Vitamin D Insufficiency is Prevalent in Severe Covid-19

I've heard that many times over the years and I have taken a Vitamin D supplement on and off (more off than on) over the years.

When this COVID-19 thing first hit, I had a physical scheduled (by chance) just about the same time, and I'd heard about this Vitamin D / COVID-19 connection, so when I went in for my physical, I asked my doctor to order a Vitamin D test as part of my bloodwork.

As it turns out, I was indeed very deficient in Vitamin D. I started taking 4000 IU a day and it's had a noticeable impact on my overall sense of wellbeing. It could, of course, be placebo effect even so. And I have no particular reason to think that it will make any difference one way or the other in terms of me getting COVID-19. But I thought it was worth pointing out one more anecdote that suggests that the old "Vitamin D is worth supplementing" refrain might just be true.

If you're in doubt, and it's an option, do what I did... just ask your doctor to run a Vitamin D test next time you go in for a checkup / physical.

> In a Boston homeless shelter, 100% of 147 COVID-19 positive subjects were asymptomatic [3].

That study actually excluded N=15 symptomatic people:

> The original cases (N=15) were identified sequentially over a 5-day period, and each was expeditiously removed from the shelter population at the time of symptom recognition. These individuals predated the implementation of universal testing procedures and are excluded from this study.

So, it's rather unsurprising that 100% of the remaining people were asymptomatic.

Actually there already is a better study where they actually tested vitamin D levels of many COVID patients [1]. It found vitamin D was strongly associated with less severe outcomes:

> Only 26% of the cases had 25(OH)D in the normal range, and virtually all of them (86%) had a mild outcome. ... Just over a third (38%) had 25(OH)D in the insufficient range, and only one of them (1.3%) had a mild outcome. ... Just over a third (36%) had 25(OH)D in the deficient range, and their distribution was pushed further toward severe and critical outcomes. Only one patient (1.4%) had a mild outcome, while 26% had an ordinary outcome, 40% had a severe outcome, and 33% had a critical outcome.

Now we should demand a controlled trial where they actually give a vitamin D intervention: this would provide causal evidence. However, avoiding vitamin D deficiency is already very well studied and has so many benefits that I think it is worth everyone's time and effort to do so.

Many people are advising high levels of vitamin D supplementation. However, there is reason to not overdo it on vitamin D supplementation and take just 1700 IU/day (or to just get sunshine) [2]. Of course, getting your vitamin D levels tested (with the help of by a doctor) is the safe way to go about this.

[1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484

[2] https://chrismasterjohnphd.com/covid-19/update-on-vitamin-d-...

i suspect VID correlates well with COVID comorbidities, like a sedentary lifestyle, hypertension, and weight problems. the opposite is also probably true, that people with good vit D levels correlate with healthier lifestyles and fewer comorbidities.

> Strikingly, 100% of ICU patients less than 75 years old had VDI [Vitamin D Insufficiency]

Since mid-March I've been trying to keep track of Vitamin D/Sunlight suggestions and papers here: https://simonsarris.com/sunlight

https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

Pale skin is an evolutionary adaptation to harvest more sunlight to convert to Vitamin D, from when humanity expanded to less sunny areas from Africa.

I'm a little shocked that doctors don't seem to tell black people this. My "survey" is probably only 5 people, but still, people need to know.

Does this mean they have checked 20 people, 13 (65%) of them were severe and all in the below-75 subset of these 13 people were deficient in vitamin D? Doesn't seem credible to me, I'd prefer some hundreds of people from completely different parts of the country.

By the way, isn't almost everybody deficient in vitamin D anyway? (see doi:10.1101/2020.04.24.20075838)

I've been taking 5000 IU for last 10 years to maintain ~55 ng/mL after finding out I was dangerously low at 12 ng/mL. And I used to live in Australia, the land of constant sunshine.

I avoid listening to the FDA recommended dose which has historically been increasing every few years. Just get your blood work done and supplement to maintain around ~ 55 ng/mL. That's better than listening to generic advice.

Btw. This pissed me off when BlueShield few years ago stopped covering Vitamin D blood tests because of this nonsense:

Most People Don't Need Vitamin D Testing https://www.bcbs.com/news/press-releases/most-people-dont-ne...

"The U.S. Preventive Services Task Force recently found the current medical evidence insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults."

"The American Society of Clinical Pathology contributed the following recommendation to Choosing Wisely®, “Many people have low levels of vitamin D, but few have seriously low levels. Most of us don’t need a vitamin D test. We just need to make simple changes so we get enough vitamin D.”"

    20 Patients in Study with COV19
      * 65% of them went to ICU (13 patients)
      * 35% of them did not (7 patients)

    Of the 13 Patients in the ICU 84.6% (11 patients) had VDI
    Of the 7 Patients not in ICU 57.4% (4 Patients) had VDI

The scale on the test results is: Interpretive Data: Deficiency: <10 ng/mL Insufficiency: 10 to 30 ng/mL Sufficiency: 30 to 100 ng/mL Toxicity: >100 ng/mL

"The majority of 25-OH vitamin D (25-D) in the circulation is derived from the conversion of 7-dehydrocholesterol in the skin that is irradiated with ultraviolet radiation in the UVB range (wavelength 290 nm to 315 nm).1-5 The extent of vitamin D formation is not tightly controlled and depends primarily on the duration and intensity of the UV irradiation. Levels produced typically reach a plateau within 30 minutes of exposure." [1]

"Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year." [2]

[1]: https://www.labcorp.com/test-menu/36721/vitamin-d-25-hydroxy... [2]: https://www.ncbi.nlm.nih.gov/pubmed/16549493

About a year and a half ago, I started taking vitamin D after my doctor told me I was slightly deficient. Within two months, there was no indication of plaques on my knees or elbows, and the little nodules that would appear on my palmar surfaces on my hands and feet became much less frequent. I am convinced that supplementing vitamin D was much more effective than any cream, and definitely less obnoxious than holding my knees and elbows to the sun at an open window on a sunny day. When I get outside frequently, I notice that basically all of my symptoms go away.

Long story short, take your vitamin D! Consult a doctor and don't take too much, since it's fat soluble and can build up to toxic levels in your system; also, since it is fat soluble, make sure your diet has enough good fats to help absorb it (guacamole and olive oil are two of my favorite supplementary foods with vitamin D).

But at the same time, isn't it suspected that vitamin D insufficiency is linked with a worse immune system generally?

(Anecdotally it made a big difference for me not getting winter colds ever since my doctor pointed out I had a significant wintertime deficiency and I started supplementing.)

In other words, there's unlikely to be any unique link between vitamin D and COVID-19. That this just falls in the wide bucket of "unhealthier people are more affected by COVID-19", similar to obesity.

Okay, let's play with this. Let us extrapolate from the strong correlation found by this retrospective review, and postulate that Vitamin D Insufficiency (VDI) is indeed a major contributing factor in either the severity of a COVID-19 infection, or the chances of contracting it. (I am not claiming this is indeed true, correlation != causation, but I think strong correlations are certainly worth looking at and playing with).

It is my observation that in my local area, the shelter-in-place order has resulted in more people spending more of their time indoors and not going outside as much. The park in my neighborhood is empty. I see less people on the bike trails visible from the roads I take to the grocery store. A nature park 20 minutes from my house, the kind that people go to to get out of the city and the hell away from other people, is closed with COVID-19 as the justification and scary signs threatening fines posted at all the entrances. And so on.

With less people getting outside, and less often, that means more people are getting less sun exposure, and less vitamin D. Assuming that their diets aren't changing to make up for that, that means more people with VDI, and those already with VDI getting worse. As such, if VDI will make it easier to catch COVID, or make the symptoms worse once caught, I can't help but wonder if these shelter-in-place orders intended to slow the spread won't end up shooting us in the foot, setting us up for a 2nd wave more brutal than had people been encouraged and incentivized to get outside more.

I really hope I'm wrong about that.

I wonder if they were correct, but for the wrong reasons. Vitamin D in humans primarily comes from a chemical reaction with sunlight in the skin. Maybe there's an indirect effect there that explains what they were seeing?

Previously, I tried supplementing with 10,000IU daily, didn't help me feel any better and took a long time to get my levels up. Doctor even told me to lie outside in a bikini every day in the sun and not to burn myself. My doc's theory is that some process in sick people uses up their vitamin D and calcium, and that's what needs to be stopped. He says he has seen patients with Vitamin D deficiency where they are cured with supplementation and/or sun, but it's not very common. It's cheap, easy, and harmless enough though to try before moving on to other things.

Outside extreme deficiencies though, I’m not sure that the band isn’t relatively large. But it is documented that D supplements for people with low levels of D does seem to reduce the incidence of pulmonary infections in general. There was a good paper on the subject published last December in Lancet (IIRC — i failed to save it in Zotero). So even before COVID-19 became a concern I upped my daily dose.

The fact that the study doesn't talk about base rates for ethnicities is pretty "striking" (to use a word they breathlessly, and wrongly, use).

(Not affiliated with the app, just happy with it.) It tells you the sun angle, peak hour of the day, and maximum time you should be in that day's sun based on your skin type, to avoid getting burnt while still getting enough D.

Be careful though - you might get a little OCD about Vitamin D tracking with this app. I did, and mainly use it now for checking how long it is safe to stay outdoors. (Instead of full blown tracking.)

The NHS also say more recently in response to the lockdown [3]:

Consider taking 10 micrograms of vitamin D a day to keep your bones and muscles healthy.

This is because you may not be getting enough vitamin D from sunlight if you’re indoors most of the day.

There have been some news reports about vitamin D reducing the risk of coronavirus. However, there is no evidence that this is the case.

Do not buy more vitamin D than you need.

They also warn:

Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart.

If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people.

Do not take more than 100 micrograms of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years.

[1] Vitamin D and Health [PDF] https://www.gov.uk/government/uploads/system/uploads/attachm...

[2] The new guidelines on vitamin D – what you need to know: https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-...

[3] Vitamin D: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...

There is strong evidence that Vitamin D does nothing. Large scale studies of vitamin D supplements show no benefit.

The article above argues that it is actually sun exposure that brings health benefits, and that vitamin D is just a byproduct. This makes sense. If vitamin D levels are strongly correlated with good health, it doesn't mean that it causes it. There might be some third factor.

Numbers in the study are very low and no significant correlation was found.

Lots of interesting postulation in the discussion. Could be worth looking at in a larger study.

Now cue the press stories, and panic buying...

It's because of stuff like this I take one. Maybe I'm wasting money, but absent a harm I feel it's worth it to hedge my bets.

Vitamin D at normal doses is quite safe, though, so I'll be supplementing my intake now even if broader long-term study shows this to be ineffective for C19.

^ Not discounting other factors

All this of course reduces vitamin D levels.

Well, let me add to the narrative, as this was the concentration of my Undergrad studies. Vitamin D, and its analogues are not actually vitamins, they're steroid-hormones and behave as such; look at its molecular structure [1] and its synthesis in the presence of UV light (as this actually how you should be acquiring it).

Most people are deficient in Vitmanin D, the recommended dose of 600 IU are actually not sufficient as many studies, research lends credence to as those that induced viable therapies were often upwards of 4000-10000 IU. The IOM is to blame for this, and a heated debate amongst researchers.

I won't go into full detail on that, but Vitamin D is a critical precursor and reactant in many vital metabolic reactions, my personal concentration was in inducing apoptosis in certain cancer cells with calcitriol, EB 1089, CB 1093, and p53. My proposals were rejected for Independent Studies and I never undertook it in the lab, unfortunately.

> Unfortunately the daily recommended value was established erroneously and should be much higher. Many research papers mention this...

Exactly. My bible was a Vitamin D book with 100+ chapters detailing researchers that published papers detailing how their models were showing that such low IU of Vitmain D were insufficient, going against the IOM's RDL.

If any of you are so inclined the 2nd Volume of Vitamin D by Feldman has been released [2], its expensive but still way less than what the last copies of vol 1 were that I paid back then.

> Nobody makes any money if it turns out to be a good treatment, so nobody will fund the research

You have no idea the amount of dismay I felt when I realized this was the case when I was in school; though I would argue they've fund(ed) it in the past, the problem is their is no way to place IP on Vitamin D itself and therefore Big Pharma's business model doesn't apply, so it can show favourable results but it will be killed because their is nothing to bring to Market as an exclusive seller like they do for drugs. Many therapies could have been explored since H1N1, 2009, but it falls on deaf ears and it takes pandemics like these to shake people into delving into Public Health more seriously.

I hope changes are made by motivated students and researchers, ideally outside of Universities because I know I no longer have the patience or drive to try any more.

1: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2F...

2: https://www.amazon.com/Vitamin-Disease-Therapeutics-David-Fe...

Makes you wonder if there is a correlation to Vitamin D insufficiency due to lack of sun light.