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dc.contributor.authorCooper, IDen_NZ
dc.contributor.authorCrofts, CAPen_NZ
dc.contributor.authorDiNicolantonio, JJen_NZ
dc.contributor.authorMalhotra, Aen_NZ
dc.contributor.authorElliott, Ben_NZ
dc.contributor.authorKyriakidou, Yen_NZ
dc.contributor.authorBrookler, KHen_NZ
dc.date.accessioned2021-05-12T02:45:05Z
dc.date.available2021-05-12T02:45:05Z
dc.date.copyright2020en_NZ
dc.identifier.citationOpen Heart 2020;7:e001356. doi: 10.1136/openhrt-2020-001356
dc.identifier.issn2053-3624en_NZ
dc.identifier.urihttp://hdl.handle.net/10292/14175
dc.description.abstractRisk factors for COVID-19 patients with poorer outcomes include pre-existing conditions: obesity, type 2 diabetes mellitus, cardiovascular disease (CVD), heart failure, hypertension, low oxygen saturation capacity, cancer, elevated: ferritin, C reactive protein (CRP) and D-dimer. A common denominator, hyperinsulinaemia, provides a plausible mechanism of action, underlying CVD, hypertension and strokes, all conditions typified with thrombi. The underlying science provides a theoretical management algorithm for the frontline practitioners.Vitamin D activation requires magnesium. Hyperinsulinaemia promotes: magnesium depletion via increased renal excretion, reduced intracellular levels, lowers vitamin D status via sequestration into adipocytes and hydroxylation activation inhibition. Hyperinsulinaemia mediates thrombi development via: fibrinolysis inhibition, anticoagulation production dysregulation, increasing reactive oxygen species, decreased antioxidant capacity via nicotinamide adenine dinucleotide depletion, haem oxidation and catabolism, producing carbon monoxide, increasing deep vein thrombosis risk and pulmonary emboli. Increased haem-synthesis demand upregulates carbon dioxide production, decreasing oxygen saturation capacity. Hyperinsulinaemia decreases cholesterol sulfurylation to cholesterol sulfate, as low vitamin D regulation due to magnesium depletion and/or vitamin D sequestration and/or diminished activation capacity decreases sulfotransferase enzyme SULT2B1b activity, consequently decreasing plasma membrane negative charge between red blood cells, platelets and endothelial cells, thus increasing agglutination and thrombosis.Patients with COVID-19 admitted with hyperglycaemia and/or hyperinsulinaemia should be placed on a restricted refined carbohydrate diet, with limited use of intravenous dextrose solutions. Degree/level of restriction is determined by serial testing of blood glucose, insulin and ketones. Supplemental magnesium, vitamin D and zinc should be administered. By implementing refined carbohydrate restriction, three primary risk factors, hyperinsulinaemia, hyperglycaemia and hypertension, that increase inflammation, coagulation and thrombosis risk are rapidly managed.en_NZ
dc.languageengen_NZ
dc.publisherBMJ
dc.relation.urihttps://openheart.bmj.com/content/7/2/e001356
dc.rights© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
dc.subjectCytokinesen_NZ
dc.subjectDeep vein thrombosisen_NZ
dc.subjectInflammationen_NZ
dc.subjectOxidative stressen_NZ
dc.subjectVenous thromboembolen_NZ
dc.titleRelationships Between Hyperinsulinaemia, Magnesium, Vitamin D, Thrombosis and COVID-19: Rationale for Clinical Managementen_NZ
dc.typeJournal Article
dc.rights.accessrightsOpenAccessen_NZ
dc.identifier.doi10.1136/openhrt-2020-001356en_NZ
aut.relation.issue2en_NZ
aut.relation.volume7en_NZ
pubs.elements-id392156
aut.relation.journalOpen Hearten_NZ


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