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.
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).
(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
