Vitamin D defficiency


1. About 1.3 million osteoporosis-related fractures occur every year in the US

2. Annual check for serum 25-hydroxyvitamin D (recommend range 20 - 40 ng/mL (50 to 100 nmol/L)) 

3. Vitamin D insufficiency <20ng/mL; Vitamin D deficiency <12ng/mL. Experts agree that levels lower than 20 ng/mL are suboptimal for skeletal health. 30 ng/mL is necessary for the elderly to prevent falls and fractures

4. Risk factors: Age, Dark skinned, Limited sun exposure, Obese, Malabsorption, Phenytoin intake, Hospitalized

5. Food to choose: Milk, Cheese, Yogurt, Salmon,Tuna, Saldine, Liver, Mushroom, etc

5. Vitamin D supplementation may have some protection for acute URI, especially in those with Vit D deficiency

6. Supplimentation: Vitamin D2 is cheaper, but Vitamin D3 is better. Severe cases needs to start with bolus and followed with maintenance dose. Malabosorption needs to be considered if not responding well to appropriate supplemention



1. Low-fat dairy and reduced meat and seafood intake
2. Protein intake from soy and legumes was associated with reduced risk

3. Avoidance of sugar-sweetened beverages

4. Fresh cherry fruit once or twice daily

5. Reduction in alcohol intake, Better wine than beer or liquor

6. For hypertension patients, recommend losartan, avoid diuretics
7. Allopurinol to lower the uric acid (goal <6 mg/dL )
8. Colchicine to reduce the frequency of recurrent gout flares



1. Maintain a healthy weight

2. Low sodium diet

3. Exercise, 30 min a day, 5 days a week

4. Home monitor, BP diary

5. Better taking the pill in the evening than in the morning



Sugar control

1. Low carbohydrate diet, Calorie count

2. Exercise

3. Home monitor

Eyes check

Optometrist/Ophthalmologist follow up yearly for retinopathy prevention

Foot check

Podiatry follow up yearly for neuropathy prevention



1. check the vision

2. check the balance

3. check the sensation of the feet

4. check the home settings for risks for fall

Kidney stone


1. Adequate hydration every day

2. Diet improvement, reduce consumption of spinach, tomato, chocolate, peanut, etc

3. High Calcium diet to reduce the absorption of oxalate

4. Low sodium diet

5. Avoid too much supplement of vitamin C

6. Reduce sugar intake

GERD (acid reflex)


1. Sleep at least 2-3 hours later after eating

2. Avoid food: coke, chocolate, coffee, orange, peppermint, tomato, fatty food

3. Quit drinking and smoking

4. Weight loss