Golf Nutrients Canada

IMPORTANCE OF OMEGA-3 FOR GOLF AND ATHLETIC PERFORMANCE

Athletes and Non-Athletes are Severely Deficient in Omega-3

“Western diets are deficient in omega-3 fatty acids, and have excessive amounts of omega-6 fatty acids compared with the diet on which human beings evolved and their genetic patterns were established.”

“The healthy ratio of omega-6 to omega-3 essential fatty acid intake is 1:1. Because of the changes in diet in the industrial world (increased human consumption of grains and grain products and grain fed industrially farmed meat vs wild game) there is widespread deficiency in the intake of omega-3 fatty acids and overconsumption of omega-6. The omega-6 to omega-3 intake ratio is now very dangerously at 20:1 or higher.”

Omega-3 Supplementation Reduces Pain

Fish oil supplementation reduces exercise-induced inflammation, decreases delayed onset muscle soreness, increases the rate of recovery, and reduces the risk for infection due to immunodeficiency.

Fish oil supplementation is associated with improved cognitive abilities including reaction time, decision making, and stabilizing mood.

“The cardioprotective effects of omega-3 fatty acids are ascribed to improvements in various cardiovascular risk factors including a reduction in blood-platelet aggregation (Mori et al., 1997; Phang et al., 2012), decreased inflammation, enhanced endothelial function, positive changes in blood lipids, and decreased blood pressure.”

“The exception is the omega-3 PUFAs; controlled trials demonstrate their efficacy in reducing joint pain associated with inflammatory conditions, including rheumatoid arthritis (RA), inflammatory bowel disease, and dysmenorrhea.”

“The agent best documented by hundreds of references in the literature for its anti-inflammatory effects is omega-3 essential fatty acids (EFAs or essential fatty acids [EPA, DPA, DHA) found in fish and in pharmaceutical-grade fish oil supplements.”

“There is extensive documentation in the rheumatology, ophthalmology, and cardiovascular literature on the beneficial anti-inflammatory affects of high-dose fish oil in the reduction of joint pain from rheumatoid and osteoarthritis, and also major positive affects on … coronary artherosclerosis, which is now considered an inflammatory disease.”

Omega-3 Supplementation Reduces Chronic Pain

“Omega-3 fatty acid supplementation offers a clinically meaningful and time-dependent reduction in chronic pain.”

“Omega-3 fatty acids may be best positioned as a safer adjunct or as a long-term strategy in the management of chronic pain.”

“This finding is consistent with previous reviews suggesting that prolonged supplementation is necessary to achieve clinically meaningful analgesic effects [because it takes months for the omega-3 fatty acids to be incorporated into cell membranes and to increase the inflammation resolving pathways that are dependent upon omega-3 fatty acids.]”

Omega-3 Supplementation Reduces Inflammation and Improves Both Recovery and Athletic Performance.

“These results form a body of evidence over more than 10 years, showing that omega-3 fatty acids are a strong, evidence-based nutritional tool for reducing the effects of post-exercise inflammation, supporting functional recovery, and sustaining long-term athletic performance.”

Omega-3 Supplementation Increases Muscle Strength and Performance and Decreases Age-Related Decline

“Omega-3 polyunsaturated fatty acids (n-3 PUFAs), specifically the most biologically active (eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)), have well-documented health promoting effects, including, but not limited to, controlling inflammatory processes in the human body and supporting cardiovascular and cognitive health and visual processes.”

“On the basis of EMG, a greater muscle activation was noted in the fish oil-supplemented groups, confirming the contribution of n-3 PUFAs to increasing muscle strength through their effect on neuromuscular conduction.”

“In the FO [fish oil] group, the omega-3 index, EPA and DHA increased by 73%, 332% and 64%, respectively, while there was no change in the placebo group. HGS [hand grip strength] significantly improved in the FO group and did not change in the placebo group. The change in HGS was positively correlated with the relative change in EPA and EPA:AA ratio.”

“For in-season athletes, the addition of LC n-3 supplementation to a dietary regime increases blood LC n-3 status and may preserve or improve muscular performance while in-season.”

Omega-3 Supplementation Improves Joint Health, Reduces Pain, and Improves Quality of Life

“This study demonstrated that Omega-3 fatty acid supplementation for 12 weeks resulted in significant improvement in joint health, reduction in pain severity, decreased bleeding frequency, and enhanced quality of life among patients with hemophilia. These findings align with existing evidence supporting the anti-inflammatory and analgesic properties of Omega-3 fatty acids observed in other musculoskeletal conditions.”

Omega-3 Supplementation Reduces Inflammation and Cartilage Destruction and Improves Joint Mobility in Osteoarthritis

“More specifically, omega-3 polyunsaturated fatty acids (PUFA) have demonstrated an influential role in the progression of OA, resulting in the reduction of cartilage destruction, inhibition of pro-inflammatory cytokine cascades, and production of oxylipins that promote anti-inflammatory pathways.”

“This is due to their anti-inflammatory properties, which result in a positive influence on pain, joint mobility, and cartilage formation.”

Omega-3 Supplementation Increases Muscle Function, Reduces Muscle Loss, and Improves Weight Loss

“Omega-3 fatty acids could increase protein anabolism, reduce protein catabolism in the context of exercise-related muscle damages, and could induce beneficial mitochondrial modifications.”

“In obesity, omega-3 fatty acids participate in weight loss and its maintenance, and can help decrease insulin resistance.”

“In sarcopenia atrophic conditions, omega 3 fatty acids allow muscle mass and function maintenance. In cancer cachexia, omega 3 fatty acids are more efficient at the pre-cachectic stage, as they can reduce protein catabolism and increase protein anabolism.”

“These effects are mediated by EPA and DHA, whose sources are solely of marine origins. As marine resources are overexploited, finding diverse sources of omega-3 fatty acids is crucial.”

Omega-3 Supplementation Significantly Increases Energy Expenditure and Fat Loss During Exercise and at Rest and Significantly Lowers Triglycerides

“The results demonstrated that fish oil supplementation significantly increased resting metabolic rate by 14%, energy expenditure during exercise by 10%, and the rate of fat oxidation during rest by 19% and during exercise by 27%.”

“In addition, FO consumption lowered triglyceride levels by 29% and increased lean mass by 4% and functional capacity by 7%.”

Omega-3 Supplementation Improves Muscle Function and Physical Performance

“Growing evidence from randomized controlled trials (RCTs) suggests beneficial effects of omega-3 PUFAs on muscle function, including physical performance parameters in mid to later life.”

“Among various dietary compounds, omega-3 polyunsaturated fatty acids (PUFAs) are gaining growing attention for their potential effects on muscle membrane composition and muscle function. Indeed, several pathways are enhanced, such as an attenuation of pro-inflammatory oxidative stress, mitochondrial function, activation of the mammalian target of rapamycin (mTOR) signaling and reduction of insulin resistance.”

Omega-3 Supplementation Improves Neuromuscular Performance and Reduces Cognitive Decline.

“In this review, we will present the biochemical mechanisms of action of omega-3 fatty acids through their mediators, specialized pro-resolving mediators [synthesized from omega-3], which have anti-inflammatory activity.”

“In a randomized study on footballers, Gravina et al. highlighted an improvement in aerobic capacity following 4 weeks of omega-3 supplementation. Black’s group showed a moderate but significant improvement in muscle pain, which translated into improved explosive power.”

A study by Guzman et al., in which 24 professional footballers were supplemented with 3.4 g of DHA per day for four weeks, produced an improvement in neuromotor skills, particularly in neural RT [reaction time].

“In this view, Godos and co-workers suggested in a meta-analysis that fish consumption is associated with a lower risk of cognitive impairment/decline in a dose–response manner.”

“The anti-inflammatory action of the two omega-3 fatty acids DHA and EPA is well established, even if unrelated to sports, solidifying the scientific rationale that justifies their integration.”

“It remains to be defined whether we want to consider these supplements as directly ergogenic (i.e., capable of directly improving performance) or as supplements that put the athlete in the best health conditions and, therefore, have a positive influence on performance.”

Supplementation with Omega-3 Decreases Fat Mass, Increases Muscle Mass, and Decreases Cortisol.

“Conclusion: 6 wks of supplementation with fish oil significantly increased lean mass and decreased fat mass. These changes were significantly correlated with a reduction in salivary cortisol following fish oil treatment.”

Omega-3 Supplementation Improves Sport Performance, Reduces Inflammation, Increases Antioxidants, Decreases LDL and Increases HDL Cholesterol, and Increases Neuro-Biomarkers of Motor Control, Agility, Balance, Reaction Time, and Positive Mood.

“Physical performance tests demonstrated greater improvements in muscular strength, power, speed, agility, and reaction-based performance in the omega-3 group compared to controls.”

“The experimental group [fish oil supplement group] showed significant improvements in the lipid profile, with decreases in LDL and triglyceride levels and an increase in HDL levels.”

“Levels of the inflammatory cytokines IL-6 and TNF-α were significantly reduced, while GSH [glutathione] levels increased and MDA [malondialdehyde] levels decreased, indicating an enhanced antioxidant status.”

“The neuro-biomarker analysis revealed increased levels of BDNF, dopamine, and serotonin.”

“Conclusions: These findings suggest that omega-3 supplementation, when combined with resistance training, has a multi-systemic enhancing effect on both physiological markers and physical performance. This combination may represent a promising strategy for optimizing athletic adaptations and recovery in physically active populations.”

Omega-3 Supplementation Enhances Cardiopulmonary Function, Exercise Recovery, Cognitive Function, Injury Recovery, and Strength and Power.

“Omega-3 fatty acids (n-3), recognized for their anti-inflammatory and brain health benefits, are being studied to enhance cognitive function, aid physical recovery, and reduce injury rates among military service members (SMs). Given the unique demands faced by this tactical population, this systematic review aims to evaluate the evidence of n-3 to support physical and mental resilience and overall performance.”

“The results highlighted evidence-based findings in five key areas where omega-3 fatty acids are being evaluated to benefit military service members. These key areas include cardiopulmonary function, exercise recovery, cognitive function, injury recovery, and strength and power.”

“While existing research suggests promising benefits, the most significant evidence was seen with cardiopulmonary function, exercise recovery, and cognitive function.”

Omega-3 Supplementation in Athletes Improves Recovery, Improves Cardiovascular and Strength Training Adaptations, Improves Mood, Reduces Fatigue, Improves Cognitive Function, and Improves Overall Health Status.

“Low O3I [omega-3 index] is common in many populations, mainly reflecting a low intake of fatty fish. Existing studies indicate that both professional and amateur athletes have O3I values below optimal.”

“Considering this low O3I [Omega-3 Index] , as well as the scarcity of EPA and DHA in foods and their pleiotropic effects, including but not limited to the control of inflammation, support of cognitive function, neuroprotection, maintaining muscle mass after injury and enhancement of training adaptations and recovery from exercise [19–27], the question arises about whether athletes should consider using supplements that contain EPA and DHA.”

“Considering their broad spectrum of actions, including but not limited to supporting nervous system function, maintaining muscle mass after injury and improving training adaptations and the lack of adverse effects at dosing regimens that might be recommended (e.g., 2 g/day), it seems reasonable for athletes to consider using EPA and DHA supplements. These would also benefit their long-term health.”

Supplementation with Omega-3 Improves Recovery and Performance for Amateurs and Athletes

“This review identified evidence to support a role of EPA/DHA in improved performance such as enhanced endurance, markers of functional response to exercise, enhanced recovery or neuroprotection.”

“The majority of evidence stems from studies in amateurs rather than athletes, although most recommendations for EPA/DHA supplementation for improved performance are made for athletes. In practical terms, athletes, and likely more so, amateurs may benefit from the consumption/supplementation of EPA/DHA.”

“Several studies suggest a potentially beneficial effect of EPA/DHA on performance by improved endurance capacity and delayed onset of muscle soreness, as well as on markers related to enhanced recovery and immune modulation.”

It Takes 3-4 Months of Daily Supplementation with Omega-3 to Become Fully Sufficient and Experience the Full Benefits

“A meta-analysis of 16 studies at 3–4 months showed significant effects for four of six pain outcomes: patient assessed pain, morning stiffness, number of painful and/or tender joints, and NSAID consumption.”

“Previous reports suggest that the therapeutic effects of omega-3 PUFAs are usually manifest after approximately 3 months (Stamp et al., 2005). We hypothesized that patients taking omega-3 PUFA supplementation for 2 months or less would not benefit significantly (for pain reduction).”

IMPORTANCE OF OMEGA-3 FATTY ACIDS FOR OVERALL HEALTH

Supplementing with Omega-3 Fatty Acids Improves Overall Health and Quality of Life and Reduces the Development of Chronic Diseases. Research Shows that Supplementing with Omega-3 Improves Immune Function, Improves Inflammation Resolution and Decreases Systemic Inflammation, Improves Blood Sugar, Improves Fat Loss, Decreases Age-Related and Disease-related Muscle Loss, Decreases Arthritis-Related Joint Destruction and Pain, Decreases Cancer Incidence and Improves Cancer Survival, Decreases Cardiovascular Disease Incidence and Improves Survival, Improves Pregnancy and Newborn Outcomes, Improves Moods and Reduces Depression and Anxiety, Improves Digestive Health and Reduces IBS and Crohn’s Inflammation and Pain.

Supplementing with Omega-3 Increases Fat Weight Loss and Improves Triglyceride Levels

“The results demonstrated that fish oil supplementation significantly increased resting metabolic rate by 14%, energy expenditure during exercise by 10%, and the rate of fat oxidation during rest by 19% and during exercise by 27%.”

“In addition, FO consumption lowered triglyceride levels by 29% and increased lean mass by 4% and functional capacity by 7%.”

“Omega-3 fatty acids promote weight loss and fat loss by inhibiting fat synthesis, enhancing fat break-down and thermogenesis (fat burning), and preventing fat storage.”

Omega-3 Essential for Immune Function and Protection from Colds, Flus, and COVID

“Specialized pro-resolving mediators (SPMs) are enzymatically derived from essential fatty acids and have important roles in orchestrating the resolution of tissue inflammation — that is, catabasis. Host responses to tissue infection elicit acute inflammation in an attempt to control invading pathogens [and repair tissue].”

“SPMs are lipid mediators that are part of a larger family of pro-resolving molecules, which includes proteins and gases, that together restrain inflammation and resolve the infection [and/or tissue damage].”

“These immunoresolvents are distinct from immunosuppressive molecules as they not only dampen inflammation but also promote host defence.”

“Because SPMs engage endogenous resolution pathways, these mediators have the potential to both decrease pathogen-mediated inflammation and enhance host defence, which distinguishes SPMs from immunosuppressive agents.”

“Non-infectious inflammation is a common and often devastating cause of human disease. Most current therapies rely on blunting the inappropriate immune response through the use of anti-inflammatory medications, all of which have significant undesirable side effects, including increasing the host susceptibility to infection.”

“ARDS [acute respiratory distress syndrome/cytokine storm] is a prevalent condition with high rates of morbidity and mortality. It is characterized by an overly robust inflammatory response to infection (for example, pneumonia and sepsis) or injury that fills the alveoli with oedema and pus, resulting in life-threatening respiratory failure. Many unsuccessful attempts have been made to therapeutically target an inflammatory pathway to limit this over-exuberant host response.”

“Long chain omega-3 PUFAs have been shown to possess immunomodulatory effects. It appears that the EPA and DHA membrane composition of immune cells can be altered with long term ingestion of omega-3 PUFAs, which can influence phagocytosis, T-cell signaling, and antigen-presenting capabilities.”

“Omega-3 fatty polyunsaturated fatty acids (PUFAs) have been shown to decrease the production of inflammatory eicosanoids, cytokines, and reactive oxygen species; have immunomodulatory effects; and attenuate inflammatory diseases.”

“There are three main properties of macrophage [immune cell] biology that have been identified to be altered by omega-3 fatty acids: the production and secretion of cytokines and chemokines, the capacity of phagocytosis, and the polarization into classically activated or alternatively activated macrophages.”

“Ten volunteers were given fish oil supplementation containing 26% EPA and 54% DHA daily for two months. Thereafter, the phagocytic capacity of the neutrophils in the blood was increased by 62%.”

“Targeting individual pro-inflammatory cytokines may not be sufficient to prevent COVID-19 progression.”

“Importantly, SPMs [specialized pro-resolving mediators derived from Omega-3 fatty acids] terminate self-sustaining inflammatory processes, such as those induced by COVID-19, by broadly inhibiting proinflammatory cytokine production and promoting a return to tissue homeostasis.”

“Moreover, conventional anti-inflammatory agents such as NSAIDs and COX-2 inhibitors, while limiting the eicosanoid storm, may be “resolution toxic” as they indiscriminately inhibit eicosanoid pathways that produce resolution mediators and thereby prevent active resolution.”

“The inclusion criteria were the age between 35 and 85 years, diagnosis of COVID-19 confirmed by a positive RT-PCR nasopharyngeal swab, as well as symptoms such as severe pneumonia, fever, fatigue, dry cough, respiratory distress, and indicated for enteral nutrition.”

“The intervention group had significantly higher 1-month survival rate compared with the control group (21% vs 3%).” *That is a 700% increase in chance of survival!!!

“Omega-3 polyunsaturated fatty acids (n3-PUFAs) are important mediators of inflammation and acquired immune responses and can amplify anti-inflammatory responses.”

Omega-3 Sufficiency Reduces Risk of Cardiovascular Disease and Mortality

“Due to the overwhelming evidence of benefit, the American Heart Association now recommends the use of omega-3 fatty acid supplements for the primary and secondary prevention of coronary heart disease.”

“Omega-3 consumption has been shown to confer positive health effects on several key age-related biological processes, including improved CV and immune function, enhanced cognition, and augmented neuromuscular function. Lower blood pressure (BP) levels and slower resting heart rates are associated with reduced risks for CVD and premature mortality. Approximately 3 g of DHA+EPA per day will lower systolic BP by a mean of 4.5 mm Hg in people with hypertension and 2 mm Hg in people with normal BP at baseline and will decrease resting heart rate by approximately 5 beats/min.”

“Conclusion: Higher DHA levels were associated with significant risk reductions in all-cause mortality, as well as reduced risks for deaths due to CV disease, cancer, and all other causes. The findings strengthen the hypothesis that DHA, a marine-sourced omega-3, may support CV health and lifespan.”

“The vagus nerve plays a fundamental role in CV and brain health and in optimal function of the immune and gastrointestinal systems. People with higher vagal tone have been shown to be at lower risk of all-cause and CVD mortality during long-term follow-up. Supplementing with omega-3 has been shown to augment vagal tone in a dose-dependent manner.”

“To increase an omega-3 index of 5.4% to 8% would require consumption of approximately 1000 mg/d of DHA+EPA, and to go from the lowest quintile in the current study, with an omega-3 index 3.5%, to 8% would require approximately 1600 mg/d of DHA+EPA.”

“Supplementation was associated with reduced risk of MI [Myocardial Infarction]; CHD [Coronary Heart Disease] events; fatal MI; and CHD mortality.”

“Supplementation with EPA and DHA is an effective lifestyle strategy for CVD [Cardiovascular Disease] prevention, and the protective effect probably increases with dosage.”

“After adjustment for demographic, cardiovascular, lifestyle, and dietary factors both individual and combined levels of EPA, DPA, and DHA were associated with lower total mortality.”

“For cause-specific deaths, all 3 PUFAs were associated with lower CVD mortality and their combined levels were associated with 35% lower risk across quintiles.”

“Among CVD subtypes, DHA seemed most strongly related to CHD death (40% lower risk), especially arrhythmic CHD death (45% lower risk), whereas DPA was most strongly related to stroke death (47% lower risk).”

“Across quintiles, individuals with higher EPA, DPA, and DHA levels had 17%, 23%, and 20% lower risk, respectively, and those with higher total 3-PUFA levels had 27% lower risk.”

“Statin Drugs (e.g. lipitor, crestor, etc) were 10 times more effective at lowering cholesterol than omega-3 fatty acids (20% vs 2% reduction in total cholesterol).”

“However, omega-3 fatty acids were 44% more effective than statin drugs in reducing death from cardiac events.”

Omega-3 Supplementation Improves Erectile Function

“The results of western blot analysis revealed that systemically administered omega-3 fatty acids ameliorated the cavernosal molecular environment.”

“Our study suggests that omega-3 fatty acids improve intracavernosal pressure and have a beneficial role against pathophysiological consequences such as fibrosis or hypoxic damage on a CPI rat model, which represents a structural erectile dysfunction model.”

Omega-3 Lowers Risk of Cancer

“Omega-3 fatty acids lower the risk of cancer through their suppressing effect on the biosynthesis of eicosanoids [molecules from omega-6 fatty acids (seed oils) that promote inflammation, suppress the immune cells that eliminate cancer cells, and stimulate cancer cell growth].”

“By affecting cell membrane composition, metabolism, signal pathways, and by direct control of gene expression, sufficient omega 3 essential fatty acid levels play a key role in the prevention of human diseases such as obesity, diabetes, cancer, neurological and brain disorders, and heart disease.”

Omega-3 Fatty Acids Essential for Brain and Emotional Health

“Vitamin D and Omega-3 fatty acids modulate depression pathways, influencing neurotransmission and reducing inflammation.”

“Observational studies and randomized trials support their efficacy, particularly in cases of deficiency.”

“Integrative approaches incorporating these nutrients into care plans enhance therapeutic outcomes.”

“Vitamin D modulates neurotransmitter activity, reduces neuroinflammation, and influences neuroplasticity, enhancing cognitive function and mood regulation. Omega-3 fatty acids, particularly EPA and DHA, exhibit anti-inflammatory properties, optimize serotonergic transmission, and stabilize neuronal membranes. Clinical evidence suggests that supplementation with these nutrients can significantly reduce depressive symptoms, particularly in patients with comorbid nutritional deficiencies. However, variability in study designs and dosages limits the generalizability of findings.”

“Among older adults, higher phospholipid long-chain omega-3 PUFA content was associated with lower prevalence of subclinical infarcts and better white matter grade on MRI. Our results support the beneficial effects of fish consumption, the major source of long-chain omega-3 PUFAs, on brain health.”

“A Purdue University study showed that kids low in Omega-3 essential fatty acids are significantly more likely to be hyperactive, have learning disorders, and to display behavioural problems.”

“The omega-3 polyunsaturated fatty acids (PUFAs) eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are key dietary components investigated extensively in relation to psychiatric outcomes, owing to the therapeutic potential of their ever-expanding repertoire of potent bioactive derivatives. Despite the different bioactivity between EPA and DHA, there is a robust biological basis in support of their anxiolytic and antidepressant potential, comprising modulation of neuronal membrane properties, receptor expression and neurotransmission, antioxidant, anti-inflammatory and pro-resolving activity, and promotion of neuroplasticity and neuroprotection. These properties may modulate brain homoeostasis, which in turn is linked to mood, making it imperative to understand the role of omega-3 PUFAs in mental ill-health.”

“Preclinical and epidemiological studies have consistently associated anxious and depressive states with poor omega-3 PUFA status. Correcting the latter by supplementation improves mood profiles.”

“Nutrition plays a vital role in the onset of depression, its severity, and its duration. Studies suggest that nutrition-deficient diets lacking omega-3 fatty acids are associated with higher risks of compromised mental health. Omega-3 long-chain polyunsaturated fatty acids (PUFA), including eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), are dietary fats found in fish oil are known for their health benefits in fetal development and healthy aging. At the same time, these marine oils are considered vital for brain health because 20% of the brain’s dry weight comprises polyunsaturated fatty acids as a major structural component of neuronal cell membrane phospholipids.”

“Similarly, the effect of omega-3 fatty acid supplementation in alleviating depressive symptoms can be associated with many published studies—Ryukyus Child Health Study elucidated the inverse association between fish intake and depression; eating less seafood was associated with reduced low omega-3 intake and higher rates of depression during pregnancy [26,27]. Similarly, another investigation into bipolar depression revealed that omega-3 fatty acids may be useful when used as a supplement for depressive symptoms in the patient cohort and that EPA-supplemented food could help relieve their depressive symptoms.”

“A total of 165 patients suffering from mild to moderated depression were randomized to receive omega-3 fatty acid supplementation, an antidepressant (single agent), or a combination of an antidepressant and omega-3 fatty acid supplementation. The clinical features of depression were assessed using the Hamilton Depression Rating Scale (HDRS) during the follow-up period. A statistically significant improvement in depressive symptoms was observed from baseline to first, second and third follow-ups within each treatment arm as measured by HRDS scores.”

“This illustrated that administered antidepressants (fluoxetine, escitalopram, or sertraline), and omega-3 fatty acid supplements were efficacious in treating depression alone as well as in combination.”

IMPORTANCE OF SUPPLEMENTING OMEGA-3 and VITAMIN D and A TOGETHER: WHY OMEGA+D SUFFICIENCY™ IS SO UNIQUELY BENEFICIAL

“Vitamin A and vitamin D balance, enhance, and contain each other through the retinoid X receptor (RXR).”

“Because they share a receptor, if we supplement either vitamin D or vitamin A in an unbalanced fashion, we create a functional deficiency of the one not supplemented.”

“Low blood levels of vitamin D, vitamin A, and carotenoids are all correlated with greater risk of heart disease.”

“In summary, we describe a unique and unexpected facet of intermolecular cross-talk between VDR and RXR and demonstrate that RXR actively participates in RXR-VDR-mediated gene transcription by directly recruiting coactivators in response to 1,25-(OH)2D3.”

“This would imply that the policy of giving vitamin D supplement alone in pregnancy instead of cod liver oil would need adjustment. Cod liver oil, as natural supplement of vitamin A and vitamin D, is well know for its beneficial effects on the growth of infants and children.”

“The large, randomized, double-blind, placebo controlled trial VITAL (vitamin D and omega-3 trial) recently confirmed that vitamin D and Omega-3 polyunsaturated fatty acid (PUFA) co-supplementation (VIDOM) can reduce the incidence of autoimmune diseases. Based on these relevant results, this commentary summarizes the molecular mechanisms behind the anti-inflammatory and immunomodulatory properties of vitamin D and omega-3 PUFAs.”

“We also describe the potential bidirectional interplay between vitamin D metabolism and omega-3 PUFA metabolism that underlies the rationale for VIDOM co-supplementation and that may contribute to enhance the anti- inflammatory and immunomodulatory actions of Vitamin D and omega-3 PUFAs when these compounds are administered in combination.”

“In this regard, the recent results of the VITAL study are of high clinical significance, since both vitamin D and omega-3 PUFAs are safe, well-tolerated, nontoxic and inexpensive nutritional supplements that may be particularly beneficial in high-risk individuals.”

“In light of the above, hypovitaminosis D and omega-3 PUFA deficiencies may represent key environmental risk factors for development of autoimmune diseases. Indeed, vitamin D and omega-3 PUFA deficiencies can be associated with an increase in systemic inflammation. Vitamin D and omega-3 PUFAs, when administered in combination (as VIDOM co-supplementation, may exert synergistic anti-inflammatory and imunomodulatory actions to a greater extent than when they are administered alone.”

“In fact, adequate circulating vitamin D and omega-3 PUFA concentrations may contribute to reduce systemic inflammation by enhancing a systemic anti-inflammatory state.”

“Accordingly, preliminary intervention studies and clinical trials demonstrated that VIDOM co-supplementation leads to significant benefits in different clinical settings, including insulin resistance and non-alcoholic fatty liver disease, prediabetes, type 2 diabetes mellitus associated with coronary heart disease, gestational diabetes mellitus, polycystic ovary syndrome, type 1 diabetes mellitus, inflammatory bowel disease, and autism spectrum disorder.”

“Such beneficial effects likely arise from the synergistic anti-inflammatory, antioxidant and immunomodulatory properties exerted by vitamin D and omega-3 PUFAs.”

“A significant reduction was observed in fasting glucose, insulin, homeostasis model assessment-beta cell function, weight and waist circumference in the co-supplementation group compared to the other three groups. Moreover, high-density lipoprotein-cholesterol levels increased significantly in the co-supplementation group compared to the other three groups [Vit D or Omega-3 alone or placebo].”

"Conclusion: Vitamin D and omega-3 co-supplementation improved fasting serum glucose, insulin, high-density lipoprotein-cholesterol level, homeostasis model assessment-beta cell function, weight and waist circumference. This co-supplementation can therefore be recommended for glycemic control.”

“A significant difference was observed in terms of reduction in anxiety and improvement in sleep quality in the co-supplementation compared to the other three groups. There was also a significant difference between the group receiving both supplements and the group receiving only placebos in terms of reduction in depression and stress.”

“Conclusion: Vitamin D and omega-3 co-supplementation improved depression, anxiety, and sleep quality in women of reproductive age with pre-diabetes and hypovitaminosis D. Therefore, these two supplements can be recommended for improving mental health.”

“Given their positive effects on mental health, the concurrent use of these two supplements can be further considered as a measure for preventing type-II diabetes.”

Women with sufficient vitamin D levels had an 80% reduction in breast cancer incidence compared to those who had deficient vitamin D levels.

IMPORTANCE OF VITAMIN D FOR GOLF AND ATHLETIC PERFORMANCE

Athletes and Non-Athletes are Severely Deficient in Vitamin D

“The majority of the child, adult, and senior industrial population is vitamin D deficient.”

“At levels below 40-50 ng/mL the body diverts most or all of the ingested or sun-derived vitamin D to immediate metabolic needs, signifying chronic substrate starvation (deficiency).”

“The above studies indicate that few modern humans living in temperate latitudes – of any age – now achieve levels of 50 ng/mL.”

“A study of young Finnish female athletes (gymnasts and runners) found that athletes did not differ from nonathletes in either vitamin D intake or serum 25(OH)D levels, and both were more likely than not to be vitamin D-deficient.”

Almost 50% of the population had serum vitamin D below 20 ng/ml.

Those with blood levels of vitamin D at 30 ng/mL had almost double the measured neuromuscular performance level of those at only 10 ng/mL. The greater the levels of vitamin D the greater the neuromuscular performance.

Supplementation with Vitamin D Improves Muscle Strength and Power

“We know that vitamin D deficiency can weaken the muscular and skeletal systems, but until now little was known about the relationship of vitamin D with muscle power and force.”

“Our study found that vitamin D is positively related to muscle power, force, velocity, and jump height.”

“Supplementation of Vit D in subjects with deficient Vit D levels resulted in a 50% increase in muscle force and reaction time.”

“A similar change was seen in the ability to relax the muscle – in other words the muscle responds quicker to the brain signal both to contract and relax. Vit D regulates calcium metabolism and calcium is responsible for muscle contraction.”

“Our results showed significant correlations between vitamin D levels and muscle strength as expressed by Squat Jump and Countermovement Jump, sprinting capacity, and VO2max in professional soccer players, irrespective the levels of performance.”

Vitamin D Has Enormous Sports Health Benefits Ranging from Increased Performance to Injury Prevention

“There is strong correlation between vitamin D sufficiency and optimal muscle function. Increasing levels of vitamin D reduce inflammation, pain, and myopathy while increasing muscle protein synthesis, ATP concentration, strength, jump height, jump velocity, jump power, exercise capacity, and physical performance.”

“25(OH)D [Vit D] levels above 40 ng/mL are required for fracture prevention, including stress fractures. Optimal musculoskeletal benefits occur at 25(OH)D levels above the current definition of sufficiency (> 30 ng/mL).”

“Vitamin D deficiency is common in athletes. For athletes presenting with stress fractures, musculoskeletal pain, and frequent illness, one should have a heightened awareness of the additional likely diagnosis of vitamin D deficiency.”

Most Athletes Have Insufficient Vit D Levels and Low Vitamin D Levels are Associated with Greater Risk of Musculoskeletal Injuries.

“Previous studies have shown a strong correlation between Vit. D levels and athletic performance. One study found that peak athletic performance occurred when Vit. D levels were at their highest. The inverse was also shown to be true, as another study found that a deficiency in Vit. D has been linked to atrophy of type II fast-twitch muscle fibers, which are crucial for physical exertion. Studies also show that there is a strong correlation between higher Vit. D levels and muscle protein synthesis, ATP concentration, jump height, jump power, and jump velocity.”

“Vit. D deficiency is a global epidemic, with 41.6% of adults in the United States meeting the criteria for deficiency [and virtually 100% have insufficient Vit D intake].”

“Although traditionally thought of as a concern mostly for older populations, recent studies have found that a significant proportion of professional athletes have inadequate or deficient levels of Vit. D. A 2018 study on the National Football League found that 59% of the athletes studied had inadequate levels of Vit. D, with 10% of those athletes meeting criteria for Vit. D deficiency. This finding may prove to be significant for athletic performance, injury risk, and recovery.”

“Many collegiate athletes had insufficient or deficient Vit. D levels. Our results showed for each 5 ng/ml decrease in an athlete’s Vit. D level, there was a 13% increase in odds of injury.”

Vitamin D Supplementation Improves Strength, Power, and Endurance.

“The prevalence of vitamin D deficiency in athletes worldwide follows the prevalence of nonathletic populations and is becoming a growing concern as it pertains to athletic performance, aerobic endurance, and injury risk.”

“Vitamin D deficiency, which has been defined differently by multiple authors, can have detrimental effects on bone, muscle, respiratory, neurological, and respiratory health [and immune health].”

“Athletic measures that appeared to benefit most from vitamin D supplementation were measures of aerobic capacity (VO2max, PWC-170) and some measures of strength and power (vertical jump, various measures of upper body strength).”

Vitamin D Supplementation Strongly Associated With Exercise Performance and Neuromuscular Coordination in All Ages and in both Athletes and Non-Athletes.

“Vitamin D levels are strongly associated with exercise performance in athletes and physically active individuals. In the elderly and in adults below the age of 65, several studies have established a close association between vitamin D levels and neuromuscular coordination.”

“Muscles are major targets of vitamin D. Exposure of skeletal muscles to vitamin D induces the expression of multiple myogenic transcription factors enhancing muscle cell proliferation and differentiation. At the same time vitamin D suppresses the expression of myostatin, a negative regulator of muscle mass. Moreover, vitamin D increases the number of type II or fast twitch muscle cells and in particular that of type IIA cells, while its deficiency causes type IIA cell atrophy.”

Vitamin D Essential for Proper Muscle Function and Athletic Performance

“Vitamin D deficiency is a worldwide epidemic, with well known impacts on calcium metabolism and bone health, but increasingly recognized associations with chronic health problems such as bowel and colonic cancer, arthritis, diabetes and cardiovascular disease. In recent years in the Sports Medicine literature, there has been an increased focus on the potential impact that inadequate Vitamin D levels may have on athletic performance.”

“Muscle structure and function is recognised to play a key role in athletic performance, and both cross-sectional and longitudinal studies allude to a functional role for Vitamin D in muscle. The identification of the Vitamin D receptor in muscle tissue provides a direct pathway for Vitamin D to impact upon Skeletal Muscle structure and function.”

Vitamin D Essential for Muscle Growth and Function, Immune Function, Cardiovascular Function and Proper Control of Inflammation

“In relation to VITD supplementation in athletes with deficiency, several studies have shown that this increases muscle strength. Higher serum levels of vitamin D are associated with reduced injury rates and better sports performance.”

“We are currently experiencing a vitamin D (VITD) deficiency pandemic across the world.”

“Vitamin D is important in bone health, but recent research also points out its essential role in extra-skeletal functions, including skeletal muscle growth, immune and cardiopulmonary functions and inflammatory modulation, which influence athletic performance. Vitamin D can also interact with extra-skeletal tissues to modulate injury recovery and also influence the risk of infection.”

“Over the past decade, interest in research in relation to vitamin D (VITD) has been growing exponentially, partly due to the increased prevalence of its deficiency in the population and the association between the deficiency of VITD and a wide range of diseases [1–3]. The importance and versatility of vitamin D in the organism is becoming increasingly evident. VITD plays an active role in immune function, protein synthesis, muscle function, cardiovascular function, inflammatory response, cell growth and musculoskeletal regulation.”

Vitamin D Essential for Cardiovascular, Immune, and Musculoskeletal Health and Performance.

“Roles for vitamin D have been established in the function of the cardiovascular, immune, and musculoskeletal systems.”

“Poor vitamin D status affects muscle strength, and vitamin D may participate in protein synthesis through the actions of the vitamin D receptor in muscle tissue. Vitamin D may protect against overuse injuries, such as stress fracture, through its well-documented role in calcium metabolism.”

“The objective of this manuscript is to review recent evidence regarding the importance of vitamin D for maintaining physical performance, and includes specific examples of how vitamin D supports the cardiovascular, immune, and musculoskeletal systems.”

4000-5000 IU/Day (500 IU/40lbs or 1 Capsule of OmegA+D Sufficiency™/40 lbs) of Vitamin D Required for Optimal Athletic Performance and Injury Prevention.

“Vitamin D deficiency can negatively affect muscle strength, power, and endurance. Furthermore, low vitamin D levels can increase the occurrence of stress fractures and other musculoskeletal injuries and can affect acute muscle injuries and inflammation following high intensity exercises.”

“Vitamin D deficiency can severely limit athletic performance, but it has been shown that vitamin D supplementation can alleviate this effect and improve performance.”

“Based on the previous findings on recovery, strength and performance, 4,000-5,000 IU of vitamin D per day may be a safe dose that can improve athletic performance [and immune function and overall health].”

Low Vitamin D Levels Significantly Reduce Athletic Performance – Proper Supplementation Amounts (500 IU/40lbs or 1 Capsule of OmegA+D Sufficiency™/40 lbs) for Months Required to Become Sufficient

“Low vitamin D levels have been demonstrated to have negative effects on muscle strength, power, and endurance; increase stress fractures and other musculoskeletal injuries; and affect acute muscle injuries and inflammation following high-intensity exercises.”

“Carswell et al. reported that vitamin D levels were positively correlated with endurance and that lower vitamin D levels could impair endurance. Geiker et al. demonstrated that muscle strength was significantly higher in male swimmers with sufficient serum vitamin D levels. Bauer et al. reported that vitamin D deficiency in handball players may increase their risks of musculoskeletal injuries and infections. Rebolledo et al.7 stated that National Football League (NFL) players commonly have insufficient levels of vitamin D and that players with a history of lower extremity muscle strain and core muscle injuries are more likely to have vitamin D insufficiency.”

“In those with low levels of vitamin D, exposure to sunlight and an improved diet or supplements may be helpful. Particularly, 2000–6000 IU of supplemental vitamin D3 can be consumed daily [depends on body weight – 500 IU/40 lbs (18kg)].”

“Because its actions address underlying processes, vitamin D supplementation may take months to facilitate pain relief, which can range from partial to complete.”

“Therefore, athletes competing in the northern half of the United States—and all of Canada and Europe—are at increased risk for vitamin D deficiency, especially during the late autumn and winter.”

“Even those residing at sunny lower latitudes are at risk for deficiency if they consciously avoid the sun or properly use sunblock. For example, a surprisingly high incidence of vitamin D deficiency exists in Miami, despite its sunny weather and subtropical latitude.”

“The definition of vitamin D deficiency is changing almost yearly as research shows the low end of ideal 25(OH)D ranges is much higher than we thought only a few years ago. For example, very recent evidence indicates ideal levels may be above 50 ng/mL [125nmol/L].”

“Those caring for athletes have a responsibility to promptly diagnose and adequately treat vitamin D deficiency. Adequate treatment requires thousands, not hundreds, of IU of vitamin D daily, doses that may make many sports physicians uncomfortable.”

Vitamin D Deficiency Significantly Increases Risk of Chronic Back Pain

“Some researchers have found this (vitamin D deficiency) to occur in up to 85% of chronic musculoskeletal pain cases, especially those involving the lower back [but including ALL JOINTS]”

“In the research investigations to date, patients found to have deficient 25(OH)D (Vitamin D) concentrations had been variously diagnosed with fibromyalgia syndrome, hyperesthesia, rheumatic disorders, osteoarthritis, back pain, bone and joint pain, muscle weakness, and other chronic somatic complaints.”

“The active 1,25(OH)2D form of vitamin D is a potent modulator of inflammation and may play a role in shutting off chronic inflammatory responses.”

Vit D Supplementation in Adequate Amounts (500 IU/40lbs or 1 Capsule of OmegA+D Sufficiency/40 lbs) Significantly Reduces Back Pain

“Subjects were treated for 3 months with 5000 IU/day to 10,000 IU/day of vitamin D3 (patients >50 kg received the larger dose).”

“There were no episodes of hypercalcemia reported, and pain symptoms were relieved in 95% of the patients.”

IMPORTANCE OF VITAMIN D FOR OVERALL HEALTH

Supplementing with Vitamin D Improves Overall Health and Quality of Life and Reduces the Development of Chronic Diseases. Research Shows that Supplementing with Vitamin D Improves Immune Function, Improves Inflammation Resolution and Decreases Systemic Inflammation, Improves Blood Sugar, Improves Fat Loss, Decreases Age-Related and Disease-related Muscle Loss, Decreases Arthritis-Related Joint Destruction and Pain, Decreases Cancer Incidence and Improves Cancer Survival, Decreases Cardiovascular Disease Incidence and Improves Survival, Improves Pregnancy and Newborn Outcomes, Improves Moods and Reduces Depression and Anxiety, Improves Digestive Health and Reduces IBS and Crohn’s Inflammation and Pain.

Supplementing with Vitamin D Significantly Lowers Cancer Risk and Improves Survival

“Vitamin D-sensitive cancers are responsible for 257,000 deaths (46% of all cancer deaths in U.S. in 2007).”

“Four year study on vitamin D supplementation showed a 77% reduction in all invasive breast cancers in women who received vitamin D supplementation versus those who did not supplement.”

“High serum vitamin D was associated with lower mortality from breast cancer.”

“Patients with the highest concentration of Vitamin D had approximately half the fatality rate compared to those with the lowest concentration.”

“In this large cohort study, serum 25(OH)D concentrations were inversely associated with all-cause and cause-specific mortality.”

“In particular, vitamin D deficiency [25(OH)D concentration <30 nmol/L] was strongly associated with mortality from all causes, cardiovascular diseases, cancer, and respiratory diseases.”

Vitamin D Essential for Immune Function and Protection from Colds, Flus, and COVID

“Vitamin D dramatically up-regulates the genetic expression of antimicrobial proteins (AMPs) in immune cells of the innate immune system (the part of the immune system that immediately attacks and kills viruses, bacteria, and fungi).”

“Also, macrophages use vitamin D to enable the synthesis of the bactericidal peptides needed to deal with bacterial invaders.”

“Vitamin D deficiency has been linked to many diseases and conditions in addition to bone diseases, including many types of cancer, several bacterial and viral infections, autoimmune diseases, cardiovascular diseases, and adverse pregnancy outcomes.”

“The estimated benefits in disease reduction were based on increasing the mean serum 25(OH)D level to 105 nmol/L. It is estimated that the death rate could fall by 37 000 deaths, representing 16.1% of annual deaths and the economic burden by 6.9% or $14.4 billion less the cost of the program.”

“It is recommended that Canadian health policy leaders consider measures to increase serum25(OH)D levels for all Canadians.”

“Besides enhancing chemotaxis and phagocytic capabilities of innate immune cells, the complex of calcitriol, VDR [Vit D Receptor], and retinoid X [Vit A] receptor directly activates the transcription of antimicrobial peptides such as defensin β2 and cathelicidin antimicrobial peptides.”

“This finding supports the theory that the vitamin D status regulates antimicrobial protein levels and may be crucial in infection control.”

“In principle, vitamin D exposure leads to a shift from a proinflammatory to a more tolerogenic immune status.”

“Tregs act to suppress proinflammatory responses by other immune cells and aim to prevent exaggerated or autoimmune responses. They are potently induced by different forms of vitamin D.”

“Taken together these results suggest that vitamin D may not only support the innate but also the adaptive immune system.”

“Low serum 25(OH)D levels have been associated with upper respiratory tract infections (URTI), including influenza, chronic obstructive pulmonary disease and allergic asthma”.

“In a Swedish RCT in 140 immunodeficient patients, daily intake of 4000 IU cholecalciferol [Vit D] over one year significantly reduced infectious symptoms, the total number of specific pathogens in the nasal fluid and the use of antibiotics in the vitamin D compared to the placebo group.”

“Over the last three decades, it has become clear that the role of vitamin D goes beyond the regulation of bone and calcium homeostasis. Indeed, vitamin D exerts a series of anti-infective, anti-inflammatory and immunomodulatory properties by acting on the vitamin D receptor (VDR), which has been identified in almost all immune cells.”

“These properties involve: i) the inhibition of production of pro-inflammatory cytokines; ii) the reduction of the antigen-presenting capacity and T-cell stimulatory ability by antigen presenting cells; iii) the upregulation of regulatory T cells (Tregs); iv) the promotion of the shift of T-cell effector phenotype (Th1 and Th17 cells) towards a regulatory anti-inflammatory phenotype (Th2); v) the promotion of the transition from pro-inflammatory interferon-gamma (IFN-γ)-secreting Th1 cells to suppressive interleukin-10-producing cells; and vi) the promotion of the shift of macrophage polarization from the pro-inflammatory M1 phenotype towards the M2 anti-inflammatory phenotype.”

“An important aspect to be considered is the optimal circulating vitamin D concentration aimed at achieving the anti-inflammatory and immunomodulatory actions exerted by calcitriol. Emerging evidence suggests that serum 25-hydroxyvitamin D [25(OH)D] levels ≥40 ng/mL are optimal to achieve the anti-infective, anti-inflammatory and immunomodulatory properties of vitamin D in vivo.”

“In this regard, a dietary and/or supplemental intake of vitamin D3 of 4000-6000 IU/day is generally safe and effective in reaching and maintaining such circulating 25(OH)D concentrations in adults.”

“In a 3 year trial taking 800 IU/day of Vitamin D reduced the incidence of colds and flu by 70%.”

“In the group taking 2000 IU/day [still less than half amount now recommended] the incidence of colds and flu was reduced by almost 100% (only 1 of 104 subjects developed cold or flu).”

“In addition, 1,25-dihydroxyvitamin D protects ß- cells from detrimental immune attacks, directly by its action on ß-cells, but also indirectly by acting on different immune cells, including inflammatory macrophages, dendritic cells, and a variety of T cells. Macrophages, dendritic cells, T lymphocytes, and B lymphocytes can synthesize 1,25- dihydroxyvitamin D, all contributing to the regulation of local immune [inflammatory] responses.”

“In fact, inadequate vitamin D and other nutrients during the development of the immune system may play a critical role in the development of autoimmune diseases. Evidence from animal models and prospective studies of rheumatoid arthritis, multiple sclerosis, systemic lupus erythematosus, and type 1 DM suggests that vitamin D has an important role as a modifiable environmental factor in autoimmune diseases.”

“Vitamin D deficiency is common in people who develop ARDS. This deficiency of vitamin D appears to contribute to the development of the condition, and approaches to correct vitamin D deficiency in patients at risk of ARDS should be developed.”

“Vitamin D deficiency is associated with an increased risk of intensive care admission and mortality in patients with pneumonia.”

“Vitamin D may improve outcomes by reducing both local and systemic inflammatory responses as a result of modulating cytokine responses.”

“Meta-analysis of IPD [individual participant data] from 10 933 participants in 25 randomised controlled trials showed an overall protective effect of vitamin D supplementation against acute respiratory tract infection."

“Benefit was greater in those receiving daily or weekly vitamin D without additional bolus doses, and the protective effects against acute respiratory tract infection in this group were strongest in those with profound vitamin D deficiency at baseline.”

“These findings support the introduction of public health measures such as food fortification to improve vitamin D status, particularly in settings where profound vitamin D deficiency is common.”

“In this meta-analysis, CAP [community acquired pneumonia] patients with vitamin D deficiency (serum 25(OH)D levels <20ng/mL) experienced a significantly increased risk of CAP, and an obvious decrease of -5.63ng/mL in serum vitamin D was demonstrated in CAP patients.”

“The evidence from this meta-analysis indicates an association between vitamin D deficiency and an increased risk of CAP patients.”

“Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines.”

“Recent research has highlighted a crucial supportive role for vitamin D in immune cell function, particularly in modulating the inflammatory response to viral infection.”

“At a cellular level, vitamin D modulates both the adaptive and innate immune system through cytokines and regulation of cell signalling pathways. Vitamin D receptor (VDR) is present on both T and B immune cells; Vitamin D modulates the proliferation, inhibition and differentiation of these cells.”

“A ‘sufficient’ vitamin D serum level is linked to a switch from a pro- to anti-inflammatory profiles in older adults.”

“This impact on the regulation of inflammation is of particular importance in older adults, the obese, and those with chronic conditions, as they may already be pre-set for a higher inflammatory response if exposed to Covid-19. A heightened inflammatory response in people who are vitamin D deficient may therefore increase the potential for ‘cytokine storm’ and consequent ARDS.”

“In this short report we observed that low 25(OH)D concentrations appear to be associated with increased mortality from Covid-19.”

“Countries with a formal vitamin D fortification policy appear to have the lowest rates of infection whilst countries with no policy and highest deficiency rates appear to be more adversely affected.”

“SARS-CoV-2 positivity is strongly and inversely associated with circulating 25(OH)D levels, a relationship that persists across latitudes, races/ethnicities, both sexes, and age ranges.”

“Vitamin D supplementation may reduce acute respiratory infections, especially in people with vitamin D deficiency. A previous study found that each 4 ng/mL increase in circulating 25 (OH)D levels was associated with a 7% decreased risk of seasonal infection, a decrement of approximately 1.75% per ng/mL.”

“This is remarkably similar to the 1.6% lower risk of SARS-CoV-2 positivity per ng/mL found in our adjusted multivariable model.”

“The risk of SARS-CoV-2 positivity continued to decline until the serum levels reached 55 ng/mL.”

“The vitamin D endocrine system may have a variety of actions on cells and tissues involved in COVID- 19 progression especially by decreasing the Acute Respiratory Distress Syndrome. We therefore evaluated the effect of calcifediol treatment, on Intensive Care Unit Admission and Mortality rate among Spanish patients hospitalized for COVID-19.”

“Of 50 patients treated with calcifediol [Vit D], one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%).”

“Of the patients treated with calcifediol, none died, and all were discharged, without complications.”

“The 13 patients not treated with calcifediol, who were not admitted to the ICU, were discharged. Of the 13 patients admitted to the ICU, two died and the remaining 11 were discharged.”

2% of Vit D treated patients required ICU care: 50% of non-treated required ICU care. 0% of Vit D treated ICU patients died: 15% of non-treated ICU patients died.

“Unlike influenza, children under age 10 are almost completely spared in COVID-19. This unusual risk factor pattern presented a mystery that spawned studies showing that COVID-19 fatalities are especially high in areas with lower levels of sunshine due to latitude or air pollution, except when population vitamin D intake is high.”

“In fact, the risk groups for severe COVID- 19 match the risk groups for vitamin D deficiency exactly, and there is biological plausibility: vitamin D is known to modulate the immune system, helping prevent both under-reaction that allows upper respiratory infections to be contracted, and the over-reaction referred to in COVID-19 as the “cytokine storm”.

“In conclusion, a high dose, oral vitamin D supplementation to augment 25(OH)D >50 ng/ml helped to achieve SARS-CoV-2 RNA negativity in greater proportion of asymptomatic vitamin D-deficient individuals with SARS-CoV-2 infection along with a significant decrease in inflammatory markers.”

“SARS-CoV-2 RNA negativity by cholecalciferol supplementation may help in reducing transmission rates of the highly contagious SARS-CoV-2 infection.”

“A reassurance for public health workers regarding greater likelihood of SARS CoV-2 RNA negativity in individuals receiving therapeutic cholecalciferol supplementation will be encouraging.”

“Importantly, a recent unbiased genomics-guided tracing of the SARS-CoV-2 targets in human cells identified vitamin D among the three top-scoring molecules manifesting potential infection mitigation patterns through their effects on gene expression.”

“In particular, by activating or repressing several genes in the promoter region of which it binds to the vitamin D response element, vitamin D may theoretically prevent or improve COVID-19 adverse outcomes by regulating: i) the renin–angiotensin system (RAS), ii) the innate and adaptive cellular immunity, iii) the physical barriers, and iv) the host frailty and comorbidities.”

“Intervention groups were participants regularly supplemented with vitamin D over the preceding year (Group 1), and those supplemented with vitamin D after COVID-19 diagnosis (Group2). The comparator group involved participants having received no vitamin D supplements (Group 3).”

“At the end of the study, the proportion of participants experiencing severe COVID-19 was lower in Group 1 (10.3%) compared to Group 3 (31.3%), just like the 14-day mortality (6.9% in Group 1 versus 31.3% in Group 3).”

“In this publication, we will demonstrate that vitamin D3 deficiency, which is a well-documented worldwide problem, is one of the main reasons for severe courses of SARS-CoV-2 infections.”

“Much research shows that blood calcidiol (25(OH)D3) levels correlate strongly with SARS-CoV-2 infection severity.”

“For the combined data, median D3 levels were 23.2 ng/mL, and a significant Pearson correlation was observed [between D3 levels and risk of mortality]. Regression suggested a theoretical point of zero mortality at approximately 50 ng/mL D3.”

“All the studies showed an increased risk of Covid-19 positive test in subjects with lower 25(OH)D levels (Fig 1), and the SRR [summary relative risk] indicated a significant double increased risk of infection for subjects with low serum VD levels compared to the highest level: SRR = 2.18.”

“Sixteen studies investigated the association between VD levels and severity of Covid-19 in terms of patient need for ICU admission or ventilation requirement or intubation” “The SRR indicated a significant double increased risk of severity [of COVID illness] for subjects with low serum 25(OH)D levels (SRR = 2.38).”

“Nineteen studies investigated the association between baseline VD levels and mortality of Covid-19 patients. The SRR for these studies suggested a significantly double increased risk of death for subjects with low level of 25(OH)D (SRR = 2.35).”

“A lower vitamin D status was more common in patients with the severe or critical disease (<20 ng/mL [87.4%]) than in individuals with mild or moderate disease (<20 ng/mL ).”

“Patients with vitamin D deficiency (<20 ng/mL) were 14 times more likely to have severe or critical disease than patients with 25(OH)D >40 ng/mL.”

“Conclusions: Among hospitalized COVID-19 patients, pre-infection deficiency of vitamin D was associated with increased disease severity and mortality.”

Supplementation with Vitamin D Especially Critical for Individuals with Dark Skin

“African Americans have higher incidence of, and mortality from, many health-related problems than European Americans. They also have a 15 to 20-fold higher prevalence of severe vitamin D deficiency. Here we summarize evidence that: the health of individuals with dark skin can be markedly improved by correcting deficiency and achieving an optimal vitamin D status, as could be obtained by supplementation and/or fortification.”

“Moderate-to-strong evidence exists that high 25-hydroxyvitamin D levels and/or vitamin D supplementation reduces risk for many adverse health outcomes including all-cause mortality rate, adverse pregnancy and birth outcomes, cancer, diabetes mellitus, Alzheimer’s disease and dementia, multiple sclerosis, acute respiratory tract infections, COVID-19, asthma exacerbations, rickets, and osteomalacia.”

Vitamin D Deficiency Increases Risk of Diabetes, Metabolic Disease, and Cardiovascular Disease

“Vitamin D deficiency has been linked to a wide field of health problems including several types of cancer and autoimmune and metabolic diseases such as type 1 DM and type 2 DM [Diabetes Mellitus].”

“Vitamin D plays an important role in glucose homeostasis via different mechanisms. It not only improves insulin sensitivity of the target cells (liver, skeletal muscle, and adipose tissue) but also enhances and improves ß-cell function.”

“The association of vitamin D status and cardiometabolic disorders (cardiovascular disease, diabetes, and metabolic syndrome) was reviewed recently in a meta-analysis of 28 independently published studies. The findings showed a significant 55% reduction in the risk of diabetes (9 studies), a 33% reduction in the risk of cardiovascular diseases (16 studies), and a 51% reduction in metabolic syndrome (8 studies) associated with a high serum 25-dihydroxyvitamin D concentration.”

A group of Type 2 diabetic subjects with chronic, painful neuropathy were supplemented with 2000 IU/day of Vitamin D for 3 months [less than half of optimal dose].

Symptoms improved from an average of “distressing” to an average of “mild”. Overall results were a nearly 50% reduction in pain scores.

Vitamin D Deficiency Causes Erectile Dysfunction

“After adjusting for lifestyle variables, comorbidities, and medication use, men with 25(OH)D deficiency had a higher prevalence of ED compared to those with levels ≥30 ng/ml.”

“In this cross-sectional analysis of a representative sample of U.S. men, vitamin D deficiency was associated with an increased prevalence of ED independent of ASCVD risk factors.”

Vitamin D Reduces Aging Process

“Researchers studying serum values of vitamin D in 2,160 twins found higher vitamin D levels may alter telomere length of leukocytes.”

“The difference between the highest and lowest tertiles of vitamin D was 107 base pairs (p=0.0009), which is equivalent to a reduction of 5.0 y of telomeric aging.”

The authors go on to state that this finding “…underscores the potentially beneficial effects of this hormone on aging and age-related diseases.”

Vitamin D Sufficiency Reduces Risk of Multiple Sclerosis by 91%

“The risk of MS decreased 40% in Caucasian men and women with every 20-ng/mL increase in circulating 25(OH)D. The reduction of risk was strongest in late adolescence. In this subgroup, a 91% reduction was seen when serum 25(OH)D levels were 40 ng/mL before age 20, compared to those with lower values.”

Vitamin D Supplementation Improves Mood and Reduces Depression and Anxiety Symptoms

“In an earlier study, patients with clinical depression were randomized to receive vitamin D3 supplementation or placebo. Those patients administered vitamin D had significantly enhanced mood and a reduction in negative- affect symptoms.”

“Sub-group analysis showed that vitamin D supplementation significantly reduced depressive symptom scores in patients with serum 25(OH)D levels higher than 50 nmol/L.”

“Vitamin D supplementation has a benefit on improving depressive symptoms in adults with primary depression and 25(OH)D levels higher than 50 nmol/L but has no effect on improving depressive symptoms in adults with primary depression and 25(OH)D levels lower than 50 nmol/L. Relatively high levels of 25(OH)D may be required for alleviating depression.” [this requires 500 IU/40lbs/day or 1 capsule of OmegA+D Sufficiency/40lbs/day].

“Results: According to most cross-sectional and cohort studies, the results highlight an inverse relationship between serum 25(OH)D levels and the risk of depression, as well as the severity of depressive symptoms. An increase in serum 25(OH)D concentration is associated with an improvement in depression test scores, with vitamin D supplementation exerting a beneficial effect on both the incidence and the prognosis of depression.”

“Conclusions: Based on current evidence which indicates the implications of vitamin D in the neurobiological mechanisms associated with depression, and the results obtained in most of the studies, which demonstrate an inverse relationship between serum 25(OH)D levels and the beneficial effect of vitamin D supplementation on depressive symptoms, vitamin D could represent an adjunctive therapy in the management of MDD.”

“Key Takeaways:

Vitamin D plays a neuroprotective role, influencing serotonin synthesis and brain plasticity, relevant for mental health conditions like depression and anxiety.

Deficiency in vitamin D is linked to increased risk of depression, ADHD, anxiety, and suicide, with supplementation showing potential benefits.”

“Vitamin D and Omega-3 fatty acids modulate depression pathways, influencing neurotransmission and reducing inflammation.”

“Observational studies and randomized trials support their efficacy, particularly in cases of deficiency.”

“Integrative approaches incorporating these nutrients into care plans enhance therapeutic outcomes.”

“Vitamin D modulates neurotransmitter activity, reduces neuroinflammation, and influences neuroplasticity, enhancing cognitive function and mood regulation. Omega-3 fatty acids, particularly EPA and DHA, exhibit anti-inflammatory properties, optimize serotonergic transmission, and stabilize neuronal membranes. Clinical evidence suggests that supplementation with these nutrients can significantly reduce depressive symptoms, particularly in patients with comorbid nutritional deficiencies. However, variability in study designs and dosages limits the generalizability of findings.”

Vitamin D Supplementation Reduces Inflammation, Improves Gut Bacteria, and Decreases Disease Activity in Patients with Ulcerative Colitis and Crohn’s Disease.

“Low vitamin D status in patients with IBD is associated with increased risk of clinical relapse, disease activity, and intestinal inflammation.”

“Higher vitamin D levels and vitamin D supplementation have been associated with gut microbiome composition shifts toward increased diversity and enrichment of beneficial gut bacteria in healthy adults and in patients with IBD.”

“Vitamin D treatment associates with decreased disease activity and inflammatory markers and increased IgA-bound and decreased IgG-bound gut microbiota.”

“Our results demonstrate that vitamin D promotes immune tolerance to gut microbiota in patients with IBD [inflammatory bowel disease -ulcerative colitis and Crohn disease].”

“Research indicates that vitamin D supplementation modulates or decreases pro-inflammatory cytokines (e.g. C-reactive protein, interleukin 6 and 12, and tumor necrosis factor-alpha) while increasing anti-inflammatory cytokines (e.g. interleukin-10).”

“Clinical investigators have further suggested that vitamin D may help to moderate painful chronic inflammatory autoimmune conditions that are influenced by excessive cytokine activity, such as inflammatory bowel disease and Crohn’s disease.”

IMPORTANCE OF SUPPLEMENTING OMEGA-3 and VITAMIN D and A TOGETHER: WHY OMEGA+D SUFFICIENCY™ IS SO UNIQUELY BENEFICIAL

“Vitamin A and vitamin D balance, enhance, and contain each other through the retinoid X receptor (RXR).”

“Because they share a receptor, if we supplement either vitamin D or vitamin A in an unbalanced fashion, we create a functional deficiency of the one not supplemented.”

“Low blood levels of vitamin D, vitamin A, and carotenoids are all correlated with greater risk of heart disease.”

“In summary, we describe a unique and unexpected facet of intermolecular cross-talk between VDR and RXR and demonstrate that RXR actively participates in RXR-VDR-mediated gene transcription by directly recruiting coactivators in response to 1,25-(OH)2D3.”

“This would imply that the policy of giving vitamin D supplement alone in pregnancy instead of cod liver oil would need adjustment. Cod liver oil, as natural supplement of vitamin A and vitamin D, is well know for its beneficial effects on the growth of infants and children.”

“The large, randomized, double-blind, placebo controlled trial VITAL (vitamin D and omega-3 trial) recently confirmed that vitamin D and Omega-3 polyunsaturated fatty acid (PUFA) co-supplementation (VIDOM) can reduce the incidence of autoimmune diseases. Based on these relevant results, this commentary summarizes the molecular mechanisms behind the anti-inflammatory and immunomodulatory properties of vitamin D and omega-3 PUFAs.”

“We also describe the potential bidirectional interplay between vitamin D metabolism and omega-3 PUFA metabolism that underlies the rationale for VIDOM co-supplementation and that may contribute to enhance the anti- inflammatory and immunomodulatory actions of Vitamin D and omega-3 PUFAs when these compounds are administered in combination.”

“In this regard, the recent results of the VITAL study are of high clinical significance, since both vitamin D and omega-3 PUFAs are safe, well-tolerated, nontoxic and inexpensive nutritional supplements that may be particularly beneficial in high-risk individuals.”

“In light of the above, hypovitaminosis D and omega-3 PUFA deficiencies may represent key environmental risk factors for development of autoimmune diseases. Indeed, vitamin D and omega-3 PUFA deficiencies can be associated with an increase in systemic inflammation. Vitamin D and omega-3 PUFAs, when administered in combination (as VIDOM co-supplementation, may exert synergistic anti-inflammatory and imunomodulatory actions to a greater extent than when they are administered alone.”

“In fact, adequate circulating vitamin D and omega-3 PUFA concentrations may contribute to reduce systemic inflammation by enhancing a systemic anti-inflammatory state.”

“Accordingly, preliminary intervention studies and clinical trials demonstrated that VIDOM co-supplementation leads to significant benefits in different clinical settings, including insulin resistance and non-alcoholic fatty liver disease, prediabetes, type 2 diabetes mellitus associated with coronary heart disease, gestational diabetes mellitus, polycystic ovary syndrome, type 1 diabetes mellitus, inflammatory bowel disease, and autism spectrum disorder.”

“Such beneficial effects likely arise from the synergistic anti-inflammatory, antioxidant and immunomodulatory properties exerted by vitamin D and omega-3 PUFAs.”

“A significant reduction was observed in fasting glucose, insulin, homeostasis model assessment-beta cell function, weight and waist circumference in the co-supplementation group compared to the other three groups. Moreover, high-density lipoprotein-cholesterol levels increased significantly in the co-supplementation group compared to the other three groups [Vit D or Omega-3 alone or placebo].”

“Conclusion: Vitamin D and omega-3 co-supplementation improved fasting serum glucose, insulin, high-density lipoprotein-cholesterol level, homeostasis model assessment-beta cell function, weight and waist circumference. This co-supplementation can therefore be recommended for glycemic control.”

“A significant difference was observed in terms of reduction in anxiety and improvement in sleep quality in the co-supplementation compared to the other three groups. There was also a significant difference between the group receiving both supplements and the group receiving only placebos in terms of reduction in depression and stress.”

“Conclusion: Vitamin D and omega-3 co-supplementation improved depression, anxiety, and sleep quality in women of reproductive age with pre-diabetes and hypovitaminosis D. Therefore, these two supplements can be recommended for improving mental health.”

“Given their positive effects on mental health, the concurrent use of these two supplements can be further considered as a measure for preventing type-II diabetes.”