One of the things that we’re doing here is you’ll see we’ve got several videos that we refer you to this one is joanne manson at Harvard she’s talking about her perspective on vitamin d on bone health cardiovascular health covet 19 and some other things so i wanted to put that link on the slide so you can go take a look at that you’ll also see several other studies that have gotten to the publication level that we refer to today now we all know that vitamin d’s impact on bone health cardiovascular health pre-diabetes diabetes is a big deal there’s emerging evidence and at this point maturing evidence that it’s relevant against covet 19.
I don’t think there’s anything that’s indicating that it helps decrease infection from coronavirus what it does do is help decrease cytokine storm and the covid19 the serious disease associated with coronavirus infection we’ll talk about that a little bit later joanne manson professor of medicine at harvard medical school and brigham and women’s explain some points on coveted 19 associations in a may 2020 video posted on medscape and that was the link in a previous study vitamin d supplementation was associated with a significant reduction in respiratory tract infections that’s not just carbon 19 this was way back in 2017 it was a meta-analysis of rcts you remember what that is randomized clinical trials the top level of scientific evidence you know the worst level is opinions from a an expert and so that’s one of the things that you see i tend to differentiate i will give my opinion as an expert but i usually do that last usually what i give is the scientific evidence the things that are out there that are published and are actually levels of quality there you know like case reviews some case control studies and then the most important the highest level is an rct or a randomized clinical trial it turns out that there are meta-analyses and a meta-analysis is where you take multiple studies of a certain type pool those studies look at the results that they got together the ultimate group for doing that is called the cochrane group there’s c-o-c-h-r-a-n-e a cochrane analysis and they’re now associated with Wikipedia so again you can’t get anything better in terms of scientific evidence than a meta-analysis of randomized clinical trials and that’s exactly what you’ve got for vitamin d supplementation looking at acute respiratory tract infections this was published in 2017 in the british medical journal that’s what bmj is the title was vitamin d supplementation to prevent acute respiratory tract infections systematic review and meta-analysis of individual participant data and again.
We’ve provided the citation over on the right and the link there in the middle 25 eligible randomized controlled trials a total of 11 321 participants ages was zero to 95 years they identified those individual participant data were obtained for over ten thousand almost eleven thousand ninety six point six percent of the participants vitamin d supplementation reduced the risk of acute respiratory tract infection among all participants we hear this and you’ll see on one of our later slides we actually talk about what you’ll hear on the internet you’ll hear people say oh you can go out and get it from the sun i can tell you i make a living i see hundreds of patients a year and i’ll typically see a husband and wife living north of the mason-dixon line or south of the mason-dixon line that doesn’t matter either you hear that if you live north you’re at risk if you live south you’re not at risk because of the better sunshine not true going out and spending time in the sun all day also not so true because again i’ll see a couple a husband and a wife the husband is out playing golf three and four hours a day the wife is indoors all day and the wife has great vitamin d levels and the husband doesn’t so it makes a couple of points number one the north south thing it’s a thought it’s an idea it’s a theory it really doesn’t pan out the thing getting out in the sun there is some scientific evidence but i can tell you from a practical basis it’s not that good you need to go ahead and consider supplementation number three we’ll talk about this a little bit later too you can over supplement and over-supplementation is dangerous.
We’ll talk about that i’ve got a couple of videos i’ve had a couple of patients come to me that were too high again we’ll talk about those vitamin d has been shown to have an immune modulating effect and can lower inflammation an analysis of data showing a possible association between high c-reactive protein remember c-reactive protein is that protein made by the liver that shows inflammation it’s part of a cardiovascular inflammation panel but i don’t use that alone and i don’t recommend that you use it alone because there are too many things that can cause a positive c-reactive protein for example if we gave a flu shot to 100 people today two days from now 66 of them would have an elevated c-reactive protein so if you’re looking at c-reactive protein to tell you whether you have cardiovascular risk as you can see if it’s elevated you don’t know if it’s from rheumatoid arthritis other types of inflammatory arthritis other inflammatory diseases a flu shot impending covid you name it so we look at other things on the inflammation panel besides c-reactive protein but let’s again let’s go back to the script and see reactive protein and talk about that for coping 19 and vitamin d3 an analysis of data showing a possible association between high c reactive protein concentration which is greater than or equal to one and a severe covered 19 mid x our iv on may 20 20 the possible role of vitamin d in suppressing cytokine storm and associated mortality in covid19 patients so again this is getting to that core of the current expectation around the mechanism for vitamin d and covet 19 there is significant and i think good evidence indicating that it probably it helps us avoid that cytokine storm and if you want to read the articles again.
There’s a link on the left and the citation on the right given that c reactive protein is a surrogate marker for cytokine storm and is associated with vitamin d deficiency based on retrospective data and indirect evidence we see a possible role of vitamin d in reducing complications attributed to unregulated inflammation and storm can vitamin d lower cover 19 risk vitamin d status is strongly associated with covid19 mortality a retrospective cohort study which included two cohorts active and expired of 780 cases with laboratory confirmed infection of sarcobi-2 in indonesia the preliminary study in april 2020 was called patterns of covet-19 mortality and vitamin d in indonesian study we referred to this a couple of times earlier on the majority of the covenant 19 cases with insufficient and deficient vitamin d status died that study that came out fairly early again April and got a lot of attention because there was a lot of suspicion around the vitamin d before that happened this came out and a lot of people reacted to it the odds of death was higher in older and male cases with pre-existing condition and below normal vitamin d levels now again based on some of the information.
We’re talking about you can see why i was surprised to and continue to be surprised when i have patients come in and they say yeah you know i’ve heard about vitamin d and covet 19 but i just never got around to it why am I surprised anyway for increased synthesis of vitamin d patients are encouraged to be outdoors and physically active while maintaining social distancing and again this is information that chris got from other folks making suggestions and yes chris will talk about some of the recommendations that you’ll see on the internet i can tell you as a doc seeing patients on a routine basis i don’t trust sunshine alone for vitamin d and i suggest very strongly that you don’t either there’s a concept called test don’t guess the other thing i recommend is go ahead and take supplementation yes vitamin d at really high levels is dangerous i’ve looked at the scientific evidence around this space specifically for this question what level of supplementation is safe you’ll see recommendations of 600 well actually i’m getting ahead of myself let me go ahead and finish the script here diet is also important food sources that are higher in vitamin d include fortified dairy products fortified cereals fatty fish and sun-dried mushrooms but let’s go back and ask that question should we be eating fortified cereals well if you have pre-diabetes probably not how about if you don’t have pre-diabetes well that’s a different question i’m not even going to go there but be careful eating all these grain products if you can’t digest the carbs in them fatty fish like salmon yeah it’s great sun-dried mushrooms fantastic dairy products oh wait a minute dairy products are bad right go back to the video that.
We did recently about saturated fat i mean that’s the thing that most people are concerned about in dairy products saturated fat and the reality is despite all of our perceptions for so many decades it doesn’t appear that saturated fat is dangerous at all like we used to think for those who are unable to be outdoors and for those who are able to be outdoors and have a low dietary intake of vitamin d it’s reasonable to consider a vitamin d supplement i would also can say for those who are outdoors a lot and for those who do get dietary vitamin d i still would say we all need to supplement and we’re getting to the point that I got to a minute ago how much should you supplement you don’t want to be dangerous but you do want get adequate amounts you’ll see it with other folks the recommended dietary allowance is six to eight hundred international units other people will say one to two thousand here’s where i was a few minutes ago i’ve been out i’ve looked at the science i haven’t seen any evidence of anybody getting into problems with five thousand international units per day and that is what I recommend the other thing i recommend is that you test don’t guess start off supplementation if you don’t have your test yet and the goal should be 60 to 80 not 25 not 20 not less than 40. most of the labs still have a recommendation of 25 to 40 nanograms per milliliter that’s old data still some of the new lab normals are changing to the higher numbers now when i say 60 to 80 not 175 what do i mean not 175 well here’s a youtube video so this is a video that i did april of 2019 a patient came to me and her vitamin d level was 175. that’s why i mentioned that i did a video on it she agreed and actually joined me for an interview video how did it get to be 175 well one of the common dose formations is a weekly dose and these weekly doses will come in both injections or pills and they’re typically 25 to 50 000 international units i don’t ever recommend those because of exactly what happened with this patient it was another doctor’s patient they she had been seeing the doctor for some other hormone related stuff and then came to me the doc had given her a prescription for 50 000 international unit pills she thought this was to be every day no it was to be every week so that’s why i never prescribed twenty five thousand international unit or 50 000 international unit doses it’s too easy to have misunderstandings like that for those of you who are curious well maybe you should go look at the video to see what happened with that patient we’ve done other videos in terms of vitamin d and covet 19 risk specifically as i said we’re giving you several other different viewpoints different videos to help learn about vitamin d3 and cobit.
So i’d like to talk with you a minute about the webinar people don’t understand what the webinar is it’s actually a great way to get some access to health care that you’re just not going to get any other way you actually get the lab tests yourself for at a local lab a quest lab near you for the inflammation panel and the ogtt and the insulin survey these are things inflammation and pre-diabetes that your doctor just does not know about and here’s the thing harvard health and many others have said look sudden death is not always so sudden the hollywood picture that it’s evolved out of the blue is not realistic it’s more like real lightning preceded by clouds wind and rain stop that metabolic storm before the lightning strikes and here’s where that metabolic storm comes from it’s inflammation and it has to do usually with pre-diabetes so again we actually get labs we go over them in the webinar and then you can start finding out how you can prevent that heart attack others said hat you couldn’t even predict we can show you how.