Dr VivekBaliga
what is a lipoma?

Lipoma – Frequently Asked Questions

Many of my patients have small swellings on various parts of the body. This is a fat deposit called lipoma.

Here are some of the frequently asked questions about lipomas.

What Is A Lipoma?

A lipoma is a small collection of fat tissue within an outer capsule. It is considered a fat tumor, but a benign one.

Think of it to look like an egg yolk.

How Common Is A Lipoma?

They are fairly common and are often seen in men.

Studies have found that 1 in a 1000 people will have a lipoma at some point in their lifetime.

There are small role of genetics in the development of lipomas. Around 2 – 3% of cases run in families.

Though seen in younger patients as well, most cases are evident between the ages of 40 – 60 years of age.

Where Are Lipomas Seen Commonly?

The most common site of lipoma is the chest and back. In practice, I see a lot of patients with lipoma on their arms, as shown in the picture.

what is a lipoma dr vivek baliga

There are not the only places lipomas are seen. They may be even seen in the gastrointestinal tract, heart and almost any other organ of the body.

Is Lipoma A Cancer?

Fortunately, a lipoma is a benign tumor. It is not a cancer.

Is Lipoma Hereditary?

As mentioned earlier, there are some cases where it can be passed on through generations. This is very rare though, and has to do with mutations in certain genes.

How Big Can Lipomas Grow?

Most lipomas measure between 1 – 2 cm. Giant lipomas have been seen, and can measure over 10 cm.

Symptoms And Signs Of Lipoma

As such, lipomas are a cosmetic issue and rarely cause any symptoms when they are on the skin.

If they are located within the organs, then they can cause symptoms in rare cases.

For example, if a lipoma is present in the digestive tract, it can cause obstruction. The persons  may be unable to pass stools.

Patients with a lipoma in the lung tissue may have a cough or breathing difficulty.

They may also be present in the heart, muscles, bones and nerves as well.

Diagnosis Of Lipoma

A clinical diagnosis is often sufficient for lipomas on the skin. An ultrasound scan can help confirm this.

In patients where lipomas are hidden within the body, further tests such as CT scans or MRI scan can help.

How Are Lipomas Treated?

Most people accept lipomas as a part of life and do not bother with any treatment.

Some wish to get it removed surgically, especially if they are cosmetically unpleasant.

Removal should be done by an expert surgeon, taking care to remove the fat tissue and the capsule that surrounds it. It incompletely removed, it could lead to a recurrence of the tumor.

If my patients wish to get them removed, I usually send them to a plastic surgeon who can remove them with minimal scar formation after wound healing.

What Is The Prognosis Of Lipomas?

They have an excellent prognosis. They are rarely life-threatening, unless they occur in rare areas.

 

what is a skin abscess dr vivek baliga

Skin Abscess – A Patient Guide

Often in clinical practice, I encounter patients who have developed skin infections. Sometimes the skin infection can be serious enough to require admission to the hospital.

These infections that require admission usually ends up being skin abscess.

What Is A Skin Abscess?

A skin abscess is essentially an infection of the skin where there is space accumulated under the skin. It is very similar to a pimple but is significantly larger and is seen deeper under the skin.

Where Are Skin Abscesses Usually Seen?

The most common site of skin abscess development is the groin, armpits, buttocks, and extremities.

However, I have seen patients develop abscesses on the scalp and on the back as well.

Symptoms And Signs

In mild cases, skin abscesses will just be a collection of pus with some redness of the skin surrounding it. It can be painful when pressed and can be warm to the touch.

In severe cases, the skin abscess can spread rapidly from the original area and affect a large area around it. This can become extremely painful and can lead to fever and severe fatigue.

I recently treated a patient who had a skin abscess of the inner thigh and who came to the clinic with severe giddiness and low blood pressure. This is because the infection had spread to the bloodstream and was affecting the normal working physiology of the body.

If the skin abscess spreads to nearby areas it can lead to a condition called cellulitis, which I shall discuss in a separate article.

Who Develops A Skin Abscess? Risk Factors.

Skin abscesses can develop in literally anyone. However, they tend to be more serious in patients who have a history of type 2 diabetes and those who do not maintain adequate hygiene.

What Causes A Skin Abscess?

Skin abscesses are caused by bacteria. The most common bacteria that cause infection are Staphylococcus aureus and streptococcus.

Investigations

It is easy to diagnose an abscess through clinical examination alone. They range between 1 to 3 cm in size but may become larger as I have discussed above.

Sometimes on the surface, they have a tiny yellow spot which is the pus that is trying to come out.

Patients who have a skin abscess require a blood test that will help determine the presence of infection within the bloodstream. Those who have diabetes will require a blood sugar test as well.

In some patients, an ultrasound scan or a CT scan may be required to determine the depth and true size of the abscess.

If pus starts to come out of the skin abscess, then a wound swab will be sent out to the lab for analysis.

Treatment Of Skin Abscess

The primary treatment for managing skin abscesses is incision and drainage i.e. a surgical procedure. A small abscess can dissolve with simple antibiotics and warm compression.

Larger abscesses can be difficult to treat as an outpatient and are best managed in a hospital setting.

Intravenous antibiotics will be administered to the patient and once the abscess has ‘calmed down‘ then the surgical procedure will likely be needed.

The surgical procedure is called incision and drainage. The surgeon, under anesthesia, will make a small cut on the top of the abscess to allow the pus to come out.

Once the pus comes out, the surgeon will insert their gloved index finger or a device to clean out all the bus from within the abscess cavity. Addressing will be and then applied to allow any remaining bus to get soaked into the dressing.

After discharge, patients may require ongoing antibiotic treatment along with regular dressings.

Complications

If an abscess is left untreated then it can spread rapidly and make the patient seriously ill. It is always best to seek advice early so that simple treatments can help resolve the condition completely.

flavonoid rich foods dr vivek baliga

Boosting Your Memory – Can Flavonoids Prevent Forgetfulness?

A healthy diet should be like a rainbow, consisting of various fruits and vegetables such as red strawberries, green spinach leaves, yellow peppers, which give you all the nutrition for day-to-day activities.

But did you ever wonder where these colors come from?

The colors of your fruits and vegetables often come from potent phytochemicals (chemicals found in plants) called as flavonoids. Now a large study from Harvard published in the journal Neurology (July issue) states that flavonoids may play a role in protecting cognition too.

The Study

Scientists evaluated collected 20 years self-reported diet data and health information for over 77,000 middle-aged men and women. The data included the frequency of participants having flavonoid-rich foods and reporting cognition related changes in their 70s, such as difficulties faced in:

  1. Understanding instructions
  2. Finding routes around familiar streets
  3. Following a TV show plot, or group conversation
  4. Remembering short lists of items (groceries list), or events that occurred recently
  5. Remembering things one after the other, over a span of few seconds

The study included six classes of flavonoids for calculating the participant’s cognitive ability:

  • Flavones (e.g., luteolin found in green chile peppers or celery)
  • Flavanones (e.g., naringenin found in grapefruits or oranges)
  • Flavonols (e.g., quercetin found in onions and kale)
  • Anthocyanins (e.g., cyanidin found in blackberries and red cabbage)
  • Polymers (e.g., theaflavins found in black tea)
  • Flavan-3-ol monomers (e.g., catechins found in red wine and strawberries)

Study Observations

Cognitive functioning is significantly affected by factors such as weight, age, physical fitness, intake of non-flavonoid nutrients, depression and alcohol intake.

The research concluded that people with the highest flavonoid intake in their diets had 19 % less chances of developing troubles like memory loss and thinking difficulty as compared to those with the lowest consumers of flavonoids.

Dr. Walter Willet, study author and professor of epidemiology at Harvard T.H. Chan School of Public Health said that the results are exciting as they show that people with high intake of flavonoids prevented or slowed down decline in memory and other cognitive facilities in elderly.

Earlier consumption of flavonoid-rich foods showed a protective effect on the brain. Lead author Dr. Tian-Shin said that even people who began consuming flavonoids late in life noticed their benefits.

However, the study was conducted as an observational study. It relied on people remembering their diets and cognition changes, and the proof was not conclusive that flavonoids can keep older people sharp.

However, there is a link between flavonoid consumption and cognitive health benefits seen even in smaller or shorter-term studies.

Flavonoids Superfoods

Certain flavonoids have shown protective effects on the brain by lowering self-reported cognitive decline as follows:

  • Anthocyanins by 24%
  • Flavones by 38%
  • Flavanones by 36 %

flavonoids for health

The vegetables and fruits associated with maximum improvement in cognitive functioning listed from highly effective to moderately effective are:

Flavonoid Rich Superfoods
  • Brussel Sprouts
  • Strawberries
  • Cauliflower
  • Raw Spinach
  • Sweet potatoes
  • Blueberries
  • Orange winter squash
  • Cooked spinach
  • Cooked carrots
  • Peaches, plums and apricots
  • Tomato juice
  • Green, yellow and red bell peppers
  • Broccoli
  • Cabbage
  • Tomato sauce
  • Lettuce
  • Tomatoes
  • Celery
  • Beets

Other beneficial foods were potatoes, onions, apples, pears, bananas, grape, raisins, tea, white wine, raw carrots and red wine.

What Is The Magic Content in Flavonoids?

Flavonoid activity for protecting cognitive functions are still in research. t However studies have shown that flavonoids are potent antioxidants that can prevent inflammation and accumulation of amyloid, a characteristic feature of Alzheimer’s disease.

Antioxidants also play a significant role in the following situations:

  • Treat inflammation and prevent tumour growth
  • Lowers blood pressure by maintaining the health of blood vessels
  • Antioxidants increase the production of brain-derived neurotrophic factors, which are nothing but chemicals that help in brain repair, strengthen the connection of nerve cells and promote growth of new brain cells, and enlarges the size of the hippocampus (a part of the brain that aids memory storage and retrieval)

Flavonoid Goals To Work On

Flavonoids have shown so many potential benefits. So what is the right amount of flavonoids you should include in your diet?

In the study, flavonoid diet intake ranged from as low as 150 milligrams (mg) per day to as high as 620 mg per day. However, keeping track of flavonoid consumption can be tricky as it varies significantly between foods. For example, half a cup of peppers contains about 5 mg of flavones, and a half cup of blueberries contains 165 mg of anthocyanins.

So for starters, start having differently coloured fruits and vegetables in your regular diet. The earlier you start, the better the results will be.

Based on recent evidence, the most effective combination is including two servings of fruits and three servings of vegetables per day. You can also try to reach a goal as a five-a-day fruit/vegetable.

This goal will help you enjoy all the good fruits like blueberries, apples, strawberries, bananas, and oranges which are potentially helpful for your brain.

Dr. Deborah Blacker, study co-author and professor and deputy chair of epidemiology at the Harvard T.H. Chan School of Public Health concluded that this diet can be called as ‘eating the rainbow’.

So the rainbow diet is a healthy as well as a delicious diet, for a healthier and maybe sharper you even when you are 70!

sudden cardiac death dr vivek baliga

Understanding Sudden Death In Young Athletes

The death of our beloved movie superstar Puneeth Rajkumar stunned his fans. A person who was so physically fit suddenly passing away was a shock to all, and just as confusing.

How does someone who is so physically fit die so suddenly?

Surprisingly, this sudden death in young individuals is not something new. Athletes dropping dead during a game is well heard of. The world of football has seen many.

I thought I would touch upon, in brief, why young and fit individuals die suddenly, and what steps you could take to screen yourself and pick any warning signs up early.

Definitions

Young athletes could be any age, though for the purposes of this discussion, we will have 2 categories – those below 35 years, and those above.

Similarly, there are those who are competitive athletes i.e. those who participate in competitions with a goal to win, and those who are recreational athletes who exercise for fitness and fun.

Heart Attack Vs Cardiac Arrest

A heart attack is a condition where the heart artery is blocked by a blood clot. This deprives the heart of blood, leading to damage to the heart muscle. The heart is still beating and the patient is still alive.

A cardiac arrest is a condition where the heart stops beating. Basically, the patient is dead.

A heart attack can lead to a cardiac arrest.

How Common Is Sudden Death In Young Athletes?

In young athletes, statistics suggest that sudden death occurs in around 1 in 1 lakh individuals a year. In older athletes, this is around 1 in 7000.

However, these are not hard facts but rather estimates.

Causes Of Sudden Death

I have listed below some of the common causes of sudden death in athletes.

1. Alteration In The Heart Structure

Sometimes, the heart is not built the way it should be. There may be problems with how the muscle is built, or there may be a problem with how the electrical wiring is within the heart muscle tissue.
These changes in structure can lead to the heart beating in an extremely fast and erratic manner.

For example, some athletes may develop a ventricular tachyarrhythmia, or an irregular, fast beating of the bottom chamber of the heart. Ventricular fibrillation is one such life-threatening rhythm problem where the heart beats in a disorganized manner at a rate that exceeds 400 beats a minute. Ventricular tachycardia is a related condition with similar risks and outcome.

Below is the link to a video of Hank Gathers, a semiprofessional basketball player who collapsed during a game despite being in top form and just having scored a basket.

If you are a sensitive person, then I would advise you not to watch the video. It is freely available on YouTube here.

Besides beating very fast, the heart may beat at an exceedingly slow rate, or even flatline. This is called bradyarrhythmia.

Other reasons include holes in the heart that were not detected at birth.

A sudden tear of the largest blood vessel in the body, called aortic dissection, can also lead to sudden death.

2. Coronary Disease – Heart Artery Blockages

This is seen in athletes above the age of 35 years.

As we age, there may be soft plaques of fat that have been deposited in the heart arteries over years. These begin forming at a very young age, and increase in size at a varying pace over time.

During aggressive exercise, these plaques can break off if they are unstable. They then travel down the blood vessel and block it completely, leading to a heart attack.

In the medical world, we call this plaque rupture.  It is a cause for sudden death in people who have pre-existing narrowing in their heart arteries.

There are many factors that contribute to the formation of these plaques. Smoking, high blood pressure, diabetes, a strong family history of heart disease and high cholesterol are the common risk factors.

Coronary disease can be detected to some extent with tests such as a treadmill test. But not all narrowing in arteries can be detected this way.

I have written a detailed article on treadmill testing and what to do if it is a positive test elsewhere.

I have discussed this aspect a little later in the ‘screening’ section below.

3. Electrical Problems

The heart pumps because of electricity that flows through it. However, sometimes the electrical flow is faulty. Think of it as faulty wiring.

When the wiring if faulty, any strenuous activity can lead to erratic heart beating as the wires cannot handle the extra load. This may lead to sudden death.

Problems with electrical flow can be detected by a simple ECG.

4. Change In The Heart Muscle Thickness

The human heart is built in a very specific way. Each of the walls of the heart, the valves and other internal structures are of a particular thickness and serve a specific function.

However, if the thickness of the heart changes, then the heart may not function normally under stress. This can be a cause for sudden death.

One such condition is called Hypertrophic cardiomyopathy (HCM), a condition where the heart muscle is abnormally thicker than normal.

HCM is a very common cause of sudden death in athletes. It is often undiagnosed.

Similarly, if there is a hole in the heart (a birth defect), then the heart may not be able to handle the stress of exercise.

If there is a defect in the way a heart valve opens and closes, it can stress the heart even during minimal exercise.

A rare cause of sudden cardiac death is Arrhythmogenic right ventricular cardiomyopathy. This is a condition where the right side of the heart is replaced with fat tissue that poorly conducts electricity. It is often missed during clinical evaluation, though can be picked up on an ECG and a cardiac MRI scan.

5. Heart Muscle Inflammation – Myocarditis

Myocarditis means ‘inflammation of the heart muscle’, and is a potentially fatal condition. Those with suspected myocarditis are advised not to exercise for at least 3 to 6 months after the diagnosis is made.

Viral infections, including COVID, have been linked to myocarditis. I have always advised individuals with fever or an active infection to avoid exercising during the infection and even for a couple of weeks after recovering to prevent myocarditis.

There are a handful of case reports of COVID vaccine causing myocarditis as well.

When the heart muscle is inflamed, it ceases to function normally, becoming weak and enlarged. Electrical abnormalities ensue, leading to irregular heart rhythms and sudden cardiac death.
If you are ill, do not exercise. Rest is the best treatment.

You can read about diagnosis of myocarditis in more detail here.

6. Rarer Causes

There are condition such as congenital long QT syndrome, Brugada syndrome and early repolarisation syndrome that can cause sudden cardiac death. I am not discussing them here as they will definitely confuse you.

Screening

If you wish to know your risk, visit your cardiologist. That’s the first step.

sudden death in athletes

A thorough history taking and physical examination itself will help risk stratify you. Your background history of high blood pressure, diabetes, family history of heart disease (or sudden death in a family member below the age of 50 years) and high cholesterol will help determine your risk.

A detailed examination to see if there are any heart murmurs or signs of your heart being weak will be conducted.

The role of investigations as a screening tool has been debated. Some suggest that tests may be futile and rarely pick up problems with the heart.

However, I personally feel differently.

A basic ECG, echocardiogram and a treadmill test, along with a blood profile to evaluate your hemoglobin, lipids and blood sugars can add some value in determining your risk.

A few years ago, I took an automated blood pressure machine to a local gym I used to visit, just to check the blood pressure of every person walking in through the doors. Over a 2 hour period, I recorded the BP of around 26 people.

Of the 26 people, I detected 2 people having a very high blood pressure. One individual aged 33 years had a BP of 220/120, and was completely oblivious to it. He was a fairly fit guy, would work out for an hour 4 times a week, and was not overweight. He even lifted weights.

I made him rest for 30 minutes and manually checked his BP again. It was the same.

I reviewed him in clinic 2 days later. It was almost the same. Conducted a home blood pressure recording test, and he averaged 190/100 on a rest day.

Not always will you know when you have a cardiac problem. Many times it is silent.

Besides the above tests, I have sometimes advised a CT coronary angiogram for patients who participate in running and intensive sporting activities.

Do The Tests Rule Out Sudden Death?

Unfortunately, no. Not all tests can predict whether you will have trouble when exercising.

It will, to some extent, determine if you are low, intermediate or high risk of sudden death.

Repeat screening once every 2 years may hold value. Those with any detected abnormalities may require annual screening.

Your doctor will guide you.

Warning Signs

If you notice any chest pain, breathing difficulty or thumping in the chest now and again when at rest or when exercising, see your doctor and get evaluated.

Never ignore what your body tells you. And for God’s sake, don’t Google all the time. Visit an expert.

Closing Remarks

Sudden cardiac death in young athletes is rare. But when it happens, it hits us hard. Taking the right steps early may help prevent this problem.

RELATED READING – STARTING AN EXERCISE PROGRAM

what causes bad breath

Is Bad Breath Bothering You? Here’s What You Can Do.

Bad breath or halitosis is an embarrassing problem and a great selling point for literally every toothpaste and mouthwash on the market. Around 50% of the population globally suffers from this condition.

What Causes Bad Breath?

Halitosis is mostly due to volatile molecules that originate from the mouth or nearby structures. These molecules can include a variety of amines, short-chain fatty acids, nitrogen-containing compounds, and even hydrogen sulfide.

Bacteria in the oral cavity are responsible for the production of these gases which are released when bacteria feed on food material in the mouth. If you have gum disease or dental caries, bacteria grow here as well and lead to bad breath.

In fact, 80-85% of cases are due to causes within the mouth.

If you have poor saliva production (a condition called xerostomia), then your breath can smell bad as a consequence of this. A coated tongue, not brushing teeth regularly and dentures is another cause.

But halitosis can also originate from non-oral sources. Those people who suffer from acid reflux disease, tonsil infections, lung infections, and some forms of gastrointestinal cancer are prone to bad breath.

High alcohol intake and smoking also affect breath.

Certain foods such as garlic, onion, radish, and pickles can lead to foul-smelling breath as well.

You May Not Have Bad Breath

There is a condition called ‘delusional halitosis’, where you believe you have stinky breath, but everyone around you thinks it’s fine. It is sometimes called imaginary halitosis.

Believe it or not, TV advertising of oral hygiene products (remember the old Close-UP toothpaste ads – you need a fresh breath to get the girl!) has led to an increased number of cases of delusional halitosis.

Some people even develop a morbid fear of bad breath, called Halitophobia. It is seen in 0.1 – 1% of the population. Such individuals may need counseling if the fear affects their quality of life.

Why Do We Wake Up With Smelly Breath?

Every morning you may find that your breath stinks. This is called physiological halitosis and is a natural phenomenon.

It happens because, throughout the night, your saliva is stagnated inside your mouth. Any food particles undergo a mild decaying process and are infected by any bacteria in the mouth. This releases smelly gases. The dead cells that line the gums also are released into the saliva, leading to bad breath.

Assessment Of Halitosis

Bad breath is evaluated through a test called organoleptic measurements. Here a patient holds their breath for a short while and then breathes out through a pipette. The doctor/examiner smells the breath from 20 cm away and scores it according to a scale.

There are other tests as well that measure gas levels in the breath. A detailed discussion on this is out of the scope of this article.

Treatment

If you suffer from halitosis, then see a dentist first. It is likely to be an oral cause.

Chewing gum may help as it improves saliva production. Good oral hygiene is essential.

Brushing teeth twice daily, gargling after meals, and using mouthwash helps mask the smell. Listerine is particularly helpful.

For some of my patients with bad halitosis, I recommend chlorhexidine mouth rinses. It is an effective killer of bacteria in the mouth. I don’t recommend it long-term as it can stain the teeth.

Clean your tongue when you brush your teeth. This can lower the smell by more than 40%. Using a tongue cleaner is better than using your toothbrush.

Flossing also helps get rid of germs between teeth. Always floss before you brush your teeth.

Patients who suffer from delusional halitosis may require cognitive behavioral therapy. There are many modalities of treatment available now that help one get over the fear of bad breath.

Should I Take The COVID Vaccine? Your Questions Answered.

In the last few days, I have received a number of calls about whether or not the COVID-19 vaccine should be taken.

I am not surprised by this, as this is naturally a concern to many that have been approached by the governing bodies about taking the vaccine.

I thought I would address some of the common questions that are being asked about the vaccine.

Please note that some of the information below may be relevant to the state of Karnataka (where I hail from), so do check with your local governing body about rules and regulations they may have. 

What Are The Vaccines Available In India?

I think you probably know the answer to this question, but nonetheless, here goes.

There are currently 2 vaccines available in India: 

  1. Covishield
  2. Covaxin

Covishield is manufactured by AstraZeneca, while Covaxin is manufactured by Bharat Biotech. The government is currently administering both these vaccines at select centers across Karnataka and the rest of the country.

Which Vaccine Should I Take?

Currently, there is no choice given to the public about which vaccine they should take. Each center has stocked the vaccines given to them by the government, so if you are allotted a center then you will have to take the vaccine they are offering there.

Please note that the decision to take the vaccine is entirely VOLUNTARY. You may opt not to have the vaccine if you do not wish to.

How Do I Register For The Vaccine?

Right now, it appears the only way to get the vaccine is to register on the COWIN website or by downloading the app.

The website is https://www.cowin.gov.in/home

Once you land on the website, you will need to register yourself or a family member using a telephone number and an OTP. Up to 4 family members can be registered using a single telephone number.

You may also register using the Aarogya Setu app, where they have included a section for COWIN registration.

I would advise you to read this article on NDTV for step-by-step instructions. 

How Is The Vaccine Administered?

Having had both doses, I can tell you that the vaccine will be administered in your left arm (Or right arm if you are left-handed).

If the thickness of muscle in your left arm is very little, they may administer it in the buttocks. I am not aware of any of my colleagues having had such an injection though.

The left shoulder muscle will be cleaned with cotton and some spirit and the injection will be administered.

Honestly, it is no different from any other injections you might have had in your lifetime.

Does It Hurt?

Well, it’s an injection!! It is going to hurt a tiny bit, but it will not bother you!

Afterward, a small number of people may develop shoulder pain which may last a couple of days. I had a little shoulder pain for 2 days after the first shot, but no pain when I had the second shot.

What Are The Side Effects?

Rarely, one may develop side effects from the injection. Common ones are –

Side Effects Of COVID Vaccine
  1. Rash and itching over the site of injection – This will settle with time or with antihistamine medications if needed.
  2. Pain at the site of the injection – as explained previously
  3. Fever – Some people who have taken the vaccine may experience fever for up to 24 hours. Paracetamol can help control the fever. Depending on your tolerance, the fever may or may not bother you. The fever may develop the evening of the injection or the following day. There is no need for antibiotics.
  4. Body pain and fatigue may be a part of the fever. That too settles within 24 hours.
  5. Nausea can occur. Vomiting is rare. Antacids could help. If nausea is troublesome, then contact your doctor.
  6. Bleeding – If given carefully, this is highly unlikely. A small amount of blood may ooze out after the injection, but this settles in seconds.
  7. Blood clot formation – This is extremely rare. Please note that such a complication can be with any intramuscular injection and not just COVID vaccines alone. It may be more prominent in people taking certain kinds of blood thinners.

I Am On ‘Blood Thinners’ – Can I Take The Vaccine?

I guess this is the most commonly asked question. There are 2 types of blood thinners that are prescribed to patients. 

  1. Antiplatelet agents – Aspirin, Clopidogrel, Ticagrelor and Prasugrel
  2. Anticoagulants – Warfarin, Nicoumadin, Dabigatran, Apixaban, Rivaroxaban

Those who are taking antiplatelet agents can take the vaccine.

Those taking anticoagulants should probably avoid the vaccine due to the risk of blood clot formation within the muscle.

For example, if you are taking tablet Ecosprin or Clopilet, or if you have had a stent or bypass surgery and are on these agents, then you can go ahead and take the vaccine.

If you have a metallic prosthetic heart valve or if you have an irregular heart rhythm and are taking Acitrom, then there is a risk of bleeding or clot formation after the injection.

However, it is not very clear.

Here is what I suggest. Speak to your doctor about whether your anticoagulation must be stopped for a few days, and whether it is safe to do so. You may not be eligible for the vaccine if you should never miss the anticoagulation medicine. 

I Have Had COVID Infection Already – Should I have The Vaccine?

Yes, please do!! You are at risk, later on, so better to have the vaccine to protect yourself.

I Have Diabetes. Can I Take The Vaccine?

If your diabetes is well controlled, with your fasting sugars within 130 and postprandial sugars within 180, then go ahead. This is not guideline-based but is just my opinion.

If your diabetes is poorly controlled, then time to get it right! Once controlled and your doctor gives you the all-clear, go ahead and get vaccinated.

Who Should Not Take The Vaccine?

If you are on anticoagulants, then probably avoid it. Check with your doctor as well.

If you have a history of allergic reactions to vaccines in the past, then best avoid the COVID vaccine. However, an allergic reaction to a painkiller or antibiotic in the past is not relevant and should not stop you from taking the vaccine.

If you have had a high fever in the last 5 days, or are currently on treatment for fever, then the vaccine should not be taken. However, if you have a simple runny nose or the common cold, or a very low-grade fever around 99 deg F, then you should be fine to take the vaccine.

Pregnant women should avoid vaccination.

Those with low immunity (cancer therapy, HIV, etc) may not have the same response that those with a normal immune system will have after the vaccine. The vaccine is still being given to them. If you have such issues, please contact your doctor.

Those with a low platelet count should avoid the vaccine as well. If you have any blood disorders like leukemia or lymphoma, speak to your hematologist about whether you can take the vaccine.

How Long Will The Vaccine Protect Me?

This is not clear. We estimate it might be around 8 months to a year. Time will tell whether we need a booster dose next year.

I Have Had My First Shot – Can I Travel Now?

Nice try. I am sure you are itching to go on that holiday you planned ages ago, but don’t plan it yet.

After the first dose, you are not adequately protected. You can still contract the infection. Make sure you follow COVID-specific precautions as advised previously to the public.

I Have Lung Disease. Can I Take It?

If you have a stable lung condition, then it should be fine to take the injection. If you are on treatment for active infection in the lungs or worsening of asthma, then wait till your pulmonologist or physician gives you the all-clear.

I Have Had A Cardiac Bypass. Can I Have The Vaccine?

Of course. If you are stable from a cardiac perspective, then go right ahead. There is no reason to avoid it.

Is Sulfa Allergy A Contraindication?

If you are allergic to sulfa or penicillin, you can still have the vaccine.

Do I Need The Second Dose? Can I Avoid It?

The first shot is called the primer shot. It just kickstarts the immunity-building process. You need your second injection – it is a booster that powers up your immune system.

Your booster dose will be given to you within 4 to 6 weeks. You will be fully protected if you take both the jabs.

How Much Does It Cost?

The vaccine costs Rs 250 to the public. My understanding is that most private hospitals are charging the same as government institutes.

Watch This Space – As and when more information pops up, I will share it with you.

7 Reasons Why You Should Not Ignore Kiwifruit

Kiwifruit is not really that popular in India, though I personally feel it should be. A native of China, the kiwifruit is a dynamic fruit loaded with nutrients.

In India, it has gained some exposure as a fruit that can help manage patients with dengue fever. But that’s just the tip of the iceberg.

Today, I will discuss the various reasons why you should never ignore the kiwifruit when you are out shopping.

The Kiwifruit

The kiwifruit is the fruit of the woody, deciduous vine belonging to the genus Actinidia. It was previously called the Chinese Gooseberry or mihoutau, being native to China for centuries.
Over the years, it has been grown in New Zealand, Chile, France, Japan and the United States, and is exported globally to various countries, including India. This explains its high cost in our country (an average single kiwifruit in India costs around Rs 25).

The fruit is not always green in color. There are different variants, some of which are golden or yellow. The one we get in India is Actinidia deliciosa, a green fruit with tiny, crunchy black seeds and a hairy outer coat.

Health Benefits Of Kiwifruit

As an ancient Chinese medicine, kiwifruit was used to cure digestive problems, hemorrhoids (piles), acidity and rheumatism (joint pains).

Nutritional Composition of Kiwifruit (table)

Source Of Vitamin C, E and Folate

When you bite into the fruit, you will be hit by a sweet, tangy note instantly. You might even grimace in pleasure.

Thats because the kiwifruit is rich in vitamin C. It contains around 80 mg to 120 mg of vitamin C per 100 grams of fresh fruit.

Vitamin C is an essential vitamin that the body gets only through diet. It is essential in the synthesis of collagen, which is responsible for keeping our skin and cartilage healthy.

Our recommended daily allowance (RDA) for vitamin C is around 70 – 90 mg per day, with an upper limit of 2000 mg daily. However, consumption of over 1 gram per day does not provide much benefit, as less than 50% will end up being absorbed.

It is also important in the synthesis of numerous hormones and in DNA synthesis.

Of course, with the recent COVID-19 infection affecting humans globally, vitamin C has been in the spotlight as a powerful immune booster, which it is.

The vitamin C also helps in better absorption of iron from the diet. So if you are low in iron or have anemia, then including kiwifruit with your iron rich diet can be very helpful.

An interesting study was published looking at kiwifruit and how it could improve vitamin C levels. In this study, the subjects were asked to consume half a kiwifruit daily for 4 weeks, then 2 kiwifruits daily for 6 weeks, and then 3 per day for another 4 weeks.

At the end of the study, they found that while half the fruit helped elevate levels of vitamin C in the blood, a whole fruit would be required to get the required levels. With 2 fruits, vitamin C levels reached ‘saturation’ level, and 3 fruits per day had no additional benefit.

In short, if you wish to boost your vitamin C intake and blood level, have a kiwifruit every day.

In addition to vitamin C, it is also a good source of vitamin E and folate. Along with vitamin C, vitamin E is a powerful antioxidant and fights free radicals and subsequent damage to vital organs, skin and hair.

Folate is required for normal blood production and in protein synthesis. It is an essential nutrient in pregnancy as it is responsible for the fetal spinal column development.
Useful In Hypertension

In a study comparing the effect of consumption of 3 kiwifruits per day versus foods rich in antioxidants, researchers found that the former group had a 11% reduction in their angiotensin converting enzyme activity level. This enzyme is responsible for hypertension, and is often targeted in medical therapy. Overall reductions were around 10 mmHg in systolic and 9 mmHg in diastolic blood pressure.

Normal levels of potassium in the blood are essential to keep the heart pumping efficiently.

Kiwifruit is a good source of potassium, coming a close second to banana among the fruits. It is naturally low in sodium, containing only 3 grams per 100 gram of fruit.

This makes it a good fruit to eat if you have high blood pressure. It may have some benefit in lowering your blood pressure, and this has been seen in some smokers.

That being said, most studies have only shown a ‘trend’, and not a significant change in blood pressure. Don’t rely on it to bring your blood pressure down naturally to normal values.

However, I recommend avoiding it if you have kidney disease, as potassium can accumulate in the blood if consumed in high quantities.

Improves Your Digestive System Health

Constipation and irritable bowel syndrome (IBS) are common problems in India. Treating IBS can be quite difficult.

In a study looking at regular kiwifruit intake over 4 weeks by healthy elderly individuals, researchers found that those with constipation had a better stool frequency, better stool volume and softer stools.  This makes the fruit useful in managing constipation.

Similarly, in individuals with IBS, a study evaluating intake of 2 kiwifruits per day for 4 weeks improved bowel function significantly.

This improvement in gut function may be related to the high quantity of soluble and insoluble fiber it contains. It contains one third soluble and two-thirds insoluble fiber. It also has the ability to hold onto water and swell up in the gut, helping bulk up the stools and in easy evacuation.

There are many other explanations on how kiwifruit improves digestive health, and I will not delve on it any more as it would just complicate this article.
If you have problems with your digestion, or have a history of constipation, try eating a kiwifruit every day. You should see an improvement in a few weeks.

Kiwifruit Is Safe In Diabetes

Green kiwi fruit which is available in India has a GI index of 39, which is low. Only 12% of the fruit is carbohydrate.

In other words, eating it if you have diabetes is not really a problem. It will not increase your sugar levels much.

Studies have found that the primary sugar in kiwifruit is fructose. This, in addition to the high fiber content in the fruit, helps keep blood glucose levels in check.

Improves Cholesterol

Kiwifruit does not contain any cholesterol. Interestingly, when it comes to metabolic parameters, kiwifruit can help lower your cholesterol.

In one particular study , regular consumption of 2 kiwifruits a day over 4 weeks improved HDL values (good cholesterol) and lowered triglyceride levels (bad cholesterol).

However, it did not have an effect on LDL levels.

Another study found that even consumption of one fruit a week had the same effect.

It is possible that the elevation in HDL cholesterol levels may be related to the polyphenols and vitamin C present in kiwifruit. The green variety increases the levels of apolipoprotein A1, a protein attached to HDL cholesterol.

Protects The Heart

I have already mentioned how HDL cholesterol levels increase with regular kiwifruit intake. This can protect the heart against heart attacks.
By lowering blood pressure, it keeps the heart under a lower deal of stress.

The vitamin C and polyphenols also benefit heart function in various ways.

However, these are not the only ways.

Another property of this fruit is its ability to lower the ‘stickiness’ level of cells called platelets.  One study showed that it reduced this by around 15%. Some have gone so far as to say it is as good as an aspirin tablet.

By lowering this, it can reduce the chances of clots forming within heart arteries, a phenomenon that is responsible for heart attacks.

There is a school of thought that kiwi fruit can increase platelet count in dengue. This is not clinically proven. That being said, there is no harm in eating it if you have dengue fever, as the vitamin C may be beneficial.

Anticancer Effects

Among the many foods that can naturally lower cancer risk, kiwifruit may have some benefit too.

However, the studies are limited.

Most studies conducted to see if it has a property of lowering cancer are lab based studies looking at DNA injury and subsequent repair through the vitamin C component of the fruit.
Also, the high fiber content and digestive tract protective effects may benefit against colon cancer.

Other Effects

There may be some role for kiwifruit in healing of acute burns. This is because it has antibacterial properties, along with the property to stimulate new blood vessel formation.
This information stems mostly from rat studies.

Risk Of Allergy

One disadvantage of kiwifruit is that it can cause allergic reactions in some people when they consume it. However, the reaction is not that severe.

Some adults may experience an itchy throat and a bloated stomach. Itching skin (urticaria) and even a more serious reaction may occur, albeit rarely.

Closing Remarks

The kiwifruit is a nutritional czar, if there ever was one. If you ever get a chance, try and chow down on one now and again to reap the multiple health benefits.

what are the health benefits of curry leaves

Curry Leaves – A Powerhouse Of Health Benefits

Our versatile Indian cuisine incorporates curry leaves in most dishes, especially in the South of India. While it adds flavor and an aroma to the food, it in fact has numerous health benefits that are often overlooked.

Curry leaves, also called Kadi Patta, have amazing health benefits. Let’s take a look at them here.

What Are Curry Leaves?

Curry leaves, also called Murraya koenigii in the world of biology, is a herb that is widely used in cooking. It originates from the curry tree.

Curry leaves contain numerous nutrients, including proteins, fiber, carbohydrates, minerals and numerous vitamins. It also contains alkaloids like murrayastine, murrayaline, pyrayafoline carbazole alkaloids.

Traditionally, curry leaves have been used as a medicine to improve digestion and appetite. It was also used as a treatment for diabetes. Besides this, it has been used in treating loose motion, blood disorders, worms, piles and open wounds.

The health benefits of curry leaves are numerous. Let’s take a look at what it can do for your health.

Nutritional Content Of Curry Leaves (per 100 grams)
  1. Water – 65 gm
  2. Protein – 7.4 gm
  3. Carbohydrate – 4.5 gm
  4. Fiber – 17 gm
  5. Fat – 1 gm
  6. Magnesium – 182 mg
  7. Potassium – 584 mg
  8. Sodium 18.6 mg
  9. Selenium – 17.25 mg
  10. Iron – 9 mg
  11. Calcium – 659 mg
  12. Vitamin C – 24 mg
  13. Vitamin E – 1.8 mg
  14. Beta Carotene – 7.6 mg

Curry Leaves Can Lower Cholesterol

There is a fair bit of data that suggests that curry leaves can lower your cholesterol levels.

In one study conducted in diabetic rats, curry leaf extract administered over 1 month lowered both total cholesterol and triglyceride levels by 31% and 37% respectively.

Human studies have also confirmed the same. In a study looking at post-menopausal women between 45 – 65 years with high cholesterol, an addition of 5 grams of curry leaf powder to their lunch over 45 days –

  • Lowered LDL (bad cholesterol)
  • Increased HDL (good cholesterol)
  • Lowered triglycerides (bad cholesterol)

It appears that curry leaves can lower cholesterol naturally. Munch on them when you get a chance!

Protection In Diabetes

The role of curry leaves in managing diabetes is rather complicated.

In diabetes, you will know that there is initially an excess of insulin secretion to try to control elevated blood sugar levels. Over time, the pancreas beta cells, which are responsible for this excess insulin production, become tired and exhausted. This leads to lower insulin levels.

Over a period of time, diabetes begins to affect multiple organs, including the heart, kidney, brain, eyes and nervous system.

Studies have found that curry leaf extracts can protect the beta cells of the pancreas, and normalise insulin levels. It also works on the way muscles utilise the glucose in the blood, increasing it’s uptake, improving muscle health and lowering glucose levels.

In a study conducted in diabetic male rats, regular oral administration of curry leaf extract reduced levels of urea and creatinine in the bloodstream. This means that it can protect the kidneys in diabetes.

Similar studies have found that these extracts can protect the nerve fibers as well, making it useful in preventing diabetic neuropathy.

It is believed that the presence of certain trace elements such as zinc, chromium, copper, iron, nickel etc. may be responsible for better blood glucose control.

curry leaves health benefits

Anticancer Effects

There are many foods that have natural anticancer effects.

The extracts of the bark of the curry leaf tree contain carbazole alkaloids called girimbine and acarbazone, which studies have shown to kill cancer cells in liver cancer.

It may also have some benefit in preventing colon and bowel cancer.

An Indonesian trial found that extract of curry leaves could kill HeLa cells, which are the cancer cells seen in cervical cancer.

Similarly, it may have a protective effect against prostate cancer.

Numerous anticancer mechanisms have been proposed, but most studies are animal studies or lab based studies and not human trials.

Liver Protection

You will know that high alcohol intake on a regular basis can destroy the liver. The carbazole alkaloids in curry leaves have been shown to have a protective effect on the liver cells.

In a study where rat livers were damaged by high doses of paracetamol, curry leaf extract fed to these rats improved liver function and appearance of the tissue under the microscope. This effect is brought about by it’s powerful antioxidant properties and ability to lower inflammation.

Similarly, a improvement in liver enzymes is also seen in rat studies.

Antibacterial And Antifungal Properties

Fighting bacterial and fungal infection with medications all the time may not always be possible.

Extracts of curry leaves have been found to possess antibacterial properties. They can fight against common bacteria such as E.coli, staphylococcus, streptococcus and proteus.

Essential oils derived from the leaf has been shown to be effective against powerful bacteria such as Pseudomonas.

The alkaloids and flavonoids that are present in curry leaf can prevent fungal infections as well. It appears to have a negative effect on a wide variety of different fungi.

Curry Leaves Protect Your Brain

Alzheimer’s disease and Parkinson’s disease are worrying clinical conditions that affect the brain and rob you of your dignity.

Studies have found that curry leaves can improve memory and learning.

Other Benefits

Besides what I have listed above, curry leaves have numerous other benefits.

For example, the oils derived from the leaves can be incorporated in creams and used to cure skin diseases such as acne, boils, itching and athlete’s foot.

Curry leaves are rich in vitamin A and calcium, so eating these can strengthen your bones as well.

Of course, don’t forget how awesome your food tastes when you add these leaves to it!

Where To Buy

Curry leaves are available with your local vegetable vendor or supermarket.

You can buy curry leaf powder online on Amazon here.

Closing Remarks

There is no doubt that there are numerous health benefits of curry leaves. Make sure that you include them as a part of your regular diet.

 

foods that prevent cancer

Anticancer Foods – Your Guide To Choosing The Best Ones

Anticancer foods – does such a thing even exist?

A diagnosis of cancer can be devastating, even if you know there is a cure. While treatments are many, prevention remains better than possible cures.

There are many ways one can reduce their risk of developing cancer. Avoiding smoking, lowering alcohol intake and regular exercise – all can help reduce your chances of developing cancer.

Probably the most important way to lower your cancer risk is consuming the right foods. I thought I would touch upon ‘anticancer’ foods, and hopefully by the time you reach the end of the article, you will realize that what you eat matters when it comes to cancer.

I will be touching upon foods that you can eat rather than spices like turmeric that have anticancer properties.

Lets go….

How Your Diet Can Increase Your Risk Of Cancer

First, I thought I would talk about how what you eat and how much you eat can increase your risk of cancer.

Low Fiber Diet

Fiber is an essential part of a nutritious diet. The more you eat, the more you protect your body against heart disease, digestive problems, and yes, cancer.

A diet low in fiber is generally seen in those who mostly eat non-vegetarian food. Meat and fish, while high in protein, lack any fiber.

Those who eat white bread or foods made from refined flour (biscuits, bakery items etc) also get no fiber in their diet.

If you recall, in an article elsewhere, I have spoken of soluble and insoluble fiber. Soluble fiber mixes with water in the gut, forming a gel that coats the inner lining of the bowel. This coating prevents harmful cholesterol and excessive sugar from being absorbed by the gut.

This has a protective effect on the body.

Insoluble fiber helps maintain a healthy digestive tract. It prevents you from becoming constipated.

Studies have found that consuming low fiber can increase your risk of bowel cancer.

Diet High In Red Meat

There are many of us who enjoy eating red meat regularly. The bad news is that there exists a strong link between red meat intake and colon cancer.

Remember that red meat, while high in protein, lacks fiber. When cooking red meat, compounds called heterocyclic amines are generated, which are carcinogenic (cancer forming).

Studies have found that these heterocyclic amines can increase the risk of breast cancer.

Overeating Is A Problem

We are a nation of over-eaters. Many of us can’t just stop a meal at a main course alone. Some want a starter and a dessert with every meal!

how to prevent cancer

Ordering food in has become the norm, though it has come down a little during the current COVID crisis. Prior to this, people would order food almost every evening, mostly because their jobs were keeping them busy.

Not just that; eating more is being made more attractive through advertising. Portion sizes are expected to be large for the money that is spent on food.

The basic problem with how we eat in our country is that we consume too many calories. Some of our diets have over 3000 to 4000 calories sometimes, and we rarely realise it.

Even if you eat your veggies every day, having a high amount of calories in your diet on a regular basis can make you overweight.

Obesity has been estimated to cause 14% of all cancer deaths in men and around 20% in women.

In a study conducted in India, women who had a higher body mass index were more likely to develop breast cancer compared to those who had a normal weight.

Just by cutting down your calories and increasing your veggie intake, the risk of cancer can come down many fold.

High calorie foods include rice and rice based foods, fried items, snacks, bakery items and foods with added sugar in them.

Refined Flour Based Foods

Foods that are made from refined flour (maida) may be tasty, but they can harm your health. Refined wheat flour contents 78% less fiber, 74% less vitamins and 69% less minerals, according to the USDA Food Database.

foods that fight cancer

In addition to this, refined flour based foods have a high glycemic index. This means that they increase the blood sugar values rapidly once they are eaten.

Various clinical studies have found that such surges in the sugar levels in the blood stream can increase the risk of gastric cancer, endometrial cancer, ovarian cancer and even colon cancer.

Of course, it is not just refined flour that can shoot up your sugars. Even simple cane sugar, honey and normal sugar we eat can have the same effect.

In other words, sugary foods that can increase your blood sugar levels rapidly can cause cancer.

So now that you have an idea of what foods can increase your risk of cancer, let’s take a look at some anticancer foods you could include in your diet.

Best Anticancer Foods You Can Eat

Here are some of my favorites –

Flax Seeds

Flax seeds are becoming a popular health supplement, mostly due to its high fiber content and presence of omega-3 fatty acids.

flax seeds anticancer foods

Flax seeds contain lignan – a compound that has anticancer effects. Mouse studies that have been conducted over years have found that a diet rich in flax seeds could lower the risk of breast cancer and it spreading as well.

There also appears to be a benefit of flax seed intake against prostate cancer in men. However, this effect is not seen with flax seed oil, but rather with whole flax seed.

Vegetarian Diet

Following a vegetarian diet can lower your chances of developing cancer. This has been proven time and again in clinical studies.

vegetable that fight cancer

Numerous anticancer elements in veggies and fruits include vitamin C and E, folic acid, lycopene, dietary fiber, selenium and isoflavones.

In fact, the American Institute of Cancer Research states that multiple types of cancers can be prevented by just following a vegetarian diet.

Cancers That Can Be Prevented By A Vegetarian Diet
  1. Oral cancer
  2. Cancer of the pharynx
  3. Esophagus (food pipe) cancer
  4. Breast cancer
  5. Stomach cancer
  6. Lung cancer
  7. Colon cancer

In recent years, there has been a move towards ‘veganism’. This is a diet made of just vegetarian food, but with no dairy products (milk, curds, cheese etc). Generally, the risk of cancer is not lower than what a vegetarian diet confers, though it seems to have more benefit in prostate cancer.

Let’s take cruciferous vegetables – broccoli, cauliflower and cabbage. These are probably the best anticancer foods, as they are rich in sulforophane, which has anticancer properties. Of these, broccoli is the most powerful.

Regular consumption of cruciferous veggies can lower your risk of breast cancer, Non-Hodgkin’s Lymphoma, lung cancer and even prostate cancer.

anticancer effects of broccoli

Tomatoes contain lycopene, a compound that has protective effects against prostate cancer, and reduces the risk by up to 40%. Cooked tomatoes have more lycopene compared to raw ones, so better to choose the latter.

I often advise patients to eat different colors of vegetables. This is because different colored veggies have alpha and beta carotenoids, which have powerful cancer fighting properties. Carrots, carrot juice and pumpkins are amazing sources. Capsicum (traffic light – red, green and yellow) also contain carotenoids.

There remains a dictum of eating 5 portions of fruit and vegetables every day. I am not sure where this number really came from, but I guess keeping this in mind makes it easier to ensure you get what your body needs. The more you eat, the better it is for you.

A single portion is a cupful of vegetables or a single fruit.

Foods Rich In Vitamin C

Citrus fruits, especially amla (gooseberry), are excellent sources of vitamin C. Vitamin C has powerful antioxidant and anticancer effects, and is sometimes used as an intravenous medicine in cancer therapy.

citrus fruits vitamin C anticancer

Doses given in cancer treatments are significantly greater than what is prescribed as a daily supplement of vitamin C.

How Much Fruits And Vegetables Should You Eat For Anticancer Effects?

It is advised by some experts to have 10 servings of vegetables and 4 or more servings of fruits a day to protect yourself from cancer.

Honestly speaking, it might be quite hard to keep track of that.

If you really want to reap the anticancer effects of foods, then you need to include them in good quantities in your daily diet.

What Is The Best Anticancer Diet Then?

In a nutshell you should include all the following that I have listed in the table below:

Your Anticancer Diet
  1. 10 servings of vegetable – include cruciferous veggies, capsicum and carrots
  2. 4 servings of fruits of your choice
  3. A good amount of green leafy vegetables
  4. Low fat diet
  5. High fiber foods – oats, whole grains
  6. Avoid red meat
  7. Include fish or take an omega 3 supplement
  8. Avoid refined flour based foods (bakery items)
  9. You may need supplements of vitamin D and B12

Closing Remarks

You could lower your risk of developing cancer with these anticancer foods. Choose well and stick to not just a good diet, but also an exercise routine.

vitamin d supplement

Vitamin D and COVID-19 – Can It Lower Your Risk?

The COVID-19 crisis is giving many sleepless nights. Many are looking for ways to build up their immunity in order to lower their chances of getting infected. Reports suggest a relationship between vitamin D and COVID infection – one where vitamin D protects you against it.

I thought I would explore the existing literature today.

The COVID-19 Crisis

You will be aware that the COVID-19 infection, also called SARS CoV-2, is a viral infection that is sweeping our planet and affecting many. It acts through numerous mechanisms, leading to fever, cough, loss of taste and smell, body pain, and in some cases diarrhoea and vomiting.

vitamin d supplements for covid

Even those taking precautions are getting affected, mostly because some people around them are not.

The only way to prevent this infection effectively is to practice social distancing, wash your hands regularly with soap and water at home, use a sanitizer with at least 70% alcohol when you are out of the house, and of course, to wear a tight-fitting mask.

Staying healthy is also essential to build up immunity against the coronavirus infection. Regular exercise, a healthy balanced diet with plenty of fruits and veggies, and a good night’s sleep is of paramount importance.

A good intake of vitamins and minerals is needed to keep our immune system at full guard. Vitamin D has a role to play in this.

The Role Of Vitamin D In Immunity

Vitamin D has been primarily recognised as a vitamin essential for bone health. Vitamin D and calcium work as a pair in strengthening our bones, keeping them healthy and preventing fractures.

Interestingly, vitamin D also helps boost your immunity. This is in fact old news, with vitamin D supplements (in cod liver oil) being previously used to treat lung tuberculosis .

Our immune system consists of various types of cells. These include monocytes, dendritic cells, B cells, T cells, and macrophages. Each of these have a role to play when fighting viral infections, including COVID-19.

On the surface of these cells are tiny receptors called Vitamin D receptors, or VDR. When the immune cells move to sites within the body where there is inflammation, the vitamin D binds to the VDR, forming a complex.

This complex moves into the nucleus of the immune cell, where it modifies the genes and produces antimicrobial compounds like defensin and cathelicidin.

This phenomenon leads to lower production of harmful products called cytokines. Cytokines are generally released in large quantities in COVID-19 infection, overwhelming the body and leading to rapid deterioration of patients.

This burst of cytokine release is called cytokine storm. Vitamin D can lower this significantly.

There are many other mechanisms through which vitamin D can boost immunity. I will not be discussing them here as it is out of the scope of this article.

Vitamin D versus Common Cold

The common cold is probably the most ‘common’ infection us humans suffer from. Visits to the doctors are mostly due to runny nose and chest congestion, especially in the rainy and cold winter months.

Studies have found that a dose of 400 IU per day of vitamin D can build up immunity against chest infections. Doses up to 2000 IU per day have also been advised.

The benefits have been seen in both adults and children.

In children, a combination of regular vaccinations and vitamin D supplementation has been found to boost immunity against respiratory tract infections. It also reduces the chances of needing antibiotics.

However, the benefit may not be seen in all.

For example, in a study looking at adults with mild to moderate asthma who were taking steroid inhalers, addition of vitamin D supplements did not help reduce cold or severity of it.

The maximum benefit of vitamin D supplementation to boost immunity against chest infections was seen in those who were deficient.

In general, combining vitamin D with vitamin C supplements can lower the duration and severity of the common cold.

Vitamin D has also been shown to have a protective effect against viruses such as the rotavirus  and HIV as well.

Vitamin D and COVID-19

The levels of vitamin D that we have in our body reduces as we get older. Unfortunately, our chances of catching the COVID-19 infection increases as we get older too.

So is there a connection between vitamin D levels and COVID-19 infection?

vitamin D and covid

There is a plethora of evidence that describes vitamin D supplementation as an effective way to prevent chest infections.

In a rather interesting study,  it was found that people who lived in countries below 35 degrees northern latitude had a lesser chance of dying from COVID-19. This was because those that are above the 35 degree latitude had lesser exposure to sunlight, and hence more likely to be vitamin D deficient.

In another study looking at COVID-19 patients admitted to an ICU, researchers found that lower vitamin D levels amplified the symptoms of COVID-19.

In a very recent study, low vitamin D levels were found to worsen conditions (high blood pressure, heart disease etc) that would indirectly lead to lowered immunity and an ability to fight COVID infection.

In other words, if you have low vitamin D levels, topping it up with supplements could not only lower your chances of contracting COVID-19; it could lower the severity of the infection if you did. There appears to be a benefit of vitamin D supplements for children as well.

As is the case always, there are proponents of the opposite. The National Institute of Clinical Excellence (NICE) in the UK has extensively reviewed the available evidence , and categorically states that there is no strong evidence supporting a role of vitamin D supplementation in COVID-19.

What Dose Of Vitamin D Is Needed To Boost Immunity?

If you have ever checked your vitamin D level in a clinical laboratory, you will find that levels below 30 ng/ml are described as deficient.

Studies suggest that keeping your vitamin D level around 50 ng/ml is ideal to protect you against viral infections.

The recommended daily dose for vitamin D is around 600 IU to 800 IU a day. However, those that are deficient will require between 2000 IU to 4000 IU daily.

I generally recommend 2000 IU daily to keep levels at an appropriate value. Higher doses can cause abdominal pain, constipation, increased thirst, vomiting and high calcium levels.

Are Vitamin D Supplements Safe?

Generally yes. But you must bear in mind that vitamin D is a ‘fat soluble’ vitamin. This means that any excess ingested can accumulate in the body.

This can be harmful.

As such, 2000 IU a day is a safe dose to take. If you are deficient, you may need a higher dose. Talk to your doctor about what is right for you.

Should I Take Vitamin D Supplements To Prevent COVID Infection?

As vitamin D is only obtained through sunlight exposure, it is likely that you will need a supplement right now.

We are all locked up in our houses, and even sitting out on your terrace every morning may not give you the dose you need.

There are plenty of over-the-counter supplements of vitamin D available in the market. If you are confused about what to take, speak to your doctor.

Bottom Line and Closing Remarks

There appears to be a connection between vitamin D and COVID infection. There also appears to be a role in vitamin D supplements lowering your chance of developing COVID infection as well.

However, there is still data needed.

I personally feel that more randomized trials that look particularly at the relationship between vitamin D levels and COVID infection are needed. This will obviously take time.

When you get a chance, check your vitamin D levels in a lab and ask your doctor if you need supplements. In addition to possibly offering protection against the COVID-19 infection, it will most certainly keep your bones and muscles healthy.