A Fresh Look at Vitamins
(Written by Dr. Gina Serraiocco as a Guest Post for PAFMG's weekly blog written by physicians for physicians.)
Let's face it. Doctors aren’t trained to read vitamin bottles, nor are they trained in what to do with them. So it makes sense when almost-front-page-news like "Vitamin D... Melatonin... reduces COVID-19 by 50%" we shrug with curiosity, cite lack of evidence, and then turn the page and move on.
So when a patient asks about a supplement, which do you do?
A. "That's expensive urine."
B. "There's no data, I don't recommend it."
C. Check PubMed. Or the Natural Supplements Database. Or refer to a knowledgeable practitioner.
Up until 5 years ago, I usually did A or B. I had an ingrained bias against supplements dating back to medical school. And then my life took a turn (too long to go into here) and I found myself in an Integrative Medicine Fellowship and also studying something called Functional Medicine.
Functional Medicine is the study of the “macro” (lifestyle, nutrition/supplements, environment/toxins, biography/trauma, mindset/spirituality) and its effect on the “micro” (genetic expression, mitochondrial health, cellular resilience, gut microbiome, etc), to engage in a root-cause approach, to tailor personalized treatment regimens, combining modern and ancient therapies in the pursuit of mind-body-spirit vitality and wellness. That is my own summary of the field, but it resonates with me deeply.
In other words, it has taken me 5 years of extra training to competently read a multivitamin bottle.
They don’t teach us this stuff in medical school. I mean, did you know that there are four forms of Vitamin B12, and that the most commercially available form – cyanocobalamin -- cannot be optimally converted into the active forms, methylcobalamin and adenosylcobalamin, by 40% of the population due to genetic variants (such as MTHFR and FUT2)? That’s a problem for some folks! But I digress.
I’m aware that there’s very little oversight of the supplement industry. However, there are multiple third party companies [USP (U.S. Pharmacopeial Convention), NSF International, Labdoor.com, ConsumerLab.com] that step in to conduct testing on supplements for safety (no heavy metals/contaminants), quality and value. Supplement adverse events, like those of drugs, are to be reported to the FDA. However, a review of the FDA Adverse Event Reporting System Public Dashboard (through 2020) shows a total of 1,670,783 drug reports, of which dietary supplements account for only 119.
So here’s how I view vitamins & supplements in the modern day (with a focus on the pandemic):
They are essential for cellular functions, but deficiency is rampant.
Ex: As important as air, food, and water, we need sunlight. But with our Silicon Valley work hours, 75% of us are not getting enough sunlight for adequate Vitamin D production. In the NorCal winter, it would require 1 hour of noonday skin exposure to sunlight, to generate 1000IU of Vitamin D. Brrrr. Additionally, SPF15 blocks 99% of Vitamin D production in the skin. Thus, Vitamin D supplementation is needed. A 2014 Cochrane Review states that Vitamin D decreases mortality overall, and a 2017 BMJ systematic review of Vitamin D supplementation shows that it is safe and decreases colds. And that was before all of the pandemic data! No, Vitamin D won’t save the whole world from COVID-19, but the available (limited) data suggests that it just MIGHT shift the mortality curve if given preventively and/or in high doses right at the onset of Covid-19 infection - more on that below.
https://pubmed.ncbi.nlm.nih.gov/24414552
https://www.bmj.com/content/356/bmj.i6583
2. Our modern lifestyles interfere with normal bodily production of certain essential compounds.
Ex: The use of electronics (blue light) halts the pineal production of melatonin past sun-down. Staying up late does the same. Melatonin, aside from being a sleep-inducer, is a powerful anti-inflammatory and immunomodulator. In fact, it beneficially dampens the NLRP3 inflammasome & NFkB transcription factor explosively activated by SARS-CoV-2 in a “cytokine storm.”
https://www.hindawi.com/journals/ije/2017/1835195
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405774
Furthermore, it’s an anti-oxidant and boosts NK/B/T-cells of the immune system. It’s not surprising then, that melatonin has been shown to reduce COVID-19+ tests by 28% (overall) and 52% in African Americans in a Cleveland Clinic study. Yes, you read that correctly. So why aren’t we all recommending it STAT, when there are zero cases of melatonin toxicity reported in history, and when it costs pennies per day? The worst thing that can happen is vivid dreaming, in which case you lower the dose. Additionally, melatonin has been shown to reduce death in mice against 6 other deadly viruses. There is precedence for its antiviral effectiveness.
3. Some nutrient deficiencies are iatrogenic, directly caused by our modern day drugs. Our own prescriptions are proven to cause depletion in our patients, but again, we’re not informed about many of them, and when we are, we’re not taught the nuances of repleting them. Birth control pills, statins, biguanides, diuretics and PPIs are the worst offenders.
https://www.health.harvard.edu/staying-healthy/are-your-medications-causing-nutrient-deficiency
https://naturalmedicines.therapeuticresearch.com/tools/charts/drug-induced-nutrient-depletions.aspx
4. Our liver requires nutrients to help us eliminate some of the 80,000 toxins that are approved for use in the US, and that we’re exposed to every day. Remember Phase 1 (Cytochrome P450) and Phase 2 (conjugation) liver detoxification from medical school? More toxin exposure = more nutrients required for bodily elimination. Toxin burden in the body is dependent on genetics, exposure, and nutrients. Most Americans are not eating the requisite 4-6 servings of daily vegetables to get the nutrients required for Phase 1&2 liver detoxification… are you? See IFM link below for a refresher.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4488002
So, back to the pandemic, given what we know, is it possible that we could still shift the COVID-19 death curve by even a few percent, using very cheap, safe & effective supplements? In an ideal world, all our decisions would be made based on copious scientific evidence and perfect trials, but our time of crisis may call for a slightly different set of rules.
In fact, the Hippocratic Oath permits this of us: “I will use those dietary regimens which will benefit my patients according to my greatest ability and judgment.” Here and now we are being asked to use our best judgment with the information at hand.
I humbly offer the below (videos by yours truly) for those who are interested in an Integrative approach to empower our patients until they are adequately vaccinated.
How to Treat COVID-19 At Home: an Integrative Perspective
(December 2020) 12 min
Best evidence-based supplements in cold/flu/COVID-19 season
(October 2020 Sutter webinar focused on preventive supplements; much more data has since been released in support of my initial recommendations) 1 hour
Optimizing Your Immune System Against COVID-19
(May 2020 Sutter webinar focused on nutrition and lifestyle) 52 min
Interestingly, much of what I have recommended from the beginning is also on the Eastern Virginia Medical School COVID-19 Protocol (for outpatients and inpatients):
So with the caveat that we’re in an unprecedented pandemic and there is always the desire for more data, this is my “Top 3” (in case you don’t have time for the links above) and how I’ve chosen to counsel friends & family. This is not meant to be an exhaustive display of rationale and research, rather an invitation for consideration:
Vitamin D:
a. Prevention: Vitamin D levels should be tested with a goal level of over 30 ng/mL. If unsure, 1000IU (25mcg) Vitamin D with a meal is safe for pretty much everyone (except in sarcoidosis and renal failure), and most patients need more. Magnesium is required for Vitamin D activation, and it also helps to decrease the risk of renal stones. I recommend 200mg Magnesium Citrate with Vitamin D, as 75% of the US have suboptimal Magnesium intake.
https://pubmed.ncbi.nlm.nih.gov/33146028
https://jaoa.org/article.aspx?articleid=2673882
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5137227
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5609393
b. Treatment: Vitamin D boost 10,000IU (250mcg) x5 days, at the FIRST SIGN of symptoms (do not wait for positive test). No chance of overdose or harm at this dose for 5 days. Real chance of decreasing mortality, esp. in elderly.
https://pubmed.ncbi.nlm.nih.gov/33039952
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194
https://www.sciencedirect.com/science/article/pii/S096007602030296X
https://www.youtube.com/watch?v=ha2mLz-Xdpg
2. Melatonin:
a. Prevention: Melatonin 0.3-3mg at bedtime.
https://pubmed.ncbi.nlm.nih.gov/33156843
b. Treatment: Melatonin 10mg at bedtime. Reduce dose if vivid dreams occur. Zero chance of toxicity.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7709121
3. Zinc:
a. Prevention: Zinc 15mg per day (often found in multivitamin)
b. Treatment: Zinc 75mg daily at the FIRST SIGN of symptoms (do not wait for positive test). Not to exceed 2 weeks at this dose.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001364.pub4/full
https://www.ijidonline.com/article/S1201-9712(20)30730-X/fulltext
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7580816
No, supplements are not going to be the miracle cure for COVID-19, but they just might help our patients’ innate immune systems function at their best. Given their relative safety and economy, they should be welcomed as an adjunct to pharmaceutical support. In any case, Melatonin and Zinc have both been shown to increase vaccine response in the elderly as well!
And yet, for the ever reluctant, even if the standard “30% placebo effect” took place, wouldn’t that still be a relief in this global pandemic? Heck, yes!
Humbly,
Gina Serraiocco MD
Board Certified Internal Medicine
Board Certified Integrative Medicine
Written by Gina Serraiocco MD, Sutter PAMF Physician, board-certified in Internal Medicine and Integrative Medicine. She has a lifelong passion for helping patients discover their innate healing abilities. Dr. Serraiocco empowers patients to gain vibrant health via personalized nutrition paradigms and lifestyle-based programs through the Integrative Medicine Department at Sutter PAMF.