We are in the dark days of a novel pandemic where any glimmer of preventive hope on the horizon is appreciated in this battle. Research has recently sounded the horns of prevention in terms of taking vitamin D to fortify the body’s immune system against the influenza and the novel coronavirus. According to the most recent public health outcry, the most at risk population should be fortifying themselves with 10,000 IU of vitamin D daily in the weeks before winter and then stabilize intake at 5,000 IU per day to maintain blood levels of 40-50 ng/ml.

What Role Does Vitamin D Play in Reducing COVID 19 Risk
Vitamin D acts by 3 mechanisms – maintaining a physical barrier, increasing cellular natural immunity, and increasing adaptive immunity. For example, Vitamin D helps maintain tight gap junctions between cells. Several articles have suggested how viruses disturb junction integrity, increasing infection by the viruses and other microorganisms who can squeeze through the leaky membranes. This is a physical barrier function.

Innate immunity is enhanced through the induction of antimicrobial peptides which exhibit direct antiviral and antimicrobial activities against a spectrum of microbes including enveloped and nonenveloped viruses, fungi and bacteria. These peptides kill the invading pathogens by invading their cell membrane and neutralizing necessary biological activities.

Cellular immunity is enhanced in part by reducing the cytokine storm induced by the innate immune system. The innate immune system generates both pro-inflammatory and anti-inflammatory cytokines in response to viral infections. Vitamin D can reduce the production of pro-inflammatory cytokines while increasing the expressing of anti-inflammatory cytokines.

Vitamin D supplementation also enhances the expression of genes related to antioxidation relative to increased glutathione production. Increased glutathione production spares the use of vitamin C which has antimicrobial and antioxidant capabilities. Glutathione is a peptide molecule that functions as an antioxidant.

What is the Optimal Blood Level for Vitamin D in Prevention of COVID-19? Research shows that 38 ng/L was sufficient for reducing community acquired pneumonia although the degree of protection rose as blood level increased with the optimal range being 40-60 ng/ml.

High doses of vitamin D seem to be well tolerated with doses of 60,000 IU/d found in the literature to treat asthma, rheumatoid arthritis, rickets, and tuberculosis in the 1930’s and 40’s. High doses of vitamin D over prolonged periods can damage the kidneys, however, there is no evidence that 20-50 mcg/day cause any harm (800-2000 IU). The tolerable upper limit for vitamin D is 4,000 IU/day.

Obviously, the research on COVID is challenging the tolerable upper limit in its recommendations suggesting that supplementation in the given range could improve outcome of the clinical COVID 19 condition. We have to remember that this is for short periods of time, however, such as the time period before winter and in persons who have low vitamin D and need repletion as well as high risk persons. The rate of deficiency in the US is about 41% for Caucasians and 82.1% for black Americans.

Improvement of Clinical Outcomes of COVID-19 with Supplementation.
 Recent research results have shown that having a mild clinical outcome rather than a critical outcome were increased approximately 19.61 times with a high vitamin D level.  Vitamin D status was found to be significantly associated with clinical outcomes. Of 212 cases of COVID 19, 23.1 % were identified as mild, 27.8 % were ordinary and 26.4 % were severe and 22. % were critical. Mean serum vitamin D level was 23.8 ng/ml with < 20 being determined as deficient. Using multinomial logistic regression, a distinct relationship was found between the level of vitamin D and the severity of clinical outcomes for each clinical risk category vs. vitamin D level.

Public Health Call to Action
Research is showing that vitamin D deficiency is common and may contribute to increased risk of respiratory infection, particularly COVID-19. It is advised that all older adults, hospital inpatients, nursing home residents and other vulnerable groups such as those with darker skins and vegetarians , those who are overweight or obese, smokers and healthcare workers be urgently supplemented with 800-2000 IU of vitamin D to enhance their resistance to COVID 19 and that this advice be quickly extended to the general adult population.

Conclusion
​While there is a slight discrepancy between the amounts of vitamin D being recommended, the fact that supplementation is being recommended should not be taken lightly. Every nursing home resident should have it in their care plan to increase vitamin D intake to 2,000-10,000 IU per day depending on their blood levels. Deficient individuals may need to supplement with 10,000 IU 5 days per week for 6 weeks and then drop down to 5,000 IU per day until blood levels reach 50-60 ng/ml and then continue with 800- 2,000 IU/day.  Others who have higher blood levels of vitamin D may only need 2000 IU per day. The best thing to do is get your blood level for vitamin D measured and then consult with your health care provider for repletion.
 
These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.
Berberine is a chemical found in several plants including the European barberry, goldenseal, goldthread, Oregon grape, philodendron, and tree turmeric and belongs to a class of compounds called alkaloids. It is said to have powerful effects similar to that of a pharmacological nature and has been used for centuries in Chinese medicine. It is just now coming of age in modern nutritional medicine in the treatment of diseases such as diabetes.

How Does Berberine Work? Berberine is known to stimulate insulin secretion and to activate AMPK, an enzyme known to regulate cellular energy metabolism. Its primary actions are to:

• Decrease insulin resistance, making the blood sugar-lowering hormone insulin more effective.
• Increase glycolysis helping the body break down sugars inside cells.
•  Decrease in sugar production in the liver.
• Slow the breakdown of carbohydrates in the gut.
• Increase the number of beneficial bacteria in the gut without systemic activity by promoting the growth of good bacteria in the gut and halting the growth of bad bacteria.·       ·         

Activation of AMPK by pharmacological agents is known to reduce the metabolic effects of diabetes, an action also simulated by berberine.

Effectiveness of Berberine in Diabetic Patients: Berberine has been found to act in a similar manner as the commonly used diabetes drug Metformin. It is not clear whether metformin and berberine undertake all actions via the same mechanisms, or some via similar and other different mechanisms. While the severe adverse gastrointestinal side-effects that interfere with metformin compliance are generally absent in berberine treatment, treatment with both berberine and metformin (or other oral hypoglycemics) has been found to be superior in controlling glucose than either treatment alone.

Dosage and treatment duration may vary with the patient’s age. Data suggests that berberine therapy becomes unremarkable in treatments lasting more than 90 days or in amounts greater than 2 grams. Further clinical studies of longer duration are needed in this area. The most effective dose is 500 mg three times a day.

Because most anti-diabetic drugs cannot be used in patients with hepatic dysfunction, renal disease, and heart disease, this makes pharmacological therapy of type 2 diabetes complicated and the use of other nutraceuticals such as berberine more desirable.

Current studies have reported the significance of berberine against oxidative stress and inflammation in cells, elaborating its vital role in diabetes mellitus. Generally, a decrease in blood glucose level by 20–40% is reported in fasting patients treated with berberine alone, this effect resembles that of rosiglitazone and metformin treatment.

Application:  Preliminary research from both animal and human studies indicate that berberine therapy in dosages of 500 mg three times per day may be an advantageous treatment for diabetes type 2 either alone or in conjunction with other hypoglycemics for optimal blood sugar control with minimal adverse side-effects.

The mechanisms of action of berberine mirror those of the common anti-diabetic drug metformin without the severe diarrhea side-effects that adversely affect medication compliance.

Further long-term studies are needed on human subjects to identify exact mechanisms of action and duration of treatment best utilized for long term blood sugar control of diabetes.
 
 
 
​These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

​Many of us brush off common aches and pains treating them with ibuprofen and hoping the bothersome things will go away, but such practices are becoming costlier not only financially, but health-wise as well. It is not uncommon to hear stories of someone with diabetes putting off care for an infected toe because of lack of insurance and several weeks down the road the toe needs to be amputated.

Culinary medicine does not have a single philosophy as it is not dietetics or functional medicine, nor is it culinary arts or food science. It is, rather, a new evidence-based field in medicine that blends the art of food and cooking with the science of medicine. Culinary medicine is all about making evidence based decisions about the food we choose to eat and how we eat it so that we can prevent and treat disease while restoring optimal well-being.

As food is condition specific, the theory goes, different clinical conditions require different foods, beverages and manners of cooking as well as types of herbs used in seasoning such foods. Although special attention is paid to using the foods that the patient regularly eats or drinks, modifications are by nature necessary but designed to empower the patient to care for herself or himself safely, effectively, and happily with food and beverage as a primary care technique.

Special attention is paid to how food works in the body and how such foods can be made pleasurable to the patient so that cooking and eating are both a healthy and enjoyable experience.
According to one study, culinary medicine started trending in response to five factors:

• Flourishing interest in dining out and fast foods as well as at the same time conflicting information about which foods were good for you, especially with regards to weight control
• Widespread unrest and frustrations with conventional medicine with a rising interest in integrative and functional medicine.
• An overwhelming abundance of packaged and processed foods along with the knowledge that such foods were not good for the body or for the chronic disease the patient was dealing with
• The rising cost of health care forcing many to choose between buying food or buying prescription medication.
• A revived enthusiasm for organic gardening, farmer’s markets, home gardening and local agriculture.

Some eating patterns have been found to be more effective than medications. We have the ketogenic diet for epilepsy and Alzheimer’s; the anti-inflammatory diet for rheumatoid arthritis; the Mediterrean diet for heart disease and type 2 diabetes; the consistent carbohydrate diet for diabetes and, last, but not least, the DASH diet for hypertension. This list is by no means, inclusive. This is where the art of Clinical Nutrition comes in or the application of special dietary patterns to chronic disease and illnesses also known as Medical Nutrition Therapy.

Preliminary research regarding culinary medicine is encouraging. A longitudinal study among 627 medical students showed hands-on cooking and nutrition education vs. traditional education improved diet, attitudes, and competencies. Results from a small randomized controlled trial of patients with type 2 diabetes showed improvement in HbA1c, blood pressure, and cholesterol after following a Mediterranean diet cooking and nutrition curriculum provided by a medical school-based teaching kitchen.
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Culinary medicine is an evidence based approach to food and lifestyle intervention. It encourages us to think of food as medicine, nutrition with cooking and necessity with creativity. The growing body of research supports the idea of food as medicine as more and more programs make successful groundbreaking efforts at making food a critical part of patients’ medical care. Some doctor’s in communities are writing prescriptions for fresh vegetables and produce and vendors respond to the prescriptions with discounts on their products. Culinary medicine can be a beautiful community health initiative that the entire family can be involved in at all stages of the wellness/disease spectrum.

Thyroid supplements are generally taken by those who think they have sluggish thyroids, they are gaining weight for no reason or they have self-diagnosed themselves with hypothyroidism. The supplement market is eager to meet the needs of desperate consumers armed with only a handful of internet articles and a plethora of misinformation.

Here we will discuss the most common thyroid supplements and what they are designed to do and why a patient should not take these supplements without a doctor’s recommendation or upon a dietitian's recommendation.

Iodine is needed for the production of the thyroid hormone. Before the 1920’s iodine deficiency was a common problem, especially in the so-called “goiter” states where soil was especially depleted. However, the U.S. implemented a salt fortification program adding iodine to salt and thus forming iodized salt. Iodine deficiency dropped. Today, iodine deficiency in the United States is not the primary cause of hypothyroidism, but rather an autoimmune condition called Hashimoto’s is the cause of 80% of the nearly 20 million Americans who currently are hypothyroid.
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In Hashimoto’s Disease (HD), iodine is often avoided. So, if someone with Hashimotos hypothyroidism supplements with iodine, the situation could be made worse as it may accelerate thyroid cell destruction. Research has shown that high doses of iodine can trigger Hashimoto’s in people who are genetically predisposed to Hashimoto’s and may perhaps have certain “vulnerabilities” like a selenium deficiency.

Selenium protects the thyroid from oxidative damage and without selenium a high iodine intake can destroy the thyroid. Iodine and selenium need to be in balance and selenium is the next most important hormone for thyroid health aside from iodine.
Taking selenium just because one thinks their thyroid is “sluggish” may not help the problem, but cover up a more serious one that need pharmacological and/or surgical intervention. Oftentimes we see patients struggle with self-perceived thyroid problems by supplementing with nutrients the thyroid needs, but giving selenium may hide an undiagnosed tumor, goiter or the synergy of nutrients needed to get the thyroid healed if it is truly sick. Both excessively high and excessively low selenium levels have proven damaging to the thyroid gland.

L-Tyrosine Most people have enough L-tyrosine in your body but occasionally a supplement is recommended if you have hypothyroidism. Be careful not to supplement on your own as too high of an L-tyrosine level can aggravate high blood pressure, manic symptoms and may interact with other medications.

Coleus Forskohlii This herb enhances the uptake of iodine into the cells and promotes the production of T3 and T4. Again the problem with this herb is the same as with supplementation with iodine.

Ashwagandha As a member of the nightshade family, those individuals with autoimmune conditions are to avoid products from this family. Grave’s Disease and Hashimoto’s Disease are both diseases of the autoimmune system and as such call for avoidance of this otherwise very beneficial herb.
Supplements should only be taken after consultation with a health professional. Seemingly wonderful products can be harmful if taken for the wrong reason or the wrong condition.
 
 Not all supplements are safe. Supplements should be recommended by a Registered Dietitian after a complete medical nutritional assessment is done.