevent us from performing at our peak.

When the body is dehydrated, the area of the brain that controls cognitive functions – language, visual/spatial perception, memory, attention and executive function –

GOT WATER?

The first time I remember hearing about vitamin D was when I was meeting with my faculty advisor in high school. It was a sunny afternoon, and my advisor suggested that we have our meeting over a walk outside: “It’s a great day to get some vitamin D!” I looked at him quizzically and he explained, “Vitamin D is really important for health, and you get it from the sun.”

More recently, I’ve heard about vitamin D as it relates to other areas I was interested in – pregnancy, immune system support and even how it relates to COVID-19.

But what exactly is vitamin D? It isn’t like other vitamins – our body can produce vitamin D when direct sunlight converts a chemical in the skin into an active form of the vitamin, which then binds to receptors in nearly every cell of the body. Vitamin D in its active form can turn genes on or off, leading to changes in the cells. In fact, vitamin D controls the expression of over 1,000 genes or about 1/24 of the human genome. This means that vitamin D can impact our health in several ways.

Studies1 have demonstrated the following benefits of vitamin D:

Improved muscle strengthImproved symptoms of depression

Courting

Deborah J. Saltzman is a bankruptcy judge in Los Angeles and member of the Wellness Committee.

Vitamin D – What is It, What are Its Benefits and How do We Get Enough?

Photo by Samuel S

Mark Hatcher is clerk of court for the Western District of Washington Bankruptcy Court and member of the Wellness Committee.

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Seasonal Eating – Summer’s Bounty

Photo by Olearys

Kiwano Melon, aka African Horned CucumberPhoto by Marco Verch

Summer Produce

Fruits and vegetables are best when harvested in their natural seasons and consumed as close to harvesting as possible. Summer is the biggest growing season of the year (growing seasons vary by region), so it is an especially good time to enjoy the largest variety of fruits and vegetables. So, visit the produce section of your local grocery store, or even better, visit a nearby farmer’s market to stock up on fresh seasonal produce.

Spring through Fall: green onions (scallions), onions, radishes and wild mushrooms.

Late Spring through Early Summer: apricots, cherries, cilantro (in cooler areas), new potatoes, Valencia oranges, peas and pea pods, radicchio, rhubarb, spring onions, strawberries and sweet onions.

Summer: basil, berries (most types), cantaloupes (late summer), chili peppers, corn, mangos, nectarines and peaches, plums and pluots (plum-apricot hybrid), summer squash, tomatoes and watermelon.

Late Summer through Fall: apples, chard, eggplant, figs, grapes, green beans, huckleberries, lemongrass, limes, melons, okra, sweet peppers and tomatillos.

Exotic Fruit of the Season

You may have seen this fruit but passed it by because of its strange and spiky appearance. However, this exotic fruit is considered vital to solving food shortages in sub-Saharan Africa. It retains significant amounts of water, even in drought, and provides a range of essential nutrients. Kiwano melon has high concentrations of vitamin C, vitamin E, magnesium, zinc and other antioxidants. It’s low glycemic, containing nutrients necessary from proper sugar and insulin metabolism and has a high water content and provides several electrolytes that are necessary for proper hydration. The nutrients found in kiwano melon support your immune system, heart, skin and bones.

The inside of the kiwano melon is mild and slightly sweet, tasting like a combination of cucumber, zucchini and kiwi, and gaining a banana-like taste as it ripens. To eat it, simply cut it in half and either scoop or squeeze out the contents. Add the pulp to smoothies or use it to top yogurt or granola. The seeds are edible as well and even more nutritious than the fruit!

becomes increasingly impaired. Depending on the level of fluid loss, symptoms can range from mild to severe.

Severe dehydration results from a rapid loss of fluid typically caused by intense exercise or prolonged exposure to hot, humid conditions. People who experience severe dehydration may appear disoriented, breathe rapidly, slur speech or lose consciousness. They are in a potentially life-threatening situation and require immediate medical attention.

But milder levels of dehydration can occur from fluid shed during low-impact activities as well, such as walking, gardening or moderate housework, especially in adults who consume only small amounts of water each day. Light-headedness, headaches, nausea and fatigue are all associated with mild dehydration, yet most people don’t recognize these symptoms as a need to drink water and instead confuse them with other conditions such as a lack of sleep or hunger.

It takes a two-percent loss of water weight before most people start to feel thirsty – one of the first indicators of dehydration – but by that time, the body is already in a moderate state of dehydration. Cognitive functions will begin to decline rapidly when fluid loss is greater than 2%, but recent studies have detected impairment if water weight drops by as little as 1%. Cognitive functions are particularly susceptible to dehydration given that brain mass is approximately 75% water.

According to a report from the American College of Sports Medicine, mild to moderate dehydration can lead to problems with decision-making. Subjects

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This little guy is Pirate. My husband and I adopted him from the local humane society here in San Diego, where I am a librarian with the federal courts. While dealing with all the stress of 2020/2021, Pirate has most definitely helped my frame of mind. His bubblegum pink nose (the photo doesn’t do it justice) always makes me smile, and his tail-chasing, doormat-battling antics make me laugh. Pirate is also very sensitive to the moods and emotions of people around him. He will jump into my lap when I’m upset – and sometimes before I even realize that I’m upset. He will nuzzle my face and demand that I rub his ears. The moment it takes to do this is a moment that pulls me away from my immediate situation. I can take a breath and gain some perspective. Seeing Pirate’s unabashed enjoyment of being petted and feeling his intense purring always makes me smile. When he hops off my lap, my mood is always improved. I can return to what I have been doing in a better frame of mind, feeling more capable of dealing with the situation at hand.

Pet Corner

Heather A. Phillips, an assistant satellite librarian in San Diego, and her husband adopted Pirate from their local humane society.

Courting Good Health’s Pet Corner will regularly feature a Ninth Circuit employee and their pet. To be featured in a future edition, email a photo and short paragraph to the Wellness Committee at Wellness_Committee@ce9.uscourts.gov, explaining how your pet contributes to your wellbeing.

who were asked to complete tasks requiring attention, motor coordination and executive functions had difficulty with such things as map recognition, grammatical reasoning, mental math and proofreading. Other studies have shown that people who are mildly dehydrated are more prone to make errors; alertness, memory, and concentration, all can be affected. People who are mildly dehydrated also are more susceptible to mood swings, including anger, confusion and frustration.

Fortunately, chronic dehydration can be easily combatted by simply drinking a sufficient amount of water every day. Recommendations for daily water intake vary, but common advice is 8.5 cups per day. Additional fluids will come from the food you eat, as many fruits and vegetables contain 90% - 95% water. How much water you should drink depends on different factors, such as health, lifestyle and the climate where you live.

Even though it is recommended that people drink more water – and many people do – the average American adult still only drinks about 2 ½ cups of water per day, significantly less than recommended. And it’s important to remember that while any source of fluids is better than none, not all are equally beneficial. Alcohol is a diuretic that can quickly dehydrate the body. Caffeine also has a mild diuretic effect although to a lesser extent.

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Developing a few simple habits can help indivduals hit their target goals:

Drink a glass of water every morning as soon as you wake up.

Set a timer to remind yourself to drink water throughout the day.

Buy a reusable water bottle with a built-in straw. The straw reduces air and makes swallowing easier and so does drinking water at room temperature.

Drink herbal teas and decaffeinated coffee.

Reduce alcohol consumption, and drink water between beverages.

Track your daily water intake.

Add lemon or cucumber slices to your water as a flavor enhancer. The lemon will also add some vitamin C.

Proper hydration is important, but it’s also possible to drink too much water. Hyponatremia is a condition that affects kidney function when the body is unable to shed excess water. It is rare among healthy adults and usually only seen among athletes who engage in extreme sports.

Drinking water as part of one’s daily routine can lead to marked improvements in mood, energy and concentration. A few easy steps can make a world of difference.

Reduced risk of type 1 diabetes in infants and type 2 diabetes in older children and adults

Treatment of hypertensionLower risk of miscarriage, gestational

diabetes and preeclampsiaSupports the immune system and fights

inflammation

But perhaps the most important benefit of vitamin D is the significant role it plays in the regulation of calcium and maintenance of phosphorus, factors that are crucial for bone and tooth health, as well as the prevention of osteoporosis and fractures in older adults.2 However, there is an optimal dosage of vitamin D and taking too high a dosage may actually have a harmful effect.3

And while more studies are needed, research has also linked vitamin D to cancer prevention, cognitive health, healthy weight and reduced risk of autoimmune diseases.4

Just this year, the studies linking higher vitamin D levels to improved respiratory health and immune functions were of great interest in connection with treating patients with COVID-19; higher doses of vitamin D were suggested to protect against the virus (although no firm conclusions have been reached on its benefits with respect to COVID-19 specifically).5

With all these benefits, you might expect that people would be doing everything imaginable to keep their vitamin D levels up, but in fact, many of us are deficient in vitamin D – some severely so. Levels of vitamin D are measured through the 25-hydroxy vitamin D blood test. Vitamin D deficiency is defined as a level below 20 nanograms per milliliter. Severe deficiency is below 12 ng/ml. In the United States, the most recent collection of data reveals that about 42% of the population is deficient in vitamin D. The deficiency numbers are more alarming for Latino (63%) and Black (82%) people.

Because vitamin D is linked to so many health benefits, it isn’t surprising that vitamin D deficiency is linked to health problems including heart disease, bone disease, fatigue, depression, cognitive decline, infertility and impaired immune function. Vitamin D deficiency has been compared to “biological aging” of five to 10 years. And to make matters more alarming, vitamin D levels drop with age, so it gets harder to maintain a healthy level as we get older. Indeed, a 70-year-old makes four times less vitamin D from the sun than a 20-year-old.

How can we ensure that our vitamin D levels are adequate? First, get a blood test to learn your level. If you’ve had regular physicals, you may already have this information, and you can look at how your vitamin D level has changed over time to get a sense of whether you should be taking any action. While there is a definition of vitamin D deficiency, there is less of a consensus on what is adequate or optimal. Certainly, we want to avoid a level below 20 ng/ml, but many of the studies suggest that levels significantly above 20 ng/ml are needed to achieve many of the benefits of vitamin D; the studies finding a link between higher vitamin D levels and lower “all-cause mortality” generally demonstrate benefits at levels between 40 and 60 ng/ml. Talking with your health care professional can help you determine what your goals are for your vitamin D level.

How can you achieve or maintain a healthy vitamin D level?

1. Sun. My high school advisor wasn’t wrong – vitamin D is certainly important for health, and sun exposure can help our bodies produce it – but sun exposure may not be enough. Vitamin D can be produced by your body when your skin is exposed to UVB rays from the sun. However, for your body to produce vitamin D, a lot of the skin needs to be exposed (think arms and legs, not just face and hands), and anything that blocks UVB rays like sunscreen or glass will prevent vitamin D production. The higher melanin levels in people with darker skin

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also inhibit the production of vitamin D (which at least partially explains the higher vitamin D deficiency numbers in Latino and Black people). Getting outside and enjoying sun exposure can help vitamin D levels, especially in climates with more sun, but it’s important to balance this against the risks of too much sun exposure, like premature aging and skin cancer. And in many climates, it can be difficult to have enough sun exposure to maintain an adequate level of vitamin D (for example, that outdoor meeting with my high school advisor was in Buffalo, New York, in the winter – we probably didn’t get much vitamin D while bundled up on a short walk).

2. Food. There are a few food sources of vitamin D. Fish liver oil (like the “cod liver oil” most of us have only heard of from books or older relatives) is considered the only “excellent” dietary source of vitamin D and the only one that comes close to the adult RDA of vitamin D (600 IU per day). Fatty fish like salmon, mackerel, tuna and sardines are a good source, but you’d probably need to eat very large portions every day to get enough. Beef liver, egg yolks and enriched dairy products all contain lower levels of vitamin D.

3. Supplements. To really increase your vitamin D level and maintain it, supplements may be the answer. Vitamin D supplements are available in several forms, and vitamin D3 is the most effective at increasing blood levels. Supplements can range anywhere from 250 IU to 5,000 IU or more. You could start with supplements in the amount of the RDA and increase depending on how your levels respond. With supplements, it’s important to be sure that you are taking a reputable supplement that actually contains what it claims. Do your research, either by consulting your physician or nutritionist, or by looking at research yourself (websites like labdoor.com do independent analysis of supplements). Also be sure that you aren’t already supplementing with vitamin D. Since fish oil can be a source of vitamin D, and many

of us take Omega-3 supplements, you may end up taking more than you want to take. Vitamin D toxicity is rare and typically isn’t seen among people taking supplements below 4,000 or even 10,000 IU, but be aware of how much you are taking and monitor how you are feeling.

1 https://www.health.com/nutrition/vitamins-supplements/vitamin-d-benefits2 https://www.everydayhealth.com/vitamin-d/vitamin-d-health-benefits-what-it-can-cant-your-body/3 https://www.health.harvard.edu/staying-healthy/too-much-vitamin-d-may-harm-bones-not-help4 https://www.everydayhealth.com/vitamin-d/vitamin-d-health-benefits-what-it-can-cant-your-body/5 https://www.uchicagomedicine.org/forefront/coronavirus-disease-covid-19/vitamin-d-covid-study

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Office of the Circuit ExecutiveElizabeth A. Smith, Circuit ExecutiveP.O. Box 193939, San Francisco, CA 94119-3939Ph: (415) 355-8900, Fax: (415) 355-8901https://www.ca9.uscourts.gov

Courting Good Health Newsletter Staff:Renée Lorda, Managing Editor, Assistant Circuit Executive for Public Information, Conference & EducationSandy Andrews, Research and Policy AnalystKatherine M. Rodriguez, Communications Administrator, Public Information, Conference & EducationAlex Clausen, Audio and Visual Specialist, Public Information, Conference & Education