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

Can you guess one of the most frequently asked questions I received when I was in private practice? No matter their age, nationality, or education level, women wanted to know – Do I need a pap smear?

Who can blame them? Recommendations have changed throughout the years, and once you think you’ve got it all figured out, it changes again. So, what’s the answer?  In this blog, you will finally know the answer to a question that has bewildered women for ages. But first, let’s talk about what a pap smear is.

What is a pap smear?

A Papanicolaou test, affectionately known as the pap smear, is a test that looks for abnormal cells on the cervix that can lead to cervical cancer. But did you know that now experts say that looking for abnormal cells of the cervix is not the only way to screen for cervical cancer? Let’s take a closer look at this.

What are the tests for cervical cancer screening?

There are three basic types of tests for cervical cancer screening – Cytology, HPV testing, and Cytology with HPV testing. While all these tests are performed the same way in the doctor’s office, they are tested differently in the lab.

• Cytology only (also known as the Pap smear) – Looks for abnormal cells on the cervix but does not screen for HPV. This type of cervical cancer screening is recommended for women 21-29 y/o.
• HPV testing only – Looks for high-risk strains of the Human Papilloma Virus (HPV). There are well over 100 different strains of HPV. But not all strains of HPV cause abnormalities that could potentially lead to cervical cancer. Therefore, screening only for high-risk strains of HPV, not for abnormal cells of the cervix itself, is one option for cervical cancer screening. This test can be performed on women 30–64 years old.
• Cytology with HPV testing (also known as the Pap smear with co-testing) – Combines the two methods described above. This test can be performed on women 30–64 years old as well. It basically combines the two methods mentioned above.

Therefore, in this blog, we will not use the term pap smear but instead cervical cancer screening. Now, let’s debunk five of the most common myths about cervical cancer screening.

Does age matter?

Myth #1:  You should have cervical cancer screening when you turn 18 years old.

Fact:  Women should start having cervical cancer screening at 21 years old. Even if someone becomes sexually active before then, screening for cervical cancer is not necessary until age 21.

How often do I really need to be screened for cervical cancer?

Myth #2:  Even if your cervical cancer screening is normal, you should still have to repeat your screening every single year.

Fact:  Women who have normal screenings of their cervix do not need to have yearly cervical cancer screening. I know some of you are saying, “Are you sure about that? Is that safe?” Yes, I am and yes it is!

Women who have normal screenings of their cervix may space out their screenings between 3 -5 years, depending on your age and what type of screening you had. I continue to stress normal because these guidelines do not necessarily apply to women who have had an abnormal result on their cervical cancer screening.

Let’s break this down further

• Cytology only (the pap smear) – This type of cervical cancer screening is recommended for women 21-29 y/o and is performed every 3 years if normal.
• HPV testing only – This type of cervical cancer screening only looks for high-risk strains of HPV, not abnormal cells from the cervix. It can be performed on women 30–64-year-old and is performed every 3 years if normal.
• Cytology with HPV testing (the pap smear with co-testing) – This test screens for both abnormal cells of the cervix and high-risk strains of HPV. It can be performed on women 30–64-year-old and can be performed every 5 years, instead of every 3 years.

The good thing is that you do not have to remember all of this. Your doctor will keep track of when you are due for your cervical cancer screening. The takeaway from this myth is that not every person needs a cervical cancer screening every year. This takes us into Myth #3.

How often should I see my Gynecologist?

Myth #3:  My doctor says that I do not need to have cervical cancer screening every year. Therefore, I do not need to see my gynecologist every year.

Fact:  You need to see your gynecologist every year. YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. One more time for the people in the back – YOU NEED TO SEE YOUR GYNECOLOGIST EVERY YEAR. Ok. I think I have made my point.

You need to see your gynecologist every year for your annual exam even if cervical cancer screening is not needed. At an annual exam, other important things occur such as:

• Blood pressure check
• Weight check (Yeah, I hate it too.)
• Breast exam
• Pelvic Exam
• Birth control options
• Risk factor screening for medical illnesses and cancers
• Menopause discussion
• Blood work
• Ordering mammograms
• Options for colon cancer screening (colonoscopy, Cologard)
• And more!

Yearly visits help to maintain the doctor-patient relationship. This is important for many reasons. But one huge perk of being seen each year is that if you develop health concerns between your yearly visits, you won’t be considered a new patient and won’t have to wait as long to be seen. Just remember, it is important to see your doctor every year even if you don’t have cervical cancer screening performed.

I’m on my period. Now what?

Myth #4:  If you are on your period, you should cancel your yearly exam.

Fact:  If you are having CERVICAL CANCER SCREENING, it is best to reschedule your appointment. The blood obtained on the specimen can make it difficult for the pathologist to interpret the results. This means that we would need to repeat your cervical cancer screening when you are not on your period.

If you are having your ANNUAL EXAM without cervical cancer screening, you can still keep your appointment. I know it may feel embarrassing being examined while you are on your period. But let me assure you, it is ok. However, if you feel uncomfortable, you can always call to reschedule your appointment.

It is understandable that it can be confusing trying to keep up with when you are due for your cervical cancer screening. If you aren’t sure and need to know before your appointment, just call. We can let you know if your cervical cancer screening is “to be, or not to be” (thank you, Shakespeare). But whatever you do, don’t just not show up for your appointment with your doctor. Always call if you need to cancel, reschedule, or have questions about your appointment.

Can cervical cancer screening look for cancers other than cervical cancer?

Myth #5:  Cervical cancer screening lets you know if you have cervical cancer, uterine cancer, and ovarian cancer.

Fact:  Cervical cancer screening only screens for cancer of the cervix. It does not screen for any other cancers. Here are how other cancers are screened for.

• Ovarian cancer – Yearly pelvic exams can help your doctor determine if there are concerns for ovarian cancer. A pelvic exam can look for any physical signs concerning for ovarian cancer. But it is also important for you to listen to your body and report any persistent swelling/bloating and or abdominal/pelvic pain. Your family history is also an important consideration.
• Uterine cancer – If you have not gone through menopause, look for significant, persistent changes in your period such as them being heavier, longer, or more frequent. If you have already gone through menopause and have not had a period for at least one year, you should report any vaginal spotting or bleeding.
• Vulvar cancer – Once again, yearly pelvic exams with your doctor are key. Also, you should report any itching on the outside of the vaginal area that is persistent.

So, back to the original question –Do I need a pap smear?  Well let’s change that question to – Do I need cervical cancer screening? The answer is… maybe. There are a few factors that go into the correct answer for each individual woman. The takeaway message is not everyone needs to have cervical cancer screening every year, but you should still see your gynecologist every year. But do not worry if you can’t remember all the ins and outs of cervical cancer screening. That’s what we are here for!

I hope that the information shared in this blog helped to shed some light on what may be right for you. Now, you can walk with your head held up high, knowing what to do, and confidently tell your girlfriends and family what they need to do as well.

Keep in mind that recommendations could very well change again in the future. But for now, you’ve got it! Plus, you’ll be going to see your gynecologist every year anyways, right?

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 works with the office as the office 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.

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.

Don’t panic.  A pap smear is a screening test for cervical cancer and pre-cancer.  The pap test is usually done in conjunction with an HPV test. There are many causes of abnormal pap smears, and most can be managed in the office.  Once your test comes back abnormal, your provider reviews the test results and decides on a plan of action.

What are the different types of abnormal pap test results?

• Atypical squamous cells of undetermined significance (ASC-US)—ASC-US means that changes in the cervical cells have been found. The changes are almost always a sign of an HPV infection. The changes may also be a result of infection or inflammation. ASC-US is the most common abnormal Pap test result.
• Low-grade squamous intraepithelial lesion (LSIL)—LSIL means that the cervical cells show changes that are mildly abnormal. LSIL usually is caused by an HPV infection that often goes away on its own.
• High-grade squamous intraepithelial lesion (HSIL)—HSIL suggests more serious changes in the cervix than LSIL. It is more likely than LSIL to be associated with pre-cancer and cancer.
• Atypical squamous cells, cannot exclude HSIL (ASC-H)—ASC-H means that changes in the cervical cells have been found that raise concern for the presence of HSIL.
• Atypical glandular cells (AGC)—Glandular cells are another type of cell that make up the thin layer of tissue that covers the inner canal of the cervix. Glandular cells also are present inside the uterus. An AGC result means that changes have been found in glandular cells that raise concern for the presence of pre-cancer or cancer.

What testing is done after an abnormal result?

• Colposcopy with or without cervical biopsy—Colposcopy is an in office exam of the cervix with a magnifying device. If an area of abnormal cells is seen, your health care provider may decide that a cervical biopsy is needed. For a biopsy, the health care provider removes a small sample of tissue and sends it to a lab for testing. The lab tests can determine whether abnormal cells are present and, if so, how severe.
• Endocervical sampling – A small brush or other instrument is used to take a tissue sample from the cervical canal.
• Endometrial sampling— In the case of an AGC result, a sample of the endometrium (the lining of the uterus) may be collected for study using an instrument which looks like a small straw.

What are the potential results of the biopsy?

• Cervical intraepithelial lesion (CIN) is used to report cervical biopsy results. CIN is graded as 1, 2, or 3.
• CIN 1 is used for mild (low-grade) changes in the cells that usually go away on their own without treatment.
• CIN 2 is used for moderate changes.
• CIN 3 is used for more severe (high-grade) changes.
• Moderate and high-grade changes can progress to cancer. For this reason, they may be described as “pre-cancer,” and are usually treated.

How are abnormal cervical cells treated?

• Loop electrosurgical excision procedure (LEEP)—A thin wire loop that carries an electric current is used to remove abnormal areas of the cervix. This procedure can be done in the office or in the operating room.
• Conization—A cone-shaped piece of the cervix that contains the abnormal cells is removed. This procedure must be done in the operating room.

These procedures are usually curative.  Once complete, patients are asked to come in for a follow up visit two weeks after the procedure to review pathology results and to form a plan for future testing.

 

Information adapted from ACOG Patient Information FAQ 187