Social distancing, masks and hand sanitizer only go so far in the fight against Covid-19, not to mention a host of other chronic and lift-threatening conditions.
There’s a reason why the department of health in Abu Dhabi earlier this summer urged residents to boost their vitamin D levels — even as the emirate remains one of the few health authorities in the world to be doing so.
The recommendation came on the back of a new local study involving 522 patients, which found more severe Covid-19 infections in 59 percent of those with vitamin D deficiency. The health department recognizes that up to 90 percent of the population in the UAE are vitamin D deficient and need to increase supplementation.
The study, which was conducted by Emirati research scholar Dr Habiba Al Safar and Dr Fatme Al Anouti, associate professor of clinical biochemistry at Zayed University, concluded that vitamin D has a preventative effect against Covid-19.
The more severe infections were found in patients who were older and more obese. Those findings backed up previous research that showed vitamin D deficiency, age and obesity have been risk factors in the more severe cases of Covid-19.
“The Department of Health-Abu Dhabi is calling on the community to take note of the importance of vitamin D supplementation,” said Dr Asma Ibrahim Al Mannaei, executive director of research and innovation at the health department. “This preventive measure, in addition to vaccinations, will be important in maintaining the health and safety of our society.”
Actively encouraging greater awareness among the public has put the UAE at the forefront of an ongoing, global debate about the connection between vitamin D and Covid-19.
Health authorities in the UK began recommending vitamin D supplementation last year, but revised their recommendation in January due to “insufficient evidence and inconsistent studies to support an increased uptake of vitamin D.”
The World Health Organization and the US National Institutes of Health aren’t recommending vitamin D either. In the US, The Mayo Clinic said: “There isn’t enough data to recommend use of vitamin D to prevent infection with the virus that causes Covid-19 or to treat Covid-19.”
Those statements are confusing, considering that a lot of the research that exists suggests otherwise.
Since the pandemic began, vitamin D has also been shown to regulate and suppress the cytokine inflammatory response typical of severe Covid-19, which is particularly important, as out-of-control inflammation (cytokine storm) is a primary cause of death. In one study, 82.2 percent of patients with severe Covid-19 were vitamin D deficient.
There are hundreds of Covid-19 and vitamin D trials awaiting completion and publication, and not all will show positive outcomes. Correlation is not always causation. However, considering vitamin D has negligible risk and potential massive gains for the health of the population during a viral pandemic, why would world governments not follow the UAE in recommending it?
It is clearly understood that vitamin D is an important immunological molecule, which influences our health greatly. It affects between five and 10 percent of our genome, and is present in the nuclei of every cell in the body.
The most essential part is actually not a vitamin at all: it’s a secosteroid and prehormone substrate that is produced by the liver called 25(OH)D. This is an essential part of your immune system, fighting the “baddies” by working with macrophages; those specialized cells in the body that are involved in the detection, ingestion, elimination and destruction of bacteria and other harmful organisms.
In the words of University College Dublin-based biochemical engineer Ivor Cummins, “it mediates, it monitors, it acts.” In short, at optimum levels, 25(OH)D is an ammunition pack for the immune system.
The research into vitamin D has long been contentious, with disagreement existing between allopathic, mainstream medicine and functional, integrative medicine.
For example, the current recommended daily allowance (RDA) in the US is 400 international units (IU) for those under 12 months; 600 IU per day for those over 12 months, with 800 IU recommended for the over-70s. The integrative medicine community, on the other hand, points to more than 125 journal articles suggesting that supplementation for under-18s needs to be at least 1,500-2,000 IU per day and 2,000-4,000 IU per day for anyone over 19.
Here, once again, the UAE is has done its research. Currently, the country’s RDA of vitamin D ranges from 600-1,000 IU for under 18s, up to 2,000 IU per day for over 18s, and recommends regular checks on 25(OH)D levels for people with darker skin, co-morbidities and expectant mothers, in order to maintain a level that’s in the 30 to 50 nanograms per milliliter (ng/ml) range. Many integrative health practitioners see 30ng/ml and higher as an appropriate and healthy range.
According to this study, “vitamin D deficiency, when serum 25-hydroxyvitamin D is lower than 25 ng/ml, occurs in risk groups all over the world, mainly in the Middle East, China, Mongolia, and India”.
While the higher RDA ranges recommended by the UAE are helpful in raising awareness, if most of the population is vitamin-deficient, that is a public health situation that requires more focused attention. For example, it would seem sensible to include vitamin D testing as part of health insurance for all citizens and residents of the UAE. Knowing your personal blood serum level is the key to taking the correct dose; they by using that information, an online calculator can ensure the correct supplementation dose, with either optimum levels or maintenance as a goal.
Intense discussions on the true health of the UAE female population and their unborn children began when a 2015 study found very low levels of vitamin D in a group of 350 adolescent females in Al Ain. Only one girl in the cohort had sufficient levels, while 230 had hypovitaminosis – aka, severely low levels.
Dr Human Fatemi, a professor of reproductive medicine at ART Fertility Clinics Abu Dhabi, is deeply concerned about the low levels of vitamin D in young Emirati women. He notes: “Lack of sun exposure significantly reduces the number and quality of eggs, which increases the prevalence of abnormal eggs in the ovaries.”
The statistics bear that out. The DHA reports that about 50 percent of women in the UAE have fertility issues compared to a world average of 15 percent. Dr Fatemi’s advice is to seek out the sun when blue UVB rays are at their most powerful for vitamin D conversion. In the UAE this would be around 10am for 20 mins of maximum skin exposure or up to one hour for darker skin, as high levels of melanin in the skin means a longer exposure time is needed to create vitamin D.
Although vitamin D intake from food is helpful and can be found in natural and fortified versions such as fatty fish, egg yolks, liver, dairy products, soy and almond milk and tofu, it is widely acknowledged that sun exposure is the most efficient way to increase levels. This is nothing new: according to this article published back in 2008 in the American Journal of Clinical Nutrition, vitamin D deficiency was a “pandemic” long before Covid-19. The authors advised that “the major cause of deficiency is the lack of appreciation that sun exposure in moderation is the major source for most humans.”
While we are lucky enough to live in a country with abundant daily sunshine, we have been taught to fear it, to hide from it and to slather ourselves and our children in sunscreen to protect us from the sun. There is a catch-22 here: UVB rays from the sun are the required catalyst to creating vitamin D, but sunscreen blocks all UVB.
Dr Joseph Mercola, an American osteopathic physician, author and alternative medicine proponent who has become controversial figure number one for his views surrounding Covid-19, suggests a balanced approach to sensible sun exposure. He advises: “Expose large amounts of your skin [at least 40 percent of your body] to sunlight for short periods daily without sunscreen. Stay out just long enough for your skin to turn the very lightest shade of pink.”
It is important to note here that excessive sunbathing is dangerous and may cause melanoma – a potentially deadly form of cancer – due to the deeper absorption of UVA rays. Choosing to expose skin during the UVB-rich part of the day kick-starts the skin’s protective functions, resulting in a tanning reaction and visibly pink skin – notifying you that absorption is finished.
Interestingly, specific wavelengths of light from the sun filter through not only on to the body but also the eyes, letting your brain know it’s sunny. The cornea contains vitamin D receptors which, when activated, facilitate the process of vitamin D synthesis. Safe sun gazing has long been a medicinal focus in many integrative medicine/naturopathic practices. One current theory says wearing sunglasses at critical, blue light UVB times of the day may prevent vitamin D absorption. More studies are needed to understand this fully, however it may make sense to let the eyes receive the early sun indirectly without the use of sunglasses to block the medicinal rays.
Covid-19 is not the only thing vitamin D protects you from. Optimizing your vitamin D levels via safe sun exposure or supplementation, or both, can actually reduce your risk of many diseases, including cancer. Cancers are associated with cell proliferation and cell division. As previously mentioned, Vitamin D optimization helps to control excess cell division, proliferation and facilitating in apoptosis, an extremely important programming system for cell death. This study’s findings support a beneficial effect of vitamin D supplements on lowering cancer-related mortality.
One 2007 study published in the Journal of Steroid Biochemistry and Molecular Biology, for example, clearly showed women with more than 48ng/ml 25(OH)D had a 50 percent lower risk of dying of breast cancer. As an analysis of studies by Grassrootshealth concluded: “Vitamin D status is a modifiable risk factor for breast cancer, and increasing 25(OH)D concentrations via supplementation at the population level is safe and affordable.”
The risk and incidence of colorectal cancer can be reduced by 55 percent with a level of 25(OH)D at 38ng/ml and higher, according to a 2007 meta analysis of six studies published in the American Journal Preventative Medicine.
Vitamin D is one of the closest things we have to a superpower, and we can all access it. Yet most people are not aware of how dangerous it is to live with insufficient vitamin D levels. The final and ultimate measure of health is all-cause mortality. A 20-year follow up study published in the Journal of Internal Medicine found that all-cause mortality was halved in people who consistently had higher levels of sun exposure, even after adjustment for other co-morbidities.
Ensuring you have optimum levels of vitamin D can truly be a lifesaver. Exposure to the medicinal rays of the sun can both heal us and work as preventative medicine, and if sun is unavailable – particularly in Northern latitudes – we have supplementation to fall back on.
The bottom line is that we are currently living through two global pandemics: Covid-19 and vitamin D deficiency. If correcting the deficiency could soften the blow of Covid-19 in the short term, and help us fight ever-rising numbers of all the other diseases in the medium to long-term, why not, as the UAE has done, recommend it? Publicize it. Get the message out that getting enough vitamin D might be just as important as getting the Covid-19 vaccine.
As Ivor Cummins puts it: “Evolution did not plan for us to be without vitamin D.”
• This story was originally published on August 3.
Natalie Hildon holds a degree in sports science and works as a holistic health and movement specialist in the UAE and online. She has 24 years experience coaching fitness, yoga and Pilates coupled with naturopathic nutrition.