Tuesday, September 22, 2009

Vitamin D and the Swine Flu

No longer needing an introduction, nearly every human with access to the news has undoubtedly heard of the swine flu (or H1N1) by now. Not one to scare easily when it comes to the media's standard depiction of the horrors of the upcoming flu season, I have to admit, this time around I am paying much closer attention to things.

While there is a good chance the swine flu will turn out to be less harmful than even the typical winter flu (which, by the way, still kills many thousands of people worldwide each year), there is also a legitimate chance it could turn out to be much, much worse. Some authorities speculate that, if H1N1 turns out to be as nasty a bug as it could be, this flu season could end up rivaling the Spanish Flu of 1918, when nearly 1 BILLION people contracted the virus worldwide, 1/2 a billion people got sick, and approximately 100 million people died.

The problem right now is we have no idea how minor or how bad things could become, as we have no idea yet as to how lethal this strain of virus could become. The 1918 virus had a potent combination of high lethality, novelty (it was a new strain) and a high transmission rate. So far, this virus has not shown us much in terms of lethality, but it is very contagious and transmissible. It is also a new virus, so no one has antibodies in their systems to fight a specific fight against it.

So, with all this bad news, is there any good news? Well, a vaccination is now available, but, based on what I've read here and here and here, I'm not going to be getting one any time soon. I am not telling anyone else to get vaccinated or not to, but I would recommend reading as much as you can about it before making your decision.

It is also important to remember that, in the majority of cases, the swine flu produces fairly minor symptoms, akin to a standard flu. What worries many authorities the most is that there have been some cases of a very severe form of the disease in young and otherwise healthy people, where the virus directly infects the lung, causing severe respiratory failure. If anything, that is what worries me a bit too. It could also mutate into a more lethal strain.

So, what's a father of two otherwise healthy young boys to do?

Well, lots of things!

However, if you get your information from the popular media, it might sound to you like the only chance we have of avoiding this bug is to wash our hands enough times that you never expose yourself to it. While hand washing is certainly a valid option for reducing transmissibility of the bug, the intense focus on this single activity still makes it seem like our bodies are basically helpless otherwise.

How on Earth can that be?

Remember, as is the case in virtually any other disease out there, we do have at least some say in what does and doesn't happen to our health. For one thing, there are these pretty fancy things in our bodies called "immune systems" that, if supported properly and treated well, can do some pretty cool stuff, namely keep us from catching this or any other bug this winter at all!

So, I'd say right about now it would be a good idea to start supporting the health and function of your fancy immune systems, which brings us (finally!) to today's topic- my favorite nutrient, vitamin D.

Many of my patients are already aware of the general health benefits of vitamin D, as I talk to nearly every one of them about it. But because of the way things work in this country, few if any of you out there are aware of the particularly important role vitamin D could play in all of this swine flu business.

While even the experts out there, like Dr. John Cannell of the Vitamin D Council, aren’t saying that optimizing your vitamin D levels will provide your body 100% immunity to the Swine Flu, they certainly feel it is well worth it to make sure your levels are optimized. Considering two key facts about vitamin D, I would tend to agree with him.

Fact 1:

Vitamin D has a profoundly positive effects on your innate immunity, the portion of your immune system that acts as your first line of defense, protecting you from anything foreign, whether your body recognizes it or not. This is the part of your immune system that would be involved in keeping you from getting sick in the first place. This is also a crucial issue, because (remembering that no one who hasn’t already caught it has antibodies to the swine flu yet) the other part of your immune system that makes antibodies to help you fight things (the “acquired” or “adaptive immune system”) will be relatively ineffectual in this case.

Fact 2:

Vitamin D is known to help suppress the release of what are known as “pro-inflammatory cytokines”. These substances are normally an important part of your immune system’s reaction to a bug, as they help to create the inflammation that results in symptoms which will help you more quickly rid yourself of the bug and return to a state of health. However, things are a bit different with the Swine Flu. Recall that, while symptoms in most people who have caught it already appear to be relatively minor, there is a subset of people (mostly young healthy people) who get severely affected. The process involved in these cases has a lot to do with these pro-inflammatory cytokines, as they are behind the massive over reaction (termed a “cytokine storm”) that leads to the lungs shutting down. Again, what does vitamin D appear to do? Suppress this action.

To summarize vitamin D’s effects on your immune system, I will quote Dr. Cannell directly:

“Thus, vitamin D appears to both enhance the local capacity of the epithelium (skin and mucous membranes) to produce endogenous (made by our bodies) antibiotics and at the same time dampen certain destructive arms of the immune response, especially those responsible for the signs and symptoms of acute inflammation, such as the cytokine storms operative when influenza kills quickly.”

Sound important? It does to me!!!

Optimizing Your Vitamin D Levels

So how do we make sure we have enough vitamin D in our bodies to be able to accomplish the feats mentioned above? Well the magic number, according to Dr. Cannell is 50. Specifically 50 ng/mL, which he says is the minimum level of vitamin D we want to see in our blood in order to do a good job of fighting bugs this winter. Remember also, the specific test to order for investigating your levels is called 25, OH Vitamin D.

To reach this level, the average adult needs to take about 5000 iu of vitamin D per day (assuming they have little to no sun exposure), and children need to take 1000 iu per 25 lbs bodyweight. I recommend you start taking extra vitamin D now (I use a specialized form of vitamin D with my patients, that is emulsified, so it is more easily absorbed, and provides 2000iu per drop), then get your levels tested in a month or so. There are numerous options available for getting your levels tested. For patients with high deductibles or no insurance coverage, I can get tests done for about $55. Another option which takes longer, but is cheaper, is to get tested via the Grass Roots Health Organization. If you can get it fully covered by insurance, that will be your cheapest option. The point is, just get it tested!

It’s important to realize though, that everyone is an individual, and some people may need to take higher doses. That is why getting tested is so crucial.

What about the naysayers?

Many authorities (especially the drug companies selling us their vaccines, and the doctors they have brain washed) aren’t quite ready to accept vitamin D as a viable option for helping to prevent this potential disaster. This is mostly due to the fact that there is no hard research yet available to fully prove it can help against the Swine Flu, and the fact that there were some aspects of the Spanish Flu that seem to prove vitamin D probably didn’t play a big role. For those of you who are still with me, I will review those issues now.

Facts from Dr. Cannell on the 1918 flu, leading to uncertainty about vitamin D’s role or lack thereof in this case:

1. Black people were less likely to contract the flu or die from the flu than whites in 1918. (people with darker skin tend to make lower amounts of vitamin D)

2. Young people, presumably with the highest 25(OH) D levels, were the most likely to die in 1918, as they have been in Mexico to date.

3. In October of 1918, the Spanish flu erupted simultaneously in both Northern and southern hemispheres.

4. Significant deaths occurred in the Northern hemisphere during the summer of 1918 although the extraordinary killing erupted in October of 1918 in the Northern Hemisphere.

5. One of the worst affected countries was Western Samoa. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed. This devastation occurred during their summer. I doubt 90% of the population of Western Samoa

6. had levels below 50 ng/mL in 1918 but I have no way of knowing. More likely, the population had little acquired immunity to any influenza virus.

Facts from Dr. Cannell suggesting vitamin D could indeed play an important role:

1. The mass of deaths in the Northern hemisphere occurred when Vitamin D levels were low (fall and winter).

2. While infection rates were similar for sailors and troops on infected troop transport ships, the sailors had 1/4 the mortality of the troops. One has to assume the 25(OH)D of sailors aboard 1918 troop transport ships was higher than the troops inside.

3. Underground coal miners in North America had the highest mortality of any occupation.

4. The incidence of influenza in the French army was much higher in troops away from the front (assumably in barracks) than in front line troops.

5. Open air hospitals in North America allegedly had lower mortalities than regular hospitals.

6. Mortality for sailors at sea was markedly lower than sailors ashore, despite the crowed conditions on board.

7. In the Western Front, the 1918 flu disappeared in August (when 25(OH)D levels reach their peak) only to return in September, when 25(OH)D levels fall rapidly.

Although there are obviously other factors at work here (stress? sugar consumption?) these facts present strong enough evidence to me to take this extremely simple step with myself, my family and to recommend it my patients.

Another key point about vitamin D Cannell points out is that, if you are going to take it, make sure you take enough vitamin D to get your levels up high enough (and of course, test yourself to be sure). He says that levels just over 30 (while considered “normal” by the conventional medical system) are not high enough to stop the pro-inflammatory cytokine release I mentioned earlier.

The Truth Begins to Trickle In

I thought it best to end this post with what seems to be some actual evidence that the swine flu can be prevented using vitamin D. You see, Dr. Cannell is a pretty popular guy amongst "physicians in the know", in other words, there are many docs out there who are actually reading what he has writes, then doing what he recommends.

Below are copies of actual letters sent to him from two such doctors. To say the results are encouraging would be an understatement! Reading these letters is what sold me on the whole idea and prompted this blog posting.

September 17, 2009- Dr. Cannell’s newsletter:

I’m writing to alert readers to a crucial email from a physician who has evidence vitamin D is protective against H1N1 and to ask you, the reader, to contact your state representatives to help protect Americans, especially children, from H1N1 before winter comes.

Letter #1

Dear Dr. Cannell:

Your recent newsletters and video about Swine flu (H1N1) prompted me to convey our recent experience with an H1N1 outbreak at Central Wisconsin Center (CWC). Unfortunately, the state epidemiologist was not interested in studying it further so I pass it on to you since I think it is noteworthy.

CWC is a long-term care facility for people with developmental disabilities, home for approx. 275 people with approx. 800 staff. Serum 25-OH vitamin D has been monitored in virtually all residents for several years and patients supplemented with vitamin D.

In June, 2009, at the time of the well-publicized Wisconsin spike in H1N1 cases, two residents developed influenza-like illness (ILI) and had positive tests for H1N1: one was a long-term resident; the other, a child, was transferred to us with what was later proven to be H1N1.

On the other hand, 60 staff members developed ILI or were documented to have H1N1: of 17 tested for ILI, eight were positive. An additional 43 staff members called in sick with ILI. (Approx. 11-12 staff developed ILI after working on the unit where the child was given care, several of whom had positive H1N1 tests.)

So, it is rather remarkable that only two residents of 275 developed ILI, one of which did not develop it here, while 103 of 800 staff members had ILI. It appears that the spread of H1N1 was not from staff-to-resident but from resident-to-staff (most obvious in the imported case) and between staff, implying that staff were susceptible and our residents were protected.


Norris Glick, MD

Central Wisconsin Center

Madison, WI

Dr. Cannell's Response:

Dear Dr. Glick-

This is the first hard data that I am aware of concerning H1N1 and vitamin D. It appears vitamin D is incredibly protective against H1N1. Dr. Carlos Carmago at Mass General ran the numbers in an email to me. Even if one excludes 43 staff members who called in sick with influenza, 0.73% of residents were affected, as compared to 7.5% of staff. This 10-fold difference was statistically significant (P<0.001).>

Second, if you read my last newsletter, you will see that children with neurological impairments, like the patients at your hospital, have accounted for 2/3 of the childhood deaths for H1N1 so far in the USA. That is, the CDC knows, because they reported it, that patients with neurological impairments are more likely to die from H1N1.

The problem is that I cannot get anyone in authority at the CDC or the NIH to listen. I need readers to email or call their senators and congresspersons in Washington. Ask your senator or congressperson to contact the CDC and NIH to complain about CDC and NIH inaction on Vitamin D and H1N1. Also, ask your senators and representative to demand congressional hearings on Vitamin D and H1N1, before it is too late. Here is the link below, just click it and follow instructions to contact your own represenatives.


Letter #2

Dear Dr. Cannell:

Thanks for your update about the hospital in Wisconsin. I have had similar anecdotal evidence from my medical practice here in Georgia. We are one of the 5 states with widespread H1N1 outbreaks.

I share an office with another family physician. I aggressively measure and replete vitamin D. He does not.

He is seeing one to 10 cases per week of influenza-like illness.

In my practice-- I have had zero cases. My patients are universally on 2000-5000 IU to maintain serum levels 50-80 ng/ml.

Ellie Campbell, DO

Campbell Family Medicine

3925 Johns Creek Court Ste A

Suwannee GA 30024



Concensus is not always good said...

Hand hygiene and facemasks have been recently demonstrated not to be statistically significant in slowing down the spread of influenza in a household. Vitamin D is the way to go.

Facemasks and Hand Hygiene to Prevent Influenza Transmission in Households: A Randomized Trial.
August 3, 2009

The CDC in Atlanta funded and participated in this trial, they simply do not promote the fact they are wasting people's time.

Dr. Daniel Chong said...

Man I wish the newspapers would stop focusing so much on that!

Natalie Henry Bennon said...
This comment has been removed by the author.
Natalie Henry Bennon said...

Can you get TOO MUCH vitamin D?
I read, I think on Dr. Mercola's website but I can't remember for sure, that the answer was no. But then someone told me vit D is fat soluble, so you don't want to take too much.

Dr. Daniel Chong said...

Hi Natalie,
You ABSOLUTELY can get too much vitamin D. That's one of the reasons why it's imperative that you get your levels tested if you are using an oral supplement. The key is though that it usually takes a lot more vitamin D to get to a potentially toxic level than people think. So, don't make the mistake of opting not to get tested and just taking a little less than recommended.