NIFS Healthy Living Blog

Healthcare providers and scientists are all working diligently to find ways to prevent, treat, and cure COVID-19. Many of us are eager for answers and probably getting tired of not knowing what to believe. One of the hot topics floating around is about Vitamin D’s role in preventing COVID-19. Can Vitamin D really protect us against COVID-19 or at least lessen the effects? Let’s take a look.

The Role of Vitamin D

Vitamin D serves many purposes in the body, the most commonly known purpose being assisting calcium absorption and bone mineralization for good bone health. It is less well known that Vitamin D plays an essential role in immunologic function—keeping your immune system strong. Vitamin D inhibits both B cell and T cell (lymphocyte) proliferation/rapid increase, affects T cell maturation, and facilitates the induction of T regulatory cells. It also helps regulate monocytes production of inflammatory markers and inhibits dendritic cell (DC) differentiation and maturation. All of this leads to a decreased production of inflammatory markers and an increase in anti-inflammatory markers. In short, it has an anti-inflammatory role.

Vitamin D and COVID

Now that you understand the role of Vitamin D in immune support, let’s look at the link between that and COVID-19. When healthcare providers check your Vitamin D levels, they request a lab called 25-hydroxyvitamin d. This is the circulating Vitamin D in your body. Ideally, we want to see that number be at least 30 ng/dL. In theory, having enough circulating Vitamin D should reduce complications by preventing the “cytokine storm” that providers are seeing in response to COVID-19 infection. The cytokine storm is when the level of inflammatory proteins rapidly rises to dangerously high levels. It is what leads to complications such as ARDS, myocarditis, and acute renal and heart failure, especially in those elderly patients with previous cardiovascular comorbidity. Researchers have started requesting this lab from patients with COVID-19.

Study Shows Decreased Risk for Adverse Affects

One cross-sectional study of 235 individuals showed that patients with at least 30 ng/dL had a significantly decreased risk for adverse effects, such as hypoxia (low oxygen levels), death of individuals over 40, and unconsciousness. Serum C-reactive protein (an inflammatory marker) was lower and lymphocyte percentage was higher in Vitamin D–sufficient COVID-19 patients. In the study, 67.2% of the 235 COVID patients had Vitamin D levels less than 30 ng/dL. The study saw no significant difference in hospitalization duration, ICU admissions, Acute Respiratory Distress Syndrome (ARDS), and intubation between insufficient and adequate Vitamin D levels.

Similarly, a study showed Vitamin D levels were significantly lower in COVID patients with severe symptoms than those with mild symptoms or no COVID at all. Of the symptomatic patients, 54 were admitted to the ICU due to ARDS—all of whom had lower Vitamin D levels than the patients not needing the ICU. Sadly, 19 patients died, and again they found that these patients had lower Vitamin D levels than the ones who survived.

Another Study Finds Lower Levels of Vitamin D in Hospitalized Patients

A study of 216 COVID-19 patients and 197 population-based controls saw significantly lower levels of Vitamin D in the patients hospitalized due to COVID-19 than the controls (of similar age and sex), which lines up with the previous studies. On the contrary, they did not find a relationship between severity of infection and Vitamin D levels like the other studies found.

Study Finds People with Vitamin D Deficiency More Likely to Test Positive

Another study of 489 patients found that those with Vitamin D deficiency (<20 ng/dL) were 1.77 times more likely to test positive for COVID-19 than those with sufficient Vitamin D levels. The study above by Hernandez et al supports this finding, showing that 82.2% of COVID-19 cases were deficient in Vitamin D compared to the population-based controls, where only 47.2% were deficient (which is significant).

Correlation Is Not Causation

Something to note: These studies are observational studies. Thus, we cannot determine a cause-and-effect relationship between vitamin D deficiency and COVID-19 infection outcomes. Correlation is not synonymous with causation. So, while these results are important and useful, we must be careful to not go as far as saying, “Vitamin D can protect me from COVID-19 or lessen the impact if I get sick with COVID-19.”

Further research is being conducted since we do have strong observational support that suggests low Vitamin D levels may favor respiratory dysfunction and even death in those with COVID-19. Several Randomized Control Trials are in process. Many are trialing high-dose Vitamin D in those with COVID-19, such as the registered study by University Hospital in Angers (France). One has already concluded, but it was small with only 50 hospitalized patients being given a high dose of Vitamin D (calcifediol) and 26 not given a high dose of Vitamin D. Only 1 of the 50 high-dosed patients needed ICU treatment, whereas 13 of the 26 not given Vitamin D needed ICU treatment. 

Vitamin D Recommendations

Let me be real clear: You do not need to start taking a megadose of Vitamin D! Doing so can actually lead to toxic effects because it is a fat-soluble vitamin. The goal is to prevent deficiency to help keep your immune system strong.

I do suggest reflecting on your Vitamin D intake and exposure. Do you get out in the sun 10–30 minutes several times weekly? Sun exposure is less common in the winter, which hints at why more people are Vitamin D deficient in the winter months. When the sun’s UV rays hit our skin, Vitamin D3 (cholecalciferol) synthesis can occur. Do you eat Vitamin D–rich sources? If not, start to add some foods that are rich in Vitamin D. This will help you reach the RDA of 600 IU for young adults under 70 years old and 800 IU for adults older than 70 years old.

Here are some Vitamin D–rich foods:

• Trout, rainbow, cooked (3 oz = 648 IU)
• Pink salmon, cooked (3 oz = 444 IU)
• Halibut, Atlantic or Pacific, cooked (3 oz = 196 IU)
• Portobello mushrooms (1/2 cup = 316 IU)
• Canned tuna (3 oz = 228 IU)
• Milk, whole, 1%, 2%, and nonfat (1 cup = 115–128 IU)
• Yogurt, various types and flavors (8 oz = 80–120 IU)
• Soy milk (1 cup = 116 IU)
• Orange juice, fortified (1 cup = 100 IU)
• Eggs (1 large = 44 IU)

If getting your RDA by eating these foods is not realistic for you, I would suggest a Vitamin D3 (cholecalciferol) supplement to help increase your intake. A Registered Dietitian can help you adapt your nutrition regimen to meet Vitamin D requirements.

Finally, speak with your healthcare provider. They can always request that your 25-hydroxyvitamin d (circulating Vitamin D in your body) lab be checked. If you’re found to be deficient, you may require larger doses for treatment.

The Bottom Line

We do have strong observational support that suggests low Vitamin D levels may favor respiratory dysfunction and even death in those with COVID-19. However, we simply do not have enough strong data to conclude that Vitamin D sufficiency can treat or prevent COVID-19 infection until Randomized Control Trials are complete.

In the meantime, the best thing to do is continue to stay healthy (or improve your health) and keep your immune systems strong, which includes eating enough Vitamin D or having adequate Vitamin D exposure.

As always, please reach out to a NIFS Registered Dietitian for any nutrition support you need.

This blog was written by Sabrina Goshen, NIFS Registered Dietitian. To learn more about the NIFS bloggers, click here.

During cold and flu season, we try to do all we can to prevent illness or speed up how fast we recover from illness. One such strategy many employ is the use of Vitamin C for a natural remedy. Several products are marketed as immune system boosters because they contain large amounts of Vitamin C. Do these products really work? We set out to investigate!

What Vitamin C Can Do for You

Vitamin C, also called ascorbic acid, is not made by our bodies. We must take in this vitamin in our diet. It is needed for not only immune function but also for these uses:

• Form collagen (skin, tendons, ligaments, and blood vessels),
• Repair and maintain bones and teeth
• Heal wounds and form scar tissue
• Aid in iron absorption

It can also help prevent cancer as an antioxidant by blocking damage that we are exposed to from air pollution, cigarettes, and UV rays from the sun.

Vitamin C deficiency is extremely rare today, but in the mid-1700s scurvy in sailors was very prevalent. Those at risk of low vitamin C intake are smokers, those with medical conditions that affect absorption (cancer cachexia), and individuals with little variety in their diets.

How Much Vitamin C Do You Need?

The recommended Dietary Allowance for men is 90 milligrams per day and 75 milligrams per day for women. Fruits and veggies are the best source of vitamin C—especially citrus fruits. It can be destroyed by heat, so cooking slightly reduces your intake. However, most of our best sources of vitamin C are consumed raw naturally, and we usually do not have to worry about this. To get a better idea of how to meet your daily requirement with food, here are the vitamin C contents of some common fruits and vegetables that are good sources:

• Red bell pepper (½ cup, raw): 95mg
• Orange, 1 medium: 70mg
• Green bell pepper, ½ cup raw: 60mg
• Broccoli, ½ cup cooked: 51mg
• Cantaloupe, ½ cup: 29mg

In short, you can skip the megadoses of Vitamin C at the pharmacy.

Can Vitamin C Treat or Prevent the Common Cold?

In the 1970s, research was released that suggested Vitamin C could successfully treat or prevent the common cold. Several studies since then have been inconsistent and have resulted in some confusion and controversy. To date, the most compelling evidence comes from a 2007 study that showed preventative treatment in the general population did not affect cold duration or symptom severity. However, in the trials involving marathon runners, skiers, and soldiers exposed to extreme physical exercise or cold environments daily as well as the elderly and smokers, there could be somewhat of a beneficial effect. It was concluded that taking Vitamin C after the onset of illness did not appear to be beneficial. Furthermore, at doses above 400mg, Vitamin C is excreted in the urine. A daily dose in the 1000–2000mg range can cause upset stomach and diarrhea.

If you want the benefits of Vitamin C, it is best to consume the recommended Dietary Allowance daily, before the start of symptoms. Ideally, you will get Vitamin C from your food instead of a supplement; you will also get several other important nutrients in addition to your Vitamin C. Remember to make half of your plate fruits and veggies at every meal or blend up a quick smoothie for an easy on-the-go snack, slice up peppers and dip in hummus, or ask for extra veggies on that sandwich, pizza, or salad.

This blog was written by Lindsey Hehman, MA, RD, CD. To learn more about the NIFS bloggers, click here.

It is important to get in the nine recommended servings of fruits and veggies each day. This can definitely be challenging. However, in the summertime when produce is readily available all over the country, this is the time to make it a priority to reach that goal! These fruits and veggies are also at their nutrient peak, which is more reason to load up and fill your plate with these colorful items!

• Tomatoes: Filled with antioxidants and Vitamin C but most importantly the phytochemical lycopene, which is a cancer fighter.
• Zucchini: This vegetable has a fiber called pectin, which has been linked to increasing heart health and lowering cholesterol.
• Watermelon: This fruit is loaded with…water, which this time of year with high temperatures is important to help stay hydrated. It contains lycopene, which is useful for preventing skin cancer.
• Oranges: Citrus fruit is loaded with potassium, which is important to replace when you lose it through sweat during the summer months. Also, since oranges are 80 percent water, they can help keep you hydrated.
• Cantaloupe and honeydew melon: More fruit loaded with water to help keep you hydrated. These melons are high in Vitamin C and potassium, and honeydew has high levels of B vitamins.
• Raspberries: This fruit is typically very pricey in the off season, so take advantage of the lower prices and get 8 grams of filling fiber per cup. They are also loaded with Vitamin C.
• Peaches and nectarines: Loaded with antioxidants, Vitamin C, Vitamin A, and fiber, these sweet treats are nutrition powerhouses and the perfect portable snack.
• Dark, leafy greens: Fill up on raw veggies versus steamed this time of year, especially greens, and load up on much-needed carotenoids. These convert to Vitamin A and protect your skin from sun damage.
• Strawberries and blueberries: These sweet berries are filled with flavonoids. They increase blood flow to the skin and decrease sensitivity to light, which can improve the skin’s appearance.

Try some or all of these produce powerhouses soon when the cost is cheaper and they are more readily available. Enjoy the health benefits along with the fresh flavors of these fruits and veggies.

This blog was written by Angie Mitchell, RD, Wellness Coordinator. To find out more about the NIFS bloggers, click here.

It can be a challenge to get in the recommended 2–3 cups of vegetables each day. Even people who like vegetables can struggle coming up with ways to increase them. Thankfully, the food industry realizes this and has come out with a ton of quick and easy options to make it simple to get in those servings.

The key is to take a stroll down the frozen food aisle. Some people are concerned that frozen veggies aren’t as healthy as fresh vegetables, but that isn’t the case. Frozen vegetables are flash-frozen at their optimum nutritional state. This guarantees that all of those nutrients are preserved. Cook them to crisp tender and the majority of those nutrients will be intact.

Not only can you go for the traditional frozen veggies like broccoli and carrots, but now there are lots of fun options to make it easier to get the recommended plant-based nutrition and vitamins into your meals.

Delicious Frozen Options

Here are some new items to toss into your grocery cart at your next shopping trip.

Cauliflower Craze

• Green Giant Riced Veggies
• Birds Eye Riced Cauliflower
• Alexia Mashed Cauliflower
• Green Giant Veggie Tots (Cauliflower)

Spiralized Sensation

• Trader Joe’s Carrot Spirals
• Green Giant Veggie Spirals—Zucchini
• Green Giant Veggie Spirals—Butternut Squash

Protein Power

• Birds Eye Protein Blends: California Style
• Birds Eye Protein Blends: New England Style
• Hanover Blended Proteins: Sicilian Style

Watch the Sodium

One thing to be cautious about is that some of these frozen veggie options are higher in sodium than the standard bag of plain frozen vegetables. Make sure to drink plenty of water with your meal to help flush out the sodium, and pair your frozen veggie side with a fresh piece of protein and a whole grain. Don’t add additional salt to the dish, and review the nutrition facts label to see which ones are higher than others.

This blog was written by Angie Mitchell, RD, Wellness Coordinator. To find out more about the NIFS bloggers, click here.

Most of us have specific goals in mind when it comes to an exercise program. We work hard to achieve these results day in and day out, but sometimes our bodies may need an extra push to get over that hump. Many people question the importance of adding supplements to a healthy diet and workout routine, as well they should.

With so many different supplements flooding the shelves these days, it’s hard to know which ones will truly help you achieve your desired results. Although I agree that some supplements might not be necessary to include in your program, others could be beneficial to many individuals no matter what their fitness goals are.

Not a Substitute for Proper Nutrition

Before I go any further, I want to note that supplementation is simply an addition to your diet and exercise regime. These are not meant to replace a well-balanced whole-food diet; they are meant to be used in conjunction.

Most of the nutrients we need are already being produced by our own bodies to a certain extent, as well as existing in foods we eat daily. Some essential nutrients such as protein, creatine, and branched-chain amino acids (BCAAs) are naturally produced in the body and can be found in meat products, including (but not limited to) red meat, fish, and ground turkey. These amounts are just large enough to support daily functioning, but may not be produced in large enough quantities to aid in dramatic physique enhancements. If you are looking to take your physique to the next level, supplementation might be just what you need.

Which Ones Should I Use?

Here are the top five supplements (in my opinion, and that of many top professionals) you could add to your exercise and diet program.

1. Branched-chain amino acids (BCAAs): BCAAs are essential nutrients that help the body slow down protein and muscle breakdown, which can aid in preventing muscle fatigue during intense workouts. It works by stimulating the building of protein in muscles, which in turn helps prevent muscle breakdown. I would not recommend using BCAAs when trying to gain muscle hypertrophy (or size), as muscle breakdown is essential for muscle growth. Instead, try a pre-workout or caffeinated drink before your workout for extra energy.
2. Creatine: Creatine is an organic acid that is produced in the liver and helps supply energy to cells all over the body (especially muscle cells). People take creatine because it allows the body to produce more energy, and with more energy a person is able to increase the intensity of their workouts. Many athletes use creatine to improve their overall performance. It also helps aid in quicker muscle recovery after an intense workout.
3. Protein: Your muscles need protein grow and recover from muscle breakdown caused by exercise. You can get plenty of protein in your diet; however protein shakes are generally lower in calories than a high-protein meal. They are also portable and more convenient that carrying around whole-food meals (here are some ideas for making your own). Two widely used proteins are whey and casein. Whey is a fast-digesting protein that aids in muscle recovery and muscle growth. Casein is a slow-digesting protein that creates a longer-lasting supply of muscle-building nutrients. Many experts recommend taking a mixture of the two proteins to ensure a release of amino acids into the blood for as long as possible, therefore aiding in lean muscle gain as well as body fat decline.
4. Multi-vitamins: Multi-vitamins are essential to support the body’s everyday functioning. Your body needs a variety of complex nutrients for optimum efficiency and performance. Taking a high-potency multi-vitamin can ensure your body is getting those essential nutrients to support thousands of metabolic reactions. Here’s more information on the importance of a multi-vitamin for your health and fitness goals, including a list of the essential vitamins and minerals you need.
5. Fish oil: Fish oil tablets are the most efficient way to get the purest and most concentrated dose of Omega-3s into your diet. Omega-3s have been proven to improve blood circulation, which in turn will allow nutrients such as protein and carbohydrates to reach muscles. Omega-3s also help with maximizing metabolic rate, which in turn helps with fat loss.

Dietary supplements can have many health benefits as well as many performance-based benefits. If you are not concerned with taking supplements for their potential performance enhancements, you should at least be taking supplements such as multi-vitamins and fish oil tablets for your general health. They can be an easy addition to your diet and exercise regimen that may have huge effects on your overall health. Add supplements on an as-needed basis after conducting a needs analysis, and implement one at a time.

If you have additional questions or concerns about supplementation, please stop by and ask any Health Fitness Specialist at NIFS or contact our Registered Dietitian, Angie Mitchell for more information.

This blog was written by Darius Felix, Health Fitness Specialist at NIFS. To find out more about the NIFS bloggers, click here.