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As we all know, people can disagree on almost everything. However, one undisputed thing is that a good supply of micronutrients, such as vitamins and minerals, is essential for the functioning of the immune system.
This is reason enough for many researchers around the world to investigate whether single micronutrients used in a targeted manner can make a COVID-19 infection less severe and thus prevent serious consequences or even death from the disease.
Vitamin D is one of the most popular research topics. And some of the published studies look pretty promising, like the work of Spanish pulmonologist Marta Castillo.
“This is one of the studies that is repeatedly cited to prove the effectiveness of vitamin D,” says Martin Smollich, a pharmacologist and professor at the Institute of Nutritional Medicine at the Schleswig-Holstein University Medical Center in the northern German city of Lübeck.
Smollich himself conducts research on micronutrients and dietary supplements. At a time when the influence of vitamins and Co. is greatly exaggerated for ideological and commercial reasons or dismissed with contemptuous derision, Smollich is trying to put together a more differentiated picture.
It looks like a test
At first glance, the results of Castillo’s study seem to give reason for optimism: of the 50 COVID-19 patients who were given vitamin D, only one arrived in the intensive care unit, while in the control group, where it was not given vitamin D, 50% needed intensive care.
“With such studies, it’s important as a first step to look at how these two groups are brought together,” says Smollich. In order for the study to be able to truly answer the question of the effectiveness of vitamin D, the two groups should have as similar a composition as possible.
Problematic methodology
But that’s exactly where the problem with this study lies. It lists some risk factors and provides information on how many patients suffered from certain pre-existing conditions (see Table 2), such as type 2 diabetes.
“Only 6% of the people in the test in the group that received vitamin D were diabetic, while 19% of the people who were given only a placebo had the condition,” Smollich says.
The study’s problems regarding hypertension are even more serious: 57% of the participants who were not given vitamin D suffered from the condition, while in the other group, hypertension was only found in 24%. of people on trial.
“This means that the vitamin D-free group had the sickest people,” summarizes the pharmacologist. And such heterogeneous groups distort the results.
“With COVID-19, we know that both diabetes and hypertension are risk factors that can cause severe disease progression,” says Smollich. “So it’s no wonder that patients in the vitamin D-free group ended up in intensive care more often.”
A study conducted with such an imprecise methodology cannot answer the question of whether test persons in the control group should be treated more often in the ICU because they lacked vitamin D or because they had more severe pre-existing conditions.
Numerous other studies and reviews have so far concluded that vitamin D administration does not have a significant influence on the severity of a COVID-19 infection.
But…!
Type 2 diabetes, obesity, and hypertension all have things in common: They are not only risk factors for serious COVID-19 infections, but they are also all diet-related diseases.
So it is wrong to think that nutrition and nutrient status play no role in tackling the coronavirus pandemic. In fact, the opposite is true.
“Nutrients are important for various levels of the immune system,” says Anika Wagner, professor of nutrition and the immune system at the University of Giessen. A nutrient deficiency weakens the immune system’s various defense mechanisms and makes it much easier for harmful bacteria and viruses to cause harm.
Are food supplements necessary?
In addition to the question of how important micronutrients are for disease prevention, there is also a constant debate as to whether our immune system is adequately supplied by only healthy foods or whether it needs dietary supplements to be at its best.
The answer is, it depends. “In principle, I recommend that the nutrient requirement be covered by the daily diet,” says Wagner.
However, the rising rate of obesity suggests that too many people are failing to practically implement a healthy diet and therefore are not getting an adequate supply of nutrients.
“Obese people often consume more food with a high energy density, but which contains only a few micronutrients,” says Wagner. This includes sugary drinks, ready meals and desserts.
“At some point, the obese person can also develop diabetes and hypertension,” he says. Lack of nutrients weakens the immune system, while overweight and diabetes and / or hypertension pave the way for a severe COVID-19 attack.
Again, vitamin D comes into play: a vitamin D deficiency occurs “with an above average frequency in cases where there are diseases and conditions that in themselves increase the risk of COVID-19: old age, obesity or type 2 diabetes “, writes Martin Smollich in his specialized blog Nutritional Medicine, which deals with aspects of clinical nutrition.
This vicious circle is neither new nor unknown. “Many pre-existing conditions that impact coronavirus disease could have been avoided with effective prevention,” the German Diabetes Society (DDG) said in a May news release.
“In Germany, the link between diet and disease is often completely ignored. And I find it very dramatic, because it’s something that could have been changed,” says Smollich. “Instead, the coronavirus pandemic has hit a society where food-related diseases are almost the norm.”
Older and chronically ill people need more nutrients
Another risk group could benefit from prioritizing nutrients for health: the elderly. “We know that the immune system does not work well in old age and that the chances of vitamin D synthesis also decrease,” says Anika Wagner. Here, he says, the use of supplements should be considered.
The Federal Institute for Risk Assessment (BfR) comes to the same conclusion. He recommends vitamin D supplements for older people and the chronically ill, especially if they are dependent on treatment.
What’s more important than taking individual micronutrients is making sure people generally have an optimized intake of nutrients in order to prevent a range of diseases, Smollich writes on his blog. “Adequate nutritional and health policy measures would appear more urgently needed than ever in view of the coronavirus pandemic,” he writes.
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