We're going to talk about COVID-19 and vitamin D today
as I said there was a lot of early information that came out
three four months ago that a lot of people got some information from a
I think it was a Filipino study prepublication
several other studies that came out there was a popular video by Eric Berg
a lot of people a lot of our viewers watch a lot of his
stuff as well as the months have gone by the science has continued to mature and
so one of the things that we're doing here is
you'll see we've got several videos that we refer you to
this one is JoAnn Manson at Harvard she's talking about her perspective on
vitamin D on bone health cardiovascular health
COVID-19 and some other things so I wanted to put that link on the
slide so you can go take a look at that you'll
also see several other studies that have gotten to the publication level
that we refer to today now we all know that
vitamin D's impact on bone health cardiovascular health
prediabetes diabetes is a big deal there's emerging evidence and at this
point maturing evidence that it's relevant against COVD-19 I
don't think there's anything that's indicating that it helps decrease
infection from coronavirus what it does do is help decrease
cytokine storm and the COVID-19 the serious disease associated with
coronavirus infection we'll talk about that a little bit later
JoAnn Manson professor of medicine at Harvard Medical School and Brigham and
Women's explain some points on COVID-19
associations in a May 2020 video posted on Medscape and that was
the link in a previous study vitamin D supplementation was associated with a
significant reduction in respiratory tract infections that's
not just COVID-19 this was way back in 2017 it was a meta-analysis
of RCTs you remember what that is
randomized clinical trials the top level of scientific
evidence you know the worst level is opinions from an
expert and so that's one of the things that you
see I tend to differentiate I will give my opinion as an expert but
I usually do that last usually what I give is the scientific
evidence the things that are out there that are published and are
actually levels of quality there you know like
case reviews some case control studies and then the most important the highest
level is an RCT or a randomized clinical trial
it turns out that there are meta-analyses
and a meta-analysis is where you take multiple studies of a certain type
pool those studies look at the results that they got together
the ultimate group for doing that is called the Cochrane group
there's C-O-C-H-R-A-N-E a Cochrane analysis and they're now
associated with Wikipedia so again you can't get anything better
in terms of scientific evidence than a meta-analysis
of randomized clinical trials and that's exactly what you've got for vitamin D
supplementation looking at acute respiratory tract
infections this was published in 2017 in the British
Medical Journal that's what BMJ is the title was Vitamin D Supplementation to
Prevent Acute Respiratory Tract Infections
Systematic Review and Meta-analysis of Individual
Participant Data and again we've provided the citation over on the right
and the link there in the middle 25 eligible
randomized controlled trials a total of 11,321 participants
ages was 0 to 95 years they identified those
individual participant data were obtained for over 10 thousand
almost 11 thousand 96.6% of the participants
vitamin d supplementation reduced the risk of acute respiratory tract
infection among all participants we hear this and
you'll see on one of our later slides we actually
talk about what you'll hear on the Internet you'll hear
people say oh you can go out and get it from the sun
I can tell you I make a living I see hundreds of patients a year
and I'll typically see a husband and wife living north of the
Mason-Dixon line or south of the Mason-Dixon line that doesn't matter
either you hear that if you live north you're at risk if you
live south you're not at risk because of the better sunshine
not true going out and spending time in the sun all day
also not so true because again I'll see a couple a husband and a
wife the husband is out playing golf three and four hours a day the wife is
indoors all day and the wife has great vitamin D levels
and the husband doesn't so it makes a couple of points number
one the north-south thing it's a thought it's an idea it's a
theory it really doesn't pan out the thing getting out in the sun there
is some scientific evidence but I can tell you from a practical basis
it's not that good you need to go ahead and consider supplementation
number three we'll talk about this a little bit later too
you can over-supplement and over-supplementation is dangerous
we'll talk about that I've got a couple of videos I've had a couple of patients
come to me that were too high again we'll talk about those
vitamin D has been shown to have an immune modulating effect and can lower
inflammation an analysis of data showing a possible
association between high C-reactive protein remember
C-reactive protein is that protein made by the liver that shows inflammation
it's part of a cardiovascular inflammation panel
but I don't use that alone and i don't recommend that you use it alone because
there are too many things that can cause a positive C-reactive protein
for example if we gave a flu shot to 100 people today
two days from now 66 of them would have an elevated C-reactive protein
so if you're looking at C-reactive protein to tell you whether you have
cardiovascular risk as you can see if it's elevated you
don't know if it's from rheumatoid arthritis other types of
inflammatory arthritis other inflammatory diseases a flu shot
impending COVID you name it so we look at other things on the
inflammation panel besides C-reactive protein but let's again let's
go back to the script and C-reactive protein
and talk about that for COVID-19 and vitamin D3
an analysis of data showing a possible association between high C-reactive
protein concentration which is greater than or equal to one
and a severe COVID-19 MedRxiv on May 2020 The Possible Role of
Vitamin D in suppressing cytokine storm and
Associated Mortality in COVID-19 patients so again this is getting to that core
of the current expectation around the mechanism for vitamin D and
COVID-19 there is significant and I think good evidence
indicating that it probably it helps us avoid that cytokine storm
and if you want to read the articles again there's a link on the left and the
citation on the right given that C- reactive protein is a surrogate marker
for cytokine storm and is associated with vitamin D deficiency
based on retrospective data and indirect evidence we see a possible role of
vitamin D in reducing complications attributed to
unregulated inflammation and cytokine storm can vitamin D
lower COVID-19 risk vitamin D status is strongly associated with COVID-19
mortality a retrospective cohort study which included two cohorts
active and expired of 780 cases with laboratory confirmed
infection of SARS-CoV--2 in Indonesia the preliminary study in April 2020
was called Patterns of COVID-19 Mortality
and Vitamin D An Indonesian Study we referred to this a couple of times
earlier on the majority of the COVID-19 cases
with insufficient and deficient vitamin D status died
that study that came out fairly early again April
and got a lot of attention because there was a lot of suspicion around the
vitamin D before that happened this came out and a lot of people
reacted to it the odds of death was higher in older
and male cases with pre-existing condition and below normal
vitamin D levels now again based on some of the information we're talking about
you can see why I was surprised to and continue to be surprised when I have
patients come in and they say yeah you know I've heard about vitamin D
and COVID-19 but I just never got around to it why am I
surprised anyway for increased synthesis of vitamin D
patients are encouraged to be outdoors and physically active
while maintaining social distancing and again this is information that Chris
got from other folks making suggestions and yes
Chris will talk about some of the recommendations that you'll see on the
Internet I can tell you as a doc seeing patients
on a routine basis I don't trust sunshine alone for vitamin
D and I suggest very strongly that you
don't either there's a concept called "test don't
guess" the other thing I recommend is go ahead
and take supplementation yes vitamin D at really
high levels is dangerous I've looked at the
scientific evidence around this space specifically for this question what
level of supplementation is safe you'll see recommendations of 600 well
actually I'm getting ahead of myself let me go ahead and finish the script here
diet is also important food sources that are higher in vitamin D
include fortified dairy products fortified cereals
fatty fish and sun-dried mushrooms but let's go back and ask
that question should we be eating fortified cereals
well if you have prediabetes probably not how about if you don't have
prediabetes well that's a different question I'm not
even going to go there but be careful eating all these grain products if you
can't digest the carbs in them fatty fish like salmon
yeah it's great sun-dried mushrooms fantastic dairy products
oh wait a minute dairy products are bad right go back to the
video that we did recently about saturated fat
I mean that's the thing that most people are concerned about in dairy products
saturated fat and the reality is despite all of our perceptions for so many
decades it doesn't appear that saturated fat is
dangerous at all like we used to think for those who are
unable to be outdoors and for those who are able to be
outdoors and have a low dietary intake of vitamin
D it's reasonable to consider a vitamin D
supplement I would also can say for those who are outdoors a lot
and for those who do get dietary vitamin D
I still would say we all need to supplement
and we're getting to the point that i got to a minute ago how much should you
supplement you don't want to be dangerous but you
do want get adequate amounts you'll see it with other folks the
recommended dietary allowance is 6 to 8 hundred international units
other people will say 1 to 2 thousand here's where I was a few
minutes ago I've been out i've looked at the science
I haven't seen any evidence of anybody getting into
problems with 5,000 international
units per day and that is what i recommend
the other thing I recommend is that you test don't guess
start off supplementation if you don't have your test yet
and the goal should be 60 to 80 not 25 not 20
not less than 40 most of the labs still have a recommendation of 25 to 40
nanograms per milliliter that's old data still some of the new
lab normals are changing to the higher
numbers now when I say 60 to 80 not 175
what do I mean not 175 well here's a YouTube video
so this is a video that I did April of 2019 a patient came to me
and her vitamin d level was 175 that's why I mentioned that
I did a video on it she agreed and actually joined me for an interview
video how did it get to be 175 well one of the
common dose formations is a weekly dose and these weekly doses
will come in both injections or pills and they're
typically 25 to 50 thousand international units
I don't ever recommend those because of exactly what happened with this patient
it was another doctor's patient they she had been seeing the doctor for some
other hormone-related stuff and then came to me
the doc had given her a prescription for 50,000 international unit
pills she thought this was to be every day
no it was to be every week so that's why I never prescribed
25,000 international unit or 50,000 international unit doses it's too
easy to have misunderstandings like that for those of you who are curious well
maybe you should go look at the video to see what happened with that patient
we've done other videos in terms of vitamin D
and COVID-19 risk specifically as I said we're
giving you several other different viewpoints
different videos to help learn about vitamin D3 and COVID
so I'd like to talk with you a minute about the webinar people don't
understand what the webinar is it's actually a great way to get some
access to healthcare that you're just not going to get any other way
you actually get the lab tests yourself for at a local lab a Quest lab near you
for the inflammation panel and the OGTT and the insulin survey these are things
inflammation and prediabetes that your doctor just
does not know about and here's the thing Harvard Health and
many others have said look sudden death is not always so sudden the
Hollywood picture that it's evolved out of the blue is not realistic it's
more like real lightning preceded by clouds wind and rain
stop that metabolic storm before the lightning strikes
and here's where that metabolic storm comes from
it's inflammation and it has to do usually with prediabetes so again we
actually get labs we go over them in the webinar and then
you can start finding out how you can prevent that heart attack
others said that you couldn't even predict we can
show you how thanks