Thursday, 30 April 2020

Hope for treatment? Remdesivir revisited.

I posted regarding Remdesivir, an anti-viral drug which had showed early promising effects for COVID. This showed shortening of the recovery time from 15 to 11 days and a reduction in mortality from 11 to 8%. So, any talk of a 'cure' is mis-placed, hopefully it might help.

Unfortunately, it showed no benefit in a subsequent trial in China. This was inadvertently posted by the WHO, noticed by the worlds press, and then quickly removed for peer review. Now it's been published in the Lancet. 

Today I read that hopes for this treatment are alive and well, at least for the moment. It seems that Gilead are now pressing ahead with larger longer trials of the intravenous drug and for better end-points. The results will be eagerly awaited.  

It may be that Remdesivir will find a role, perhaps even in combination with other drugs as the results of trials come in. COVID science is moving along at an incredible pace. Patients and patience are needed.

One disadvantage is that it's an intravenous drug with implications for its use and availability for most of the world, las well as its cost. 

The other issue is whether, like many anti virals (and MS drugs) it will be more effective if administered  early and to at-risk patients with milder illness. Personally I think this likely to be the case but makes the issues of administration and cost loom larger still.

In any case, until the trial results roll in, hope springs eternal. 

Watch this space!

Tuesday, 28 April 2020

Making Vitamin D work for you - update

More Vitamin D data.

Vitamin D is increasingly hitting the headlines. The association of its lack with a poor outcome with COVID19 is becoming more clear. The more I look, the more complicated it becomes, yet the simpler the implications.

I came across a paper, from pre-COVID days in 2016, showing that Vitamin D deficiency in  patients undergoing removal of their oesophagus correlates with their subsequent development of Adult Respiratory Distress (ARDS) on ITU. They propose ways in which the vitamin might help reduce inflammation at the level of the alveoli, those tiny air sacs at the far end of the airways which look like bunches of grapes and do the work of gas exchange without which life is not possible.

ARDS is the respiratory problem with COVID too.

In addition to this, a powerful effort to collect data on vitamin D and its link to mortality called a meta-analysis, also carried out in the pre-COVID era, concluded that "the association between 25(OH)D ( VItamin D3) level and all-cause and cause-specific mortality was remarkably consistent".

A more recent retrospective study of COVID patients in Indonesia showed a correlation of Vitamin D levels with outcome, even when corrected for age and other illnesses. Results revealed that the majority of the fatal cases were older men with pre-existing conditions and who also had sub-normal Vitamin D levels. Helpfully, they corrected for age and pre-existing illness. Even then the risk of death from COVID was 10 times greater in those who have very low levels of Vitamin D (deficiency) and seven time more in those whose levels are less low, but not normal (insufficient). 

Deficiency I should add, is defined as a level lower than 30mmol/l and insufficiency less than 50mmol/l. I try to keep mine about 100 and ideally 150mmol/l. 

Reverse causation? Perhaps. People who are ill and old have lower Vitamin D levels, so while this in not absolute proof, of causation, the association is compelling. 

For those who have 17 minutes to spare, this youtube session is a good summary of this current situation with Vitamin D.

The upshot of all this is that it really makes sense to make sure your vitamin D3 levels are about the same as our skimpily clad outdoor-living healthily eating ancestors. 

Is it really as simple as just buying and taking supplements?

Magnesium and Vitamin D

Magnesium is a mineral which plays an essential role in the synthesis and metabolism of vitamin D. Getting adequate amounts in the diet is a problem for modern societies dependent on poor quality agricultural produce and the resultant mineral depleted foods. A recent paper suggests that magnesium is required for Vitamin D to be synthesised; the implication being that taking vitamin D orally, though worthwhile and urgent, might not be the panacea we hope for unless you have enough Magnesium on board. 

They observed that "high intake of total, dietary or supplemental magnesium was independently and significantly associated with reduced risks of both vitamin D deficiency and insufficiency." 

In other words Vitamin D and Magnesium are two vital components in the metabolic jigsaw which keeps us healthy. Supplements will not be needed if you eat good, fresh food. But do you?

Vitamin K2 and Vitamin D

The plot thickens! Vitamin K2 also might have a role in MS as a recent study with MS has revealed. It too has a role in calcium metabolism in association with Vitamin D. Early days with this....

Making sense of all this....

When it comes to the human metabolism, nothing is simple. Before you get Googling to find endless supplement sites trying to sell you their wares, take one step back.

Magnesium is common in good food. Mammals are likely to be able to synthesise K2 from K1 (well, mice at least), and K1 is also readily available in good food.

The ultimate message here is to get outdoors. Yes even with the lockdown it is essential that we get out in the sun as much as we can with the only caveats to not get burnt and to maintain physical distancing. In combination with this, eating a healthy diet too is absolutely critical, now more that ever!

Put another way, the adverse effects of mineral and nutrient depleted foods produced by almost ubiquitous intensive farming practices are being magnified by the COVID pandemic.

As a nation we now spend less, as a proportion of our income on food than ever before. Even so it is a struggle for many less well off households to be be able to afford the quality food they need for health. Cheap food is easy to buy and readily available, affordable to the smaller budgets, but with a big health price tag. That is why magnesium seems be lacking in our diet, zinc too -  more on that later.

With COVID, now is the time to ensure that the multitude of minerals, vitamins and the many other ingredients essential for health are present in your food in the quantities that mean you can avoid the need for daily supplements. Apart that is, from the sunshine Vitamin when you don't get enough sun.

The inter-twining of the COVID and Vitamin D  and magnesium stories are revealing more as time goes by; increasing in scientific complexity yet distilling the critical message of that age old mantra:

We are what we eat. 

So eat well!

Monday, 27 April 2020

COVID19 - The Good Bad and Ugly

The Good:

Let's start with the good. Why not?

Despite the pain of lockdown, the advantages of isolation go beyond reducing COVID19 cases to a level the NHS can manage.  

Not only has the NHS, so far, been heroically successful in managing the workload, they are learning as they go along, and quickly. I wondered how this might play out when reflecting on my time looking after babies needing ventilation for Respiratory Distress (also due to lack of the lung surfactant needed keep the alveoli open) on Special Care Baby Unit in the 1980's. In terms of technology those days might as well have be in the stone age. There wasn't one computer in the hospital at that time, and a mobile phone was the size of a breeze block.

Nevertheless even during my two years of involvement there, techniques for ventilation moved on rapidly. Basically from energetic ventilation to keep the babies gas measurements normal, to carefully using the smallest pressures and oxygen for the least amount of time possible. This significantly reduced the damage done to the babies lungs. Might something similar be happening with COVID19?

The need for ventilators was predicted on the basis of the first experiences in China, and the procurement scramble reflected the assumption that many hospital cases would need them. It seems now that we are ventilating less patients that initially expected and learning fast that COVID19 is new and different from previous experience of viral pneumonia and Adult Respiratory Distress Syndrome. Patients, it seems, are less clinically unwell than their oxygen saturation levels would, in normal situations, imply.

The upshot of this is the good news. I suspect that more people, like Boris Johnson, will be getting by with close monitoring and support, nasal oxygen, or Continual Positive Airways pressure. (CPAP). This is rather like the sensation of breathing into a strong wind, which helps keep the airways open and can reduce the need for ventilation. If ventilation is needed, then I'm sure with experience, the outcome from this will improve too. Rather awkwardly for staff ventilating patients, the prone position seems to help.

In summary, there is alot of learning going on about this novel condition and the message to delay infection and get COVID ready by maximising health and fitness remains as important as ever. 

The Bad...

Never believe the hype! I had hopes that Remdesivir would offer treatment for COVID19, with lots of expectation and no doubt increased share price for Gilead, the American drug company who hold its patents. Early reports of its 'compassionate' use in France and the US led us to believe that the knights in shining armour might be on their way; only to be dashed once again by the harsh reality delivered by properly controlled randomised controlled trials.

There are shenanigans though. The report of its failure was posted by the WHO and then removed, as it had 'not been peer reviewed'. This won't detract from the reality that the trial failed to show any benefit.

It also turns out that the asymptomatic phase of COVID19 is significant enough for rapid spread outside the confines of lockdown or isolation, even in a skilled nursing home. Again this means that after the lockdown there are likely to be more waves of infection and so once again the message is to get COVID ready. 

The Ugly...

The Trumpster and Bolsanaro are making fools of themselves. Despite their power and influence, they seem not to understand the nature of responsibility. Their statements are verging on the comic, if it were not for their lofty positions.

They exhibit a deadly combination of ignorance and total self confidence. Surely these characteristics will not be affordable as we come out of this crisis, whenever that might be. I read so much high quality comment from genuinely clever people, health staff, scientists, reporters, and ordinary people which are in the main, so inspiring. Then there are these two!

Of course, Trump states that he was only 'being sarcastic". It didn't look like it at the time. This sort of evasion reminds me of school. Or was it pre-school. On second thoughts no. Pre-school children have far more dignity and composure.

Keep healthy! 

Sunday, 26 April 2020

Junk the Junk food and reduce your COVID risk.

New US surveillance shows obesity is the biggest single reversible risk factor for severe COVID19 in younger groups and indeed is a major cause of the other big risk factors affecting older groups.

They found obesity to be the single largest risk factor in the under 50's admitted to hospital and only overtaken in the older groups by hypertension and heart disease, which are strongly linked to obesity and diabetes which in many cases is caused by it.

Doctors are rightfully up in arms about the food industry and their part in the obesity pandemic and thus full ITU's around the world. 

So am I!

This post describes my experience of successfully helping people lose weight and with the COVI19 crisis is now more relevant than ever...... 

Anyone overweight or obese, and indeed anyone who buys sugar, read on.

Allegory time...

Imagine if you will, sitting in a cafĂ© in any city in the world. While idly people-watching, you notice two thirds of the passers-by have green, glowing ears! Imagine too that green-glowing ears were known to cause illness, suffering and premature death as well as bankrupting health systems and societies. It also worsens COVID and other infections. Then consider the main cause of green-glowing ears was discovered to be a specific, commercial food additive designed to enhance taste. What do you think would happen?

Well, I guess you would expect uproar! The media would immediately run angry sensational headlines; the government would dive straight in with prohibition, the manufacturers of the particular food additive would be sued out of existence, imprisoned even for manslaughter.  There would be self-help groups for the green-glowers; the problem would gradually disappear from ears and from the streets of the world to then be confined to the history books.

Or would green glowing ears could become the new normal, with the health and social costs accepted as the price to pay for tasty food and mega-profits?

You would think the former, but I would put my money on the latter. Why? Because in my surgery I witnessed this phenomena. Not of course green glowing ears, but people visibly poisoned by the food they ate. My patients waistlines were expanding, so too their suffering and my workload.

This is what has happened due to copious amounts of sugar added to our diet - our greatest ever act of human mass-poisoning. The obesity caused by sugar loaded diets have become engrained in our culture, visible on every street and now in every intensive care unit in the world. Its hideous effects largely accepted as a price to pay for commerce. 

The "food industry, with a tiny grain of truth, argue it's far more complicated than that. Its all about balance, they say, getting out more! Just do more physical work to shed the fat you deposit within due to their products and their profits.

By balance, they mean go swimming, for example. Burn up 300 Kcal in the pool, and then eat one of their 300Kcal products afterwards. That is the sort of balance that is tipping the NHS, and indeed society, into eternal overdraft.

I tried to get a handle on this at work. 

Back in the mid-90's I measured the height and weight of 100 consecutive patients to find my observations confirmed. 38% of my patients were obese, 37% overweight, 24% normal weight and one single person thin. This was reflected in the amount of arthritis, heart disease, diabetes, and other complaints that I had to help with.

Coupled with this there was a certain nilhism amongst colleagues as to how effective dietary advice really was. We seemed to do quite well with helping people quit smoking, but with diet, most of the time it seemed to make no difference. Why? 

Well it might be that cutting down and stopping smoking is conceptually simple. You know how many cigarettes you’re smoking and how many you used to, and you know when you have succeeded. Targets and aims are black and white. Reduce, stop, celebrate and move on. With food it’s not so simple, there is confusion a mountain of contradictory advice.  How might this be tackled?

Off I went to the National Diet and Nutrition Survey to find out in a bit more detail what we are eating. An image caught my mind. It has been on my "lifestyle and MS" slide presentations ever since and is of even more importance today. Here it is:

Putting this another way:

The average UK adult will eat their own body weight in sugar every four years.

The average UK teenager will eat their own body weight in sugar every two years.

The average UK child will eat their own body weight in sugar every year.

This sort of sugar intakes cannot be compatible with health.

The amounts of calories this represents had immediate implications for my day to day work and the day to day life of my patients.

As it this wasn't shocking enough, the graph didn't tell the whole story. These are averages.

My average patient had average health, the outliers did not. For every patient taking half the average, there would be one taking double. As ever, those deprived and living in poverty eat and suffered the consequences the most. The poor, are in effect, paying with their health for the profits of others. this might seem radical, but it is the simple terrible reality of our times.

I started to ask my patients how much sugar they were consuming. Not easy and not wholly accurate, but it went something like this:

Doctor:   How much sugar do you add to your diet?
Patient:  Not much.
Doctor:   Do you have any in your hot drinks?
Patient:  Yes.
Doctor:   How many.
Patient:  Not many.
Doctor:   How many
Patient:  Two.
Doctor:  How many hot drinks do you have a day
Patient:  (After a think) About 8.
Doctor:  Thats sixteen spoons of sugar a day.
Patient:  Yes, I suppose so.
Doctor:   That's 320Kcal a day, about 12% of your energy intake.
Patient:  Is it?
Doctor:   Put another way, those calories are stored as 12Kg of fat, every year!
Patient:  Really!
Doctor:   I think I might have just found out how to cure your diabetes!
Patient:  Wow!
Doctor:   Can you stop adding sugar to your tea.
Patient:  Definitely!
Doctor:   Excellent, I'll see you in three months. 

Three months later....

Doctor:  Hello there. Did you manage to give up sugar?
Patient:  I did.
Doctor:  I'm delighted! Pop on the weighing scales please.
Patient:  Why do doctors always say "Pop"?
Doctor:   I have no idea.
Doctor:  Clamber onto the weighing scales please
Doctor:  You have lost 2.5 Kg!
Patient:  Brilliant.
Doctor:   Yes, fantastic, keep it up and see me again in three months.
Patient:  Will do, is there anything else I can do?
Doctor:   Sorry I have run out of time.....

Please note, it wasn't always this easy.

The record sugar intake in my patients was an astonishing 600 spoons of sugar a week, with some very evident health consequences. Copious amounts of Lucozade the culprit in this case. This isn't a matter of blame, I felt considerable compassion for people with this problem. I have to admit it became an obsession of mine. It still is.

After a couple of experiences like this, I started to record what happened after giving the following simple advice:

1. Stop adding sugar to hot drinks.
2. Stop drinking any soft drinks.
3. Identify sugar rich food products and get them out of your diet.
4. Save confectionary, biscuits, buns for special occasions, if at all.
5. Then cut down on spuds, rice, pasta.

250 patients and four years later this is what the spreadsheet revealed.

185 (74%) lost weight.
(Those who didn't admitted to not having followed the advice)
Average weight loss was 7% of body weight maintained over 4 years
46 (18%) lost more than 10% of their body weight
40 (16%) were no longer classified as obese
3 out of 13 patients with diabetes were "undiagnosed".

There were marked improvements in diabetes, hypertension, well being, and a wonderful sense of being in control of their own health.

Patients generally felt much better. So did I!

I will post more on this later, including the detailed written advice I used to give patients about sugar, energy, weight loss, diet and food.

Suffice it to say that when I was diagnosed with MS, I took my own advice. You can't give it up completely; it is present in small quantities in some quite healthy foods, but getting the bulk of it out of your diet will get help you get rid of countless dangerous calories and kilos.

How about exercise:

Exercise it good for the body, if careful, and the mind. However, it a hard ask to use it to lose weight without reducing calories in the diet, as the following information shows:

  • A teaspoon (5g) of sugar contains 20 Kcalories
  • This (incredibly) contains enough energy to walk about 300 yards (3mph)
  • The average sugar consumption in the UK is about 120 spoons of sugar a week.
  • About 15 % of the calories we eat in the UK comes from pure sugar

  • The energy from this added sugar is enough to walk about 20 miles a week

In other words, it's a great idea to exercise, but losing weight by exercising alone is a very hard, almost impossible thing to do.

What about a healthy diet?

This was not a part of my advice to patients. I only had ten minute appointments, so advice was confined, with exceptions, to the massive benefits of just not eating a terrible diet. There is more to be considered when it comes to a really healthy diet, and a multitude of opinions, but the first step to losing weight is not to eat a terrible sugary one.

What about fasting?

Fasting too is a really helpful way to lose weight and to stay or become healthy. There are a number of different ways of doing it. Speaking for myself, I don't eat after about 6 in the evening and delay breakfast till 11 in the morning. I then take doggie out for a walk, as I get the feeling exercising in the fasting state might well bring added benefits. With no sugar in my diet and and daily fasting, I actually find it hard to keep my weight up. A handy dilemma to have in this day and age. More on this later....

The very last word...

The easy and most rapid way to improve your diet and lose weight is to give up as much added sugar as you can. Be below average! In doing that you will be doing your bit to reduce the national average.

Dare I say it? This would save lives and save the NHS!

Friday, 24 April 2020

Vitamin D - The Sunshine Vitamin and you

Vitamin D is incredibly interesting - never more so than today. With our indoor life and lack of oily fish in the diet (or in the sea) it’s deficiency has become more widely recognised. Now, with COVID’s predominance in the BAME community, and links between COVID outcome and Vitamin D3 levels,  understanding it has become an urgent, potentially lifesaving matter for us as individuals as well as for public health.

I should say that by Vitamin D, I mean vitamin D3, the active form of Vitamin D. Suffice it to say that vitamin D2 in one of its precursors and needs the action of sunlight to activate it to vitamin D3.

It's actually more like a hormone than a vitamin in that we can make it for ourselves, and it has widespread widespread biological effects. It's called a vitamin for historical reasons. Vitamin D because it was discovered after Vitamins A B and C. I kid you not!

That there is more rickets, the consequence of severe Vitamin D3 lack in the UK that at any time over the last 50 years is a clue that deficiency is more common that we might think.

When I was diagnosed with Multiple Sclerosis, in 2012, I naturally had a closer look at what lies behind this strange and interesting disorder. My own vitamin D level was marginally low, though not as low as some of my patients. Building on my non-specialist knowledge I soon noticed it’s considerable variation with latitude and this led me to the important role of Vitamin D in MS

The map shows the distribution of MS; the redder the area, the more common the MS:

And more specifically:

Pretty convincing, but what about the rest of you people without MS?


This picture show how low our Vitamin D levels are compared to how they are with full sun exposure or in our primate cousins.

It is clear that Vitamin D levels are almost universally low in the general population.  This graph show Vitamin D levels in the 7500 white people in the UK in 2007 studied in 2007. 


So, Levels needed for the immune benefits of Vitamin D (>70nmmol/l) are commonly low, even in the white population.

Levels have been shown to be low through Europe, a phenomenon the authors of this paper called, prophetically enough, a pandemic!

Blood levels measured in a London ante-natal clinic came up with the shocking fact that Vitamin D levels less that 25nmol/l (that is very very low) were found in 47% of Asian women, 58% of black women and 13% of white women. This deficiency causes problems for bone health, and the levels are far short of those needed for immune benefits. 

Further, low levels of vitamin D are linked with increased risk of cardiovascular disease, respiratory disease and cancer. 

In summary it seems to be there is abundant evidence of the lack of Vitamin D and its potential benefits throughout the population and more so in BAME groups. 

For people with MS it is clear that low vitamin D levels are associated with an increased risk of diagnosis and a worse course of the disorder. Not only do blood levels predict outcome, but so does where you live; the further north, the more common it becomes. So, is this due to Vitamin D, or just an association?

Years ago I found it disappointing that simple randomised trials of supplementation had not totally answered this question. Vitamin D is simply too cheap and readily available for anyone to provide the substantial amount of cash needed to run such a definitive trial. There would be no financial profit to be made!

Further, a large, long term placebo controlled trial would now be highly unethical, as it would involve denying the placebo arm a treatment for which there is already enough evidence to use.

So, it seemed clear to me the best thing to do is to go along with the best science available. This clearly suggests taking the vitamin as well as spending enough time in the sun to manufacture as much of my own as possible. The evidence is good enough for people with MS to make sure their levels are in the upper ranges of normal. 

It is also clear to me that the need for people with dark skins and those leading an indoor life to become vitamin D replete is urgent. 

I now have been taking 5000iu daily for many years, without any problems so far. This is the dose most likely to replace the deficiency of sun exposure and modern diet and is not linked to any evidence of toxicity. Many people I know with MS do the same. Why wait for perfect science which will likely as not never arrive? 

How does this relate to COVID19?

Vitamin D and COVID 19

It is beyond the scope of this post to look at the physiological mechanisms whereby Vitamin D could affect outcome with CODIV, but as a clue this study highlights its cell membrane stabilising and anti-inflammatory properties. These mechanisms might help reduce damage caused by the cytokines which mediate inflammation and are behind so many ‘modern’ illnesses. 

It is this cytokine storm which is behind severe COVID. 

When it became clear that COVID was hitting people with dark skin far harder that the white population, my ears pricked up. The first ten doctors to die in the UK had dark skin, so did the first two pregnant women to die. There is a well observed preponderance of people with dark skin in intensive care units around the world. 

An excellent review has been conducted by Dr David Grimes, see here for more details.

The Intensive Care and National Audit research Centre revealed that 35% of those in ITU were BAME, whilst only making up 13% of the general population. Though comprising 44% of NHS workers, they comprise 68% of NHS workers known to have died as of the 17th April 2020. It has been reported that in some American cities, BAME groups occupy 70% of the ITU beds despite only representing 30% of the population. 

This is jaw dropping data!

For sure, some of this is due to deprivation. Poverty, overcrowding, discrimination, stress and lack of opportunity are far more common the BAME community and I’m sure this explains some of it, but those doctors dying of COVID were not likely to be materially deprived. 

Some of this excess might play out through the immune damaging effects of lifestyle, smoking, alcohol, and a pretty terrible fast food predominant diet. Obesity too plays a big role as three quarters of ventilated patients are overweight or obese. COVID is magnifying society’s ills wherever it strikes, but I am sure there is more. 

The theoretical background to this is beautifully simple. Homo sapiens, in our original state, all had black skin to protect us from the blistering equatorial and tropical sun in which we evolved. This would have not have changed had we not been globetrotters. 

Migration to temperate zones with short winter days and far less sunlight created less than fully understood evolutionary pressure against those with darker skin. One postulated reason for this is that darker skin led to less conversion of vitamin D's building blocks to the active Vitamin and the resulting deficiency caused Rickets, the most extreme manifestation of Vitamin D deficiency. 

If so, one of the consequences of would be bony deformities, including contracted pelvic outlets which would led to difficult childbirths. This created an evolutionary advantaged for those with lighter skin. Now we have a temperate zone where light skinned populations can absorb more light and thus make sufficient levels of the ‘sunshine vitamin’.  

Indeed, it may well be that life as far north as Scandinavia, even Scotland, was only made possible with a very rich oily sea food diet loaded with Vitamin D. Hence the increased incidence of MS up there as that rich food source has diminished in the seas as well as the diet. 

In this modern age, many migrations later, we have people with different levels of melanin in their skin everywhere. Back to the problem of absorption of sunlight and back we are again with important issue of Vitamin D deficiency. Levels of Vitamin D are low in most of the population, though lowest in those with dark skin. 

In my opinion, public health organisations have not caught up with this as yet, though do recommend supplementation for pregnant women and young children. The 400iu a day they recommend is to “maintain healthy bones teeth and muscles”, and deliver immune benefits.

People from BAME background are not only more likely to be deficient, but are also less likely to take supplements.

Fortification of food is potentially better that leaving vitamin D intake to the individual. In Finland it has improved things, though even after fortification reports suggest only a third of children achieved recommended Vitamin D levels.

Reducing inequality, deprivation and the consequent unhealthy lifestyles might inevitably reduce the risk of Vitamin D deficiency, but it is unreasonable to wait for this to happen, more so in my opinion with successive Conservative Governments who have seen an increase in inequality deprivation and poverty while in power. It seems to be to me risky in the extreme not to bring vitamin D levels in the blood and thus the body to normal levels by taking Vitamin D3 5000iu daily. Why not indeed!

I penned a letter to the Guardian which got some interesting replies. Colleagues have  written asking for support with campaigns to improve research on this. Do help by signing. Thanks Lola!

A campaigning group in Scotland got in touch. They shared unpublished data on Vitamin D status and severity of COVID. Thanks Rob! 

Researchers retrospectively looked at the records of 212 cases in South East Asia to examine any link between vitamin D blood levels and outcome from COVID. 

Summarising their findings; 3.6% of those with normal vitamin D levels developed severe disease as opposed to 40% of those with Vitamin D deficiency.

Now this might reflect people with low vitamin D levels have other health problems which led them to be indoors and away from the sun.  Yet, despite scientific criticism of retrospective data, association rather that causation, and reverse causation, surely it makes sense to supplement at this point in time? I certainly does for me.

If you make this choice there are a couple of points to mention.


First, sunlight is very good for you as long as you don’t get burnt. It is said to raise melatonin levels meaning better sleep and has a positive effect on mood. Natural ways of getting Vitamin D likely to be the best. However the lockdown might be making this difficult to achieve, as have the last few gloomy summers as well as the online world, indoor life and modern working environments.

The most sensible dose to replace the effect of missing sunlight is 5000 iu a day. Being in the sun for 20 minutes front, back and sides will mean you synthesise the maximum amount of Vitamin D the body can make before running out of Vitamin D precursors – this is about 15000iu daily. 


This is unlikely and clearly not the case for the majority of the population. We simply don’t eat enough oily fish. As I have mentioned, there are not enough fish left in our depleted seas to fulfil this need. This table shows why diet will rarely be good enough to compensate for the modern lifestyle of dark skin in temperate zones. 

So supplements make sense. Vitamin D3 is ideally taken once daily with a fatty meal as it is a fat soluble vitamin. 

There might be confusion between the use if IU (International units) which relate to activity and micrograms which relates to weight. 1mcg = 40iu, or 5000iu daily = 125mcg. 

In summary, get out in the sun, eat well and supplement with Vitamin D3.

I hope you find this helpful.

Enjoy the sun!