The more fit, the lower the risk of depression and death from heart disease.
Physical fitness in middle age is tied to a lower risk of late-life depression and death from cardiovascular disease, a new study reports.
Both depression and cardiovascular disease are common in older people, and rates of depression are high in the presence of cardiovascular illness, especially stroke. Moreover, depression is a risk factor for adverse outcomes in cardiovascular disease patients.
Researchers examined 17,989 men and women, average age 50, from 1971 to 2009, gathering health and behavioral information, including data on aerobic fitness. They followed them from the time they initiated Medicare coverage through 2013. There were 2,701 diagnoses of depression and 841 cardiovascular deaths. The study is in JAMA Psychiatry.
Depression and cardiovascular disease rates declined steadily as fitness in middle age increased. Compared with those in the lowest fitness category, people in the highest were 16 per cent less likely to have depression, 61 percent less likely to have a cardiovascular illness without depression, and 56 percent less likely to die from cardiovascular disease after becoming depressed.
“There is a long-term connection between fitness, depression and cardiovascular death,” said the lead author, Dr. Benjamin L. Willis, director of epidemiology at the Cooper Institute in Dallas. “And it’s something you can approach with modifiable behavior. It’s never too late to get off the couch and start having some physical activity.”
When it comes to relationships, most of us are winging it. We’re exhilarated by the early stages of love, but as we move onto the general grind of everyday life, personal baggage starts to creep in and we can find ourselves floundering in the face of hurt feelings, emotional withdrawal, escalating conflict, insufficient coping techniques and just plain boredom. There’s no denying it: making and keeping happy and healthy relationships is hard.
But a growing field of research into relationships is increasingly providing science-based guidance into the habits of the healthiest, happiest couples — and how to make any struggling relationship better. As we’ve learned, the science of love and relationships boils down to fundamental lessons that are simultaneously simple, obvious and difficult to master: empathy, positivity and a strong emotional connection drive the happiest and healthiest relationships.
Maintaining a strong emotional connection
“The most important thing we’ve learned, the thing that totally stands out in all of the developmental psychology, social psychology and our lab’s work in the last 35 years is that the secret to loving relationships and to keeping them strong and vibrant over the years, to falling in love, again and again, is emotional responsiveness,” says Sue Johnson, a clinical psychologist in Ottawa and the author of several books, including Hold Me Tight: Seven Conversations for a Lifetime of Love.
That responsiveness, in a nutshell, is all about sending a cue and having the other person respond to it. “The $99 million question in love is, ‘Are you there for me?’” says Johnson. “It’s not just, ‘Are you my friend and will you help me with the chores?’ It’s about emotional synchronicity and being tuned in.”
“Every couple has differences,” continues Johnson. “What makes couples unhappy is when they have an emotional disconnection and they can’t get a feeling of secure base or safe haven with this person.” She notes that criticism and rejection — often met with defensiveness and withdrawal — are exceedingly distressing, and something that our brain interprets as a danger cue.
To foster emotional responsiveness between partners, Johnson pioneered Emotionally Focused Therapy, in which couples learn to bond through having conversations that express needs and avoid criticism. “Couples have to learn how to talk about feelings in ways that bring the other person closer,” says Johnson.
Keeping things positive
According to Carrie Cole, director of research for the Gottman Institute, an organization dedicated to the research of marriage, emotional disengagement can easily happen in any relationship when couples are not doing things that create positivity. “When that happens, people feel like they’re just moving further and further apart until they don’t even know each other anymore,” says Cole. That focus on positivity is why the Gottman Institute has embraced the motto “small things often.” The Gottman Lab has been studying relationship satisfaction since the 1970s, and that research drives the Institute’s psychologists to encourage couples to engage in small, routine points of contact that demonstrate appreciation.
One easy place to start is to find ways to compliment your partner every day, says Cole — whether it’s expressing your appreciation for something they’ve done or told them, specifically, what you love about them. This exercise can accomplish two beneficial things: First, it validates your partner and helps them feel good about themselves. And second, it helps to remind you why you chose that person in the first place.
Listen to the brain, not just your heart
When it comes to the brain and love, biological anthropologist and Kinsey Institute senior fellow Helen Fisher has found — after putting people into a brain scanner — that there are three essential neuro-chemical components found in people who report high relationship satisfaction: practicing empathy, controlling one’s feelings and stress and maintaining positive views about your partner.
In happy relationships, partners try to empathize with each other and understand each other’s perspectives instead of constantly trying to be right. Controlling your stress and emotions boils down to a simple concept: “Keep your mouth shut and don’t act out,” says Fisher. If you can’t help yourself from getting mad, take a break by heading out to the gym, reading a book, playing with the dog or calling a friend — anything to get off a destructive path. Keeping positive views of your partner, which Fisher calls “positive illusions,” are all about reducing the amount of time you spend dwelling on negative aspects of your relationship. “No partner is perfect, and the brain is well built to remember the nasty things that were said,” says Fisher. “But if you can overlook those things and just focus on what’s important, it’s good for the body, good for the mind and good for the relationship.”
Happier relationships, happier life
Ultimately, the quality of a person’s relationships dictates the quality of their life. “Good relationships aren’t just happier and nicer,” says Johnson. “When we know how to heal [relationships] and keep them strong, they make us resilient. All these clichés about how love makes us stronger aren’t just clichés; it’s physiology. Connection with people who love and value us is our only safety net in life.”
A comprehensive study has exposed the ongoing myth that links Crepitus (the popping or grinding of knuckle joints) and arthritis. The outcome of the study reveals that there is no such link between osteoarthritis and the practice of the cracking of joints or any other medical condition. The same holds true for any other joint that pops, like the hip or knee.
The act of cracking a joint means bending a person’s joints to produce a distinct cracking or popping sound. It is sometimes done as part of a joint adjustment/mobilization routinely performed by a chiropractor, osteopath or physical therapist.
We asked Consultant Orthopaedic Surgeon, Mr Joyti Saksena of Total Orthopaedics at Highgate Private Hospital to further explain the cracking of joints and whether there are any other health risks associated with it.
Will cracking my knuckles give me arthritis?
For a long time, this was thought to be the case. However, several studies have shown that there is no direct correlation. One of the largest studies in 2011 compared the hand x-rays of two groups of people, those that regularly cracked their knuckles and those that did not. The study concluded that there was no difference in the prevalence of osteoarthritis.
Why does my neck crack loudly when I turn my head?
The cause of cracking joints can be due to a number of reasons but again research has shown that it is most likely an effect of ‘bubbles’ either forming or bursting within the synovial fluid of the joint on sharp movement. However, other causes could be tendons or muscles snapping over bony prominences. As Hip and Knee specialist at Total Orthopaedics I see this often around the hip, known as a snapping IT (ilio-tibial) band.
How do I know if a bone cracking is abnormal?
If the bone cracking is associated with pain, swelling or ‘pins and needles’ then that would suggest that something is not normal and may need investigating further.
Should I be worried if my knees crack when I run?
Knee cracking again is not uncommon but if it is associated with pain and swelling that may be abnormal. ‘Crepitus’ is noise often heard or felt at the front of the knee. This is likely to be when the cartilage of joint is worn or wearing out. If there is a pain, locking or catching then referral to a specialist may be beneficial.
Is it safe to crack my back after sitting down all day?
Many people often do this. In fact, certain allied health professionals use it as a way ‘to realign’ the spine. As long as it does not cause pain then It is likely to be safe to do.
Is there a way to keep joints as healthy as possible?
There are a number of products available to keep joints healthy. There have been some large clinical trials looking at many of over the counter products and results have often been quite variable thus not giving us any conclusive evidence. That said, I often recommend trying products and giving them 3-6 months to see if there is any improvement. If there is, it may be worth continuing as per the manufacturer's guidance.
Products can be divided into those that are applied topically, those that are ingested for example nutritional supplements and those that are injected into the joint.
Topical treatments that can help with arthritic type pain include analgesic gels, capsaicin cream and products that either heat or cool the joint.
Oral tablets that can help to maintain healthy joints include glucosamine, chondroitin and COD liver oil. Turmeric has been recently shown to act as a natural anti-inflammatory.
Injectable agents were initially confined to steroids or hyaluronic acid injections. However, for example, Total Orthopaedics have been undertaking a three-week course of once weekly platelet-rich plasma injection which has shown good evidence for the management of osteoarthritis. It helps by acting as a catalyst to stimulate the bodies own healing potential.
A few shots during pregnancy could keep babies healthy and protect them from a potentially deadly infection, according to a new guide for pregnant women and obstetricians.
For the first time, the American College of Obstetricians and Gynecologists (ACOG) has released a one-page immunization guide for pregnant women that spells out which vaccinations they should ask their doctors about. The guide’s authors put a lot of emphasis on the acellular pertussis vaccine, or Tdap, which protects babies from whooping cough, a potentially fatal infection for newborns.
“Our goal was to increase vaccination rates among pregnant women and make it easier for providers to routinely prescribe them,” Dr Laura Riley, one of the guide's authors and chair of the ACOG immunization work group, told Newsweek.
Medical vials and syringe. A new guide tells pregnant women what shots they need to keep their babies healthy.GETTY IMAGES
The document is a simple reference sheet meant to clear up any confusion that providers and patients might have about vaccinations. It lists nine vaccinations and when they can be administered throughout pregnancy. The flu shot is recommended because women’s immune systems are affected by pregnancy, and they're more likely to get seriously sick from influenza. The hepatitis A vaccine can also be given to pregnant women and should be given in the midst of an outbreak, Riley said.
“Many times, providers don’t know if hepatitis A can be given during pregnancy because we don’t do it all of the time,” she said.
The Tdap vaccination is suggested for nearly every pregnant woman, as it protects newborns against whooping cough, a contagious infection especially for infants that can make them gravely ill. According to the Centers for Disease Control and Prevention, half of babies who get sick with whooping cough end up in the hospital, and some die.
“You can’t vaccinate children until they are a year old. The only way to protect newborns, for which whooping cough is deadly, is to vaccinate the mother during pregnancy,” Dr. Heather Sankey, an obstetrician and gynecologist practicing at Massachusetts’s Baystate Medical Center, told Newsweek.
“Sometimes people don’t think about pregnancy as a time when you might vaccinate someone,” said Sankey, who was not one of the doctors responsible for drafting the document.
This new guide will be a helpful reminder and could raise awareness about the right protocol for treating women, she said. “[ACOG] very much wants us to be taking care of women and thinking of the big picture.”
Many health problems seem to have their origins in the gut—and that even goes for depression and anxiety, new research suggests.
A high-fat diet changes the bacteria in the gut and makes you more likely to suffer from depression and anxiety as a result.
Researchers started investigating a possible link after noticing that obese people with type 2 diabetes were more likely to suffer from acute depression. While anyone can be depressed, the diabetic seems to feel it more keenly.
When laboratory mice are fed a high-fat diet, they become more erratic, and show signs of depression, anxiety and obsessive behaviour, say researchers from Harvard Medical School.
"Your diet isn't just making your blood sugar higher or lower, it's also changing a lot of signals coming from gut microbes, and these signals make it all the way to the brain," said lead researcher C. Ronald Kahn.
His research team noticed that mice fed a high-fat diet developed signs of anxiety and depression, and their behaviour returned to normal when they were given antibiotics, which changed the bacteria in the gut, known as the microbiome.
A similar pattern was seen when healthy mice were given bacteria from the guts of anxious and depressed mice. But their mood didn't alter when they were given the bacteria of mice whose microbiome had been changed with antibiotics.
The researchers surmise that the brain can also become insulin-resistant, a classic first sign of diabetes, on a high-fat diet. The change to the microbiome also affects neurotransmitters, the chemicals that transfer signals across the brain.
Kahn and his team are trying to narrow down the types of bacteria that affect depression and anxiety, and, from that, the supplements that could create healthier brains.
"If we could modify those bacteria, either by putting in more beneficial bacteria or reducing the number of harmful bacteria, that might be a way to see the improved behaviour," he said.
Every second person seems to have a tattoo these days—but instead of checking out the best designs, you should make sure your immune system is healthy first. A tattoo can trigger health problems in those whose immunity is compromised, a new report has discovered.
Doctors noted the connection when a woman started to suffer from chronic pain in her left hip, knee and thigh a few months after she had had a tattoo.
She'd had tattoos on her right-side years earlier without any ill effects, but in the intervening years, she had been taking drugs to dampen down her immune system responses after having had a double lung transplant.
The pain after the second tattoo was so great that she eventually had to take powerful painkillers. Doctors hadn't worked out that the tattoo was the cause of her problems at the time and referred her to a rheumatology clinic.
A biopsy of her thigh muscle eventually discovered she had inflammatory myopathy, or chronic muscle inflammation, with symptoms including muscle weakness and pain.
Although the cause of myopathy is often mysterious and can happen spontaneously, the doctors believe in this case it was caused by the tattoo which she had when the immune system was already compromised.
The type of ink and colourants used in tattooing can cause reactions from mild skin irritation to systemic infection, but problems become much more likely if the immune system is not healthy.
"The tattoo industry has no regulated or professional body to enhance standards," the doctors say in a case study report, "and in this case, the tattoo application by an unregulated parlour, combined with the patient's immune suppression, could have resulted in the adverse reaction."
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What does vitamin D deficiency look like? In its most extreme form, prolonged and severe vitamin D deficiency during childhood, known as rickets, can delay growth and lead to visible skeletal deformities.
Today, rickets is relatively rare, but that doesn’t mean that vitamin D deficiency is—more than 40 percent of Americans are deficient. The potential health consequences of this epidemic are serious, as vitamin D deficiency is linked to osteoporosis, heart disease, diabetes, autoimmune diseases, high blood pressure, and poor pregnancy outcomes.
D-ficient? Odds are you don’t know.
According to the Vitamin D Council, symptoms of vitamin D deficiency can be subtle—or even nonexistent—in the early stages. You might experience some tiredness and general aches and pains, but these symptoms are easy to dismiss because there are many things that cause them.
Aches and pains? You can easily chalk them up to the aftereffects of your last workout—or simply not being 20 anymore. Tiredness? That could be because you aren’t getting enough quality sleep.
Lindsay Obermeyer, MS, RDN, CLT, a Portland, Oregon–based registered dietitian nutritionist and owner of Your Time Nutrition, said she personally experienced chronic joint pain, had labs done, and discovered that her vitamin D was 29 ng/dL (nanograms per deciliter), which is considered deficient by some standards. She started taking a daily dose of vitamin D3, and her joint pain was gone within a week.
I had two different clients with the same symptoms, had them tested for vitamin D, both were less than 30, both had relief from joint pain after supplementing. It’s a very common problem up here in the Northwest.
It can sometimes be hard to tell when you’re in need of more vitamin D. Here are 15 signs that will help you know if you’re vitamin D deficient.
1. Muscle Weakness
You should be aware that muscle weakness can present as generalized body fatigue. If you’re experiencing a more general fatigue around your body, muscle weakness issues in specific areas may stay hidden and go unnoticed for months.
As vitamin D deficiency worsens, symptoms become stronger and harder to ignore. General aches and pains may become muscle and bone (musculoskeletal) pain, and tiredness may progress to muscle weakness. Still, it’s easy to search for answers in the wrong direction.
2. Bone Pain
In a study of 150 patients referred to a clinic in Minnesota for persistent, general musculoskeletal pain, 93 percent had vitamin D levels equal to or below 20 ng/mL, a level considered deficient by most experts.
As an adult, your bones are no longer growing, but new bone tissue constantly replaces the old. Severe vitamin D deficiency interferes with that replacement, leading to the softening of bones known as osteomalacia (or “adult rickets”), which causes pain and increases of osteoporosis.
Shunning the sun and avoiding dairy can leave you with a vitamin D deficiency that might lead to bone pain. This can be difficult to distinguish from muscle or joint pain, but it generally manifests itself as a deep, aching pain that isn’t isolated in an exact area.
There are some indicators that can help differentiate bone pain from muscle pain. Muscle pain is usually centralized to one point and is exaggerated by movement or physical activity. Bone pain, on the other hand, is broader and deeper.
Constant respiratory problems may present in different ways. Someone suffering from these issues may feel easily winded after a task they’d normally be fine handling. Or it may be as seemingly obvious as struggling to catch a breath for an extended period.
Years ago, doctors used to ask new mothers if their newborns’ heads were sweating more than normal. This can be a very early sign that a baby is vitamin D deficient. If you’re breastfeeding, it may be helpful to consume more foods that are rich in vitamin D or include some vitamin D drops in your regimen to make sure your baby is getting a sufficient amount.
My vitamin D results came back very very low at one point, and I asked the doctor very nervously if the baby would be all right and her response was basically, “Oh yeah, she’s the one that took it all”.
Foods that contain higher concentrations of vitamin D include fatty fish (such as tuna), orange juice, soy milk, and some cereals. You’ll also want to stock up on dairy products, such as cheese, that is enriched with vitamin D.
As it turns out, the sun is vital to keeping a smile on your face. Vitamin D is often referred to as the sunshine vitamin because it is activated in your skin by sunlight. If you live in a place that sees less sunlight than global averages, the lack of light could literally kill your mood.
It’s important that light therapy is used to deal with depression caused by vitamin D deficiencies because the two can become seriously intertwined.
There are many different types of light boxes that can improve your health. The Sperti Vitamin D Light Box is “the only recognized ultraviolet light box for vitamin D production,” and the NatureBright SunTouch Plus Light and Ion Therapy Lamp, a bestseller on Amazon, “balances your body clock, leaving you feeling rested, refreshed, and nourished all over.” Each type has the potential to improve your health, but if you’re in need of light therapy, choose one based on what you hope to get out of it.
Research suggests that vitamin D deficiency may play a role in the development of polycystic ovary syndrome (PCOS), a leading cause of female infertility. One common symptom of PCOS is acanthosis nigricans, which results in dark, velvety skin patches.
“In the fertility world in the Northwest, we like to get a baseline on all of our patients and we see many who are deficient,” said Seattle-area registered dietitian nutritionist Judy Simon MS, RDN, CD, CHES, of Mind Body Nutrition.
“One young woman in her early twenties had visible acanthosis nigricans around her neck and on her chest. She had PCOS and pre-diabetes. After six weeks of Vitamin D supplementation the acanthosis was practically gone and she was feeling much less fatigued.”
7. Chronic Infections
Vitamin D is known to have an effect on over 2,000 genes in the human body, so it’s no surprise that the strength of your body’s immune system is also tied to how much vitamin D you are taking in.
When there’s a healthy amount of vitamin D being processed by your body, your immune system is resilient and able to fight off infections and disease. However, a lack of vitamin D can be devastating to your overall health and leave you vulnerable to constant attacks and health problems or scares.
Vitamin D supplements are sold everywhere, but make sure your doctor helps you select the best option for you based on your health needs.
Some cardiovascular disease-related symptoms that are easier to spot are dizziness, heavy bloating (particularly in the legs), respiratory issues, and chest pain. If you’re experiencing any of these symptoms, you should contact your doctor immediately.
If you want to make sure you’re on the right path, home tests are available to check for a lack of vitamin D. These tests will screen your blood and possibly show you if you need to make some changes in your supplementation routine.
Psoriasis may present itself as a scaly rash on your scalp or other parts of your body. Often it can be agitated by stress (unfortunately, finding out you have psoriasis tends to cause stress too). Although psoriasis is not always connected to a lack of vitamin D, the vitamin is sometimes used during treatment. The Mayo Clinic claims that if you have a lack of vitamin D, it will be harder for your body to defend itself against psoriasis.
There is no cure for psoriasis, but it is controllable with treatment. Besides reducing stress and getting your vitamin D, there are other methods for dealing with troubles caused by psoriasis.
Studies have now shown that low vitamin D levels increase a person’s chances of having chronic pain; supplements can sometimes help relieve it. So, if you’re in pain, talk to your physician about the best way to boost your vitamin D intake.
If you want to try a preliminary test for determining if what you’re experiencing is the same thing as chronic pain, doctors have a recommendation: Press against the area of your chest known as your breastbone (also called your sternum). If you feel a sharp pain when you press down on that area, it’s likely that you’re experiencing chronic pain related to vitamin D deficiency.
Vitamin D is one of the vitamins your body needs to create energy, and without it, you can end up feeling tired most of the day. This will make it hard for you to get around or even get to work. Without much energy, you may start changing your daily behavior in negative ways, which in turn may impair your overall health.
Continued tiredness can contribute to other symptoms caused by low amounts of vitamin D in the body. If you’re tired, you’re less likely to exercise or go outside. Avoiding activity or sunshine can amplify the effects of a vitamin D deficiency. If you fall into a routine that involves avoiding strenuous activity or sunlight, you’re much more susceptible to issues like depression or mood swings.
Listen to what your body is telling you. Something might be seriously off if you notice that you just don’t have the drive to stay active anymore. You should consult your doctor if you have constant feelings of tiredness that last longer than a few days.
Harvard University conducted a review of health studies across numerous cohorts that associated increased risk of multiple health outcomes including cardiovascular disease and hypertension (abnormally high blood pressure) with vitamin D deficiency.
It’s important to note that high blood pressure can significantly increase your risks for serious health issues such as heart attacks and strokes.
But don’t panic if you think or know you’re suffering from hypertension. It’s a common health issue that affects more than 3 million people in the U.S. every year. It can be identified without any blood or medical tests but will require an official diagnosis from your doctor, at which point appropriate treatment can be prescribed.
If you do suffer from anxiety, you may want to consider purchasing vitamin D supplements and adding them to your daily routine for that reason. Vitamin D has been proven to have positive effects similar to antidepressants and may reduce your overall blood pressure.
As we mentioned in relation to depression, vitamin D affects the levels of serotonin in your brain, which is what affects your mood. If you’re feeling cranky, it might be because you’re not producing enough serotonin. Vitamin D will help your moods stay balanced by ensuring your brain is working with the materials it needs to stay energized and focused.
From plastic in our oceans to the k...If you notice mood swings that seem out of the ordinary, visit your doctor for a simple blood test. They will be able to identify what’s going on, and if a lack of vitamin D is the issue, they’ll help you make a plan to get better.
The solution may be as simple as getting out in sunlight more often or eating foods that are rich in vitamin D. For people who can’t handle too much direct exposure to the sun, supplements are readily available, so consider reaching for some before going off on anyone or getting too frustrated with yourself!
14. Chronic Kidney Disease
Kidneys help remove waste from your blood. When they’re not functioning correctly, your bloodstream can fill up with waste, seriously damaging your health. Doctors have recently connected kidney health to cardiovascular disease. They’ve also discovered how important vitamin D can be to your kidneys’ health.
As you get older your kidneys are not as efficient at processing vitamin D. Be sure to eat some vitamin D–rich foods or take a supplement. If you do take a supplement, also consider taking vitamin K2 to activate the right proteins in the digestion process. Ensuring that your kidneys are working properly to process vitamin D is just as important as getting your proper nutrients.
15. Reduced Endurance
If you’re an athlete and you’re seeing your endurance decrease for no apparent reason, it might be because you have low vitamin D levels. Experts in athletic circles now realize that vitamin D is crucial to energy levels, especially when it comes to endurance. Even active people who get outside every day can experience these issues, despite getting more than the recommended amount of sunlight per day (20 to 30 minutes).
Fortunately, if vitamin D deficiency is causing your issues, your endurance should return to normal when you get your vitamin D levels back to normal. Remember: You don’t always need to opt for pills to get your proper dose of vitamin D. Try a supplement in powder or liquid form to mix with your smoothies or protein shakes.
A Side Effect of Modern Life?
For many of us, work means days spent at a desk and leisure means binge-watching the latest Netflix series or catching up on social media. That’s a lot of indoor time, but even when we are outdoors we’re likely to double down on sun protection to prevent premature aging and skin cancer.
Dairy products are fortified with vitamin D, but milk sales are in decline, as more people avoid dairy due to restrictive diets, milk allergies, or lactose intolerance.
What’s your risk?
Although 4 in 10 Americans may be deficient in vitamin D, some people have a higher risk. As mentioned, if you spend a lot of time indoors and protect your skin with clothing or sunscreen when you are outdoors (as you should), your risk increases. Living in northern climates—where winters are longer, colder and darker—amplifies this risk. But a few other risk factors might surprise you:
1. Dark skin. The darker your skin, the more sun it takes to make vitamin D.
2. Body mass index (BMI) over 30. Vitamin D can become “sequestered” in excess body fat instead of making its way to the bloodstream.
3. Past gastric bypass surgery.
Why It Matters
Linke says that bringing vitamin D levels back to the normal range has been a “game changer” for many of her clients who have autoimmune conditions. She cites another client—a woman in her late twenties—whose vitamin D was a 4.
Her rheumatoid arthritis was very bad, she couldn’t walk down stairs unassisted, couldn’t walk without holding on to walls, couldn’t fit into her shoes so she wore flip flops.
Within 10 days of starting vitamin D, along with magnesium (magnesium deficiency can interfere with vitamin D metabolism) and dietary changes, she was able to wear regular shoes and walk without assistance.