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“We should therefore think of metabolic disease as a disease of the immune system too.” Dr. Aseem Malhotra
Obesity33 and vitamin D34 are heavily discussed topics given the current pandemic. With the prevalence of metabolic syndrome (insulin resistance, hypertension, abdominal obesity, and high blood lipids)35 and vitamin D deficiency,36 and their emerging association with COVID-19,37,38 we are keen to shine a light on how and why they can drive low immunity.
Overweight individuals tend to be depleted in vitamins and minerals.39 This usually arises due to over-consumption of micronutrient-scarce, ultra-processed foods and poor gut health. Vitamin D deficiency is particularly common.40,41 Strikingly, a very low carbohydrate diet has been shown to independently improve vitamin D status by supporting weight loss!42 In addition to body weight, there are several other common drivers of low vitamin D, including low sunlight exposure, 43,44 pregnancy,45 old age,46 dark or covered skin,47 low magnesium status,48 and digestive surgery (e.g. gastric bypass,49 gallbladder removal50). Most of us will likely resonate with at least a few of these. If so, your vitamin D level is probably sub-optimal and in need of optimisation.
Vitamin D can reduce risk of infections, especially respiratory tract infections.51,52 It supports the production of anti-microbial substances53 and helps to inhibit microbial entry into the lungs by making lung tissue less permeable.54 It even reduces the risk of immune complications by helping to prevent the inflammatory ‘cytokine storm’ which can otherwise cause profound lung tissue damage.55,56 Beyond the immune system, vitamin D supports blood pressure57 and blood glucose regulation,58 which is significant since cardiovascular issues and diabetes can increase the risk of serious infection.59
Inflammation driven by obesity is itself a risk factor for low immunity.60,61 Excess body fat produces molecules called proinflammatory cytokines, which increase inflammation in the body. This background inflammation is often compounded by other drivers of inflammation, such as low vitamin D and omega-362 status, intestinal hyperpermeability,16 poor sleep,63 and alcohol.64 This toxic combination allows inflammation to become chronic. Inflammation is itself a source of stress on the body,65 which can drive a vicious cycle of chronic inflammation, high stress, and low immunity! In this scenario, the immune system is so busy mounting an unnecessary inflammatory response that it cannot properly defend us against pathogen exposure, increasing infection risk.
Not only this, when an obese individual picks up an infection, they are more likely to experience immune complications.The cytokine storm is thought it to be a major driver of lung injury and increased mortality from viral respiratory infections, including COVID-19,66 and obesity is a significant risk factor.67 High blood glucose levels68,69 and sleep apnea,70 which usually co-present with obesity, may increase the risk further.
A powerful way to preventively support your immunity and all-round health, is to support weight management and metabolic health, and an optimal vitamin D status. As Martineau and Forouhi (2020) said about optimising vitamin D, in particular, in light of the current pandemic: “there is nothing to lose from their implementation, and potentially much to gain.” 34
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36. Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-165. doi:10.1007/s11154-017-9424-1
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38. Grant WB, Lahore H, McDonnell SL, et al. Evidence that vitamin d supplementation could reduce risk of influenza and covid-19 infections and deaths. Nutrients. 2020;12(4). doi:10.3390/nu12040988
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50. Polat HB, Beyazal MS. The effect of cholecystectomy on 25-hydroxyvitamin D levels and bone mineral density in postmenopausal women. Arch Osteoporos. 2018;13(1). doi:10.1007/s11657-018-0458-0
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