Vitamin D supplementation to prevent acute respiratory tract infections (2017)
bmj.com
bmj.com
This year I started supplementing with 2000 UI of vitamin D daily and it's as if my immune system started functioning normally, in the last 10 months I only caught a really light cold that I could barely notice, whereas before this the winter season alone would bring 2 severe cold or flu episodes that would knock me down for several days.
I can't really say if it's the vitamin D, or other changes in my life, like losing some weight or walking more, or the cold exposure I've been practicing (primarily because I heard it burns calories :-)), it might be even placebo, I haven't isolated these variables well, but my wife and close ones are amazed by the transformation. E.g. 3 weeks ago everyone in my household got the flu, except for me.
So now I got everyone in my household on vitamin D, especially b/c of this coronavirus scare. During summer time we might not need it, but the sun doesn't see us during winter. And vitamins are probably no defense against the coronavirus, but a deficiency could amplify the damage (as vit D has a role in our immune system) so it's best to ensure that we aren't deficient. Also we tolerate large doses of vitamin D, so it can't hurt.
I have reduced my alcohol intake, lost weight and have been taken medication that isn't an immunosuppressant (acetretin), for the psoriasis, along with the NHS giving me a free flu jab as I'm in an at-risk group despite being only in my early 40s.
I was taking vitamin D back in 2017 after it was recommended to me by one of the doctors, but slowly got out of the habit, and I'm now wondering if it can help with some of this. I have a jar of 3000 UI knocking around, so I'll start taking it today, and see how this goes - I have an outward looking signal on how well my immune system is behaving based just on my skin condition, which I've lived with for years so should be a good indicator of whether it improves or not.
If you want to know more, just ping me via the channels mentioned in my profile and I'll happily update in a month or two - let's see if I can provide a sense of it!
However, my vitamin D levels were low. I started taking D3 and noticed that some symptoms got worse at first but gradually went away after a few weeks. Now, every time symptoms come back, I take vitamin D and they are gone a few days later.
And in the past decade, I can count only a few times when I was struck hard by cold or flu, and they were when I had let supplementation trail off. When I'm having it daily, then the typical inflammatory symptoms only appear near or past the peak of the infection, and otherwise it just presents as tiredness and scatterbrained thinking, which I have learned to notice and pay some attention to.
I currently believe that some theraputic benefit may continue up to 8000 IU or so, but this is purely guesswork on my part, having tried amounts higher and lower. What I am confident in saying, having reviewed the research recently, is that there is some clinically studied, but poorly understood positive correlation between vitamin D supplementation and regulation of cytokine production, which is crucial for surviving the symptoms of respiratory diseases of this type.
Nothing constructive to add, but I wanted to say I am glad you are feeling much better. This is great to hear!
If you can, you should ask your physician to have your vitamin D level marked. Too much is not good either.
95% of the population need supplementation with 1700 UI to reach a serum level of 75nmol/L (considered optimal) [1]. Men can metabolize 3000-5000 UI [2]. The body adapts to higher doses by stopping solar synthesis thus we can tolerate up to 10000 UI [3].
Also vitamin D is a fat soluble vitamin and a supplement isn't necessarily absorbed well. Thus 2000 UI is generally recommended for individuals that have sub-optimal levels (this was a prescription from my doctor which is fairly standard) and it isn't considered toxic if you take up to 10000 UI.
[1]: https://www.ncbi.nlm.nih.gov/pubmed/17344484
When I was in my twenties I've gone through severe asthma episodes, due to exposure to such allergens and once you get inflamed it's really hard to reverse without proper treatment. So I eventually went on a treatment with corticoids and Symbicort and by avoiding the problematic allergens I've been fairly well under control ever since, haven't needed any treatment for years. Before that I was using Ventolin, which wasn't working well and gave me tachycardia episodes, thank god treatment for asthmatics got better.
But I remained fairly sensitive to colds, many colds I catch evolve into bronchitis.
https://www.ncbi.nlm.nih.gov/pubmed/28768407
I will simply quote from the abstract:
> This could lead to a recommendation of 1000 IU for children <1 year on enriched formula and 1500 IU for breastfed children older than 6 months, 3000 IU for children >1 year of age, and around 8000 IU for young adults and thereafter. Actions are urgently needed to protect the global population from vitamin D deficiency.
Essentially, the recommended intake that pharmacists and labels tell you is outdated and founded in a statistical error. Adults are recommended to take >8,000IU every day and not ~1,000IU as still believed by many professionals who last updated their brainbase decades ago.
> Recommendations stemming for a single standard for optimal serum 25(OH)D concentrations ignores the differing genetically mediated determinates of serum 25(OH)D and may result in ethnic minorities in Western countries having the results of studies done with subjects not representative of ethnic diversity applied to them. Vitamin D levels vary for genetically mediated reasons as well as environmental ones.
Basically, rarely is anything simple enough for a "one size fits all" approach.
Front end developers have to do so.
I guess we know how to avoid the trouble -- make hypotheses and test them. The trouble there is that the placebo effect is not a bad thing -- if you're doing things which you think will improve your wellness and it works, who cares whether there's a chemical mechanism? It works!
That's an exceptionally oversimplified view on the placebo effect.
There's a very obvious issue: If you take something that helps you due to placebo it may still also harm you due to its side effects. Some vitamins have been shown to increase overall mortality.
But there's another issue, and that is that often what people observe isn't the placebo effect, but something called "regression to the mean". Which is basically the effect that you may take something and you get better, though you would've gotten better anyway, because that's the natural progression of the disease you have. This is very likely a bigger reason for all the "I took it myself and got better, so I know it works!"-stories out there than the placebo effect. And the "who cares why it works?" argument doesn't count for regression to the mean.
> who cares whether there's a chemical mechanism? It works!
There probably even is a chemical mechanism that improves your health. Mental conditions like fear increase your heartbeat, respiration and muscle tonus, being relaxed does the opposite. Stress is a factor we know is contraproductive for the immune system and general health.
The effects have severe limitations of course and I don't think you can take anything to "trigger" the placebo effect. You need the healthy self deception part for it to work.
You're completely right, biochemists and medical chemists know fully well it's tainted by Pauling's late work and will tell you so. If even a small positive effect was missed because of that taint, that's a terrible legacy that led to many avoidable deaths (all the people that suffered or died until the positive effect is finally recognized). We should be better at salvaging such effects from their imperfect creators.
https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...
4000 IU per day would probably help a lot of people and is still an order of magnitude under the intake that's known to be toxic (60,000 IU/day for several months).
EDIT: Look at figure 2 in the Paper. Looks pretty random to me. Result is almost exclusively driven by 4-5 small (<250 participants) and old studies.
[1] https://www.vox.com/2018/10/4/17933880/vitamin-d-health-sun-...
[1] https://www.quora.com/What-is-the-industrial-process-involve...
[2] https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...
Seeing the seasonal difference was a bit of an eye-opener. And I have been on high dose Vitamin D supplements this winter. And all of my "winter" issues have more or less disappeared.
[1] http://gmmmg.nhs.uk/docs/nts/NTS-Recommendation-on-Vitamin-D...
> When all studies were analysed together, no statistically significant effect of vitamin D was seen on the proportion of participants with at least one upper respiratory tract infection, lower respiratory tract infection, hospital admission or emergency department attendance for acute respiratory tract infection, course of antimicrobials for acute respiratory tract infection, or absence from work or school due to acute respiratory tract infection. However, when this analysis was stratified by dosing frequency, a borderline statistically significant protective effect of daily or weekly vitamin D supplementation against upper respiratory tract infection was seen (adjusted odds ratio 0.88, 0.78 to 1.00; 4483 participants in 11 studies, P=0.05; table 5⇓).
Which to me makes it sound like it makes almost no difference.
Edit: The above could be for pre-exsisting patients.
Said that, the effect of the main outcome is not that big (if I read that correctly, it reduces your chances of getting a respiratory disease by ~4%)
Both sorts of reports (of primary and secondary effects) have their own sorts of biases. In general, while there is tendency to only publish and report significant effects (and this applies for both primary and secondary outcomes), study design matters, and a study may not be well designed to detect, or account for other factors, for secondary outcomes- in N, choice of population, control procedures and variables used, or even how accurately and systematically that data was recorded. Does make it hard to evaluate.
Eat more red meat (I rarely touched it in the past), and take a daily supplement was the charge. The mental clarity and well-being improvements are palpable.
I suspect that essentially all people living at relatively northern latitudes have some sort of vitamin D deficiency. From what I know you need to have your face and arms exposed to direct sunshine for at least 15 minutes/day to keep healthy vitamin D levels in the body. Good luck with that in the European/Canadian/Northern US winter.
White skin itself is an evolutionary adaption for getting enough vitamin D outside of tropical Africa. The extreme "melanin-anemic" blond & blue eyes look of Scandinavia is thought to be because it has a uniquely warm weather for the latitude, which make it possible to grow (vitamin D poor) grains there. That supports by far the biggest population density that far north, but also induces extreme whiteness to soak up every possible sun ray.
Conversely, if you have dark skin and live in the non tropics, you absolutely need to monitor and enhance your vitamin D intake. Sadly, doctors don't seem to bring this up with dark skinned patients, at least from what I hear from my (OK, not that many...) black friends.
- Scandinavia is very far north and therefore gets less sun in the winter (obviously)
- Apparently the soil of Scandinavia is well suited to crops that are high in Vitamin D
The soil being good for Vitamin D crops (plus lightening of skin/hair and fish diets etc) was a part of why people were able to live in such far northern climates even if they didn't always have access to fish.
IIUC it's the other way around. soil/climate allows for foods low in Vitamin D -> Vitamin D needed from other sources -> evolutionary pressure for getting it from the sun -> less melanin in skin
Some fungi have decent vitamin D, but it's certainly not a major "crop" in Scandinavia.
"White" and "dark" refer to the skin's effects on visible light. Visible light is different wavelengths from UV light; vitamin D production in the skin depends on UV light. "Dark" skin blocks UV light more than "white" skin does.
I think this is how it works: The melanin is not transparent, so it stops the light from penetrating beyond the very surface, and so a smaller volume of skin cells get access to sunlight.
To go a little deeper: Sunlight does two major things in our skin. It creates vitamin D, and destroys folate. Both are essential, so the various skin colors we have reflect the balance evolution has struck in various environments.
Incidentally you can test this yourself: if you go out in the summer you will tan i.e. your skin will darken. This is adaptation to lower the risk of sunburn and skin cancer.
If you could design a human from scratch, it might be most efficient to give northerners a D synthesizing pigment that's opaque in the necessary wavelength, resulting in the situation you describe.
Instead we have protective pigments near the surface, synthesizing structures underneath, and a need to balance D synthesis against UV damage.
Sure, some photons do get reflected, but the benefit is from those photons that get deeper into the skin.
At the end of the day I don't know enough, so I'm not making the claim about Vitamin D quantities, but isn't the evidence that there was at least some form of adaptation evident based upon skin tone alone?
I agree. Don't overdo it though, 5000 IU daily seems a bit much :) I live in Amsterdam and take 2000.
1: https://www.medscape.com/viewarticle/744128 2: https://www.ncbi.nlm.nih.gov/m/pubmed/28768407/
I think it depends on the person. If you get your blood level checked when you have a regular physical, you can adjust the dose as needed to keep the level where you want it (I shoot for the upper end of the normal range, and 5000 IU a day seems to be doing that for me).
2000 IU a day, 3-5 days a week. Not strict about it, just whenever I remember. Big difference in terms of energy, depression, sleep quality, etc.
I've messed around with higher levels but they usually give me wicked headaches.
You can probably play around with the brands and doses a little. I think the important thing is to take gel capsules with oil inside and not solid pills. Vitamin D is fat-soluble so I think solid pills don't get absorbed very well.
Most articles I have read recommend somewhere between 2000 and 5000 IUs. Some recommend higher.
I wonder what the actual numbers are for this. This weekend, I got out for a couple of 3 hour bike rides, for instance, but it was chilly out, so nothing but my face was exposed.
7-dehydrocholesterol --(UVB @ 296nm)--> previtamin-D --(thermal isomerization)--> cholecalciferol
The first step reaches equilibrium after about 15 minutes in Fitzpatrick type 1 skin in UV index 3-5 (moderate), and about 2 hours in Fitzpatrick type 6. The total amount produced is dependent on the surface area of exposed skin, and the previtamin isomerizes slowly, over about 12 days.
Time to equilibrium is about half the time to acquire sunburn at a UV index high enough to catalyze the previtamin-D reaction. At UV index 6-7 (high), time to burn is about the same as the time to reach previtamin-D equilibrium. At UV index 8 or higher (very high), you will burn faster than you make previtamin-D, and should maybe avoid being exposed during the midday hours. At UV index 11 or higher (extreme), if you are Fitzpatrick type 1, you will carbonize to a burnt matchstick the instant you step out of shadow, like a cartoon vampire, and you should not only not be outside, but should also be huddling in a dark basement waiting on the tyranny of the sun to pass.
Thanks to the equilibrium in the skin, the maximum absorbed dose from sunlight is the equivalent of about 20000 IU per day. High vitamin-D intake also requires increased vitamin-K consumption to reduce calcification of soft tissues.
Even that might not be enough, since in many people the body's ability to synthesize vitamin D when exposed to sunlight decreases with age. The only way to know for sure where you stand is to get your blood levels checked when you get a physical, and supplement if you need to.
This sort of thing is impossible to diagnose correctly without lab tests.
Our modern diets could cause further nutritional deficiencies. I doubt that many people in the West eat fish regularly or supplement with algae oil due to the conveniences of processed food. Same with iodine. Wheat germs have the highest concentrations in vitamin B1, but whole grains in general (rolled oats etc.) are good so you should probably cut the processed food out as much as possible.
My doctor recommends all his patients supplement with B12, regardless of whether they're vegetarian, because of the above mentioned potential for everyone to have B12 deficiency, and, according to him, tests for B12 aren't reliable.
Pretty sure that's the reason almost all milk in the USA is fortified with Vitamin D (and A)
Depends on your own skin color too.
The biggest effect anything I had on me is Testosterone Enthante 250mg twice a week.
Also I wonder if taking 8,000 IU vitamin D can desentivize the system overtime
No you can't. That's not how this works.
Yes I can :D
While my experience is obviously not definitive scientific proof it can still bring some value.
To give you a more simple example: when I broke my leg I went to the doctor's and put it in a cast. That helped me tremendously. Is that a well designed randomized controlled trial? No. Is it good advice to anybody with a broken leg? I would say so.
The setup you describe is for proving (with some statistical certainty) a certain causal relationship.
But the author doesn't want to prove it. It has already been proven experimentally. What he said is that he can tell us from his own experience. You don't need a controlled study for that.
I can tell from experience that a certain vitamin X deficiency can be very bad (e.g. because I had it, my doctor verified it, and I got very sick and had Y symptoms) without needing to prove that vitamin X causes Y if it's already proven.
Which is the same case with vitamin D. The parent didn't say he'll prove something novel, just that they'll verify it from experience.
Note that verification from experience is still very useful, even when something isn't proven. It's not as rigorous as science, but it's still very useful, can be life-saving, and it's how civilisation advanced for 1000s of years before we got "controlled studies". People already knew from experience not to eat X or Y plant for example (e.g. poisonous), without official studies and control groups.
People should still be required to be able to make deductions and learn from experience at this level before they offload everything to scientists.
Me: "You can't say that."
Philosopher: "I just did."
Remainder of students: laughter
https://www.sciencedirect.com/science/article/pii/S0264410X0...
The good news is, it's only four NASAs now. Their budget is up to $22.6 billion this year.
I was blown away recently when I discovered that the causes of myopia aren't really known, but don't seem to be primarily genetic.
Research done by National Institute of Child Health and Human Development (NICHD) in 2008 found that the influenza virus has a "butter-like coating". The coating melts when it enters the respiratory tract. In the winter, the coating becomes a hardened shell; therefore, it can survive in the cold weather similar to a spore. In the summer, the coating melts before the virus reaches the respiratory tract.[8]
I don't get sick while people around me do.
There is no one solution fits them all.
As I personally have a cold quite often I was curious to look into this a bit. Around the same time another metaanalysis was published with a similar question [1], but quite different results (i.e. Vitamin D is unlikely to help).
Here's [2] an (unfortunately only german) article by an austrian webpage associated with the cochrane collaboration (i.e. that should be considered a relatively trustworthy source) that explains this difference due to the fact that the BMJ metaanalysis included many low quality studies that were excluded in the other metaanalysis. This is an indication that this is might be not a real effect, but an artifact of the low quality evidence this analysis is based on.
tl;dr I won't buy Vitamin D supplements.
[1] https://journals.plos.org/plosone/article?id=10.1371/journal...
[2] https://www.medizin-transparent.at/vitamin-d-und-das-immunsy...
I recall someone telling me you had to be careful of supplementing D or you could promote calcification in arteries. You had to take with a calcium shop or something. Is that true?
taken from the Wikipedia article: https://en.wikipedia.org/wiki/Vitamin_D
Edit: maybe this came off as a humble brag? Getting a downvote or two, which I don't mind, but I wouldn't want to give off the wrong impression. I only work from home, I am not a jetsetting nomad, I can just work around my outdoor activities now.
Anecdotally I feel less lethargic when I remember to take them than when I slip out of the habit. I'm not sure whether that is just the placebo effect but the cost is low enough that it's worth it in either case.
This advice may not be applicable to people living in sunnier climes. Here is an overview of the guidelines on the NHS website which includes a link to the 300 page scientific review.
https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-...
0. https://www.bmj.com/about-bmj/resources-readers/publications...
1. https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
However, their conclusion that the findings warrant public health interventions and widespread supplementation is arguable. There are real risks and costs to over-supplementation, and the absolute risk reduction they demonstrate (from 42% to 40%) is not large.