The Research Behind the Use of Mouthwashes & Nasal Sprays That Might Destroy COVID-19

As always, consult a physician when taking any medicine, but staples in the household medicine chest might help deactivate COVID-19. Relatively unpublicized research has recently resulted in the development of several inexpensive new products--as well as finding a new use for some old-fashioned ones—that could lessen one’s chances of catching COVID-19 or disabling the SARS-CoV-2 virus before it does much harm. Surprisingly, these findings advocating the use of mouthwashes and nasal swabs first appeared in scientific publications in April and May 2020. They might not be as flashy as the recently announced COVID-19 vaccines are, but they could possibly help protect the public against the virus: Kirk-Bayley, Justin, Sunkaraneni, Vishnu and Challacombe, Stephen, (May 4, 2020). in The use of povidone iodine nasal spray and mouthwash during the current COVID-19 pandemic may reduce cross infection and protect healthcare workers points out that since povidone iodine has proven to be an effective virucide against earlier coronaviruses, such as MERS CoV, if administered in the nasal cavities and/or as a mouthwash, it might reduce the viral load of droplets and aerosols before a human host has the chance to pass on COVID-19. Sizun J., Yu M. W., Talbot P. J. (2000, September). Survival of human coronaviruses 229E and OC43 in suspension and after drying on surfaces: a possible source of hospital-acquired infections. The Journal of Hospital Infection. 2000 Sep;46(1):55-60. supports this claim because povidone iodine has reduced upper respiratory infections in strains of OC43 and 229E human coronaviruses in aqueous suspension by at least 50 percent on absorptive and non-absorptive surfaces in a hospital environment. Likewise, COVID-19: Povidone-iodine intranasal prophylaxis in front-line healthcare personnel and inpatients (PIIPPI). (2020, April 28;2020 May 14). National Library of Medicine posits that the antiseptic Povidone-iodine (PVP-I) should be effective against SARS-CoV-2 because of its previous success destroying bacteria, fungi, and viruses. In vitro assays, a concentration of one percent PVP-1 has cut viral activity 99.9 percent, and after two minutes, a concentration of 0.23 percent has sufficiently reduced viral loads “appreciably”. Then again, researchers have long known that foods high in iodine, such as cod and seaweed, when added to the diet act as virus prophylactics, according to Warren, Gary. (2020, April). Iodine intake to reduce COVID-19 transmission and mortality. Research Gate. Thus, researchers first speculated that adding foods rich in iodine to a diet might destroy COVID-19’s ability to replicate itself, thus eventually leading some of them back to the realization that gargling a povidone iodine or cetypyridinium chloride (CPC) mouthwash might be another way to reduce the spread of COVID-19. However, proving this theory sometimes gets very specific as Dunleavy, Brian P. (2020, September 17). Nasal solution may stop the spread of COVID-19, UPI demonstrates. If one can believe these claims, a peer-reviewed study published by JAMA Otolaryngology—Head & Neck Surgery, notes that a nasal antiseptic solution, povidone-iodine, “administered to each nostril” in 15 seconds inactivates” COVID-19. Thus, Eli Lilly plans to market this solution--both as nasal and oral rinse--under the brand name Halodine after the completion of clinical trials starting in October. Because of this and similar research, the media has slowly begun to suggest the possible effectiveness of povidone-iodine mouthwashes like Plax Advanced and Listerine Gum Therapy (as well as others found by searching “povidone iodine mouthwashes AND COVID” as prophylactics) when the University of Connecticut’s dental school has touted its use: UConn health researchers find a simple oral rinse can inactivate the COVID-19 virus. (2020, June 18)--all within a contact period of 15 seconds followed by a rinsing period of at least 30 seconds in a laboratory setting. They, however, caution against the use of povidone-iodine mouthwashes if one is allergic to iodine, pregnant, or has thyroid problems. Similarly, research at Cardiff University in Wales has discovered that mouthwashes containing at least a 0.07 percent solution of cetypyridinium chloride (CPC) destroy the COVID virus in saliva as Woods, Amanda. (2020, November 17). Pocisone-Mouthwash can kill COVID-19 in 30 seconds, study reveals. New York Post. This means that mouthwashes originally created to fight gum disease can perhaps also disarm the COVID-19, according to preliminary laboratory studies performed before the start of clinic trials. Of course, the British researchers have yet to conduct a clinical study to discover how long these results last. Even so, very soon, antiseptic nasal solutions will be available: Dunleavy, Brian P. (2020, September 17). Nasal solution may stop the spread of COVID-19, study finds. UPI. In a peer-reviewed study published by JAMA Otolaryngology—Head & Neck Surgery, a nasal antiseptic solution, povidone-iodine, “administered to each nostril” in 15 seconds inactivates” COVID-19. Eli Lilly plans to market this solution both as nasal and oral rinse, under the brand name Halodine sometime after the completion of clinical trials. Similarly, Bluewillow Biologics has released the nasal spray, NanoBio. Finally, nebulized mists might also enhance the treatment of COVID-19 if readers can believe a much earlier study: Kawana, Akihiko, and Kudo, Koichiro. (1999). A trial of povidone-iodine (PVP-I) nasal inhalation and gargling to remove potentially pathogenic bacteria colonized in the pharynx: In 1999, Japanese researchers theorized that inhaling a nasal mist with a miniscule amount of povidone-iodine in it is an effective means of removing pathogenic bacteria from the lungs, mouth, and sinuses after comparing the results of dispensing the same with both a control group of participants who gargled the solution and another group who inhaled it. By extension, some COVID-contemporary physicians hypothesize that an effective way of dispensing povidone-iodine is in a nebulized mist since not only will it reach the sinuses and throat, but it will also penetrate the lungs. Please also note disclaimers by manufacturers like Listerine in the Forbes' article, "Listerine: Our Mouthwash ‘Is Not Intended To Prevent Or Treat Covid-19" primarily because researchers at present confine their experiments to petri dishes rather than double blind studies of subjects who either swish with a povidone-iodine mouthwash or three percent hydrogen peroxide and those who are given a placebo mouthwash. Also, understand no one knows how often adults (only) should gargle with a povidone-iodine or hydrogen peroxide mouthwash. Nevertheless, consumers who want to purchase Povidone-iodine mouthwashes will find that ACT, Listerine, and Tom’s of Maine are among the well-known brands that carry alcohol-free povidone-iodine mouthwashes as each bottle's list of ingredients should note.

Common Sense Solutions for Dealing with the Ever-Continuing COVID-19 Pandemic

A Coronavirus Checklist for Concerned Citizens & Ambitious Politicians

Evelyn E. Smith

Medical science has proven that some of the original advice the public received about COVID-19 is wrong because researchers have continued to test hypotheses that explore how best to contain and treat COVID-19.

 

Because knowledge about how to deal with the virus continues to change, I recommend occasionally reading up on the subject by reading Pub Med abstracts https://pubmed.ncbi.nlm.nih.gov/ as well as sources like Web M. D. and the Mayo Clinic, all of which do not politicize the subject.  Google Scholar also offers additional articles that provide an international point-of-view. The medical community understands why advice about how to treat COVID-19 changes, but a sizeable percentage of the general public for the most part perhaps does not.

 

Originally, few “home remedies” to make the virus less virulent appeared in the popular press, although Web M. D. did discuss taking Vitamin D3 as a preventive measure in March 2020: https://pubmed.ncbi.nlm.nih.gov/  Similarly, my STEM Library Science Blog offered an annotated bibliography on Vitamin D in April and again in July (https://evelynsmithsstemscienceblog.blogspot.com/2020/04/ ).

 

Not only has knowledge about how to deal with COVID-19 grown, but the virus itself has mutated as well into a less virulent virus.  Accordingly, a single vaccination against the virus will not necessarily work as various authorities have admitted that since viruses are always changing and adapting, the COVID-19 virus will continue to infect more victims. Additionally, at least six strains of COVID-19 currently exist: https://www.sciencedaily.com/releases/2020/08/200803105246.htm

 

Masks are more likely to work if the public wears them correctly, which means covering the nostrils.  However, some individuals are more likely to wear a mask as if it were a fashion accessory: https://blogs.webmd.com/public-health/20201027/why-is-it-important-to-cover-your-nose-with-a-mask

 

It may be just me, but I am not prepared to take any vaccination that researchers rush through production without going through all the clinical trials it will need to go through. Instead, I would rather continue to take vitamin D3 and zinc and consistently eat a healthy (Mediterranean) diet, so if I contract the virus, I will most likely be able to fight the disease successfully.  These measures do not confer immunity, but usually they do tend to make COVID-19 less severe. In the meantime, I cover my nose and treat to keep my distance from those who do not do so: https://www.healthline.com/nutrition/immune-boosting-supplements#The-bottom-line  All the same, the public probably will not submit to a very restrictive second lockdown imposed from above no matter how many experts mandate it.

 

Public Health authorities have traditionally quarantined the most vulnerable populations; for example, older adults over age 70 and those with pre-existing conditions, during epidemics and pandemics rather than enforcing a lockdown on the general public. This is what Israel has tried to do, although it has also imposed some general lockdowns https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-020-01191-7

 

A few states skewed the COVID-19 statistics for the United States because they housed elderly COVID-19 patients with the general population in nursing homes rather than in closed wards reserved only for COVID-19 patients. https://nypost.com/2020/06/27/almost-half-of-us-covid-19-deaths-are-linked-to-nursing-homes/

 

 Social isolation results in increased mental health problems and a decimated economy, which in turn causes more societal problems:  drug abuse, alcoholism, suicide, child abuse and neglect, for instance: https://www.psychologytoday.com/us/blog/head-games/202003/what-are-the-psychological-effects-quarantine.

 

Most elementary school and middle and high school students definitely need to be attending classes in person (https://owlcation.com/academia/Why-Traditional-Classroom-Learning-is-Better-than-Online-Courses) because a) single parents need to work; b) someone (usually a teacher) is more likely to discover and report child abuse and neglect if a child is attending school; c)  isolation can lead to depression; d)  public school students are more likely to complete their assignments and do well in school if they keep to a schedule, which in many instances they can only accomplish by attending a physical classroom. e) Students also need to exercise and participate in sports. f) Yes, personal affirmation and encouragement works better in person than Online or on Zoom. Of course, schools may need to switch to virtual school only temporarily if not enough substitute are available to cover classes for quarantined teachers. By necessity, this will also limit or cancel the students’ summer vacation.

 

Unfortunately, in the United States, both Democrat and Republic politicians and the media have politicized the COVID-19 virus more than they should have. No easy answers exist, although eventually the disease will completely run its course as did the Spanish Flu in 1918 and 1919. Even so, it definitely should not become a vehicle for social engineering! 

 

Perhaps, however, COVID-19 will be a spur that prods Americans into taking better care of their health, thus cutting the incidence of diabetes, heart disease, and obesity by diet and exercise.

 

Never under estimate the power of prayer.  Even with public health measures that limit the size of a congregation and mandate the wearing of masks, the faithful need the in-person support of fellow believers.

 

 

 

In Other News: The United Kingdom has launched the Open Safely Platform--a Internet compendium of actual patient cases. So when will the United States launch a similar site? (11/21/2020) See: https://opensafely.org/

Reducing the Severity of COVID-19

Using Vitamin Supplements and Diet to Lessen COVID-19 Mortality Rates

Evelyn E. Smith

Since a safe and effective COVID-19 vaccine may take months to materialize (Mukherjee), the public is looking for ways to lessen the severity of COVID-19 as it spreads to a younger population while most of the public also sees the necessity of opening up the economy.  At the same time, parents, teachers, and politicians are engaged in a debate weighing the pros and cons as to whether children should return to school in September.  Accordingly, now is the time to plan a preemptive response that will decrease inflammation should anyone come down with COVID-19. After all, the original intent of the lock down was to flatten the curve while protecting the most vulnerable--the elderly and those with chronic health problems--notably diabetes and cardiovascular disease.  

Please remember that the suggestions listed below will not prevent anyone from catching the COVID-19 virus, but they might lessen its severity.  Individual and family pro-active stances include,

1)    Taking a multi-vitamin or vitamin supplements that contain at the minimum the Recommended Daily Allowance of vitamins A and D and zinc, selenium, and magnesium trace elements (Jayawardenaab, Calder), although everyone should consult a physician before taking this step,

2)    Adhering to a healthy Mediterranean diet (Mediterranean diet),

3)    Spending time in the sun for at least 15-minutes (Chan),

4)    If obese (Adult BMI Calculator, CDC), gradually losing five percent of one’s body weight with a physician's supervision since COVID-19 more ruthlessly strikes over-weight individuals (Javawardenaab). 

Intervention is necessary since admittedly some people are more at risk than others; for example, in the United States, Americans with preexisting conditions make up six times more of all hospitalizations and 12 times more of all deaths. These conditions include cardiovascular disease, chronic liver disease, diabetes, cancers that suppress the immune system, HIV/AIDS, tuberculosis, chronic neurological disorders, and sickle-cell disease.  Hence, 22 percent of the world’s population is at risk (Saplakoglu).

Public Health departments and charities, such as the Salvation Army and religious groups, also need to launch practical responses that go beyond requiring social distancing, hand washing, and the wearing of face masks as they sponsor diet and exercise programs that target specific populations to bring down COVID-19 mortality rates: According to the Center for Disease Control, 42.4 percent of American adults are obese.  Broken down by ethnic groups, 49.6 of adult blacks are obese, 44.8 percent of adult Hispanics are obese, 42.2 percent of adult whites are obese, and 17.4 percent of adult Asians are obese. Americans with a college education, however, are less likely to be obese (Adult obesity facts). 

a)    Adults age 65 and older, although those over age 70 are most at risk,

b)     Adults with preexisting chronic health problems,

c)    Adults of with sub-Saharan-African ancestry and other dark-skinned populations since dark skin tones are less likely to absorb Vitamin D than lighter skin tones (Parva).

At the same time, school and YMCA programs for youth and children can also ward off life-long health problems like obesity and diabetes while adhering to social-distancing recommendations. The Center for Disease Control and Prevention notes that 18.5 percent of American children and adolescents are obese.  This holds particularly true for Hispanics (25.8 percent) and African American children and teens (22 percent) when compared with white American (14.1 percent) and Asian (11 percent) children and teens  as well as children and teens from lower  and middle income families (Childhood obesity facts).

Steps that both governments and private groups, such as the YMCA, the Salvation Army, community colleges, and religious organizations can take to bring down the mortality rate of COVID-19 include

1)    Publicizing how everyone can take positive steps to lessen the severity of COVID disease, explaining the link between obesity, a diet deficient in Vitamin D, and higher death rates from COVID-19 and other respiratory viruses,

2)    Opening or keeping open supermarkets that operate in inner city “food deserts”,

3)    Starting walking and bicycling clubs outdoors to both take off excess weight and absorb the sun’s ultra-violet light that produces natural Vitamin D: Potential recruits for these programs might include all ages of adults and children who might participate individually or with families, night-shift workers, the obese, individuals with preexisting conditions, and individuals with darker skin tones since their skin receives less vitamin D from the sun.

4)    Starting community and high school and middle school Victory gardens that lend out gardening tools, so individuals and families can grow fresh fruits and vegetables.

5)  Schools could hold outdoor classes, letting the children spread out and possibly take off their face masks.

6)  Schools, colleges, and universities could provide multi-vitamin supplements to their students and faculty.

Additionally, parks and recreation departments, health clubs, community college adult learning programs, and health food stores can offer discounts for potential customers with chronic conditions, interesting them in taking part in outdoor exercise programs and taking vitamin supplements, and weight loss programs like Weight Watchers can offer similar incentives as well as taking these programs into the workplace. Restaurants and supermarkets can also offer heart-healthy diet specials.

The Research Behind this Annotated Bibliography

While Online sources might be touting all kinds of exotic supplements, initial studies are yet to be backed by clinical trials.  Even so, a few well-executed Boolean searches on Google and PubMed turn up the following helpful, research-based hints that readers might wish to ask their doctors about while they simultaneously adopt a Mediterranean style or similarly healthy ethnic diets and walk 30 minutes a day to take-off excess weight, while getting at least 15 to 30-minutes a day of healthy sunshine, which is, of course, the main source of vitamin D (Raman). This is also important since regular daily exercise reduces depression and anxiety in both children and adults (Depression and Anxiety, Mayo Clinic).

Google Scholar and a Must-Read Reference

If the medical community as well as the general public wishes to improve its ability to enhance natural immune responses to COVID-19, readers should consult the following review published in the July/August 2020 issue of Diabetes & Metabolic Syndrome: Clinical Research and Reviews. Researchers plowed through over 600 articles on vitamins and minerals and their ability to increase immune response in viral infections, including COVID-19, whereupon they were able to offer some very practical recommendations that almost everyone can put into action.

Javawardenaab, Ranil, Sooriyaarachchibc, Piumika,and Chourdakisd, Mkchail, et al.  (2020, July-August) Enhancing immunity in viral infections, with special emphasis on COVID-19: A review.  Diabetes & Metabolic Syndrome: Clinical Research and Reviews. (https://doi.org/10.1016/j.dsx.2020.04.015. https://www.sciencedirect.com/science/article/pii/S1871402120300801#!).

Using keywords to search PubMed, Web of Science, and SciVerse Scopus medical databases, and winnowing pertinent articles down from 640 documents to 43 articles, researchers determined that vitamins A and D potentially benefited nutritionally deficient populations while selenium and zinc were most likely to enhance immune response. Malnutrition, of course, increased morbidity and mortality rates.

Vitamin D was particularly beneficial in heightening immune response in influenza A and B, parainfluenza 1 and 2, and Respiratory syncytial virus. (RSV). Researchers also noted that zinc deficiency links with increased susceptibility to infectious diseases, including viruses.

Recommendations: 

·         Everyone should consume five portions of fruits and vegetables daily.

·          Meals should also contain a whole-grain starchy carbohydrate.

·         Two to three portions of broiled or baked fish, poultry, or lean meat (or its vegetarian equivalent) should be part of a daily diet.

·         Obese individuals should lose five percent of their body weight over a 12-week period to improve immunity.

Since both PubMed and Google Scholar are available to the general public and do not require access to a university database, all Internet users can continue to access these sources and perhaps perform some searches on their own.

PubMed Sources: Supplementing Diet and Sunshine

Vitamin D intake needs to be backed up by adequate nutrition to maintain a functioning immune system, which will lessen the severity of COVID-19 and other respiratory viral infections.  At this point in time, however, articles published in medical journals are scanty at best:

Calder, Philip C., Carr, Anita, Gombart, Adrian F., and Eggersdorfer.  (2020, April 23) Optimal nutritional status for a well-functioning immune system is an important factor to protect against viral infections. Nutrients. 12(4): 1181. doi: 10.3390/nu12041181. Free PMC article.(https://pubmed.ncbi.nlm.nih.gov/32340216/).

Nutrition’s role in the immune system is “well-established” particularly when it comes to treating acute respiratory tract infections.  Hence vitamins A, B 6, B 12, C, D, E, and Folate  as well as trace elements, including zinc, iron, selenium, magnesium, copper, and omega-3 fatty acids found in oily fish and fish and krill oil all play “important and complementary roles in supporting the immune system”.  Thus, the authors recommend taking at the minimum Recommended Daily Allowance of vitamins and minerals and as necessary taking separate supplements within the R. D. A. upper safety limits specifically for Vitamin C and D. 

Grant, William, Lahore, Henry, McDonnel, Sharon L., et al. (2020, Apr 2). Evidence that vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths.  Nutrients. 12(4): 988. doi: 10.3390/nu12040988. Free PMC article. (https://pubmed.ncbi.nlm.nih.gov/32252338/).

Vitamin D supplements might help reduce the risk of respiratory infections, including influenza and COVID-19 because they lower viral replication rates and reduce concentrations of pro-inflammatory cytokines that produce inflammation in the lining of the lungs. Several, but not all, observational studies and clinical trials have noted that vitamin D supplements also reduce the risk of influenza. Accordingly, the researchers recommend taking 10,000 IU/ d of Vitamin D 3 for several weeks to raise 25(OH)D concentrations above the 40-60 nh/m: (100-15- nmol/L). They also suggest that even higher doses approved by the patient’s physician might be useful for those individuals already infected with COVID-19.  However, they caution that randomized controlled trials and larger population studies are necessary to evaluate this advice.

Iddir, Mohammed, Brito, Alex, Dingeo, Giulia, et al. (2020 May 27). Strengthening the immune system and reducing inflammation and oxidative stress through diet and nutrition: Considerations during the COVID-19 crisis. Nutrients. 12(6): E1562. doi: 10.3390/nu12061562.  Free PMC Article. (https://pubmed.ncbi.nlm.nih.gov/32471251/).

Sufficient protein intake remains crucial for optimal antibody production during the Coronavirus pandemic while low micro-nutrient absorption correlates with inflammation and oxidative stress that can weaken the immune system. Dietary nutrients particularly high in anti-inflammatory and antioxidant capacity include vitamin C and E as well as carotenoids; for instance, lutein, and polyphenols; for example, ginkgo biloba.  Additionally, vitamin D is also particularly effective in reducing inflammation.

Obese patients may also particularly benefit from Vitamin D supplements, so they should ask their physicians if they need to take a higher dosage of Vitamin D supplements than the R.D.A. for adults and older adults.

Farhanghi, Mahdieh Abbasalizad, Mahboob, Soltanali, and Ostadrahimi.  (2009, April). Obesity induced magnesium deficiency can be treated by vitamin D supplementation.  JPMA:  The Journal of the Pakistani Medical Association. 59)4: 258-61.  Free Article. (https://pubmed.ncbi.nlm.nih.gov/19402296/).

A study of 82 Pakistani women aged 17 to 50 years that compared the magnesium and vitamin D levels in both the obese and those of normal weight found that levels of both Vitamin D and magnesium were lower than that of average weight individuals: 27 percent of obese women were deficient in magnesium.  A subsequent vitamin D injection thus caused a significant increase in magnesium levels in the obese women but not in the women of average weight. Thus, researchers concluded that magnesium levels can be modified by an increased intake of vitamin D.

Both Vitamin D and magnesium deficiency are also common in older adults, but when an increased magnesium intake complements Vitamin D intake, this reduces mortality rates in older individuals because adequate levels of magnesium are necessary for the body’s absorption of Vitamin D. 

Note: Adults age 60 and older and individuals with preexisting conditions should follow the advice of health professionals:

Reddy, Pramod and Edwards, Linda R (2019, Jan/Feb).  Magnesium supplementation in Vitamin D deficiency. American Journal of Therapeutics.  26(2): e124-e132. doi: 10.1097/MJT.0000000000000538. (https://pubmed.ncbi.nlm.nih.gov/28471760/).

Vitamin D and magnesium replacement therapy reduces non-vertebral fractures, overall mortality and the incidence of Alzheimer’s dementia in older individuals.  Vitamin D screening is “readily available”, but no “simple and adequate” laboratory tests measures magnesium deficiency.  Even so, magnesium is essential for the metabolism of vitamin D.

Xinqing Deng, Yiqing Song, Manson, JoAnn E., et al. (2013, August 27). Magnesium, vitamin D status and mortality: Results from US National Health and Nutrition Examination Survey (NHANES) 2001 to 2006 and NHANES III. BMC, 11:187. doi: 10.1186/1741-7015-11-187. doi: 10.1186/1741-7015-11-187.   Free PMC article. (https://pubmed.ncbi.nlm.nih.gov/23981518/).

Independent studies have found that high intake of dietary or supplemental magnesium correlates with reduced risks of vitamin D deficiency.

Shea, M. Kyla, Booth, Sarah L., and Massaro, Joseph M. et al. (2008, Feb.1). Vitamin K and vitamin D status: Associations with inflammatory markers in the Framingham offspring study. American Journal of Epidemology. 167(3): 310-320. doi: 10.1093/aje/kwm306. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3151653/).

In a community-based sample, researchers found an inverse association between maintaining an adequate level of Vitamin K and inflammation.  However, the same sampling of vitamin D status did not consistently find systemic inflammatory markers. Both dietary and non-dietary factors determined the variation of vitamin D markers, and researchers also wondered if inflammation caused by vitamin D deficiency might not show up in a sample of healthy older adults.  Additionally, since study participants were primarily of northern European descent living in the Northeastern United States, the study could not apply these findings to other ethnic groups, younger people, or individuals living in “sunnier climates”.

Building Immune Responses to Viral Infections: Reputable Articles Accessed Via Google

Understanding how to lessen the effects of COVID-19 through preventive medicine, of course, is a work in progress as this University of Oxford article shows.

Chan, T H. (2020, April 1).  Ask the expert:  The role of diet and nutritional supplements during COVID-19.  The Nutrition Source.  Harvard School of Public Health. (https://www.hsph.harvard.edu/nutritionsource/2020/04/01/ask-the-expert-the-role-of-diet-and-nutritional-supplements-during-covid-19/)

To further understand the link between nutrition and immunity, Chen consulted a panel of experts, who offered his audience some advice.

COVID-19 appears to be more severe when it infects older adults with chronic, preexisting conditions like diabetes, hypertension, and cancer because of their nutritional needs.

A healthy diet that boosts the immune system highlights the consumption of fruits, vegetables, whole grains, legumes, and nuts, allows for the moderate consumption of fish, dairy, and poultry, and limits the intake of red and processed meats, carbohydrates and sugar. Sticking to a healthy diet also prevents unintended weight loss and ensures that the body is making enough immune cells and antibodies.

Many people’s diets do not meet recommended daily allowance guidelines, and since studies show taking supplements can reduce the severity of viral infections, taking vitamins D, C, and zinc will quite possibly have the same effect on COVID-19. 

Although the body produces Vitamin D when the skin is exposed to sun light, levels of vitamin D in the blood tend to be low during the winter and spring months when people stay indoors. Taking a multi-vitamin with the Recommended Daily Allowance of vitamin D is a solution to this lack of sun exposure for those with light skin tones, but individuals with darker skin tones may need up 4,000 International Units a day during the winter months since melanin in the skin blocks ultraviolet light.

If Vitamin D supplements are unavailable, and/or or if one is concerned about taking dangerous levels of vitamin D supplements, individuals with lighter skin tones should spend 15 minutes mid-day in the sun while individuals with darker skin tones might need to spend three to four times longer in the sunshine.

Lee, Joseph, van Hecke, Oliver, and Roberts, Nia. (2020, May 1). Vitamin D: A rapid review of evidence for treatment or prevention in COVID-19. CEBM. (https://www.cebm.net/covid-19/vitamin-d-a-rapid-review-of-the-evidence-for-treatment-or-prevention-in-covid-19/).

Performing Boolean searches from April 14, through April 23, 2020, researchers turned up no evidence that linked vitamin D deficiency with the likelihood of catching COVID-19.  They did, however, determine that taking a Vitamin D 3 supplement over weeks or months might prevent other acute respiratory infections in individuals deficient in vitamin D.  Even so, they recommended that all United Kingdom citizens should take a vitamin D 3 supplement, although they also suggested that 97.5 percent of the British population should be able to maintain sufficient vitamin D levels by just including oily fish, red meats and egg yolks in their diet and exposing their skin to ultra-violet light daily—in other words, taking a 15 to 30-minute walk outside on their lunch hour. Nevertheless, researchers admitted that older adults, individuals diagnosed with chronic diseases, and individuals with darker skins might be deficient in vitamin D.  Of course, no clinical trials have yet published reported results, and no peer reviews of the Oxford study yet exist.

Hamblin, James (2020, June 3) Paging Dr. Hamblin: Does vitamin D help fight COVID-19? The Atlantic. (https://www.theatlantic.com/health/archive/2020/06/paging-dr-hamblin-can-vitamin-d-stop-coronavirus/612547/).

One-sentence Synopsis: Taking 1,000 IU of vitamin D daily “is reasonable to do, given the circumstances.”

·         Soon after the COVID-19 pandemic began in China, Chinese researchers prescribed taking Vitamin D to lessen the severity of COVID-19.

·         In April 2020, Philippine research discover a link between higher vitamin D levels in the blood and higher survival rates.

·         In May 2020, a Northwestern University study found that high COVID-19 mortality rates correlated with lower levels of vitamin D. Indeed, the study found that vitamin D not only strengthens the immune system, but it also might prevent it from becoming overactive, resulting in a cytokine storm, “a misdirected inflammatory response” that kills COVID-19 patients.

Thus, even though clinical trials as of June 2020 do not back up this initial research, doctors are beginning to recommend taking vitamin D supplements.  This, however, comes with two caveats:

1)    Taking excessive amounts of Vitamin D can be hazardous to one’s health (Gaby, Zeratsky).

2)    The inability of darker skin tones to absorb as much Vitamin D as easily as lighter skin tones do does not fully explain the gap in mortality rates that exists between black Americans (13 percent of the population with 24 percent of the COVID-19 mortality rate) and white Americans because age, chronic preexisting conditions, poor nutrition, stress levels, income, and status [Lower-income African Americans often live in food deserts] all influence immune health (Hamblin).

References

Adult BMI calculator. (n.d.) Centers for Disease Control and Prevention. (https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html).

Adult obesity facts: Overweight and obesity. (2018).  Center for Disease Control (CDC). (https://www.cdc.gov/obesity/data/adult.html).

Childhood obesity facts. (2019, July 24). Center for Disease Control and Prevention. (https://www.cdc.gov/obesity/data/childhood.html).

Depression and anxiety: Exercise eases symptoms. (2017, January 27), Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495

Gaby, Alan. (2011, January 11).  Is too much vitamin D dangerous? Bottom Line, Inc. (https://bottomlineinc.com/health/supplements/is-too-much-vitamin-d-dangerous).

How to safely get vitamin D from sunlight.  Healthline. (https://www.healthline.com/nutrition/vitamin-d-from-sun#bottom-line).

Mediterranean diet: A heart-healthy eating plan. (2019, June 21).  Healthy lifestyle. Nutrition and healthy eating.  Mayo Clinic. (https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/mediterranean-diet/art-20047801),

Mukherjee, Siddharta. (2020, June 9).  Can a vaccine for Covid-19 be developed in record time?  The New York Times Magazine.  

(https://www.nytimes.com/interactive/2020/06/09/magazine/covid-vaccine.html).

Parva, Nareen R., Tadepalli, Satish, et al. Prevalence of Vitamin D deficiency and associated risk factors in the U.S. population. Cureus.
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/).

Raman, Ryan. (2018, April 28). How to safely get vitamin D from sunlight.  Healthline. (https://www.healthline.com/nutrition/vitamin-d-from-sun#bottom-line).

Saplakoglu, Yasemin. (2020, June 16). 1 in 5 people across the globe are at risk of developing COVID. (https://www.livescience.com/coronavirus-risk-underlying-health-conditions.html).

Zeratsky, Katherine. (2020, April 17). What is vitamin D toxicity?  Healthy Lifestyle: Nutrition and healthy eating.  Mayo Clinic.(https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108).

Addendum

If readers remember the plot of The Cat in the Hat, one solution to a problem results in another problem that needs remedying. Applying this principle to face masks, they bring up a new health problem known as "mask mouth", which results in gingivitis, which in turn can result in Alzheimer's as well as strokes. Admittedly, no PubMed or Google Scholar articles as yet are available on "mask mouth", but there is medical research that links gingivitis to dementia: 

In other words, 1) brush after every meal particularly if wearing a face mask for any length of time, 2) take a mask removal break at work after safely distancing oneself from others and remove the mask, and 3) invest in an electric toothbrush. Finally, comparative studies have finally caught up with the coronavirus, revealing a correspondence between deficient vitamin D3 levels and severe ratner than asystematic cases of COVID-19.

  

Jain, A., Chaurasia, R., Sengar, N.S. et al. Analysis of vitamin D level among asymptomatic and critically ill COVID-19 patients and its correlation with inflammatory markers. Nature (2020, November 19). https://www.nature.com/articles/s41598-020-77093-z" >

  

In a six-week observational study of both asymptomatic and severely-ill COVID-19 patients, researchers documented that 32.96 percent of the asymptomatic (Group A) patients were deficient in vitamin D while 96.82 percent of the severely-ill (Group B) were deficient in vitamin D. An inflammatory response was higher in vitamin D deficient individuals.

Miller, Andrew Mark.  (2020, August 7). Dentists say 'mask mouth' can cause serious health complications, including stroke.  Washington Examiner. https://www.washingtonexaminer.com/news/mask-mouth-dentists-warn-prolonged-use-of-masks-leading-to-poor-oral-hygiene?fbclid=IwAR3aKpc9k8Ho-AwwyMRzNZUNNpa4AC1c92WgdeJq3DYtvB5zZ0hjVrX3sYM  

Siddiqui, Huma, Eribe, Emenike, et. al. (2019).  High throughput sequencing detects gingivitis and periodontal oral bacteria in Alzheimer's Disease autopsy brains.  Journal of Neuroscience Research. 1(1).  doi:  https://doi.org/10.357102/nrj.10003

 https://www.researchgate.net/profile/Emenike_Eribe/publication/337260973_High_Throughput_Sequencing_Detects_Gingivitis_and_Periodontal_Oral_Bacteria_in_Alzheimer's_Disease_Autopsy_Brains/links/5dcd9ce84585156b35135bae/High-Throughput-Sequencing-Detects-Gingivitis-and-Periodontal-Oral-Bacteria-in-Alzheimers-Disease-Autopsy-Brains.pdf

Proactive Medicine: Getting Some Sunshine and Vitamin D to Fight COVID-19

 Shining the Light on Getting Enough Vitamin D to Counter COVID-19

Evelyn E. Smith

While up to now public health physicians and task forces have concentrated on self-isolation and quarantine as a means of controlling the COVID-19 virus, increasingly independent sources have started to urge readers to take a proactive approach to combatting COVID-19 by making sure they have a healthy immune system to start with since a healthy immune system as well as a body free from co-morbidities is better equipped to fight all respiratory viruses. Moreover, this spring and summer everyone can immediately start to take three proactive steps to enhance over-all physical health:

1)     Ask for a blood test to check for possible Vitamin D deficiency, and then maintain appropriate Vitamin D levels by getting enough sunlight for one’s skin type; and if necessary, take the appropriate level Vitamin D supplement upon the advice of a physician since it is also most important not to take too much Vitamin D in supplement form.

2)    Follow a regular aerobic exercise routine outdoors for thirty minutes five days per week*.

3)    Maintain a healthy diet, which if adhered to, will bring down high blood pressure and improve cardiovascular health.

Today’s topic, however, shines the light on the easiest  and perhaps most inexpensive step anyone can take—getting enough Vitamin D, which, of course, results when both the liver and the kidneys take the Vitamin D found in sunlight, and to a lesser extent in fatty fish, eggs, and fortified milk and cereals, and convert it into calcium.

Thus, the cure for vitamin D deficiency and a weak immune system is for the most part is a relatively simple one:

a)    Get enough sunshine every day when the sun shines during the spring and summer months.

b)    As necessary (upon the advice of one’s physician) take the appropriate level of a Vitamin D supplement. No peer-reviewed studies or randomized trials as yet exist as to whether spending time in the sun or taking a Vitamin D supplement will decrease the mortality rate of COVID-19, but improving the immune system's health will not hurt anyone. 

Pointing Out Vitamin D Deficiency Might Be Controversial:

Here is where some controversy comes into play since darker skin tones absorb less Vitamin D found in sunlight than lighter skin tones:

As Found on YouTube:

Campbell, John. (2020, April 15). Vitamin D and immunity, lots of evidence. YouTube. https://www.youtube.com/watch?v=GCSXNGc7pfs

British medical practitioner Dr. John Campbell argues that evidence is strong enough that Vitamin D deficiency might increase the severity of viruses that listeners should ask their physician whether they should be taking vitamin D supplements during the COVID-19 pandemic. He also points to Public Health England’s recommendation that everyone in England should take a daily 10 microgram supplement in autumn and winter. Moreover, Campbell also recommends that individuals with darker skin tones take a Vitamin D supplement throughout the year.

Translation: Instead of taking only the Politically-Correct sociological approach adhered to by American academics to explain the discrepancy in the mortality rates between African, Hispanic, and Native Americans and European Americans [living in food deserts, undue stress caused by social inequality, prevalence in service occupations], some British physicians, including John Campbell, are adhering to a natural selection argument for taking Vitamin D during the COVID-19 pandemic: Light-skinned people manufacture more Vitamin D than those individuals with darker skin tones, which protect them from the sun. Additionally, during the winter months, or when everyone is confined to the indoors, a large percentage of the population of all skin tones is likely to be Vitamin D deficient—a condition that correlates--but does not necessarily cause--various comorbidities, or preexisting health conditions.

Then again, food deserts do exist in the United States as does social inequality. However, taking an adult multi-vitamin everyday might be the prudent course of action for all adults to do. 

Moreover, additional research also suggests another explanation for the higher mortality rate among African Americans:

Kiddie, Jason. (2020, April 8).  A possible explanation for the COVID-19 racial disparity.  Medpage Today. https://www.medpagetoday.com/infectiousdisease/covid19/86023

A deficiency of L-arginine and subsequently nitric oxide is another possible explanation for why African American death rates are higher than white American death rates. 

Online Nutrition Sources

Espostio, Lisa and Kotz, Deborah. (2018, July 18). How much time in the sun do you need for vitamin D.  U.S. News & World Report. https://health.usnews.com/wellness/articles/2018-07-18/how-much-time-in-the-sun-do-you-need-for-vitamin-d

In the winter, everyone living in the Northern Hemisphere 37 degrees North of the equator (or anywhere North of Atlanta, Georgia) does not get enough sun in the winter months to absorb enough Vitamin D from sunlight. Although over sun exposure increases the risk of melanoma and skin cancers, Northern Europeans should allow for 10 to 15 minutes of unprotected sun exposure between 10 a.m. to 3 p.m. However, Hispanic, Native, and African Americans as well as Europeans who tan easily may need 15 to 20 or more minutes of sun exposure mid-day to achieve this dosage. Since individuals deficient in Vitamin D double their risk of dying from heart disease, most studies now recommend achieving a balance between getting in a little midday unprotected sun exposure most days of the week and the habitual use of sunscreen.

Grant, William B, Lahore, Henry, et al. (2020, April 12). Evidence that Vitamin D supplementation could reduce risk of influenza and COVID-19 infections and deaths. Nutrients. https://www.mdpi.com/2072-6643/12/4/988

Even though some studies and clinical trials report that adequate intake of Vitamin D reduces the risk of influenza, others do not report these findings. Grant and his fellow researchers, however, point to the lower number of COVID-19 cases in the Southern Hemisphere during the first three months of 2020 as well as to findings that vitamin D deficiency contributes to acute respiratory distress syndrome (ARDS), and that case fatality rates increase with age and with chronic disease comorbidity as circumstantial proof that relates low levels of Vitamin D with increased mortality rates associated with COVID-19. The researchers thus recommend that those most at risk for COVID-19; for example, the elderly and those diagnosed with comorbidities, take 10,000 I.U. of Vitamin D supplements to rapidly raise their levels of Vitamin D. Even so, the researchers nevertheless caution that controlled trials and larger population studies will need to prove this hypothesis.

Bottom Line:  Consult a physician before taking the appropriate-level Vitamin D supplement.  Remember more Vitamin D, however, is not necessarily better, for it may damage the liver and kidneys.

Public Health England Asks Brits to Take Vitamin D

Hancocks, Nikki. (2020, April 23). Public Health England extends vitamin D supplement advice during lockdown. Nutraingredients. https://www.nutraingredients.com/Article/2020/04/23/Public-Health-England-extends-Vitamin-D-supplement-advice-during-lockdown

England’s National Health Service is advising its entire population to take a daily supplement of 10 micrograms of Vitamin D to avoid Vitamin D deficiency since they might not be getting enough sunlight during the quarantine. This advisory particularly applies to high-risk individuals and the elderly. New research findings are not the reason for this advisory, however.

Mayor, Susan. (2016, July 21). Public health England recommends vitamin D supplements in autumn and winter. The BMJ [British Medical Journal]. https://www.bmj.com/content/354/bmj.i4061

Since diet alone will not allow the English to achieve their recommended daily dose of Vitamin D during the autumn and winter months, Public Health England recommends that both children and adults should take a daily vitamin D supplement during that part of the year.

Medical Sources for General Audiences

Hensrod, Donald. (2017, April 25). Mayo Clinic Q. and A. How much vitamin D do I need? Mayo Clinic. https://newsnetwork.mayoclinic.org/discussion/mayo-clinic-q-and-a-how-much-vitamin-d-do-i-need/

Vitamin D. deficiency is associated with osteoporosis, multiple sclerosis, rheumatoid arthritis, chronic pain, and such comorbidities as diabetes, high blood pressure, cardiovascular disease, and some cancers, although correlation does not mean that vitamin D deficiency causes these conditions. The skin absorbs most Vitamin D from the sun, although individuals wearing a sunscreen with an SPF factor of 8 or greater and dark-skinned individuals may not be absorbing enough Vitamin D from sunlight. Foods with vitamin D include egg yolks, cheese, cod-liver oil, beef liver, and fatty fish, such as tuna, salmon, sardines, herring, and mackerel. U.S. markets also fortify milk with Vitamin D.

Kubala, Jillian. (2020). Can Vitamin D lower your risk of COVID-19? Healthline. https://www.healthline.com/nutrition/vitamin-d-coronavirus

Currently, no known preventive measures apart from social distancing and maintaining proper hygiene practices can keep anyone from coming down with the Sars-COVID-19 virus; however, some research shows that maintaining a healthy level of vitamin D generally guards against respiratory diseases since Vitamin D enhances the function of immune cells.  Conversely, studies associate low levels of Vitamin D with an increased susceptibility to infectious diseases and immune-related disorders, including tuberculosis, asthma, COPD, and viral and respiratory infections. Taking a Vitamin D supplement also reduces the morality rate in older adults. Typically, the prescribed supplement dosage is between 1,000 and 4,000 I.U. daily.

Note:  Everyone should consult a physician before taking Vitamin D supplements, so as not to overdose oneself.

Sunlight destroys coronavirus quickly, say US scientists. (2020, April 24).  https://medicalxpress.com/news/2020-04-sunlight-coronavirus-quickly-scientists.html?utm_source=join1440&utm_medium=email&utm_placement=itkst

Medical science has long understood that radiation damages any virus’s ability to reproduce, but now researchers have determined the exact amount of time it takes.

COVID-19’s half-life, or the time it takes for it to reduce to half its amount on hard surfaces is 18 hours with a room temperature of between 79 to 75 degrees Fahrenheit, or 21 to 24 degrees Celsius, but this time span reduces to just six hours when the humidity rises to 80 percent and to just two minutes when the virus is in the presence of direct sunlight.  As for an aerosol (suspended in air) COVID-19 virus, while its half-life is one hour when the temperature is between 70 to 75 degrees Fahrenheit  with 20 percent humidity, in the presence of sunlight, the time it takes to destroy the virus drops to one and a half minutes.

PubMed, National Library of Medicine Sources

It is a little too soon for a peer-reviewed, randomized clinical trial on whether Vitamin D works, but rest assured one is in the works.

Parva, Nareen R., Tadepalli, Satish, et al. Prevalence of Vitamin D deficiency and associated risk factors in the U.S. population. Cureus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634

Parva et al note that 82.1 percent of African Americans are Vitamin D deficient, and 62.9 percent of Hispanic Americans are Vitamin D deficient. Additional risk factors for Vitamin D deficiency include obesity, not enough regular milk consumption, and a formal education that does not go past secondary school. The primary source of Vitamin D is sunlight while fatty fish, such as salmon and tuna, is another natural source of Vitamin D.

In other words, researchers urge that everyone who lives at a Northern latitude, all dark-skinned people, and those with pre-existing conditions should take Vitamin D supplements while light-skinned people, who are likely to sunburn, should limit their mid-day sun exposure during the summer months while at the same time getting enough Vitamin D.

Editorial Note: Of course, a Mediterranean diet that features the consumption of fatty fish  at least twice a week would probably decrease the cholesterol levels of all concerned**; and scheduling a brisk 30-minute mid-day walk outdoors might lower everyone’s risk of cardio-vascular disease, hypertension, and diabetes.

Teymoon-Rad, M., Shokri, F., et al. (2019, March). The interplay between vitamin D and viral infections. Reviews in Medical Virology. doi. 10 1002/my2032. https://www.ncbi.nlm.nih.gov/pubmed/30614127

Regularly monitoring Vitamin D levels is necessary, even though post-modern medicine has yet to fully understand the affect Vitamin D has on viral infections.

Vitamin D on prevention and treatment of COVID-19 z9COVITD-19). (Updated: 2020, April 17). ClinicalTrials.gov. U. S. National Library of Medicine. https://www.clinicaltrials.gov/ct2/show/NCT04334005

In a currently ongoing, 200 participant, randomized clinical trial, “The Effect of Vitamin D Administration on Prevention and Treatment of Mild Forms of Suspected Covid-19”, researchers have hypothesized that the administration of Vitamin D supplements will produce significant improvement in the heath status for those patients diagnosed with non-severe, symptomatic COVID-19.  Similar research relates reduced levels of Vitamin D with the cause of bovine coronavirus in the past. The targeted completion data for this trial is 30 June 2020.

______

*Laskowski, Edward R (2016).  How much should the average adult exercise every day.  Health-lifestyle/ Fitness. Mayo Clinic. https://www.mayoclinic.org/healthy-lifestyle/fitness/expert-answers/exercise/faq-20057916

The United States Department of Health and Human Services recommends taking 150 minutes of moderate aerobic exercise, or 75 minutes of strenuous aerobic exercise, during a week as well as the strength training of all major muscle groups twice weekly.  This might mean taking a brisk walk for thirty minutes five days a week.

***Fish and Omega-3 fatty acids. (2017, March 23).  American Heart Association. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/fish-and-omega-3-fatty-acids

The American Heart Association recommends eating two servings a week of fatty fish (salmon, mackerel, herring, trout, sardines, albacore tuna), although the public should avoid eating fish with the highest potential or mercury contamination.

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