Health & Fitness

I’ve written many articles reviewing how nutrients such as vitamins C and D can help prevent and even play a role in the treatment of COVID-19. Now, researchers have highlighted the value of yet another vitamin or, rather, complex of vitamins, namely B vitamins.

The paper,^1,2,3,4 “Be Well: A Potential Role for Vitamin D in COVID-19,” was published online August 15, 2020, in the journal Maturitas. The paper is the result of a joint collaboration between researchers at the University of Oxford, United Arab Emirates University and the University of Melbourne, Australia.

While no studies using B vitamins have been performed on COVID-19 patients, the researchers stress that, based on B vitamins’ effects on your immune system, immune-competence and red blood cells (which help fight infection), supplementation may be a useful adjunct to other prevention and treatment strategies. They are not suggesting B vitamins might prevent or treat COVID-19 by themselves.

Why Well-Regulated Immune Function Is Essential

One of the factors that make COVID-19 so dangerous to those with underlying conditions or old age is its ability to overactivate your immune system, triggering cytokine and/or bradykinin storms.

By strengthening and modulating immune function, in other words, making it function more appropriately and effectively, nutrients such as vitamins B, C and D can play important roles in minimizing your risk of this deadly development. As explained by Dr. Uma Naidoo, a nutrition expert at Harvard Medical School, who was not involved in the paper:⁵

“You can think of the immune system as an army. Its job is to protect the body. But if the immune system army isn’t well-regulated, it can overreact and actually cause more damage — this overreaction is what often happens in COVID-19 and is referred to as the cytokine storm.

Cytokines are inflammatory molecules released by immune cells. They are like the weapons of the immune system army. So, if immune cells are soldiers, cytokines are guns and grenades.

And in a poorly regulated immune system, the body’s cytokine storm induced by COVID cause lots of inflammation in the body, just as if little grenades were being tossed around. This is what causes the worst outcomes and death in COVID.

It follows that anything that improves immune system function and decreases the chances that an infected person will have a catastrophic cytokine storm may improve the outcome of COVID-19 cases and decrease the overall death rate. Therefore, it’s quite feasible that B-vitamin supplementation could contribute to preventing the worst COVID outcomes.”

B Vitamins for Healthy Immune Function

As noted by the authors of “Be Well: A Potential Role for Vitamin D in COVID-19”:⁶

“There is a need to highlight the importance of vitamin B because it plays a pivotal role in cell functioning, energy metabolism, and proper immune function.

Vitamin B assists in proper activation of both the innate and adaptive immune responses, reduces pro-inflammatory cytokine levels, improves respiratory function, maintains endothelial integrity, prevents hypercoagulability and can reduce the length of stay in hospital.

Therefore, vitamin B status should be assessed in COVID-19 patients and vitamin B could be used as a non-pharmaceutical adjunct to current treatments …

Vitamin B not only helps to build and maintain a healthy immune system, but it could potentially prevent or reduce COVID-19 symptoms or treat SARS-CoV-2 infection. Poor nutritional status predisposes people to infections more easily; therefore, a balanced diet is necessary for immuno-competence.”

The graphic below illustrates the roles various B vitamins play in the COVID-19 disease process. As you can see, B vitamins are involved in several disease aspects, including viral replication and invasion, cytokine storm induction, adaptive immunity and hypercoagulability.

B Vitamins Play Many Roles in COVID-19 Disease Process

The paper goes on to detail how each B vitamin can be used to manage COVID-19 symptoms:

Vitamin B1 (thiamine) — Thiamine improves immune system function, protects cardiovascular health, inhibits inflammation and aids in healthy antibody responses. Vitamin B1 deficiency can result in an inadequate antibody response, thereby leading to more severe symptoms. There’s also evidence suggesting B1 may limit hypoxia.

Vitamin B2 (riboflavin) — Riboflavin in combination with ultraviolet light has been shown to inhibit replication of the MERS-CoV virus, and the combination has also been shown to decrease the infectious titer of SARS-CoV-2 below the detectable limit in human blood, plasma and platelet products.

Vitamin B3 (niacin/nicotinamide) — Niacin is a building block of NAD and NADP, which are vital when combating inflammation. As explained in “Be Well: A Potential Role for Vitamin D in COVID-19”:7 “NAD+ is released during the early stages of inflammation and has immunomodulatory properties, known to decrease the pro-inflammatory cytokines, IL-1β, IL-6 and TNF-α. Recent evidence indicates that targeting IL-6 could help control the inflammatory storm in patients with COVID-19. Moreover, niacin reduces neutrophil infiltration and exhibits an anti-inflammatory effect in patients with ventilator-induced lung injury … In addition, nicotinamide reduces viral replication (vaccinia virus, human immunodeficiency virus, enteroviruses, hepatitis B virus) and strengthens the body’s defense mechanisms. Taking into account the lung protective and immune strengthening roles of niacin, it could be used as an adjunct treatment for COVID-19 patients.”

Vitamin B5 (pantothenic acid) — Vitamin B5 aids in wound healing and reduces inflammation.

Vitamin B6 (pyridoxal 5′-phosphate/pyridoxine) — Pyridoxal 5′-phosphate (PLP), the active form of vitamin B6, is a cofactor in several inflammatory pathways. Vitamin B6 deficiency is associated with dysregulated immune function. Inflammation increases the need for PLP, which can result in depletion. According to the authors, in COVID-19 patients with high levels of inflammation, B6 deficiency may be a contributing factor. What’s more, B6 may also play an important role in preventing the hypercoagulation seen in some COVID-19 patients:8 “In a recent preprint it is suggested that PLP supplementation mitigates COVID-19 symptoms by regulating immune responses, decreasing pro-inflammatory cytokines, maintaining endothelial integrity and preventing hypercoagulability. In fact, it was shown three decades ago that PLP levels reduce abnormalities in platelet aggregation and blood clot formation. Recently researchers at Victoria University reported that vitamin B6 (as well as B2 and B9) upregulated IL-10, a powerful anti-inflammatory and immunosuppressive cytokine which can deactivate macrophages and monocytes and inhibit antigen-presenting cells and T cells. COVID-19 patients often respond to the virus by mounting an excessive T cell response and secretion of pro-inflammatory cytokines. It may be that PLP is able to contribute to dampening the cytokine storm and inflammation suffered by some COVID-19 patients.”

Vitamin B9 (folate/folic acid) — Folate, the natural form of B9 found in food, is required for the synthesis of DNA and protein in your adaptive immune response. Folic acid, the synthetic form typically found in supplements, was recently found9 to inhibit furin, an enzyme associated with viral infections, thereby preventing the SARS-CoV-2 spike protein from binding to and gaining entry into your cells. The research10 suggests folic acid may therefore be helpful during the early stages of COVID-19. Another recent paper11 found folic acid has a strong and stable binding affinity against SARS-CoV-2. This too suggests it may be a suitable therapeutic against COVID-19.

Vitamin B12 (cobalamin) — B12 is required for healthy synthesis of red blood cells and DNA. A deficiency in B12 increases inflammation and oxidative stress by raising homocysteine levels. Your body can eliminate homocysteine naturally, provided you’re getting enough B9 (folate), B6 and B12.12 Hyperhomocysteinemia — a condition characterized by abnormally high levels of homocysteine — causes endothelial dysfunction, activates platelet and coagulation cascades and decreases immune responses. B12 deficiency is also associated with certain respiratory disorders. Advancing age can diminish your body’s ability to absorb B12 from food,13 so the need for supplementation may increase as you get older. According to “Be Well: A Potential Role for Vitamin D in COVID-19”:14 “A recent study showed that methylcobalamin supplements have the potential to reduce COVID-19-related organ damage and symptoms. A clinical study conducted in Singapore showed that COVID-19 patients who were given vitamin B12 supplements (500 μg), vitamin D (1000 IU) and magnesium had reduced COVID-19 symptom severity and supplements significantly reduced the need for oxygen and intensive care support.”

How to Improve Your Vitamin B Status

As a general rule, I recommend getting most if not all of your nutrition from real food, ideally organic to avoid toxic pesticides, and locally grown. Depending on your situation and condition, however, you may need one or more supplements.

To start, review the following listing of foods that contain the B vitamins discussed in this article. If you find that you rarely or never eat foods rich in one or more of these nutrients, you may want to consider taking a high quality, ideally food-based supplement.

Also consider limiting sugar and eating fermented foods. The entire B group vitamin series is produced within your gut, assuming you have healthy gut flora. Eating real food, including plenty of leafy greens and fermented foods, will provide your microbiome with important fiber and beneficial bacteria to help optimize your internal vitamin B production.

Nutrient	Dietary Sources	Supplement Recommendations
Vitamin B1	Pork, fish, nuts and seeds, beans, green peas, brown rice, squash, asparagus and seafood.15	The recommended daily allowance for B1 is 1.2 mg/day for men and 1.1 mg/day for women.16
Vitamin B2	Eggs, organ meats, lean meats, green vegetables such as asparagus, broccoli and spinach.17	The RDA is 1.1 mg for adult women and 1.3 mg for men. Your body cannot absorb more than about 27 mg at a time, and some multivitamins or B-complex supplements may contain unnecessarily high amounts.18
Vitamin B3	Liver, chicken, veal, peanuts, chili powder, bacon and sun-dried tomatoes have some of the highest amounts of niacin per gram.19 Other niacin-rich foods include baker’s yeast, paprika, espresso coffee, anchovies, spirulina, duck, shiitake mushrooms and soy sauce.20	The dietary reference intake established by the Food and Nutrition Board ranges from 14 to 18 mg per day for adults. Higher amounts are recommended depending on your condition. For a list of recommended dosages, see the Mayo Clinic’s website.21
Vitamin B5	Beef, poultry, seafood, organ meats, eggs, milk, mushrooms, avocados, potatoes, broccoli, peanuts, sunflower seeds, chickpeas and brown rice.22	The RDA is 5 mg for adults over the age of 19. Pantothenic acid in dietary supplements is often in the form of calcium pantothenate or pantethine.23
Vitamin B6	Turkey, beef, chicken, wild-caught salmon, sweet potatoes, potatoes, sunflower seeds, pistachios, avocado, spinach and banana.24,25	Nutritional yeast is an excellent source of B vitamins, especially B6.26 One serving (2 tablespoons) contains nearly 10 mg of vitamin B6. Not to be confused with Brewer’s yeast or other active yeasts, nutritional yeast is made from an organism grown on molasses, which is then harvested and dried to deactivate the yeast. It has a pleasant cheesy flavor and can be added to a number of different dishes.
Vitamin B9	Fresh, raw, organic leafy green vegetables, especially broccoli, asparagus, spinach and turnip greens, and a wide variety of beans, especially lentils, but also pinto beans, garbanzo beans, kidney beans, navy and black beans.27	Folic acid is a synthetic type of B vitamin used in supplements; folate is the natural form found in foods. (Think: Folate comes from foliage, edible leafy plants.) For folic acid to be of use, it must first be activated into its biologically active form (L-5-MTHF). Nearly half the population has difficulty converting folic acid into the bioactive form due to a genetic reduction in enzyme activity. For this reason, if you take a B-vitamin supplement, make sure it contains natural folate rather than synthetic folic acid. Nutritional yeast is an excellent source.28 Research29 also shows your dietary fiber intake has an impact on your folate status. For each gram of fiber consumed, folate levels increased by nearly 2%. The researchers hypothesize that this boost in folate level is due to the fact that fiber nourishes bacteria that synthesize folate in your large intestine.
Vitamin B12	Vitamin B12 is found almost exclusively in animal tissues, including foods like beef and beef liver, lamb, snapper, venison, salmon, shrimp, scallops, poultry, eggs and dairy products. The few plant foods that are sources of B12 are actually B12 analogs that block the uptake of true B12.	Nutritional yeast is high in B12, and is highly recommended for vegetarians and vegans. One serving (2 tablespoons) provides nearly 8 mcg of natural vitamin B12.30 Sublingual (under-the-tongue) fine mist spray or vitamin B12 injections are also effective, as they allow the large B12 molecule to be absorbed directly into your bloodstream.

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You may think that liver disease is only a significant concern for those who drink alcohol excessively, but it’s currently estimated that 80 to 100 million Americans have nonalcoholic fatty liver disease, or NAFLD,¹ a form of liver disease that occurs without alcohol abuse.

Because NAFLD can progress into other more serious issues such as cancer and cirrhosis, and is considered a risk factor for heart disease, kidney disease, and Type 2 diabetes,² finding strategies to treat it has become a major public health priority.

As of right now, there are no FDA-approved medications for the condition, but research shows that lifestyle and dietary changes, like supplementing with bergamot and artichoke extracts, may be of help.

Bergamot and Artichoke Can Reduce Fat in the Liver

In a study published in Frontiers in Endocrinology in August 2020,³ researchers enrolled 102 participants between the ages of 35 and 70 with fatty liver and slightly elevated cholesterol in a double-blind clinical trial.

The participants were randomized into two groups: One group received a placebo and the other group received a daily dose of 300 milligrams of Bergacyn FF, a supplement containing bioactive compounds from Bergamot and wild artichoke, also called wild cardoon or Cynara cardunculus L., for 12 weeks.

In addition to taking the supplement, participants were also instructed to follow a Mediterranean-style diet, and obese participants were instructed to reduce their calorie intake by 400 to 500 calories per day. After 12 weeks, researchers concluded that the supplement reduced overall liver fat by 7%. In participants over the age of 50, liver fat was reduced by 15%.

While bergamot and wild artichoke contain many bioactive substances, the researchers attributed the effects to polyphenols, specifically. Polyphenols act as antioxidants, helping combat oxidative stress and protecting the body from free radicals.

They also stimulate lipophagy,⁴ the breakdown of fat droplets in the body. Citrus fruits are especially rich in a class of polyphenols called flavonoids, but bergamot, a bitter, inedible kind of citrus fruit, contains the highest concentration.⁵

The most beneficial compound in wild artichoke is cynaropicrin, a terpene that reduces oxidative stress and fights inflammation. Wild artichoke also contains other beneficial compounds, such as caffeoylquinic acids, luteolin and apigenin.⁶

In an earlier study,⁷ researchers found that the combination of bergamot and wild artichoke extract could also decrease oxidative stress and combat vascular inflammation, or inflammation of the blood vessels in Type 2 diabetics with NAFLD.

What Is Nonalcoholic Fatty Liver Disease?

To grasp why this study is so significant, you have to understand the impact of NAFLD and how it’s affecting the population. NAFLD is an umbrella term that encompasses two main forms of liver disease: nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH).

NAFL is the milder form. It’s characterized by the accumulation of fat on the liver, but without inflammation or damage to the liver cells.⁸ While some people with NAFL go on to develop more serious liver conditions, the risk is low.

NASH is the more serious form of NAFLD. In addition to excess fat on the liver, NASH is characterized by hepatitis, or inflammation of the liver that can cause scarring. Eventually, NASH can progress to cirrhosis, or excessive scarring of the liver that can lead to liver damage.

Twenty percent of the 80 to 100 million Americans with NAFLD have NASH, and 30% to 40% of those with NASH will go on to develop scarring of the liver (fibrosis).⁹

NAFLD on the Rise in Children

NAFLD was previously considered a condition that mostly affected adults, but because more and more children are becoming overweight or obese, it’s now also one of the leading causes of chronic liver disease in children. While estimates differ, NAFLD is thought to affect around 3% to 12% of the general pediatric population and 70% to 80% of children who are obese.¹⁰

This is partly due to a certain gene variant called PNPLA3 and partly due to excessive sugar consumption. In a 2008 study,¹¹ researchers found that having the PNPLA3 gene could increase the risk of fat accumulation in the liver and liver inflammation. The Hispanic population, who happen to be the most susceptible to fatty liver disease, are most likely to carry this gene.

Researchers from a different study¹² specifically looked at how a high intake of carbohydrates and sugar could affect the livers of overweight Hispanic children with the PNPLA3 gene. They found that children who had two copies of the gene had more accumulation of fat on the liver when eating a diet with significant amounts of added sugar.

Fructose was especially concerning because it activated SREBP-1, a protein that plays a role in stimulating de novo lipogenesis, the process that converts carbohydrates into fatty acids in the liver and inhibits the breakdown of fats in the liver.

More Ways to Support Liver Health

While there are no approved treatments for NAFLD, various studies show that scarring, inflammation and fat accumulation can all be reversed if the condition is caught early enough. Of course, it’s also best to prevent a condition like NAFLD rather than trying to reverse it once you have it. Fortunately, there are a lot of things you can do, and lifestyle changes you can make, to support your liver health.

In addition to supplementing with bergamot and wild artichoke extracts, other modifiable factors that can have a significant impact on the development of NAFLD include:

Eliminating sugar from your diet — Consuming too much sugar is known to cause fatty liver disease by stimulating de novo lipogenesis. Fructose has the most significant effect, but sucrose (table sugar) and glucose can also contribute.13 While eating natural sources of sugar, like fruit, occasionally isn’t likely to cause a problem, you want to avoid added sugar, especially high-fructose corn syrup, in your diet.

Eating more choline — Choline deficiency has been connected to an increased risk of fatty liver.14 You can protect your liver and your health by increasing your intake of choline-rich foods such as eggs, grass fed beef liver, organic, free-range chicken breast and grass fed ground beef.15

Losing weight (or maintaining a healthy one) — If you’re overweight, losing weight can help improve your liver health, even without changing any other factors. In a 2015 study that was published in Digestive Diseases and Sciences,16 researchers found that significant weight loss — defined as more than 10% of total body weight — could reverse fibrosis even in advanced forms of NASH. Some of the participants in the study even regressed from stage 4 NASH all the way back to stage 1.

Exercising regularly — Aerobic exercise helps you burn excess calories, reduces liver fat cells and can significantly reduce liver enzymes, even without any changes in weight.17 Exercise can also improve insulin sensitivity, which can also reduce your risk of developing NAFLD.

Limiting medications — Limit any medications to those necessary and follow dosing recommendations. Some medications, like corticosteroids, antidepressants, antipsychotics and tamoxifen (used to treat breast cancer) increase your risk of NAFLD and other health conditions.18 Reduce those risks by making lifestyle changes to minimize your dependence on medications.

Managing high blood pressure — High blood pressure increases your risk of metabolic syndrome and insulin resistance, which are connected to the development of NAFLD.19 There are several natural methods of reducing high blood pressure while working with your physician to wean off medication.

Reducing insulin resistance — Insulin resistance may lead to metabolic syndrome, prediabetes and Type 2 diabetes, all precursors to NAFLD.20 You can reduce insulin resistance by following a low-carbohydrate diet, exercising regularly and losing weight.

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To say we’re living through challenging times sounds like both a cliché and an understatement. In recent months, news about the pandemic, economic woes, and bitter political debates have triggered tremendous anxiety and sadness for many Americans.

But when people look back on their lives, it is usually the most difficult challenges that gave them a new perspective or caused them to grow the most. Of course, in the midst of a crisis, it doesn’t feel that way. But there are steps you can take to cope during difficult times, using techniques from the field of positive psychology.

How can positive psychology help in trying times?

Initially, positive psychology focused mainly on pursuing rewarding experiences that made people feel more joyful. But psychologists soon realized this sort of happiness depends on fleeting experiences, rather than a more enduring sense of contentment. As a result, the field shifted to concentrate on cultivating satisfaction and well-being but staying open to the full range of emotional experiences, both good and bad. Contrary to what you might expect, trying to resist painful emotions actually increases psychological suffering.

“Positive psychology is not about denying difficult emotions. It’s about opening to what is happening here and now, and cultivating and savoring the good in your life,” says Ron Siegel, PsyD, assistant professor of psychology at Harvard Medical School.

If you develop the habit of counting your blessings, for example, you may be better able to appreciate the positive aspects of life that remain even after a painful event like a job loss or a death. And helping others, even when you are struggling, can increase your positive feelings and help you gain perspective.

Growing evidence suggests that positive psychology techniques can indeed be valuable in times of stress, grief, or other difficulties. They may also help you develop the resilience to handle difficulties more easily, and bounce back more rapidly after traumatic or unpleasant events. Here are three positive psychology practices you can try.

Be more mindful

Mindfulness is the practice of purposely focusing your attention on the present moment and accepting it without judgement. Learning to live more in the present is especially helpful when the future is uncertain. Formal mindfulness-based stress reduction programs have been shown to help reduce physical and psychological symptoms in people facing a variety of challenges, including cancer and chronic pain. To practice at home, you can try some of the free guided recordings of mindfulness meditations narrated by Dr. Siegel, available at www.mindfulness-solution.com.

Share some kindness

Research suggests that people who volunteer their time tend to be happier than those who don’t. Those who give charitable donations may even get a small mood boost. Try this exercise: When you have a free afternoon, flip a coin. Heads, do something self-indulgent (for instance, give yourself a manicure). Tails, do something to help your community or another person (for example, call or write to an elderly person). Notice how you feel at the time and in the hours and days that follow.

Practice gratitude

Gratitude is a thankful appreciation for what you receive, whether tangible or intangible. With gratitude, you acknowledge the goodness in your life. You can apply this to your past (by retrieving positive memories and being thankful for elements of your childhood or past blessings), the present (not taking things for granted as they come), and the future (being hopeful and optimistic that there will be good things arriving). Our brains are wired to take note of when things go wrong. But keeping a gratitude journal — writing down things you’re thankful for — makes you more aware of when things go right.

The post Staying positive during difficult times appeared first on Harvard Health Blog.

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Choline is an often-overlooked nutrient — so overlooked that it wasn’t until 1998 that the Institute of Medicine officially recognized it as an essential nutrient.¹ Choline has many roles in human metabolism and is involved in everything from cell structure to the synthesis of neurotransmitters.

Choline is necessary for cell-membrane signaling, the transport of lipids and methyl-group metabolism, which is involved in detoxification. During development, choline is essential for the brain and memory in the fetus and decreases the risk of neural tube defects.²

A deficiency in choline may contribute to liver disease, atherosclerosis and neurological disorders, and its importance continues through adulthood and into old age.

While choline is found in a variety of foods, intakes for adults and children are believed to be far below optimal levels, putting public health at risk and leading experts to suggest that [intake of choline-rich foods should be encouraged.³ Among them, krill oil may be superior, due to its unique phospholipids.⁴

Why Krill Oil Is an Ideal Source of Choline

Norwegian researchers conducted a study looking into the use of phosphatidylcholine from krill oil to counteract the drop in choline that often occurs among athletes competing in triathlons. Choline plays a role in normal muscle function, and it’s known that the concentration of free choline may decrease during long distance high-intensity exercise.⁵

Krill oil contains 69 choline-containing phospholipids to synthesize phosphatidylcholine, a critical component of human cell membranes.⁶ This is key to its benefits as a source of choline, because it’s estimated that 60% of choline in organic salts is otherwise lost when gut bacteria convert it to the metabolite trimethylamine (TMA).

Enzymes may then turn TMA into trimethylamine-N-oxide (TMAO), a potential biomarker for insulin resistance and heart problems. Krill oil, however, contains fatty acids in the form of phosphatidylcholine (PC) — unlike fish oil, which contains them in triglyceride form.

As noted by the researchers, “Choline in the form of PC is considerably less converted to TMA as demonstrated in a single-dose study with krill oil,⁷ potentially resulting in more efficient delivery of choline.”⁸ It’s been shown for instance, that 28 days of krill oil supplementation increased choline levels in healthy young adults.⁹

Krill Oil May Protect Choline Status in Athletes

Writing in the journal Frontiers in Nutrition, researchers set out to determine if supplementing with phosphatidylcholine from krill oil prior to a triathlon would counteract the expected drop in choline during the race.¹⁰ For the study, 24 athletes received either 4 grams of krill oil or 4 grams of mixed vegetable oil daily for five weeks prior to the race.

Blood samples to assess choline and its metabolites were taken before, immediately after and the day after the race. Choline concentrations significantly declined from before the race to after among the athletes, but those in the krill oil group had significantly higher concentrations of choline compared to the vegetable oil group, and also had a significantly greater increase in choline after the race was completed.

“In conclusion,” the researchers noted, “krill oil may help to prevent that circulating choline concentrations become limiting during endurance competitions.”¹¹ However, it’s not only athletes who may benefit from the choline krill oil provides, especially considering that a National Health and Nutrition Examination Survey found that 90% of the U.S. population had inadequate choline intake.¹²

Risks of Choline Deficiency

Choline is a nutrient that’s important throughout life. Among adults deprived of choline, 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage — signs of organ dysfunction — as did 44% of premenopausal women.¹³ When incremental amounts of choline were added back into their diets, normal organ function was restored. As noted by researchers in the journal Nutrition Reviews:¹⁴

“Because of its wide-ranging role in human metabolism, from cell structure to neurotransmitter synthesis, choline deficiency is now thought to have an impact on diseases such as nonalcoholic fatty liver disease, atherosclerosis (via lipoprotein secretion), and possibly neurological disorders. Therefore, getting adequate choline in the diet is important throughout life for optimal health.”

Some of the symptoms associated with low choline levels include memory problems, lethargy and persistent brain fog. Choline also prevents the buildup of homocysteine in your blood, which is important since elevated levels are linked to heart disease, cancer, cognitive decline and bone fractures.¹⁵

Choline also reduces chronic inflammation, and research shows that people with choline-rich diets have lower levels of inflammatory markers such as C-reactive protein, homocysteine, interleukin-6 and tumor necrosis factor.¹⁶ Meanwhile, choline deficiency is linked with DNA damage and apoptosis, and breast cancer risk may be reduced by 24% among women who eat a high-choline diet.¹⁷

Choline for Brain and Liver Health

Choline has also been implicated in the risk of dementia,¹⁸ may improve cognitive performance¹⁹ and low levels are associated with increased anxiety levels.²⁰ It’s believed that choline may help to support the structural integrity of neurons, benefitting brain function in the elderly, and may even reduce the progression of dementia in people with Alzheimer’s disease.²¹

Further, without choline a range of your body’s metabolic processes will be seriously affected. According to the U.S. National Institutes of Health:²²

“The body needs choline to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital for cell membranes. Therefore, all plant and animal cells need choline to preserve their structural integrity.

In addition, choline is needed to produce acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions. Choline also plays important roles in modulating gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development.”

A deficiency in choline can also lead to liver damage, including nonalcoholic fatty liver disease (NAFLD or hepatosteatosis). Because choline is involved in fat metabolism, low levels of the nutrient can result in an overaccumulation of deposits of fat in your liver.²³

Not only have studies found that risk of NAFLD increases with lower dietary choline intake, but the risk of NAFLD was found to be 32% lower in women, and 25% lower in men, with the highest choline intakes compared to those with the lowest.²⁴

Are You Getting Enough Choline?

A Dietary Reference Intake (DRI) has not been established for choline, but the Institute of Medicine set an adequate daily intake value for men, women and children. The daily values are 425 milligrams (mg) per day for women, 550 mg for men and 250 mg for children as a minimum amount to prevent choline deficiency and potential organ damage.

However, requirements may vary depending on your overall diet, genetic makeup and other lifestyle factors. Groups at particularly high risk for choline deficiency include pregnant mothers, endurance athletes, postmenopausal women, vegans and those who consume high amounts of alcohol. Here's a further breakdown from the National Institutes of Health:²⁵

Age	Male	Female	Pregnant Women	Nursing Women
0 to 6 months	125 mg/day	125 mg/day
7 to 12 months	150 mg/day	150 mg/day
1 to 3 years	200 mg/day	200 mg/day
4 to 8 years	250 mg/day	250 mg/day
9 to 13 years	375 mg/day	375 mg/day
14 to 18 years	550 mg/day	400 mg/day	450 mg/day	550 mg/day
19 years and older	550 mg/day	425 mg/day	450 mg/day	550 mg/day

While your liver makes a small amount of choline naturally, the amount it synthesizes is not enough to meet your body’s needs. This means you’ll need to consume it via your diet regularly.

Krill and Other Dietary Sources of Choline

According to a study published in the journal Nutrients, only 8.03% of U.S. adults are getting enough choline (including only 8.51% of pregnant women).²⁶ Krill oil is a simple solution, which can boost choline levels after a single dose.²⁷

In a study comparing phosphatidylcholine, present in krill oil, and choline bitartrate salt, it was found that the krill oil led to higher levels of the important metabolites betaine and dimethylglycine (DMG) along with lower levels of TMAO, which can lead to health issues, compared to the other choline source. Researchers explained:²⁸

“Krill oil is increasingly recognized as a useful source of phosphatidylcholine, in addition to its acknowledged role in providing the omega-3 fatty acids EPA and DHA. In a former study, phosphatidylcholine was shown to raise plasma choline levels more efficiently compared to ingestion of free choline as choline chloride.”

Aside from krill oil, eggs — particularly the yolks — are another excellent choline source. Among egg consumers, more than 57% met the adequate intake levels for choline, compared to just 2.4% of people who consumed no eggs.²⁹

In fact, the researchers concluded that it’s “extremely difficult” to get enough choline unless you eat eggs or take a dietary supplement, though it’s preferable to get nutrients from dietary sources whenever possible.³⁰ Other dietary sources of choline include:³¹

Grass fed beef liver	Organic pasture raised chicken
Atlantic cod	Alaskan salmon
Kidney beans	Quinoa
Brussels sprouts	Broccoli
Shitake mushroom	Cauliflower

Krill oil also offers additional nutrients alongside choline — another reason why it’s a great choice. In addition to choline, krill provides eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are beneficial for heart health and have been shown to improve blood pressure,³² reduce overall inflammation, reduce the effects of rheumatoid arthritis³³ and depression³⁴ and help slow the progression of Alzheimer's disease.³⁵

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While health experts in the U.S. and many other countries are warning of a second wave of COVID-19 as we move into fall and winter, one nation that does not appear to worry about a resurgence of people testing positive for the virus and/or hospitalizations and deaths attributable to COVID-19 is Sweden.

Anders Tegnell, the chief epidemiologist in charge of Sweden's coronavirus response, has stated¹ he does not believe Sweden will see a second wave with widespread contagion as the country is seeing a rapid decline in positive tests, indicating herd immunity has been achieved.²

Sweden's Trajectory Shows How Unnecessary Lockdowns Are

Sweden, one of the few countries that did not shut down schools and businesses or mandate strict social distancing or mask wearing rules, choosing the route of natural herd immunity development instead, has been sharply criticized by many over the past several months.

Rather than locking down the whole country, Sweden only temporarily closed high schools and colleges, banned gatherings of more than 50 people and asked seniors over the age of 70 to self-isolate. All others were simply asked to respect physical distancing recommendations, and to work from home whenever possible.

Tegnell told The Guardian³ that the primary goal has been to slow the spread to avoid overwhelming medical services. As you may recall, this was the original plan just about everywhere. The difference is, Sweden actually stuck to the original goal, whereas other nations have twisted response plans to, apparently, prevent infection transmission altogether, even among those for whom the risk of such an infection is vanishingly minor.

At this point, Sweden is proving to be a valuable test case, demonstrating just how ineffective and unnecessary the global shutdowns have been. Countries that enacted draconian freedom-restrictions are faring no better than Sweden, which allowed its citizenry to largely go about their business as usual. As noted by the National Review back in April 2020:⁴

"In theory, less physical interaction might slow the rate of new infections. But without a good understanding of how long COVID-19 viral particles survive in air, in water, and on contact surfaces, even that is speculative ...

It is possible that the fastest and safest way to 'flatten the curve' is to allow young people to mix normally while requiring only the frail and sick to remain isolated.

This is, in fact, the first time we have quarantined healthy people rather than quarantining the sick and vulnerable. As Fredrik Erixon, the director of the European Centre for International Political Economy in Brussels, wrote⁵ in The Spectator (U.K.) last week:

'The theory of lockdown, after all, is pretty niche, deeply illiberal — and, until now, untested. It's not Sweden that's conducting a mass experiment. It's everyone else.'"

UK Enacts New Restrictions in Face of Mounting 'Cases'

Despite Sweden's tactical success, many countries are continuing to enforce and even enact new lockdown restrictions due to new upticks in positive tests. For example, September 22, 2020, British Prime Minister Boris Johnson announced⁶ new restrictions, which he predicts may remain in place for the next six months, warning that if Britons fail to follow the rules, they may be looking at a second lockdown.

This, even though there's no concomitant rise in hospitalizations or deaths. The vast majority of people testing positive at this point remain asymptomatic.

Johnson's announcement came on the heels of dire — and completely implausible — predictions by professor Chris Whitty and Sir Patrick Vallance, whose models predict the U.K. may be looking at 50,000 new "cases" (i.e., positive tests) per day by mid-October unless new restrictions are put into place.

In the video below, journalist Ben Swann reviews why such predictions are likely to be a gross overestimation, and one that is unlikely to result in a dramatic increase in hospitalizations or deaths.

Sweden's Death Rate Hits Zero

Meanwhile, in Sweden, infection rates have reached an all-time low. As reported by The Guardian, September 16, 2020:⁷

"According to the European Centre for Disease Prevention and Control (ECDC), the Scandinavian country's 14-day cumulative total⁸ of new cases was 22.2 per 100,000 inhabitants on Tuesday, against 279 in Spain, 158.5 in France, 118 in the Czech Republic, 77 in Belgium and 59 in the UK, all of which imposed lockdowns this spring.

Twenty-two of the 31 European countries surveyed by the ECDC had higher infection rates. New cases, now reported in Sweden only from Tuesday to Friday, are running at roughly the rate seen in late-March, while data from the national health agency showed only 1.2% of its 120,000 tests last week came back positive …

Thirteen Covid-19 patients are in intensive care in Swedish hospitals, and its seven-day average of coronavirus-related deaths is zero."

The two graphs from The Guardian, below, show Sweden's infection rate and deaths per million, compared to other countries that enforced stricter lockdown rules.

High Mortality Was Due to Nursing Home Failures

Initially, Tegnell's approach came under fire as Sweden's death toll soared five to 10 times higher than its neighboring countries, Denmark, Norway and Finland. However, Tegnell insists this early spike in deaths was not due to a lack of lockdowns or social distancing in general, but rather due to a failure to prevent infection in nursing homes, where a majority of the deaths actually occurred.

"Of course something went wrong there," Tegnell told The Guardian.⁹ Other than that, Swedish authorities insist the strategy to encourage and trust citizens to take personal responsibility for their health and well-being has been the correct one.

Contrary to other nations, Sweden's decision has also resulted in consistent public messaging about disease prevention, thereby avoiding the confusion, frustration and distrust that comes from getting mixed messages.

In April 2020, Emma Frans, science communicator and a postdoctoral researcher in medical epidemiology at the Karolinska Institutet in Stockholm, told the National Review:¹⁰

"The strategy in Sweden is to focus on social distancing among the known risk groups, like the elderly. We try to use evidence-based [measures]. We try to adjust everyday life. The Swedish plan is to implement [measures] that you can practice for a long time."

The Vanishing Middle-Class

As a result of their sensible approach to the pandemic, Sweden has also largely escaped the financial ruin experienced in other areas, including the U.S. This also means they've minimized the impact of the pandemic on mental health. As Tegnell told¹¹ The Daily Mail, April 4, 2020, "We can't kill all our services. And unemployed people are a great threat to public health. It's a factor you need to think about."

Indeed, preventing healthy people from working is upending the middle-class in the U.S. and elsewhere, and has (as expected) resulted in a massive rise in suicide and other tragedies. As noted by Robert F. Kennedy Jr. in "How the Government Uses Fear to Control," research from the 1980s found that for every 1-point rise in unemployment there were 37,000 excess deaths, 4,000 excess imprisonments and 3,300 excess admissions into mental institutions.

Kennedy also cites recent data from a hospital in San Francisco that stated they saw one year's-worth of suicides in a single month, a 1,200% increase, and British research showing that while there were 30,000 excess deaths in nursing homes during a five-week period during the lockdown, only one-third of them were due to COVID-19.

In other words, the death rate from isolation was double that of the virus itself. People didn't get the proper medical care for chronic conditions and so on. Kennedy also rightly points out that what we will see — and are already seeing — is the obliteration of the middle-class and the shift of wealth from the poor to the already ultra-rich.

A September 20, 2020, article¹² in The Wall Street Journal highlights the financial devastation experienced by the American "loan-laden white-collar" middle-class. Journalist AnnaMaria Andriotis tells the story of Alysse Hopkins, a Rockland County, New York foreclosure and personal-injury lawyer:

"In a good year, the 43-year-old lawyer and her husband, Ian Boschen, 41, together brought in about $175,000, the couple said — enough to cover the mortgage, two car leases, student loans, credit cards and assorted costs of raising two daughters in the New York City suburbs.

After the coronavirus halted many foreclosures and closed courts, her work dried up. Unemployment benefits have helped, Ms. Hopkins said, but the family is running low on savings and can't keep up with $9,000 in monthly debt payments including mortgage installments. 'It frustrates me to not be able to earn a living,' she said. 'I have a law degree, almost 20 years of practice' …

While lower-wage workers have borne much of the brunt, the crisis is wreaking a particular kind of havoc on the debt-laden middle class … The coronavirus has spared few industries and expanded unemployment benefits designed to replace the average American income didn't cover all the lost pay of higher-earning workers, especially in or near expensive cities.

The extra $600 weekly payments expired in July, putting them even further behind. 'What I see happening here is a core assault on successful college-educated families, which are the new breed of middle-class American families,' said Anthony Carnevale, director of the Georgetown University Center on Education and the Workforce. 'There's a professional workforce that's getting slammed.'"

Lockdowns Have Likely Done More Harm Than Good

So far, most efforts to curb COVID-19 infection have proven to be ill advised. Evidence shows the illness spreads mostly indoors,^13,14,15 for example, casting doubt on the sanity of closing parks and beaches, especially during the summer. 

Importantly, the total all-cause mortality is not significantly different than in previous years, as discussed by my interview with Denis Rancourt. Many other deaths have been shifted to COVID-19, bringing a high spike in deaths, but when you look at the area under the curve for total deaths, it really doesn't differ from previous years.

This statistic has also been highlighted by the American Institute for Economic Research.¹⁶ As early as April 2020, they referred to the COVID-19 pandemic as "An egregious statistical horror story" that resulted in "a vandalistic lockdown on the economy," which:

" … would have been an outrage even if the assumptions were not wildly astronomically wrong. Flattening the curve was always a fool's errand that widened the damage …

The latest figures on overall death rates from all causes show no increase at all. Deaths are lower than in 2019, 2018, 2017 and 2015, slightly higher than in 2016. Any upward bias is imparted by population growth.

Now writing a book on the crisis with bestselling author Jay Richards, [statistician William] Briggs concludes: 'Since pneumonia deaths are up, yet all deaths are down, it must mean people are being recorded as dying from other things at smaller rates than usual.' Deaths from other causes are simply being ascribed to the coronavirus.

As usual every year, deaths began trending downward in January. It's an annual pattern. Look it up. Since the lockdown began in mid-March, the politicians cannot claim that their policies had anything to do with the declining death rate.

A global study¹⁷ published in Israel by Professor Isaac Ben-Israel, chairman of the Israeli Space Agency and Council on Research and Development, shows that 'the spread of the coronavirus declines to almost zero after 70 days — no matter where it strikes, and no matter what measures governments impose to try to thwart it.'

In fact, by impeding herd immunity, particularly among students and other non-susceptible young people, the lockdown in the U.S. has prolonged and exacerbated the medical problem."

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Choline is an often-overlooked nutrient — so overlooked that it wasn’t until 1998 that the Institute of Medicine officially recognized it as an essential nutrient.¹ Choline has many roles in human metabolism and is involved in everything from cell structure to the synthesis of neurotransmitters.

Choline is necessary for cell-membrane signaling, the transport of lipids and methyl-group metabolism, which is involved in detoxification. During development, choline is essential for the brain and memory in the fetus and decreases the risk of neural tube defects.²

A deficiency in choline may contribute to liver disease, atherosclerosis and neurological disorders, and its importance continues through adulthood and into old age.

While choline is found in a variety of foods, intakes for adults and children are believed to be far below optimal levels, putting public health at risk and leading experts to suggest that [intake of choline-rich foods should be encouraged.³ Among them, krill oil may be superior, due to its unique phospholipids.⁴

Why Krill Oil Is an Ideal Source of Choline

Norwegian researchers conducted a study looking into the use of phosphatidylcholine from krill oil to counteract the drop in choline that often occurs among athletes competing in triathlons. Choline plays a role in normal muscle function, and it’s known that the concentration of free choline may decrease during long distance high-intensity exercise.⁵

Krill oil contains 69 choline-containing phospholipids to synthesize phosphatidylcholine, a critical component of human cell membranes.⁶ This is key to its benefits as a source of choline, because it’s estimated that 60% of choline in organic salts is otherwise lost when gut bacteria convert it to the metabolite trimethylamine (TMA).

Enzymes may then turn TMA into trimethylamine-N-oxide (TMAO), a potential biomarker for insulin resistance and heart problems. Krill oil, however, contains fatty acids in the form of phosphatidylcholine (PC) — unlike fish oil, which contains them in triglyceride form.

As noted by the researchers, “Choline in the form of PC is considerably less converted to TMA as demonstrated in a single-dose study with krill oil,⁷ potentially resulting in more efficient delivery of choline.”⁸ It’s been shown for instance, that 28 days of krill oil supplementation increased choline levels in healthy young adults.⁹

Krill Oil May Protect Choline Status in Athletes

Writing in the journal Frontiers in Nutrition, researchers set out to determine if supplementing with phosphatidylcholine from krill oil prior to a triathlon would counteract the expected drop in choline during the race.¹⁰ For the study, 24 athletes received either 4 grams of krill oil or 4 grams of mixed vegetable oil daily for five weeks prior to the race.

Blood samples to assess choline and its metabolites were taken before, immediately after and the day after the race. Choline concentrations significantly declined from before the race to after among the athletes, but those in the krill oil group had significantly higher concentrations of choline compared to the vegetable oil group, and also had a significantly greater increase in choline after the race was completed.

“In conclusion,” the researchers noted, “krill oil may help to prevent that circulating choline concentrations become limiting during endurance competitions.”¹¹ However, it’s not only athletes who may benefit from the choline krill oil provides, especially considering that a National Health and Nutrition Examination Survey found that 90% of the U.S. population had inadequate choline intake.¹²

Risks of Choline Deficiency

Choline is a nutrient that’s important throughout life. Among adults deprived of choline, 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage — signs of organ dysfunction — as did 44% of premenopausal women.¹³ When incremental amounts of choline were added back into their diets, normal organ function was restored. As noted by researchers in the journal Nutrition Reviews:¹⁴

“Because of its wide-ranging role in human metabolism, from cell structure to neurotransmitter synthesis, choline deficiency is now thought to have an impact on diseases such as nonalcoholic fatty liver disease, atherosclerosis (via lipoprotein secretion), and possibly neurological disorders. Therefore, getting adequate choline in the diet is important throughout life for optimal health.”

Some of the symptoms associated with low choline levels include memory problems, lethargy and persistent brain fog. Choline also prevents the buildup of homocysteine in your blood, which is important since elevated levels are linked to heart disease, cancer, cognitive decline and bone fractures.¹⁵

Choline also reduces chronic inflammation, and research shows that people with choline-rich diets have lower levels of inflammatory markers such as C-reactive protein, homocysteine, interleukin-6 and tumor necrosis factor.¹⁶ Meanwhile, choline deficiency is linked with DNA damage and apoptosis, and breast cancer risk may be reduced by 24% among women who eat a high-choline diet.¹⁷

Choline for Brain and Liver Health

Choline has also been implicated in the risk of dementia,¹⁸ may improve cognitive performance¹⁹ and low levels are associated with increased anxiety levels.²⁰ It’s believed that choline may help to support the structural integrity of neurons, benefitting brain function in the elderly, and may even reduce the progression of dementia in people with Alzheimer’s disease.²¹

Further, without choline a range of your body’s metabolic processes will be seriously affected. According to the U.S. National Institutes of Health:²²

“The body needs choline to synthesize phosphatidylcholine and sphingomyelin, two major phospholipids vital for cell membranes. Therefore, all plant and animal cells need choline to preserve their structural integrity.

In addition, choline is needed to produce acetylcholine, an important neurotransmitter for memory, mood, muscle control, and other brain and nervous system functions. Choline also plays important roles in modulating gene expression, cell membrane signaling, lipid transport and metabolism, and early brain development.”

A deficiency in choline can also lead to liver damage, including nonalcoholic fatty liver disease (NAFLD or hepatosteatosis). Because choline is involved in fat metabolism, low levels of the nutrient can result in an overaccumulation of deposits of fat in your liver.²³

Not only have studies found that risk of NAFLD increases with lower dietary choline intake, but the risk of NAFLD was found to be 32% lower in women, and 25% lower in men, with the highest choline intakes compared to those with the lowest.²⁴

Are You Getting Enough Choline?

A Dietary Reference Intake (DRI) has not been established for choline, but the Institute of Medicine set an adequate daily intake value for men, women and children. The daily values are 425 milligrams (mg) per day for women, 550 mg for men and 250 mg for children as a minimum amount to prevent choline deficiency and potential organ damage.

However, requirements may vary depending on your overall diet, genetic makeup and other lifestyle factors. Groups at particularly high risk for choline deficiency include pregnant mothers, endurance athletes, postmenopausal women, vegans and those who consume high amounts of alcohol. Here's a further breakdown from the National Institutes of Health:²⁵

Age	Male	Female	Pregnant Women	Nursing Women
0 to 6 months	125 mg/day	125 mg/day
7 to 12 months	150 mg/day	150 mg/day
1 to 3 years	200 mg/day	200 mg/day
4 to 8 years	250 mg/day	250 mg/day
9 to 13 years	375 mg/day	375 mg/day
14 to 18 years	550 mg/day	400 mg/day	450 mg/day	550 mg/day
19 years and older	550 mg/day	425 mg/day	450 mg/day	550 mg/day

While your liver makes a small amount of choline naturally, the amount it synthesizes is not enough to meet your body’s needs. This means you’ll need to consume it via your diet regularly.

Krill and Other Dietary Sources of Choline

According to a study published in the journal Nutrients, only 8.03% of U.S. adults are getting enough choline (including only 8.51% of pregnant women).²⁶ Krill oil is a simple solution, which can boost choline levels after a single dose.²⁷

In a study comparing phosphatidylcholine, present in krill oil, and choline bitartrate salt, it was found that the krill oil led to higher levels of the important metabolites betaine and dimethylglycine (DMG) along with lower levels of TMAO, which can lead to health issues, compared to the other choline source. Researchers explained:²⁸

“Krill oil is increasingly recognized as a useful source of phosphatidylcholine, in addition to its acknowledged role in providing the omega-3 fatty acids EPA and DHA. In a former study, phosphatidylcholine was shown to raise plasma choline levels more efficiently compared to ingestion of free choline as choline chloride.”

Aside from krill oil, eggs — particularly the yolks — are another excellent choline source. Among egg consumers, more than 57% met the adequate intake levels for choline, compared to just 2.4% of people who consumed no eggs.²⁹

In fact, the researchers concluded that it’s “extremely difficult” to get enough choline unless you eat eggs or take a dietary supplement, though it’s preferable to get nutrients from dietary sources whenever possible.³⁰ Other dietary sources of choline include:³¹

Grass fed beef liver	Organic pasture raised chicken
Atlantic cod	Alaskan salmon
Kidney beans	Quinoa
Brussels sprouts	Broccoli
Shitake mushroom	Cauliflower

Krill oil also offers additional nutrients alongside choline — another reason why it’s a great choice. In addition to choline, krill provides eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which are beneficial for heart health and have been shown to improve blood pressure,³² reduce overall inflammation, reduce the effects of rheumatoid arthritis³³ and depression³⁴ and help slow the progression of Alzheimer's disease.³⁵

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