Activated Vitamin D trial

well a warm welcome to today's talk Monday the 18th of September now I'm going to be looking at some research on vitamin D that's come from Japan today now note this research is not from Canada not from New Zealand not from the United States not from the United Kingdom it wasn't conducted out by a large-scale pharmaceutical industry or company it was conducted by local clinicians and academics in Japan pity we can't manage to do this kind of research in our countries that some might think and of course vitamin D is remarkably cheap pharmaceutical Industries probably wouldn't want to spend 10 million dollars on a clinical trial because they can't get their money back because it's already uh out of patent it's a generically available molecule and not only that vitamin D did turn out in a large-scale randomized control trial to be exquisitely effective then who knows that might influence the sales of other products the pharmaceutical industries make but that sort of speculation let's look at what we know this is giving activated vitamin D and it's a study from Japan as we've said in the Delta and the Omicron era of covert now we've looked at the benefits of vitamin D on this channel numerous times um preventing colon colon cancer um or reducing the incidence of colon cancer almost certainly reducing the incidence of numerous other cancers reducing heart disease reducing the likelihood of diabetes reducing the likelihood of dementia and of course the whole immunity boosting uh properties of vitamin D and the anti-inflammatory properties and probably a few others I can't quite remember off offhand but that's what this is looking at specifically looking at the effect of um vitamin D supplementation in the covid pandemic but it probably work equally well for other infections they had an intervention group and a control group now because this didn't have a large-scale funding it was a retrospective study what they did was they took they looked at people that had the activated vitamin D and compared those to people that hadn't so they did have an intervention group they did have a control group but it was retrospective obviously would like it to be prospective on a much larger scale but as we've said that costs a lot of money but despite that the data that's come out of this is really quite significant now interestingly they did find low vitamin D concentrations in between 65 and 77 percent of the people that actually went into the trial so in Japan as in other countries a lot of people already have really quite low levels of vitamin D and it's the people with the lowest levels of vitamin D that probably benefit most from the supplementation of the vitamin D this is low hanging fruit that we really need to pick for the health of ourselves and the people around us now uh the vitamin D group in terms of needing respiratory support six percent needed response respiratory support whereas in the control group it was 14 percent and that's a significant difference given the numbers um that that's basically demonstrates a very high probability of efficacy in terms of needing high flow oxygen four percent in the vitamin D group needed high flow oxygen but it was 11 in the placebo group now in terms of death the people in the vitamin D group three percent died these were people that were being admitted Hospital were already ill of course five percent in the control group but the difference there was not enough to be significant so we can't say there is a difference there if the numbers have been larger then of course the picture could have been very different but there was a decrease in survival of controls over time so as time went on the controls were less likely to survive so that's what this is about if you want to watch now I'm just going to give a bit of background biology here just before we uh delve into this so what actually happens here is the skin will produce vitamin D in response to sunlight as we know and we can also absorb vitamin D from the gastrointestinal tract this is the stomach now that then goes in the blood to the liver and the liver is the biochemical factor of the body it processes it and it turns it into something called calcifidiol but that calcifidiol itself then goes to the kidney for further processing into a molecule called calcitrol and it was this molecule here that the Japanese researchers were actually giving and it's this molecule here which is believed to have most of the biological effects on the DNA on the cells and the body cells and the immune cells so that's what they were given the kind of shortcut in the process because if you take vitamin D orally for example or in the sun it can take days to a week or two to get through the liver and the kidneys to get into the active form therefore if you're already ill there's not a lot of point if you're already ill taking well maybe in the very early stages but if you're taking vitamin D tablets the ordinary D3 that we get from the supermarket or our pharmacists that would take time to activate so really quite clever that the Japanese were were bypassing this now here's the study here from Japan this is the study here and we'll be comparing with data from this or this this so this is just out this is just the end of August 2023. we'll be comparing it with this study from 2020 and this study from uh 2020 as well I believe yeah 2020 and we'll find that these three studies are basically in agreement so while we haven't got one huge mega study like we'd like with tens of thousands of people across different uh continents checking the difference between giving one molecule or the other molecule or the third molecule um that would be the best thing to do checking that against uh Placebo checking that against other medications given that that hasn't happened this is the next best thing we've got so let's let's dive into the detail now so this is the study published in clinical nutrition it's a peer-reviewed journal so this is this is pretty good quality science really despite the small scale of the study vitamin D deficiency is associated with elevated risk severity and mortality as we said using the example of covert but it's also true in asthma so less people if people are low in vitamin D they're more likely to die from or get sick from asthma tuberculosis which of course can be largely respiratory chronic pulmonary obstructive disease which is so common so common in our societies and viral respiratory infections so we know that vitamin D low vitamin D levels give a worse prognosis for all of these conditions and um the fact that the government said nothing about this during the covid pandemic really is incredible quite incredible now this is the first consistent paper here that we looked at which is this one so comparing it with this paper here now what what is this saying well this paper here is uh says vitamin D is essential for several cellular processes wound healing immunity and inflammation and we also know that there are vitamin D receptors in every type of immune cell so you probably know there's different sorts of immune cells there's neutrophils that specialize in combating bacterial infection there's lymphocytes which specialize in combating viral infections and there's other things like uh the the big monocytes that become macrophages that are phagocytic and Gobble up um foreign material all of these cells have vitamin D receptors so it's reasonable to assume that all of these cells need adequate amounts of vitamin D to optimize their function it works at the cellular level now Studies have displayed strong interrelationships with vitamin D deficiency and progression of lung disorders according to this or the paper it's ease of supplementation and development of personalized medicine so it's easy to Bunk it up you just take a few tablets for a week or two it's just bunkage it's easy to bunk up could lead to an effective adjunct and cost-effective essentially free cost effective therapeutic modality for high fatality pulmonary disease and of course sadly I have seen so many people die of lung disease so that makes sense the other consistent paper that we're looking at is from 2020 evidence that vitamin D supplementation could reduce risk of influenza and covert infections and deaths check out the references for themselves I always Supply them now to reduce the risk of infection this paper says it's recommended that people at risk of influenza and or covert 19. consider taking 10 000 international units of vitamin D3 for a few weeks to rapidly increase their vitamin D blood levels and of course that will feed through to the activated form through the kidneys and then they say followed by 5 000 international units a day so this is this paper is saying people that are low that are at risk of covert should bunk it up fairly quickly with 10 000 units a day and then followed by 5 000 units a day as a maintenance dose they say the goal should be to raise vitamin D concentrations is in the plasma to 40 to 60 nanograms per ml that's 100 to 150 nanomoles per liter it's a Pity we measure this differently this is the way that's typically measured in the United States and this is the way it's measured in the UK but it's the same now of course this is what this paper says I can't advise you what to take ideally you would get your blood levels checked now I've been trying to get my GP to check my blood levels of vitamin D for a few years and I have now succeeded so I now as of the end of August I know what my vitamin D levels are and I'm going to reveal that to you now so uh my vitamin D levels at the end of August were 85 nanomoles per liter and that translates into 34 nanograms per ml now if you take the normal range here is considered to be 20 to 60. you can see I'm not all the normal range there is considered to be 50 to 100. you can see that mine aren't that high um 85 nanomoles 34 nanograms so just to be completely clear that and that are exactly the same a mountain that blood is just different units now I was surprised how low it was because um typically I've been taking four to eight thousand units of vitamin D a day but then when the sunny weather came along I stopped taking that and it just went out in the sun I know you know I dig my Gardens and my allotment in the Sun and uh you know get some sunbathing in when I got the time I'd had a fair bit of sun exposure and um and yet after all this at the end of the summer my vitamin D levels weren't that high and that's with some supplementation so personally I've increased the amount of supplements so I'm taking 8 000 units a day now to try and bunk that up a bit because really I think and we really could debate these levels here as well I mean are these levels that are given as normal uh 20 to 60 nanograms a million is that the ideal level or should they really be a bit higher than that because a lot of these vitamin D recommendations were the levels which are advised to prevent rickets whereas what we want is the levels to optimize the immune system and we'll optimize the anti-cancer system and the anti-heart disease system and the anti-dementia system and the anti-diabetes system all these things as well we need we need to optimize so a bit disappointed how low mine was to be quite honest so ideally everyone would get their blood levels checked by the doctor and they would titrate those accordingly but um that's what that paper said there uh but of course I can't advise you what to what to take for treatment of people who become infected with covid-19 higher D3 doses might be useful and and of course as influenza season comes up why don't we optimize our vitamin D levels because we know that this is uh important for immunity uh vitamin D deficiency is relatively common according to the original paper so we're back at the Japanese paper now we're looking at the original um its original paper from Japan surprisingly common actually um especially among the elderly people with obesity now the elderly don't get out as much people with obesity vitamin D is a fat soluble vitamin so people that are obese end up with less in the blood so people that are obese would have to give much higher doses for much longer to top their blood levels up because the vitamin D goes into the fatty tissues and patients also who were low on vitamin D with comorbidities including hypertension which is cause and effect there of course is an interesting question diabetes um again is there some effect on metabolism on on absorption there we don't know COPD often they don't get out as much either and chronic kidney disease and if it's got chronic kidney disease the kidneys may not be working as well so they don't translate it into the active form and of course it just so happens that these are all the major risk factors for covert so is there an overlap here is it the lack of vitamin D that's predisposed into severe covert partly is probably the answer to that how partly we don't really know but the paper does say that vitamin D induces production of antiviral peptides one called defensing for example and and these go in the uh in the respiratory passages so help protect us from viral infections up regulates anti-inflammatory cytokines such as interleukin 10 so you get more of that there's an anti-inflammatory but it down regulates pro-inflammatory cytokines into looking one interleukin-6 tumor necrosis Factor Alpha so it down regulates those pro-inflammatory cytokines if there's less of those there's less boosting to the inflammatory process vitamin D affects the Angiotensin converting enzyme axis which of course is the receptor site for the covid uh virus the the SARS coronavirus II specifically so there's probably some extra specific anti-covert effect there and uh vitamin D also has a protective effect against acute respiratory distress syndrome which as you remember when in the early stages of covert the alveoli the air sacs in people's lungs that are essential to get the oxygen into the blood and the carbon dioxide from the blood back into the air to be breathed out these fill up with water inflammatory fluids that's acute respiratory distress syndrome part of the reason people were dying as well as the intravascular effects of course efficacy of activated vitamin D supplementation in coronavirus so that that's what this study is looking at the effect of the activated form the activated form so as we said they're completely bypassing the body system and giving this activated form in tablets straight away which makes a lot of sense because these people were already uh poorly of course so it was prescribed on day one or day two generally for these treatments the earlier you give them the better potential treatments which are effective in covert um can't remember any just now but of treatments which are potentially effective in in covert are always more efficacious if they're given early in the disease process as early as possible in the disease process if you wait till someone's already got a cytokine storm then probably all you can do to treat that is give the steroids rather than the more specific Therapies um so they wanted to evaluate the effect of this activated vitamin D on the presentation and severity of mortality in patients hospitalized with covert so these are hospitalized patients not a preventative routine like the previous paper and doses that we discussed now they looked at data from April 2021 to October 2021 which was Delta time and they also looked at uh Omicron time as well but it doesn't matter really because they were comparing those that had the activated vitamin D and those that hadn't so they were comparing like with like which of course is the key thing in in controlled trials um that's what they gave to the active group what they were looking for is the need for additional respiratory support need for oxygen and in hospital mortality rate these were the the outcomes that they wanted to monitor now the experimental group not that large they looked back there was 122 patients as we've said this should be done properly on a huge scale but that would cost money and have to be sponsored by someone and uh industry that sponsors most of these trials is simply not has not done that so far um median age was 66 in the so this is the group that had the experimental group had the vitamin D and their Baseline vitamin D deficiency was really quite High 77 slightly younger in the control group 58 was the median age and the age difference wasn't really quite significant although it was getting close to it so basically the people in the vitamin D group were slightly uh older on average um Baseline vitamin D deficiency 65 in the control group and the Baseline deficiency the difference between the control group and the experimental group that had the vitamin D was uh not significant but it was 0.07 so it was nearing significance um right proportion of those requiring more respiratory support in hospital mortality so the vitamin D group required more respiratory to support six percent of the time the control group it was 14 of the time so we see the vitamin D group required respiratory support much less and that result is highly significant b equals 0.1 so that's a 99 likely to be an accurate result which we counter highly significant result in in research terms now after what they did called propensity scoring so what they did in propensity scoring was they looked at the differences between the two groups what medications were they on what were the comorbidities what were the age um and they tried to account for these factors and they still found it was significant so it went down to P equals 0.03 that means there was still 97 percent sure there was a real a real effect so again it's it's significant data had the numbers been um way larger and the differences between the two groups as great then the p-values would have been much much smaller and the level of certainty would have been much much higher um now this shows this is that this is a survival this is the control group here so we find that over time the survivability in the control group actually went down quite uh quite dramatically so the control group just weren't surviving as long as time went on down to about what 40 there um so much lower proportions of survival in the control group compared to the vitamin D group so over time this indicates that the effect is becoming more uh more significant over time as time went on the survival sadly in the control group went down whereas in the vitamin D group the survival stayed higher more patients surviving just to break it down a little bit more the vitamin D group uh proportion of patients who required high flow oxygen four percent control group it was 11 again that result was significant in hospital mortality three percent versus five percent p-value there not significant because the numbers of people dying weren't large enough to get statistical significance but need for additional respiratory support six percent versus 14 They concluded it works it may improve well no they concluded it may to be fair the proper researchers may may improve outcomes it looks fairly probable from what we've said reducing composite outcomes including the need for additional respiratory support and in hospital mortality so um low cost they didn't report any Adverse Events there was no high levels of calcium when you take vitamin D if you take very high amounts of Vitamin D it can liberate some free calcium and the thing there is to take some vitamin K2 because if you take the vitamin K2 the K2 sequesters that calcium into the bones and not into the tissues so it makes your bone stronger so personally I take vitamin D with uh K2 we don't get much K2 in our diet in Western countries because it comes from fermented foods so um from this no side effects reported so looks pretty safe no severe significant adverse reactions reported and it looks pretty safe and from the data we have it looks to be effective I wouldn't like to use the term safe and effective but this is what that stood here indicates so pretty interesting low-cost treatment why isn't this being researched all over the place and rolled out I think we know the answer to that now um I'm going to put a link um to download my textbook so if you want to brush up on physiology I think about about half a million downloads of these now so this must be one of the world's most read physiology books largely of course because it's free you can download it free if you do live in the UK and you want a hard copy of this one I'll put a link on I've still got a few hundred left I need to get around to do another print run at some stage um but um the physiology book is there but completely free download high resolution PDFs printed out put it in your workbooks do what you want with it I'll put it in the public domain and my pathophysiology notes now I haven't got this in hard copy at the moment I haven't had time to update it but um again you can download the whole thing in high resolution PDF or completely uh three for your educational interest um it is really some really interesting stuff in this when you when you write something you kind of forget about it then you go back and look at it think oh that's quite interesting that something I've written a few years ago but but uh anyway that's them free downloads um as you would uh choose and for now thank you for watching um it's just a Pity we don't have more safe effective low cost remedies sometimes based on things that are freely available or very very cheaply available sometimes based on things like repurposed drugs more natural uh natural compounds more optimization of diet more optimization of the microbiome more optimization of vitamin D levels all of these things more exercise making sure we get plenty of sleep all of these things that can promote Health that don't cost anything therefore often don't get promoted by clinical trials it's a sad situation but it's where we are but that's probably why you're watching this video if you stay to the end thank you for for watching don't forget to do the free downloads

Channel: Dr. John Campbell

Views: 555,993

Keywords: physiology, nursing, NCLEX, health, disease, biology, medicine, nurse education, medical education, pathophysiology, campbell, human biology, human body

Id: 0Ken0luasu0

Length: 25min 0sec (1500 seconds)

Published: Mon Sep 18 2023