Update on Corona virus

August 26, 2020

Since the last newsletter from May 28, things have gone well here in Denmark.
On the other hand, viruses have become widespread, especially in those countries that have not taken the spreading of infection seriously.
In the past month, however, localized infection clusters have emerged in various places here in Denmark as well, especially in immigrant communities.
The reasons for this have been mentioned in the previous newsletters, whose advice is still valid, so I will not repeat it here, but instead focus on what has happened in the last 3 months.

Studies
In a literature study(1) from Norwegian, Russian and Swedish public health institutes six researchers have concluded that early intervention with Zinc, Selenium and Vitamin-D can alleviate the course of the disease, and virtually prevent the cytokine storm, which is the process responsible for the destruction of tissues, microthromboses, inflammation, etc. -the whole cascade that can take the life of the Covid-19 sick persons.

An almost simultaneous study(2) from Germany analyzed Serum-Selenium and Serum-Selenoprotein P, and both values were significantly lower in those who did not survive Covid-19.
(Selenium: 53.3 ± 16.2 vs. 40.8 ± 8.1 μg / l, Selenoprotein-P: 3.3 ± 1.3 vs. 2.1 ± 0.9 mg / L p<0.001). These results must be said to be highly relevant in our country, where we consume so little selenium. This study falls nicely in line with the former study.

On August 3, an article was published in the Lancet(3) which strongly calls for increased intake of vitamin D based on solid literature reviews.
This also falls in line with the first study mentioned above.

And, finally, there is a meta-analysis(4) of the role of vitamin D in the development of acute respiratory infection. It includes 30,000 people in controlled trials (RCTs), and has shown significantly reduced risk of acute respiratory infection already at 10-25 µg of vitamin D daily.
This confirms a previous meta-analysis(5), which also found a significant inverse correlation between the risk of acute respiratory infection and the vitamin D content in the blood.
All of the above studies are nicely in line with the advice mentioned in the five newsletters from May.

Authorities distribute vitamins
Azerbaijan has registered 35,000 Covid-19 cases in a population of 10 million. Of these, 1,800 were hospitalized and 508 died.
Here, the Ministry of Health has provided more than 3,500 Covid-19 patients with a free “medicine package” containing: Vitamin C, Vitamin D, Magnesium, Selenium, Zinc and Paracetamol.
The idea is then that the patients stay at home and treat themselves there.
Every day they are then contacted by the local hospital clinic and have to answer a series of questions, just as the doctor checks that they are taking their pills.
So far, a significant reduction in the number of hospitalizations in this group has been observed(6).

You can only shout cheers when you see authorities who can think outside the box and dare to start such a project. My guess is that the trend will continue and that home treatment will continue to reduce hospital admissions in Azerbaijan.

The idea is not bad because you initiate a completely harmless treatment of a, for some people, -dangerous disease.
But why wait until they get sick?

With timely care, one can improve the immune system of the entire population if one simply provides information about these supplements and their significance.

What could be done here in Denmark is to provide subsidies to the vulnerable groups, especially residents of the country’s nursing homes, who are completely dependent on the public perception of vitamins and minerals. If their own doctor does not prescribe a vitamin supplement, then residents are often denied help to get the supplements, despite their own desire. They are completely dependent upon the doctor’s knowledge or lack thereof. I think Danish authorities and medical staff would be shocked if we measured the level of vitamin D in the country’s nursing home residents.
If you do not want to use public funds to donate these subsidies to the residents, then you can at least make sure that both residents and their relatives are informed.

These newsletters on Covid-19 are unfortunately necessary as this knowledge and the scientific back-up are neglected in the public advice to the Danish population.

Take care of yourself and others

Claus Hancke MD
Specialist in general medicine

References

  1. Alexander J, Alehagen U et al. (2020) Early Nutritional Interventions with Zinc, Selenium and Vitamin D for Raising Anti-Viral Resistance Against Progressive COVID-19. Nutrients 2020, 12, 2358.
  2. Moghaddam A, Heller R et al. (2020) Selenium Deficiency Is Associated with Mortality Risk from COVID-19. Nutrients 2020, 12, 2098.
  3. Martineau A, Forouhi N (2020) Vitamin-D for Covid-19: a case to answer. Lancet 2020;8:735-6.
  4. Joliffe D, Martineau A, Damsgaard Camilla et al. (2020) Vitamin D supplementation to prevent acute respiratory infections: Systematic review and meta-analysis of aggregate data from randomised controlled trials. medRxiv BMJ (endnu ikke peer reviewed) 17.juli 2020.
  5. Martineau A et al. (2017) Vitamin D supplementation to prevent acute respiratory tract infections: Systematic review and meta-analysis of individual participant data.
    BMJ 2017;356:i6585.
  6. lmahamad A, (2020) 3.500 covid-19 patients provided with free medication. Azernews 18.august 2020. https://www.azernews.az/healthcare/168099.html

Zinc is important for the immune system

– also for Covid-19 disease

May 18 2020

In continuation of the previous two newsletters on Vitamin D and Selenium, a little important information about Zinc and its importance to the immune system is now presented here.

In these corona times, it is especially necessary that we each optimize our immune system so that we are well prepared for a possible new wave in about half a year from now, when people’s deposits of vitamin D again are declining.

In the Western part of the world, about 25% of the population has some level of zinc deficiency, especially the elderly, people with high alcohol consumption, people with chronic infections, those who get certain types of medicine, and elite athletes, who use up their magnesium and zinc.

Zinc is part of more than 200 different enzyme systems and is a prerequisite for normal growth and cell formation and a well-functioning immune system.

There is solid evidence that zinc deficiency leads to increased susceptibility to infection. Since zinc supplementation has also been found to reduce the duration of a cold, various zinc lozenges have been tried, and a Cochrane study of 18 studies found that 75 mg of zinc a day could reduce the duration of cold symptoms in healthy people, provided the zinc tablets were given within the first 24 hours after symptom onset.

The effect lies, among other things, in the skin and mucous membranes, where zinc is necessary for the cell replication that the body initiates when an infection is to be fought. This is especially true regarding the growth, maturation and differentiation of circulating lymphocytes, T cells and the killer cells, NK cells that we need to fight viruses.

In 2010, an in vitro study showed that zinc inhibits another coronavirus, namely SARS-CoV, which caused an epidemic in 2002. Zinc has a direct antiviral effect by inhibiting SARS-CoV RNA polymerase, which is a prerequisite for virus replication.

There is no specific study yet on the effect of zinc on the current CoV-Sars-2, but natural connections are looked for and, for example, the current Covid-19 disease is characterized by many people’s losing the sense of taste and smell, which is also seen in the case of zinc deficiency.
But it could be coincidence.

We have to take zinc all the time, as it is not stored specifically. It is not difficult to get enough zinc here in Denmark, just by eating real food and not industrial synthetic ‘plastic’ food. Zinc is found in meat, seafood, organ meat, fish, eggs, legumes, cereals, dairy products, green vegetables, fruits and berries. An intake of 20-30 mg per day is enough.

If you take zinc as a supplement, remember that it can reduce the copper content of the body, as zinc will upregulate the metallothionein synthesis, which can cause copper loss. This is probably not of great importance here in Denmark, where a large pig production has given us all a solid copper supplement.

In any case, we need zinc to optimize our immune system, so we are ready to fight an virus infection.

Now you have read about vitamin D, selenium and zinc in relation to the immune system.
The next newsletter to arm your immune system against Covid-19 will be about Vitamin C.

Take care of yourself and others,

Claus Hancke, MD,
Specialist in general medicine

Refs:

  • Read Scott A, Obeid S et al. The role of Zinc in antiviral immunity.(2019) Adv Nutr 2019;10:696–710
  • Skalny et al: Zinc and respiratory tract infections: Perspectives for Covid-19. Int J Molecular Med. April 13, 2020
  • Mossad S, Macknin M, Mendendorp S, et al. Zinc Gluconate Lozenges for Treating the Common Cold: A Randomized, Double-Blind, Placebo-Controlled Study. Annals of Internal Medicine 15 July 1996
  • Velthuis AJW, van den Worm SHE, Sims AC, Baric RS, Snijder EJ, van Hemert MJ (2010). Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. PLoS Pathog 6(11): e1001176.
  • Shankar AH, Prasad AS. Zinc and immune function: The biological basis of altered resistance to infection. Am J Clin Nutr. 1998 Aug;68 (2 Suppl): 447S-463S. doi: 10.1093/ajcn/68.2.447S.
  • Singh M, Das RR. Zinc for the common cold. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD001364. DOI: 10.1002/14651858.CD001364.pub4
  • Yoshimura A, Naka T, Kubo M. SOCS proteins, cytokine signalling and immune regulation. Nat Rev Immunol 2007;7(6):454–65.

Zinc, Research references

January 1999

1. Aamodt RL, Rumble WF, Johnston GS et al. Absorption of orally administrated 65Zn (zinc) by normal human subjects. Am J Clin Nutr 1981; 34: 2648-2652.
2. Bales CW, Freeland-Graves JH, Askey S et al. Zinc, magnesium, copper, and protein concentrations in human saliva. Age- and sex-related differences. Am J Clin Nutr 1990, 51: 462-469.
3. Balogh Z et al. Plasma Zinc and its relationship to clinical symptoms and drug treatment in rheumatoid arthritis. Ann Rheum Dis 39(4): 329-32, 1980.
4. Berg JM, Shi Y. The galvanization of biology. A growing appreciation for the roles of zinc. Science 1996; 271: 1081-1085.
5. Brody I. Topical treatment of recurrent herpes simplex and post-herpetic erythema multiforme with low concentrations of zinc sulphate solution. Br J Dermatol 104; (2):191-4, 1981.
6. Caselli M, Bicocchi R. Taux serique du zinc chez les malades atteints du syndrome d’immunodeficit acquis. Presse Med 37:1877-8, 1986 (in French).
7. Cunnigham-Rundles S, Cunningham-Rundles WF. Nutrition and immunology. New York: Alan R. Liss. 1988: p 197-214.
8. Cousins RJ, Hempe JM. Zinc. In: Present knowledge in nutrition. 6th edn. Washington, DC: Nutrition Foundation. 1990: p 251-260.
9. Cousins RJ. Zinc. In: Present knowledge in nutrition. 7th edn. Washington, DC: Nutrition Foundation. p 293-306, 1996.
10. Crofton RW et al. Zinc metabolism in celiac disease. Am J Clin Nutr 52; (2):379-82, 1990.
11. DeBartolo HM Jr. Zinc and diet for tinnitus. Am J Otol 10; 3: 256, 1989.
12. De Gordon AM. Effects of adjuvant therapy with zinc in human immunodeficiency infection. Abstract. J Am Coll Nutr 11; (5):601, 1992.
13. De Gordon AM. Evaluation of tissue zinc status through cell-mediated immune response in HIV disease. Abstract. J Am Coll Nutr 11; (5):602, 1992.
14. Eby GA. Use of topical zinc to prevent recurrent herpes simplex infection: Review of literature and suggested protocols. Med Hypotheses 17:157-65, 1985.
15. Eby GA. Linearity in dose-response from zinc lozenges in treatment of common colds. J Pharmacy Technol 11:110-22, 1995.
16. Engel ED et al. Diabetes melitus: Impaired Wound Healing from Zinc Deficiency. J Am Pod Assoc 71: 536-44, 1981.
17. Finnerty EF. Topical zincin the treatment of herpes simplex. Cutis 37; (2):130-1, 1986.
18. Fitzherbert J. Genital herpes and zinc. Med J Aust 1:399, 1979.
19. Gersdorff M et al. The zinc sulfate overload test in patients suffering from tinnitus associated with low serum zinc. Preliminary report. Acta Otorhinolaryngol Belg 41; 3: 498-505, 1987.
20. Gersdorff M et al. A clinical correlation between hypozincemia and tinnitus. Arch Otorhinolaryngol 244; 3:190-3, 1987.
21. Gibson RS, Anderson BM, Scythes CA. Regional differences in hair zinc concentrations. A possible effect of water hardness. Am J Clin Nutr 1983; 37: 37-42.
22. Godfrey JC, Sloane B, Smith D. Zinc gluconate and the common cold: a controlled clinical study. J Int Med Res 20; 3:234-46, 1992.
23. Gordon YJ et al. Irreversible inhibition of herpes simplex virus replication in BSC-1 cells by zinc ions. Antimicrob Agents Chemother 8; (3):377-80, 1975.
24. Grennan DM et al. Serum copper and zinc in rheumatoid arthritis and osteoarthritis. N Z Med J 91; 652: 47-50, 1980.
25. Hambidge KM. Zinc deficiency in young children. Am J Clin Nutr 1997; 65: 160-161.
26. Haring BSA, Van Delft W. Changes in the mineral composition of food as a result of cooking in ‘hard’ and ‘soft’ waters. Arch Environ Health 1981; 36: 33-35.
27. Hegazi SM et al. Effect of Zinc Supplementation on Serum Glucose, Insulin, Glucagon, Glucose-6-Phosphatase and Mineral Levels in Diabetics. J Clin Biochem Nutr 12: 209-15, 1992.
28. Honkanen VEA et al. Plasma zinc and copper concentrations in rheumatoid arthritis: Influence of dietary factors and disease activity. Am J Clin Nutr 54: 1082-6, 1991.
29. Huber AM, Gershoff SN. Effects of zinc deficiency on the oxidation of retinol and ethanol in rats. J Nutr 10:11:1486-90, 1975.
30. King JC, Hambidge KM, Westcott JL et al. Daily variation in plasma zinc concentrations in women fed meals at six-hour intervals. J Nutr 1994; 124: 508-516.
31. King JC. Does poor zinc nutriture retard skeletal growth and mineralization in adolescents? Am J Clin Nutr 1996; 64: 375-376.
32. Kondo T, Toda Y, Matsui H. Effects of exercise and sleep deprivation on serum zinc. J Trace Elem Exp Med 1990; 3: 324-354, 1990.
33. Koyama H, Hosokai H, Tamura S et al. Positive association between serum zinc and apolipoprotein A-II concentrations in middle-aged males who regularly consume alcohol. Am J Clin Nutr 57: 657-661, 1993.
34. Krebs NF, Reidinger CJ, Hartley S et al. Zinc supplementation during lactation. Effects on maternal status and milk zinc concentrations. Am J Clin Nutr 61: 1030-1036, 1995.
35. Krotkiewski M et al. Zinc and muscle strength and endurance. Acta Physiol Scand 116; 3: 309-11, 1982.
36. Mahajan S, Prasad A, Brewer G et al. Effect of changes in dietary zinc intake on taste acuity and dark adaptation in normal human subjects. J Trace Elem Exp Med 5: 33-45, 1992.
37. Mares-Perlman JA et al. Association of zinc and antioxidant nutrients with age-related maculopathy. Arch Ophthalmol 114:991-7, 1996.
38. Masters DG, Keen CL, Lonnerdal B, Hurley LS. Zinc deficiency teratogenicity. The protective role of maternal tissue catabolism. J Nutr 113: 905-912, 1983.
39. Mattingly PC et al. Zinc Sulphate in Rheumatoid Arthritis. Ann Rheuma Dis 41: 456-7, 1982.
40. Meadows NJ, Ruse W, Smith MF et al. Zinc and small babies. Lancet 2: 1135-1137, 1981.
41. Menkes C-J et al. Traitement de la polyarthrite rheumatoide par le sulfate de zinc par os. Presse Med 7: 760, 1978 (French).
42. Mobarhan S et al. Dietary zinc deficiency produces electroretinogram ERG abnormalities without depleting total ocular zinc. Fed Proc 43:685, 1984.
43. Mocchegiani E, Veccia S, Ancarani F, et al. Benefit of Oral Zinc supplementation (as an adjunct to Zidovudine (AZT)) Therapy against Opportunistic Infections in AIDS. Int J Immunopharmacol 17; (9):719-27, 1995.
44. Moser-Veillon PB, Reynolds RD. A longitudinal study of pyridoxine and zinc supplementation of lactating women. Am Clin Nutr 52: 135-141, 1990.
45. Mossad SB, Macknin ML, Medendorp SV et al. Zinc gluconate lozenges for treating the common cold. A randomized, placebo controlled study. Ann Intern Med 125: 81-88, 1996.
46. Mussalo-Rauhamaa H et al. Predictive clinical and laboratory parameters for serum zinc and copper in rheumatoid arthritis. Ann Rheum Dis 47; 10: 816-19, 1988.
47. Naveh Y et al. Zinc metabolism in rheumatoid arthritis: plasma and urinary zinc and relationship to disease activity. J Rheumatol 24; 4: 643-6, 1997.
48. Newsome DA, Swartz M, Leone NC, et al. Oral zinc in macular degeneration. Arch Ophthalmol 106:2:192-8, 1988.
49. Newsome DA et al. Zinc content of human retinal pigment epithelium decreases with age and macular degeneration, but superoxide dismutase activity increases. J Trace Elem Exp Med 8:193-9, 1995.
50. Nishi Y. Anemia and zinc deficiency in the athlete. J Am Col Nutr 15: 323-324, 1996.
51. Pandley SP et al. Zinc in rheumatoid arthritis. Indian J Med Res 81: 618-20, 1985.
52. Peretz A, Nève J, Jeghers O, Pelen F. Zinc distribution in blood components, inflammatory status, and clinical indexes of disease activity during zinc supplementation in inflammatory rheumatic diseases. Am J Clin Nutr 57: 690-4, 1993.
53. Posacki C, et al. Plasma, Copper, Zinc, and Magnesium Levels in Patients with Premenstrual Tension Syndrome, Acta syndrome : Obstet Gynecol Scand 73; 452-5, 1994.
54. Prasad ASP. Clinical biochemical and nutritional spectrum of zinc deficiency in human subjects: An update. Nutr Rev 41: 197-208, 1983.
55. Rangnekar GV, Gamur MS. Serum and urinary zinc levels in urolithiasis. Br J Urology 71:527-9, 1993.
56. Reunanen A, Knekt P, Marniemi J et al Serum calcium, magnesium, copper and zinc and risk of cardiovascular death. Eur J Clin Nutr 50: 431 – 437, .
57. Shambaugh GE Jr. Zinc for tinnitus, imbalance, and hearing loss in the elderly. Am J Otol 7; 6:476-7, 1986.
58. Simmer K, Thompson RP. Maternal zinc and intrauterine growth retardation. Clin Sci 68: 395-399, 1985.
59. Singal PK, Dhillon KS, Beamish RE, et al. Protective action of zinc against catecholamine-induced myocardial changes. Electrocardiographic and ultrastructural studies. Lab Invest 44:426, 1981.
60. Soltan MH, Jenkins DM. Maternal and fetal plasma zinc concentration and fetal abnormality. Br J Obstet Gynaecol 89: 56, 1982.
61. Sandstead HH. WO Atwater memorial lecture. Zinc. Essentially for brain dcvelopment and function. Nutr Rev 1985; 43: 129-137, 1985.
62. Schauss AG, Bryce-Smith D. Nutrients and brain function. Basil: Karger. p 151-162, 1987.
63. Shah DR et al. Effect of oral zinc sulphate on serum lipids and lipoproteins in human subjects. Indian J Physiol Pharmacol 32;1:47-50, 1988.
64. Shambaugh GE Jr – interviewed in Anonymous. Hearing loss may be linked to zinc deficiency. Geriatrics 38; 4:21, 1983.
65. Shambaugh GE Jr. Zinc for tinnitus, imbalance, and hearing loss in the elderly. Am J Otol. 7: 476-477, 1986.
66. Shambaugh GE Jr. Zinc. The neglected nutrient. Am J Otol. 10: 156-160, 1989.
67. Shambaugh GE. Zinc, an essential nutrient for hearing and balance. Int J Biosocial Med Res. 13: 192-199, 1991.
68. Simkin PA. Oral zinc sulphate in rheumatoid arthritis. Lancet ii: 539-42, 1976.
69. Simkin PA. Treatment of Rheumatoid Arthritis with Oral Zinc Sulfate. Agents and Actions; (suppl.) 8: 587-95, 1981.
70. Sturniolo GC, Montino MC, Rossetto L et al. Inhibition of gastric acid secrecion reduces zinc absorption in man. J Am Col Nutr 4: 372-375, 1991.
71. Svenson KL et al. Reduced zinc in peripheral blood cells from patients with inflammatory connective tissue diseases. Inflammation 9; 2: 189-99, 1985.
72. Takihara H, Cosentino MJ, Cockett AT. Effect of low-dose androgen and zinc sulfate on sperm motility and seminal zinc levels in infertile men. Urology 22: 160, 1983.
73. Taper LJ, Oliva JT, Ritchey SJ. Zinc and copper retention during pregnancy. The adequacy of prenatal diets with and without dietary supplementation. Am J Clin Nutr 41: 1184-1192, 1985.
74. Taylor CM, Bacon JR, Aggett PJ et al. Homeostatic regulation of zinc absorption and endogenous losses in zinc-deprived men. Am J Clin Nutr 53: 755-763, 1991.
75. Thomas EA, Bailey LB, Kauwell GA et al. Erythrocyte metallothionein response to dietary zinc in humans. J Nutr 122: 2408-2414, 1992.
76. Tuormaa TE. Adverse effects of zinc deficiency. A review from the literature. J Orthomol Med 10: 149-164, 1995.
77. Ulshafer RJ. Zinc content in melanosomes of degenerating RPE as measured by X-ray maping. Prog Clin Biol Res 314:131-9, 1989.
78. Wagner PA, Bailey LB, Christakis GJ, Dinning JS. Serum zinc concentrations in adolescents as related to sexual maturation. Human Nutr. Clin Nutr 39C: 459, 1985.
79. Zlotkin SH, Casselman CW. Urinary zinc excretion in normal subjects. J Trace Elem Exp Med. 3: 13-21, 1990.

 

Sources:
Joseph E. Pizzorno Jr., Michael T. Murrey & Melvyn R. Werbach.