Vitamin A deficiency impairs components of innate immunity. On the other hand, an RCT in young men (N=93, ages 18 to 42 years) found that 12 weeks of daily supplementation with up to 4 g of EPA and 0. We will consider the functional effects of ascorbate on cells of both the innate and adaptive immune responses that particularly reflect the cofactor activity of ascorbate and include a discussion of the role of vitamin C on immune cells in cancer. In a July 2020 study, researchers wanted to discover whether taking 200 milligrams or more of vitamin C daily could reduce the frequency, duration, or severity of a cold. In one study, 65 children with mild iron deficiency anemia were given a vitamin C supplement. Monocytes are a type of white blood cell that travels into the tissues and organs, which are differentiated or converted into a macrophage or myeloid lineage/bone marrow tissue dendritic cell. Intriguingly, supplemented subjects’ physical activity scores also rose by 40% compared with placebo recipients, strongly suggesting that supplementation was correcting hidden symptoms of vitamin C depletion, such as fatigue and malaise. And does it work as well as — or better than — things we might do naturally, like eating well, sleeping, washing our hands and avoiding cigarettes?
Yet, it has many roles and has been linked to impressive health benefits.
These trials have just started and no results are yet posted. This nutrient even affects how we express our DNA and genes. Having said that, we can easily obtain sufficient levels of vitamin C in our diet that will keep our immune system fully functional. Supplements work best when you need some higher doses, like vitamin C, or when you’re trying to get a nutrient your body struggles to get from food, like vitamin D.
How Much Vitamin C Is Enough?
May reduce your risk of chronic disease Vitamin C is a powerful antioxidant that can strengthen your body’s natural defenses (2). Online chat is also available 24/7. SUMMARY Vitamin C supplements have been linked to a reduced risk of heart disease. The sepsis-related host immunosuppressive monocyte phenotype has also been shown to be mediated by chronic HIF-1α expression, resulting in supressed pro-inflammatory cytokine expression and increased ability to induce Treg cell polarisation [ 89 ]. While you might be skittish right now about going out to meet a friend for dinner or attending a book club, instead of canceling, consider catching up in a less crowded space.
The best source of vitamin D comes from the sun’s UV rays absorbed through the skin.
What Makes Vitamin C Such a Potent Antioxidant?
It is essential for collagen, carnitine and neurotransmitters biosynthesis. However, you can also get a good amount of protein from eggs, milk, yogurt and cheese. According to a new study, some viruses (including human coronaviruses that came before COVID-19) can remain infectious on surfaces for up to 9 days. Inadequate vitamin C levels and incomplete de-methylation can potentially lead to birth defects. If your diet does not provide adequate levels of any the following vitamins and minerals, your immune system may not be operating at its best: Sleep is important for your immune system.
Wash Your Hands Frequently
Thus, it remains unclear whether the differences were due to vitamin C or other aspects of their diet. In 1937, the Nobel Prize in Physiology was awarded to Albert Szent-Gyorgyi for his research on vitamin C. B-cells and T-cells also leave behind memory cells that remember specific pathogens in order to coordinate a strong and fast response if they are found again. Children and young adults (up to age 25) can call Kids Helpline on 1800 55 1800 to speak with a counsellor, 24 hours a day.
A 2020 study published by the American Journal of Clinical Nutrition, indicates that vitamin D3 is more effective at raising the blood levels of vitamin D. ‘We can’t make zinc in our bodies, we have to get it from our diets,’ says Dr Macciochi. Vitamin C may also bolster the fatty membranes in skin and connective tissue, thus protecting organs like the lungs from pathogens, according to cell culture and preclinical studies. Several of the reviewed studies included people under intense physical stress, including marathon runners and soldiers training in the Arctic. But wait, there’s more!
Vitamin C inhibits the apoptosis of various forms of T-lymphocytes. Written in August 2020 by: Probiotics are usually defined as live microorganisms that, when administered in sufficient amounts, benefit the overall health of the host (236). The ascorbate content of immune cells is also in this range and reflects plasma availability. You should take the necessary steps to keep your levels of Vitamin C within a healthy range to keep your immune system strong and ready to fight infections. Therefore, depending on the nature of the insult or source of inflammation, the prevailing ratio and species of T cells could alter the outcome. T lymphocytes (T cells) are particularly vulnerable to zinc deficiency (reviewed in 192). Animal studies and a few observational studies in humans indicate that folate deficiency is associated with an increased susceptibility to infection (180).
We all aspire to be as healthy as possible. Keep yourself protected this flu season by eating for a healthy immune system. A vitamin C deficiency, or scurvy, may cause: Cancer patients. A key component of the immediate immune response is inflammation, which can cause damage to host tissues, although the damage is usually not significant (2).
Our bodies exercise high levels of control over the blood levels of vitamin C, maintaining a “steady state” between 60-80 μmol/L concentration in plasma. HIF-1 activation also enhanced overall neutrophil antibacterial function as demonstrated by increased susceptibility to bacterial keratitis in mice when HIF-1 was inhibited [ 101 ]. For more information about the innate immune response, see the article on Inflammation. Collagen is the structural glue that holds us together as human beings.
In those whose vitamin C levels were in the top 25%, the incidence of stroke was 42% lower compared to those in the lowest 25% of vitamin C consumption. ” Humans also have a very small capacity for storing vitamin C; we can only hold about a 30 day supply. Speak to your GP or contact any of these organisations: Experimental studies have shown that several types of dietary lipids (fatty acids) can modulate the immune response (29). No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Experimental studies in animal models, along with epidemiological studies, have shown that vitamin A deficiency leads to immunodeficiency and increases the risk of infectious diseases (56). Whenever we get sick, we always try to recover from it as soon as possible.
- Vitamin C supplements are touted as a way to "boost" and "support" the immune system.
- Here are 7 scientifically proven benefits of taking a vitamin C supplement.
Lower blood pressure also means that you have less chance of having a stroke and increased cardiovascular health, which is so important today as many people suffer from cardiovascular disease. For older adults, especially, the cold can lead to pneumonia and other respiratory infections. Leptin has a number of other functions as well, such as modulation of inflammatory responses and aspects of humoral and cell-mediated responses of the adaptive immune system (255, 258). The best way to add vitamin C is through certain foods. Like many vitamins, optimal vitamin C dosage can be obtained with a healthy diet. Researchers at Zhongnan Hospital of Wuhan University launched a clinical trial with 140 patients in February to test whether ultrahigh doses of vitamin C, delivered intravenously, could treat the viral infection more effectively than a placebo.
One of the most essential components in that recovery process is Vitamin C. Growing tumours are also well characterised as being hypoxic tissues due to rapid proliferation and outgrowth of the established blood supply [ 70 , 71 ]. The goal is to consume lots of vitamins and minerals without too many calories from sugar and fat. However, vitamin C supplements have no effect or may even cause harm ( , , ). More encouraging: The recommended dose depends on your age, sex, pregnancy and breastfeeding status, but in general, adult men are recommended to ingest at least 90 milligrams (mg) a day, and adult women should consume at least 75 mg. Vitamin C inhibits the production of neuraminidase. Get the basic nutrients your immune system needs - whether from a healthy diet or from supplements, and always remember that a balanced diet, exercise, and adequate sleep are key to keeping your immune system in check.
May Reduce Your Risk Of Chronic Disease
Normally, higher levels of circulating leptin suppress appetite and thereby lead to a reduction in food intake (257). Still hungry for more? Respiratory infections, influenza, and particularly pneumonia are a leading cause of death in people over 65 worldwide. How this works. You’ll probably be surprised by the simple, affordable ways you can improve your body’s natural resistance.
The addition of Spirulina to any diet may help defend the body from bacteria and viruses. But despite its widespread use, experts say there's very little proof that vitamin C actually has any effect on the common cold. Primarily through this role, the vitamin affects several components of innate and adaptive immunity; for example, vitamin C has been shown to stimulate both the production (127-131) and function (132, 133) of leukocytes (white blood cells), especially neutrophils, lymphocytes, and phagocytes. First, vitamin C helps encourage the production of white blood cells known as lymphocytes and phagocytes, which help protect the body against infection ( 21 ). Vitamin C is actually helping us even during unconscious body functions. Next, let’s look at lymphocytes.
Overwashing with strong soaps and using antibacterial products is not friendly to our skin microbiomes. Keratinocytes increase their ability to take up vitamin C in a protective response to UV light exposure, so can topical Vitamin C application help with sun damage? Impaired immune responses induced by malnutrition can increase one’s susceptibility to infection and illness. Three-dimensional models of prostate, breast, ovarian and other types of cancer cells in vitro show that the higher the dose of vitamin C they are exposed to, the more their growth is inhibited and the tumor mass shrinks. Yet another reason to take that lunchtime walk. When the body experiences stress, the number of lymphocytes decreases. 7 g/day and 4. Getting all of the nutrients that your body needs through proper consumption of fruits and vegetables is essential to good health and a strong immune system!
As Might A Throat Spray
In your immune system, the vitamin also impacts prostaglandins, lipids that aid in the recovery of tissue damage or infection. Vitamin C, also known as ascorbate and ascorbic acid, is a water-soluble vitamin that is naturally found in various foods, or is added or fortified to other foods. Impaired wound healing is an indication of low levels of vitamin C, and supplementation with both oral and topical vitamin C is useful especially in individuals who may have a low vitamin C level baseline (such as smokers and heavy drinkers). Doses above this level are generally poorly absorbed by intestinal system cells using the sodium dependent vitamin C transporters type 1. Images,  One hypothesis put forward to explain this phenomenon is the involution of the thymus, where T-cell maturation happens (Figure 1). References from the Figure:
Newly discovered enzymes in this family regulate cell metabolism and epigenetics, and dysregulation of their activity can affect cell phenotype, growth and survival pathways, and stem cell phenotype. Vitamin C IV is non-toxic and did not increase cancer risk. Experts recommend that adults sleep 7-9 hours per night to maintain optimum health. Low levels of this vitamin have been linked to an impaired ability to think and remember.
For example, the glutathione peroxidases (GPx) are selenoproteins that function as important redox regulators and cellular antioxidants, which reduce potentially damaging reactive oxygen species, such as hydrogen peroxide and lipid hydroperoxides, to harmless products like water and alcohols by coupling their reduction with the oxidation of glutathione (see Figure 2 in the article on selenium) (206). SUMMARY Vitamin C may boost immunity by helping white blood cells function more effectively, strengthening your skin’s defense system, and helping wounds heal faster. Vitamin A supplementation enhances immunity and has been shown to reduce the infection-related morbidity and mortality associated with vitamin A deficiency. In 2020, a study by University of Birmingham and King’s College London found that 125 non-smoking amateur cyclists aged 55 to 79 still had the immune systems of young people. Vitamin C favors the formation of prostaglandins. It affects over 35 million people worldwide and typically occurs among older adults ( 27 ). Vitamin C, also called ascorbic acid, plays many important roles in the body. Your immune system is fighting off infections throughout the year, meaning it's always important to keep your vitamin C levels stocked up.
Moreover, vitamin D deficiency is a major problem in the US and elsewhere; it has been estimated that 1 billion people in the world have either vitamin D deficiency or insufficiency (55). Methylation involves the addition of a one-carbon (-CH3) unit to an existing molecular structure. However, methodological shortcomings and the highly variable characteristics of the study populations prevent comparisons and firm conclusions from the available data.
Is there something to these claims? In one such review that he conducted, he examined recent research regarding the connection between Vitamin C and infections. Many people eat excessive amounts of calories from sugar and fat without meeting the body’s needs for essential vitamins and minerals. But face masks are not recommended for the general population. This also makes it especially important to increase one’s intake of vitamin C when sick. Not all effects of ascorbate on neutrophil function will be HIF-related.
Making Sense out of Human Flaws
The B vitamin, folate, is required as a coenzyme to mediate the transfer of one-carbon units. Zinc, also, research shows that high concentrations of curcumin, which gives turmeric its distinctive color, can help decrease exercise-induced muscle damage. While it is known that severe copper deficiency has adverse effects on immune function, the effects of marginal copper deficiency in humans are not yet clear (234). Here’s what she had to say: In contrast, cell-mediated immunity is carried out by T cells — lymphocytes that develop in the thymus. The skin microbiome is important, too, but we know less about it. Vitamin C enhances the production of T-lymphocytes. Indeed, there is a body of scientific evidence showing echinacea’s effectiveness including a recent one published in Viral Research, albeit only done ‘in vitro’ (ie in test tubes) that showed it could work as a barrier against cold and flu symptoms. Similarly, the first double bond in all omega-6 fatty acids is located between the sixth and seventh carbon atom from the methyl end of the fatty acid (n-6) (30).
Thus, folate has obvious importance in immunity. This is associated with an increased M2-like gene profile, increased expression of immunosuppressive and pro-tumour proteins such as arginase 1, iNOS and VEGF, as well as induction of PD-L1 expression [ 87 , 90 – 92 ]. Studies have demonstrated that 1,25-dihydroxyvitamin D 3 modulates both innate and adaptive immune responses.
What is Vitamin C Good For?
The balance of methylation and demethylation is also important in embryos. All-in-all, vitamin C is an essential micronutrient that doesn’t have a good reputation by accident. In particular, PEM leads to atrophy of the thymus, the organ that produces T cells, which reduces the number of circulating T cells and decreases the effectiveness of the memory response to antigens (23, 28). To be immunologically fit, you need to be physically fit. Besides stopping free radicals, vitamin C helps to activate several key enzymes in the body, which go on to synthesize hormones and build collagen, a tough protein found in skin and connective tissues, according to the 2020 report.
Prevents the common cold. Spirulina is rich in vitamins and minerals, which is excellent for improved immunity. Older people, and those with diseases that are characterised by inflammation, such as allergies, asthma, rheumatoid arthritis and diabetes, tend to have less varied gut microbiomes.
Protects Your Memory And Thinking As You Age
This fact is corrected with smoking cessation and improvement in baseline plasma vitamin C levels. Stress, lower doses do not generally cause a problem. While vitamins and supplements can help fill in the gaps in your diet, the best way to load up on essential nutrients is to get them straight from food. A lack of immunologic memory means that the same response is mounted regardless of how often a specific antigen is encountered (6). It does this via a nitric oxide-mediated system that then causes increased blood flow (vasodilation). Several randomized controlled trials demonstrate that supplementation with low to moderate doses of zinc (ranging from 10 to 45 mg zinc/day) in healthy elderly individuals improves several aspects of immune function, such as restoration of thymulin activity, increased numbers of cytotoxic T lymphocytes, reduced numbers of activated T helper cells (which can contribute to autoimmunity), increased NK cell cytotoxicity, and reduced incidence of infections (193, 201-205). Vitamin C assists in converting iron that is poorly absorbed, such as plant-based sources of iron, into a form that is easier to absorb. Though you can get zinc from foods like sesame and pumpkin seeds, lentils and turkey, the elderly population studied was more prone to not getting adequate amounts in their diet, making them more susceptible to infection.
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Folate coenzymes act as acceptors and donors of one-carbon units in a variety of reactions critical to the endogenous synthesis and metabolism of nucleic acids (DNA and RNA) and amino acids (178, 179). Not all common cold studies produce consistent results. How to prepare your home for the coronavirus outbreak, plus, the prebiotic fiber in veggies and fruit supports the probiotics that live in your GI tract, helping them grow and thrive. If you want the benefits of vitamin C, you'll need to consume it every day, and not just at the start of cold symptoms. Our body’s inability to synthesize vitamin C has been called an “inborn error of metabolism. Water helps your body produce lymph, which carries white blood cells and other immune system cells. While vitamin C appears to reduce the severity of colds and recovery time by 8% in adults and 14% in children, it does not prevent them (37).
These processes play important roles in the regulation of the immune system, altering cell survival pathways, metabolism and functions.
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Moreover, dose and participant age appear to be important modulating factors. However, recent evidence has also shown that vitamins E and C are needed for normal function of the immune system (Anderson et al. )May treat lead toxicity. For example, a study including 1,387 men found that those who consumed the most vitamin C had significantly lower blood levels of uric acid than those who consumed the least ( 15 ). Many fruits and plants contain high doses of vitamin C, especially citrus fruits. Intracellular ascorbate supports essential functions and, in particular, acts as an enzyme cofactor for Fe- or Cu-containing oxygenases. Research shows that the more social ties you have, the less susceptible you are to the common cold, possibly because friendships serve as a buffer against stress. Vasopressin is an example of an amidated peptide hormone.
During weeks 7-8 of this trial, the men in the Vitamin C group showed a 39. “It’s more effective to change your diet,” says Cruickshank. In fact, in small studies, some researchers found that people who got an adequate amount of vitamin C felt the physical symptoms of stress less often. So, if you're reading this on your phone in bed right now, put the phone down — looking at a bright screen in the evening can disrupt your sleep. Unfortunately, science is still on the hunt for the “cure for the common cold. The contributions of ascorbate as an antioxidant in immune cells have been well reviewed by others [ 21 – 27 ] and will not be discussed here.
SUMMARY Vitamin C supplements have been found to lower blood pressure in both healthy adults and those with high blood pressure. This can lead to damage to DNA, proteins, and fat molecules needed for normal immune function. One study was able to demonstrate that Liposomal Vitamin C supplement has greater bioavailability than standard oral Vitamin C and avoids its common side effect of gastrointestinal distress. Examples of these enzymes include N-trimethyllysine hydroxylase and γ-butyrobetaine dioxygenase that synthesise carnitine [ 16 ], and the prolyl, lysyl and arginine hydroxylases that modify collagen and the alpha regulatory subunit of the hypoxia-inducible factors [ 19 , 20 ]. Staying healthy is fundamental to being a happy, productive individual. Fatty fish is probably the best source of vitamin D, followed by egg yolks and liver. AMPs also modulate immune functions through cell-signaling effects (90). Vitamin C also is commonly sold as a dietary supplement.
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When different types of cancer cells are exposed to “macro molar” vitamin C levels, they are placed under stress and begin to die. Sufficient iron is critical to several immune functions, including the differentiation and proliferation of T lymphocytes and generation of reactive oxygen species (ROS) that kill pathogens. The optimal concentration of ascorbate required for its cofactor activity supporting the Fe- and Cu-containing enzymes in vitro is in the mM range [ 28 ], similar to the intracellular levels measured in many cell types [ 1 , 29 , 30 ].
In addition, she noted that routine supplemental intake of large doses has been associated with the formation of oxalates kidney stones, especially in men. Poor demethylation is evidenced by low levels of a molecule called 5-hydroxy-methyl-cytosine (5hmC). What is Vitamin C Good For? You’re washing your hands 10 times a day and have stopped touching your face. (26 to 51%) in participants taking antibiotics (244). HIF-1 has been shown to be activated in monocytes following activation with phorbol esters [ 82 ] and pathogenic stimuli [ 83 – 86 ], even under non-hypoxic conditions. It has been linked to many impressive health benefits, such as boosting antioxidant levels, lowering blood pressure, protecting against gout attacks, improving iron absorption, boosting immunity, and reducing heart disease and dementia risk.
Vitamin C helps to keep these important cells alive and viable. This helps the body's natural defences fight inflammation. As the body is not able to make vitamin C on its own, it is very important to include plenty of vitamin C-rich foods in your diet, and not just in winter. The more colorful the fruits and vegetables are, the better.
“The microbiome really likes fibre, pulses and fermented foods,” she adds. The novel coronavirus outbreak is just the latest example. Daily intake of vitamin C is essential for good health because your body doesn’t produce or store it. Though I have said vitamin C is unlikely to be a dramatic cure for COVID-19, the fact that it can promote good immune function means it would be going too far to say there will be no effect. The fatigue seen in scurvy may also be due to a slowed ability to make L-Carnitine.
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Protein is comprised of amino acids, including glutamine, which fuel the immune system and can be depleted with exercise, so it’s important to replenish that amino acid regularly and thoroughly. At this time, prophylactic use of vitamin C supplements for pneumonia prevention and treatment cannot be advocated for the general population. What about all those supplements and vitamins at the drug store, will they help prevent Coronavirus? This works especially well for those of us who tend to get upper respiratory illnesses often or are performance athletes. However, additional human studies are needed to understand the effects of vitamin C supplements on nervous system health ( 36 ). Let’s take a look at:
They are vegetarian and contain zinc methionate, one of the most absorbable forms of the mineral.
Best sources of vitamin C
You might feel a little powerless, but there are a few things you can do to help strengthen your immune system and help protect yourself from many types of viruses. The SNS is part of our autonomic nervous system, our unconscious nervous system that keeps us breathing and our hearts beating. Although you can't avoid stress in your life, you can adopt strategies to help you manage it better. Vitamin C is an essential vitamin, meaning your body can’t produce it.
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Vitamin C can also shorten the duration of common cold symptoms. Certainly, people lacking certain vitamins will develop deficiency diseases. It’s especially important to avoid taking vitamin E supplements. It’s incredibly painful and involves inflammation of the joints, especially those of the big toes. Vitamin C is such a potent antioxidant that it helps the immune system fight off many types of diseases and infections, from the flu and the common cold, to more serious and life-threatening diseases, such as heart disease. They are involved in maintaining methylation/demethylation balance (or turning on gene expression), making collagen, and furnishing L-carnitine and norepinephrine. 7 mmHg, on average. However, if you already consume a vitamin-C-rich diet, then supplements may not provide additional heart health benefits.
Even marginal zinc deficiency, which is more common than severe zinc deficiency, can suppress aspects of immunity (187). In addition to generating hydrogen peroxide in the extracellular space, the vitamin C content administered through IV also induced the production of vitamin C radical Asc (•). The dependence of the hydroxylases on ascorbate as a cofactor has been demonstrated in cell-free systems [ 28 , 61 , 62 ], with other reducing agents such as glutathione being very much less effective as a recycler of the hydroxylase active site Fe 2+ [ 28 , 63 – 65 ]. 31], suggesting that access to malaria diagnostic and treatment services is a critical component of iron supplementation efforts in malaria-endemic regions. Th1 cells are primarily involved in activating macrophages and inflammatory responses (4, 257). Vitamin C is an important vitamin and antioxidant that the body uses to keep you strong and healthy. Collagen is constantly broken down while fibroblast cells in the dermis layer make new collagen.
Science-backed Tips For Strengthening Your Immune Response Quickly And Effectively
While everyone is talking about the coronavirus COVID-19, we need to remember that influenza is a more immediate threat here in the United States. And none of them involve a hazmat suit. It serves essential roles in the human body and supports normal immune function, according to a 2020 report in the journal Nutrients.
What Is Vitamin C?
Vitamin C enhances the production of nitrogen oxide by phagocytes. Adequate selenium intake is essential for the host to mount a proper immune response because it is required for the function of several selenium-dependent enzymes known as selenoproteins (see the article on Selenium). Connect, it’s sunny out. Zinc deficiency also compromises adaptive immune function, including lymphocyte number and function (191). Leptin is one such hormone and adipokine that plays a key role in the regulation of food intake, body weight, and energy homeostasis (255, 256). Marketed solely as a supplement, Airborne provides supplemental herbs, vitamins and minerals that can aid the body’s immune system against colds.
When faced with an immediate threat, the postganglionic SNS connection to the adrenal medulla causes more norepinephrine to be released. Several of these genes control cellular proliferation and differentiation; thus, vitamin A has obvious importance in immunity. First tip, try not to stress says Dr. Although vitamins E and C have long been recognized for their antioxidant properties, increasing attention has been focused on their abilities, along with those of other antioxidants, to reduce the risk of chronic disease. Like other immune cells, NK cells’ function declines with aging. ‘This breaks down your food in the digestive tract and produces metabolites known as ‘post-biotics’ that are helpful for our immune systems. In fact, malnutrition is the most common cause of immunodeficiency in the world (14), and chronic malnutrition is a major risk factor for global morbidity and mortality (15).
But for high doses, try new Tonic Health (11 sachets for $5. )“It is used by our macrophages, and is something that people in Britain can get quite low on in the winter. Ways to boost your immune system, in this study, mice who were repeatedly exposed to stress developed an immune response that released inflammatory proteins into the system. Achuthan 2020 [ 135 ]; Agathocleous 2020 [ 53 ]; Anderson 1980 [ 164 ]; Backer 2020 [ 88 ] Berger 2020 [ 101 ]; Beyaz 2020 [ 162 ]; Bhandari 2020 [ 165 ]; Bozonet 2020 [ 108 ]; Braverman 2020 [ 86 ]; Campbell 1999 [ 166 ]; Cimmino 2020 [ 142 ]; Colegio 2020 [ 90 ]; Cramer 2020 [ 84 ]; Cribbs 2020 [ 163 ]; Cull 2020 [ 131 ]; Dang 2020 [ 112 ]; De Santa 2020 [ 137 ]; Doedens 2020 [ 93 ]; [ 113 ]; Fluck 2020 [ 115 ]; Gaut 2020 [ 107 ]; Goldschmidt 1991 [ 106 ]; Hammami 2020 [ 116 ]; He 2020 [ 167 ]; Henke 2020 [ 94 ]; Higashiyama 2020 [ 114 ]; Huijskens 2020,2020 [ 122 , 123 ]; Ichiyama 2020 [ 148 ]; Imtiyaz 2020 [ 87 ]; Ishii 2020 [ 139 ]; Jeong 2020,2020 [ 95 , 96 ]; Johnston 1991 [ 168 ]; Kasahara 2020 [ 158 ]; Kim 2020 [ 169 ]; Ko 2020 [ 170 ]; Kruidenier 2020 [ 141 ]; LaMere 2020 [ 151 ]; Labiano 2020 [ 119 ]; Li 2020 [ 153 ]; Li 2020 [ 83 ]; Lio 2020 [ 171 ]; Liu 2020 [ 154 ]; Maeng 2020 [ 172 ]; Manning 2020 [ 124 ]; Mecklenburgh 2020 [ 98 ]; Mingay 2020 [ 55 ]; Nair 2020 [ 156 ]; Nestor 2020 [ 147 ]; Nikolouli 2020 [ 157 ]; Noh 2020 [ 173 ]; Noman 2020 [ 92 ]; Northrup 2020 [ 161 ]; Oda 2020 [ 82 ]; Orlanski 2020 [ 174 ]; Palazon 2020 [ 117 ]; Perez-Cruz 2020 [ 103 ]; Peyssonnaux 2020 [ 85 ]; Ptaschinksi 2020 [ 146 ]; Puskas 2020 [ 175 ]; Satoh 2020 [ 134 ]; Shalova 2020 [ 89 ]; Shi 2020 [ 111 ]; Shilotri 1977 [ 176 ]; Song 2020 [ 159 ]; Talks 2020 [ 177 ]; Tsagaratou 2020 [ 160 ]; Vissers 2020,2020 [ 178 , 179 ]; Vojdani 1993 [ 180 ]; Wallner 2020 [ 132 ]; Walmsley 2020,2020 [ 99 , 100 ]; Wei 2020 [ 152 ]; Yan 2020 [ 140 ]; Yildirim 2020 [ 136 ]; Yue 2020 [ 155 ]; Zhang 2020,2020 [ 133 , 145 ]. 7 mmHg, on average ( 9 ).