Dark Skin and Special Risk

  Reducing Covid-19 Illness in Black and Ethnic Populations

Download:  Handout for Darker Skin October       Prepared by Connie Eash, M.S.               cneash@gmail.com

Darker Skin = Greater Risk

  • Covid-19 incidence and death rates are higher among the black populations in Chicago, Louisiana, and Michigan.
  • John Hopkins reports that mostly black counties have more than 3-fold higher infection rate and 6-fold higher death rate than predominately white counties. (1)
  • Of the 106 healthcare workers in the United Kingdom who died from Covid-19 as of April 22, 63% were from the black and ethnic communities, and 94% of the doctors and 71% of the nurses who died from Covid-19 were black or ethnic. (2)
  • Additional risks include age, obesity and sun avoidance.

Why is Dark Skin a Risk Factor?

  • Most of our vitamin D is made in the skin when it’s exposed to the sun.
  • Melanin, or the color, in our skin protects us from sun damage, but also slows down the production of Vitamin D in the skin.
  • Our immune system needs vitamin D to work properly.
  • Vitamin D protects against Covid-19, influenza (3), respiratory infections (4,5), certain cancers [colon (6), prostate (7) and breast (8)], diabetes type 2 (9), and cardiovascular disease (10).   These illness are also more prevalent in those with dark skin.

A Vitamin D – Covid-19 Connection

  • A study of 212 Covid patients found that D Levels over 30 ng/ml increase the odds of having a mild vs a critical outcome by 19.6 times. (11)
  • In 780 hospitalized Covid patients, the death rate of those with D levels below 20 ng/ml was 98.9%, for those with 20-30 ng/ml it was 87.8%, and for those with more than 30 ng/ml, the death rate was only 4.1%. (12)
  • Several studies found that countries with lower average D levels had more cases and deaths from Covid-19. (13,14)
  • No other factor has been found to be as significant in preventing severe illness and death from Covid-19.

Measure and Correct D Levels

  • The test for D is the serum 25(OH)D test.
  • Although there is some confusion over what the numbers should be,  The Endocrine Society has set the lower limit to 30 ng/ml, based on a thorough review of the scientific evidence.
  • CDC statistics show that most of us have low vitamin D levels, but the black and hispanic groups are even more at risk. (15)
  • The Endocrine Society recommends these doses of vitamin D3 supplements:
    • 600-1000 IU/day for children 1-18
    • 1500-2000 IU/day in adults
    • 3000 – 6000 IU/day if obese.
    • Initial doses should be higher, if 25(OH)D levels are lower than 30 ng/ml. (16)

Vitamin D is the Most Important Nutrient

Vitamin D has been our focus, because research has shown more protection against Covid-19 than any other nutrient or drug. Vitamin D3 works with vitamin K2 and magnesium, so those supplements would also be beneficial.    

Work with Your Doctor

Pharmaceutical companies will not put money into marketing for vitamins.  Patients usually have to ask for the test and recommendations for supplementation.

Note: This is not meant to replace sanitation and personal protection measures, nor the recommendations of your physician.

References

1 Yancy CW. COVID-19 and African Americans; JAMA. 2020;323(19):1891-1892. doi:10.1001/jama.2020.6548

2 Kirby T.  Evidence mounts on the disproportionate effect of COVID-19 on ethnic minorities.  Lancet Respir Med. 2020 May 10, doi: 10.1016/S2213-2600(20)30228-9

3 Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H.  Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren.  The American Journal of Clinical Nutrition, May 2010, 91(5): 1255–1260, https://doi.org/10.3945/ajcn.2009.29094

4 Jolliffe DA, Greenberg L, Hooper RL, Mathyssen C, Rafiq R, de Jongh RT, Camargo CA, Griffiths CJ, Janssens W, Martineau AR. Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials.  Thorax April 2019; 74(4).

5 Martineau Adrian R, Jolliffe David A, Hooper Richard L, Greenberg Lauren, Aloia John F, Bergman Peter et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data BMJ 2017; 356 :i6583

6 McCullough ML, Zoltick ES, Weinstein SJ, Fedirko V, Wang M, Cook NR, Eliassen AH, et al. Circulating Vitamin D and Colorectal Cancer Risk: An International Pooling Project of 17 Cohorts, JNCI: Journal of the National Cancer Institute, Volume 111, Issue 2, February 2019, Pages 158–169. https://doi.org/10.1093/jnci/djy087

7 Nyame YA, Murphy AB, Bowen DK, et al. Associations Between Serum Vitamin D and Adverse Pathology in Men Undergoing Radical Prostatectomy. J Clin Oncol. 2016;34(12):1345‐1349. doi:10.1200/JCO.2015.65.1463

8 Yao S, Kwan ML, Ergas IJ, Roh JM, Cheng TYD, Hong CC, McCann SE, Tang L, Davis W, Liu S, Quesenberry CP Jr, Lee MM, Ambrosone CB, Kushi LH, Association of Serum Level of Vitamin D at Diagnosis With Breast Cancer Survival: A Case-Cohort Analysis in the Pathways Study, March 2017, JAMA Oncol. 2017;3(3):351-357. doi:10.1001/jamaoncol.2016.4188

9 Rafiq S, Jeppese PB. Is Hypovitaminosis D Related to Incidence of Type 2 Diabetes and High Fasting Glucose Level in Healthy Subjects: A Systematic Review and Meta-Analysis of Observational Studies. Nutrients. 2018 Jan; 10(1): 59.  doi: 10.3390/nu10010059

10 Saponaro F, Marcocci C, Zucchi R. Vitamin D status and cardiovascular outcome. J Endocrinol Invest 42, 1285–1290 (2019) https://doi.org/10.1007/s40618-019-01057-y

11 Alipio M. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with Coronavirus-2019. Preprint posted: 9 Apr 2020 Last revised: 7 May 2020. https://papers.ssrn.com/sol3/Papers.cfm?abstract_id=3571484

12 Raharusun P, Sadiah P, Cahni B, Erdie A, Cipta B. Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (April 26, 2020). Available at SSRN: https://ssrn.com/abstract=3585561 or http://dx.doi.org/10.2139/ssrn.3585561

13 Ilie, PC, Stefanescu S. & Smith L. The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality. Aging Clin Exp Res (2020). https://doi.org/10.1007/s40520-020-01570-8

14 Laird E, Rhodes J, Kenny RA. Vitamin D and Inflammation: Potential Implications for Severity of Covid-19. Ir Med J; Vol 113; No. 5; P81.  http://imj.ie/vitamin-d-and-inflammation-potential-implications-for-severity-of-covid-19/

15 National Report on Biochemical Indicators of Diet and Nutrition in the U.S. Population 1999-2002.  https://www.cdc.gov/nutritionreport/99-02/pdf/nr_ch2b.pdf

16 Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM, Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul; 96(7):1911-30