by Ian Wishart
[17]http://www.sacbee.com/2012/07/17/4637302/vitamin-d-supplementation-may.html
[18] “Vitamin D deficiency is a predictor of reduced survival in patients with heart failure; vitamin D supplementation improves outcome,” Gotsman et al, European Journal of Heart Failure, 2012, doi: 10.1093/eurjhf/hfr175
CHAPTER 8
COMMON INFECTIONS
“Whether vitamin D should be implemented as a mandatory vitamin to prevent pandemic influenza is the question”
– Journal of Medical Hypotheses, 2010
There’s an often repeated saying, “there’s no cure for the common cold”. It’s not entirely true anymore – scientists have recently discovered an essential extract from a little-known South African geranium with the unpronounceable name “umckaloaba” has unique anti-bacterial and anti-viral properties that allow it to knock colds, common influenza, pneumonia and bronchitis on the head. They had to give it a more user friendly name – Kaloba – and it’s now registered in several countries including Australia as a medicine because of its success in clinical trials.[1]
The thing about Kaloba is that it actually stimulates the body’s immune system into responding more powerfully and swiftly to incoming infections. Intriguingly, that’s what vitamin D appears to do as well.
While vitamin D might not give you relief from a cold in three days, like Kaloba, there are studies that indicate people with high vitamin D levels get far fewer colds and infections in the first place.
A randomized controlled trial published in 2007 tested three groups for a year. One group received a capsule containing 2000IU of vitamin D to be taken each day. The second group received a capsule containing an 800IU daily dose, and the third received a placebo.[2]
Nearly all of those taking the placebo were found to have suffered colds or influenza during the year-long trial. Only one person taking the 2000IU daily supplement reported cold/influenza symptoms. Remember, none of the participants knew whether they were in the vitamin D group or not.
The people taking the lower dose 800IU supplement reported some cold/flu symptoms, but an order of magnitude fewer than those on the placebo.
What appears to be important however is not the size of the supplement itself, but how long you’ve been taking it and whether your blood levels of vitamin D have been brought up to a protective level.
A second trial by the same research team two years later tested 162 adults in a randomised trial over the 12 weeks of the winter season. Half the sample received 2000IU a day, and the other half a placebo.[3]
Unlike their first year long study, this one beginning at the start of winter showed no protective effect of vitamin D at all. Why would that be? Possibly because at the start of winter your vitamin D levels have already fallen below par in most cases, so you are starting from a catch-up rather than optimum position.
The previous study actually had a twist in the tale that proves the point I am making. Although reported as a “year long trial”, it had actually begun as a three year trial. For the first two years, the vitamin D participants had been receiving only the 800IU dose. Then in the final year they boosted the dosage for some of those people to 2000IU and commenced a year long drag race to the finish. This meant that many of those with the high-dose vitamin D had actually been taking vitamin D for three years, giving them a chance to seriously lock in the blood serum benefits.
Placed in perspective, it’s not hard to see why the second study over the 12 week winter season flopped. The secret is really in the long-term blood levels, not the size of the daily supplement.
Which is exactly the conclusion the researchers reached in regard to their second study:
“There are several reasons why vitamin D3 supplementation may have been ineffective at preventing URIs [upper respiratory tract infections] in this study. First, the subjects started vitamin D3 supplementation during the wintertime and not beforehand. It takes about 3 months for 25-OHD levels to reach a steady state with supplementation. Because it takes a significant amount of time to build up vitamin D stores, the effect of vitamin D supplementation lagged behind the cold and influenza season. Vitamin D3 supplementation may be more effective in preventing URIs if started during autumn when sunlight begins to decrease.”
Other reasons include that the people in the first 2007 study began with much lower vitamin D levels (18.4 ng/ml average), meaning the control group remained vitamin D deficient while the vitamin takers improved. In the second 2009 study, however, both controls and vitamin-takers began with an average baseline of 25.6 ng/ml, meaning they were both already out of the danger zone.
Proof of this thesis can be seen in the actual rates of infection. In the 2007 study, 30 of the 39 placebo-takers reported a URI (77%). In the 2009 study only 41% of those on placebo suffered an infection. We know the placebo-takers had much higher vitamin D blood levels than those in the first study, and they suffered a big drop in reported infections. Ergo, point proved.
Another randomised, double-blind trial conducted at Yale University involving nearly 200 people in 2010 has gone on to prove that people with low vitamin D levels are twice as likely to develop respiratory tract infections:
“One hundred ninety-five (98.5%) of the enrolled participants completed the study. Light skin pigmentation, lean body mass, and supplementation with vitamin D were found to correlate with higher concentrations of 25-hydroxyvitamin D. Concentrations of 38 ng/ml or more were associated with a significant (p<0.0001) two-fold reduction in the risk of developing acute respiratory tract infections and with a marked reduction in the percentages of days ill.”[4]
The inferences to be drawn from this are obvious, they say:
“Maintenance of a 25-hydroxyvitamin D serum concentration of 38 ng/ml or higher should significantly reduce the incidence of acute viral respiratory tract infections and the burden of illness caused thereby, at least during the fall and winter in temperate zones. The findings of the present study provide direction for and call for future interventional studies examining the efficacy of vitamin D supplementation in reducing the incidence and severity of specific viral infections, including influenza, in the general population and in subpopulations with lower 25-hydroxyvitamin D concentrations, such as pregnant women, dark skinned individuals, and the obese.”
So the sunshine vitamin substantially reduces your family’s risk of catching colds or flu – who knew?
We’ve touched on possible reasons for this in earlier chapters but it’s worth another look. Vitamin D is known to stimulate the immune system into producing natural antibiotics, as Li-Ng’s 2009 study explains:[5]
“The active form of vitamin D, 1,25-dihydroxyvitamin D (1,25-OH2D) increases the production of endogenous [it means self-made naturally] antibiotics called antimicrobial peptides (AMP).[6]
“AMPs such as defensin and cathelicidin have a broad range of actions against microorganisms, including bacteria, fungi and viruses. Defensins can block viral infection by directly acting on the virion or by affecting the target cell and thereby indirectly interfering with viral infection.[7] One of the defensins called retrocyclin-2 inhibits influenza virus infection.”[8]
It’s yet more proof that dermatologists are fundamentally and dangerously wrong when they tell us to “avoid the sun…there is no safe level of exposure”. Our bodies are designed to interact with sunlight to create antibiotics and antivirals. Over the past century, and in particular the past fifty years, we have moved away from our natural place under the sun, and we are reaping the rewards of that decision healthwise.
While US regulators um and ah over vitamin D, the European Food Safety Authority has ruled that the compound is immunoprotective:[9]
“The Panel concludes that a cause and effect relationship has been established between the dietary intake of vitamin D and contribution to the normal function of the immune system and healthy inflammatory response, and maintenance of normal muscle function.”
Even as they announced that, the scientific test resul
ts continued to roll in.
A Japanese research team managed to stave off Influenza A in schoolchildren in a randomized trial of vitamin D supplements. Three hundred and thirty four children were split into groups receiving either 1200IU of vitamin D a day, or a placebo.
The test ran through the northern hemisphere winter, from December 2008 through March 2009, and overall children on supplements reduced their risk of infection by 42% compared with children in the control group. As reported earlier in this book, the improvement was even more significant for children with a history of asthma – they slashed their risk of influenza A by 83%.[10]
The impact of vitamin D levels on influenza risk is leading to some researchers openly discussing whether vitamin D supplementation should be a mandatory public health step in preparation for the next global flu pandemic:[11]
“Influenza was associated with a higher tendency to develop superimposed bacterial pneumonia, and prevention may avoid the higher risk of pneumonia, especially in elderly and chronic lung disease patients. Whether vitamin D should be implemented as a mandatory vitamin to prevent pandemic influenza is the question.[12] Juzeniene et al. studied pandemic and nonpandemic influenzas in Sweden, Norway, the United States, Singapore, and Japan. The higher exposure to UVB radiation in summer and consequently higher 25(OH)D levels protect against influenza.[13]
It’s not just colds and flu that vitamin D has been proven to help protect you against.
TUBERCULOSIS
One of the classic infections it helps beat is tuberculosis, a disease that’s been preying on humans since the dawn of time. Characterised by the disintegration of lung tissue to the point of fatality, and easily spread by contact and coughing, it’s a vicious disease that, coincidentally is re-emerging in the population in much the same way that rickets is back in the news.
“There is no need to get vaccinated against tuberculosis,” reported NaturalNews recently,[14] “if you maintain high enough levels of vitamin D, suggests a new study published in the journal Science Translational Medicine. Researchers found that, in the presence of even minimally adequate levels of vitamin D, the body’s own immune system will naturally trigger an immune response against the disease and many others without the need for drug or chemical interventions.”
The real lesson to take from this is not that tuberculosis is beating modern antibiotics because of increased antibiotic resistance. No, the real lesson is that you are only likely to contract tuberculosis in the first place if your vitamin D levels are low.
Often, the disease strikes in Africa and Asia. A recent Pakistani study found people with low vitamin D levels were 500% more likely to fall victim to tuberculosis. You might assume that being relatively sunny in Pakistan they’d be OK, but in truth most people, particularly women, are fully clothed from head to toe. Those surveyed had vitamin D levels as low as 4.6 ng/ml, a sharp contrast with the ideal target of between 40 and 50 ng/ml.
“In this cohort follow-up study from Pakistan,” concluded the researchers, “low vitamin D levels were associated with progression to active TB disease in healthy household contacts. No deaths occurred during the follow-up period from either TB or unrelated causes. Our findings also suggest that vitamin D deficiency may explain the higher susceptibility of women to disease progression in our cohort.”[15]
Similar low vitamin D levels were seen in Mongolian children, and vitamin D supplementation cut their risks of tuberculosis by 60%.[16]
It’s that study from the journal Science Translational Medicine, however, that nails just how crucial vitamin D is. They point out that combating TB worldwide depends on understanding how human immune systems work to fight infections.
“Acquired T cell responses are critical for host defense against microbial pathogens, yet the mechanisms by which they act in humans remain unclear,” reports lead author Mario Fabri.[17]
It is said that ‘sunlight is the best disinfectant’, and that’s exactly what Fabri’s team discovered. They found that T-cells are fired up with interferon and natural antibiotics like cathelicidin to batter Mycobacterium tuberculosis when it infects the human body. Without vitamin D to ignite the immune system, our biological engine coughs a couple of times and gives up, becoming overwhelmed with the infection.
Fabri’s researchers discovered something else as well. Dark-skinned people are more vulnerable to diseases like TB because of genetic variations that are preventing them from manufacturing sufficient amounts of vitamin D. That deficiency was able to be rectified through supplements.
“These results suggest a mechanism in which vitamin D is required for acquired immunity to overcome the ability of intracellular pathogens to evade macrophage-mediated antimicrobial responses. The present findings underscore the importance of adequate amounts of vitamin D in all human populations for sustaining both innate and acquired immunity against infection.”
HOSPITAL SUPERBUGS
In the western world, hospital-acquired infections – diseases you pick up during a stay in hospital – are actually the biggest cause of death in the health system. Nearly two million cases are reported each year in US hospitals alone, and 100,000 deaths are attributable to them each year in the United States.
A review published 2012 reveals the costs of these avoidable infections to US consumers alone are up to $45 billion a year.[18]
“Health care–associated and hospital-acquired infections are two entities associated with increased morbidity and mortality. They are highly costly and constitute a great burden to the health care system. Vitamin D deficiency (< 20 ng/ml) is prevalent and may be a key contributor to both acute and chronic ill health. Vitamin D deficiency is associated with decreased innate immunity and increased risk for infections. Vitamin D can positively influence a wide variety of microbial infections.”
In terms of what you are likely to catch in hospital, “Pneumonia was the most likely disease, followed by bacteremias, urinary tract infections, surgical site infections, and others.”
Nearly 13% – or roughly one in eight – people admitted to American hospitals end up with one of these infections, prolonging their stay in hospital or sometimes killing them. The latest study pegs the cost of treating these people at up to US$21,000 per person, with an extra US$33,000 loading per infectee across the board in the costs associated with premature death and lost earning potential for the percentage who die. That’s up to $54,000 on average, per person. Little wonder health administrators are trying to find ways to reduce the risk.
The new review says the answer probably lies with vitamin D:
“Vitamin D modulates the immune system[19] and appears to have systemic antimicrobial effects[20] that may be crucial in a variety of both acute and chronic illness.
“In a previous publication, we outlined the most important actions of vitamin D against many infections, whether they are bacterial, mycobacterial, fungal, parasitic, or viral.[21] We also found that vitamin D deficiency was intimately linked to adverse health outcomes and costs in veterans with staphylococcal and Clostridium difficile(C. difficile) infections. Vitamin D–deficient patients with C. difficile or staphylococcal infections had costs more than five times higher than those of nondeficient patients. The total length of hospital stay was four times greater in the vitamin D–deficient group. Also, the total number of hospitalizations was significantly greater in vitamin D–deficient patients.[22]
“Similarly, vitamin D–deficient patients with MRSA and Pseudomonas aeruginosa infections had higher costs and service utilization than patients who were not vitamin D deficient.[23] In a retrospective study by McKinney and colleagues, ICU survivors had a significantly lower rate of vitamin D deficiency than did nonsurvivors (28% vs. 53%). The risk of death was significantly higher in ICU patients with vitamin D deficiency.[24]
The study reports that one Seattle surgeon specialising in treating war veterans has taken to routinely giving patients a 50,000IU dose of vitamin D before surgery, and found that post-surgery complications have al
most disappeared. It’s an issue being looked at in intensive care units as well.
One study of ICU patients found 82% were either vitamin D deficient or insufficient. Those with optimal vitamin D were more likely to recover and go home soonest. Those at the lowest levels of vitamin D were more likely to catch an infection and stay longer.[25]
“Vitamin D therefore appears to be important for patients with critical illness.”
An Israeli research team discovered that the lives of patients admitted to intensive care units and placed on mechanical life support in that country literally depended on their vitamin D levels. Those with the lowest levels were more likely to die, and die sooner. Of the 130 critical care patients studied, those with the highest vitamin D levels lived longer in the ICU and had better levels of white blood cells to fight infection.
The study examined blood vitamin D levels on admission. A hundred and seven of the patients were deficient, with an average of less than 15 ng/ml. The study looked at their survival rates up to sixty days. Of the 44% who died, those with the lowest vitamin D levels lasted only 15 days on average, whereas those who had been admitted with higher vitamin D levels lived for 24 days and their bodies showed more signs of fighting to live.[26]
And what of our love hate relationship with antibiotics?
“Currently, prescribing traditional antimicrobials for infectious processes is customary in medicine. The current use of antimicrobials in the United States costs billions of dollars, and the overuse of antibiotics persists and contributes to the emergence of resistant organisms. Vitamin D is likely to emerge as a powerful and hitherto unrecognized antimicrobial agent. Evidence is mounting that vitamin D could help to manage infectious illnesses.”[27]
To get the jump on superbug infections, however, doesn’t come easy. The research team recommended vitamin D blood levels of at least 95 nmol/L (38 ng/ml) to boost immunity enough to achieve a 50% risk reduction in MRSA infection.