Vitamin D and COVID-19: Debating the Research

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The paper published in the Irish Medical Journal inspired a lot of commentary by healthcare professionals in all forums. I selected one report from Medscape, an online journal I subscribe to, that summarized all sides of the issue. The writer interviewed a variety of vitamin D experts including the authors of the study in the Irish journal.

The predicted response came from a researcher in Maine: there are no randomized controlled trials, scientific research’s gold standard, that prove that raising vitamin D levels will protect against serious COVID-19 infections. That’s not quite as harsh as it sounds. He recognizes the importance of vitamin D—he’s studied it for 25 years. He’s just stating the facts as he sees them.

The author of the original paper acknowledges that but suggests that because a deficiency in vitamin D can be remedied quickly with vitamin D supplementation, let’s grab the low-hanging fruit and act now with minimal potential for side-effects or negative outcomes. A leading epidemiologist suggests that for some people, vitamin D may reduce the risk of the “cytokine storm” that happens to some people that leads to death from the virus.

What are we supposed to do with such disparity between experts? You haven’t seen anything yet, but we’ll come up with some recommendations on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. Irish Med J. 2020; 113 (5):81-88.
2. Vitamin D: A Low-Hanging Fruit in COVID-19? – Medscape – May 17, 2020.

Vitamin D and COVID-19: Upside-Down World

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Vitamin D has been in the health news as it relates to the COVID-19 virus. Are vitamin D levels related to the severity of symptoms if you’re exposed to the virus? We’ll take a look at a recent observational study and the medical responses to it this week.

There have been reports that people with higher vitamin D levels in their blood were doing better in response to the COVID-19 infection than those with lower levels. Researchers in Ireland decided to check that out in a unique way. Using epidemiological data from European countries that were hit with the COVID-19 virus, they found something interesting. Countries such as Spain and Italy that had more sunshine had lower vitamin D levels and did poorly in response to the virus. Countries in northern Europe such as Norway and Finland with their short winter days had higher levels of vitamin D and did better in response to the virus.

This is counter to what we would expect. The higher the sun, the higher the vitamin D, right? Evidently not. What was the difference? Due to the lack of sunshine in the north, supplementation with vitamin D was recommended by government health agencies, but there were no vitamin D recommendations in the southern countries. Is vitamin D the solution to this COVID-19 virus? Nothing is ever quite that simple, as we’ll find out on Thursday.

What are you prepared to do today?

        Dr. Chet

Reference: Irish Med J. 2020; 113 (5):81-88.

Not Fear, Respect!

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I’ve read many comments on social media platforms about COVID-19, and the tone remains the same. An ever-growing group of people are talking about theories and conspiracies of all type. “The numbers are rigged to show more deaths from COVID-19 than there really are,” or “Doctors have discovered treatments that work and are being suppressed.” Lately we have this “Plandemic” movie making the rounds. Then there are the people who claim that our liberties are being taken away by being forced to stay home, wear masks, and not work or go to restaurants; they claim we are being forced to be afraid to go into public.

Our perspective on life is governed by the prism we look through. People who fear vaccinations are already saying they will never get a COVID-19 vaccination if there ever is one. People who fear the government are alarmed by the slightest perception of the infringement of their constitutional rights. Almost everyone who understands the disease is afraid of the COVID-19 virus. I want to change your perspective. In doing so, I’ll explain why staying home is a good idea.

In case you’re wondering why my opinion carries any weight, there’s this: in my heart of hearts, I’m a scientist and a teacher. You can check my website bio to learn more, but the important point is that I probably understand science and scientific research better than you do (you undoubtedly know more about your area of expertise than I do). I don’t look at the science news with a political bias, just with a solid education and years of experience that helps me understand what the science really means and what the studies really prove. My mission in life is to share that information with you to help you be healthier, and I can’t think of a time that offer to share has been more important than now.

The Virus: We Just Don’t Know Enough

The virus is the enemy. In order to defeat it, we need to know enough about it to beat it, but we just don’t know enough yet. Here are the most significant questions.

Why do some people catch the virus and don’t have symptoms, yet they can spread it to others very easily? This is the primary question we need answered. Is it that the virus mutates more easily in some people than in others? Is it the total amount of exposure? Is it a genetic factor? The easy ones such as ethnicity, hair color, and eye color haven’t been explored as deeply as they should. Is the microbiome a factor? I could go on and on, but until we know why some people have no symptoms while the virus kills others, we should be prudent in exposing ourselves to it.

Why do some treatments work well in some people and not in others? Case in point is intravenous vitamin C; it helped some people live longer when treated with hydroxychloroquine and the Z-pack while it had no impact on others. We have a partial answer: it worked only in those who were deficient in vitamin C. That also tells us that even people who had enough vitamin C were still susceptible to the virus and died. Not everyone can take the malaria drug hydroxychloroquine because it causes fatal arrhythmias in some people. Until we get a treatment in place that can work for just about everyone if they get the severe form of COVID-19, we should be prudent in being exposed to the virus.

Do we have to wait for a vaccine? No, because there may never be one. While it’s a completely different virus, there’s still no vaccine for HIV some 40 years after its discovery, and it’s possible there may never be a vaccine for this one either. However, scientists seem to be making progress so it looks hopeful, but probably not for 18–36 months.

Testing

Testing is going to have to be part of the solution. Who wants to go to a place of business for an extended visit such as a gym or a haircut or a meal if you don’t know if the people working there have the infection or not? The number of tests required to open the economy and keep it open should create an economy of scale that lowers the cost, and in time the testing should be dependable, precise, and cost effective. The industrial health-manufacturing complex should take on the task of providing these products at the lowest price possible to make it worthwhile for businesses to provide it for employees and customers.

Antibody testing to see if a person had the virus should also be a priority. Antibodies may not create immunity, but they may have some benefit against the virus should a person be exposed again. That’s important to know.

If I had a business where people must show up in person, I’d begin to create the signage “All employees tested daily!” and “We test our customers for free!” That will happen at some point and the sooner the better.

The Bottom Line: Respect

The word “respect” should replace “fear” when talking about COVID-19. People can rant and rave in social media if they want; that’s their right. But if they’re exposed to enough of the virus, they will get it. What happens to them? We can’t predict. We also can’t predict what will happen to their family, their friends, and every person they come in contact with. I can’t imagine anyone who would be willing to put people they care about at risk.

One of the saddest aspects of our time is the stark partisanship and the way it colors everything we see—red versus blue, urban versus rural, white collar versus blue collar. When it shapes the way we see science, it frankly scares me. It’s not a situation where, oops, you might gain a few pounds or vomit for a couple days. This virus could take your life or your parent’s life or your friend’s life; even if you or they survive, you or they may face a lifetime of health challenges such as severely diminished lung function; as an example, a runner may never have the lungpower to run again. And at this point, we know the virus can produce devastating symptoms in a small percentage of children who get it, but we don’t know why and we have no idea what the life-long aftereffects may be; most parents (and grandparents) won’t want to take that gamble.

I don’t want you to be afraid, I just want you to respect the power of the virus and the scientific knowledge we’re slowly gaining.

I’m staying home with the exception of grocery shopping and doctor’s appointments that can’t be done by phone, and I wear a mask when I go out—not to protect myself, but as a courtesy to others. Same for Paula.

We’re not prisoners. The warm weather is finally here, and there’s work to do in the yard. We’re blessed because Paula and I have been working at home for years. We don’t fear catching the virus. We just respect it and understand where we stand at this moment in time.

If you change the prism you look through, respect makes a lot more sense than fear or disbelief. Act accordingly.

What are you prepared to do today?

        Dr. Chet

Old School: One Step

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I’ve been lifting weights at home since the “Stay Home, Stay Safe” mandate closed all the fitness centers. I wanted to make the workouts a little more difficult and keep my heart rate elevated between sets, so I went old school: I used a step stool. I could have used a step on the stairs outdoors, but it’s still too cold and I would have to move the weights outdoors. Lucky for me, Paula has a sturdy wooden step made for her by her brother, Steve, many years ago.

Up-up-down-down. Over and over. Every five rotations, change the lead foot. In other words, if you stepped up with your right foot first, you switch to stepping up with your left foot first. I began with 60 seconds between sets of weight training and will cap it at two minutes. I still want to stress the muscles that are lifting as well.

Couple of important points. I always steady myself by lightly keeping my hands on a counter. You could always use handrails if you’re using a flight of stairs, but never use the top step; for safety’s sake always use the bottom step. You don’t want to fall down a flight of stairs.

You don’t need fancy equipment to get a good workout. All you need is just one step.

What are you prepared to do today?

        Dr. Chet

I’m Alive V2.51

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When I opened my eyes Sunday morning, I knew I had another year to do what I was created to do: teach people how to be healthy and fit. For those of you who are new readers, here’s the story: when I wake on May 10th every year, my superstitious belief is that I have at least one more year to live. That was the day my dad died in 1969. In case you’re wondering, I’m version 2 (my father was the first Chester John Zelasko) and it’s been 51 years since my father died. It makes no sense in the real world, especially for a guy who’s a scientist, but every May 10 is a milestone for me.

It’s been one heck of a year. I had big plans to be on the road more, but as the saying goes, Man plans and God laughs. I never would have believed a virus could change society so completely. You may believe that the government over-reacted or you may believe they acted too slowly. Whichever camp you’re in, what I do care about is that you respect this virus. Not fear it—respect it. At this point, I can’t tell you who is at risk for a severe infection and who isn’t. The elderly for sure and many with comorbidities, which is over 80% of the U.S. population. True, the risk is small for the most severe infections. Are you willing to take that chance for yourself? For your parents? For your children? It may not be you at risk, but as a carrier, you may put others at risk. As I said, not fear; just respect.

At first we thought children were at little risk from the coronavirus, so I didn’t worry much about that guy in the pic with me (a picture taken March 3, the last time we were all out of the house together). But every day brings new information, and the risks to kids are coming into focus. I’ll be a happy grampa when the day comes that Riley can get vaccinated against the virus along with the rest of us. (We’ll put aside talk of vaccines until another day.) And in the meantime, I’m willing to do whatever it takes to keep myself and the rest of the family healthy because we all need each other.

What will the next year be like? No clue. At some point, I’ll be back on the road, but who knows when that will be. I’m a teacher, and I’ll find a way to keep doing that effectively in this digital age. Stay tuned.

One way you can learn more about health is by becoming an Insider. Tomorrow night is our monthly conference call and you still have time to join and submit questions. Check it out.

What are you prepared to do today?

        Dr. Chet

Product Claims for GOLO

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Another ubiquitous commercial on television is for a weight loss program called GOLO for Life, a dietary supplement and a weight loss program. It’s the one that uses an illustration to explain insulin resistance: the muscle in the abdominal area is blocked from using belly fat by a barrier. Insulin resistance is much more complicated than that, but I guess it makes a point. The claim in an expanded version of the commercial on the GOLO website is that “the program is clinically proven to reduce insulin resistance.” There are many more claims, but I’m going to stick with that one.

The company supported four studies on the GOLO for Life program; I’ll cover the two pilot studies today—one in the U.S. and another in South Africa—and the remainder on Saturday.

The U.S. pilot study did not have a control group, had a significant number of dropouts, and did not report the caloric intake of the subjects. The subjects lost a significant amount of weight and lowered their HbA1c by 4%.

The South African study was not so much a study as a series of GOLO programs conducted as part of wellness programs in businesses. The data were combined for analysis. Again, there were significant dropouts and caloric intake was not reported. The subjects using the supplement lost more weight than the controls.

Why did I make a big deal about caloric intake? If we don’t know how much they claimed they ate, we don’t know whether to attribute the results to the supplement or the weight loss program or both. The purpose of pilot studies is to help set up clinical trials, and we’ll take a look at those on Saturday.

What are you prepared to do today?

        Dr. Chet

Research on Health and Apple Cider Vinegar

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Watching more television than usual means I’m seeing more commercials than I’m used to seeing. It’s time to take a look at some dietary supplements that make health claims in television commercials. I’m going to focus on the science behind any claims being made on the product label or on the product’s website to see if they pass the FDA regulations. The product claims are worded as the FDA suggests; the question is whether the science is substantial enough to make the type of claims the FDA allows.

The first product is Goli, an apple cider vinegar (ACV) gummy supplement. The website makes claims about weight loss, appetite control, blood sugar control, energy, immune function, detox, gut health, skin, and heart health. I chose to examine heart health.

The company used three studies to support the claim. The first examined the use of 750 and 1,500 mg of ACV in a drink. The results showed no clear pattern of benefit although triglycerides went down. The second study compared a group using ACV plus calorie reduction with a control group that had no intervention; in this case, the restricted calories could explain any benefits. Finally, they used data from the Nurses Health Study that reported better heart outcomes in women who used oil-and-vinegar salad dressing. The focus of that research was on the type of oil, not the type of vinegar.

Based on the FDA Guidelines, claims cannot be made from research that uses an ingredient in food as the substantiation for a benefit from a dietary supplement. I checked the research on several of the other claims they made and the research they used, and I came to the same conclusion. They may be very tasty gummies, but the research does not appear to support the claims they make. But if you want to take a gummy or two to reduce your appetite, our grandson Riley recommends sour gummy worms. Just FYI.

What are you prepared to do today?

        Dr. Chet

References:
1. Guidance for Industry: Substantiation for Dietary Supplement Claims Made Under Section 403(r) (6) of the Federal Food, Drug, and Cosmetic Act. https://bit.ly/2QLDRa2
2. Biosci, Biotechnol, Biochem. 2009; 73(8):1837-1843.
3. https://doi.org/10.1016/j.jff.2018.02.003.
4. Journal of the American College of Nutrition, 2001; 20:1(5-19).

Eliminating Pain

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Chronic pain afflicts us all at some time. I’ve talked about my knee enough to write a book, but pain can be in many areas: lower back, shoulders, feet, hips, wrists, and deep muscle pain as might occur from fibromyalgia. Should you give the pain time to work itself out? No—that’s the worst thing you can do, because you may be setting yourself up for years of pain that could have been prevented.

Pain Pathways

Chronic pain may develop when pain pathways become established without intervention. While complicated in nature, what happens is that the series of biochemical reactions and different types of sensory neurons that let your brain know that something is painful get stuck in the “on” position. The original cause, whether from an injury, surgery, or a disease or condition, may have healed, but the nerve fibers are still sending pain signals. In order to affect changes in those pain pathways, you must take action.

Relieve the Pain

This seems obvious, but too many people refuse to do it. What I mean is that whether you’ve been prescribed pain medication or use over-the-counter medications, take them regularly. You don’t get hero badges for avoiding medications and staying in pain. You’re also not limited to medications.

There are many supplements that work for some people, including high-EPA omega-3 fish oil, glucosamine and chondroitin, tart cherry juice, turmeric, and others. If you’re going to take them, be consistent. We also now have CBD oil for internal use and creams and sprays for topical use. Some people find it works well for them, while for others they don’t work at all. How to know? Try each one.

If you can relieve the pain, you can return the area to normal functioning. This is especially true for muscles and joints. When you’re in pain, you compensate by changing the way move. That makes matters worse over the long haul. I’m not suggesting that you will be completely pain free, but if you’re able to move better, that will help you with the second part of pain management.

Rehabilitate

If you’ve had surgery on joints or soft tissue, you had to go through a physical therapy program to restore range of motion and function. The exercises that you were given were supposed to continue until you had a complete return to joint function. Most people get part way there and then stop. My father-in-law had surgery on both shoulders; he completely rehabbed his right shoulder after rotator cuff surgery, but he stopped short with his left. As a result, he could get close to putting his right arm fully extended overhead but got to only about ear level with his left.

Besides stretching to get back range of motion, you can also strengthen the muscles directly involved in the motion as well as those that provide stability to the joint. As just one example, the rotator cuff muscles do just that: they rotate the humerus. But the biceps, triceps, pectoralis major, and deltoid all provide stability to the shoulder. The best thing to do is to check with a physical therapist, most likely using an online video service these days, and get the exercises if you don’t know them. Then get to work.

The Bottom Line

In order to live your life fully, you must deal with chronic pain. The keys to pain management are to

  • Reduce the pain
  • Work on improving your movement of the area involved
  • Work on strengthening the area and surrounding tissues
  • If all else fails, consult a pain specialist.

That’s my goal for the next 60 days: to take a weakness and make it as strong as possible without causing any damage. Progress slowly and be methodical in the approach, and if that doesn’t work, get a referral to a pain clinic. Your life is too important to let pain rule you.

What are you prepared to do today?

        Dr. Chet

Citations Are Important

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When I wrote the first Memo on citrus fruit last week, I omitted part of the date from the citation found at the bottom of every Memo that cites a study or publication. Only a single person noticed. As I wrote in response, sometimes you look at something so many times you don’t see what’s wrong. She noticed because she typically looks up research and wanted to see if it was something she had read before.

From the time I was in graduate school, I’ve always tried to get citations right, especially those that refer to scientific journals. I’ve been on too many frustrating walks through the stacks in research libraries to cause that kind of grief for someone else.

Today you can search databases of journals quite easily. That is, unless you’re given an incomplete citation or worse, just the name and the year—and the year is wrong. I’ll try to make sure I triple-check them from now on. But please, once in a while, look up the research paper or book and take a look at the research paper yourself. You might find you enjoy it.

What are you prepared to do today?

        Dr. Chet

Does Vitamin C Increase Melanoma Risk?

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Last week’s Memos on citrus fruits raised an obvious question; one reader mentioned it, so I thought I should write about it. Here’s the question: was vitamin C examined for any possible relationship with the development of melanoma? Yes, but take a look at what the researchers wrote in the set-up for the study.

After examining the research, they found that vitamin C is toxic for melanoma cells; it kills melanoma cells via multiple pathways and prevents them from multiplying. These are all test-tube studies but still give some indication of the potential role within the body. Because of the prior research, they hypothesized that any increased risk for getting melanoma was related to other compounds in citrus fruit, such as the phytonutrients, and not the vitamin C.

As you would expect, vitamin C levels increased as more citrus fruit was eaten. However, the risk of melanoma didn’t rise as the vitamin C levels from fruit and supplements increased. That confirmed it was some other aspect of the fruit that led to a higher rate of melanoma.

Let’s be sure that we don’t interpret the results to mean that we should megadose on vitamin C to prevent melanoma; the research definitely does not say that. But the skin is connective tissue, so it may be prudent to take additional vitamin C, glucosamine, and collagen to protect your skin, especially if you’re a sun-lover.

This study is also a reminder that our diet needs to be balanced. Too much of anything—even something as healthy as citrus fruit—can lead to problems. Everything in moderation.

What are you prepared to do today?

        Dr. Chet

Reference: J Clin Oncol 2015; 33:2500-2508.