Does the thought of figuring out what supplements you should take make you feel like you are lost in the jungle? Well, don’t worry! I will be your guide and share some highlights about these mysterious nutrients, as well as point out ways to include these in your diet. So, without further ado, let’s get to it!

What are vitamins?

Wikipedia defines vitamins as molecules that are necessary for the body to function properly.^[1] Well, “How is this different from minerals and herbs,” you might ask? Vitamins are essential nutrients for the body that come from living things. They differ from minerals because although both are essential, minerals are found within the earth. Herbal products come from plants. But even though they come from living things, they are not necessarily essential for the body to function.^[2]

How many essential vitamins are there?

There are 13 essential vitamins. They include Vitamins A, C, D, E and K, as well as seven different B vitamins. Let’s talk more about each of these essential vitamins.

Vitamin A

Vitamin A is important for your vision and immune system. It is also critical for most of the major organ systems in your body to function properly. Worried that you are not getting enough Vitamin A? Have no fear. It is felt that the average person gets enough Vitamin A in their diet, regardless of their dietary preferences or restrictions. Preformed Vitamin A, known as retinol, is typically found in meats, eggs and dairy products. However, beta-carotene, which is the most common precursor to Vitamin A, can be found in all sorts of fruits and vegetables. Do you like cantaloupe, apricots, and mangos? If you do, you’re in luck! These are good sources of Vitamin A. According to the National Institutes of Health (NIH), carrots and spinach will score you about 50% of your daily requirement. But serve up a baked sweet potato and you will hit the motherload, a whopping 150% of your daily requirements!

For more information about Vitamin A, check out this link: https://ods.od.nih.gov/factsheets/VitaminA-Consumer/

Vitamin C

Vitamin C, also known as ascorbic acid, is an antioxidant. Antioxidants help to protect cells from damage due to free radicals. Our bodies are exposed to free radicals through the body breaking down food for energy and through the environment by pollution or cigarette smoke. In turn, free radicals can contribute to illnesses such as heart disease and cancer. So, Vitamin C is important to help your body deal with things that we either consciously or unknowingly expose our bodies to.

Vitamin C is probably most notable for being a booster for your immune system. According to the NIH, people receive the most benefit by getting enough Vitamin C daily as opposed to just taking it when cold symptoms begin. Your body also needs Vitamin C to make collagen, which helps with wound healing. But did you know that Vitamin C also helps your body to absorb iron? I would always encourage my anemic patients to take their iron with orange juice to help maximize their iron absorption. But you could also combine an iron rich food, such as spinach or legumes, with one of these foods that are full of Vitamin C. (More to come on iron in our mineral section.)

For most people, when we think about Vitamin C, oranges are the first thing that we think of. It is true that citrus fruits, such as oranges, lemons, and grapefruits, are a good source of Vitamin C. But other fruits, such as kiwi, cantaloupe, strawberries, and blueberries, contain Vitamin C as well. In the mood for veges? Red and green bell pepper, broccoli, and baked potatoes are delicious foods that can bring a little Vitamin C into your day.

For more information about Vitamin C, check out this link: https://ods.od.nih.gov/factsheets/VitaminC-Consumer/

Vitamin D

Vitamin D is critical for strong bones and absorbing calcium. Research has also shown that there are benefits in promoting heart health and reducing certain cancers. Vitamin D is found in fatty fish, such as salmon and tuna, as well as egg yolks. Do you follow a plant-based lifestyle? Fortified soy, almond, and rice milk; mushrooms; fortified cereals; and fortified orange juice are all vegan friendly sources.

Another way to get Vitamin D is through good old fashion sunshine. Vitamin D3, otherwise known as cholecalciferol, is absorbed from sunlight, and converted by the body to usable Vitamin D. So, enjoy a stroll in the park on a sunny day with an iced soy latte and get your Vitamin D!

It is possible to have your Vitamin D level checked by your doctor to see if supplementation would be beneficial. But be careful. Many insurance companies will not cover this as a routine screening test. There needs to be a justifiable medical reason for testing such as a concern for Vitamin D deficiency. Risk factors for Vitamin D deficiency can include getting limited sun exposure, poor dietary intake of Vitamin D, and problems with absorption.

For more information about Vitamin D, check out this link: https://ods.od.nih.gov/factsheets/VitaminD-Consumer/

Vitamin E

Vitamin E is a fat-soluble nutrient that is an antioxidant. It plays a vital role in the immune system. Vitamin E is also important for hair, skin, and nails, as well as vision.

Vitamin E can be found in nuts and seeds as well as vegetable oils, like sunflower and corn. Prefer to go green? Spinach and broccoli are good sources of Vitamin E as well. You can also get your daily dose of Vitamin E through certain fortified foods. Be sure to check the label for d-alpha-tocopherol, which is natural Vitamin E, or dl-alpha-tocopherol, which is synthetic Vitamin E.

For more information about Vitamin E, check out this link: https://ods.od.nih.gov/factsheets/VitaminE-Consumer/

Vitamin K

Vitamin K is important for blood clotting and healthy bones. It can be found in vegetables, such as spinach, kale, and broccoli; vegetable oils; blueberries; and figs. Since Vitamin K does affect your blood clotting, check with your doctor before starting it if you are on blood thinners, such as Coumadin.  

For more information about Vitamin K, check out this link: https://ods.od.nih.gov/factsheets/VitaminK-Consumer/

B vitamins

There are seven B Vitamins. Here is a brief description of each and a link if you would like more information.

• B1 (Thiamin)- Thiamin helps your body to produce energy. It is also important for growth and development. It can be found in cereals, whole grains, rice, potatoes, and beans. https://ods.od.nih.gov/factsheets/Thiamin-Consumer/  
• B2 (Riboflavin)- Riboflavin also helps with energy production, growth, and development. It can be found in cereals, whole grains, and green vegetables such as asparagus and spinach. https://ods.od.nih.gov/factsheets/Riboflavin-Consumer/  
• B3 (Niacin)- Niacin is important for energy production and healthy skin. It also promotes proper functioning of the nervous system and digestive system. It can be found in nuts, whole grains, beans, and fortified foods. https://ods.od.nih.gov/factsheets/Niacin-Consumer/   
• B5 (Pantothenic acid)- Pantothenic acid serves an important role in energy, growth and development as well as breaking down fats. It is found in almost all foods. Some of my personal favorite sources are shitake mushrooms, avocados, potatoes, whole grains, peanuts, and sunflower seeds. https://ods.od.nih.gov/factsheets/Pantothenicacid-Consumer/
• B6 (Pyridoxine)- Pyridoxine is important for red blood cells, the immune system, and brain development during pregnancy. It can be found in potatoes, wheat germ, bananas, and dried beans. https://ods.od.nih.gov/factsheets/VitaminB6-Consumer/ 
• B7 (Biotin)- Biotin, like the other B Vitamins, is a key element in energy production. It has long been felt that biotin helps with hair, skin, and nail health. However, according to the NIH, scientists are still doing research to confirm this. Biotin can be found in peanuts, bananas, mushrooms, watermelon, and grapefruit. https://ods.od.nih.gov/factsheets/biotin-Consumer/
• B8 (Folic acid)- Folic acid is vital for the production of DNA and other genetic material. It is recommended that all women who could become pregnant take in at least 400 mcg of folic acid daily. If you are considering pregnancy, it is important to have folic acid in your system before getting pregnant. This helps to promote healthy development of the fetus and to reduce the risk of neural tube birth defects such as spina bifida. Sources of folic acid can include green leafy vegetables, citrus fruits, mushrooms, nuts, peas, and beans. https://ods.od.nih.gov/factsheets/Folate-Consumer/ 
  
  

Do I need a vitamin supplement?

It is possible to get all the essential vitamins that you need while eating through your diet. The key is to have a well-balanced diet that incorporates a wide range of foods. Eating some of your fruits and vegetables raw can help to maximize the vitamins you are ingesting by preventing important nutrients from being lost during the cooking process. But if you feel that you may be missing out on some of these key vitamins, a multivitamin can be an excellent way to get everything that you need in one pill. However, some people prefer to only supplement the individual vitamins that they may be lacking. That option is acceptable too. Just be careful not to overdo it. Although vitamins are important to help the body function properly, you do not need to excessively exceed the daily requirements. Too much of a good thing can also be harmful. If you are taking a supplement, look at the back of the bottle to see what percentage of your daily requirement is in the supplement. There are also resources online that can tell you how much of a particular vitamin is in a certain food.  

If you are considering adding a vitamin to your daily routine, check with your doctor first to see if the vitamin is right for you. You can also check with your pharmacist to ensure that the vitamin does not interact with any other medications that you are taking.

In our next segment, we will talk about some of the common mineral supplements.

-Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified OB/GYN. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now serves as the Medical Director.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

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^[1] https://en.wikipedia.org/wiki/Vitamin

^[2] https://www.pharmacytimes.com/view/vitamins-and-minerals-explained

In the first part of our series, we talked about Postpartum Care: Taking “You” Home from the Hospital. We then moved on to Postpartum Care: When Do I Need to Call My Doctor in part two. So what’s next in the final chapter of this three-part series?

Postpartum depression. This topic requires more than just a paragraph in a postpartum care blog post. To increase awareness around this topic, we will spend this post reviewing 4 Things You Should Know About Postpartum Depression.

1. Postpartum depression is NOT the baby blues.

While you were growing your “little nugget” inside of you, there were all sorts of hormones needed to support your body and your nugget’s growth. As nugget made his or her exit on the big day, the hormones purchased their one-way ticket and started making their exit as well. This sudden withdrawal of hormones can cause changes in emotions resulting in the baby blues or postpartum depression. How will you know the difference between the two?

Baby Blues: For most women, the baby blues are experienced 2-3 days after delivery. The symptoms typically go away in 3-5 days, but they can last up to two weeks. According to the Mayo Clinic, symptoms women can experience are:

• Mood swings
• Anxiety
• Sadness
• Irritability
• Feeling overwhelmed
• Crying
• Problems concentration
• Changes in appetite
• Difficulty sleeping

Postpartum Depression: Postpartum depression is NOT the baby blues. Some symptoms are similar, but postpartum depression symptoms are more intense, last longer than two weeks, and interfere with your ability to care for yourself and your baby. Symptoms of postpartum depression can even start up to one year after delivery. So don’t disregard these symptoms if they start later on. According to the Mayo Clinic, symptoms of postpartum depression include:

• Depressed mood
• Extreme mood swings
• Crying a lot
• Difficulty bonding with your baby
• Withdrawing from friends and family
• Change in appetite (eating too much or too little)
• Insomnia or sleeping too much
• Fatigue or loss of energy
• Loss of interest and pleasure in activities you enjoy
• Irritability and anger
• Feeling that you are not a good mother
• Hopelessness
• Feelings of worthlessness, shame, guilt, or inadequacy
• Difficulty thinking clearly, concentrating, or making decisions
• Restlessness
• Anxiety
• Panic attacks
• Thoughts of harming yourself or your baby
• Recurrent thoughts of death or suicide

2. It happens more than you think.

According to the American Psychological Association, 1 in 7 women experience symptoms of postpartum depression. More than likely, someone you know has experienced this. One of the reasons why we don’t realize it is so prevalent is that we, as a society, don’t talk about it enough. Unfortunately, there is a stigma that exists about mental health. However, the more we talk about it, write about it, and sing about it from the mountaintops, we start to break down the walls of shame surrounding this disorder. As we speak up and share our personal experiences, it might touch another woman and let her know she is not alone. There is light in the darkness, and there is hope.

3. and 4. “Postpartum depression is not your fault- it is a real, but treatable, psychological disorder.”

The above quote is from a brochure by The American Psychological Association. I could not have said it better myself, and it brings up two excellent points. That’s why I had to label the section 3 AND 4!

Let’s start at three. Postpartum depression is not your fault. It does not mean you are a “bad mother” or don’t love your baby. It is a medical disorder. It is no different than other medical disorders that can occur during pregnancy that are not a woman’s fault. No one blames a woman for having pre-eclampsia (high blood pressure in pregnancy) or gestational diabetes.

Therefore, you should not blame yourself for having postpartum depression. Postpartum depression is NOT YOUR FAULT.

The fourth item you should know about postpartum depression is that there are treatments available. Here are a few that your doctor might discuss with you:

Antidepressants. Antidepressants can be prescribed by your OB/GYN or your Primary Care doctor. They can help you feel a little more like yourself as your body transitions during this time. It doesn’t mean you will be on this medication for the rest of your life. But, when you and your doctor decide you are ready to be off them, it is important not to stop them abruptly. You will need to wean from them under the guidance of your physician. And yes, there are options that are safe to use while breastfeeding!

Therapy. Talking to a trained professional is another option. Not only does this provide a safe, judgement-free zone to express how you are feeling, but therapists can also provide you with coping techniques to navigate this tumultuous time.

Support groups. Speaking with others who are going through or have made it through postpartum depression can be therapeutic. There is just something comforting about being around others who have been where you have been. It can be a source of hope and encouragement. There are in-person and online groups available. Postpartum Support International is an organization that offers resources, including on-line support groups, to women and families affected by postpartum depression. For more information about the Texas Chapter, please visit https://psichapters.com/tx/.

Well, there you have it! Our journey through the postpartum period is complete. We reviewed what to expect after delivery, when to call your doctor, and what to know about postpartum depression. I hope this information answers some of your questions about the postpartum period. But if you have other questions, check out the Education tab on our website, www.WHSNT.com, to find out more about the postpartum period and other topics.

Until next time, be well, and be sure to show yourself grace and love.

-Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

About the author: Dr. Kristin Williams is a board-certified OB/GYN. She graduated from Wayne State University School of Medicine in Detroit, Michigan. After completing one year of training at Tulane University in New Orleans, Louisiana, Dr. Williams moved to Dallas, Texas to complete her residency at Parkland Hospital. She worked in private practice with Women’s Health Specialists of North Texas for 16 years and now serves as the Medical Director.

If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline. All calls and texts are confidential, and help is available 24/7 for those experiencing suicidal thoughts or mental health-related distress.

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.

In our last blog post, we talked about what is normal in the postpartum period. But, what is NOT normal? In the second part of our 3-part series, we are going to look at five things you should let your doctor know about immediately.

• Heavy vaginal bleeding

Whether a woman has a vaginal delivery or a Cesarean section (aka C-section), some vaginal bleeding after delivery is normal. Typically, it is heavier in the first 24 hours after delivery. After that, the bleeding starts to decrease. First it will be like a normal period, then taper down to spotting, and  finally, it will stop. The amount of time that a woman bleeds after giving birth varies from a couple weeks to up to six weeks. The key is that the vaginal bleeding should gradually decrease overtime. If the bleeding suddenly increases — you begin to completely fill a pad in an hour for at least two hours — you should notify your doctor or seek medical attention.

• Foul-smelling vaginal discharge

Lochia, a mixture of blood and mucus, is the normal discharge that occurs after delivery. Normal lochia does not have a foul-smelling odor to it. If you notice a significant odor to your discharge, you should notify your doctor or seek medical attention.

• Pus from your C-section incision

If you have had a C-section, the hospital will let you know the best way to care for your incision at home. Some women have stitches, and some have staples. There could be little strips of adhesive tape, glue, or nothing at all. Regardless of how your doctor closes your incision, you might experience a few drops of blood or fluid on your dressing or underwear. This is ok. However, experiencing pus, large amounts of blood-tinged fluid, or heavy bleeding is not normal. Anything that is heavy enough to fill a thick pad or bandage with fluid or any amount of pus is a reason to notify your doctor or seek medical attention.

• Fever

A fever of 100.4 or greater is something that should be evaluated. There are many reasons that a woman could have a fever after giving birth. It could be related to the breasts, the uterus, your incision, or even a respiratory infection. No matter the reason, it is not normal to have a fever of 100.4 or greater and you should notify your doctor or seek medical attention.

• Red, painful breasts

Whether you are breastfeeding or bottle feeding, your breasts can become engorged due to the increased blood flow to the breasts after delivery. The increased blood flow to your breasts encourages milk production. Breast engorgement can lead to discomfort. Warm compresses to the breasts, massaging the breasts before nursing, or pumping the breasts can help soothe discomfort. If you are not breastfeeding, it is no longer recommended that you bind your breasts. A good supporting bra is recommended. Acetaminophen, or Tylenol, can help ease discomfort. However, if your breasts become painful AND red, that could be a sign of an infection called mastitis. If one or both of your breasts become red and swollen, you should notify your doctor or seek medical attention.

In summary, here are five reasons to reach out to your doctor or seek immediate medical attention:

1. Vaginal bleeding that suddenly increases and is heavy enough to fill a pad in an hour for at least two consecutive hours.
2. A significant odor to your lochia, (aka vaginal discharge) after delivery.
3. Heavy drainage from your C-section incision — enough to fill a thick pad or bandage with fluid —or if any amount of pus is noted.
4. A fever of 100.4 or greater.
5. Red, painful breasts.

Well, there you have it! You are equipped with a few facts about what could require a call to your doctor after delivery. In our next discussion, we will talk about postpartum depression.

Until then, be well and make sure to show yourself love and grace.

Dr. Kristin Williams

Medical Director of Women’s Health Specialists of North Texas

This blog provides general information and discussions about health and related topics. The information and other content provided in this blog, or in any linked materials, are not intended and should not be construed as medical advice. This information is not a substitute for professional medical expertise or treatment.

If you or any other person has a medical concern, please consult with your healthcare provider, or seek other professional medical treatment. Never disregard professional medical advice or delay seeking care based on the information you have read on this blog or in any linked materials. If you think you may have a medical emergency, call or go to the Emergency Room or dial 9-1-1.