Clapham Manual Therapy and Functional Movement

The Importance of Vitamin D

As we head into autumn with increasing concerns about a second wave, we believe that everyone should be getting a vitamin D test to ensure that you have sufficient levels for maximal health.  Even if you have spent time getting a tan over the summer, do not assume that your levels are high enough. Everyone’s ability to turn sunlight into active vitamin D is different, and this decreases as we get older. If your levels are low, you should consider supplementation to minimise your risk of severe COVID-19 symptoms this winter.  It is estimated that in excess of 20% of the UK population is deficient in vitamin D, with the elderly and BAME population being at higher risk. Also remember that the recommended levels are actually very conservative, only indicating the level needed to avoid deficiency disease, not what’s required for optimal health, making supplementation even more important for many of us. You can get tested at your GP or check your levels yourself with a home test kit from Monitor My Health, whose profits go to fund the NHS.

Even though the mainstream is focused on vaccination and pharmaceutical solutions to COVID-19, there is increasing evidence showing that vitamin D is vitally important both in the prevention of severe disease and in treatment in the hospital setting as it modulates the immune system.  A new piece of research from Spain followed the treatment of 76 patients who were hospitalised with COVID-19.  They were given the same standard of care, except 50 patients were also given calcifediol, a form of vitamin D3.  In this group, only one patient (2%) was admitted to the ICU and recovered, whereas of the 26 untreated, 13 (50%) needed transfer to the ICU where 2 died and 11 recovered. This result is statistically significant and hopefully will be replicated in future larger trials.

The following graph shows the severity of COVID-19 symptoms by vitamin D status, indicating that it is important for prevention as well as treatment.

Vitamin D chart

Vitamin D is actually misnamed as technically it is a hormone not a vitamin.  It is synthesised in the skin in response to ultraviolet light from the sun, and is then transported to the liver and kidneys where it is converted to an active hormone. There are receptors throughout the tissues of the body, where its functions include:

  • Modulating the function of the immune system, stimulating it to produce antibodies
  • Regulating and suppressing the cytokine inflammatory response. The ability to downregulate the inflammatory response is particularly important for COVID-19, as out of control inflammation (cytokine storm) is a primary cause of death
  • Essential for the proper absorption of calcium into bones therefore reducing fracture risk and improving bone health
  • Important for proper contraction and relaxation of muscles, so making us stronger
  • There are many vitamin D receptors in the lungs and so can reduce inflammation here, which is very important in all respiratory illnesses
  • Reducing the risk of  high blood pressure and cardiovascular disease
  • Helping to regulate kidney function
  • Protective of cognitive function. Research has shown that seniors with low vitamin D levels have an increased risk of dementia
  • Reducing the risk of depression and multiple sclerosis
  • There is even some research that says that it is necessary for leptin, the satiety hormone, to work well.  So low levels could leave you permanently hungry, making it much harder to lose weight.

As you can see, there are many reasons beyond COVID-19 to ensure that your vitamin D levels are optimal.  A final thought is that if you do decide that you need supplementation beyond extra sunlight, which is going to be hard to get in the UK as we head into the winter months, you should seriously consider adding vitamin K2 into the mix. D and K2 work together to ensure that calcium is deposited into bones rather than into the soft tissues and arteries,  thus improving bone density rather than increasing atherosclerosis.  Vitamin K2 can be obtained naturally in natto (a Japanese fermented bean product that many people find disgusting, although we quite like it), some hard cheeses, and liver, but most people are not eating enough of these to get sufficient amounts of this vitamin, making supplementation even more important. So get tested, get some sun and, if your levels aren’t up to snuff, then get some supplements.


Coronavirus and your immune system

coronavirus and masked womanFour weeks into lockdown and we are well into our new routine here in Clapham: daily meditation and exercise followed by video calls with patients, a daily walk, and more time for study, reading etc.  We are also preparing for the possibility that we will contract COVID-19 at some time over the next year. We are approaching this as though we were training for a race or other athletic endeavour. We are not hoping to get it. However, with the reality of a vaccine being at least 18 months away, it seems unlikely and undesirable, considering the effects on the population’s mental, financial health that we can all stay on strict lockdown until then.  We, therefore, want to spend this time preparing our immune systems to be in the best possible shape to mount an effective response to the virus.

Although the knowledge of this pathogen is evolving from day to day, we know that there is a vast difference in the effect it has, with most people getting mild symptoms easily treated at home, but a few suffering very badly and needing intensive medical support. Why is there this difference? The answer is multifactorial and may relate to the amount of the pathogen they were exposed to i.e. viral load, which may explain the number of medical staff treating COVID-19 patients without adequate PPE that have succumbed. But the other factor is the response of the infected person’s immune system, which has a genetic component but is also related to a person’s current state of health and metabolic function.  Almost everyone who is getting seriously ill is suffering from an underlying condition or conditions such as heart disease, diabetes or obesity. It is known that all of these have a lifestyle component and are hitting people at increasingly early ages.  Therefore, there is much we can do whilst in lockdown to improve our health and immune systems.

In short, the things that you can do to improve your immune system response are also things that will improve your metabolic health and resilience. So here are some ideas split into three groups: nutrition, exercise, and psychological. Now, none of us is perfect, and doing all these things all the time may be too much, so we believe in the 80:20 rule, especially in lockdown: try and do as much as you can (80%), but don’t beat yourself up too much when you trip up (20%).

Nutrition – immune health starts in the gut!

  1. If you are overweight or obese, this is the time to try and tackle this problem as it really does increase your risk of a poor outcome with COVID-19. This is often related to insulin resistance.  If you want help with diet or exercise, Jack has a wealth of experience.

  2. Even if you are of normal weight you need to think about your diet and try to eat as healthily as possible.  Much of the immune system is in the gut lining, so if you are constantly bombarding this with too much sugar, alcohol and processed food, this puts the system on alert, starting the chronic inflammation which is the underlying factor in most lifestyle diseases.  So do try to eat real and nutrient-dense food to get sufficient micronutrients for the normal physiological function of your body.  We focus on unprocessed meat (including organ meats) and fish, with plenty of vegetables and a moderate amount of fruit and fermented dairy.

  3. There is also some evidence that industrial vegetable oils drive inflammation, so another reason to avoid processed foods which are full of these. Cook with butter, olive oil, coconut oil or animal fat.

  4. Many of us now have more time under lockdown to get into the habit of cooking meals from scratch. If you do want a comforting sugary treat, make it yourself from real ingredients.

  5. It is also important to support your microbiome, so we make sure to eat fermented foods such as kombucha, kefir, and sauerkraut every day

  6. We have increased our use of supplements as an insurance policy, but supplementation is not a substitute for a nutrient-rich diet. We are currently using:

    1. Vitamin D

    2. Vitamin C

    3. Fermented cod liver oil

    4. Astragalus

    5. Turmeric

    6. Magnesium

    7. Zinc

  7. We also use intermittent fasting as this can boost immunity and enhance longevity via autophagy. We generally skip breakfast, resulting in a 12-16 hour intermittent fast, and since lockdown have added a weekly dinnertime to dinnertime (24 hour) fast.

  8. Don’t drink too much. Alcohol is not great for the immune system. Sometimes the reduction in stress from a glass of wine is more important, but don’t overdo it.

  9. Stop smoking – this shouldn’t need any explanation


Exercise has an effect on the immune system but it is a Goldilocks situation. Rather than HIIT or long runs, both of which can contribute to an inflammatory state that can suppress the immune system, focus on lower-intensity activities such as walking, mobility, breathwork, and bodyweight training.

Check out our new video where Jack puts Sue through a bodyweight training session, offering some ideas on how to improve your fitness without much space or proper gym equipment. Also don’t forget that Jack can help design you your own workout by video, or if pain is stopping you from exercising, both Sue and Joel are offering video calls to help you.


Our mental state literally affects our physiology, and increased stress levels suppress our immune system, so we do need to try and keep fear under control at this difficult time:

  1. Breathing and or mindfulness. Check out the breathing video we featured in the last newsletter.  Diaphragmatic breathing can stimulate the spleen, the home of your immune cells.  It sits under the lower ribs on your left side so encouraging the movement here may improve its function.

  2. Limit consumption of news and social media. We do need to stay abreast of world developments, but ration it to maybe once a day, and try not to focus on the things that you can’t do anything about.  That fear and stress amp up your cortisol levels and suppress your immune system.

  3. Watch some comedy or put on some music and dance instead.

  4. If you are not in a vulnerable group, try not to obsess about contracting COVID-19, but do be concerned about not passing it on.

  5. Try some gratitude, even though the world is in a difficult situation, trying to focus on a few small good things can be really helpful for our state of mind, as without effort we do tend to focus on the negative.

  6. The Greek philosophy of stoicism, which advocates facing challenges with grace, humour and perspective may be of help.

  7. Maintain virtual contact with friends and family. We’ve been arranging a few ‘quarantini’ dates (remember the 80:20 rule for drinks) with friends near and far.

  8. Cold showers can give your immune system a boost, as well as wake you up!

  9. Sufficient sleep is a huge factor in immune function.  Some people find that lockdown is giving them the chance to sleep more as they are no longer ruled by the tyranny of the alarm and the commute, but for others, anxiety levels may be increased and make sleep harder.  It’s important to follow good sleep hygiene rules, and try to avoid caffeine and alcohol close to bedtime, and if you still need a little assistance try herbal remedies such as valerian, reishi mushrooms, magnesium or 5-HTP rather than sleeping pills, which don’t provide true restorative sleep and may leave you feeling knocked out the next day.

mona lisa with a mask