Are you pregnant or thinking of becoming pregnant? You”;re probably prepared for morning sickness, weight gain, and an expanding belly. But did you know your skin can also undergo a variety of changes when you”;re expecting? These changes are due to normal alterations in hormones that occur during pregnancy. Rest assured, most skin conditions that develop or worsen during pregnancy are benign, and tend to improve following delivery.
Darkening of the skin
A large majority of women experience darkening of their skin due to hormone shifts that occur during pregnancy. You may notice that the areas around your thighs, genitals, neck, armpits, and nipples darken. Many women also develop linea nigra, a dark line extending between the belly button and pubic bone. It is also not uncommon for women to experience darkening of their pre-existing moles and freckles. (If you are concerned that a spot on your body is growing or changing more than you”;d expect, see a dermatologist for further evaluation.) However, most pigmentary changes tend to return to normal following childbirth, but may take many months to do so.
Melasma, the “;mask of pregnancy”;
Perhaps the most cosmetically distressing pigmentary change to occur in pregnancy is melasma, also known as the “;mask of pregnancy.”; Melasma, which can appear as dark patches on the forehead, cheeks, and upper lip, develops in approximately 70% of pregnant women. Melasma is exacerbated by exposure to sunlight. To help prevent it, consistently use sunscreens with sun protection factor (SPF) greater than 50, wear sun-protective clothing and hats when spending time outdoors, and avoid too much direct sunlight.
Melasma can sometimes persist after delivery, though it tends to improve after childbirth. If you wish to treat melasma after delivery, there are many treatments that can be prescribed or performed by a dermatologist, including skin lightening agents, chemical peels, and certain types of lasers. Hydroquinone, which is one of the most commonly used lightening agents on the market, is not safe to use during pregnancy or while breastfeeding. If you want to use a cream that has brightening properties while pregnant, look for glycolic acid or azelaic acid in the ingredient list.
Stretch marks, also called striae gravidarum, are pink or white streaks of thin skin that develop in up to 90% of pregnant women. They occur due to expansion and stretching of skin during pregnancy, and they are most frequently seen on the abdomen, breasts, buttocks and hips. Stretch marks tend to develop in the late second and third trimester.
Many treatments, including vitamin E-containing oils, olive oil, and cocoa butter, have been used for prevention and treatment of striae, but unfortunately there is limited data to suggest the that any of these products are truly effective. These pink or red marks tend to fade to skin color following delivery, although they rarely disappear entirely. Evidence suggests that topical hyaluronic acid, tretinoin, and trofolastin can be used, with varying degrees of success, after delivery. If topicals are not effective, research has shown that several laser treatments, energy-based devices, and microneedling can lead to visible improvement in striae by increasing production of collagen (a structural component of skin) and decreasing blood flow to the lesions.
Many women experience breakouts during their pregnancies, especially those who had acne prior to pregnancy. This typically occurs in the first trimester and is related to the surge of estrogen causing overproduction in oil glands. Guidelines for the treatment of acne during pregnancy are scarce due to the lack of safety data. Dermatologists often recommend a combination of topical azelaic acid and/or benzoyl peroxide. If these treatments are not effective, topical antibiotics such as erythromycin or clindamycin can be added in some cases. Oral antibiotics, including erythromycin, azithromycin, and cephalexin, may be used for persistent cases. Oral and topical retinoids, normally a mainstay of treatment for moderate to severe acne, can result in birth defects and should be avoided during pregnancy.
If you develop any skin eruptions during pregnancy that cause concern, you should be evaluated by a dermatologist prior to starting any medications.
There”;s been a lot of talk lately about whether or not the fast-tracked COVID-19 vaccine will in fact be safe and effective. While vaccine makers insist that any vaccine reaching the market will have undergone rigorous testing, the way trial protocols are designed suggests these vaccines may leave a lot to be desired.
As reported1 by Forbes contributor William Haseltine, a former professor at Harvard Medical School and Harvard School of Public Health, while Moderna, Pfizer, AstraZeneca and Johnson & Johnson have all published their vaccine trial protocols in a rare display of transparency, “;close inspection of the protocols raises surprising concerns.”;
In a nutshell, the trial designs are such that the vaccines will get a passing grade even if their efficacy is minimal. Of course, we must also consider vaccine side effects and I”;ve also written several articles about mounting safety concerns.
COVID-19 Vaccine Trials Rigged to Pass Efficacy Test
As noted by Haseltine, prevention of infection would typically be a critical endpoint of any vaccine trial. In other words, you want to ensure that when you take the vaccine, your risk of infection is significantly reduced.
However, when it comes to the COVID-19 vaccine, shockingly, preventing infection is not a criterion for success in any of these trials. The only criterion for a successful COVID-19 vaccine is a reduction of COVID-19 symptoms, and even then, the reduction required is minimal.
“;We all expect an effective vaccine to prevent serious illness if infected. Three of the vaccine protocols –; Moderna, Pfizer, and AstraZeneca –; do not require that their vaccine prevent serious disease only that they prevent moderate symptoms which may be as mild as cough, or headache,”; Haseltine writes,2 adding:
“;The pharmaceutical companies intend to do trials ranging from 30,000 to 60,000 participants. This scale of study would be sufficient for testing vaccine efficacy.
The first surprise found upon a closer reading of the protocols reveals that each study intends to complete interim and primary analyses that at most include 164 participants. These companies likely intend to apply for an emergency use authorization (EUA) from the Food and Drug Administration (FDA) with just their limited preliminary results.”;
To get a “;passing”; grade in the limited interim analysis, a vaccine must show a 70% efficacy. However, again, this does not mean it will prevent infection in 7 of 10 people. As explained by Haseltine:3
“;For Moderna, the initial interim analysis will be based on the results of infection of only 53 people. The judgment reached in interim analysis is dependent upon the difference in the number of people with symptoms …; in the vaccinated group versus the unvaccinated group. Moderna”;s success margin is for 13 or less of those 53 to develop symptoms compared to 40 or more in their control group.”;
The other vaccine makers are basing results on a similar protocol, where only a limited number of vaccinated participants are exposed to the virus to evaluate the extent of their symptoms.
Johnson & Johnson”;s interim analysis will include results from 77 vaccine recipients who have been infected with SARS-CoV-2, and if fewer than 18 of them develop symptoms of COVID-19, compared to 59 in the control group, the vaccine will be considered successful.
In AstraZeneca”;s case, the interim analysis includes 50 vaccine recipients. The vaccine will be a success if 12 or fewer develop symptoms after exposure to SARS-CoV-2, compared to 19 in the 25-person control group.
Pfizer”;s interim analysis is the smallest of the bunch, with just 32 vaccine recipients. Their success margin is seven or fewer vaccine recipients developing symptoms, compared to 25 in the control group. In the primary analysis, efficacy is set to about 60%, and at most, 164 volunteers will be included in that analysis.
Especially concerning are that those receiving the vaccine in these trials are young and healthy individuals who are not really at high risk of dying from COVID-19. This makes the results of these trials highly questionable in the far more vulnerable population of the elderly.
Trials Are Merely Testing Reduction of Common Cold Symptoms
As if that”;s not eyebrow-raising enough, the minimum qualification for a “;case of COVID-19”; amounts to just one positive PCR test and one or two mild symptoms, such as headache, fever, cough or mild nausea. As noted by Haseltine, “;This is far from adequate.”;
All they”;re doing is testing to see if this COVID-19 vaccine will minimize common cold symptoms. They are not actually ensuring the vaccine will prevent serious COVID-19 complications. Johnson & Johnson”;s trial is the only one that requires at least five severe COVID-19 cases to be included in the interim analysis.
“;One of the more immediate questions a trial needs to answer is whether a vaccine prevents infection. If someone takes this vaccine, are they far less likely to become infected with the virus?
These trials all clearly focus on eliminating symptoms of COVID-19, and not infections themselves. Asymptomatic infection is listed as a secondary objective in these trials when they should be of critical importance.
It appears that all the pharmaceutical companies assume that the vaccine will never prevent infection. Their criteria for approval is the difference in symptoms between an infected control group and an infected vaccine group. They do not measure the difference between infection and noninfection as a primary motivation,”; Haseltine writes.4
Severe illness and death are also secondary objectives in these trials, and none of them include failure to prevent hospitalization or death as an important barrier to success. The increasingly disappearing common sense tells us that if the vaccine cannot reduce infection, hospitalization or death, then it cannot end the pandemic, which means everyone who takes the vaccine will be doing so in vain.
Some COVID-19 Vaccine Trials Are Not Using Inert Placebos
In addition to all of that, some COVID-19 vaccine trials are using other vaccines as “;placebo”; rather than truly biologically inert substances such as saline, which effectively makes if far easier to hide any vaccine side effects. While Moderna is using a saline solution placebo,5 AstraZeneca is using injected meningococcal vaccine rather than a true placebo.6
Another way AstraZeneca is masking potential side effects is by administering the vaccine along with certain drugs. In one of its study arms, subjects are given acetaminophen every six hours for the first 24 hours after inoculation. The pain and fever reducer could potentially mask and downplay side effects such as pain, fever, headache or general malaise.
In addition to masking side effects, it is widely recognized among literate natural medicine physicians that using acetaminophen during acute viral infections is not a wise strategy as it impairs the immune response to fight the infection.
As reported by Wired:7
“;The press release for …; results from the Oxford vaccine trials described an increased frequency of “;minor side effects”; among participants. A look at the actual paper, though, reveals this to be a marketing spin …;
Yes, mild reactions were far more common than worse ones. But moderate or severe harms –; defined as being bad enough to interfere with daily life or needing medical care –; were common too.
Around one-third of people vaccinated with the COVID-19 vaccine without acetaminophen experienced moderate or severe chills, fatigue, headache, malaise, and/or feverishness.
Close to 10 percent had a fever of at least 100.4 degrees, and just over one-fourth developed moderate or severe muscle aches. That”;s a lot, in a young and healthy group of people –; and the acetaminophen didn”;t help much for most of those problems.”;
Two Trials Paused Due to Safety Concerns
September 6, 2020, AstraZeneca paused its Phase 3 vaccine trial due to a “;suspected serious and unexpected adverse reaction”; in a British participant.8,9 The company did not initially divulge the nature of the adverse reaction, but it has since been revealed the volunteer developed severe inflammation of the spinal cord, known as transverse myelitis.10,11
September 12, 2020, the British Medicines Health Regulatory Authority gave AstraZeneca the go-ahead to resume its Phase 3 trial in the U.K., after an independent review found it “;safe to do so.”;12,13 According to an AstraZeneca spokesperson, the incident was a case of undiagnosed multiple sclerosis.14
Days later, September 19, 2020, The New York Times reported15 a second case of transverse myelitis had occurred in the AstraZeneca trial. According to one expert consulted by the NYT, the occurrence represented a “;dangerous pattern,”; and that a third incidence might shut down the vaccine trial indefinitely.
AstraZeneca, however, claims the two cases are “;unlikely to be associated with the vaccine,”; and that there”;s “;insufficient evidence to say for certain that the illnesses were or were not related to the vaccine.”;16 October 21, 2020, it was reported17 that one of the volunteers in AstraZeneca”;s Brazilian trial had died from COVID-19 complications, but that the trial would continue anyway.
October 12, 2020, Johnson & Johnson halted its trial due to “;unexplained illness”; in one of its participants.18,19 Like AstraZeneca, Johnson & Johnson has kept mum about the details of the illness, saying “;it”;s important to have all the facts before we share additional information.”;
After the second dose, 100% reported side effects ranging from fatigue (80%), chills (80%), headache (60%) and myalgia or muscle pain (53%).
Despite that, the 100-mcg dose was ultimately chosen to move on to Phase 3 trials.22 In the highest dosage group, which received 250 mcg, 100% of participants suffered side effects after both the first and second doses.23 Three of the 14 participants (21%) in the 250-mcg group suffered “;one or more severe events.”;
An October 1, 2020, report24 by CNBC reviews the experiences of five participants in Moderna”;s and Pfizer”;s SARS-CoV-2 vaccine trials. One of the participants in Pfizer”;s vaccine trial “;woke up with chills, shaking so hard he cracked a tooth after taking the second dose.”;
A Moderna trial participant told CNBC he had a low-grade fever and felt “;under the weather”; for several days after his first shot. Eight hours after his second shot he was “;bed-bound with a fever of over 101, shakes, chills, a pounding headache and shortness of breath. He said the pain in his arm, where he received the shot, felt like a “;goose egg on my shoulder.”; He hardly slept that night, recording that his temperature was higher than 100 degrees for five hours.”;25
Two others reported similar side effects, and a third warned you would need to take a day off after the second shot. CNBC also noted that “;as companies progressed through clinical trials, several vaccine makers abandoned their highest doses following reports of more severe reactions.”;
Might Certain COVID-19 Vaccines Raise Risk of AIDS?
Disturbingly, a group of researchers are now expressing concern that some COVID-19 vaccine candidates might put certain people at a higher risk of acquiring HIV, the virus that causes AIDS.26,27,28
Using the failed attempt to create an HIV vaccine as an example, researchers explain29 that the genetically engineered adenovirus, Ad5, used in the HIV vaccine trials, is the same one being used now in four COVID-19 candidates being studied in the U.S., Russia and Pakistan.
At the time of the failed HIV vaccine, scientists were unable to identify the exact reason why Ad5 seemed to increase the risk of HIV; it just inexplicably did. Interestingly, Dr. Anthony Fauci was the lead author on the HIV study,30 in which he questioned “;whether the problem extends to some or all of the other recombinant vectors currently in development or to other vector-based vaccines.”;
Reflecting on that question, the researchers say they decided to go public with this information now, because Ad5 vaccines for COVID-19 might soon be tested in populations with high HIV prevalence, and they believe that informed consent about the HIV/AIDS risk should be part of the COVID-19 clinical studies.
Will COVID-19 Vaccine Be Mandatory?
According to one September 2020 poll,31 only 51% of Americans said they “;definitely or probably”; would get the COVID-19 vaccine when it comes out. Another survey32 found only 44% would take the first-generation vaccine even if they were paid $100. Mounting vaccine hesitancy was bemoaned in an October 1, 2020, article33 in the New England Journal of Medicine, and the answer, the article suggests, is to make it mandatory for all.
And, to entice compliance, the authors recommend implementing severe penalties for noncompliance, such as the suspension of employment and/or house arrest.
An October 19, 2020, article 34 by Wisconsin Public Radio also warns that if precedents hold, employers may have the right to force workers to get vaccinated. Potential exceptions might include certain medical issues, bona fide religious objections, and certain union contracts that bar vaccine requirements.
Operation Warp Speed recently selected Walgreens and CVS as nationwide partners in the coming vaccine distribution effort.35 Nursing homes and long-term care facilities around the U.S. can opt in by signing up to have either of these companies come and administer the vaccine to its residents and staff, once available.
So-called “;health passports”; are also becoming reality. Ireland, for example, has already begun its national trial. The Health Passport Ireland initiative uses an app to track and display results of COVID-19 testing. Vaccination status will be added once a vaccine becomes available.
Untold amounts of money are also being spent on programs to tag, track and trace the human population in the name of public health and safety. According to an article36 in the journal JAMA, the estimated cumulative costs of the COVID-19 pandemic related to lost output and health reduction amounts to more than $16 trillion in the U.S. alone, or about 90% of our annual gross domestic product.
“;For this reason, policies that can materially reduce the spread of SARS-CoV-2 have enormous social value,”; the article claims. However, testing, tracing and isolation rules, all of which are promoted in this article, also have a price, and it”;s one that any sensible person would reject, namely the loss of privacy and liberty.
As reported37 by The Last American Vagabond, governments are selling our freedom in the name of public health. Do we really want to live in a “;biosecurity state”;? These freedom-robbing strategies are being sold to us as the path back to normalcy, but the reality will be anything but normal.
As detailed in “;The Global Takeover Is Underway,”; the pandemic and the global response to it is far from accidental. Overwhelmingly, the evidence points to it being part of a much larger scheme to implement the last stages of a technocratic takeover.
The COVID-19 pandemic has dramatically widened the economic gap between average people and the wealthy elite,38,39 and continuing down the path we”;re currently on will only make this disparity worse, not better.
The globalist plan isn”;t about creating a better world for the average person, it”;s about enslaving us so that we cannot reject or even resist what”;s ultimately coming. Forced vaccinations are but one aspect of the plan that must be resisted at all cost.
Amy Coney Barrett has been confirmed as the next Justice on the Supreme Court of the United States.
The Senate voted on Monday (October 26) and Barrett was confirmed with 52 votes to confirm. Senator Susan Collins of Maine was the only Republican senator to vote no on the confirmation after saying that she felt it was too close to the election to consider a nominee.
Democratic politicians, including Vice Presidential candidate Kamala Harris and former presidential candidate Hillary Clinton, are among those speaking out just minutes after the vote took place.
“This is a dark day. But it’s important to remember why Republicans fought so hard to steal this Supreme Court seat. They’ve realized a truth that shakes them to their core: The American people are not on their side. And we’ll keep fighting until we take our democracy back,” Senator Elizabeth Warren tweeted.
You can read more reactions from Democratic politicians below.
Today Republicans denied the will of the American people by confirming a Supreme Court justice through an illegitimate process–;all in their effort to gut the Affordable Care Act and strip health care from millions with pre-existing conditions.
I am frustrated, and frankly, very angry. It did not have to be this way. By rushing to confirm this Supreme Court nominee, Senate Republicans openly and unapologetically defied the will of the American people–;all to further their extreme, conservative agenda.
It is a sad day for the Senate and for the Court. My Republican colleagues put the rule of “;because we can”; over the traditions and precedents of the Senate, the principles we hold dear as an institution, and the integrity of the federal judiciary.
I will be voting against Judge Barrett”;s nomination tonight. More than 225,000 Americans have died from COVID-19 & more than 60 million ballots have already been cast in the election that is just eight days away. This is not the time to be pursuing partisan power grabs.
Republicans do this because they don”;t believe Dems have the stones to play hardball like they do. And for a long time they”;ve been correct. But do not let them bully the public into thinking their bulldozing is normal but a response isn”;t. There is a legal process for expansion.
As Lili finished her workout, it felt like everyone was staring at her.
Because they were.
It took her longer to complete the group session than everyone else, and the coach made a point of having the whole class stick around and encourage her.
Afterward, the coach and classmates approached Lili to say: “;It”;s really great that you”;re exercising. Good for you.”;
She understood everyone was trying to be inclusive and nice. But, deep down, Lili also knew she was being singled out for her 300-pound frame. It made her feel incredibly self-conscious.
So she never went back.
Ranjan had a similar experience. He struggled with binge eating, and felt ashamed when his coach said, “;It”;s not that hard to avoid fast food,”; and “;Unless you”;re about to run a marathon, there”;s no reason to ever eat a bagel.”;
He quit two weeks into a 12-week group diet challenge–;even though he”;d already paid in full.
Angele ghosted her coach, too, after months of great progress.
She”;d originally signed up to feel stronger and more in control of her body. And though her trainer knew weight loss wasn”;t her goal, his compliment about how fit she looked was met with a blank stare.
Turns out, Angele was struggling with the trauma of an assault that happened years before. Comments about her body were majorly triggering.
These coaching scenarios? They”;re all inspired by real client stories.
The coaches who made these mistakes never knew what went wrong. Or how much pain they”;d inadvertently caused.
But the underlying reason for each is the same: Many health and fitness professionals tend to focus too much on weight loss and body size.
If reading that made you feel like putting your fist through the screen, hear us out: We”;re not suggesting that helping clients lose weight is wrong.
Many of your clients WILL absolutely want to lose weight, for various reasons.
But there”;s a difference between helping clients who come to you for weight loss and assuming all clients want to lose weight.
This is especially important to understand if you work with clients in larger bodies–;many of whom may not want to lose weight right now, or ever.
Here”;s the most important thing to know: Regardless of whether a client wants to lose weight or not, the way you talk about weight, body image, and fat loss can make or break the coach-client relationship.
It affects how freely clients share information–;and ultimately whether they”;re able to succeed.
This is particularly true with clients who:
have trauma and/or negative feelings around their body or weight are in a body that doesn”;t fit the norm of what their culture considers “;fit and healthy.”;
(FYI: It”;s pretty likely that many of your clients will fall into one, if not both, of these categories.)
In this article you”;ll find:
5 strategies for forming strong, lasting relationships with clients of all body sizes. Dozens of resources that can help you understand clients on a deeper, more personal level. What to say (and not say) to clients who are struggling with body image, guilt, and shame.
(Note: This article isn”;t intended to “fix” complex issues like weight stigma. But it can help you avoid reinforcing harmful ideas about weight, weight loss, and what health truly means.)
5 ways to respectfully support all clients–;no matter what kind of body they”;re in.
It”;s not a coach”;s job to tell a client how their body should be.
Here at Precision Nutrition, we believe all clients:
Get to decide their own goals, whether that”;s weight loss or anything else. Deserve to feel safe and supported sharing their goals and decisions with their coach, whatever those goals and decisions are. Benefit from being informed about ways they can improve their health–;including options that have nothing to do with weight or size.
Okay, so what does that look like in practice?
We”;ll show you.
Are we talking about body positivity here?
But also, not really.
Originally, the body positivity movement was a safe space for people in the most marginalized bodies–;people who are treated as “;other”; for how their bodies looked.
These days, you might associate the term “;body positive”; with Instagram photos of people highlighting their cellulite, stretch marks, and stomach rolls.
Ironically, these types of posts have become especially popular among people in relatively fit, conventionally-attractive bodies. In other words, the movement has been co-opted by the mainstream.
That”;s why some of today”;s activists, particularly ones within the nutrition and fitness world, use terms like body liberation, body neutrality, and anti-diet instead.
If you want to learn more about weight stigma/bias movements like Health at Every Size, how fatphobia is intertwined with other “;isms”; like racism or ableism, and other related topics, you”;ll find boxes throughout this article that provide further resources to explore.
#1: Give every client the blank slate treatment.
See if you can spot what goes wrong in this coach-client interaction.
Martha is a 48-year-old woman. She”;s always lived in a larger body. In the past year, she”;s struggled with chronic back pain. She thinks making some changes to her exercise and nutrition habits might help, so she contacts a coach she found on Facebook.
In the initial consultation, Martha introduces herself in her customarily lively, outgoing way. The coach says:
“;I”;m so glad you reached out to me. In your email, you mentioned you”;re dealing with back pain. I think we can definitely make some changes that”;ll help with that! How much weight do you want to lose? It”;s so smart of you to be proactive about this!”;
Martha”;s utterly deflated. This coach won”;t be hearing from her again.
Why? Two big problems:
Martha never mentioned wanting to lose weight. She said she”;s dealing with back pain, but that”;s all the coach knows about Martha”;s health.
What the coach in this scenario didn”;t know was that Martha has struggled with her weight for what feels like her whole life. She”;s often felt too big, too bulky, too awkward in her body.
Now in her late 40s, she”;s starting to feel at peace with herself. After all, this body has been home for nearly five decades.
So when Martha hears what this coach has to say? She feels those old emotions creeping back. She”;s frustrated, angry, and fed-up with people–;like this young, genetically-predisposed-to-be-fit coach–;assuming she can”;t possibly be happy with her body.
This isn”;t just a rookie coaching mistake, by the way. Experienced coaches do stuff like this, too.
Thanks to our cultural conditioning, many of us have hidden biases in this area. So it”;s important to be conscious of not equating:
weight with health desire to improve health, fitness, or food choices with weight loss
Because when you”;re fine with your weight but someone assumes you”;re not…; or they imply you shouldn”;t be… it stings.
Even the most confident people will likely feel a pang of, “;Wait, is my body okay? Am I okay?!”; Or even: “;I was right. This fitness stuff just isn”;t for me.”;
The takeaway: Don”;t assume your clients want to lose weight.
Check your assumptions. Consider what you don”;t know about your clients, and how you might learn more about them.
Wait for them to tell you what they want.
Otherwise, you risk damaging your relationship–;and causing your client pain–;before you even get started.
Why is fat activism a thing?
… and why should you care about it as a coach?
People in smaller bodies are often shocked to learn what life can be like for people in larger bodies.
For instance, one client in a larger body told us that if she appears to be buying “;junk”; food for herself at the grocery store, she braces herself for comments from the cashier, other people waiting in line, and even people passing her in the freezer aisle.
And those comments? They can range from “;are you sure you want to buy that?”; to “;better not buy that ice cream, fatty.”;
If you”;re a straight-size person reading this–;that is, a person who can walk into any store and find clothes that fit–;you may be shocked to learn this ACTUALLY HAPPENS.
Imagine not being able to buy your stinking ice cream in peace. Now imagine that”;s the least of the prejudice you experience on a daily basis. (Especially if you”;re also white, cisgender, and heterosexual–;so you”;re really not used to it.)
And if you”;re in a larger body–;or ever have been–;you might be thinking “;Do people really not know this happens?!”;
People in larger bodies are discriminated against all the freaking time. We know this from real-life experiences and research. For example, people in larger bodies are more likely to:
Receive a lower standard of health care because their doctors are biased (either consciously or unconsciously) 1 2 3 Get fewer preventative health services and screenings, which can mean not discovering life-threatening health problems in time 4 5 Avoid making doctor appointments because they”;re afraid of being judged or mistreated 6 7
Be unfairly passed over for jobs, promotions, and educational opportunities 8 9
Deal with mental health challenges, potentially related to discrimination. 10
These are just some of the disadvantages people in larger bodies experience. And for Black and brown people–;especially women–;they”;re compounded by racism. This is particularly true in the area of health care. 11 12
These problems are part of why body positivity, fat activism, and other related movements exist.
But these movements are about more than helping people defend themselves from discrimination and stigma.
They”;re also about helping people shift from feeling ashamed–;and like they”;ll never fit in–;to feeling actively proud of their bodies.
Not in spite of being big. But because they”;re big.
If fat activism”;s existence doesn”;t quite add up to you, consider this: What if no matter how you feel about yourself, society tells you there”;s something wrong with your body and it”;s all your fault? In this situation, reclaiming the narrative for yourself is one of the most powerful things you can do.
#2. Dig deeper–;even when a client”;s goal is as simple as “;I want to lose weight.”;
About half of Americans say they want to lose weight, according to the Centers for Disease Control and Prevention. 13 (And that trend is likely to translate to other similar cultures.)
There”;s also this: Some clients say they want to lose weight simply because they feel that”;s the only societally acceptable option for their body. Or because they”;re living in a culture that tells them losing weight will automatically make them happier and healthier.
Plus, clients often have important secondary goals, in addition to weight loss. For instance, our Precision Nutrition Coaching clients are almost always interested in fat loss. But that”;s not all they”;re after.
On a 1 to 10 scale, clients commonly rank the following as a 9 or higher:
looking and feeling better (81 percent), which may or may not have anything to do with weight loss developing consistency (75 percent) maintaining their healthy habits (74 percent) gaining energy and vitality (59 percent)
Over time, these goals may become more important than weight loss.
Talk with your clients to clarify their goals and motivations so:
They understand that weight loss isn”;t the only option available to them. You get the information you need to help your clients succeed.
The following strategies will help you do just that.
Present a variety of goals that are all treated as equally valid.
One way PN Master Coach Kate Solovieva normalizes all types of body goals: giving clients options.
For instance, whether she”;s working with a 75-year-old woman or a 25-year-old man, Solovieva might ask: “;What are you hoping to achieve through coaching? Do you want to gain weight, lose weight, feel stronger, move without pain, love how you look naked?”;
By letting your clients know they have lots of different choices, they”;re more likely to feel safe telling you what they really want. You might even open their eyes to the fact that weight loss isn”;t their only way forward.
Ask this secret-weapon question.
Here”;s a powerful coaching question for any client who wants to lose weight, courtesy of Precision Nutrition”;s Director of Curriculum, Krista Scott Dixon, PhD:
“;What else is going on for you right now?”;
Just ask it, and let your client talk.
“;Being “;on a diet”; is an A+ way to avoid all the other crap in your life,”; says Dr. Scott-Dixon. Sometimes when people realize they don”;t have anything to fill the void, they decide going on a diet will help them feel better and more fulfilled.
Your client might reveal that they”;re going through a divorce, dealing with a sick parent, or feeling unhappy in their job.
Losing weight won”;t fix those problems.
This is why it”;s a good idea to…
Always ask why.
We often use an exercise called The 5 Whys with our clients.
It starts with a simple question: “;Why do I want to change my eating and exercise habits?”;
Then, whatever answer your client comes up with, ask why again. And so on, five times, until you get to the heart of what”;s really behind their goal.
Sometimes, when people can”;t come up with a compelling deeper reason to lose weight, they realize weight loss might not be what they”;re really after.
(And sometimes it IS weight loss. That”;s okay, too.)
#3. Understand that body image exists on a spectrum.
“;If you work with clients enough, you know that almost everyone has some kind of body angst. It doesn”;t matter what shape they have,”; says Dr. Scott-Dixon.
As a coach, you can help people develop more productive, deep-health promoting experiences of themselves in their bodies.
Why should you care? “;We know objectively that the more you hate yourself, the worse your life is,”; Dr. Scott-Dixon says.
Struggling with body image:
Makes it harder to do well academically (especially for women), which can shut down future educational opportunities and chances at landing your dream job 14 Increases the likelihood of disordered eating, as well as eating disorders like anorexia nervosa and bulimia, making anything related to food feel like an uphill battle 15 16 May make you feel afraid to date or get romantic with someone. (Think: turning off the lights so they can”;t see you, or never speaking up about your romantic feelings for someone out of fear of being rejected) 17 Can lead to generally feeling like your life sucks (officially, this is called “;poor quality of life”;), along with having a difficult time going through the motions of daily life, including interacting with other people 18 Means you”;re less likely to work out or be active, maybe because the idea of going to the gym or moving your body feels super uncomfortable or intimidating 19 Increases risk of depression, anxiety, and low self-esteem 20
Many people believe that criticizing themselves will help them excel at changing their habits and living better, healthier lives.
But constant self-criticism and being “;down”; on yourself can make it much, much harder to adopt healthy habits.
For example, clients in larger bodies who also struggle with body image sometimes tell us they don”;t feel comfortable entering gyms and other fitness or wellness spaces. Often, it”;s because they don”;t feel these spaces are meant for people who look like them.
While it”;s true some gyms aren”;t particularly welcoming to people of all body sizes, improving body image can make finding a supportive fitness space and developing regular exercise habits feel much more manageable.
How to respond to body negativity
Chances are, you”;ve heard a client say something like:
“;Ugh, I hate my fat legs!”; “;I really need to lose this belly fat. It”;s disgusting.”; “;I hate my body right now.”;
What can you possibly say to make someone feel better?
According to Precision Nutrition Super Coach Lisanne Thomas, the most impactful thing you can do is ask productive questions.
You might frame it like this:
“;Can I ask you a question about that?”;
If they say yes, proceed with something like…;
“;Imagine your best friend/partner/child just had that thought about themselves. How might you respond to them if they shared that thought with you?”;
“;Imagine someone speaking to your loved one like that while in your presence. How might you show up for your friend/partner/child in support and response to those words?”;
These questions can help people recognize just how unkind they”;re being to themselves.
In a recent Facebook Live, Chrissy King, a writer, speaker, powerlifter, and strength and fitness coach shared her strategy for challenging what our bodies are “;supposed”; to look like.
When faced with a comment like, “;My stomach rolls are so gross,”; question what exactly makes them gross, and what standard you”;re measuring against.
“;This doesn”;t come from a place of judgement or shame,”; said King. “;There are no right or wrong answers. It”;s just that we”;re taking the time to really think through it. When we really sit with our feelings, underlying a lot of these things aren”;t our own personal beliefs. These are things we are taught. These are things that we see societally.”;
So it may be worth asking:
“;What would it mean if you woke up tomorrow and didn”;t have that roll on your stomach?”; “;What would change about your life?”; “;Would you be a better person?”; “;Would you be a happier person?”;
People may find that their answers surprise them.
Of course, you can”;t just snap your fingers and decide to love your body. So think about body image on a spectrum.
On one end: Body negativity, or actively disliking your body.
On the other end: self-love.
And body neutrality, or “;meh,”; as we like to refer to it? Somewhere in between.
Here”;s the thing: We might exist on multiple parts of the spectrum at once. Human beings are complex, and body dissatisfaction and positive body image aren”;t direct opposites of each other. 21
But the goal is to nudge ourselves up the continuum, so we”;re spending more time in the body neutrality and self-love sections than before.
The bottom line: You can”;t make a client love their body.
But you can refrain from adding more negativity to someone”;s baggage.
And remember, complete body positivity and absolute self-love aren”;t necessarily the goal.
“;For many people, getting to “;meh”; is actually a pretty good goal,”; says Dr. Scott-Dixon.
Precision Nutrition Super Coach Lisanne Thomas often talks about self-love with her clients. “;My role as a coach is to help a client love and care for their body and do with it what they want,” she says.
While conversations about self-love can be helpful, sharing articles, videos, books, and more that “;speak for themselves”; may also help start a productive discussion, or just provide food for thought.
Below are some of Coach Lisanne”;s favorite resources.
Your client tells you they ate a pint of ice cream last night.
What”;s your gut reaction?
Think about it. Then read on.
As much as possible, avoid saying anything that might make your client feel ashamed, Solovieva recommends.
Beware of responses that sound supportive, but are actually criticism, like, “;Oh, that”;s a bummer. How”;d you get so off track?”; or even, “;No worries! We all slip up from time to time.”;
“;Clients are always listening to see how you talk about things,”; Solovieva says. It helps them determine how trustworthy you are with their most difficult feelings and behaviors.
This is important in many areas, but especially when it comes to food. That”;s why, when faced with a client eating a late-night pint of ice cream, Solovieva starts with:
“;What flavor was it?!”;
She might follow it up with any number of questions, like “;How are you feeling this morning?”; or “;Did you enjoy it?”;
These kinds of open-ended, judgement-free questions help clients feel comfortable talking about what”;s really going on in their heads.
Normalize all food choices.
People aren”;t great at remembering or estimating what or how much they”;ve eaten. 22 This is often what”;s at play when clients say they”;re not overeating (or undereating), but still aren”;t seeing results.
But there could be another reason clients aren”;t reporting their food intake accurately: They don”;t feel safe doing so.
And this can be conscious OR unconscious.
Conscious: Your client chooses not tell you about their late-night pint of ice cream because they fear your response–;and how it”;ll make them feel.
Unconscious: They underestimate their food intake because they want to avoid being shamed for eating eight ounces (or thumbs) of cheese instead of the “;acceptable”; serving size of one.
In either case, it”;s going to make it hard for you as a coach to see what”;s really going on.
One way to normalize food choices, according to Solovieva: Openly talk about foods that people may believe are “;off limits.”; (Friendly reminder: There are no “;bad”; foods.)
For instance, you might ask:
“;What do you normally eat for lunch at work? Is it more like a salad, or a sandwich, or tacos?”;
When talking about food planning for the weekend, you might say:
“;What are you having for dinner Saturday night? My family always has pizza!”;
From there, you can still encourage clients to make their meals “;a little bit better”; by adding a side of veggies, or upping the protein content. But normalizing your client”;s food choices helps you meet them where they”;re at.
Skip body-shaming “;motivational”; language.
Many coaches don”;t realize certain phrases and cues can make people feel “;less than.”;
Here are some ways coaches might unintentionally be signaling clients that there”;s something wrong with their bodies, plus what to say instead.
(Note: Many of these cues have been commonly used for what feels like forever. So we”;re not criticizing coaches for using them. We”;re pointing out why evolving your language will ultimately help your clients–;and your coaching.)
Model healthy, or at least neutral, body image.
You set an example for your clients. In many cases, they look to you for information about what it means to be healthy and fit.
So saying you”;re going to “;shred for summer”; probably isn”;t the best way to signal to your client that their post-baby body (or whatever kind of body) is completely fine.
We”;re not saying you need to have it all figured out yourself.
In fact, it”;s common for coaches to:
feel shame about or have a complicated relationship with their own bodies feel like an imposter for not fitting into a certain body ideal worry they don”;t look “;good enough”; to attract clients have gone through their own body transformation journey have experienced living in a bigger body themselves (whether currently or in the past)
Ironically, coaches who have been through their own process of coming to health and fitness after feeling ashamed about their bodies are often the best qualified to really understand what clients go through, Dr. Scott-Dixon points out. That”;s a superpower in itself.
So if you”;re comfortable, it may help to share your own body image journey with clients once you”;ve gotten to know them.
Showing vulnerability lets clients know they”;re not alone.
Plus, people are more likely to be open and honest about their challenges when they feel you can relate.
No matter where you are on the body negativity to self-love spectrum, be conscious of the language you use. This includes what you say around your clients, in your marketing materials, and in your social media posts.
That way, you can ensure you”;re not passing any of your own body image struggles onto others–;or reinforcing their existing ones.
#5. Be trustworthy.
Trust is a key element in the coach-client relationship.
Here”;s the tricky part: “;You can”;t make clients trust you,”; says Precision Nutrition Coach Jon Mills. “;You have to be trustworthy.”;
So how do you do that, exactly?
The art of coaching is about being trustworthy for ALL your clients, including those who:
are in larger bodies have a disability or chronic illness identify as trans and/or non-binary are part of marginalized communities come from cultures different from your own
You might be thinking: “;I don”;t have any clients like that!”; or “;I don”;t really cater to any of those groups.”;
The truth is that you probably do–;even if you don”;t realize it.
Many disabilities and health issues, like ADHD and diabetes, can be completely invisible from the outside. You won”;t necessarily know someone”;s sexual orientation, gender identity, or race from looking at them.
And just because you don”;t currently have clients who outwardly appear different from you in terms of body size, race, gender, or in any other aspect doesn”;t mean you can”;t coach those clients.
What coaches need to know about intersectionality
We can”;t talk about weight stigma and bias without talking about race and intersectionality.
Intersectionality is a term coined by law professor Kimberlé Crenshaw. It refers to how social and political categorizations like race, class, and gender interconnect to create both discrimination and privilege. 23
Crenshaw pointed out that when it came to discrimination, the legal system wanted to know, for instance, whether a Black woman was being discriminated against because of her gender OR her race. There wasn”;t a framework for understanding how it could be both at the same time. Thus, intersectionality was born.
Intersectionality helps us understand that fatphobia and discrimination against racialized, trans, queer, disabled and other marginalized bodies are all deeply intertwined.
So it”;s great to be a size-inclusive coach. But that also means understanding that multiple aspects of discrimination and marginalization compound each other, and how this effect may impact your clients.
Maybe you”;re wondering: How can you possibly become an expert in body positive coaching, coaching trans athletes, working with people with disabilities, and anti-racism?!
This may come as a relief: You don”;t have to be an expert.
First, you can turn to plenty of experts for help. Many of these activists have courses, books, and other resources, like the ones listed in the boxes throughout this article.
But what”;s even more important, Mills says, is this:
Clients are experts in their own experiences.
Usually, you can learn directly from them.
That doesn”;t mean it”;s their job to educate you.
But you can listen to and engage with the lived experience of the person right in front of you, Mills suggests.
“;Often, it”;s not even that they need you to be really involved in their personal experience as their coach. They just need to know that you”;re not going to devalue it.”;
We have work to do.
Many of us have hidden biases, body image concerns, and areas where our awareness is lacking.
To grow into more inclusive coaches, according to Mills, we first must lose the “;fix it”; mindset. We won”;t solve weight stigma, racism, or any other type of discrimination by changing the equipment in a gym or taking a course. (Though those can be good action steps.)
“;When we try to fix problems, we”;re trying to get a sense of control,”; Mills points out. “;And to meet people where they”;re at, you need to lose that desire to control things and be open and receptive.”;
And meeting clients where they”;re at? That”;s what matters most.
Learning how to coach clients, patients, friends, or family members through healthy eating and lifestyle changes–;in a way that”;s personalized for their unique body, preferences, and circumstances–;is both an art and a science.
A federal health agency reportedly just put an end to a coronavirus vaccine PSA campaign, funded by $250 million in taxpayer money, after offering a special vaccine deal to Santa Claus performers, according to a report from the Wall Street Journal on Sunday (October 25).
According to audio recordings, as part of the plan, a top official in the Trump administration wanted Santa performers to promote the benefits of a COVID-19 vaccine by offering early access to the vaccine before the general public.
“The deal was the brainchild of the official, Michael Caputo, an HHS assistant secretary, who took a 60-day medical leave last month. The rest of the campaign now is under an HHS review,” WSJ reported.
The Department of Health and Human Services confirmed Friday (October 23) the Santa plan would be scrapped.
Ric Erwin, chairman of the Fraternal Order of Real Bearded Santas, called the news “;extremely disappointing,”; and said that “this was our greatest hope for Christmas 2020, and now it looks like it won”;t happen.”;
The ad effort, which was to include TV, radio, online and podcast announcements, was set to be titled “;Covid 19 Public Health and Reopening America Public Service Announcements and Advertising Campaign,” aimed to “;defeat despair, inspire hope and achieve national recovery,”; according to a work statement reviewed by The Wall Street Journal.
A former White House official said some celebrities, including Dennis Quaid, declined to participate after concerns that the campaign would be seen as political.
In a 12-minute phone call in late August, Michael Caputo reportedly told Ric Erwin of the Santa group that vaccines would “likely be approved by mid-November and distributed to front-line workers before Thanksgiving.”
“;If you and your colleagues are not essential workers, I don”;t know what is…I cannot wait to tell the president. He”;s going to love this,” he reportedly said on the call.
Vitamin B12, a water-soluble vitamin also known as cobalamin, plays a role in numerous biochemical reactions and neurological functions in your body, including DNA synthesis.1 Your body can”;t make vitamin B12 on its own, so it must be obtained via your diet or supplementation.
A deficiency can be serious and leads to a number of related changes, including personality disturbances, irritability and depression, along with a wide range of symptoms, including joint pain, “;pins and needles”; sensations, numbness and shortness of breath.2
One of the lesser known symptoms, however, may affect your voice. If you frequently experience hoarseness, a vitamin B12 deficiency could be to blame.
Hoarseness, Vocal Fold Palsy Linked to B12 Deficiency
Researchers from the department of nutrition science at East Carolina University reviewed 89 case studies of vitamin B12 deficiency, looking for causes, clinical manifestations and outcomes.3 Neurological, psychiatric, oral, dermatological and other “;rare signs and symptoms”; were reported, signaling just how varied the symptoms can be.
One of the case studies involved a 61-year-old man who suffered from vitamin B12 deficiency as a result of excessive alcohol consumption.4 His symptoms included gradually progressive hoarseness along with vocal fold palsy.
Vocal fold palsy occurs when one or both vocal folds become paralyzed and do not move properly. If one vocal cord does not move properly, it can lead to a hoarse voice, whereas if both vocal folds aren”;t working, it can cause trouble with breathing.5
Typically, vocal fold palsy is related to surgical procedures, such as thyroid surgery or carotid artery surgery, or neck or chest tumors, but often the cause is unknown. In the original case report, which was published in The Journal of Laryngology & Otology in 2011, the researchers wrote:6
“;A 61-year-old man presented to the emergency medical ward with an eight-week history of gradually progressive hoarseness and weakness of both lower limbs …; The patient”;s hoarseness was constant in nature, requiring repeated throat-clearing.”;
He was treated with vitamin B12 replacement therapy, which resolved his symptoms:7
“;…; At follow up the patient”;s voice and vocal fold function were noted to have improved. Both his voice and lower limb function continued to improve. Over the following three months, the patient made a full recovery, mirroring the normalization of his serum B12 levels.
We believe that this case demonstrates a strong relationship between vitamin B12 deficiency and vocal fold palsy”;
Metformin Linked to B12 Deficiency, Hoarseness
In another case, a 55-year-old man with Type 2 diabetes also suffered from hoarseness, leading him to visit an otolaryngology (ear, nose and throat) clinic. Bilateral vocal fold paralysis was detected as a result of vitamin B12 deficiency, and according to the researchers, the condition resolved after his vitamin B12 levels increased:8
“;Hoarseness of the patient progressively recovered after a month of treatment …; After 3 months, the patient’s neuropathy complaints were repaired and the vocal fold were evaluated as normal.”;
In this case, the man had been taking insulin, valsartan and metformin for five years. Metformin, a diabetes drug, has previously been linked to vitamin B12 deficiency. In one study, average vitamin B12 levels were lower among those taking metformin, and 4% were deficient compared to 2% in the placebo group.9
Further, nearly 20% of those taking metformin had borderline low vitamin B12 levels compared to 10% of those taking a placebo. More people in the metformin group were also anemic, which is associated with vitamin B12 deficiency.
The case-study researchers noted, “;Physicians should be kept in mind that long term use of metformin could result vitamin B12 deficiency when assessing the etiology of vocal fold paralysis.”;10
The Journal of Laryngology & Otology researchers also noted that it”;s important for clinicians to consider vitamin B12 deficiency in the case of vocal fold palsy, stating, “;It is important to consider vitamin B12 deficiency as a cause, as speedy identification and treatment can help prevent permanent neurological damage.”;11
Some Vitamin B12 Deficiency Symptoms May Be Missed
The symptoms of vitamin B12 deficiency can be subtle or mirror other conditions, putting them at risk of being overlooked or misdiagnosed by clinicians. One of the effects of deficiency is a blood condition called megaloblastic anemia. It causes the bone marrow to release immature blood cells,12 which are unable to deliver adequate amounts of oxygen to the body. The result is fatigue and pale skin.
Those with megaloblastic anemia may also develop jaundice, a slight yellowing of the skin or eyes. Some with vitamin B12 deficiency also report experiencing eye twitching or eyelid spasms. In the featured study, a 74-year-old woman with B12 deficiency also experienced blurred vision, along with gait disturbances and problems with balance.13
Mental health problems can also be a sign of not enough B12, and it”;s been observed that up to 30% of patients hospitalized for depression may be B12 deficient,14 while among the elderly with depressive disorders, those with B12 deficiency may be 70% more likely to experience depression. Those researchers went so far as to say that vitamin B12 may be causally related to depression.15
Vitamin B12 May Be Useful for COVID-19
B vitamins also play an important role in cell functioning, energy metabolism and immune function, leading one group of researchers to suggest that they could be useful for treating COVID-19, and vitamin B status should be assessed in COVID-19 patients.
“;Vitamin B assists in proper activation of both the innate and adaptive immune responses, reduces proinflammatory cytokine levels, improves respiratory function, maintains endothelial integrity, prevents hypercoagulability and can reduce the length of stay in hospital,”; researchers wrote in the journal Maturitas.16
In terms of vitamin B12, specifically, it modulates gut microbiota, and low levels may lead to increased inflammation and oxidative stress. A study also suggested that vitamin B12 supplements may reduce COVID-19-related organ damage and symptoms.17
Researchers with the Singapore General Hospital and Duke-NUS Medical School also set out to determine if a combination of vitamin D, magnesium and vitamin B12 would improve outcomes among COVID-19 patients aged 50 and older.
Seventeen patients received oral vitamin D3 (1,000 IU), magnesium (150 milligrams (mg)) and vitamin B12 (500 mcg) –; together known as DMB –; upon admission for a median of five days while 26 patients who did not receive DMB served as the control group.18
Significant benefits were seen among the DMB group, with only 17.6% requiring initiation of oxygen therapy during their hospitalization, compared to 61.5% of those in the control group. The requirement for oxygen is associated with an increased risk of needing intensive care, and the DMB group also benefited in this area.
Among those in the DMB group who required supplemental oxygen (three out of the 17 patients), two required ICU admission while one did not. Among the control group, all of those who needed supplemental oxygen required further ICU support. Nine of the DMB patients were given the combination within the first week of the onset of symptoms, and only one among them required oxygen therapy.
The researchers explained that vitamin D, magnesium and vitamin B12 present a unique three-pronged approach for tackling COVID-19, noting, “;Vitamin B12 is essential in supporting a healthy gut microbiome which has an important role in the development and function of both innate and adaptive immune systems.”;19
Who”;s at Risk of Vitamin B12 Deficiency?
It”;s been suggested that nearly two-fifths of Americans may have lower than ideal B12 levels, with 9% deficient and 16% below 185 pmol/L, which is considered marginally deficient.20 While vegetarians and vegans are susceptible since B12 is derived from animal products, even meat eaters may be deficient, as problems with absorption are common.
B12 is tightly bound to proteins and high acidity is required to break this bond. Some people may not have sufficient stomach acid to separate the B12 from the protein. Advancing age may also diminish your ability to absorb the vitamin from food and increase your risk of deficiency, as may any of the following scenarios:
People who regularly drink alcohol, as B12 is stored in your liver.
Anyone with an autoimmune disease like Crohn’s or celiac, which may prevent your body from being able to absorb B12.
People who drink more than four cups of coffee daily are more prone to vitamin B deficiencies than non-coffee consumers.21
Those who’ve had gastric bypass surgery and therefore have altered digestive systems, as this may impair B12 absorption.
People exposed to nitrous oxide (laughing gas), which can wipe out whatever B12 reserves you may have in your body.
Adults over 50, because as you grow older, your ability to produce intrinsic factor decreases.
People with helicobacter pylori infection. Intrinsic factor is a protein made by stomach cells that’s necessary for B12 absorption. H. pylori bacteria can destroy intrinsic factor, thereby preventing B12 absorption.
People who take antacids, which have a tendency to interfere with B12 absorption, especially over time.
Patients who take metformin for low blood sugar, as the drug interferes with B12 absorption, doubling your risk of deficiency.22
Anyone taking a proton pump inhibitor (PPIs) like Prevacid or Nexium or H2 blocker such as Pepcid or Zantac. Research shows taking PPIs for more than two years increases your risk of B12 deficiency by 65%.23
Women taking birth control pills for an extended period of time, as the estrogen impairs absorption.24
In adults, B12 deficiency can develop in about six years, which is how long it takes to deplete your body’s B12 stores.26 So, it”;s important to be aware of your intake and catch a B12 deficiency early, as impaired brain and nerve development can be very difficult to correct once the damage is done.
Regularly eating B12-rich foods, such as grass fed beef liver, wild rainbow trout and wild sockeye salmon, is important to maintain adequate levels, but if you suspect you may be deficient, weekly B12 shots or a high-dose, daily supplement may be necessary.
Methylcobalamin, which is the naturally occurring form of vitamin B12 found in food, is more absorbable than the cyanocobalamin, which is the type found in most supplements.27