Jan
22
2022

Booster Vaccinations Against Covid-19 Variants are Very Effective

This article will inform you that booster vaccinations against Covid-19 variants are very effective. Studies in patients from Israel who received a third vaccination (booster shot) showed much less omicron infections. Researchers compared the number of omicron infections in patients with only two shots and another group with three vaccinations (regular vaccination+booster shot). In patients who had booster shots infection rates were 10-fold lower.

Antibody titers matter

What seems to be happening is that antibody titers against Covid-19 rise after each vaccination providing more and more protection against the virus. Patients in this study had 90% less Covid-19 infections after a booster (=3 shots with the Pfizer vaccine) when compared to a double vaccinated group. Researchers compared nursing home residents who were previously sick with Covid-19 versus those who were not. They did PCR tests in April or June of 2020 to identify that there was a past history of Covid-19 infection with a subsequent recovery. Within 3 weeks after one dosage of an anti Covid-19 vaccine their antibody tests rose to above 40,000 arbitrary units (AU) per milliliter. The threshold was 50 AU to be positive.

The Israeli experience

An Israeli study was published on Nov. 5, 2021. Researcher determined the antibody titers in blood samples after anti-Covid-19 vaccinations. They investigated the antibody titers after two vaccinations and compared them to antibody titers after three vaccinations. The latter vaccination is often referred to as a booster shot. 97 study participants had blood tests taken after two vaccinations with an average antibody titer of 440 AU/mL. Any value above 50 was considered to be seropositive. However, 10 to 19 days following the booster shot the average antibody titer rose to 25,468 AU/mL, which is an enormous increase.

Older age patients and kidney transplant patients responding to booster shots

After two vaccinations there were lower antibody titers in older patients aged 67-74 compared to patients age 18-55. But after the booster shot this age difference was no longer present. On the sideline the researcher also followed a group of kidney transplant patients. These would be considered to be patients with a chronic disease. Initially, following the standard two vaccinations these patients were negative for an antibody response. But after the third vaccination (booster shot) 49% of the kidney transplant patients showed a positive antibody test.

Antibody titers in patients with past natural Covid-19 infection

Researchers also investigated the antibody response of patients against the spike protein of Covid-19. As this publication shows after a natural Covid-19 infection plus one vaccination of the Pfizer/Moderna vaccine the antibody titer was 20,120 arbitrary units per milliliter. In contrast, the other group consisted of two vaccinations of the Pfizer/Moderna vaccine. They had antibody titers of 22,639 arbitrary units per milliliter. This was not significantly different from the first group. It also did not matter whether in the first group the prior natural Covid-19 infection was 1, 2, 3 or more months before the first vaccination with the Pfizer vaccine.

Discussion

New information emerged since the beginning of the Covd-19 pandemic. There was confusion about how often people would need a vaccination before they would be immune against Covid-19. After one vaccination with the Pfizer/Moderna vaccine the protection rate against Covid-19 is around 50%. After two vaccinations the protection rate is around 95%. Experience with the booster vaccination teaches us that the protection rate is almost 100%. There was no difference between the antibody response of the group with the age of 18-55 and the group with the age of 67-74 after the third shot (booster shot).

But there is a proviso: the immune system must be capable of full activation to produce enough antibodies by the B cells. B cells are the lymphocytes that traveled through  the bone marrow after which they started producing antibodies against viruses. As the results with the kidney transplant patients showed, only 49% of them were able to produce positive antibody titers. The reason for this is that kidney transplant patients must take immune system suppressing drugs to avoid a rejection of the kidney transplant.

Other reason for poor antibody response

Other patients with chronic diseases (diabetics, autoimmune disease patients etc.) and patients older than 60 can also have a weaker immune system. Part of this can be when one or more of the 14 supplements is missing that are necessary for a full immune response. It is important before the Covid-19 vaccinations to take the 14 necessary supplements to get a good antibody response.

Booster Vaccinations Against Covid-19 Variants are Very Effective

Booster Vaccinations Against Covid-19 Variants are Very Effective

Conclusion

Several studies showed that the antibody response after the anti-Covid-19 vaccine increases significantly. The measurements revealed that after two injections the antibody titer was 440 AU/mL. After the third (booster) injection the antibody titer increased significantly to 25,468 AU/mL. This explains why some people after one or two vaccinations still may be able to come down with Covid-19, but after the additional booster injection (3rd vaccination) the immune response in terms of antibody production is 58-fold higher than after the second vaccination. This gives the immune system a full response. Some patients with chronic diseases (obesity, diabetes, autoimmune diseases etc.) will have certain immune deficiencies. This explains a higher infection rate among these people as well as a higher mortality rate. We all can take the booster vaccine against Covid-19. In addition, we can take the 14 immune supplements to stimulate our immune system.

Oct
30
2021

Acetaminophen Damages the Fetus

Many women take acetaminophen when pregnant, but acetaminophen damages the fetus. It is important to realize that acetaminophen is a common over-the-counter pain reliever. In addition, it is also often combined with codeine as headache pills. Acetaminophen goes under these brand names: Tylenol, Tylenol Arthritis Pain, Tylenol Ext and Little Fevers Children’s Fever/Pain Reliever. The international name of acetaminophen is the name “paracetamol”.

An international group of 13 scientists are calling health care professionals to limit the use of acetaminophen in pregnant women. CNN reported about this under this link.

These scientists published an article in the medical journal Nature on the dangers of paracetamol use in pregnancy.  Specifically, they said that acetaminophen can alter fetal development, which includes reproductive, neurodevelopmental and urogenital disorders.

History of acetaminophen

The chemical name for acetaminophen is N-acetyl-p-aminophenol. Acetaminophen is simply a shortened version of that chemical name. It was introduced in the US in 1955 as Tylenol® and in the United Kingdom in 1956 under the brand name Panadol®. In particular, acetaminophen was recommended to control fevers and to help with pain control.

In the 1960’s the Swiss watch industry provided workers who complained of headaches freely with acetaminophen. With this in mind, within a few years studies showed that many of these women who took a lot of this medication developed kidney problems. This led to an increase of the creatinine level in the blood. The kidney damage from acetaminophen was dubbed “phenacetin kidneys”. Outside of the US acetaminophen has the name phenacetin. Many of these patients subsequently had to receive dialysis and later kidney transplants.

Acetaminophen toxicity

The recommended dose of acetaminophen is 650 mg to 1000 mg 4-6 times daily, not to exceed 4 grams/day. The therapeutic window for this drug is very narrow, because 7.5 grams per day to 10 grams per day are already toxic. For children the dose is 15 mg/kg every 6 hours to a maximum of 60 mg/kg per day.

The other known toxicity concerns liver function. This article about Tylenol toxicity explains this in more detail.

Many people do not know about the limit for the over-the-counter acetaminophen and take too much for a fever or a painful condition. Just because a drug is available over the counter does not mean that it is harmless. If you don’t watch for toxic levels, you could end up dead or find yourself waiting for a liver transplant.

New evidence that acetaminophen damages the fetus

91 scientists from Australia, Brazil, Canada, Europe, Israel, Scotland, the UK and US have signed a declaration. In it they ask pregnant women not to take acetaminophen “unless its use is medically indicated”. Among the reasons for the declaration is that acetaminophen certainly can cause neural tube defects and cardiovascular disorders in fetuses. Pediatrician Dr. Leonardo Trasande, director of environmental pediatrics at NYU Langone Health, did not partake in this research. He has done safety studies on acetaminophen and pointed out the similarity in chemical structure between acetaminophen and phthalates. Like phthalates acetaminophen disrupts the reproductive development in animals and humans.

Evidence for neurodevelopmental disruption

Dr. Shanna Swan, a professor of environmental medicine at the Icahn School of Medicine at Mount Sinai in New York said: “There’s enough evidence to find increased risk of undescended testicles and a shortening of the anogenital distance, which is a predictive of later decreased sperm count and decreased fertility. We also see impaired ovarian function which has consequences for later fertility, although females have been less studied.”

The conditions that relate to acetaminophen toxicity were attention deficit hyperactivity disorder (ADHD), behavior abnormalities and autism spectrum disorders. In addition, language delays, conduct disorders and decreased IQ were due to neurodevelopment disruption from acetaminophen toxicity.

Mechanism of action of acetaminophen and side effects

Acetaminophen has been on the market for over 60 years. But scientists still don’t know exactly how it acts in the body to help control pain and reduce fever. There is a consensus that acetaminophen acts on the central nervous system inhibiting the synthesis of prostaglandins. These biological compounds have a leading role in causing fever, pain and inflammation. But the scientific proof for this consensus is still outstanding.

Side effects

There are a multitude of side effects that can occur with the use of acetaminophen. Common side effects are hives, itching, swelling of the mouth and throat and tingling in the mouth or throat. Other side effects are swelling in the face or hands, breathing difficulties or chest tightness. Acetaminophen can cause a loss of appetite, nausea and vomiting. Severe stomach pain can be another symptom of acetaminophen side effects. As you can see from the above link there are many more known side effects of acetaminophen.

Acetaminophen Damages the Fetus

Acetaminophen Damages the Fetus

Conclusion

Acetaminophen (=paracetamol, phenacetin) is a popular over-the-counter fever and pain remedy. But a narrow therapeutic width can cause serious overdoses where both the liver and the kidneys suffer irreparable damage. When people unknowingly take too much acetaminophen, they enter into the toxic range. This can cause disability and death. Kidney damage from acetaminophen became known as “phenacetin kidneys” already in the 1960’s in female workers of the watch industry in Switzerland. They developed headaches from constantly working with magnifying glasses and had free access to acetaminophen provided by the employer. Later, in North America liver disease developed when patients overdosed with over-the-counter acetaminophen for fever and pain control.

Interruption of fetal development from exposure of the fetus to acetaminophen 

At the present time the focus is on newer findings of researchers. They noticed that exposure of pregnant women to acetaminophen damages the fetus. This results in undescended testicles and a shortening of the anogenital distance which is a predictive of later decreased sperm count and decreased fertility. These are findings for males. Findings in females are less studied at this point in time. Dr. Leonardo Trasande pointed out the similarity in chemical structure between acetaminophen and phthalates. Like phthalates acetaminophen disrupts the reproductive development in animals and humans. Patients should take acetaminophen only under supervision with doses that are safe. The old notion that acetaminophen would be safe in pregnancy is no longer true in light of the new medical findings. Any pregnant woman should discuss with her physician what she can safely take.

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Sep
04
2021

Effects of a Plant-centered Diet on Cardiovascular Disease in Midlife

A study followed younger patients for 32 years looking for the effects of a plant-centered diet on cardiovascular disease in midlife. The researchers determined the heart attack and stroke rates when the participants were in their 50’s to 60’s. When on a plant-based diet cardiovascular disease rates fell by 52% compared to a control group with a meat containing diet. One subgroup changed the diet from a regular diet to a plant-based diet over 13 years. This reduced the risk ratio by 61% for heart attacks and strokes when assessed later.

Details of this study

There were 4946 adults as participants of this 32-year study. They were recruited in 1985 and 1986, at which time none of them had cardiovascular disease. The study completed in 2018. The results were published on Aug. 4, 2021. The researchers assessed the plant-centered diet quality using a tool with the name “A Priori Diet Quality Score” (APDQS). The higher the score, the higher the quality of the food. This means the person consumed nutritionally rich plant foods, limited amounts of high-fat meat products and less healthy plant foods.

Although a plant-rich diet consisted primarily of nutritionally rich plant foods, small amounts of animal products were also allowed. This involved low-fat dairy products, non fried poultry and steamed or grilled fish. This made the diet tastier and ensured that people would stick to this diet for decades.

Improvements of heart attack rates with plant-centered diet

After 32 years 289 cases of cardiovascular disease developed. The researchers compared participants with the highest food quintile to participants with the lowest food quintile. As mentioned, the risk for participants on a plant-based diet was 52% lower to get a cardiovascular disease. Moreover, a subgroup changed from a higher risk (fatter meals, meat, less vegetables) diet to a lower risk diet (lean fat, lean poultry, vegetables). Physicians followed this subgroup for 13 years and the risk ratio for heart attacks and strokes fell by 61%.

Comparison to other diet studies

There are other studies that looked at the effect of diet changes on the risk of developing heart disease. One such study examined 86 cross-sectional studies and 10 prospective studies in a meta-analysis. Vegetarian diets reduced deaths from heart attacks by 25% and brought down the incidence of total cancer rates by 8%. A vegan diet reduced the risk of total cancer by 15%.

In a study from the United Kingdom dated March 2019 several clinical trials were analyzed regarding non-diabetic populations. The question came up, what the effect of a Mediterranean diet was on cardiovascular disease incidence and mortality. The authors reviewed 30 RCTs (49 papers) with 12,461 randomized participants and seven ongoing trials. In one study the observation time was 46 months. A Mediterranean diet reduced the cardiovascular disease mortality by 65%!

Another study from Spain

Another study from Spain published in 2019 examined 7356 older adults (average 67 years) and followed them for 6.8 years. The investigators kept track of the physical activity and put everybody except the controls on a Mediterranean diet. The group on the lightest leisure-time physical activity consuming a Mediterranean diet had the lowest mortality. The all-cause mortality of this group was 73% lower than the control group.

What is so healthy about the Mediterranean diet?

Despite a wide variation between all the 15 countries bordering the Mediterranean Sea, there are common characteristics: an abundance of vegetables and fruit, along with nuts and legumes. Cereal products are largely whole grain. Olive oil is the principal fat source, and people eat fish, seafoods and poultry in moderation. They consume red meat rarely. Cheese and yogurt can be part of the diet, depending on the region.

The first clinical evidence supporting the health benefits of the Mediterranean diet came from the Lyon Heart Study. The researchers placed patients who had a heart attack either on the diet designed by the American Heart Association or a Mediterranean style diet. After a follow-up of 27 months, the group eating the Mediterranean diet had a reduction of heart attacks by 73% and a decreased mortality by 70% compared to the other group.

More detail on the ingredients of the Mediterranean diet

An analysis of the various foods of the Mediterranean diet shows the reasons for the health benefits clearly. The fats that people on a Mediterranean diet eat are heart-healthy monounsaturated fats like olive oil or fats that contain omega-3 fatty acids. They come from fish (tuna, salmon, trout, sardines) or from plant sources (walnuts, other tree nuts and flax seed).

As there is an emphasis on natural foods, the diet is extremely low in trans fatty acids (hydrogenated fats), which otherwise increases the risk for cardiovascular disease. As people consume more than 300g of vegetables per capita daily, the contents of antioxidants and other beneficial plant chemicals is much higher in comparison to Western diets. There are many individual components of the Mediterranean diet that contribute to the reduction of disease. This is particularly true for heart disease. It also is apparent, that there is not one single food or nutrient that is responsible for the health benefits. What matters are the interactive effects of all the nutrients that lead to the health benefits.

No processed food means healthier living

The practical application does not mean deprivation and starvation, but a move away from processed fats (margarine), baked goods (donuts, muffins, pastries), and high saturated fat snacks and trans fats (chips, crackers, cookies, pies). Food choices move towards those of fresh fruit and vegetables, nuts, fish, and olive oil. Portions or servings have to be adequate to maintain a healthy weight.

Mediterranean food is not the heaping plate of pasta with an afterthought of vegetables. It also is not the super-size fast food pizza with pepperoni and cheese. Mediterranean food incorporates fresh food rather than fast food. It entails a shift from large portions of red meat to smaller portions of fish, a transition from highly processed foods to ample helpings of dark green vegetables with a dose of olive oil. Low amounts of alcohol, especially red wine can make a meal enjoyable, which means that the limit is one drink per day for women, and two drinks per day for men. After dinner go for a walk!

Olive oil is one of the reasons why the Mediterranean diet is so healthy

In the past it was thought that the monounsaturated fatty acids in olive oil would be the reason why it is protective of the heart. However, newer studies have shown that it is the polyphenols and among these in particular hydroxytyrosol that lower blood pressure and protect you from hardening of the arteries.

A 2012 study from Spain has found that mortality from heart attacks was 44% lower than that of a control group who did not incorporate olive oil in their diet.

How polyphenols in olive oil work for you

Only two tablespoons of extra virgin olive oil per day protect you from heart disease. It does so by reducing the total cholesterol level in the blood as well as the LDL cholesterol level. When there is more polyphenol in olive oil (such as in extra virgin olive oil), the body produces more HDL, which is essential to extract oxidized LDL from arterial plaque. On top of that polyphenol rich olive oil increases the size of the HDL particles (these larger particles have the name HDL2), which are more efficient in extracting oxidized LDL from arterial plaques. A Sept. 2014 study in humans showed that higher polyphenol olive oil as found in extra virgin olive oil caused an increase in the more effective HDL2 particles. This cleans out plaques from arteries more effectively than the regular, cheaper olive oil.

Effects of a Plant-centered Diet on Cardiovascular Disease in Midlife

Effects of a Plant-centered Diet on Cardiovascular Disease in Midlife

Conclusion

Several large, well-controlled studies showed that there are pronounced effects of a plant-centered diet on cardiovascular disease in midlife. Heart attack rates and mortality rates were reduced by 25% to 73% on a Vegan diet or a Mediterranean diet. When people combine a plant-centered diet with regular physical exercise they also live longer. One of the ingredients of a Mediterranean diet is extra virgin olive oil. It contains polyphenols that lower total and LDL cholesterol. It also increases the larger particles of HDL cholesterol with the name HDL2. HDL2 is more efficient in extracting oxidized LDL cholesterol from arterial plaques.

What you can eat on a plant-centered diet

A plant-centered diet incorporates fresh food rather than fast food. It entails a shift from large portions of red meat to smaller portions of fish, a transition from highly processed foods to ample helpings of dark green vegetables with a dose of olive oil. Instead of large portions of beef and sausages shift to seafood (tuna, salmon, trout, sardines), walnuts, other tree nuts and flax seed. The statistics clearly showed the effects of a plant-centered diet on cardiovascular disease in midlife with a reduction of heart attacks and mortality.

Some of the text above was published previously here.

Jul
10
2021

Extreme Heat and Heat Related Deaths

Extreme heat and heat related deaths are closely linked. A record heat wave hit the North West of the US and British Columbia in late June/early July. Many people died from heat stroke and from cardiovascular problems. Here I like to review the medical literature regarding extreme heat and heat related deaths. Also, why is it important to cool down? Much of what I like to communicate was published in a review article by CNN. But I also reviewed many other websites and added links below.

How does global warming contribute to the summer heat?

There are a few explanations how global warming drives the heat in summer even higher.  Essentially, what weather experts are saying is that the jet stream can get stuck in one place during a summer heat wave and the heat keeps getting more intense. Global warming is responsible for heat waves that are higher than in the past. Conversely, in winter global warming can produce cold waves that are colder than in previous years.

Why is extreme heat dangerous for us?

According to the CDC between 2004 and 2018 an average of about 700 Americans died from heat-related causes. The majority of deaths occurred between May and September. There are a number of observations that explain why more people die during a heat wave.

In 2006 there were widespread heat waves and as a result there was a peak in heat related deaths.

  • When people have pre-existing cardiovascular disease, this gets aggravated during a heat wave and the death rate from cardiovascular disease increases during a heat wave. About 25% of heat related deaths are due to an underlying cardiovascular disease.
  • Age by itself plays a big role in heat related deaths. People above the age of 65 are several times more likely to die from a heat related cardiovascular disease than the general population.

     Under reporting of heat related deaths

  • Many times, it is not clear whether a death is due to a medical condition or due to exposure to heat. A death certificate that reports a heart attack as the cause of death during a heat wave will be missed when statisticians attempt to get a number for heat related deaths after a heat wave.

Medical causes why extreme heat and heat related deaths are linked

Our body is used to an inside temperature range between 97 to 99 degrees Fahrenheit (36.1 to 37.2 degrees Celsius). The body can compensate in two ways to counter a rise of the body temperature from heat exposure.

  1. When the brain senses a rise in body temperature, the sweat glands open up and sweat is produced. The evaporating sweat cools down the body temperature.
  2. The body has a second coping mechanism to cool you down. The body can dilate its blood vessels and increase the heart rate. This brings the blood more to the surface. This is when your forehead and the extremities give off heat and you lower your body temperature.
  3. But with exposure to extreme high temperatures both of these mechanisms are not enough to decrease your core temperature.

Avoiding heat-related illness

  • The Mayo Clinic link explains that it is important to drink enough fluids to avoid dehydration. This helps with the second coping mechanism mentioned that cools you down (see above).
  • When the outside temperature rises beyond 86 degrees Fahrenheit (=30 degrees Celsius) it is wise to stay inside air-conditioned premises. This could be your house, if you have air-conditioning, an air-conditioned mall or a public building. A cool pool, bathtub, or cold cloths applied to your arms, legs and torso cool you down as well. Otherwise, intermittent cold showers or cold baths will do the same.

Health conditions that are a higher risk for heat related deaths

The population group at higher risk for developing heat-related illness and eventual deaths are infants and children up to age 4. In addition, anybody older than 65 years is also at risk. Pre-existing medical conditions like diabetes, heart disease and chronic lung disease (COPD) increase the risk of dying from excessive heat exposure. Being overweight or obese is also a risk factor. Heat exhaustion and heat stroke are conditions that require hospitalization.

Common heat-related symptoms

Symptoms of heat exhaustion are: profuse sweating, a pulse that is fast and weak, clammy skin, vomiting and nausea. In addition, there can be cramps in muscles, weakness, tiredness, dizziness, headaches and fainting.

Symptoms of heat stroke are: high fever of 104 degrees Fahrenheit (= 40 degrees Celsius) or higher. Take the temperature with a rectal thermometer to get the core temperature. Other symptoms of heat stroke are altered mental state (confusion, agitation, delirium and seizures). Further, the skin may turn red as the temperature increases, and there may be rapid and shallow breathing. The heartbeat races and the head may throb from a severe headache. Both patients with heat exhaustion and heat stroke need hospital care. Call an ambulance.

Extreme Heat and Heat-Related Deaths

Extreme Heat and Heat Related Deaths

Conclusion

We have to take extreme heat and heat related deaths seriously. Only when we employ counter measures will the death toll from heat related deaths go down. Prevention is everything. But if a person develops heat exhaustion and heat stroke swift transportation to a hospital is a must. This can often save a life. We all need adopt an awareness what our risks are regarding heat and heat related deaths. We need to apply early countermeasures by getting into cooler areas and by drinking enough fluids to prevent dehydration. Prevention is everything regarding extreme heat and heat related deaths.

Jun
26
2021

Being A Morning Person Can Prevent Depression

A British study concluded that being a morning person can prevent depression. It was reviewed also in CNN. The study used sleep data from 85,000 UK participants in the Great Britain Biobank Study. They wore wrist activity monitors that provided sleep data. Researchers compared the sleep data with the self-reported mood changes. They found that if the sleep pattern is misaligned with the circadian rhythm, those who are night owls are at a higher risk of developing mood disorders. The controls were those who were morning persons. They were not affected by the misalignment effect.

Normal sleep pattern

Natural sleep habit or the circadian rhythm starts between 10 PM and 11 PM and continues for 7 to 8 hours. Your hormones are replenished during your sleep. This helps your body’s hormones and the immune system to restore itself overnight.

“The health problems associated with being a night owl are likely a result of being a night owl living in a morning person’s world, which leads to disruption in their body’s circadian rhythms”. This is what sleep specialist Kristen Knutson said. She is an associate professor of neurology and preventive medicine at Northwestern University Feinberg School of Medicine.

Reclaim your natural sleep habit

The key is to learn to live within your circadian rhythm pattern. Caffeine is a powerful stimulant and will stop you from falling asleep. For this reason, it is best to avoid caffeine-containing beverages. If you cannot live without your favourite cup of java, switch to the decaffeinated version. Stop using LED lights (from TV, computers, tablets or smartphones) 2 hours prior to your bedtime. Use dark curtains and enjoy a comfortable bed. Maybe read that thriller, earlier in the day instead of making it your bedtime story. And do yourself a favour: you do not need the eleven o’clock news on TV!  They will probably stop you from falling asleep. Go to sleep between 10PM and 11PM.

Children can have problems with sleep disturbances and depression

Another study published March 22, 2021 in the Jama Network showed that depression had an association with sleep disturbances in youth and children.

A meta-analysis of 16 publications looked at depression and disturbed sleep. It showed that depression was 1.5-fold higher in sleep disturbed youths/children compared to controls with a normal sleep pattern.

Other studies re. being a morning person can prevent depression

Another study with Dr. Knutson as the lead author appeared in 2018. The authors found that various health conditions, mood disorders and mortality were on the increase the more the sleep rhythm deviated from the circadian rhythm. Morning persons were protected from this effect. But night shift workers and night owls were at a higher risk of disease. Specifically, they found the following associations for evening types.

  • Evening types compared to morning types had a 1.94-fold risk of psychological disorders
  • The risk of diabetes was 1.30-fold for evening types
  • Neurological disorders had a 1.25-fold risk in evening types
  • Gastrointestinal/abdominal disorders occurred 1.23-fold more often in evening types
  • respiratory disorders were 1.22-fold more common in evening types
  • Evening types had a 10% increased risk of all-cause mortality

The researchers concluded that externally imposed timing of work and social activities has potentially serious health consequences.

Circadian misalignment responsible for disease

Dr. Knutson also said: “Circadian misalignment could also lead to inadequate sleep duration and quality, which could also impair mood and exacerbate mood disorders.”

In other words, circadian misalignment to circadian rhythm problems. This can cause mood disturbances, but eventually lead to the diseases listed above.

Evidence of health risks in night shifts workers

The medical literature is full of examples that the health of night shift workers is significantly affected by circadian misalignment. Here are a few examples.

1.Here is a random selection to illustrate the health risks of night shifts workers. A study from 2015 examined the sleep patterns of 315 shift nurses and health care workers in Iranian teaching hospitals. They found that 83.2% suffered from poor sleep and half of them had moderate to excessive sleepiness when they were awake.

2.This South Korean study examined 244 male workers, aged 20 to 39 in a manufacturing plant. Researchers compared blood tests from daytime workers to blood tests from night shift workers. They also obtained inflammatory markers like the C-reactive protein and leukocyte counts. Night shift workers had significantly higher values. The investigators concluded that shift workers have increased inflammatory markers. This is a sign of a higher risk of developing cardiovascular disease in the future.

Higher mortality and higher cancer risk in nighttime workers

3. A Swedish study found that white-collar shift workers had a 2.6-fold higher mortality over a control group of daytime white-collar workers.

4. Another study compared night workers in the age group of 45 to 54 with daytime workers and found a 1.47-fold higher mortality rate in the night shift workers.

5.In a study from China 25,377 participants were part of a study that investigated cancer risk in males with more than 20 years of night shift work. They had a 2.03-fold increased risk to develop cancer compared to males working day shifts. Women with night shift work in this study showed no effect with regard to cancer development.

Healthy telomeres with healthy sleep pattern

It is true that you can suffer multiple health problems, as all of your hormones depend on the resetting during your deepest sleep between 2AM and 4AM triggered by the nighttime melatonin response. Even your telomeres, the caps of chromosomes in every cell get shortened from too much stress and too little sleep.

One example of such a study comes from Milan, Italy. https://oem.bmj.com/content/75/Suppl_2/A480.1

In this 2018 study researchers compared 46 nurses who had worked in night shifts with 51 nurses working day shifts. Among the night shift workers breast cancer was common, but not among day workers.

Shortened telomeres, hypomethylation of BRC1 gene and p53 gene

In the night shift nurses from Milan there was hypomethylation of the breast cancer gene BRC1. There was also hypomethylation of the general cancer gene p53. At the same time significant telomere shortening occurred in night shift nurses who had worked night shifts for more than 15 years. This likely all worked together in causing night nurses to develop breast cancer more frequently.

Shortened telomeres mean a shortened life span. The reason for this is that people with shortened telomeres develop heart attacks, strokes and cancer. This is what shortens the life span. How do we avoid this risk? Go back to healthy sleep habits. As mentioned above it is best to start going to sleep between 10PM and 11PM and sleep for 7 to 8 hours. Night owls delay going to sleep by 2 to 3 hours.

Being A Morning Person Can Prevent Depression

Being A Morning Person Can Prevent Depression (click image to enlarge)

Conclusion

A publication in Molecular Psychiatry demonstrated that evening person (night owls) are more likely to develop depression. This is in comparison to morning persons. As discussed, other researchers showed that evening persons also can develop diabetes and neurological disorders. In addition, respiratory disorders and gastrointestinal disorders are more common in night owls as well. When it comes to mortality, evening persons have a 10% increase of mortality over morning persons. There is a large body of literature regarding diseases of night shift workers. Night Shift work is perhaps the most extreme example of a circadian misalignment. It leads to poor sleep, inflammation in the body, increased cancer risk and higher mortality compared to day shift workers.

Prevent telomere shortening

Even the telomeres get shortened in night owls and night shift workers. We can prevent problems like these by going to bed in time and sleeping according to our circadian rhythm. If you had a poor night’s sleep, make up for it with the help of an afternoon nap. Do not sleep all afternoon though; half an hour or one hour will be enough. Even a short, restful nap after coming home from work can restore your feeling of wellness.

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Feb
20
2021

Two Articles Showed that Fish Oil Reduces Cardiovascular Disease and Mortality

Recently two articles showed that fish oil reduces cardiovascular disease and mortality.

British study recording the effects of fish oil over 10 years

For one thing, the British Medical Journal published an article comparing people who supplemented with fish oil with people who did not. In this case, the ones who supplemented had a lower risk of mortality and had lower cardiovascular disease than the control group. In brief, 427,678 subjects were enrolled in this British study between 2006 and 2010. Questionnaires at the beginning of the study revealed how many capsules of fish oil the subjects consumed. Hospital records and death certificates provided information about cardiovascular disease mortality at the end of 2018. Altogether, 31% of the subjects said that they were taking fish oil supplements regularly.

In short, here are the results of the study showing what fish oil did.

  • 7% lower cardiovascular events
  • 16% lower risk of cardiovascular disease mortality
  • 20% lower mortality risk from heart attacks
  • 13% lower risk of death from any cause (when compared to people who did not use fish oil)

Discussion

Given these points, the authors stated that it was the omega-3 fatty acids in fish oil that caused all the beneficial effects. This included lowering of blood pressure, triglycerides and reducing the heart rate. Fish oil was also responsible for improvement of endothelial function, inflammation and blood clotting. In addition, fish oil protects against cardiac arrhythmias. They stated: “Fish oil supplementation could be an inexpensive, quick, safe way of increasing an individual’s omega-3 fatty acid intake”.

Mayo Clinic study of taking higher doses of omega-3 polyunsaturated fatty acids

A study dated Sept. 17, 2020 showed the cardiovascular benefits of higher doses of omega-3 fatty acids. This was the second of two articles that showed that fish oil reduces cardiovascular disease and mortality. It was published in Mayo Clinic Proceedings. This metaanalysis involved 40 interventional studies and 135,000 patients. Two types of omega-3 fatty acids, namely EPA and DHA were studied with regard to the prevention of cardiovascular disease. EPA and DHA supplementation had the following effects.

  • 35% reduction of risk of a fatal heart attack
  • 13% reduction of heart attacks in general
  • 10% reduced risk of coronary heart disease occurrence
  • 9% reduction of mortality from coronary heart disease

The researchers described that the higher the dose of omega-3 fatty acid supplementation, the greater the protection.

An extra dose of 1000 mg per day of EPA and DHA reduced the risk of cardiovascular disease as follows. There was a reduction of cardiovascular disease by 5.8% and of heart attacks by 9%. I take 1800 mg of EPA/DHA twice a day, a total of 3600 mg per day.

Two Articles Showed that Fish Oil Reduces Cardiovascular Disease and Mortality

Two Articles Showed that Fish Oil Reduces Cardiovascular Disease and Mortality

Conclusion

Two independent studies of fish oil or omega-3 fatty acids came to similar conclusions.  Heart attacks and strokes are significantly reduced. And mortality in the group that used fish oil supplementation was also significantly reduced. An extra dose of 1000 mg per day of EPA and DHA reduced the risk of cardiovascular disease as follows. There was a reduction of cardiovascular disease by 5.8% and of a heart attack by 9%. Based on these findings the researchers recommended that patients should use EPA/DHA supplementation to reduce cardiovascular risk. EPA/DHA supplementation lowers blood pressure, triglycerides and the heart rate. Fish oil was also responsible for improvement of endothelial function, also for the prevention of inflammation and blood clotting. In addition, fish oil protects against cardiac arrhythmias. The end result is that you live a healthier life.

Jan
23
2021

Review about Human Oncolytic Virus Research in 2020

The British Medical Journal published a review about human oncolytic virus research in 2020. That is to say, the BMJ published this report in July 2020. On the negative side, the report is rather complex with many technical terms. With this in mind, I will keep it as simple as possible for this summary. Notably, oncolytic viruses are a new way of treating cancer. Adenovirus was the most common oncolytic virus in use by cancer research in the past 20 years. It must be remembered, researchers applied this to mainly melanoma and gastrointestinal cancers. In the past I discussed the use of oncolytic viruses in a related post.

History of licencing of oncolytic viruses

  1. The first oncolytic virus was licenced in 2004 in Latvia. This was an RNA virus derived from the native ECHO-7 strain of a picornavirus, called Rigvir. This oncolytic virus was approved for treating melanomas.
  2. Shortly after, in 2005, China approved a genetically modified adenovirus, H101 as an oncolytic virus. The approval was for the treatment of nasopharyngeal carcinoma combined with chemotherapy.
  3. In 2015, the U.S. the FDA approved T-VEC (Talimogene laherparepvec), an attenuated herpes simplex virus, type 1. This new oncovirus encodes granulocyte-macrophage colony-stimulating factor (GM-CSF). This is effective for the local treatment of inoperable, recurrent melanoma. It works for cutaneous, subcutaneous and nodal lesions in patients with recurrent melanoma after initial surgery.

Review of 20 years of human oncolytic virus research

The investigators reported about 97 clinical trials with oncolytic viruses performed between 2000 and 2020. That is to say, this involved 3233 patients with cancer. Most of these trials were phase I (50.5%) trials. There were an additional 6.2% studies, which were phase I/II. 11.3% were phase II clinical trials and only 2.1% were phase III clinical trials. 29.9 % of the literature did not specify what type of trial the investigations were about. However, they likely belonged into the phase I category as they reported on first trials of a therapy on man.

Oncolytic viruses derive from various types of viruses 

The number of studies that used a certain virus-derivative are included in brackets. It must be remembered that most of the studies dealt with six viruses: adenoviruses (30), herpes simplex virus (HSV-1) (23), reovirus (19), poxvirus (12), Newcastle disease virus (NDV) (5) and measles virus (3).

Stimulation of the immune system through GM-CSF

In 24 studies the researchers introduced GM-CSF transgene into an oncolytic virus. GM-CSF is a glycoprotein that is normally produced by granulocytes, a type of white blood cell. In this case, it stimulates dendritic cells, the precursors of T cells to produce killer T cells. Notably, this stimulates the immune system to better fight cancer.

Types of cancer targeted with oncolytic viruses

It is important to realize that the majority of the studies treated melanoma cases and gastrointestinal cancers. Namely, gastrointestinal cancers included esophageal cancer, gastric (stomach) cancer, colorectal cancer and pancreatic cancer. There were 30 studies involving melanomas with 1000 patients. There were 76 clinical trials regarding gastrointestinal cancers with 577 patients.

Moreover, other cancers where oncolytic viruses were studied were head and neck cancer (15 studies) breast and gynecological cancers (31 studies), genitourinary cancers (26 studies), and sarcomas (16 studies).

Other drugs given along with oncolytic viruses

It must be remembered that of the 97 total studies 62.9% were clinical trials where oncolytic viruses were the only therapy. In 37.1% of the studies physicians gave the oncolytic viruses along with cytotoxic chemotherapy, immunotherapy or radiotherapy.

Side effects of treatment with oncolytic viruses

The safety profile for treatment with oncolytic viruses appears to be tolerable. Fever was common, as were chills. Some patients reported nausea and vomiting, flu-like symptoms, fatigue and pain. But these symptoms disappeared within a few days.

Suppression of the bone marrow for a period of time was common, but more so when there was a combination of  oncolytic viruses with chemotherapy. None of the patients transmitted viruses to household contacts or the healthcare team.

Antitumor activity in clinical trials with involvement of oncolytic viruses

An analysis of clinical responses to oncolytic virus therapy showed the following:

  • 1% had disease control, which broke down as follows (items 2,3 and 4)
  • 4% complete control (=cure)
  • 7% partial control
  • 12% stable disease
  • 9% No response to treatment with oncolytic viruses

HSV-1 derived oncolytic viruses had the best response. The responses were not as good with adenovirus, reoviruses and with vaccinia viruses.

Discussion

Researchers of the BMJ publication analysed 97 clinical trials regarding oncolytic viruses over the past 20 years. This showed a number of points worth mentioning.

  1. The goal of oncolytic virus therapy is to induce tumor cell death. Physicians could achieve this indirectly by stimulating the immune system. Oncolytic viruses can stimulate both the innate immune system and the tumor-specific adaptive immune response.
  2. In the earlier years a lot of clinical trials investigated the safety of oncolytic viruses. But it became clear that oncolytic viruses were safe and fairly well tolerated.
  3. Many clinical trials involved oncogenic viruses with GM-CSF recombinant genes. This gene makes the oncolytic virus produce the GM-CSF protein, which stimulates dendritic cells. The end result is that the immune system produces more killer T cells that attack cancer cells, which results in higher cure rates.

More problems with oncolytic viruses

  1. There are still many questions about how oncolytic viruses stimulate the immune system. More basic research is necessary in this field. Despite 20 years of research the cure rate of 3.4% and achieving partial control and stable disease in another 17.7% is not acceptable. Perhaps combinations with other cancer treatment methods may improve the cancer cure rates. The reviewers suggested one such combination, namely immune checkpoint blockade with oncolytic virus therapy.
  2. There is no resolution about which route of administering oncolytic viruses is best. Intratumor application in melanoma cases seems the be optimal. But other solid tumors are difficult to reach. In these cases, intravenous applications were a choice. In this case oncolytic viruses experience dilution in the blood and do not have a high enough concentration when they arrive at the cancer.
Review about Human Oncolytic Virus Research in 2020

Review about Human Oncolytic Virus Research in 2020

Conclusion

In a review researchers discussed the use of oncolytic viruses in cancer therapy over 20 years . Oncolytic viruses are derivatives mostly from adenoviruses, herpes simplex virus (HSV-1), reovirus, poxvirus, Newcastle disease virus (NDV) and the measles virus. In various clinical trials researchers found that disease control was achieve in only 21.1% of treated cases. There was a cure rate of 3.4%, but another 17.7% had partial control of the cancer or stable disease. But 78.9% of treated patients showed no response to treatment with oncolytic viruses. Obviously more research is necessary to improve the cure rates in cancer patients treated with oncolytic viruses. Clinical trials with combinations of immune checkpoint blockade and oncolytic virus therapy would also be helpful. All in all, oncolytic therapy is at this point not yet an effective form of treatment for cancer.

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Nov
07
2020

Removal of Senescent Cells Can Extend Life

Several animal and human studies by the Mayo Clinic showed that removal of senescent cells can extend life. Researchers Xu et al. showed in 2018 that senescent cells weaken the body. Senescent cells are damaged cells that are still living. They can cause the release of inflammatory cytokines. The researchers showed in mouse experiments that intermittent senolytics increased life expectancy by 36%. Senolytics are drugs that dissolve senescent cells; the senolytic cocktail consisted of dasatinib plus quercetin.

In these mouse experiments their risk of dying was reduced by 65% compared to control mice that did not take senolytics.

Senescent cells causing premature aging

In the past 5 years research on aging and on chronic diseases made a lot of progress. Researchers realized that the accumulation of senescent cells is what causes both. All this happens because the process of apoptosis, the removal of dead cells, is impaired in the aging person. It appears that in older age there is a problem with dying cells and their removal. Instead they linger on and start producing cytokines, which cause inflammation. This can damage other cells and lead to organ failures. All this explains why older people often get chronic diseases and do not reach their normal lifespan. The accumulation of senescent cells also blocks regenerative factors that improve one’s health.

Senolytics

Dasatinib is a kinase inhibitor that was developed to treat acute myelogenous leukemia in adults and children. Researchers did animal experiments with a combination of dasatinib and quercetin for several years. They also have started smaller pilot clinical trials in humans. It appears that the human findings are very similar to the animal findings. But more research is needed to answer questions about side-effects and effects of removal of senescent cells.

Details about animal experiments with senolytics

The Mayo Clinic research showed that old mice treated with senolytics (dasatinib and quercetin) live 36% longer than controls that did not receive senolytics. Another part of this series of experiments showed that senescent cells are indeed what kills prematurely. They took senescent cells from old mice and transplanted them into young mice. Soon the young animals showed deterioration health wise and they died prematurely. Another control group were older mice that received senescent cells from old mice. They too died prematurely. Treatment with senolytics (dasatinib and quercetin) improved physical functioning and also survival.

Details about human trials regarding senolytics

For three days 11 participants received senolytics (dasatinib and quercetin). The effect of the drugs was evident for 11 days. The subjects took 100 mg of dasatinib daily and 500 mg of quercetin twice per day for 3 consecutive days. This dose was repeated twice more on a weekly basis for a total of 3 weeks. These patients had idiopathic pulmonary fibrosis. This is an incurable disease where senescent cells accumulate. These patients showed significantly improved gait speed, walking endurance, chair rise test performance and scores of other physical performances. All this occurred on day 5 after the initial dose of senolytics.

Alternative senolytics, so removal of senescent cells can extend life

Dasatinib as a senolytic has significant side effects.

For this reason, researchers looked for alternatives. Theaflavins, isolated from black tea fits this bill. It is non-toxic, but it is also effective as a senolytic. Researchers from Life Extension have developed a senolytic product containing theaflavins and quercetin. Instead of regular quercetin they included quercetin phytosome, which has 50-times more potent bioavailability. One capsule contains 74 mg of quercetin phytosome (the equivalent of 1250 mg of regular quercetin) and 275 mg of theaflavins.

Discussion

Future research needs to show whether or not the Life Extension senolytic indeed does what it promises. It claims that only one capsule per week stimulates apoptosis, reduces cytokines and increases longevity. I would like to see a clinical study that examines all these parameters. One measure of longevity is to determine the length of leukocyte telomeres. All the other laboratory tests are readily available. Research in this field will certainly continue and scientists will likely develop other senolytics.

Removal of Senescent Cells Can Extend Life

Removal of Senescent Cells Can Extend Life

Conclusion

The accumulation of senescent cells causes both aging and chronic diseases. Research showed that in older age the process of apoptosis, the removal of dying cells, is incomplete. As a result dying cells accumulate. They produce inflammatory cytokines, can damage other healthy cells and lead to chronic organ failure. In addition, cancer cells can develop and the patients can die prematurely. Senolytics are substances that clear out senescent cells. In mouse experiments they have already led to improved survival and health. Clinicians performed a clinical trial on patients with idiopathic pulmonary fibrosis, which is an incurable disease where senescent cells accumulate. They showed significantly improved gait speed, walking endurance, chair rise test performance and scores of other physical performances. One pill once per week with dasatinib and quercetin can achieve this. More research in this area can clarify why senolytics work and what the side effects are.

Oct
10
2020

Medical Myths about Aging

Medical myths about aging are easy to debunk. Many people believe that it is inevitable that they become disabled as they age, their lives become unbearable, without passion, boring and full of pain. Some aspects of your health may decline with age, none of the myths discussed below is inevitably happening in everyone. Studies showed that a positive outlook on aging and life in general will help you to live longer and stay healthier.  Here I discuss 7 common myths about aging.

Myth 1: Everyone will experience physical deterioration

It is common for people to experience reduced muscle strength, increased blood pressure, excessive fat accumulation and osteoporosis. A study with 148 older patients showed that an expectation of reduced fitness in older age actually resulted in less physical activity when older age arrived.

But you can maintain good cardiovascular function and good muscle strength with a regular exercise program.  This study showed that men and women can reduce mortality by exercising regularly, even in older age.

Myth 2: Older adults cannot exercise

There are several reasons why older people stop exercising or are afraid to start exercising. People use the excuse of their arthritis getting worse from exercise. But studies showed the opposite: joint function improves and joint pains are getting better with exercise. Your muscles get stronger and you are less likely to fall. Your heart and lungs are improving their functions and your mentation improves. Exercise increases the HDL cholesterol, which reduces the risk for heart attacks and strokes.

Myth 3: As we age, we need less sleep

For many years there was the notion that older people need less sleep. What was not known then was that people above the age of 60 have no appreciable secretion of melatonin from the pineal gland. But when they replace their melatonin deficiency by taking a nighttime dose of 3 mg at bedtime, they will sleep better and longer. They may need a second dose of melatonin in the middle of the night. We need 7 to 8 hours of sleep at night for our diurnal hormone rhythm.

This will also slow down our aging clock.

Myth 4: Your brain slows as you age

Dementia is common when you get older. 13.9% have it at age 71 and older. 37.4% have dementia over the age of 90. But the majority, namely 86.1% in the 71+ age group and 62.6% above the age of 90 do not have dementia. A Mayo Clinic study showed that when the person engaged in artistic activities in midlife or later in life the risk for mild cognitive impairment (MCI) development was reduced by 73%, involvement in crafts reduced it by 45% and engagement in social activities by 55%. In a surprise finding the use of a computer late in life was associated with a 53% reduction in MCI development. These are very significant observations.

Physical activity reduces risk for dementia

Apart from stimulating your brain, physical activities also significantly reduce the risk for dementia. A synopsis of 11 such studies showed that dementia is reduced by 30% when physical activity is started in midlife and the person is aging compared to non-exercisers.

Myth 5: Osteoporosis occurs only in women

There is a serious misunderstanding about osteoporosis. Several factors work together that can cause osteoporosis. Women in menopause are more likely to develop it due to the missing ovarian hormones estrogen and progesterone. These hormones work together and stimulate vitamin D induced calcium deposition into bone as well as decreasing bone resorption.

Vitamin K2 also deposits calcium into the bone. In postmenopausal women who take bioidentical hormone replacement, vitamin D and K2 the bone density remains strong. Unfortunately, the opposite is true in postmenopausal women who take synthetic hormones. Synthetic hormones have side chains that do not fit the natural hormone receptors of a woman. This is why osteoporosis persist. And, yes, men get osteoporosis, but typically 10 years later. Typically, they get into andropause where testosterone production declines 10 years later.

Myth 6: People stop sex as they age

With age men can develop erectile dysfunction (ED) and women vaginal dryness, both of which can interfere with having sex. A large study showed that only 0.4% of men in the age group 18-29 had ED. In the age group of 60-69 there were 11.5% who suffered from ED. What this means though is that 88.5% of men age 60-69 did not suffer from ED. Fortunately for those who have ED drugs like Cialis and Viagra can correct their problem and they can have regular sex. What a change from 25 years ago when none of these drugs were available (approval of Viagra by FDA in 1998 and of Cialis in 2003).

Bioidentical hormone replacement beyond menopause and andropause preserves your normal sex drive as well. There are additional benefits of bioidentical hormones. They have positive effects on the heart, brain, bones and the muscle mass.

Myth 7: It is too late to stop smoking now

One of the myths that many older smokers like to say is that it would be too late to stop smoking. They think the damage to heart and lungs is permanent and quitting now is too late. Fact is that quitting smoking immediately improves your blood circulation and gives you more oxygen. In just 1 year the risk of getting a heart attack is cut into half. In 10 years, the risk of a heart attack or stroke is the same as that of non-smokers. There is a reduction of getting lung cancer by half.

Medical Myths About Aging

Medical Myths about Aging

Conclusion

There are all kinds of medical myths about aging. We may think that physical deterioration is inevitable. Or we believe that older people cannot exercise. And we cannot help it, but our brain slows down as we get older. And there is the question whether we need less sleep as we age. Osteoporosis is a disease of women, is it not? These older couples, they don’t have sex any more, do they? And is it too late to stop smoking now that I am 65 years old? All of these myths exist, but there is a need to debunk them.

The truth behind the medical myths about aging

I explained in detail what the medical truths are behind these questions. Many of these myths have developed in the past. But with regular exercise, balanced nutrition (Mediterranean diet) and a positive attitude much of these old myths can be overcome. Bioidentical hormone replacement when hormones are missing is another powerful tool. Yes, we all age. But we are still living and can enjoy life as long as it lasts.

Sep
05
2020

How to Manage Clot Formation with Covid-19

A publication in the Canadian Medical Association Journal describes how to manage clot formation with Covid-19. A significant amount of cases among Covid-19 patients come down with clotting problems. This means that an infection with SARS-CoV-2 (or Covid-19 coronavirus) may initially present with a fever and cough. But a few days later it can suddenly turn into a dangerous disease with severe clots, multiple organ failures and death.

Clot occurrence with Covid-19

It is important to realize that most patients with SARS-CoV-2 do not need hospitalization. But physicians admit 10 to 15% of patients to the hospital. Of these 20% end up with treatment in the Intensive Care Unit (ICU). Of all the hospitalized patients between 5% and 30% develop some form of thrombotic event. Notably, complications of clot formation can be a stroke, a heart attack, a pulmonary embolism or a deep vein thrombosis in the leg. In a recent study from the US 400 random hospitalized patients with Covid-19 144 patients were admitted to the ICU. 4.8% had radiologically confirmed deep vein thrombosis. Overall there were 9.5% with thrombotic events that developed during the hospital stay.

How does a coagulopathy develop with Covid-19?

Truly, SARS-CoV-2 enters the body cells through an interaction of its viral spike protein with the angiotensin-converting enzyme 2 (ACE2) receptor. To explain, numerous organs and tissues express this receptor. This includes lung alveolar type 2 epithelial cells, endothelium, the brain, heart and kidneys. To emphasize, ACE2 leads to angiotensin II degradation. With the SARS-CoV-2 stimulation of the ACE2 receptor there may be an accumulation of angiotensin II, which causes a procoagulant state. Injury of the endothelium explains inflammation in the lining of the blood vessels in multiple organs. Commonly affected organs are lungs, heart, kidneys and intestines. The inflammatory reaction is what can lead to clot formation. When part of an organ has died off because of mini clots that destroyed part of the organ, this process can eventually lead to organ failure. Lung failure, heart failure and kidney failure can develop in these sick patients.

Adequate vitamin D blood levels are important for the immune system

By all means, vitamin D is very important for the integrity of the immune system. With vitamin D blood levels below 15 to 20 ng/mL (37.5–50 nmol/L) the immune system is paralyzed, and any viral or bacterial infection tends to overwhelm the body. Of course, this is the reason why the mortality due to Covid-19 coronavirus is highest in patients with these low vitamin D blood levels. People with secondary illnesses (diabetes, arthritis, autoimmune diseases, cancer) and patients above the age of 60 have the lowest vitamin D blood levels and have the highest mortality rates. This publication describes this in more detail.

Best vitamin D blood level is in the upper normal range (50-80 ng/mL)

Above a vitamin D blood level of 30 ng/mL (=75 nmol/L) a patient’s immune system is functioning normally. However, the immune system is strongest at a vitamin D blood level of 50–80 ng/mL (125–200 nmol/L), which is the upper range of the normal level for vitamin D in the blood.

Keep in mind that vitamin D toxicity occurs only above 150 ng/mL (375 nmol/L).

Specific effects of vitamin D on Covid-19

There are three major effects that vitamin D has.

  1. A strengthening of the epithelial barrier not allowing the coronavirus to penetrate into the lung tissue as easily.
  2. Release of defensins and cathelicidin, two crucial antiviral polypeptides that eradicate any virus in the system.
  3. Interruption of the “cytokine storm”, an overwhelming inflammation which is responsible for viral pneumonia to develop. Without the cytokine storm there is no damage to the lungs and people do not need treatment in the ICU. This is particularly important for people above the age of 60 and for people with pre-existing diseases.

In like manner, with the stabilizing effect of vitamin D regarding the immune function more severe forms of Covid-19 can turn into less severe forms with a better outcome.

Treatment of patients with Covid-19 who have clotting problems

Patients need to be assessed with respect to their risk of developing clots. This publication describes that high risk patients have elevated D-dimer levels. When blood clots dissolve the body produces D-dimer, a protein fragment. Normally the D-dimer test is negative in a person that does not produce clots. But in sick patients with Covid-19 who form clots this blood test typically shows D-dimer >2500 ng/mL. In addition the tests show high platelet counts (more than 450 × 109/L), C-reactive protein (CRP) >100 mg/L and an erythrocyte sedimentation rate (ESR) >40 mm/h.

Indeed, with this constellation of blood tests in a severe Covid-19 case in the ICU setting, the physician uses heparin intravenously or subcutaneously to counter clot formation. However, this needs to be balanced against the risk of causing severe internal bleeding.

Separate from the anticoagulant effect, heparin seems to also suppress inflammatory cytokine levels. In addition, heparin suppresses neutrophil chemotaxis and migration. Physicians rescued many patients from death using heparin therapy.

Risk versus benefit clinical trials of heparin therapy are required

At this point there are only retrospective clinical trials available to describe risk versus benefit of heparin therapy. Some show no difference, others do. There are two international clinical trials on their way to shed more light on this situation. Until the results of these clinical trials are available, physicians need to treat patients to the best of their knowledge.

How to Manage Clot Formation with Covid-19

How to Manage Clot Formation with Covid-19

Conclusion

Clot formation in sick Covid-19 patients is responsible for many deaths in Covid-19 patients. The SARS-CoV-2 (or Covid-19 coronavirus) causes a cytokine storm with injury to the lining of the arteries. This can affect multiple vital organs and the condition may lead to organ failure. This activates the clotting system and causes clots all over the body. When this process occurs, patients get very sick and the death rate climbs. Physicians were able to rescue some patients with heparin therapy. Two international clinical trials are on the way. Hopefully  these trials answer questions about this newer treatment method. The downside of heparin therapy is the complication of massive bleeding, which causes deaths as well. When it comes to Covid-19, don’t rely on curative medicine. Strengthen your immune system by preventative therapy like vitamin D3 that can interrupt the cytokine storm.

And even with a “well-prepared” immune system it is extremely important to follow all the guidelines of distancing, disinfecting and wearing face masks. We need all the help we can get!