Thumb your nose at swine flu

Judging from what we know about vitamin D, it is highly probable that it confers substantial protection from viral infections, including swine flu.

Dr. John Cannell of the Vitamin D Council (www.vitamindcouncil.com) first connected the dots, identifying the possibility of an influence of vitamin D on incidence of flu.

In 2006, Dr. Cannell reports noticing that the patients in his psychiatric ward in northern California were completely spared from the influenza epidemic of that year, while plenty of patients in adjacent wards were coming down with flu. Dr. Cannell proposed that the apparent immunity to flu in his patients may have been due to the modest dose of 2000 units vitamin D per day he had prescribed that the patients in other wards had not been given. (Since the hospital was run by the state of California, Dr. Cannell apparently had only so much leeway with vitamin D dosing.) While it’s not proof, it’s nonetheless a fascinating and compelling observation.

A similar conclusion was reached in a recent analysis of the National Health and Nutrition Examination Survey demonstrating that the higher the vitamin D blood level, the less likely respiratory infections were.

Personally, I used to suffer through 2 or 3 episodes of a runny nose, sore throat, hacking cough, fevers and feeling crumby every winter. Over the last 3 years since I’ve supplemented vitamin D, I haven’t been sick even once. The past two years I didn’t bother with the flu vaccine, since I suspected that my immunity had been heightened: no flu either winter.

And so it has been with the majority of my patients. Since I began having patients supplement vitamin D to achieve normal blood levels (we aim for 60-70 ng/ml), viral and bacterial infections have become rare.

New research is uncovering myriad new ways that vitamin D enhances natural immune responses to numerous infections, including tuberculosis, bacteria such as those causing periodontal disease and lung infections, and viruses like the influenza virus. Enhanced immunity against cancer is also an intensive area of research on vitamin D.

Will vitamin D supplementation sufficient to achieve desirable blood levels confer sufficient immunity to swine flu should it come to your door? From what we know and what we’ve seen in the few years of vitamin D experience, I think it will in the majority. But I do believe that we should still heed public health warnings to avoid contact with others, minimize exposure to crowds, avoid travel to affected areas, etc.

Comments (35) -

  • Anna

    4/29/2009 4:40:00 PM |

    Our family has had great results in regarding upper respiratory infections since getting our Vit D levels up to an optimal level (over 60 ng/ml).  While we sometimes do come down with a mild cold, the symptoms are now very short-lived and mild.  If we raise our Vit D dose by 50% for a few days at the first sign of a cold, the illness seems to stall and go away within 2-4 days.

    I've actually never had an influenza virus illness that I know of and only 1 flu shot about 8 years ago.  Other than my usual practices to maintain health, I don't plan to do anything different to avoid swine flu (even after visiting the home of one of my neighbors, who was exposed to one of the confirmed San Diego Swine flu cases - the single mother couldn't send the sick child to school, so she brought her to work).

  • arnoud

    4/29/2009 5:14:00 PM |

    Truly amazing, the scope and reach of the benefits of adequate levels of Vitamin D!  Even more amazing is that we are only now (recent years) are learning how essential Vitamin D is, while, sadly, adequate Vitamin D supplementation has not yet become part of main stream practice.

    As it is too early, not much is known yet about the current swine flu virus.   It is worrisome that it has been fatal for many people.  Interestingly, the deaths generally occur in the age group from 20 to 65 years old.  Could it be possible that these are the hard working folks who nearly spend every day-light hour inside office buildings and factories - no getting sun-light ---> not producing Vitamin D in their skins?   If Vitamin D shortfall is the critical risk factor, then this suggests a causal relationship could be identified?

  • Anonymous

    4/29/2009 6:42:00 PM |

    This post is a bit simplistic.

    I have been supplementing with Vitamin D for 1.5 years and my levels tested to where the medical enthusiasts for Vitamin D recommend it be.

    I've still come down with two nasty respiratory viruses over the past year.

    One of the other credentialled health bloggers I read suggests the exact opposite--the high levels of inflammation may protect against the flu.

    I don't think any of us know enough to make a call on this. The fatal 1918 flu killed people who had a robust immune response. It was that immune response that caused the pulmonary edema that killed them.

    The way everyone is grabbing onto this possible epidemic to support whatever their prized ideology might be, be it political or health-oriented gives a lot of insight into human nature but very little into how to deal with an emerging threat.

  • manny paul

    4/29/2009 6:53:00 PM |

    The World Health Organization raised its global alert level on the spreading swine flu virus Monday, but stopped short of declaring a global ...on swine flu worldwide

  • Anne

    4/30/2009 6:33:00 AM |

    I read that the reason why mostly young adults died in the 1918 flu pandemic was because their 'healthier' immune systems produced a “cytokine storm” which killed them whereas the weaker immune systems of young children and elderly people did not respond so. Where does that leave all of us with good immune systems then ? I've not had a cold for three years ! I don't want a “cytokine storm” reaction !

    Anne

  • pooti

    4/30/2009 11:30:00 AM |

    I agree with the cytokine storm threat for the newly emerging viruse strains of the H1N1 virus and also the H5N1 virus.

    But if you believe the information out there, most people didn't die of the swine flu during the 1918 epidemic. The majority of the enormous death toll from that epidemic was due to post viral/secondary streptococcus infection (a bacterial infection). So it really was the complications that killed them.

    Of course, you could apply the chicken and egg rational here and say that the reason so many contracted pneumonia and strep is because their system was compromised by the fluid generated as a result of the viral infection...(i.e. the CS).

  • Peter

    4/30/2009 12:43:00 PM |

    First reports of the H1N1 virus are that healthy people in their 20's and 30's are more likely to die from it than, say, old people who have lower D levels.  Might be better to stop vitamin D if the flu gets here and and the first reports turn out to be accurate.

  • Jonathan Byron

    4/30/2009 2:58:00 PM |

    There is some evidence that UV light and vitamin D levels are the seasonal factors that drive the winter flu epidemics. Not sure if this one may be a bit different, as it started in near tropical areas in the spring. But overall, there is good evidence that higher vitamin D leads to fewer respiratory infections.

    Another nutrient of interest is n-acetylcysteine, an amino acid that increases glutathione and other anti-oxidant/anti-inflammatory systems in the body.

    In this Italian study, twice a day acetylcysteine cut the symptoms of influenza by 2/3. The acetylcysteine group had just as many antibodies to the flu (indicating they were exposed) - but they were far less likely to go on to develop dis-ease from the virus, and when they did, it was usually much less intense.

  • Jenny Light

    4/30/2009 3:45:00 PM |

    One thing that I have yet to see reported in the media is the fact that Mexico City (the hot bed for deaths) has probably one of the worst air pollution problems in the world!  As this swine flu virus strongly involves the respiratory system, it should be no surprise that the already compromised lungs of these people can't handle it!  If there ARE deaths in the US (native citizens), watch them be centered in our most polluted cities!

  • StephenB

    4/30/2009 3:46:00 PM |

    I've just had an intestinal flu, despite my D levels being at 62ng/ml. My doctor said that it couldn't be swine because it wasn't respiratory.

    On the other hand, before supplementing with D, I would get one or more upper respiratory infections (usually bacterial) per year, and I didn't have any this year.

    StephenB

  • TedHutchinson

    4/30/2009 7:20:00 PM |

    Jonathan Byron
    Vitamin D3 also increases glutathione
    The role of vitamin D in the mental health of older adults"Not just that paper
    Dr Cannell Vitamin D council
    has several links to other sources confirming Vit d upregulates glutathione.

    I know it's only anecdotal but since I've raised my 25(OH)D no colds, no flu, no urinary tract infections (biggy for me as I must self catheterize 5 times daily and UTI's were persistent)

  • manny paul

    4/30/2009 7:26:00 PM |

    An NRI who flew to Hyderabad from Texas, the US state which reported the first swine flu death outside Mexico, was on Wednesday found to have the flu symptoms..
    swine flu to hyderabad

  • Anonymous

    4/30/2009 7:47:00 PM |

    Thanks for this POST!!!

    Another reason to run around with no clothes on when the "SUN" is shining and warm. Free Vitamin D....

    Has anyone done a study on nudist colonies, and the impacts of flu in these places...?

  • Dan

    4/30/2009 10:59:00 PM |

    The fact that this started in Mexico and so far has only killed Mexicans doesn't support your vitamin D theory.  I'm not saying its wrong or that I don't take plenty of D myself, just that it's premature to conclude D prevents this thing.  Also, the first patient to die was a door-to-door tax collector, and probably got mucho sun.

  • Dr. William Davis

    5/1/2009 12:19:00 AM |

    Don't forget that getting sun does NOT necessarily mean that vitamin D has been activated sufficient to increase blood levels to the optimal range.

  • Anne

    5/1/2009 7:11:00 AM |

    TedHutchinson wrote: "Anne Stoss Therapy from Dr CannellBiotech  etc"

    Ted - I already take a high dose of vitamin D3 and my serum levels are fine and my immune system great - which is why I'm concerned about a  "cytokine storm”  which was what they think killed so many people in the 1918 flu epidemic. A "cytokine storm"  happens when people have a good immune system, like us with our good levels of D ! That's why the people with poor immune systems, the eldery and very young, survived the 1918 pandemic: http://en.wikipedia.org/wiki/Cytokine_storm

    Anne

  • TedHutchinson

    5/1/2009 2:59:00 PM |

    Anne
    If you clicked the links provided you would understand Dr Cannell was detailing how taking extremely large amounts of Vitamin D3 AT THE FIRST SIGN of flu MAY prevent the cytokine store.
    That was why I also provided a link to a supplier of cheap 50,000iu D3.
    I have raised my 25(OH)D to above 60ng. I think doing that will lower my chance of getting an upper respiratory tract infection but I also have a pot of 50,000iu/d3 in the cupboard and should things turn out worse than I expect I will follow Dr Cannell's suggestions to the letter.

  • Anne

    5/1/2009 6:31:00 PM |

    I couldn't find a reference to cytokine storm in Dr Cannell's article first time but now I have clicked on one of the links it in and it led to a study about vitamin D and influenza which mentions preventing cytokine storm.  Thanks Ted....now I understand !

  • Mike

    5/1/2009 6:43:00 PM |

    I located this reference document while visiting the Vitamin D Council's web-site, regarding Vitamin D and the Flu. Hope this gets widely circulated!

    http://www.virologyj.com/content/5/1/29

    You can find the links at their site under "Noteworthy News."

    Swine Flu and Vitamin D — 30 April 2009

    http://www.vitamindcouncil.org/

  • Anna

    5/1/2009 8:05:00 PM |

    Here's an interesting post on cytokine storms & the flu.  This researcher on inflammation seems to have views much in line with Dr. Davis and TYP.

    http://coolinginflammation.blogspot.com/2009/04/extreme-flu-remedies.html

  • Anonymous

    5/2/2009 1:23:00 PM |

    Notwithstanding the excellent information that the heart scan blog provides, I think we should all be cautious in drawing conclusions based on singular/individual experiences.
    Trevor

  • TICQueen

    5/2/2009 9:36:00 PM |

    Increase your intake of vitamin C. Vitamin C not only boosts your immune system, but in higher dosages has been shown to be an antiviral as well. The recommendation is to dramatically increase your intake at the first sign you may have been exposed to the flu. Search for "the Vitamin C Foundation" to find an effective dosage for you.


    You can get a complete Swine Flu guide at http://www.swineflurecommendations.com
    Ensure you are getting enough vitamin E in your diet. There has been at least one clinical study completed that links adequate vitamin E intake with reduced viral activity. Studies have also shown there may be a link between vitamin E and a reduced duration and severity of flu symptoms.

  • Hoop

    5/3/2009 2:12:00 PM |

    I've gradually dialed up my vitamin D3 dose over the last 8 years. Motivated by  hope of reducing my prostate cancer risks.
    I started at 2000 IU per day which dose didn't stop all my colds and flu episodes but since I reached 6000 (or more) I've had neither illness. I only take the larger dose during the Autumnn
    and Winter months and on those days
    when I miss the midday spring and summer sun. YMMV I suppose it still could be chance but so far so good.

    Dwight

  • maxthedog

    5/16/2009 12:13:00 AM |

    Regarding cytokine storms:  Vitamin D3, as 1-25(OH)D3 aka, "calcitriol" is said to modulate the immune response (in part) by way of upregulating the production antimicrobial peptides known as cathelicidins, and to a lesser degree, beta-defensin (cathelicidins are strongly expressed along the epethelial lining of the lung, for those interested in D3 and respiratory infections). This *does not* mean that taking vitamin D3 will increase the strength of the immune system's inflammatory response.  The opposite is the case:  vitamin D *increases* the production of anti-inflammatory cytokines and *decreases* the production of pro-inflammatory cytokines, thereby throttling down the Th1 mediated immune response.  Think of it this way, you're out in the sun for a while, your skin becomes a bit red.. the body's response is to lower the tendency towards greater inflammation, while simultaneously upregulating the production of antimicrobial peptides that work by effectively cleaving bacteria and virus apart like a pair of scissors to paper.  Antimicrobial peptides do not work by way of releasing an oxidative burst in the way the Th1 mediated response works!  The immune system is far too complex to simply characterize it's behavior with words such as "strong" or "weak" - there is a whole lot more going on under the hood than such a simplistic view allows.

  • Anna

    5/16/2009 7:23:00 PM |

    Dr. Cannell has some info to that effect (anti-inflammatory characteristics of Vit D and flu-induced cytokines) in the newsletter that went out yesterday or today.

  • sadie

    5/27/2009 5:25:41 AM |

    I have been taking 5000iu a day of D3. My level is 23.9 so my GP wants me to take 50,000 D3 twice a week for 4 weeks and then once per week. I'm wondering if this much should be just to get the level up and then take a higher dose each day. And I'm looking for a higher dose gelcap of D3. Would appreciate others thoughts on this.

  • Amanda Crowe

    6/3/2009 5:18:08 AM |

    H1N1 (referred to as "swine flu" early on) is a new influenza virus causing illness in people. Symptoms of swine flu are similar to those caused by other influenza viruses. Health authorities across the globe are taking steps to try to stem the spread of swine flu after outbreaks in Mexico and the United States. The World Health Organization has called it a "public health emergency of international concern."

  • Ken

    6/16/2009 2:20:31 PM |

    Maybe in certain circumstances - like  being exposed to am infection such as swine flu - ingesting vitamin D is good for you. I still have to wonder - why is the amount made in a day of full body exposure to strong sunlight limited to 10,000IU in the first 20 minutes. Moreover that is just one way the potential levels of D are prevented from affecting blood levels; a high proportion of  ingested vitamin D is excreted in the bile according to Vieth.

    Somewhere along the line there's  a net disadvantage to constant high levels I think.
    Mad dogs and ....

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    8/14/2009 12:42:49 PM |

    On Monday morning an Arkia airlines plane took off from Ben Gurion Airport carrying rabbis and kabbalists and flew over the country in a flight aimed at preventing the swine flu virus from spreading in Israel through prayers.

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Deja vu all over again?

Deja vu all over again?

HeartHawk brought a report and debate on The Heart.Org website to my attention:

Screening for risk factors or detecting disease? Debate divides the CV community. After landing on theheart.org, paste this onto your URL address:article/883239.do. (Full address: http://www.theheart.org/article/883239.do. I don't know why, but I couldn't go there directly.)

Some interesting comments:

Dr. Jay Cohn (University of Minnesota):

"They're saying that we can't identify disease very effectively so let's just stick with risk factors, which we know are very poorly predictive and nonspecific. It boggles my mind as to why they won't open up their minds to the importance of moving forward in finding better strategies to identify the disease that we are treating. It's very strange. They criticize these disease markers because they are not predictive of events, but they are looking at very short-term outcomes. We're interested in lifetime risk. We're screening people in their 40s who are concerned about morbid events in their 60s and 70s, and no trials are going to track them that long."

"You have to accept the pathophysiologic reality that heart attacks don't occur in the absence of coronary disease, and coronary disease doesn't occur in the absence of endothelial dysfunction and vascular disease, all of which now can be identified."

". . . Can we as a society and as a profession accept the idea that there is a link between the vascular abnormalities and the events? "And that that linkage is tight enough that it should allow us to accept slowing of progression of the vascular abnormalities as an adequate marker for slowing disease progression, without waiting for events to occur? As soon as you use the word surrogate, people jump up and say we have all these markers that we know don't work well—things like premature ventricular contractions [PVCs] on the electrocardiogram, LDL, HDL—but those are not the markers we're talking about. We're talking about structural and functional changes in the blood vessel and in the heart."



Wow. The idea may be starting to catch on.

As an interesting aside, Cohn et al use a 10-test panel to screen for vascular disease:

"Named for the center's benefactor, the Rasmussen score includes tests for large and small artery elasticity (compliance), resting blood pressure, blood-pressure response to moderate treadmill exercise, optic fundus photography, carotid intimal-media thickness (IMT), microalbuminuria, electrocardiography, left ventricular (LV) ultrasonography for LV volume and mass, and brain natriuretic peptide (BNP). Each test result is scored out of 10 for low, intermediate, or high risk, and the combined results yields a score that Cohn et al believe is more predictive than any of the existing standalone tests."


The counterarguments in this debate were provided by Dr. Philip Greenland (Northwestern University), who repeated his oft-used argument that, while he accepts that vascular disease can be identified, no one has proven that measuring it improves outcomes:

"We do have that evidence for risk-factor screening. Even though people criticize risk-factor assessment because it is not sensitive enough or not accurate enough, the interesting and curious thing is that we actually have evidence that if you go to the trouble of screening for risk factors and treating them, patients have better outcomes. We do not have that evidence for any of these other tests."


An interesting debate ensues that includes Track Your Plaque friend, Dr. William Blanchet, who characteristically argues persuasively in favor of broad screening for coronary disease with coronary calcium scoring:

"If we were doing our jobs in primary prevention, we would not need to look at improved intervention and secondary prevention to reduce coronary death."


Here's a shock: Dr. Melissa Shirley-Walton, the cardiologist who previously preached the "cath lab on every corner" argument seems to have undergone a change of heart:

"What if I walked up to a gentleman and said, "you are at risk for CAD, take a statin", to which he replies, "I'm afraid of those meds". BUT if he sees his calcium score........he is then convinced to be pro-active. What is so wrong with that? What is so wrong with allowing him to spend 250.00 US out of pocket in order to save the US 150,000.00 US later on?

No hard endpoints you say with intensive therapy for primary prevention? What about extrapolating from trials for secondary prevention like HATS? ARBITER2? And what exactly is the true definition of secondary prevention? Is it truly primary prevention if we already have intima thickness abnormalities, or fatty streaks? That would more likely fall under secondary prevention by today's new standards.

So, I'm all for any visual aid that will encourage compliance with life style change, necessary medical therapy and followup. If the patient is willing to spend 250.00$ to get a calcium score, so be it. Better yet, why not lower the price so everyone can have the option if they are motivated enough to seize an opportunity?"



I have to admit that I thought that Dr. Blanchet was wasting his time trying to persuade Shirley-Walton et al, but perhaps he is having an impact, though having hammered away at them for the last year or so.

These arguments, for me, eerily echo many previous debates I've heard. But I am encouraged by the more favorable treatment the notion of atherosclerosis screening is receiving. Just 5 years ago, all coronary calcium scoring would have received from the conventionalists is "more clinical studies are needed."

So perhaps the cardiology and medical worlds are inching slowly towards broad acceptance of screening for coronary and vascular disease.

BUT, screening is not sufficient. What do you do with the information?

Here is where the conventional-thinkers stop. The question that seems to occupy them: Perhaps we should screen people for hidden coronary and vascular atherosclerosis so we can better decide who needs a statin drug or a procedure.

I would pose a different challenge: We should screen people for hidden coronary and vascular atherosclerosis so we can better decide who needs to engage in an intensive program of disease reversal using natural means and as little medication and procedures as possible.

Well, perhaps in time.

Comments (8) -

  • Jenny

    1/10/2009 3:17:00 PM |

    I've been mulling over that Veterans study published in NEJM that found lowering blood sugar had no impact on CVD in older veterans with diabetes. The conclusion from this seems to be that people shouldn't bother lowering blood sugar.

    That conclusion seemed to me to be just like saying, "Water does not put out fire" based on a study where a single pail of water was not able to make any difference in a raging house fire.

    Obviously some damage is irreversible and if you wait until someone is 65 and has had diabetes for a decade (many years of which the diabetes was undiagnosed) you are not going to be able to fix it in a year or two of doing even the correct things.

    This is probably true with all the other factors.

    OTOH, as I keep being reminded every time I visit the nursing home, there are times when a swift and fatal heart attack is a whole lot better than the alternatives. Without heart disease your old age likely to with years of cancer, COPD, or dementia.

  • JD

    1/10/2009 5:39:00 PM |

    http://www.sciencedaily.com/releases/2009/01/090106181731.htm

    More reasons not to take statins due to risk factors.

    "Results showed that 21% of the patients who were thought to need statin drugs before the scan (because of the Framingham and NCEP assessment tools) did not require them; “26% of the patients who were already taking statins (because of the risk factor assessment tools) had no detectable plaque at all,” said Kevin M. Johnson, MD, lead author of the study."

  • steve

    1/10/2009 6:46:00 PM |

    excellent post.  I fail to see why a calcium score is necessary if sub fraction testing of lipids is done.  Why isn't it enough to see that if you have tons of small LDL particles and little large fluffy ones, as well as low HDL then you need to take some lifestyle corrective action?

  • Anonymous

    1/10/2009 10:53:00 PM |

    Good blog Dr.D.

    FYI..In Torrance, they are doing a two for one calcium score test. So we are going for it. Costs a total of $400.00 for 2. Its the location on your website TYP.

    So thanks for sharing the testing locations.

    Stevie

  • pomeropd

    1/11/2009 12:57:00 PM |

    Good to hear someelse is attempting to develop a monitoring/early detection approach.

    BUT, the cost mentioned on their website $1800 is far more costly than a CT calcium score.

  • mark

    1/11/2009 11:28:00 PM |

    Dr. Davis, I did an archive search for Vitamin A and came to this entry:

    http://heartscanblog.blogspot.com/2008/06/vitamin-d-newsletter-autism-and-vitamin.html

    You wrote: "5) Vitamin A--Is vitamin A with vitamin D good or bad? This one I do not have an answer to. Reading the literature Dr. Cannell cites didn't help much. (Dr. BG--Any comments? Dr. BG is a vitamin A advocate.)"

    Chris Masterjohn wrote an article for the Weston Price Foundation on Vitamin D, and a sizeable segment deals with the relationship of intakes of  vitamin D AND A.  He provides some references, which will hopefully provide an answer to the question.

    The article is here:
    http://westonaprice.org/basicnutrition/vitamin-d-safety.html

    Mark.

  • Scott W

    1/12/2009 12:17:00 AM |

    One of my favorite quotes - Leo Tolstoy wrote:

    "I know that most men, including those at ease with problems of the greatest complexity, can seldom accept even the simplest and most obvious truth if it be such as would oblige them to admit the falsity of conclusions which they delighted in explaining to colleagues, which they have proudly taught to others, and which they have woven, thread by thread, into the fabric of their lives."

    It's about ego and losing face. Facts that disagree with their belief system are either incorrect or irrelevant.

    Scott W

  • Thomas

    1/12/2009 8:03:00 PM |

    Two points: science is about trying to improve our explanations, not searching for correlations (or 'risk factors', or 'links'). The role of experiment is to select between explanations.

    So we ought to be conjecturing and criticising/testing theories of heart disease.

    Treatment is a separate, medical, problem.

    On a philosophical level, I think we need to look at the individual: well-being and motives.

    It's probably correct to say that people need to cut back on carbs and alcohol, however, we need ask *why* people go after those things, and other addictions generally.

    If cutting carbs comes at the cost of self-coercion and misery, then we may have fixed somebody's CVS but we haven't solved the deeper problem. Which is a longterm recipe for relapse.

    Or are we afraid to venture near the intellectuals quagmires of subjectivity and spirituality?

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