In the news                  September 15, 2020

Vitamin D and friends – their role in COVID-19

            Early in the course of the pandemic several supplements, including vitamins, minerals and herbal products were touted to be preventative or even curative for the SARS-CoV-2 disease that is now labeled COVID-19. How well have they performed? Unfortunately there are very few valid studies, i.e., randomized, placebo-controlled, double-blind with enough “power” or numbers of participants to raise hopes of a cure. However there is an emerging sense among the scientific community that some supplements, especially vitamin D, do make a difference in terms of susceptibility to severe disease.

            A low level of vitamin D may eventually be considered as a comorbidity along with obesity, diabetes, high blood pressure, kidney disease, heart disease and immune suppression. An article in the journal Nutrients by reputable researchers from several countries makes the point with the intriguing title Evidence that vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths.

            Since vitamin D is produced in the body by the action of a specific wavelength of sunlight, we form less of it in the winter. This correlates with the peaks of influenza activity that are the opposite in the northern and southern hemispheres, occurring in their winter seasons.

            There are several ways in which vitamin D is protective against severe influenza and coronavirus disease, but especially that it lowers pro-inflammatory cytokines and raises anti-inflammatory cytokines, the agents of the often-fatal cytokine storm.

            By now everyone is aware that older persons have a high fatality rate from COVID-19 and the reasons become clearer when we realize why they have low levels of vitamin D: blood levels of this vitamin decrease naturally with age; older persons tend to have limited exposure to sunlight; they are more likely to take several prescription medications, especially those such as antihypertensives, antibiotics and anti-inflammatory drugs that lower vitamin D levels; they are more likely to have generous fat deposits in which vitamin D becomes sequestered and unavailable to bolster the immune system.

            The authors of the above article make a bold statement: “To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5.000 IU/d.” Even those of us who recommend at least 1,000 IU (International Units) per day are surprised by this but it could well be preventive for persons at risk and even that level of intake carries absolutely no risk of side effects.  

            They also suggest that magnesium, because it helps to activate vitamin D, should be taken with the supplement. Vitamin C and zinc participate in the immune process. Most of us get enough zinc. Immunologists find that the recommended dietary allowance for vitamin C is too low. It’s enough to prevent scurvy but not enough for optimal immune function. The latter may require 200-500 milligrams per day of vitamin C.

            You can expect more studies on nutritional approaches to boosting immunity as humanity faces the increasing frequency of pandemics and the disturbing rise in antibiotic resistant bacteria.      

Lifestyle

            Another annoyance of aging — it’s the C-word: constipation.

            One of the world’s most famous poopologists, Dr. Denis Burkitt, practiced for many years among the natives of Central Africa. I won’t go into detail about his findings but he noted that because of their diet that was high in plant foods, he never saw among them three conditions: constipation, appendicitis and diverticulitis. Of course, all of us have experienced the first, many the second and a few the third.

            As you can guess from the above paragraph, all three problems are obviously diet-related, since the American descendants of Africans are familiar with all of them. Hunter-gatherers take in approximately ten times as much plant fiber as we do, so no wonder. Most of our calories come in the form of refined grains and sugars, which makes the problem worse.

            The sedentary lifestyle contributes to constipation – ask any long-haul truck driver – so you should add regular exercise to your high-fiber diet. 

            There are two reasons why constipation should not be ignored or tolerated. When it becomes chronic it leads to diverticulosis, the formation of pockets that bulge out from the wall of the large intestine and when these become infected the result is diverticulitis, a condition that is always painful, sometimes requires hospitalization and occasionally causes death from peritonitis. Another reason is the increased risk of colon cancer, a risk that is small but real.

            As in so many of these “annoyances of aging” the presence of constipation may indicate disease, one of the most common of which is hypothyroidism, low thyroid activity. Some prescription drugs, especially opiates, are notorious for the bowel sluggishness that they cause.

            Laxatives are not the answer but if you can’t relieve constipation with diet, consider stool softeners like Miralax and Metamucil.