TO DATE, CLINICIANS HAVE
RECOGNISED LINKS BETWEEN – AMONG OTHER THINGS - COVID-19 AND DIABETES AND OBESITY. HERE, TERRY MAGUIRE ASSESSES THE ROLE OF VITAMIN D IN A PERSON’S ABILITY TO FIGHT THE EFFECTS OF THE VIRUS….
VITAMIN D: does it have a role to play?
By Terry Maguire T
he data is clear: people in ethnic groups living in the United Kingdom are more likely to die if they contract the SARS-Co-2 virus. Earlier this year, Public Health England (PHE) concluded¹ that Black, Asian and Minority Ethnic (BAME) communities are more susceptible due to social deprivation. This certainly fits the current political narrative well, but may not explain that poor clinical outcomes could simply be down to a lack of sunlight and low vitamin D levels.
The PHE report ‘Beyond The Data’ does, indeed, identify a possible role for vitamin D but, as Lionel Shriver pointed out in the Spectator in June², this seems more of an after-thought than a potential and important clinical cause.
Whether we have black skin or white skin, we too often forget that it is only down to our genes and their ingenious ability to help us to adapt to the environments we choose to live in. Early man emerging out of Africa around 56,000 years ago most likely had black skin. As these small human groups moved further north, they became, through genetic selection, fair skinned. The reason for this was vitamin D, which is created in the skin through the action of sunlight and which is vital for good health and fertility. At the latitude of the British Isles, darker skin meant less vitamin D
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and less vitamin D meant early death through a myriad of diseases. In females, it meant a greater risk of not being able to carry a child full term.
The role of sunlight and its ability to improve health through the production of vitamin D and other health vital chemicals, such as nitric oxide, is receiving renewed interest because of a possible link with poorer outcomes from COVID-19 infection. Current research is suggesting that the health implication of low vitamin D levels has much wider health importance.³ I have always stuck to government recommendations on vitamins and minerals, ie, eating a healthy diet is sufficient for the maintenance of optimal health. It seems, however, that vitamin D does not obey this rule. Vitamins are essential in that they cannot normally be manufactured in the body. Vitamin D, however, can and our exposure to sunlight is key to maintaining healthy levels of it. Our diets too will help. Indeed, Inuit people living successfully in the Arctic stay healthy with very little sunlight because their fish and seal-based diet is rich in vitamin D.
Some years back, a link between obesity and low levels of vitamin D was clarified: obesity causes lower levels of vitamin D (rather than the other way around) and scientists suggested that vitamin D, a fat soluble vitamin, may become ‘trapped’ inside fat tissue so that less of it is available to circulate inside the
blood.4
As we know, there is a direct correlation between obesity and COVID-19 deaths and people from Asian and Afro-Caribbean origin are more likely to have higher BMIs.
Vitamin D acts more like a steroid hormone than an enzyme catalyst - which is the role of other vitamins - and has a fundamental role in the regulation of numerous metabolic processes such as inflammatory response regulation. Most COVID-19 deaths are due to an exaggerated inflammatory lung response. Other diseases linked to low vitamin D levels include heart disease, cancers and diabetes - all identified as risks for COVID-19.
Living our lives in these cloudy northern latitudes ensures that, even with a balanced diet, we are unlikely to have sufficient vitamin D. Supplementation is important and is being more recognised by GPs. It is certainly essential for ethnic minority groups - especially those who have recently arrived from sunnier climes. Supplementation will need to be much as much as four times the current daily recommended 400 IU. We seem to get much better benefit from sunlight-produced vitamin D than supplementation and this may be due to production of other chemicals, such as the muscle relaxant nitric oxide.
We cannot ignore the potential benefit of sunshine but, for years,
government campaigns have informed us that there is no such thing as a healthy tan. There is now, it seems, justification for revisiting this advice. Yes, sun exposure is linked to carcinoma of the skin, yet where the prevalence of skin carcinomas diagnosis is growing year on year, there has not been a similar increased in deaths due to the more dangerous types, such as malignant melanoma.
Racism is obnoxious and Black Lives Matters protests have moved social equality a little closer, but there remains some considerable way to go. Political narrative is important, but this narrative should be honest. As Lionel Shriver points out, many Black doctors in the UK died of COVID-19 related symptoms and they were not from the lower socio-economic groups. We need to properly appreciate the real causes and their relative importance.5
Social inequality
is important but so too, it seems, are genetic differences that, when worked out, might be as important - and more helpful - in protecting Black lives.
References 1. Beyond the Data. Understanding the impact of COVID-19 on BAME groups. Public Health England. 2. Lionel Shriver, Spectator June 25 2020 A minority opinion on COVID-19 deaths. 3.
http://www.wphna.org/htdocs/2011_ aug_wn3_vitaminD.htm 4. Vimaleswaran KS, Berry DJ, Lu C, et al. Causal Relationship between Obesity and Vitamin D Status: Bi-Directional Mendelian Randomization Analysis of Multiple Cohorts. PLoS One Medicine. Published online February 5 2013. 5.
https://www.thelancet.com/journals/ landia/article/PIIS2213-8587(20)30268-
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