Vitamin D is called the ‘sunshine vitamin’ as it is produced in large quantities by the action of sunlight on the skin. The science clearly shows that ‘optimal’ levels of vitamin D (circa 150 nmol/L – UK units) are associated with a significant reduction in the risk of developing a number of chronic diseases (other than osteoporosis) including, but not limited to cancer, diabetes, Alzheimer’s, depression, high blood pressure, autoimmunity, asthma, eczema, multiple sclerosis, cardiovascular disease and respiratory diseases.

There has been a flurry of research/reviews appearing in the literature over the past 6 months discussing/analyzing/questioning the potential role that optimising vitamin D levels might have on reducing the severity of COVID-19. One particular recent preliminary study titled ‘Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study – (Prabowo Raharusuna et al, April 26, 2020)   analysed the outcomes of 780 hospitalised COVID-19 patients and concluded that ‘when compared to cases with normal vitamin D status, death was approximately 10.12 times more likely for vitamin D deficient cases’.

The chart below (taken from the above study) clearly shows that when vitamin D levels are above 32 ng/ml (US measurement) which equates to 80 nmol/L in UK numbers, the risk of death is reduced 10 fold. This very strongly suggests that one of the most effective strategies that you can do, to stay as well as possible, should you ever get COVID-19 is to have optimal levels of vitamin D, which is circa 150 nmol/L.

This is an extraordinary observation that has enormous potential therapeutic and prophylactic implications, especially as supplementing with vitamin D is cheap and easy to do. Another recent review paper titled ‘Point of view: Should COVID-19 patients be supplemented with vitamin D?’ (C Annweiler et al – Maturitas, 2020), analyses the available evidence base according to the ‘Hills Criteria of Causation’ (used to assess evidence of a ‘causal relationship’) and concludes that ‘vitamin D may be considered a biological determinant of COVID-19 outcomes’. This paper then goes on to say that ‘given the lack of specific treatment for COVID-19, the urgency of the pandemic, and the safety of vitamin D supplementation, these observations provide an argument for testing vitamin D as an adjuvant treatment to improve the clinical presentation of COVID-19 and its prognosis’.

A number of randomised controlled trials are now thankfully underway. In the meantime, given the significant evidence base linking ‘optimal’ levels of vitamin D to improved COVID-19 outcomes, why would one not measure current levels (can be done at home using a finger prick test – https://www.revital.co.uk/revital-nhs-vitamin-d-test-kit-kit and  https://medichecks.com/products/vitamin-d-25-oh-blood-test are good options)    supplement accordingly (a safe dosage to take per day to improve levels would be 5,000 IU) to achieve/maintain optimal levels, especially as there is a great deal of concern about a second wave of COVD-19 in the coming winter? Whilst clearly this will not prevent COVID-19 being contracted, the current data does strongly suggest that it will reduce the risk of potentially fatal complications – thereby protecting the NHS and saving lives.

Please do not simply supplement with vitamin D without testing levels, as it is a fat-soluble vitamin, and can therefore become toxic at high levels. It is also important that you monitor progress (retest every few months) if supplementing with vitamin D, so that the dosage can be adjusted accordingly to achieve/maintain optimal levels. You cannot guess your levels – you have to test. Vitamin D supplementation should always be discussed further with your doctor if you have parathyroid issues, elevated calcium levels, kidney disease or sarcoidosis.

Another key point to consider is that it is generally accepted that Black Asian and Minority Ethnic (BAME) groups living in the West have significantly lower levels of vitamin D compared to their white counterparts. This is due to the fact that the sun is not strong enough to generate sufficient levels of vitamin D due to the sunlight protective effect of increased melanin pigment in the skin. Maybe, just maybe this is one of the most significant reasons as to why a disproportionate number of this group are dying of COVID-19?

It should also be noted that as a nation the UK has one of the highest levels of vitamin D deficiency in Europe, with average levels at 47.4 nmol/L and that it is perfectly possible that this fact is contributing to the high COVID-19 death rate (105 per million) that we are experiencing compared to other countries (on the other end of the scale Slovakia has an average vitamin D level of 81.5 nmol/L and a death rate of 0.4 per million) – ‘The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality’ – Petre Cristian Ilie et al – Aging Clinical and Experimental Research.

So in summary, the evidence base would very strongly suggest that one of the simplest things that you can do to reduce the risk of developing serious complications if you contract COVID-19, is to optimise your vitamin D levels – aiming for circa 150 nmol/L, by testing, supplementing and monitoring your progress.

Coeliac disease (CD) is an autoimmune condition where the body’s immune system attacks and damages the villi (the finger like small protrusions in the small intestine/gut). Originally considered a rare childhood condition it is now recognised as primarily an adult disease. CD is essentially a disease of malabsorption. If the cells are not getting the micronutrients from the food that we eat, then logically a number of significant health problems can eventually manifest anywhere in the body.

A recent meta analysis in The American Journal of Gastroenterology concludes that – ‘the incidence of coeliac disease is significantly rising (7.5% every year for the past few decades)’.

Incidence is the number of new cases expressed as proportion of the population being studied and provides a better understanding of what is really going on, compared to measuring prevalence, which is a measure of existing cases in a particular population.

So what is going on? A number of factors are certainly at play here including, access to improved blood tests since the 1990s; the change in guidelines in respect of being able to diagnose CD in certain children without the requirement of a biopsy and the increased awareness amongst clinicians/doctors that the classical symptoms of abdominal pain and diarrhoea occur in less than 50% of coeliacs. Other common symptoms including migraines, skin problems, depression, fertility issues, chronic fatigue, joint pain, liver and cardio vascular disease, osteoporosis, other autoimmune conditions (especially type 1 diabetes and autoimmune thyroiditis) and neurological problems. This is of course all welcome progress, but is not the full picture.

Environmental factors are also more than likely playing a significant role here. These factors include, the hybridisation of wheat to create dwarf wheat – which has a significantly higher gluten content compared to ancient varieties, the timing and amount of gluten introduced into the diet of infants, the amount of antibiotic exposure within the first year of life and the presence of childhood infections. Add into the equation the explosion in the use of glyphosate/Roundup since the early 1990s due to the practice of ‘crop desiccation’, where glyphosate (a patented antibiotic) is sprayed on wheat (and other staples) just before harvest to improve yields and one can start to understand why we are seeing the continued rise in one of the most common lifelong disorders in North America and Europe.

Osteoarthritis (OA) is an ‘age related low-grade inflammatory disease of the joints’ which causes the protective cartilage cushion between the bones to wear down, allowing the bones to rub together, creating a great deal of pain and discomfort. In the UK, OA affects 8.75 million people contributing to a significant burden on our health and social care systems. Modern medical treatments involve the use of paracetamol, non-steroidal anti-inflammatory drugs (e.g. ibuprofen), opioids, steroid injections, joint replacement/fusing and osteotomies. The use of drugs will provide pain relief, masking the symptoms but will not get to the root cause of the problem. Taken for long periods of time, these drugs can cause significant long-term health issues in themselves.

OA is often described as a ‘wear and tear disease’ that is caused by getting older. There is now very compelling evidence to suggest otherwise. Obesity is the strongest risk factor for OA onset in the knees, but the fact that being overweight/obese also increases the risk of developing OA in non-weight bearing joints, such as the hands/wrists, suggests that physical weight/wear and tear of the joints are not the only factors at play. In 2017 researchers at the University of Surrey identified a significant link between the body’s metabolism (the chemical processes that occur within us to maintain life) and OA – The role of metabolism in the pathogenesis of osteoarthritis – Nature Reviews Rheumatology, 2017.

In this review a comprehensive explanation is made on how poor dietary choices and lack of exercise can trigger the reprogramming of cells in the joints (and indeed the rest of the body) from a balanced resting state to one that is highly active, creating a number of cellular by-products that both inhibit the repair of/and destroy tissue, as well as fuelling inflammation. We know that regular moderate exercise confers significant benefits to overall joint health, as it strengthens muscles, prevents further cartilage breakdown and builds bone.

Lead author, Professor Ali Mobasheri summarises: ‘It is important never to underestimate the significance of a healthy diet and lifestyle as not only does it impact upon our general wellbeing but can alter the metabolic behaviour of our cells, tissues and organs leading to serious illnesses’. The big question of course is what exactly does that ‘healthy diet’ look like for the individual, as healthful foods for one can literally be a slow poison for another.

As a new year dawns, I thought that it would be appropriate to write a few words about ‘health’. So what is ‘health’? ‘Health’ is defined by the World Health Organisation as being ‘a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity’. The key point here is that ‘health’ is about so much more than just the absence of disease and embraces all aspects of our interactions with each other and the World around us. Given this definition, just how many of us, might actually be classified as being truly ‘healthy’?

As a species we are currently sinking under a tidal wave of chronic disease – these are long-term health conditions that require on-going management and their prevalence is growing at an alarming rate. These include cancer, dementia, diabetes, kidney disease, high blood pressure, asthma and depression. Our NHS is literally being overwhelmed by complex chronic conditions. To put this into perspective NHS statistics reveal that approximately 45% of the English population have at least one chronic condition, with 16% having one or more. What is extremely concerning is that 15% of young adults (11-15) in England now have a chronic condition and 70% of the health care budget is being spent on chronic disease management.

The current approach is clearly broken. We cannot afford to just keep pumping extra billions of pounds into a system that with all the best will in the world is simply ‘managing disease’ using a ‘top down’ approach to treat symptoms with prescribed medications. We need instead to focus on the creation and promotion of ‘health’, so that the body is effectively unable to harbour disease.

We are over medicalised and need to take a step back from the current accepted paradigm and instead practice a number of simple yet powerful choices that most of us can make of consuming more nutrient dense foods, reducing toxin exposure, practicing mindfulness, less reliance on social/digital media with more real world interactions and regularly getting out in nature and moving. Of course there are times when it is appropriate to use medications to help manage certain acute and complex chronic conditions. The objective however should always be wherever possible to minimise medication load and duration. Remember that poor health is not due to a lack of medications. Wishing you a very happy and healthy 2020.

Type 1 diabetes (T1D) is an autoimmune disease. The body’s immune system destroys the beta cells in the pancreas that are responsible for producing insulin. Insufficient insulin production hinders the ability of tissues to absorb glucose (sugar) supplied by food and drink leading to dangerously high levels of glucose in the blood. Left untreated, high blood glucose can lead to extremely serious health complications. T1D occurrence is currently growing at 3% per annum. The risk of developing T1D is 10 times greater than the general population in children with a parent that has the condition. Coeliac disease and T1D share common genetic predispositions, meaning that these conditions often co-exist.

As T1D is an autoimmune disease, it is unsurprising to find that the literature implicates a number of potential triggers and exacerbators of this condition, including genetics, the timing of introduction of both cow’s milk and gluten into the diet, maternal diet (gluten content and vitamin D status), infections (viruses are a known trigger of autoimmunity), stress, toxic load, the balance of the gut micro flora, digestive system health and the integrity of the gut barrier.

It is nearly 15 years since the concept that autoimmunity develops via a complex interaction between our genetic base and our environment was first postulated. The single largest point of interaction between our environment and our genetic base takes place in the gut – the small intestine has the surface area of half a badminton court.

Our genes are set at conception, however our environment (composed of dietary choices plus viral/bacterial/toxin and stress load) is to a large extent controllable, as is the health and permeability (leakiness) of the gut. Both current thinking and clinical experience show that by modulation of both the environment and intestinal permeability (leakiness of the gut), it is often possible to not only arrest the development of autoimmunity, but also potentially even reverse it.

‘……..once the autoimmune process is activated, it is not self-perpetuating; rather, it can be modulated or even reversed…..’

Professors Fasano and Shea-Donohue – Nature Reviews Gastroenterology and Hepatology 2005: https://tinyurl.com/yyz3vom2

The destruction of the pancreatic cells is a gradual process (even though symptoms may appear suddenly). There is therefore a window of opportunity to comprehensively evaluate environmental triggers and digestive system imbalances that may be both triggering and exacerbating this significant condition. ‘It’s what you know for sure that just ain’t so’…