Vitamin D
Vitamin D AND the Immune System
COVID-19 is increasingly on people’s minds and many are focusing on how to keep their immune systems strong. There is a link between vitamin D and strong immune systems. Vitamin D can regulate the innate and adaptive immune responses. When vitamin D is deficient there is a link to autoimmune disease and an increased susceptibility to infection. Cod liver oil, which has a high content of vitamin D, is often used in tuberculosis treatment. A report that included almost 19,000 patients from the years of 1988 to 1994, showed patients reporting low levels of vitamin D (<30 ng/ml) also self-reported recent upper respiratory infections. Although recent studies have not shown consistent results, most likely due to methodological concerns, there is one well-designed study in school aged children that demonstrated that vitamin D administration decreased the flu (influenza) by 42%.
What is vitamin D and what role does it play?
Vitamin D is a fat soluble vitamin that helps support healthy bones through calcium absorption, promoting bone mineralization, and providing immune and cardiovascular support. It also plays a role in muscle function and the brain function and emotional health.
Which vitamin D supplement is best? How much vitamin D?
There are two major types of vitamin D, vitamin D3 and vitamin D2. Humans produce vitamin D3, also known as cholecalciferol, in their skin when exposed to sunlight. The only other source of vitamin D3 is found in animals. Vitamin D2 is sourced from plant foods and is known as ergocalciferol.
Calcidol, also known as 25-hydroxyvitamin D3, is a pre-hormone made directly from cholecalciferol (vitamin D3). This occurs in the liver by the enzyme 25-hydroxylase CYP27A1. This pre-hormone is not active; however, it is the major form of vitamin D that circulates in the bloodstream. Vitamin D blood tests typically measure the concentration of this pre-hormone. The activated form is known as calcitriol (1,25-dihydroxyvitamin D3). The enzyme 1-alpha-hydroxlation CYP27B1, converts the pre-hormone (calcidiol) in the kidneys to the active form, calcitriol. This is the most potent steroid hormone in the body. (Yes Vitamin D is a hormone, and technically calling it a vitamin is a misnomer).
Most studies show that vitamin D3 (cholecalciferol) is more effective than vitamin D2 (ergocalciferol) at raising blood levels of calcifedol. The recommended daily dose is 2,000 IU of vitamin D3 per day. Always check with your provider before supplementing.
What about when we age, what happens to our vitamin D?
Studies have found as people age; they lose the amount of vitamin D they are able to produce from the sun. This may be a result of the loss of enzymes needed to synthesize the vitamin. Research has found that low levels of vitamin D may be linked to poor cognitive performances in seniors. In addition, if a person receives an adequate amount of vitamin D it may significantly lower levels of inflammation and physiologic stress, factors that may slow down aging.
What do my lab levels mean and what is normal?
Typically blood tests measure the levels of the inactive pre-hormone, Calcidol (25-hydroxyvitamin D3). Although this hormone is not active it is the most reliable measurement of an individual’s vitamin D level. Lab level numbers will vary from lab to lab and providers may differ in what they believe is normal or low. However, most experts recommend having a level between 20 ng/ml to 40 ng/ml, and many will also push for levels between 30 ng/ml to 40 ng/ml. In general levels below 10 ng/ml are considered deficient. If you have your lab levels drawn for vitamin D you will want to work closely with your provider to determine if your levels are low.
References:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3166406/. Accessed on March 20, 2020
- Urashima M, et al. Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren. Am J Clin Nutr. 2010; 91(5):1255–60. [PubMed: 20219962] Accessed on March 20, 2020
Is it COVID or Is it My Allergies?
Is it COVID or is it my allergies?
Spring is the season of pollen and that means allergies. But what if you are experiencing symptoms how do you know it is not COVID and it's just your alleriges?
Symptoms of COVID vs Allergies
Well per the CDC symptoms of COVID include a cough, fever, and sore throat. With allergies you will not experience a fever. This is a big clue that if you have a fever, it's probably something other than your allergies.
WIth allergies you may experience itchiness in your throat, but it should not feel sore. Also, with allergies you may experience itchy eyes, nose and ears.
With COVID you might feel extreme exhaustion, this not common with allergies. In addition, if it is your allergies you might have a runny nose and congestion and possibly a cough. However if you are feeling short of breath, where you are having trouble breathing this is probably not due to your allergies and is something else that needs medical attention.
If you are having trouble breathing or experiencing bluish lips or face, confusion or persistent pain or pressure in the chest you should seek medical attention immediately.
This post is not designed to substitute medical advice from your provider. If you have concerns, please always contact your healthcare provider.
References
- https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html accessed on 11/27/2020
COVID and Children
MIS-C stands for multi-system inflammatory syndrome. Per the CDC it is a rare but severe condition that is reported around 2 to 4 weeks after the onset of COVID-19 in children and adolescents.
The condition is serious as the features include shock (with cardiac involvement), GI symptoms and significantly elevated markers of inflammation. Inflammation may include the heart, lungs, kidneys, brain, skin, eyes and GI organs. Symptoms may also include a prolonged fever, rash, and evidence of COVID. Per the CDC the cause of MIS-C is unknown, however many children that had MIS-C tested positive for COVID-19.
Parents and clinicians should keep an eye on all children diagnosed or having symptoms of COVID, as MIS-C may not appear until weeks after being infected.
In April 2020 a cluster of children in Europe were reported to have hyperinflammatory shock with features similar to Kawasaki disease and toxic shock syndrome. As of July 29, 2020, there were a total of 570 MIS-C cases reported to the state health departments. Out of the 570 patients 10 patients were reported to have died.
In addition, based on an analysis published by the CDC, the cumulative rate of COVID-19 associated hospitalizations among children (8 per 100,0000) has been low compared to adults (164.5). However, one in three hospitalized children were admitted to an intensive care unit.
This new emerging data means children are not immune to COVID-19. Caution should be taken not only with adults and children with underlying conditions, but everyone of all ages, regardless of underlying conditions. Call your provider if you come in contact with anyone with COVID or develop any symptoms.
References:
- https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/children/mis-c.html. Accessed on August 11, 2020
- https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e2.htm. Accessed on August 11, 2020
- https://www.cdc.gov/mmwr/volumes/69/wr/mm6932e3.htm?s Accessed on August 11, 2020
Famotidine and COVID
Based on preliminary data, famotidine a common heart burn medication that is available both by prescription and over the counter, may play a role in fighting COVID-19. This is based only on a small observation on data from patients in China who had heartburn and contracted COVID-19. From the study it was observed that 22% of the 1,536 patients who were not on famotidine died or were intubated and put on a ventilator. This was compared to the 84 patients that were on famotidine and 10% died or were put on a ventilator.
What is the mechanism behind famotidine?
The answer is unclear and needs to be researched further to validate if famotidine is beneficial in COVID-19. Zantac (or ranitidine) which belongs to the same class of medication was not shown to be effective against COVID-19. In addition, computer modeling has shown that the mechanism that famotidine uses to fight heartburn may also help against COVID-19. It does not appear to bind to an enzyme as some had speculated but rather it plays a role with histamine and COVID-19. Additional studies need to be performed before an answer is concluded.
There is a study in New York that is being conducted using high doses of famotidine in IV. The researchers will be posting the results as soon the trial ends. So, should you be using famotidine? There is not enough evidence to indicate to start taking famotidine. If you have heartburn and are concerned about COVID-19 work with your provider and pharmacist.
Reference:
- https://www.cnn.com/2020/05/09/health/famotidine-covid-19-correlation-study/index.html. Accessed on June 14, 2020
- https://blogs.sciencemag.org/pipeline/archives/2020/05/29/famotidine-histamine-and-the-coronavirus. Accessed on June 14, 2020
- https://www.drugtopics.com/latest/famotidine-trial-underway-nyc-covid-19-treatment. Accessed on June 14, 2020
- https://www.cuimc.columbia.edu/news/heartburn-drug-may-have-potential-against-covid-19. Accessed on June 14, 2020
What to Know About COVID-19
What is COVID-19?
COVID-19 is a disease that is transmitted by respiratory secretions. It is a novel, or new, strand of the coronavirus. COVID-19 is from the same family of MERS and SARS and thought to have originated as an animal coronavirus that infected people and then spread from people to people.
SARS-COV-2, which is a betacoronavirus, is the virus that causes COVID-19. COVID-19 is abbreviated for coronavirus disease 2019.
The disease classification has changed from an outbreak to epidemic to now a pandemic. The differences are how fast and quickly it can spread across a region. It is a world pandemic and as of today has spread to every continent except Antarctica. Because there is little to no immunity the virus is able to spread worldwide.
How is it transmitted?
COVID-19 is a respiratory infection that can be transmitted from respiratory droplets of infected people who cough or sneeze. Therefore, the CDC recommends people to stay at least 6 feet away from each other and not in direct contact. Some people may spread the virus prior to feeling symptoms. Additional ways of contracting the virus is from touching the surface or object that may have the virus and then touching your own mouth, nose or eyes.
Who is most at risk?
Since this virus is new, everyone is considered at risk. There are certain populations that are considered higher risk than others. This includes the elderly, infants, immunocompromised patients and anyone with an underlying condition, such as asthma or diabetes. This is a large population and it is important to be aware of the symptoms.
What are symptoms of COVID-19?
It may take days until symptoms do occur, anywhere from 2 to 14 days after exposure. Symptoms include a fever, dry cough, and itchy throat. Severe cases include difficulty breathing, requiring a respirator to help them breath. Call your doctor immediately if you think you have been exposed to COVID-19 and develop symptoms. The CDC states that emergency symptoms include: difficulty breathing or shortness of breath, persistent pain or pressure in the chest, new confusion or inability to arouse and bluish lips or face. Immediately seek medical help by calling your doctor if you think you have been exposed and are experiencing symptoms.
Diabetes AND COVID
Why are patients with diabetes considered more vulnerable to COVID-19?
The World Health Organization has categorized people with underlying conditions such as asthma, immunocompromised, and diabetes at greater risk for COVID-19.
Patients with asthma have a harder time of breathing when compared to someone who does not have asthma. Since COVID-19 is a virus transmitted thru respiratory secretions this puts patients with asthma in a high risk category. Immunocompromised patients have little to no immune system placing these patients at greater risk of infection including the COVID-19 virus. These reasons put these populations at larger risk for COVID-19.
But why are diabetes patients considered high risk for COVID-19?
There are two types of diabetes, Type I Diabetes and Type II Diabetes. Both involve a deficiency or absence of the body making insulin. In Type I Diabetes the body is making little to no insulin and patients must inject with the prescription insulin. In Type II Diabetes the body is not making enough insulin and are either adapting lifestyle changes, taking medications by mouth or injection and/or injecting insulin. When the body does not have enough insulin, the body’s sugars rise. This may increase inflammation within the body and resulting in an increased risk to infections.
According to the American Diabetes Association, people with diabetes face a problem of having worse outcomes with COVID-19 and NOT a greater chance of contracting the virus. This is based on the cases in China which people with diabetes who contracted COVID-19 had higher rates of serious complications and death as compared to people without diabetes. In addition, if someone had additional underlying conditions such as heart disease and diabetes, the risk of serious complications from COVID-19 increased. When a person with diabetes contracts an infection, this increases inflammation and put’s a person at greater risk for further complications.
Some TIPS…..
Ensuring your diabetes is under control is critical. Things that may help control your diabetes is taking your medications as prescribed, checking your blood sugars levels regularly, diet and exercise, and talking to your doctor to optimize your sugar blood levels. If you have not been adhering to your medications it is critical you do to help control your blood sugar levels. Talk to your doctor or pharmacist if you have any questions or need additional tips to help control your blood sugar levels. If you have diabetes and suspect that you have contracted COVID-19 immediately seek medical care.
References:
- World Health Organization. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public/myth-busters. Accessed on March 22, 2020
- American Diabetes Association. https://www.diabetes.org/coronavirus-covid-19. Accessed on March 22, 2020