cholecalciferol

Vitamins are substances that your body needs to grow and develop normally. Vitamin D is important to your body because:

• It helps your body absorb calcium. Calcium is one of the main building blocks of bone. A lack of vitamin D can lead to bone diseases such as osteoporosis or rickets.
• It also has a role in your nerve, muscle, and immune systems:
  • Your muscles need it to move
  • Your nerves need it to carry messages between your brain and your body
  • Your immune system needs vitamin D to fight off bacteria and viruses

You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms vitamin D naturally after exposure to sunlight. However, too much sun exposure can lead to skin aging and skin cancer. So many people try to get their vitamin D from other sources.

Very few foods naturally contain vitamin D. Most people get vitamin D in their diet from foods that are fortified. This means that vitamin D is added to the food. These foods may include milk, cereal, and yogurt. Foods that naturally have vitamin D include egg yolks, saltwater fish, and liver.

Vitamin D is available in supplements. It is also included in many multivitamins. The two forms of vitamin D in supplements are D2 and D3. Both types increase vitamin D in your blood, but D3 might raise it higher and for longer than D2. Vitamin D is fat soluble. You can absorb it better when you take your supplements with a meal or snack that includes some fat.

The amount of vitamin D you need each day depends on your age. The recommended amounts, in international units (IU), are:

• Birth to 12 months: 400 IU
• Children 1-13 years: 600 IU
• Teens 14-18 years: 600 IU
• Adults 19-70 years: 600 IU
• Adults 71 years and older: 800 IU
• If you are pregnant or breastfeeding: 600 IU

But certain people may need extra vitamin D, such as:

• Older adults
• Breastfed infants
• People with dark skin
• People with certain conditions that limit the absorption of fat, such as Crohn's disease, celiac disease, and ulcerative colitis
• People who have obesity or have had gastric bypass surgery

Check with your health care provider to see if you need to take vitamin D supplements, and if so, how much you should take. Your provider may want to first do a vitamin D test to see if you are getting enough of it.

NIH: National Institutes of Health Office of Dietary Supplements

Vitamin D deficiency means that your body is not getting enough vitamin D to stay healthy.

Vitamin D helps your body absorb calcium. Calcium is one of the main building blocks of bone. Vitamin D also has a role in your nervous, muscle, and immune systems.

You can get vitamin D in three ways: through your skin, from your diet, and from supplements. Your body forms vitamin D naturally after exposure to sunlight. But too much sun exposure can lead to skin aging and skin cancer, so many people try to get their vitamin D from other sources.

The amount of vitamin D you need each day depends on your age. The recommended amounts, in international units (IU), are:

• Birth to 12 months: 400 IU
• Children 1-13 years: 600 IU
• Teens 14-18 years: 600 IU
• Adults 19-70 years: 600 IU
• Adults 71 years and older: 800 IU
• Pregnant and breastfeeding women: 600 IU

People at high risk of vitamin D deficiency may need more. Check with your health care provider about how much you need.

You can become deficient in vitamin D for different reasons:

• You don't get enough vitamin D in your diet
• You don't absorb enough vitamin D from food (a malabsorption problem)
• You don't get enough exposure to sunlight
• Your liver or kidneys cannot convert vitamin D to its active form in the body
• You take medicines that interfere with your body's ability to convert or absorb vitamin D

Some people are at higher risk of vitamin D deficiency:

• Breastfed infants, because human milk is a poor source of vitamin D. If you are breastfeeding, give your infant a supplement of 400 IU of vitamin D every day.
• Older adults, because your skin doesn't make vitamin D when exposed to sunlight as efficiently as when you were young, and your kidneys are less able to convert vitamin D to its active form.
• People with dark skin, which has less ability to produce vitamin D from the sun.
• People with conditions that make it difficult to absorb nutrients from food, such as Crohn's disease, ulcerative colitis, and celiac disease.
• People who have obesity, because their body fat binds to some vitamin D and prevents it from getting into the blood.
• People who have had gastric bypass surgery, a type of weight loss surgery which creates a bypass of part of the small intestine. Since vitamin D is absorbed there, bypassing part of it makes it harder to absorb enough vitamin D.
• People with chronic kidney or liver disease, which can affect your ability to change vitamin D into a form your body can use.
• People who take medicines that affect vitamin D levels, including certain cholesterol, anti-seizure, steroid, and weight-loss medicines.

Talk with your provider if you are at risk for vitamin D deficiency. There is a blood test that can measure how much vitamin D is in your body.

Vitamin D deficiency can lead to a loss of bone density, which can contribute to osteoporosis and fractures (broken bones).

Severe vitamin D deficiency can also lead to other diseases:

• In children, it can cause rickets. Rickets is a rare disease that causes the bones to become soft and bend. African American infants and children are at higher risk of getting rickets.
• In adults, severe vitamin D deficiency leads to osteomalacia. Osteomalacia causes weak bones, bone pain, and muscle weakness.

There are a few foods that naturally have some vitamin D:

• Fatty fish such as salmon, tuna, and mackerel
• Beef liver
• Cheese
• Mushrooms
• Egg yolks

You can also get vitamin D from fortified foods. You can check the food labels to find out whether a food has vitamin D. Foods that often have added vitamin D include:

• Milk
• Breakfast cereals
• Orange juice
• Other dairy products, such as yogurt
• Soy drinks

Vitamin D is in many multivitamins. There are also vitamin D supplements, both in pills and in a liquid for babies.

If you have vitamin D deficiency, the treatment is with supplements. Check with your provider about how much you need to take, how often you need to take it, and how long you need to take it.

Getting too much vitamin D (known as vitamin D toxicity) can be harmful. Signs of toxicity include nausea and vomiting, poor appetite, constipation, weakness, and weight loss.

Very high levels of vitamin D can damage the kidneys. It also raises the level of calcium in your blood. High levels of blood calcium (hypercalcemia) can cause confusion, kidney failure, and irregular heartbeat (arrhythmia).

Most cases of vitamin D toxicity happen when someone overuses vitamin D supplements. You cannot get too much vitamin D from sun exposure because the skin limits the amount of vitamin D it makes.

Rickets causes soft, weak bones in children. It usually occurs when they do not get enough vitamin D, which helps growing bones absorb the minerals calcium and phosphorous. It can also happen when calcium or phosphorus levels are too low.

Your child might not get enough vitamin D if he or she:

• Has dark skin
• Spends too little time outside
• Has on sunscreen all the time when out of doors
• Doesn't eat foods containing vitamin D because of lactose intolerance or a strict vegetarian diet
• Is breastfed without receiving vitamin D supplements
• Can't make or use vitamin D because of a medical disorder such as celiac disease

In addition to dietary rickets, children can get an inherited form of the disease. Symptoms include bone pain or tenderness, impaired growth, and deformities of the bones and teeth. Your child's doctor uses lab and imaging tests to make the diagnosis. Treatment is replacing the calcium, phosphorus, or vitamin D that are lacking in the diet. Rickets is rare in the United States.

Osteoporosis is a disease in which your bones become weak and are likely to fracture (break). The disease can develop when your bone mineral density and bone mass decrease. It can also happen if the structure and strength of your bones change.

Osteoporosis is called a "silent" disease because it doesn't usually cause symptoms. You may not even know you have the disease until you break a bone. This could happen with any bone, but it's most common in the bones of your hip, vertebrae in the spine, and wrist.

Your bones are made of living tissue. To keep them strong, your body breaks down old bone and replaces it with new bone. Osteoporosis develops when more bone is broken down than replaced. You lose bone mass and changes happen in the structure of your bone tissue. This can happen as you get older. Other risk factors can also lead to the development of osteoporosis or increase your chance of developing the disease.

Anyone can develop osteoporosis, but you are more likely to develop it if you have one or more risk factors:

• Your sex. Osteoporosis is more common in women, especially after menopause (postmenopausal).
• Your age. Your risk increases as you get older. It is most common in people over age 50.
• Your body size. It is more common in people who are slim and thin boned.
• Your race:
  • White and Asian women are at highest risk.
  • African American and Mexican American women have a lower risk.
  • White men are at higher risk than African American and Mexican American men.
• Family history. Your risk of osteoporosis may be higher if one of your parents has osteoporosis or broke their hip.
• Changes to hormones. Low levels of certain hormones can increase your chance of developing osteoporosis.
• Diet. A diet that is low in calcium and/or vitamin D or does not include enough protein can raise your risk.
• Long-term use of certain medicines, such as:
  • Corticosteroids
  • Proton pump inhibitors (which treat GERD)
  • Medicines to treat epilepsy
• Having other medical conditions, such as:
  • Endocrine diseases
  • Certain digestive diseases
  • Rheumatoid arthritis
  • Certain types of cancer
  • HIV
  • Anorexia nervosa, a type of eating disorder
• Your lifestyle. Certain lifestyle factors can contribute to bone loss, such as:
  • Smoking tobacco
  • Long-term heavy alcohol use
  • Physical inactivity or prolonged periods of bedrest

Osteoporosis usually doesn't cause symptoms. You may not know that you have it until you break a bone.

Health care providers often diagnose osteoporosis during routine screening for the disease. The U.S. Preventive Services Task Force recommends screening for:

• Women age 65 and older
• Postmenopausal women under age 65 who have factors that increase the chance of developing osteoporosis

For men, it isn't clear yet whether regular screening is helpful. More research is needed to know for sure.

To find out if you have osteoporosis, your provider:

• Will ask about your medical history and whether you have ever broken a bone
• May do a physical exam, which could include checking for:
  • A loss of height and/or weight
  • Changes in your posture
  • Balance and gait (the way you walk)
  • Your muscle strength
• Will likely order a bone density scan
• May do a fracture risk assessment, which is a short questionnaire that helps estimate your risk of breaking a bone in the next 10 years
• Will likely order a bone density scan
• May do a fracture risk assessment, which is a short questionnaire that helps estimate your risk of breaking a bone in the next 10 years

The goals for treating osteoporosis are to slow or stop bone loss and to prevent fractures. Your provider may recommend:

• A healthy, balanced diet that includes enough calcium, vitamin D, and protein
• Lifestyle changes such as quitting smoking and limiting alcohol
• Regular physical activity including weight-bearing exercise (like walking), strength training, and balance exercises
• Fall prevention to help prevent fractures
• Medicines, such as:
  • Medicines that slow down bone loss
  • Medicines that help rebuild bone

In addition to managing your osteoporosis, it's important to avoid activities that may cause a fracture. These can include movements that involve:

• Twisting your spine, like swinging a golf club
• Bending forward from the waist, like sit ups and toe touches

You can also help reduce the risk of breaking a bone by preventing falls.

To help keep bones strong and help prevent osteoporosis, the best thing to do is to eat a healthy diet rich in calcium and vitamin D. Getting regular physical activity, limiting alcohol, and not smoking can also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Calcium is a mineral, a nutrient that you need (in small amounts) to keep your body healthy. You have more calcium in your body than any other mineral.

Calcium has many important jobs:

• To build and maintain strong bones. Your body stores almost all of its calcium in your bones and teeth to keep them strong.
• To help your muscles move.
• To help your nerves to carry messages between your brain and the rest of your body.
• To help your blood vessels move blood throughout your body.
• To help release hormones that affect many functions in your body.

Not getting enough calcium can cause several conditions, including:

• Osteoporosis, a disease which can make your bones weaker and more likely to break.
• Rickets, a disease in children that causes soft, weak bones.
• Osteomalacia, a condition which causes soft bones in children and adults.

You can get calcium from foods and supplements. You may be able to get enough calcium by eating a variety of foods, including:

• Dairy products such as milk, cheese, and yogurt. These are the main food sources of calcium for most people in the United States.
• Leafy, green vegetables such as kale, broccoli, and Chinese cabbage (bok choi).
• Fish with soft bones that you can eat, such as canned sardines and salmon.
• Calcium-enriched foods such as breakfast cereals, fruit juices, soy and rice drinks, and tofu. The product labels for these foods will show how much calcium they have.

Calcium is available in supplements. It is also included in many multivitamins. The two main forms of calcium supplements are calcium carbonate and calcium citrate:

• Calcium carbonate is absorbed best when taken with food. Some over-the-counter antacids, such as Tums and Rolaids, also contain calcium carbonate.
• Calcium citrate is absorbed well on an empty stomach or a full stomach. People with low levels of stomach acid absorb calcium citrate more easily than calcium carbonate.

Calcium is absorbed best when you take 500 mg or less at one time. If you are taking more than that amount each day, take a smaller dose twice a day rather than taking it all at once.

Calcium supplements might cause gas, bloating, and constipation in some people. If you have any of these symptoms, you could try:

• Spreading out the calcium dose throughout the day
• Taking it with meals
• Switching the form of calcium you take

The amount of calcium you need each day depends on your age and other factors. The recommended amounts, in milligrams (mg), are:

• Birth to 6 months: 200 mg
• Infants 7-12 months: 260 mg
• Children 1-3 years: 700 mg
• Children 4-8 years: 1,000 mg
• Children 9-13 years: 1,300 mg
• Teens 14-18 years: 1,300 mg
• Adults 19-50 years: 1,000 mg
• Adult men 51-70 years: 1,000 mg
• Adult women 51-70 years: 1,200 mg
• Adults 71 years and older: 1,200 mg
• Pregnant and breastfeeding teens: 1,300 mg
• Pregnant and breastfeeding adults: 1,000 mg

Certain people may have trouble getting enough calcium, including:

• Children and teens age 4 to 18 years
• People who are Black or Asian
• Adults age 50 years and older living in poverty
• Postmenopausal women; your body absorbs and retains less calcium after menopause
• People who don't drink milk or eat other dairy products

Check with your health care provider to see if you need to take calcium supplements, and if so, how much you should take. Your provider may want to first do a calcium blood test to see if you are getting enough of it.

NIH: National Institutes of Health Office of Dietary Supplements

Nutrition is about eating a healthy and balanced diet so your body gets the nutrients that it needs. Nutrients are substances in foods that our bodies need so they can function and grow. They include carbohydrates, fats, proteins, vitamins, minerals, and water.

When you're pregnant, nutrition is more important than ever. You need more of many important nutrients than you did before pregnancy. Making healthy food choices every day will help you give your baby what they need to develop. It will also help make sure that you and your baby gain a healthy amount of weight.

You need more folic acid, iron, calcium, and vitamin D than you did before pregnancy:

• Folic acid is a B vitamin that may help prevent neural tube defects.
  • Before pregnancy, you need 400 mcg (micrograms) per day.
  • During pregnancy and when breastfeeding, you need 600 mcg per day from foods and/or vitamins. It is hard to get this amount from foods alone, so you will most likely need to take a supplement that contains folic acid.
• Iron is important for your baby's growth and brain development. During pregnancy, the amount of blood in your body increases, so you need more iron for yourself and your growing baby. You should get 27 mg (milligrams) of iron a day.
• Calcium during pregnancy can reduce your risk of preeclampsia. It's a serious medical condition that causes a sudden increase in your blood pressure. Calcium also builds up your baby's bones and teeth.
• Pregnant adults should get 1,000 mg (milligrams) of calcium a day
• Pregnant teenagers (ages 14-18) need 1,300 mg of calcium a day
• Vitamin D helps the calcium to build your baby's bones and teeth. All women, pregnant or not, should be getting 600 IU (international units) of vitamin D per day.

Keep in mind that taking too much of a supplement can be harmful. For example, very high levels of vitamin A can cause birth defects. Only take vitamins and mineral supplements that your health care provider recommends.

You also need more protein when you are pregnant. Healthy sources of protein include beans, peas, eggs, lean meats, seafood, and unsalted nuts and seeds.

Getting enough fluids is another special nutritional concern during pregnancy. When you are pregnant, your body needs even more water to stay hydrated and support the life inside you. So it's important to drink enough fluids every day.

How much weight you should gain depends on your health and how much you weighed before pregnancy:

• If you were at a normal weight before pregnancy, you should gain about 25 to 35 pounds
• If you were underweight before pregnancy, you should gain more
• If you were overweight or had obesity before you became pregnant, you should gain less

Check with your provider to find out how much weight gain during pregnancy is healthy for you. You should gain the weight gradually during your pregnancy, with most of the weight gained in the last trimester.

How many calories you need depends on your weight gain goals. Your provider can tell you what your goal should be, based on things like your weight before pregnancy, your age, and how fast you gain weight. The general recommendations are:

• In the first trimester of pregnancy, you probably do not need extra calories
• In the second trimester, you usually need about 340 extra calories
• In the last trimester, you may need around 450 extra calories per day
• During the final weeks of pregnancy, you may not need extra calories

Keep in mind that not all calories are equal. You should eat healthy foods that are packed with nutrients - not "empty calories" such as those found in soft drinks, candies, and desserts.

During pregnancy, you should avoid:

• Alcohol. There is no known amount of alcohol that is safe for a woman to drink during pregnancy.
• Fish that may have high levels of mercury. Limit white (albacore) tuna to 6 ounces per week. Do not eat tilefish, shark, swordfish, marlin, orange roughy, or king mackerel.
• Foods that are more likely to contain germs that could cause foodborne illness, including
  • Refrigerated smoked seafood like whitefish, salmon, and mackerel
  • Undercooked meat, poultry, eggs, and seafood
  • Refrigerated meat spreads
  • Store-made salads, such as chicken, egg, or tuna salad
  • Unpasteurized or raw milk
  • Unpasteurized juices or cider
  • Unpasteurized soft cheeses, such as unpasteurized feta, Brie, queso blanco, queso fresco, and blue cheeses
  • Raw sprouts of any kind (including alfalfa, clover, radish, and mung bean)
  • Raw cookie dough
  • Unwashed fruits and vegetables
• Too much caffeine. Drinking high amounts of caffeine may be harmful for your baby. For most people, it's best to limit caffeine to less than 200 mg per day during pregnancy. But first check with your provider about whether you should have caffeine at all.

Primary ovarian insufficiency (POI), also known as premature ovarian failure, happens when a woman's ovaries stop working normally before she is 40.

Many women naturally experience reduced fertility when they are about 40 years old. They may start getting irregular menstrual periods as they transition to menopause. For women with POI, irregular periods and reduced fertility start before the age of 40. Sometimes it can start as early as the teenage years.

POI is different from premature menopause. With premature menopause, your periods stop before age 40. You can no longer get pregnant. The cause can be natural or it can be a disease, surgery, chemotherapy, or radiation. With POI, some women still have occasional periods. They may even get pregnant. In most cases of POI, the cause is unknown.

In about 90% of cases, the exact cause of POI is unknown.

Research shows that POI is related to problems with the follicles. Follicles are small sacs in your ovaries. Your eggs grow and mature inside them. One type of follicle problem is that you run out of working follicles earlier than normal. Another is that the follicles are not working properly. In most cases, the cause of the follicle problem is unknown. But sometimes the cause may be:

• Genetic disorders such as Fragile X syndrome and Turner syndrome
• A low number of follicles
• Autoimmune diseases, including thyroiditis and Addison disease
• Chemotherapy or radiation therapy
• Metabolic disorders
• Toxins, such as cigarette smoke, chemicals, and pesticides

Certain factors can raise a woman's risk of POI:

• Family history. Women who have a mother or sister with POI are more likely to have it.
• Genes. Some changes to genes and genetic conditions put women at higher risk for POI. For example, women Fragile X syndrome or Turner syndrome are at higher risk.
• Certain diseases, such as autoimmune diseases and viral infections
• Cancer treatments, such as chemotherapy and radiation therapy
• Age. Younger women can get POI, but it becomes more common between the ages of 35-40.

The first sign of POI is usually irregular or missed periods. Later symptoms may be similar to those of natural menopause:

• Hot flashes
• Night sweats
• Irritability
• Poor concentration
• Decreased sex drive
• Pain during sex
• Vaginal dryness

For many women with POI, trouble getting pregnant or infertility is the reason they go to their health care provider.

Since POI causes you to have lower levels of certain hormones, you are at greater risk for other health conditions, including:

• Anxiety and depression. Hormonal changes caused by POI can contribute to anxiety or lead to depression.
• Dry eye syndrome and eye surface disease. Some women with POI have one of these eye conditions. Both can cause discomfort and may lead to blurred vision. If not treated, these conditions can cause permanent eye damage.
• Heart disease. Lower levels of estrogen can affect the muscles lining the arteries and can increase the buildup of cholesterol in the arteries. These factors increase your risk of atherosclerosis (hardening of the arteries).
• Infertility.
• Low thyroid function. This problem also is called hypothyroidism. The thyroid is a gland that makes hormones that control your body's metabolism and energy level. Low levels of thyroid hormones can affect your metabolism and can cause very low energy, mental sluggishness, and other symptoms.
• Osteoporosis. The hormone estrogen helps keep bones strong. Without enough estrogen, women with POI often develop osteoporosis. It is a bone disease that causes weak, brittle bones that are more likely to break.

To diagnose POI, your health care provider may do:

• A medical history, including asking whether you have relatives with POI
• A pregnancy test, to make sure that you are not pregnant
• A physical exam, to look for signs of other disorders that could be causing your symptoms
• Blood tests, to check for certain hormone levels. You may also have a blood test to do a chromosome analysis. A chromosome is the part of a cell that contains genetic information.
• A pelvic ultrasound, to see whether or not the ovaries are enlarged or have multiple follicles

Currently, there is no proven treatment to restore normal function to a woman's ovaries. But there are treatments for some of the symptoms of POI. There are also ways to lower your health risks and treat the conditions that POI can cause:

• Hormone replacement therapy (HRT).HRT is the most common treatment. It gives your body the estrogen and other hormones that your ovaries are not making. HRT improves sexual health and decreases the risks for heart disease and osteoporosis. You usually take it until about age 50; that's about the age when menopause usually begins.
• Calcium and vitamin D supplements. Because women with POI are at higher risk for osteoporosis, you should take calcium and vitamin D every day.
• In vitro fertilization (IVF). If you have POI and you wish to become pregnant, you may consider trying IVF.
• Regular physical activity and a healthy body weight.Getting regular exercise and controlling your weight can lower your risk for osteoporosis and heart disease.
• Treatments for associated conditions. If you have a condition that is related to POI, it is important to treat that as well. Treatments may involve medicines and hormones.

NIH: National Institute of Child Health and Human Development

Some people think that tanning gives them a healthy glow. But tanning, either outdoors or indoors with a tanning bed, is not healthy at all. It exposes you to harmful rays and puts you at risk for health problems such as melanoma and other skin cancers.

Sunlight travels to earth as a mixture of both visible and invisible rays. Some of the rays are harmless to people. But one kind, ultraviolet (UV) rays, can cause problems. They are a form of radiation. UV rays do help your body make vitamin D, but too much exposure damages your skin. Most people can get the vitamin D that they need with only about 5 to 15 minutes of sun exposure two to three times a week.

There are three types of UV rays. Two of them, UVA and UVB, can reach the earth's surface and affect your skin. Using a tanning bed also exposes you to UVA and UVB.

UVB rays can cause sunburn. UVA rays can travel more deeply into the skin than UVB rays. When your skin is exposed to UVA, it tries to protect itself from further damage. It does this by making more melanin, which is the skin pigment that makes your skin darker. That's what gives you a tan. This means that your tan is a sign of skin damage.

Since tanning means overexposure to UV rays, it can damage your skin and cause health problems such as:

• Premature skin aging, which can cause your skin to become thickened, leathery, and wrinkled. You may also have dark spots on your skin. These happen because long-term exposure to UV rays makes your skin less elastic. The more sun exposure you have, the earlier your skin ages.
• Skin cancers, including melanoma. This can happen because the UV light damages the DNA of your skin cells and interferes with your body's ability to fight the cancer.
• Actinic keratosis, a thick, scaly patch of skin that usually forms on areas exposed to the sun, such as the face, scalp, back of the hands, or chest. It can eventually become cancerous.
• Eye damage, including cataracts and photokeratitis (snow blindness)
• A weakened immune system, which can increase your sensitivity to sunlight, decrease the effects of vaccines, and cause you to have reactions to certain medicines.

• Limit sun exposure. Try to stay out of the sun between 10 a.m. and 4 p.m., when its rays are strongest. But remember that you still get sun exposure when you are outside on cloudy days or are in the shade.
• Use sunscreen with sun protective factor (SPF) 15 or higher. It should also be a broad-spectrum sunscreen, which means that it gives you both UVA and UVB protection. If you have very light skin, use SPF 30 or higher. Apply sunscreen 20-30 minutes before going outside and reapply it at least every 2 hours.
• Wear sunglasses that block both UVA and UVB rays. Wrap-around sunglasses work best because they block UV rays from sneaking in from the side.
• Wear a hat. You can get the best protection with a wide-brimmed hat that is made out of a tightly woven fabric, such as canvas.
• Wear protective clothing such as long-sleeved shirts and long pants and skirts. Clothes made from tightly woven fabric offer the best protection.

It is also important to check your skin once a month. If you do see any new or changing spots or moles, go see your health care provider.

Indoor tanning is not better than tanning in the sun; it also exposes you to UV rays and damages your skin. Tanning beds use UVA light, so they expose you to a higher concentration of UVA rays than you would get by tanning in the sun. Tanning lights also expose you to some UVB rays.

Some people think that getting a "base tan" in a tanning salon can protect you when you go in the sun. But a "base tan" causes damage to your skin and will not prevent you from getting sunburn when you go outside.

Indoor tanning is particularly dangerous for younger people. You have a higher risk of melanoma if you started doing indoor tanning while you were a teen or young adult.

Some research shows that frequent tanning may even be addictive. This can be dangerous because the more often you tan, the more damage you do to your skin.

There are other ways to look tan, but they are not all safe:

• Tanning pills have a color additive that turns your skin orange after you take them. But they can be dangerous and are not approved by the Food and Drug Administration (FDA).
• Sunless tanners have no known risk for skin cancer, but you do have to be careful. Most spray tans, lotions, and gels use DHA, a color additive that makes your skin look tan. DHA is considered safe for use on the outside of your body by the FDA. You need to make sure it doesn't get into your nose, eyes, or mouth. If you use a spray tan, be careful not to breathe in the spray. Also, remember that these "tans" do not protect you from UV rays when you go outside.

Vitamins are substances that your body needs to grow and develop normally. There are 13 vitamins your body needs. They are:

• Vitamin A
• B vitamins (thiamine, riboflavin, niacin, pantothenic acid, biotin, vitamin B-6, vitamin B-12 and folate)
• Vitamin C
• Vitamin D
• Vitamin E
• Vitamin K

You can usually get all your vitamins from the foods you eat. Your body can also make vitamins D and K. People who eat a vegetarian diet may need to take a vitamin B12 supplement.

Each vitamin has specific jobs. If you have low levels of certain vitamins, you may get health problems. For example, if you don't get enough vitamin C, you could become anemic. Some vitamins may help prevent medical problems. Vitamin A prevents night blindness.

The best way to get enough vitamins is to eat a balanced diet with a variety of foods. In some cases, you may need to take vitamin supplements. It's a good idea to ask your health care provider first. High doses of some vitamins can cause problems.

Your bones are made of living tissue. To keep them strong, your body breaks down old bone and replaces it with new bone. But when more bone is broken down than replaced, you lose bone density, also called bone mass. Bone density is a measure of the amount of calcium and other minerals in bone. Bones containing more minerals are denser. They tend to be stronger and less likely to fracture (break).

Losing bone density can weaken your bones. In some cases, it can lead to osteoporosis. This is a disease which can make your bones more likely to break. Low bone density that is not low enough to be osteoporosis is sometimes called osteopenia.

Your bones become less dense as you age. Other factors can also make you more likely to lose bone mass, such as:

• A family history of osteoporosis or low bone mass
• Not developing good bone mass when you are young
• Having certain medical conditions, such as:
  • Endocrine diseases
  • Certain digestive diseases
  • Rheumatoid arthritis
  • Certain types of cancer
  • HIV
  • Anorexia nervosa, a type of eating disorder
• Taking certain medicines, such as:
  • Corticosteroids
  • Proton pump inhibitors (which treat GERD)
  • Medicines to treat epilepsy
• Smoking tobacco
• Long-term heavy alcohol use
• Physical inactivity or prolonged periods of bedrest

Not everyone who has low bone mass gets osteoporosis, but they are at higher risk for developing it.

A bone density scan is the best way to measure your bone health. It compares your bone density, or mass, to that of a healthy person who is the same age and sex as you are. It can show:

• Whether you have low bone density
• Whether you have osteoporosis, a disease that makes your bones weak
• Your risk for breaking bones
• Whether your osteoporosis treatment is working

To help keep your bones strong and help prevent osteoporosis, the best thing to do is to eat a healthy diet rich in calcium and vitamin D. Getting regular physical activity, limiting alcohol, and not smoking can also help. In some cases, your health care provider may prescribe medicines to prevent osteoporosis.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases