Vitamin D studies confirm correlations

welcome to this talk now the vitamin d sag goes on more and more evidence is emerging and i'm going to look at some of that today and yet governments around the world just seem to completely fail to take it on what is going on here i mean there can't be some international global conspiracy it's just very very strange that no one's organized large-scale interventional clinical trials and uh governments really don't seem to have taken this message up the uk government's giving out 400 international units of vitamin d to vulnerable people which is a minute dose and probably won't be enough to make any difference so why is it not being taken on seriously this really is a strange question you can understand the pharmaceutical companies not pushing it because vitamin d is dirt cheap actually and they can't make any profit out of it now we don't condone that but but really why governments aren't taking it up and why international guidelines aren't changing is really a mystery anyway let's look at the latest uh the latest couple of pieces of research that i've dug out that i found particularly interesting now the first one uses data from this now this is um this is uk biobank and this is um well it tells you what it is large-scale biomedical database and research resource containing in-depth genetic and health information from half a million participants and growing all the time so largely a database but they also keep specimens as well that can be uh referred back to so some pretty interesting uh stuff going on there this is really a start of mega data that you if you've got half a million or a million people in your database you can basically type in any question you like and get some kind of answer for it as long as that data is there anyway that's what we're looking at so um vitamin d uk biobank data now habitual use of vitamin d supplements and the risk of covered 19 disease now this is people that claim to take vitamin d on a regular basis so it is it is a regular supplement and we've looked evidence before that indicates that taking vitamin d daily or or every few days or weekly is better than taking it monthly in a large bowler's dose it seems to be more seems to be absorbed so relatively small amounts on a regular basis seem to be a good idea so at the moment i'm taking about three thousand international units a day um so the the those kind of levels in winter in the northern hemisphere that's what i'm taking um ideally you get your blood levels checked and your doctor prescribes it for you don't do what i do check it out but uh that's just an indication of what i'm taking personally and that's another thing doctors just aren't testing for vitamin d levels it's all very strange everyone should have the vitamin d levels checked by their doctor and this should be then titrated to to optimize their vitamin d levels but it's simply not happening now that's but that's what this is about um published in the american journal of uh nutrition so here is the actual uh publication um the american journal of clinical nutrition and this was published on the 29th of january 2021 so it's an it's it's not new uh data because it's from this biobank but it's a new analysis of the data and quite a sophisticated analysis quite a mathematical analysis so the background is vitamin d supplementation lowers the risk of acute response to tract infection i think we can say that is established now in influenza we have studies for example that show that emerging evidence vitamin d insufficiency is related to higher risk of coronary vice infection and disease well certainly i would say it's probably emerged but that is what they're saying they're saying it's emerging evidence although in my view the case is already convincing objectives to investigate the perspective association between habitual use of vitamin d so this is prospective now having said that when you actually read the paper they're actually taking data that's sometimes uh fairly old so quite how they can claim its perspective i'm not sure but the data is very well analyzed so um just to carry on with that sentence to investigate the perspective association between habitual use of vitamin d supplement and the risk of covid19 infection is what this is about associations according to level of circulation and genetically predicted vitamin d right so they're looking so in other words they're looking at two things well three things really that they're looking at is there a relationship between people who take vitamin d regularly is there a relationship between people's vitamin d levels when they entered this study and their risk of covered 19 and is there a genetic component to this now i didn't know this actually but there's a genetic component that some people have higher levels of vitamin d naturally and other people's have low levels of vitamin d naturally and there's various genes that have been identified for that ch check out the study if you're interested in that it is it it is um quite uh quite interesting i can't pretend to understand it all myself it's fairly specialized genetics but it's interesting and of course the very very simple thing that the darker color your skin the slower you make vitamin d in the sun and remember 90 of vitamin d comes to the diet from the 90 of vitamin d most people come from the sun 10 only comes from diet unless you're an inuit and eat large amounts of fish and seal and things like that but most of us don't um so uh so that's the two things they're looking at now i will give you the bottom line on this because i know people get bored watching these videos sometimes the bottom line is that people who take vitamin d regularly are fairly highly protected i think it's 34 is the number but the the level of vitamin d on admission to the survey in the blood and the genetic predispositions and other yeah the genetic and circulating vitamin d predicts predispositions um do on were not associated with reduced risk of covering 19. so the big thing this study shows is that taking vitamin d regularly is associated with the protective effect but we'll go on and we'll go on and look at it so um 800 and 297 adults met the criteria from this half million on the on the biobank uh record i've covered 19 test results from the uk biobank so there was 8 279 had records of their covered 19 uh tests and this was people that tested positive in the first wave 16th of march 2020 to the 29th of june 2020. so that's when this data is uh analyzing right results of these 8297 adults uh nearly 1400 tested positive during this time period pretty high number because it is it's the first wave time period but still quite a high number 16.6 percent i was surprised at how high that is 16.6 of people tested positive now that's well higher than the national average for that period of time so that does indicate that this might not be a fully representative sample because that is a pretty high number now regular vitamin d uses 363 non-regular vitamin d uses 7934 and you can see what this gives although the numbers are different the mathematics can take account for that you've got basically an experimental group there and you've got a control group there so you've got two groups that you can now compare and contrast this is the sort of thing you can do with this large scale data it's almost like a ready pre-made experiment now what they did was they just ran the numbers they just ran the numbers and didn't adjust for any risk factors any comorbidities or anything and when they just ran the numbers they found out that um the odds ratio was 78 in other words uh that's uh 22 isn't it 22 protective effect so someone on vitamin d was only 78 point it's a 78 is likely to get the infection that means the protective effect was 22 with the unadjusted numbers but and it's a big but the p value is one point zero zero point one and of course a p value needs to be zero point zero five or less for the result to be significant now if the p value is 0.05 that means they're 95 sure the result is a correct result whereas with this p-value uh there it means there are only uh 90 sure that this was an actual result and that's not good enough so this number didn't count but interesting interesting that that was there but then what they did was their statistical people use the strange mysterious powers of mathematics and they adjusted uh very valid statistics they they adjusted for covariance of the factors so they adjusted for age sex race origin whether the patient was in hospital or not blood type years of education tdi that stands for total dyspnea index that's just a that's basically uh dysmere that's the english spelling that means shortness of breath so it's wet it's how quickly people get short of breath basically in various uh various exercise situations or otherwise whether they smoke whether they're drinkers whether they take part in physical activity whether they have a healthy diet score or use of any other supplements so when they took into account all of these things and of course we know that age is a risk factor we know that sex is a risk factor we know that genetic origins are risk factors these things are known an inverse correlation emerged so that an inverse correlation is the higher the amount of vitamin d that was taken the lower the amount of covered 19 that's the inverse relationship as i think we know um so between habitual use of vitamin d supplement and the risk of carbon 19 infection now notice this is people that are taking it regularly this is habitual use this is the interesting thing that really came out in this study regular users and the odds ratio there was a 0.66 0.66 so uh if you take 0.6.66 or 66 off 100 you get 34 is the level of protection so they were only 66 as likely to get the infections as people that didn't take didn't take the vitamin d but here um the result is significant because that is less than 0.00.05 so that is a significant result so the chances of that happening were by chances are unlikely the result is significant so there you go habitual uses of vitamin d supplement was significantly associated with the 34 lower risk of covered 19 infection 34 lower risk i'll take that 34 lower risk there you go is that that's like that's the main result that's that's pretty uh that's pretty good it's pretty good no association with baseline blood vitamin d levels and the risk of covered 19 infection or the genetic factors so the other one as we said didn't check out now to be fair people often had their vitamin d status checked a few years before when they first entered the database and there wasn't many up-to-date samples of vitamin d to compare it to so um it's whether people are habitual users is the main factor there so not too surprising that it didn't come up with anything because the data was a bit out of date for that now um there's a lot of talk and this is this is really interesting a lot of talk about other supplements and i get asked questions on this constantly um so let's see what the data says association between the risk of covered 19 infection and habitual use of other individual supplements do these have an effect so we know that the vitamin d supplement has a 34 protective effect what about vitamin c what about all the other supplements that people take so there's people that took supplements of vitamin a vitamin b compound vitamin b vitamin c vitamin e folic acid and a multivitamin so some people took these as individual supplements and some people took a multivitamin other people took calcium zinc iron selenium glucosamine which we often take for salt joints and fish oils now the answer is that none of these had an association none so the vitamin d did the vitamin d did and none of these had any association now i must say i was a little surprised by the zinc one because we know that zinc in certain circumstances has anti-viral properties but i think the thing is most people in the uk are not short of zinc if people were deficient in zinc i think that will probably make a big difference but there you go none of these made a difference to the likelihood of people getting covered 19. so that's that study there um habitual use of vitamin d supplement the risk of coronavis disease infection and the answer is habitual use of vitamin d seems to have a 34 protective effect from that data it's a correlation i know it's a correlation we need interventional trials why don't we get one is one of the mysteries um is there life on other planets is there a monster in loch ness you know these are just mysteries and why isn't this done you know it's just not why isn't it done the answer to both of those questions is no by the way um but anyway that's a separate point um sorry that's just me being mischievous i like to stir up a bit of trouble occasionally um we might talk about that seriously one day right vitamin d deficiency outcomes uncovered 19 patients now this is another study again peer-reviewed journal um vitamin d efficiency and outcomes have covered 19 patients and this is from germany so quite a nicely uh nicely conducted study again not interventional we've still basically only got that uh spanish study that's interventional from andalusia and not many not much else really anyway so let's look let's look at this this plate this paper um respected journal nice piece of science vitamin d deficiency in outcomes and covered 19 patients medical university heidelberg in the beautiful rhine of valley uh this came out in september 2020. so fairly new stuff we have looked at this briefly before but i'm looking at a bit more detail now identification and modifiable prognostic factors may help to improve outcomes is there background of course modifiable this is modifiable because we can increase the amount of vitamin d prognosis means how well the disease is likely to do in the future so it's a prognostic factor they're looking for numbers fairly small 185 but these were diagnosed and treated in heidelberg so they had good control of the um good control of the cohort uh the downside to that is it was a single center study this would have been much better if it had been uh 10 or 100 times as many patients in a multi-center study but it's not this is what we've got we can only look where the light is mean vitamin d level was 16.6 nanograms per mil very low and this actually shocked me 16.6 nanograms per mil very low vitamin d levels in this population in heidelberg already i would say abnormally low association of vitamin d status with the disease severity and survival is what they're looking at uh vitamin d status first assessed at presentation so what they had was the people that hadn't checked the vitamin d levels on already they actually on the on this cohort this 185 people they had frozen blood samples from when they were first admitted and they're able to go back and look at that and check the vitamin d levels and then they could compare that with their clinical outcomes so this is a very legitimate scientific method now deficiency [Music] calcifidiol is the active form in the blood as we probably know the defined deficiency has less than 12 nanograms per mil which is less than 30 nanomoles per liter using the other way to measure it so that that is actually i would say someone is very very deficient at that level but anyway there was 41 uh sorry 22 41 people were at this level now i i would say what would say if someone's blood levels are very low would say it's in their boots it won't work so i would say that vitamin d levels are in their boots uh very low indeed uh yet a relatively high percentage now as well as that when they first admitted they went back and looked at median interleukin six levels a hospitalization and they were significantly higher now interleukin-6 is one of these cytokines so uh interleukin into so the the luke the luke part is the leukocytes of the white blood cells so an interleukin is is a chemical that takes messages from one blood cell to another it's one of these cytokines and this particular one interleukin-6 is a pro-inflammatory cytokine so people with high levels of interleukin-6 are more likely to get the severe inflammatory reactions which of course as we know are the main cause of mortality and severe disease in covid19 so they had more inflammation going on already at admission which was associated with their low vitamin d status and they actually measured the interleukin-6 so it was a it was 70.05 was the level of interleukin fairly high in those that were deficient in vitamin d as opposed to those that had high levels of vitamin d that their level was 29.7 and the units there are pico grams per milliliter so um higher levels of inflammatory pro-inflammatory cytokines in the people with the lowest levels of vitamin d again a very interesting finding straight off there now insufficiency they're described as less than 20 nanograms per ml which is less than 50 nanomoles per liter so to get from nanograms per mil which is one way of measuring it to millimoles um nanomole non from to get from nanograms per mil to nanograms uh th this is a nano moles per liter and uh ml per liter is the more common way to write it so anyway you can see the multiplication factor there is times 2.5 so 50 nanomoles per liter is insufficient and again i would say these are really quite low anyway most of the patients were insufficient by their criteria 64 118 the higher levels it was only 26 patients but it still gives groups so you know you've got a group of very low there which is 41. you've got a group of um moderately low there which is uh 118 and you've got a group of higher levels which is 26. so again you've got you've got comparison groups there you can compare these groups you can compare that group with that group or you can compare that group with with that group so you've got your comparison groups medium vitamin d levels was sufficiently lower in the inpatient group versus the outpatient groups so um about half of this cohort of these people were actually hospitalized so about half of 185 were hospitalized and the ones that were hospitalized had lower vitamin d levels average lower vitamin d levels than those that could be managed at home with less severe disease so another interesting finding specific results median observation period was 66 days so it's pretty good follow-up 93-50 of the patients require hospitalization as we said 28 patients required ventilation so 93 hospitalized 28 needing ventilation and there were 16 deaths so again you've got reasonable numbers to compare with to the groups and they did adjust for age sex and comorbidities and deficiency was associated with a higher risk for ventilation and death but um the differences were striking quite striking let me give them to you the hazard ratio is how the risk of something happening so um for people with low levels of vitamin d they were six more than six times more likely to be ventilated 6.12 times more likely to require mechanical ventilation and the odds of that result are rising by chance p equals 0.001 less than one in a thousand so um really quite striking sick more than six times more likely to be mechanically ventilated if they were shorter vitamin d the the lowest group in vitamin d and the deaths people with the lower levels of vitamin d were 14.73 times more likely to die i mean wow what a difference that is just stunning stunning results really so um would you like to reduce your chances of your population being mechanically ventilated by a factor of six and reduce deaths by a factor of 14.7 i mean just run this kind of number here 14.7 through the amount of deaths in your country and divide that by 14.73 and you get a much smaller number so uh the lowest levels of vitamin d are six times more likely to be ventilated nearly 15 times more likely to die i mean this is um it is a stunning it's a stunning finding now the because they collected a lot of data they also looked at other hazard ratios so um men were 1.6 times more likely to become mechanically ventilated than women over 60s were three point two percent three three point two times more likely to be mechanically random ventilated than the younger age group and people with at least one significant co-morbidity 2.7 times more likely to be mechanically ventilated nothing surprising there as we know and these figures here are for deaths so men were two and a half times more likely to die over 60s were 7.7 well over seven nearly eight times more likely to die and people with significant co-morbidity is 5.3 times more likely to die but remember the vitamin d it was uh it was higher than all of these so it was a more significant risk factor the low vitamin d levels were a more significant risk factor in this study than sex age and comorbidity they were the figures increased risk of mechanical ventilation increased risk of death i mean it's just it's just incredible now of course predictably this they say we need interventional studies frustrating but obviously true we need a large-scale clinical trial on this it's a bit confusing because um in this this study they looked at two different things um so um c chole cholecalciferol is the vitamin d3 that you take in the diet no that's always made by your skin so diet or skin when it's exposed to a sunlight ultraviolet b and that's converted in the liver to um calcifidiol which is the active form in the blood but then actually that they also looked at this one here called a calcitrol which is another form of vitamin d so what happens is um that that comes from the skin or the um or the food and in the liver that's converted to a calcifidiol then the calcifidiol is converted to calcitrol in the kidneys so so there's actually a three-stage conversion there um but the reason i mentioned that is that so this is the final form remember when you take vitamin d it takes about a week to convert that into that three to three to about nine days to convert that into that and that into that's converted in the kidneys but the reason i put this in is the active form of vitamin d this 125 dioxide hydroxyl vitamin d d3 which is the calcitrol now the reason it's important is this is pluripotent that means it does many things pluripotence a hormone is actually a hormone an important modulator of both innate and adaptive immunity that's why it's important as well as doing many other things as well as pluripotent but very important for innate and adaptive immunity so i thought that was interesting um let's hope government agencies are listening but you were so thank you for thank you for watching

Channel: Dr. John Campbell

Views: 602,376

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

Id: au6FKi8aAsA

Length: 26min 57sec (1617 seconds)

Published: Thu Feb 04 2021

Reddit Comments

[u/nocontactnotpossible]

And what about a healthy bmi

[u/Mike456R]

Expect this post to be down voted into oblivion by the “3 letter group”.

[u/mistermojorizin]

does "confirm correlations" mean "yes, the are indeed correlations!" or does it imply some further causal link?