Cytokine Storm & Vitamin D relationship?

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

I am very appreciative for the time and thoroughness taken by Dr. Heaney to address some of the basic questions we have been asking on this thread. It is a real honor to have people of the stature and expertize of Dr. William Grant and Dr. Robert Heaney participate here with us in this discussion.

I hope that those following this very interesting conversation over the last few days have enjoyed it as much as I have. It has been very informative to me and before I got involved in this thread, thought I knew all about vitamin D!

Well, another notion of mine hits the dust.

At any rate while I think what Dr. Heaney said was pretty clear, I decided to paraphrase his responses in my own words. Below is my interpretation of what he said.

Specifically, he recommends supplementing with vitamin D3 rather than vitamin D2.

Second, he didn't say exactly what dose people should take but did say most vitamin D experts he knows take 5,000iu vitamin D3 daily.

Thirdly, he confirmed that doses up to 10,000iu per day are probably safe (but did not recommend that dose or any specific dose).

Fourth, he confirmed that having a 25 OH vit D3 serum goal of between 40ng and 80ng was reasonable to obtain both the bone benefits and probably those related to infection resistance and cancer prevention.

Finally, he expressed hope that there was a relationship between vitamin D and autoimmune diseases like MS and diabetes but thinks to get this benefit requires that the mother (and probably father too although we never consider him) of the child be vitamin D replete and otherwise well nourished before becoming pregnant.

Grattan Woodson, MD

 

[Shannon Bennett]

Re: Cytokine Storm & Vitamin D relationship?

Dr. that answers most but not quite all of my questions. The only thing I/we still need to know is the dosage for children-how much, age limits, etc...

Dr. Woodson, I would like to extend our overwhelming gratitude to you and to Dr. Heaney.
:tiphat::applause:

 

[kiwibird]

Re: Cytokine Storm & Vitamin D relationship?

I second that Shannon. Your advice and knowledge has been invaluable. Thank you.

 

[the doctor]

Re: Cytokine Storm & Vitamin D relationship?

Dr. that answers most but not quite all of my questions. The only thing I/we still need to know is the dosage for children-how much, age limits, etc...

Dr. Woodson, I would like to extend our overwhelming gratitude to you and to Dr. Heaney.
:tiphat::applause:

Shannon, thanks for the kind comments.

I am not a pediatrician but do know that those involved in pediatric medicine have been reconsidering this issue.

I think the RDA for kids remains pretty low, 200iu but no more than 400iu of D2.

So, I don't have an answer for you about this but would speculate that kids need a lot more than these levels of D3 as a supplement for optimal health especially those who do not get adequate sun exposure due to where or how they live.

GW

 

[AlaskaDenise]

Re: Cytokine Storm & Vitamin D relationship?

Thank you Dr. Woodson and Dr. Heaney. :applause:

I really appreciate your willingness to share your time and expertise on this subject.

Regarding children, in past generations there was a tradition of giving a baby a daily "sunbath" of 15+ minutes - for good health. It also helps clear up diaper rash.

.

 

[AlaskaDenise]

Re: Cytokine Storm & Vitamin D relationship?

Tolenio:

Thanks for the links.

It not only gives the index number, but recommended exposure times.

Another UV index with an available UV widget is at:

http://www.epa.gov/sunwise/uvindex.html#lookup

To add the widget to a website (hint F1 and Sally) see: http://www.epa.gov/sunwise/uviresources.html

.

 

[sharon sanders]

Re: Cytokine Storm & Vitamin D relationship?

Thank you everyone.

 

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

Today's Daily - a publication of Statistics Canada - reports on a survey of Vitamin D levels in the Canadian population:

http://www.statcan.gc.ca/daily-quotidien/090702/dq090702-eng.pdf

________

Canadian Health Measures Survey:
Vitamin D blood plasma concentrations in
the population
2007/2008 (preliminary)

This release presents preliminary data on blood plasma
levels of vitamin D from the Canadian Health Measures
Survey (CHMS), the most comprehensive direct health
measures survey undertaken on a national scale in
Canada.

Results show the mean concentration of Vitamin
D in blood plasma for the Canadian population
aged 6 to 79 was 66.9 nanomoles per litre (nmol/L)
in 2007/2008. Children aged 6 to 11 had the highest
concentration (76.0 nmol/L) followed by older Canadians
aged 60 to 79 (73.5 nmol/L).

The national estimates reflect measures from
one-half of the CHMS sample (slightly more than
2,600 Canadians aged 6 to 79) that is representative of
the national population. Data were collected across Canada during a
one-year period from March 2007 to February 2008,
covering all seasons. These are the first national
data on the vitamin D status of Canadians available in
over 35 years.

Vitamin D is a nutrient that helps the body use
calcium and phosphorus to build and maintain strong
bones and teeth. The CHMS measures vitamin D levels
as part of the assessment of chronic disease risk factors
and nutritional status.

The CHMS preliminary national estimates of
vitamin D in plasma concentrations, by age and sex,
are being released today to provide baseline estimates
to researchers and other organizations interested in
nutrition.

Normal population reference ranges for plasma
vitamin D, and possible health effects, are not
well-defined in Canada or the United States. A
comprehensive review jointly funded by the American
and Canadian governments is currently underway to
review the 1997 Dietary Reference Intakes values for
vitamin D.

Note: The CHMS measures plasma 25-hydroxyvitamin
D, or 25(OH)D, a circulating metabolite that reflects
different forms of vitamin D in our bodies that we get
through dietary sources or through skin exposure to
sunlight. The release of full CHMS data will begin
in January 2010 with information related to this topic
such as outdoor activity, sunscreen use, and food
consumption of fish and milk. Additional information
on nutrition and supplement intake is available from
the Canadian Community Health Survey (2004) and
comparative American data are available from the
National Health and Nutrition Examination Survey.
Nanomoles per litre (nmol/L) is a concentration
measure that reflects the number of vitamin D
molecules per litre of blood. Because molecules
are small, we would have to add multiple zeros to each
nmol measure to actually show the concentration of
vitamin D molecules per litre of blood.

[ Multiple tables are published in the Daily, linked above.]

J.

 

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

UV plots in real time for certain points in Canada - Churchill's values may be closest to Island Lake / St. Theresa Point MB.

http://exp-studies.tor.ec.gc.ca/e/ozone/uv_plots.htm

And the Map of the measurement points:

http://exp-studies.tor.ec.gc.ca/e/ozone/ozonecanada.htm

J.

 

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

And the year to date graphs of UV (from the link above and a bit farther down on the page).

Look at Regina's, which is approximately the same latitiude of Winnipeg. If 3.5 is the sun-skin threshold, that level isn't reached until March:

http://exp-studies.tor.ec.gc.ca/ozo.../max/STN338/uv/dailymaxuv-Brewer-111-2009.gif

And for Churchill, not until mid-April or early May:

http://exp-studies.tor.ec.gc.ca/ozo.../max/STN077/uv/dailymaxuv-Brewer-026-2009.gif

J.

 

[Shannon Bennett]

Re: Cytokine Storm & Vitamin D relationship?

Clear as mud is an excellent description. They are comparing apples to oranges with no explanation of whether or not the population is anywhere near where it should be for adequate vitamin D.

Hello,

Any information provided by the governments cannot be taken at face value. You will have to look at specific research criteria to look for distortions. For example a study conducted in summer, a study that focused on a population segment omitting others, etc.

I am not sure how this translates in ng/L;

As far as I know the recomended range is 40-90 ng/L but how that that converts to nmol/L I have no idea.

For the layman it is clear as mud and maybe that is how they want it.

Later,
Tom

 

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

Hello,

As far as I know the recomended range is 40-90 ng/L but how that that converts to nmol/L I have no idea.

For the layman it is clear as mud and maybe that is how they want it.

Later,
Tom

I'm definitely a layperson.

But conversion is possible:

http://www.globalrph.com/conv_si.htm

Conventional Units - International Units
Using this table: To convert from a conventional unit to a SI Unit, multiply by the conversion factor listed (eg Albumin 3 g/dl x 10 = 30 g/L. To convert from SI Units to conventional units, divide by the listed conversion factor.


Vitamin D
1,25-Dihydroxyvitamin D pg/mL 2.6 pmol/L
25-Hydroxyvitamin D ng/mL 2.496 nmol/L

And the study collected data on "The CHMS measures plasma 25-hydroxyvitamin D, or 25(OH)D..."

So 40 ng/ml = 99.84nmol/L and the tables can be redrawn to compare measured values with recommended values.

J.

 

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

Clear as mud is an excellent description. They are comparing apples to oranges with no explanation of whether or not the population is anywhere near where it should be for adequate vitamin D.

StatsCanada never makes recommendations or opinions about what to do based on the data. Or at least, not in an obvious manner. The line about the first study on vit D in 35 years could be an indication that this is an impoprtant subject that has been a very low priority for a long while.

It's up to the experts to interpret the data and form it into commentary and recommendations. Survey and descriptive stats are StatsCanada's game; doing something with that raw data is up to the researcher, and from there, the lobbyists and politicians.

The data published today is not segmented - at least not in the manner we want. There are percntiles, but I don't know of what - likely percentiles of household population? But no info on regions or cultural differences. Perhaps when they start releasing the full data in January.

But the best we can hope for, I suggest, is a retrospective study of D levels in the confirmed Aboriginal cases.

J.

 

[palbert]

Re: Cytokine Storm & Vitamin D relationship?

Dr. Woodson emailed me a few days ago to hear the perspective of Autoimmunity Research Foundation on this discussion. As some of you know, the Director of the Foundation, Trevor Marshall, PhD, has made the case that supplemental vitamin D is the last thing you would want to give people at risk for the flu. Allow me to explain the relevance of Marshall's work to this discussion.

The Autoimmunity Review that Dr. Woodson mentioned, for which I am first author, is a good starting point and will give the reader a lot of valuable context.
http://autoimmunityresearch.org/transcripts/AR-Albert-VitD.pdf

Here are the propositions we are putting forward:

• When active/activated, the Vitamin D Receptor (VDR) transcribes hundreds, more likely thousands of genes, including those involved in innate immune function.
• 1,25-D is the active form of vitamin D. It turns on the Receptor.
• 25-D is the inactive form of vitamin D. It turns off the Receptor.
• The body controls activity of the VDR through various pathways which alternatively upregulate or downregulate levels of the vitamin D metabolites: 25-D and 1,25-D.
• Without getting into the multiple enzymes which downregulate 25-D, the body effectively "chooses" to limit the concentration of 25-D, with the ultimate goal being the upregulation of VDR activity. In other words, a low 25-D is a result of disease.
• A range of pathogens including L-forms (which Dr. Woodson mentioned in his previous post) but also biofilm bacteria, other intracellular pathogens, and viruses create ligands that bind to inactivate or otherwise downregulate activity of the Receptor. This is a logical survival mechanism. The following pathogens and substances created by pathogens have been shown to downregulate activity of the Receptor. We expect that this list will grow in time (several of these studies have just come to the fore in the last few months).

1. Epstein-Barr virus ? shown to downregulate expression of the VDR by a factor of about five http://www.ncbi.nlm.nih.gov/pubmed/19550398
2. HIV ? inhibits conversion of 25-D into 1,25-D http://www.ncbi.nlm.nih.gov/pubmed/9814454
3. Live Borrelia burgdorferi reduced VDR expression in monocytes by 50 times, and lysates (?dead? Borrelia) reduced it by 8 times http://www.ncbi.nlm.nih.gov/pubmed/19461888
4. Mycobacterium tuberculosis ? shown to downregulate the VDR 3.3-fold http://www.ncbi.nlm.nih.gov/pubmed/12890386
5. ?Gliding? biofilm bacteria have been shown to created Capnine, a ligand which inactivates the VDR http://www.ncbi.nlm.nih.gov/pubmed/18200565
6. a substance, created by pathogens, which beaks up the VDR is caspase-3 http://www.ncbi.nlm.nih.gov/pubmed/18832097

• The state of chronic inflammatory disease is characterized by an underactive VDR.
• Any patient whose VDR is downregulated is immunocompromised and cannot fully respond to pathogens.
• Some have supposed that if you give a patient additional vitamin D, the body would immediately hydroxylate it into 25-D and then again into 1,25-D. This is not a given. First of all, according to a number of studies, 1,25-D is already high in people sick with chronic disease. We argue that the substance cannot activate the VDR is because the Receptor is blocked by pathogen-created ligands or otherwise downregulated. A second point is that at high levels, 1,25-D interferes with the activity of *other* key nuclear receptors.... The takeaway here is that giving a person sick with chronic disease vitamin D only further interferes with the immune response - the last thing a doctor would want to do for those patients susceptible to the flu or other pathogens requiring a robust immune response.

As popular as vitamin D supplementation is these days, this is not the craziest idea. If anyone has questions about this model or would like to see additional studies supporting different components of it (there is a reason why I broke up the model into bullet points), please ask. Marshall's model is not perfect, but there is lot more evidence supporting it than people seem to realize, certainly more than I can include in a short post.

Best,
Paul

 

[Shannon Bennett]

Re: Cytokine Storm & Vitamin D relationship?

Palbert, I would like to be the first to welcome you to Flutrackers.

So, from what I read in your bullet points is we still know far too little to recommend substantially raising D levels through supplements. However, we do know that D levels in many is below recommended let alone optimal. Therefore, you would not suggest the use of supplements in those with an immune compromised system. And, I suspect you are also suggesting people are tested before simply taking supplements.

 

[kiwibird]

Re: Cytokine Storm & Vitamin D relationship?

Thank you Palbert. Does this thinking relate mainly to the taking of Vitamin D after exposure to viruses etc., or does it also relate to the "filling the tank" proactive approach we were contemplating.

 

[cartski]

Re: Cytokine Storm & Vitamin D relationship?

[*] Some have supposed that if you give a patient additional vitamin D, the body would immediately hydroxylate it into 25-D and then again into 1,25-D. This is not a given. First of all, according to a number of studies, 1,25-D is already high in people sick with chronic disease. We argue that the substance cannot activate the VDR is because the Receptor is blocked by pathogen-created ligands or otherwise downregulated. A second point is that at high levels, 1,25-D interferes with the activity of *other* key nuclear receptors....

The takeaway here is that giving a person sick with chronic disease vitamin D only further interferes with the immune response - the last thing a doctor would want to do for those patients susceptible to the flu or other pathogens requiring a robust immune response.[/LIST]

As popular as vitamin D supplementation is these days, this is not the craziest idea. If anyone has questions about this model or would like to see additional studies supporting different components of it (there is a reason why I broke up the model into bullet points), please ask. Marshall's model is not perfect, but there is lot more evidence supporting it than people seem to realize, certainly more than I can include in a short post.

Best,
Paul

Thank you very much for joining this discussion.

Wow, this is getting complex for my layperson's brain!

I think many of us have been thinking of vitD supplementation as a prophylactic, rather than a treatment. In other words, coming into the fall and the high risk flu period, and continuing through winter, I want my body systems operating as optimal as possible. Since I live in the north, that means supplementation is a logical tactic. Let the body upregulate or downregulate as it sees fit; my job is to see that it has all the tools it needs.

And the big risk is a cytokine storm, which, to my simple understanding, is an uncontrolled immune reaction to the virus. An overly robust immune response is not desireable with this kind of viral flu (as seen in the age distribution of the H1 cases as opposed to the normal flu cases). The body need time to get rid of the virus, but the storm reaction doesn't allow that to happen. So if vitD siupplementation regulates that reaction to help prevent the storm, that's good.

But now, all that logic changes in the presence of the chronic diseases listed. And, possibly depending on the chronic disease and its 'in vogue" treatment, or some other general advice about depletion levels, some might well be on vit D supplementation already (which may be likely for Aborignals in the north).

So supplement if healthy; don't supplement if chronically ill.

And hope that one knows whether or not one suffers from a chronic inflamatory disease in order to take the appropriate course of action.

J.

 

[prepdeb]

Re: Cytokine Storm & Vitamin D relationship?

Welcome Palbert and thank you for commenting on this subject.

I'm not sure I understand though.
I have mild COPD and hepatitis C. I've been battling illness for the past month or so, with each return being milder than the previous.
Into my third round of whatever is causing the flu-like symptoms.

Does this mean supplementing with vitamin D would be detrimental?
I'm assuming it would be alright to supplment when not ill.

As someone who has existing health issues, I'd like to do whatever I can to improve my situation.

Thanks in advance to anyone who can explain this to me. Sorry for being dense.

 

[kiwibird]

Re: Cytokine Storm & Vitamin D relationship?

Prepdeb - I don't think we have to worry about being dense (I was thinking the same thing about myself) but have eased my mind with the fact that these are world experts in their field - and they are in dialogue - and perhaps grappling with different conclusions!

There is a sense of urgency with this problem though. We, in the Southern Hemisphere, are actually fighting this virus already and the decisions we make, with regard to supplements and healthcare, will directly and quickly affect those around us, especially our children. We truly appreciate this discussion and thank everyone who is contributing.

 

[palbert]

Re: Cytokine Storm & Vitamin D relationship?

Thank you for your gracious hello and your questions. I'll address a few of the points raised.

"However, we do know that D levels in many is below recommended let alone optimal."

We argue that in the state of chronic disease the optimal 25-D is... zero. (Yes, I know, it sounds shocking, doesn't it?)

That we have a certain store of vitamin D and we must "fill the tank" is a pervasive meme among doctors and researchers. Not to diminish the complexity of carbohydrate metabolism, which I'm sure is complex, but vitamin D is not metabolized like a carbohydrate. It is *carefully regulated.* We would put forth that vitamin D does not get used up.

Vitamin D is classified as a secosteroid. What does that mean? It means that it looks like a steroid (one unfused carbon ring different than a steroid) and it is regulated as such.

Think about the Vitamin D Receptor as a control mechanism for the innate immune response. Say the innate immune response detects pathogens and decides it wants to turn on the innate immune response. The way it does this is by increasing the amount of active form of vitamin D (1,25-D) and decreasing the amount of inactive form of vitamin D (25-D). As 1,25-D increases and 25-D decreases, the VDR successfully transcribes the genes necessary for the innate immune response. I could point to a series of mechanisms that the body has in place to regulate levels of the vitamin D metabolites.

It is widely assumed that low levels of 25-D cause or exacerbate disease. But what if it was the other way around? What if the body was acting in the most sane, logical manner it could and choosing to downregulate (that is the right word) levels of 25-D so as to upregulate immune function? If this were true, giving a patient additional vitamin D, whether it is D2 or D3, would be doing the exact thing our body would have us not do. In other words, we're saying you give an immunocompromised patient supplemental vitamin D, and you are making him more immunocompromised.

"Therefore, you would not suggest the use of supplements in those with an immune compromised system."

Exactly. And I'm saying that people who have low levels of 25-D - and that includes almost everyone with chronic disease - are immunocompromised. I would offer that the very people this board is worried about most including the elderly, the infirm, etc. are the populations that are least likely to benefit from vitamin D supplementation....

Consider this. In practice, widespread and systematic supplementation of vitamin D serves to drive a kind of self-fulfilling prophesy. When whole populations are given large amounts of vitamin D, the only members of that population who remain ?deficient? are those whose immune systems are fighting disease by actively downregulating 25-D. In other words, the more rigorously vitamin D is added to milk, juice, snack bars, and breakfast cereals, the less likely it is that someone has low levels of vitamin D but no chronic disease.

"Does this thinking relate mainly to the taking of Vitamin D after exposure to viruses"

No, it applies to supplementation in general. Vitamin D is stored in the fat and a person's 25-D can remain elevated for several years (in spite of the body's most vigorous attempts to downregulate the metabolite).

I hope this helps explain. For those who want to read more, you can check out our Foundation's Knowledge Base, which is a work in progress. Here's one page that touches on a lot of this:
http://mpkb.mp-dev.com/doku.php/home:pathogenesis:vitamind:metabolism

Paul

p.s. Just now, I see some additional questions. I'll let this post sit for a little bit in case other people want to chime in.