Women with PCOS have been found to have worse symptoms if their vitamin D* levels were low.  That is worse obesity, lower pregnancy success, excess facial hair as well as a long list of other problems. 1;2.

Unfortunately an alarming 67–85% of PCOS women have been found to have extremely low levels of vitamin D in their bodies. 2.

So it’s time to talk about a thorny issue for all Australians … sunshine exposure.

I’m sure most Aussies have known someone who has been diagnosed with a sun cancer of some type and we’ve certainly taken the message to stay out of the sun to heart.  I regularly see clients with extremely low vitamin D levels who look at me in horror when I suggest their skin feels the warm rays of the sun on a daily basis without sunscreen**.

But here’s the thing…  Whilst your body gets most of the vitamins and minerals it needs from the foods you eat only a few foods naturally contain any vitamin D so it’s almost impossible to get what your body needs just from unprocessed food 3. 

I certainly don’t mean baking yourself like a rotisserie chicken! In fact your skin can make Vitamin D quickly, particularly in the summer. You don’t need to tan or burn your skin to get vitamin D.  You only need to expose your unprotected skin for around half the time it takes for your skin to turn pink and begin to burn. Whilst how much vitamin D you make from the sun depends on the time of day, where you live in the world, your age and the colour of your skin the more skin you expose the more vitamin D is produced. 3.

Strange though it might sound some of us struggle to make Vitamin D from the sun.  For this reason I encourage you to get your own Vitamin D level checked via a simple blood test your doctor can prescribe or your naturopath can order for you.

*Vitamin D is made in the body after it has been exposed to the sun, eaten in foods and can be consumed in a supplement.

**Please be sun safe and use your common sense. Never let yourself burn. If you have been given medical advice to protect yourself from the sun you must follow that advice as it has been personalised to your own body and circumstances.  

In health,

Sonia x

References:

1. Kotsa, K., Yavropoulou, M. P., Anastasiou, O., & Yovos, J. G. (2009). Role of vitamin D treatment in glucose metabolism in polycystic ovary syndrome. Fertility and Sterility, 92(3), 1053-1058.

2. Thomson, R. L., Spedding, S., & Buckley, J. D. (2012). Vitamin D in the aetiology and management of polycystic ovary syndrome. Clinical Endocrinology, 77(3), 343-350.

3. Vitamin D Council (n.d.). How do I get the vitamin D my body needs? Retrieved from: https://www.vitamindcouncil.org/about-vitamin-d/how-do-i-get-the-vitamin-d-my-body-needs/

Polycystic ovary syndrome (PCOS) is on the increase causing rising rates of devastating infertility. But sadly that’s not all.  It’s also found with insulin resistance which means for PCOS gals they experience debilitating fatigue, easy weight gain / difficulty losing weight and a higher chance of diabetes. 

The buzz around a supplement called myo-inositol has been so strong that a high quality review was performed on all of the scientific trials undertaken around the world.  This factual report concluded myo-inositol taken by  PCOS gals may:

•          cause ovulation

•          raise progesterone levels

•          lower testosterone levels

•          lower insulin levels after eating sugar (glucose)

•          and cause weight loss!

Remarkably, in all the studies analysed, no side effects were reported at the doses of both 2 and 4 g/day.  It is worthwhile sharing the 4 g/day did cause a more complete and effective treatment in those with PCOS.

Let’s hear from the scientists of this report:

“MYO (myo-inositol) mechanism of action appears to be mainly based on improving insulin sensitivity of target tissues, resulting in a positive effect on the reproductive axis (MYO restores ovulation and improves oocyte quality) and hormonal functions (MYO reduces clinical and biochemical hyperandrogenism and dyslipidemia) through the reduction of insulin plasma levels.”

There is also some VERY exciting research on inositol and slow thyroid function! 

In Health,
Sonia x

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Reference: 

Unfer, V., Carlomagno, G., Dante, G., & Facchinetti, F. (2012). Effects of myo-inositol in women with PCOS: a systematic review of randomized controlled trials. Gynecological Endocrinology, 28(7), 509-515. DOI: 10.3109/09513590.2011.650660

So you’ve been told your thyroid is normal but you are still exhausted, forgetful & gaining weight?

You’ve been told your thyroid is normal but you suspect it isn’t. Did you know your immune system could be causing these symptoms 7 years before they show up on your ‘thyroid test’?

Antibodies from the immune system have been found attacking the thyroid up to 7 years before it was severe enough to cause the need for medication (Caturegli, et al., 2013).

That’s 7 long years of weight gain, fatigue, illness, joint pain & moodiness.  Having lived through this myself it was 7 years too long!

The good news is it is possible to determine your antibody levels with a simple blood test – it’s almost like looking into a crystal ball and seeing your thyroid future .

If you are experiencing any of the following it might be worthwhile checking your immune system’s treatment of your thyroid to get a head start on healing:

•    feeling more tired than you think you should be considering how much you are sleeping

•    gaining or losing weight even though you have not changed how you are eating or exercising

•    are feeling anxious or depressed

•    Someone in your biological family has an autoimmune disease.

Whilst you may not be able to access these tests via medicare without a confirmed abnormal TSH test you can order them easily via your naturopath if you opt to pay for them yourself. 

The tests for the assessment of your immune system’s impact on your thyroid when low thyroid function is suspected: 

Thyroperoxidase antibody test (anti-TPO)

Antibodies to thyroglobulin test (TgAb).

If you suspect something is wrong make sure you know your risks, get the right tests & have an effective solution tailored to your body.

In health,

Sonia x

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Reference:

Caturegli, P., De Remigis, A., Chuang, K., Dembele, M., Iwama, A., & Iwama, S. (2013). Hashimoto’s thyroiditis: celebrating the centennial through the lens of the Johns Hopkins hospital surgical pathology records. Thyroid, 23(2), 142-150.http://dx.doi.org/10.1016/j.autrev.2014.01.007

Even as the scientific knowledge on causes of excess weight increases our own weight is not decreasing.  Look around any work site, office or supermarket and you can see the proof behind the statistics telling us we have been getting fatter.

Scarily this trend is reflected with our kids.  Recent population studies have found that between 21% – 27% of school-aged children in Australia are overweight or obese.  One quarter of our youth with an uncertain future marred by escalating health problems (1, 2, 8)!

Whilst the evidence on excess weight tells us categorically weight loss is not as simple as the old ‘calories-in versus calories-out’ debate it is certainly one piece of the jigsaw puzzle on obesity (5).  So how do we lower calories without having the burden of weighing, measuring, recording and calculating everything we eat and drink?

I was pondering this problem recently while unpacking my Nonna’s old dinner set and I was struck by how much smaller the dinner plates, bowls and cups were from what I use every day. Even more remarkable was the comparison with my Great Grandma’s afternoon tea dishes which I vividly remember being used to serve delicious home-made treats.  If I hadn’t the clear memory of their use I would have sworn it was a child’s play set they were so small!

The size difference was so marked I started thinking about the link between the ever increasing size in our dinnerware, my own family’s weight timeline from my tiny Great Grandma through to me now and if anyone had researched the correlation between plate size and weight size. 

I jumped on the ‘net to check out the science. Our plates have increased approximately 44% in size from only the 1980s to early 2000s (3) and a correlation has been found between the increased size of plates, portions and calories and the rise in obesity rates in Western society (9).

So this morning for breakfast I decided to use my Nonna’s plates.  For the past 12 months I have been eating a specific sized piece of protein (meat or fish) because I want to take advantage of protein’s ability to make me feel full for longer and reduce hideous 3.30pm sugar cravings.

This morning was one of the first times in 12 months I couldn’t finish my breakfast.  Seeing how piled-up the food was on my Nonna’s plate instantly made me feel like I was over-stuffing myself, and, remarkably I simply just stopped eating when I felt full.

Straight back to the research!  Now I wanted to find out if there was research on smaller plate sizes leading to less calories consumed. Some studies have indeed found increasing plate sizes led to an increase in the portion size of foods and calories eaten (4, 6). 

However these findings need to be balanced against the conclusion of a controlled environment study on differing sized plates on food where no change in food and calorie intake was linked to changing plate sizes (7).

Interestingly the study that found plate size was not linked to calories consumed had excluded participants if they were overweight / obese or had a disordered attitude to food. What if the conclusion of the study is linked to the categories of people it excluded? 

From my experience clients who easily maintain a balanced and healthy weight typically have the ability to regulate their food intake regardless of where and when they are dining. Potentially this might mean these effortlessly slim folk automatically eat the calories they need without regard to what plate it is presented on.

I have found people who struggle to keep their weight down tend to have a higher chance of a disordered relationship with food. Potentially these people may be influenced by the appearance of food on their plate.

Any recommendations for people wanting to lose weight?  Using smaller plates, bowls and mugs might provide instant and daily portion control with no effort.

What have I personally implemented on my weight-loss adventure? Well rather than throwing away the cracked and incomplete dinner set from my Nonna I have decided to use it for everyday meals.

And I ended up eating my left-over brekkie for lunch and at 4pm I’m still travelling strong with no sugar cravings!

No weight loss even though you have reduced calories

Portion control or ‘calories-in versus calories-out' is only one part of the jigsaw puzzle of shedding fat.  If you are struggling to lose weight despite reducing your food intake and or increasing your exercise it is time to explore the hormonal drivers of weight. 

There are many hormonal reasons why weight loss is difficult including but not limited to:

Insulin - the way your body responds to sugars

Thyroid - how much energy your body actually burns

Leptin - the foods you crave and how full you feel

Cortisol - how your body responds to your stress levels and if you lose weight or gain weight when stressed

Oestrogen, progesterone and testosterone - your female / male hormone levels may influence the way your body burns your food intake and calories.

So if reducing portion size does not change your weight don’t give up there may be a hormone hijacking your efforts!

In health,

Sonia x

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References:

1. Booth, M.L., et al., NSW Schools Physical Activity and Nutrition Survey, (2004), Summary Report. 2006. Sydney: NSW Department of Health.

2. Hands, B., et al., Physical Activity and Nutrition Levels in Western Australian Children and Adolescents: Report. 2004. Perth:  Western Australian Government.

3. Klara, R. (2004). Table the issue. Restaurant Business, 103, 14–15.

4. Ledikwe, J.H., Ello-Martin, J.A. & Rolls, B.J. (2005). Portion sizes and the obesity epidemic.  The Journal of Nutrition, 134(4), 905-909.

5. Redman, L.M. & Ravussin, E. (2011). Caloric restriction in humans: Impact on physiological, psychological and behavioural outcomes.  Antioxidant Redox Signal, 14(2), 275-287. doi: 10.1089/ars.2010.3253

6. Rolls, B.J., Morris, E.L. & Roe, L.S. (2002). Portion size of food affects energy intake in normal-weight and overweight men and women. The American Journal of Clinical Nutrition, 76(6), 1207-1213.

7. Rolls, B. J., Roe, L. S., Halverson, K. H., & Meengs, J. S. (2007). Using a smaller plate did not reduce energy intake at meals. Appetite, 49(3), 652-660.

8. Wake, M., Hardy, P., Canteford, L. Sawyer, M. & Carlin, J.B. (2006). Overweight, obesity and girth of Australian preschoolers: prevalence and socio-economic correlates. International Journal of Obesity (London), 31(7):1044-1051.

9. Young, L.R. & Nestle, M. (2002). The contribution of expanding portion sizes to the US obesity epidemic. American Journal of Public Health, 92(2), 246–249.

I wish more than anything in the world I had found a thyroid-literate naturopath & doctor before I suffered through miscarriages & spent thousands and thousands of dollars on IVF. It’s one of the reasons why I went back to college for 4 years of full time study to become a naturopath, nutritionist and herbalist myself & why I am so passionate about supporting women with thyroid issues.

Hypothyroidism is the 2nd most common condition affecting women of reproductive age. The terrible tragedy is the pregnant woman with hypothyroidism has an increased risk miscarriage and other major gestational problems, that’s why. If you know someone trying to fall pregnant who suspects they may be hypothyroid or is experiencing repeated miscarriages give them the gift of a lifetime by encouraging them to seek a thyroid literate medical professional and naturopath to support their journey to bring a new life into this world.

In Health,

Sonia x

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References:

Benhadi, N., Wiersinga, W. M., Reitsma, J. B., Vrijkotte, T. G. M., & Bonsel, G. J. (2009). Higher maternal TSH levels in pregnancy are associated with increased risk for miscarriage, fetal or neonatal death. European Journal of Endocrinology, 160(6), 985-991. 

Poppe, K., Velkeniers, B., & Glinoer, D. (2008). The role of thyroid autoimmunity in fertility and pregnancy. Nature Reviews Endocrinology, 4(7), 394.

Do you find you are looking for something to pep you up to get through the day?  Is the diet coke / coffee and chocolate afternoon snack more than the occasional go-to food?

I was talking fatigue and craving-busting strategies with my gorgeous friend Leah who is a mum to 2 active boys (3yo & 18months), a professional singer with a busy performing schedule and a part-time student.  Leah was asking me for snack ideas that were portable, affordable, healthy and most important of all helped her juggle all her daily balls…. challenge accepted. 

Super Fast Grab ‘n Go

Here are my favourite grab ‘n go fatigue busting snacks.  I call them grab ‘n go because there is no cooking and very little preparation so if you are like my friend Leah and need to pack a whole lot of activity into your day before you race out the front door throw some of these in your bag and go:

• Banana & 10 walnut halves. Natures snack food, perfectly portable.

• Whole carrot stick (chopped in half or quarters if you are feeling fancy) used to scoop out your preferred nut butter.

• Slice up an apple and smear a little of that left-over nut butter on your slices – yum!

• Tin of sustainably fished salmon or tuna emptied into a crisp lettuce leaf and throw in a chopped tomato if you have time and a knife. Choose Cos or Iceberg lettuce for the best result.  Wrap the fish and tomato up like a parcel in a couple of leaves and munch away.  Best served with many napkins to catch runaway dribbles.

• Celery boats. Take a celery stick and get into the groove pressing as much soft cheese as it will hold when tightly packed. Try salty goats cheese or creamy cottage cheese and sprinkle with a touch of paprika for smokiness or turmeric for Indian flavour.

When You Are Set Up For Success

If I know I have a busy week I make a couple of different meals at the same time either the night before or on the weekend:

• Oven-roasted chicken drumstick eaten cold dipped in tomato salsa (I’ll usually roast a whole chicken and then use it throughout the week in a number of meals more on this money saving idea in a later post).

• Leftover chicken meat shredded and stuffed into ½ an avocado.

• Hard-boiled eggs are fantastic, portable, power-packs of protein and  followed with a whole cucumber eaten like an apple raw and crunchy.

• And my personal go-to-snack that I always have a container of in my fridge… turkey meatballs.  I pair a turkey meatball with a crisp lettuce leaf and a generous dollop of avocado for savory goodness or with a slice of strawberry or a blueberry for tart sweetness.

Turkey MeatBalls

•          500 grams (1 pound) of turkey mince

•          1/2 teaspoon ground/minced/grated ginger

•          1 teaspoon ground sage

•          Season with salt and pepper to taste I use 1/2 teaspoon salt & 1/4 pepper

•          Coconut oil to cook with

In a large bowl, mix the ground turkey, ginger, salt, sage and black pepper until well blended – I use my hands. Form the minced meat into balls or flat patties.  Should make 10 small serves or 5 very large serves.

Heat a frying pan over medium heat and add coconut oil. Add patties and brown on both sides turning until cooked through.  Break open one and check it is no longer pink in the middle because no one needs to be spending their time off work being sick. Based on a receipe originally found on Brenda Watson Allergy Free Site.

If you want to check to see if your snacks measure up here’s what needs to go into them:

•          Ingredient #1 = Protein  

Protein improves appetite control so you don’t keep going back for more snacks until dinner-time rolls around.  Protein also seems to modulate food hedonics, that is, cravings knocked-on-the-head (1).

•          Ingredient #2 = Carbohydrate

Complex carbohydrates that give you sustained energy are the best choice to pair with your protein base.

Emergency Help For Chocoholics

If you find that you just cannot stop eating chocolate or sweets once you start have you tried short-circuiting the urge with the herb Gymnema sylvestre (say gym – neema)?

Its unusual name is derived from a Hindu word “Gurmar” meaning “destroyer of sugar” and it is typically used with overweight/obese people to prevent sugar cravings and in traditional cultures with the symptoms of diabetes (2).

What I love about Gymnema is when you put a drop of it on your tongue whatever you eat afterwards does not taste sweet and it becomes pretty unpalatable and easy to stop. It is thought the peptide molecule gurmarin blocks the ability to taste sweet flavours and reduces sweet cravings (2).  Gymnema is useful in an emergency when your willpower is failing and somehow you have found your hand lodged in the sweets jar or your mouth overflowing with chocolate.

Before I sign-off and munch on a carrot stick with almond butter I want to share with you that in a 2014 study on overweight/obese teenage girls they found that those who had a protein rich breakfast had far less food cravings for the rest of the day (1).  If you are grabbing for a regular afternoon snack it may be related to what you ate for breakfast.  Something to think about and explore.

I’d love to hear your favourite energy-boosting, craving-busting snack! 

In health,

Sonia x

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References:

1. Hoertel, H. A., Will, M. J., & Leidy, H. J. (2014). A randomized crossover, pilot study examining the effects of a normal protein vs. high protein breakfast on food cravings and reward signals in overweight/obese “breakfast skipping”, late-adolescent girls. Nutrition Journal, 13(1), 80.

2. Saneja, A., Sharma, C., Aneja, K. R., & Pahwa, R. (2010). Gymnema sylvestre (Gurmar): A review. Der Pharmacia Lettre, 2(1), 275-284.

Vitamin D levels are often low in Hashimoto’s hypothyroidism as well as Graves hyperthyroidism.  

Unfortunately low ‘sunshine vitamin’ levels mean possibly a higher risk for a whole host of problems including:

•          depression

•          osteoporosis

•          inability to resist colds and ‘flus.

Spending more time lolling about in the sun unfortunately may not work alone as a strategy for increasing Vitamin D levels in those with Hashimoto’s and Graves as they may not be able to make vitamin D from sunshine in enough quantity to provide full benefit. 

So if you have Hashimoto’s or Graves, are hypothyroid or hyperthyroid, and you are feeling down, getting sick a lot and tired all the time make sure you get your vitamin D levels checked. 

Personally I encourage my Hashimoto’s & Graves clients to have their Vitamin D levels tested at the end of summer which should be at their highest level. 

In health,

Sonia x

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References:

Feng, M., Li, H., Chen, S. F., Li, W. F., & Zhang, F. B. (2013). Polymorphisms in the vitamin D receptor gene and risk of autoimmune thyroid diseases: a meta-analysis. Endocrine, 43(2), 318-326.

Probiotics and weight loss - can a probiotic make you skinny?

A 12 week randomised, controlled trial on 87 generally healthy adults with “obese tendencies” found those fed the probiotic Lactobacillus gasseri SBT2055 showed statistically significant decreases in abdominal fat, as well as body weight, BMI, waist and hip circumferences, and body fat mass as compared with their control group (3).

The probiotic selected in the study came from human intestine and had been found to reduce enlarged fat cells caused by a high-fat diet in rats.  The strain had also been found to bind with cholesterol and promote its clearance (2). 

Do you match the participants’ profiles?

•          Between 33–63 years old

•          Body mass index (BMI) between 24.2 and 30.7kg/m2,

•          Abdominal visceral fat area between 81.2 and 178.5 cm2

•          Apart from their weight and fat stores participants did not have any serious health concerns including liver disease, autoimmune diseases or diabetes.

•          All participants were able to drink milk as the probiotic was in fermented milk.

•          Participants were Japanese (3).

So do you have car keys at the ready to race out and hunt down Lactobacillus gasseri SBT2055?

The good news:

•          Previous and more recent studies on the same strain of probiotics have been able to reproduce similar results (1).

•          Research on the influence of bacteria on obesity is an exploding area of study and many more discoveries are soon to be released (2).

The not so good news:

•          The study size was very small, only 87 participants.

•          Men far outweighed women:  59 men and 28 women.

•          Potentially Japanese diets and lifestyles may interact with the probiotic strain in ways that our ethnic heritage does not.

•          Two of the researchers listed on the study were from dairy manufactures. However no conflicts of interest were declared (3).

Would I recommend it?

If you were between 33 – 63, overweight, with fat stores around your tummy Lactobacillus gasseri SBT2055 could certainly be one element of your tailored treatment plan. It is important to also eat a diet rich in the foods probiotic bugs enjoy eating so make sure you also increase your veggies and fibre in general. 

In health,

Sonia x

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References:

1. Cani, P. D., & Delzenne, N. M. (2011). The gut microbiome as therapeutic target. Pharmacology & therapeutics, 130(2), 202-212.

2. Delzenne, N. M., Neyrinck, A. M., Bäckhed, F., & Cani, P. D. (2011). Targeting gut microbiota in obesity: effects of prebiotics and probiotics. Nature Reviews Endocrinology, 7(11), 639-646.

3. Kadooka, Y., Sato, M., Imaizumi, K., Ogawa, A., Ikuyama, K., Akai, Y., … & Tsuchida, T. (2010). Regulation of abdominal adiposity by probiotics (Lactobacillus gasseri SBT2055) in adults with obese tendencies in a randomized controlled trial. European Journal of Clinical Nutrition, 64(6), 636-643.  doi:10.1038/ejcn.2010.19;

It’s the Easter Sunday tally of chocolate and hot cross buns and it’s time to get science to help me prevent pimples popping-up like bunny rabbits!

Don’t believe me that chocolate and hot cross buns can cause acne?  Studies on twins have proven, whilst the tendency to spots can run in families, diet has a very large impact on whether or not your face has an outcrop of zits (6).

In fact the Journal of Dermato-Endocrinology said “nutrition is one of the most important parameters that is involved in modulating skin health and condition” (3).

Causes of acne:

• Cows milk including skim milk. Proven by studies on girls before the onset of their period and in adult women (6).

• High glycemic foods, that is, foods high in sugar alter insulin and hormone production and function causing the skin to produce more oil (6).

• Type of fat eaten.  Healthy fats in fish, avocados and meat do not promote pimples but unfortunately fats in processed foods may (6).

• Chocolate. The (scientific) jury is still out on milk chocolate, however, if your chocolate has dairy, sugar and was not made in your kitchen it is more than likely to be pimple promoting (6).

Well considering afternoon tea was a high sugar nougat filled Easter Egg it’s too late for analysis of causes – time to research solutions!

When I was an image obsessed teenager I insisted my GP prescribe a course of antibiotics to fix my acne promising like a junkie jonesing for a fix “this would be my last time”!  Fast forward 20 years and my personal history of multiple immune disorders is a warning to all that antibiotic abuse is a short-sighted, short-term solution.

Natural solutions to Acne:

Vitamins and Minerals: Pimples typically leave a wound that is red, lumpy, and inflamed and nutrients like vitamins A and C, zinc and glucosamine may reduce pimple healing time and improve the appearance of the wound (3). 

Low sugar, high fibre:  Not only are high sugar diets linked to acne but a study on male volunteers noticed a greater improvement in total acne lesions while eating a low sugar, high fibre diet (3).

Avoid dairy and processed fats (6). 

Scientific theory but little research on vitamin D. Vitamin D is produced by your skin after sun exposure and scientists believe it may play some role in helping with acne.  Whilst this has not been proven there are many other benefits to regular sun exposure so I’ll make sure I top up my Vitamin D every day this week* (4,5).

Natural antiseptic: If pimples do turn up I will pop a drop of topical antiseptic tea tree oil (an essential oil of the Australian native tree Melaleuca alternifolia) on the bumps.  A single-blind, randomised clinical trial on 124 patients of 5% tea-tree oil compared with 5% benzoyl peroxide lotion found both treatments had a significant effect in reducing the number of inflamed and non-inflamed lesions and improving acne.  Although the onset of action in the case of tea-tree oil was slower it also had fewer side effects (1).

My own theory with my own research: When dodging the very real possibility of pizza face I make sure my “organs of excretion”, that is, my liver, kidneys, bowels and lungs are working to move out the indulgences of the weekend.  In practical terms this means I add vegetables to every meal to increase fibre and the possibility of a big poo, drink over 2L (0.5 gallon) of water a day and go for a walk in the fresh air. On my face I use a clean salt based stick as an antibacterial solution just in those areas I am most likely to break out.

If you find that you have acne that is not responsive to these simple lifestyle measures you might have an underlying condition requiring further investigation and targeted treatment personalised to your body and circumstances.  

Happy Easter Sunday!

Sonia x

*Please always be sun safe.  I get my sun exposure before 11am, protect my face from the sun and leave before I turn pink.

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References:  

1. Bassett, I. B., Pannowitz, D. L., & Barnetson, R. S. (1990). A comparative study of tea-tree oil versus benzoylperoxide in the treatment of acne. The Medical Journal of Australia, 153(8), 455-458.

2. Melnik, B. C. (2013). The role of mTORC1 in acne pathogenesis and treatment.  Expert Review of Dermatology, 8(6), 617-622. doi:10.1586/17469872.2013.846514.

3. Piccardi, N., & Manissier, P. (2009). Nutrition and nutritional supplementation: impact on skin health and beauty. Dermato-endocrinology, 1(5), 271-274.

4. Reichrath, J. (2007). Vitamin D and the skin: an ancient friend, revisited. Experimental dermatology, 16(7), 618-625.

5. Schwalfenberg, G. K. (2011). A review of the critical role of vitamin D in the functioning of the immune system and the clinical implications of vitamin D deficiency. Molecular nutrition & food research, 55(1), 96-108.

6. Spencer, E. H., Ferdowsian, H. R., & Barnard, N. D. (2009). Diet and acne: a review of the evidence. International journal of dermatology, 48(4), 339-347.