Vitamin D Determines Severity in COVID-19: Researchers Urge Government to Change Advice

Researchers from Trinity College Dublin are calling on the government in Ireland to change recommendations for vitamin D supplements.

A new publication from Dr. Eamon Laird and Professor Rose Anne Kenny, School of Medicine, and the Irish Longitudinal Study on Ageing (TILDA), in collaboration with Professor Jon Rhodes at University of Liverpool, highlights the association between vitamin D levels and mortality from COVID-19.

The authors of the article, just published in the Irish Medical Journal, analyzed all European adult population studies, completed since 1999, which measured vitamin D and compared vitamin D and death rates from COVID-19.

Vitamin D is produced in the skin from UVB sunlight exposure and is transported to the liver and then the kidney where it is changed into an active hormone that increases calcium transport from food in the gut and ensures calcium is adequate to keep the skeleton strong and free of osteoporosis.
But vitamin D can also support the immune system through a number of immune pathways involved in fighting SARS-CoV-2. Many recent studies confirm the pivotal role of vitamin D in viral infections.

This study shows that, counter intuitively, countries at lower latitude and typically sunny countries, such as Spain and Northern Italy, had low concentrations of vitamin D and high rates of vitamin D deficiency. These countries also experienced the highest infection and death rates in Europe.

The northern latitude countries of Norway, Finland, and Sweden, have higher vitamin D levels despite less UVB sunlight exposure, because supplementation and fortification of foods is more common. These Nordic countries have lower COVID-19 infection and death rates. The correlation between low vitamin D levels and death from COVID-19 is statistically significant.

The authors propose that, whereas optimizing vitamin D levels will certainly benefit bone and muscle health, the data suggests that it is also likely to reduce serious COVID-19 complications. This may be because vitamin D is important in regulation and suppression of the inflammatory cytokine response, which causes the severe consequences of COVID-19 and ‘acute respiratory distress syndrome’ associated with ventilation and death.

Professor Rose Anne Kenny said:

“In England, Scotland and Wales, public health bodies have revised recommendations since the COVID-19 outbreak. Recommendations now state that all adults should take at least 400 IU vitamin D daily. Whereas there are currently no results from randomized controlled trials to conclusively prove that vitamin D beneficially affects COVID-19 outcomes, there is strong circumstantial evidence of associations between vitamin D and the severity of COVID-19 responses, including death.”

“This study further confirms this association. We call on the Irish government to update guidelines as a matter of urgency and encourage all adults to take supplements during the COVID-19 crisis. Deficiency is frequent in Ireland. Deficiency is most prevalent with age, obesity, in men, in ethnic minorities, in people with diabetes, hypertension and in nursing homes.”

Dr. Eamon Laird added:

“Here we see observational evidence of a link of vitamin D with mortality. Optimizing vitamin D intake to public health guidelines will certainly have benefits for overall health and support immune function. Research like this is still exploratory and we need further trials to have concrete evidence on the level of vitamin D that is needed for optimal immune function. However, studies like this also remind us how low our vitamin D status is in the population (even in sunny countries) and adds further weight to some sort of mandatory vitamin D fortification policy. If the Nordic countries are allowed to do this, there is no reason Ireland, the UK or rest of Europe can’t either.”

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Magnesium can cause sudden cardiac death

A new prospective study based on data from the Women's Health Initiative found a potential inverse association between dietary magnesium and fatal coronary heart disease in postmenopausal women.

The study, which also showed a trend between magnesium and sudden cardiac death in this population, is published in the Journal of Women's Health, a peer-reviewed publication from Mary Ann Liebert, Inc., publishers.

Charles Eaton, MD, Alpert Medical School of Brown University, and a large team of researchers from various institutions coauthored the article entitled "Association of Dietary Magnesium Intake with Fatal Coronary Heart Disease and Sudden Cardiac Death: Findings from the Women's Health Initiative."

The researchers examined magnesium intake at baseline for more than 153,000 postmenopausal women and identified the development of fatal coronary heart disease and sudden cardiac death over the subsequent 10.5 years of follow-up. The data revealed that higher magnesium intake was associated with a statistically significant risk reduction in fatal coronary heart disease and a reduction in the risk of sudden cardiac death.

Susan G. Kornstein" Susan G. Kornstein, MD, Editor-in-Chief of Journal of Women's Health and Executive Director of the Virginia Commonwealth University Institute for Women's Health, Richmond, VA, stated: "If the findings of this study are confirmed, future research should test whether high-risk women would benefit from magnesium supplementation to reduce their risk of fatal coronary heart disease."

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Common nutrient supplementation may help combat Alzheimer's disease

Researchers have found that Choline, a lifelong dietary regimen has the capacity to prevent Alzheimer's disease (AD).

Researchers looked into whether choline could alleviate the effects of Alzheimer's.

Earlier this year, researchers found transgenerational benefits of AD-like symptoms in mice whose mothers were supplemented with choline. The latest work expands this line of research by exploring the effects of choline administered in adulthood rather than in fetal mice.

Notably, researchers found benefits of lifelong choline supplementation in male mice with AD-like symptoms. The results nicely replicate findings by this group in females, the lead author said.

Intriguingly, the beneficial effects of lifelong choline supplementation reduce the activation of microglia. Microglia are specialised cells that rid the brain of deleterious debris.

They observed reductions in disease-associated microglia, which are present in various neurodegenerative diseases, offer exciting new avenues of research and suggest ways of treating a broad range of disorders, including traumatic brain injuries, multiple sclerosis and Parkinson's disease.

Choline acts to protect the brain from Alzheimer's disease in at least 2 ways, both of which are explored in the new study. First, choline blocks the production of amyloid-beta plaques. Amyloid-beta plaques are the hallmark pathology observed in Alzheimer's disease.

Secondly, choline supplementation reduces the activation of microglia. Over-activation of microglia causes brain inflammation and can eventually lead to neuronal death, thereby compromising cognitive function. Choline supplementation reduces the activation of microglia, offering further protection from the ravages of AD.

Mechanistically, the reduction in microglia activation are driven by alteration of 2 key receptors, the alpha 7 nicotinic acetylcholine and Sigma-1 receptor.

In the scientific community, it is well understood that Alzheimer's disease causes harm to the brain long before clinical symptoms are made evident. And once these symptoms are identified, it is too late--- the disease has become irreversible. In addition to causing disorientation and memory loss, the disease causes loss of motor control in those who are afflicted.

Prior research concerning Alzheimer's has indicated that there is one factor at play. Rather, a multitude of factors that are believed to contribute to the development of the disease, including genetics, age, and lifestyle. Additionally, studies suggest that diet can have a significant effect on on creasing or lowering the risk of cognitive decline.

Choline can be found in various foods. According to the US department of agriculture (USDA), high levels of choline are found in chicken liver ( 3 oz, 247 mg), eggs ( 1 large egg with yolk- 147 mg), beef grass0fed steak ( 3 oz-  55 mg), wheat germ ( 1 oz toast- 51 mg), milk ( 8 oz- 38 mg) and Brussels sprouts ( 1/2 cup- 32 mg).

All plant and animal cells require choline to maintain their structural integrity. It has long been recognised that choline is particularly important for brain function.

The human body uses choline to produce acetylcholine, a neurotransmitter responsible for functioning  memory, muscle control and mood. Choline is also used to build cell membrane and plays a vital role in regulating gene expression. Additionally, a new report in Jan. 2019 found that choline acts as an agonist for Sigma-1 receptors, which are implicated in AD pathogenesis.

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Study suggests vitamin D supplementation may slow type 2 diabetes progression

In a recent study it has been found that Vitamin D supplementation may slow type 2 diabetes progression rate in newly diagnosed and pre-diabetes patients.

The type 2 diabetes is an increasingly prevalent disease, which puts a huge burden on patients and society and can also lead to serious health problems including nerve damage, blindness and kidney failure.

People suffering from a high risk of developing type 2 diabetes ( prediabetes) can be identified by several risk factors including obesity or a family history of the disease. Although low vitamin D levels have previously been associated with an increased risk of developing type 2 diabetes, some studies have reported no improvement in metabolic function.

However, these often had a low number of participants or included individuals with normal vitamin D levels at the start who were metabolically healthy, or who had long standing type 2 diabetes. Whether vitamin D supplementation has any beneficial effect in patients with prediabetes or with newly diagnosed diabetes, especially in those who have low vitamin D levels, remains uncertain.

In this study, lead researcher along with her fellow researchers examined the effect of vitamin D supplementation on glucose metabolism in patients who are newly diagnosed with type 2 diabetes or identified as at high risk of developing the condition.

Markers of insulin function and glucose metabolism were measured before and after 6 months of high-dose vitamin D supplementation ( approximately 3-10 times the recommended dose).

Although only 46% of study participants were determined to have low vitamin D levels at the start of the study, supplementation with vitamin D significantly improved the action of insulin in muscle tissue of participants after 6 months.

The lead researcher said, the reason we saw improvements in glucose metabolism following vitamin D supplementation in those at high risk of diabetes, or with newly diagnosed diabetes, while other studies failed to demonstrate an effect in people with long-standing type 2 diabetes is unclear. This could be due to the fact that improvements in metabolic function are harder to detect in those with a longer-term disease or that longer treatment time is needed to see the benefits.

The lead researchers suggested that future studies should evaluate whether there are individual clinical or genetic factors that affect how different people respond to vitamin D supplementation and if the positive effect on metabolism is maintained in the longer term.

Type 2 diabetes and prediabetes are a growing public health concern and although our results are promising, further studies are required to confirm our findings, to identify whether some people may benefit more from this intervention, and to evaluate the safety of high-dose vitamin D supplementation recommendations be followed, she added.

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Role of Vitamin D in neonatal health

Babies who do not get enough amount of Vitamin D tend to have its deficiency. Here, we help you to understand the role of Vitamin D in neonatal health, the symptoms to watch out for in babies and how to overcome the deficiency.

Babies require Vitamin D for healthy growth and development and it also helps them build strong, healthy bones and teeth. Babies who do not get enough amount of it are said to be deficient in Vitamin D. It is common in our population and therefore in pregnant women. To prevent Vitamin D deficiency in infants, pregnant women who are at risk should be screened and treated for it in the 1st trimester. Screening of the newborn's vitamin D status is not essential as it is the mother's status which should be evaluated.

What is Vitamin D deficiency in newborns?
 
According to WHO, Vitamin D plays a pivotal role in bone metabolism through the regulation of calcium and phosphate homeostasis and in regulating the immune system. Vitamin D is produced by the body during exposure to sunlight but is also found in oily fish, eggs and fortified food products. Infants are born with low Vitamin D in the 1st few months of life. As the Vitamin D content of breast milk is dependent on maternal vitamin D status and is often low and sun exposure may be restricted for infants living at higher latitudes for various reasons. Vitamin D deficiency in infants can lead to bone malformation ( rickets), seizures and difficulty breathing. Since, vitamin D is required for building strong, healthy bones and teeth. Parents can make sure your baby has enough vitamin D by giving a daily supplement ( a dose of drops every day) after consulting the expert. This should be done as soon as the baby is born. Tons of research suggests that a routine, vitamin D  supplementation programme should be seriously considered starting from the neonatal period extending  right through the childhood into adolescence. Oral Vitamin D3 supplementation as an oil emulsion has been shown to be associated with significant and sustained increases in 25 (OH)D from baseline in fully breastfeeding infants through 7 months. Whereas, few studies also revealed that newborns with vitamin D deficiency had 44% increased risk of being diagnosed with schizophrenia as young adults, compared with newborns with normal levels of Vitamin D.

Incidences of Vitamin D deficiency in newborns in India

Vitamin D deficiency has emerged as a significant public health problem throughout the world. Even in the Indian context, it has been reported to be present in many children in spite of the wide availability of sunlight. The manifestations of deficiency may vary from hypocalcemic seizures, tetany in infancy and adolescence to florid rickets in toddlers. Also, various studies suggest that women who lack Vitamin D will give birth to such children. Ideally, both the mother and children should go out in the sun by wearing half-sleeve cotton clothes, which tend to allow absorption of the required vitamin. In the case of neonatal babies are also hardly out in the sin. Hence, it is essential to address it at the right time.

Symptoms of vitamin D deficiency in infants
Craniotabes ( softening of skull bones)
Other osseous signs ( such as rickets) are not seen in the newborn but classical signs in the older infant include a broadening of the metaphyses, bowing of the long bones once weight bearing
Hypocalcaemic seizures

How to know if your baby is at risk of Vitamin D deficiency?
If they're breastfed
If mothers don't have enough Vitamin D
Babies born prematurely

Know how low Vitamin D can be harmful to babies
Some children with low vitamin D get bone and muscle pain. As mentioned earlier, very low vitamin D can lead to soft bones and raise the risk of rickets in children. Rickets only occurs when children are growing - if a child has softer bones from low Vitamin D, the bones can bend and cause bow legs or knock knees, and other changes too. Low Vitamin D can cause low calcium, which can invite muscle cramps in children. Not only this, but low calcium levels may also cause seizures ( convulsions or fits), mainly in young babies.

Diagnosis of Vitamin D deficiency
Serum 25-OHD concentration os the most excellent indicator of vitamin D status.
The normal adult concentration is > 50 nmol/L, although several sources use > 75 nmol/L for pregnant women.

How should the vitamin D deficiency be tackled in newborns
According to the WHO, vitamin D supplements may be effective in preventing rickets, particularly for infants and children, who may be at higher risk due to limited sun exposure or those with darker skin pigmentation.  Also, it recommends that newborn babies must be supplied with Vitamin D through sunlight or supplements in the 1st few months of life. An infant between the ages of 1-2 years requires 400 IU per day, while older children need 600 IU. Regular sunlight exposure can help keep vitamin D deficiency at bay. But, you should speak to your expert before exposing children to the sun.

Breast milk is the best food that you can offer to  your frowing baby. Ecen if you make your baby eat other foods, you can continue to breastfeed until 2 years. As discussed earlier, breast milk has only small amounts of vitamin D ( 4-40 IU per litre), which may not be sufficient for your newborn. That's why babies who are breastfed should receive a daily supplement of vitamin D from birth until they get enough from their diet. This should also be strictly done under the guidance of the expert.

Treatment of vitamin D deficiency involve giving ergocalcified or cholecalciferol for 3 months.
High dose bolus therapy ( 300,000- 500, 000 IU) should be given to children over 12 months of age. If compliance or absorption issues are suspected.

THIS IS ONLY FOR INFORMATION, ALWAYS CONSULT YOU PHYSICIAN BEFORE HAVING ANY PARTICULAR FOOD/ MEDICATION/EXERCISE/OTHER REMEDIES.                                    PS- THOSE INTERESTED IN RECIPES ARE FREE TO  VIEW MY BLOG-                                                                                           https://gseasyrecipes.blogspot.com/    

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