welcome this video is about the deed that everyone is talking about yes that vitamin D and how it may
or may not help with kovat but before you watch this video it would be a good idea to watch my
previous video on vitamin D if you haven't already because that helped you better understand vitamin
DS role in this video also let's review how SARS coronavirus 2 causes some people to have severe
disease and sometimes death it all starts when the virus gets into the lungs all the way down
to those tiny little air sacs they're called the alveoli it's those same alveoli that are
responsible for bringing oxygen into the blood in removing carbon dioxide from the blood there
are two types of alveoli type 1 and type 2 the virus attaches to the H 2 receptor on those type
2 alveoli and it uses that receptor to gain entry into the cell once inside the cell it hijacks the
cells machinery and starts making copies of itself but it also causes the cell to have less ace 2
receptor on its surface and this has consequences but more on that and a bit after the virus makes
copies of itself inside the cell it bursts out and starts invading more alveolar cells unlike
other viruses the stars coronavirus 2 then goes to the alveoli next-door-neighbor the pulmonary
capillaries the lining of those pulmonary capillaries is called the endothelium and they
also have ace 2 receptors the virus then latches onto the AC receptors and invades those cells
as well this also causes a decrease in ace to receptors they're having less ACE 2 receptors is
bad because ultimately that leads to a buildup of more and more angiotensin 2 in the lungs and less
angiotensin 1 7 & 1 9 this causes an increase in constriction of the arteries that go to the lungs
this is known as pulmonary vasoconstriction it also leads to higher likelihood of clot formation
and more inflammation in general so when the virus invades not only does it cause alveolar in
pulmonary capillary destruction but also leads to the cytokine storm and massive inflammation
and all this is made worse as a result of decreased numbers of those ACE 2 receptors
so what does not having enough vitamin D have to do with this and if insufficient vitamin D
levels cause more severe disease why is that well I have to first clarify that it's not proven that
insufficient levels of vitamin D lead to worse outcomes but while hasn't been proven it also
certainly hasn't been disproven there's more and more compelling evidence suggesting that lower
levels leads to worse outcomes and there's no question that vitamin D plays an important role
in our immune system more and more studies are coming out that are sorting out its exact role
in this capacity but the link between poor vitamin D status in the risk of certain infections remains
cloudy let's rewind to 2017 for a second because at that time there was a meta-analysis study that
consisted of 25 different randomised trials with about 11,000 patients in total evaluating
the incidence of acute respiratory infections vitamin D supplementation reduced the percentage
of patients experiencing an acute respiratory tract infection the incidence of these URIs in the
vitamin D group was 40 point 3 percent compared to 42 point two percent in the placebo group and
a subgroup analysis vitamin D supplementation was most effective in patients with vitamin D levels
less than 10 and G's per ml in and those treated with daily or weekly smaller doses as opposed to
a huge single dose the takeaway message from this meta-analysis study is that being vitamin
D deficient probably makes people more prone to getting upper respiratory infections and
that's why they should take supplemental vitamin D but people who have low levels should be taking
supplemental vitamin D regardless vitamin D has major effects on nearly all cells of our immune
system including dendritic cells macrophages and T and B lymphocytes all of these immune
cells have a receptor that binds to vitamin D called wait for it vitamin D receptor or vdr
for short in this study showed that there are over 30 single nucleotide polymorphisms of the vdr gene
meaning over 30 different variations of the gene that codes for VD are several of these genetic
variants are associated with higher likelihood of URIs so some people because of their genetics are
more prone to getting you our eyes when vitamin D binds to VTR it then influences the expression of
certain genes it essentially tells the cell to start making more molecules that play a role in
fighting off infection it tells the cell to start making certain cytokines in groups of molecules
called calf Ellis Eden's and beta defensins ll 37 is the one and only active catalyst Eden in
our body it's been shown to disrupt the membrane of the influenza virus in inhibit production of
new viral particles for some types of viruses it also alters cytokine production our immune
system also has beta defenses which is another group of molecules to help fight infections
beta defense in to in particular has been shown to have antiviral properties against influenza
vitamin D in combination with the VD our increased gene expression of beta defense and - meaning
it increases beta defense in two levels inside certain cells of our body such as immune cells in
alveoli but it also tells the cell to decrease the production of certain molecules that play a role
in the cytokine storm pulmonary epithelial cells including alveoli contain high levels of 1-alpha
hydroxylase enzyme which is the enzyme that allows for local production of one alpha 25 dihydroxy
vitamin D which is the active form of vitamin D also known as calcitriol so calcitriol inhibits
the production and secretion of many cytokines and chemokines including r antes which is also
known as CCL v if you watch my previous videos you may recall that ray aunty's is like a magnet that
attracts cd4 lymphocytes to further participate in that cytokine storm which is causing even more
damage it's also known that vitamin D deficiency impairs the ability of macrophages to mature and
impairs hydrogen peroxide production which is important for killing off viruses in bacteria
vitamin D also plays a role in maintaining tight junctions in between the lung cells which is
important to act as a barrier against infection in a 2016 study that gave something called LPS
to mice LPS stands for lipopolysaccharide and essentially induces sepsis in a RDS some of the
mice were normal mice while other mice were vdr knockout mice meaning they had their vdr gene
removed so they didn't have any vdr the mice who had the VTR fared better compared to the
mice who didn't have it they found that the mice who didn't have the VTR had more degeneration
of alveolar epithelial tight junctions but also check this out in 2017 there's a study where they
once again gave LPS to rats they then gave these rats the active form of vitamin D calcitriol what
the study showed is that these rats made less angiotensin ii and less angiotensin ii type 1
receptor and more of the ACE 2 receptor the rats who received calcitriol also had less lung damage
compared to the rats who didn't get calcitriol so at least in rats in possibly in humans vitamin D
causes a decrease in angiotensin 2 in the lungs which like I mentioned earlier in this video is
a good thing there was another study that was done in mice that provided evidence that the vitamin D
binding to the VTR minimizes lung damage in a RDS by blocking the reigning angiotensin system in the
lungs and then there was this interesting study published in the prestigious New England Journal
Medicine which coincidentally was published in December of 2019 the same time that the kovat
outbreak started in Wuhan China in this study they looked at people who were critically ill
in the ER and measured their vitamin D levels if they were deficient they gave them big doses of
vitamin D to half the patients the other half got a placebo they then moved all of these patients to
the intensive care unit they of course treated them for whatever illness they had in addition
to giving them the single dose of 540,000 I use of vitamin D this was a randomized double-blind
placebo-controlled phase 3 trial the primary endpoint was 90-day all-cause mortality there
were over a thousand patients in the study and all of them had vitamin D levels less than 20 mg
per ml for the ones who received that big dose of vitamin D their levels on average came up to 50 n
G's per ml the placebo groups levels remain low with an average of 11 the 90-day mortality was
23.5% in the vitamin D group and 20.6% in the placebo group so the vitamin d3 didn't provide
an advantage over placebo with respect to 90 day mortality and critically ill vitamin D deficient
patients and while this study was a well performed study there are two big issues with this trial for
one these patients had low vitamin D levels at baseline and they didn't get vitamin D until they
were already critically ill it might have been too late for vitamin D to have any significant
impact at that point the second issue with this trial is that they gave vitamin D to critically
ill patients in general not critically ill patients with a specific disease so this study
tells us that giving vitamin D to a deficient patient who was critically ill is generally not
beneficial key word there being generally but if they repeated this study and say just influenza
patients or just Cova patients that would be a very interesting study also the other question
becomes would these patients have had less severe illness had they not been vitamin D deficient and
we don't know what we do know is that there are certain demographics that have low vitamin
D levels for example they're usually lower in the elderly those with darker skin it also depends on
where you live about 40 percent of Europeans are vitamin D deficient and 13% are severely
deficient vitamin D deficiency is more common in the subtropical and mid-latitude countries
compared to tropical and high latitude countries and severe vitamin D deficiency was found to be
nearly zero percent in some high-latitude countries there are probably less people
the vitamin D deficiency in those areas because of fortification of food there and I'm guessing
more consumption of fish which is one of the few foods that has so looking at the demographics
there seems to be a lot of geographic overlap between severe Kovac and areas with vitamin D
deficiency and this study in New Orleans I believe they looked at vitamin D levels in 20 covid 19
patients two-thirds of the patients required ICU admission of the ICU patients 85 percent of them
had vitamin D insufficiency all of the 212 cases of Covid 19 in this study the majority of patients
did just fine the average vitamin D level was 24 n G's per ml but critically ill patients had the
lowest levels and statistical analysis showed that the higher the vitamin D level the better
the odds of having a better outcome so randomized controlled trials are desperately needed and as
of right now there are three that are taking place or are about to take place there's the covid trial
in France and then there's another RCT in Iran and another one in the United States in this
randomized control trial in the United States it's looking at vitamin D in conjunction with
aspirin to see if it a reduces the incidence of covid and B if it lessens the severity
of covid so the world awaits these results and when they finally are published I'll be sure to
let you know so make sure you subscribe to this channel and hit that Bell button because I hear
that's good for you so I'm sure there will be or already are even more randomized control trials of
vitamin D with covid but there are still some big questions that need to be answered like one what
level of vitamin D is adequate to protect against or minimize the impact of covid two what level of
vitamin D is considered too high three should more and more people get their vitamin D levels checked
especially during this pandemic when less and less people are physically going to the doctor and four
should people just supplement themselves and if so how much these are all tough questions to answer