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Comment by sgustard | Hacker News Reader

Hmm, my doctor specifically said a few weeks ago:

"During active COVID-19 infection symptoms (fever, cough), please AVOID these common supplements: Echinacea, Elderberry, Polysaccharide extracts from Medicinal Mushrooms and Vitamin D as these MAY theoretically exacerbate the cytokine inflammatory storm. It's OK to take them preventively (if you are already doing so) but please stop at the first sign of COVID-19 symptoms."

Hence I've been avoiding adding Vitamin D to my daily ritual; anyone have any supporting data?

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> "During active COVID-19 infection symptoms [...], please AVOID[...]"

> Hence I've been avoiding adding Vitamin D

Do you have active symptoms?

The concern is about a studied connection between Vitamin D supplementation and an increase in concentration of the IL-1b inflammation marker (see, e.g., [1]), which has been implicated in cytokine storms. The other supplements mentioned have similar effects.

This correlation suggests that you might not want to be taking Vitamin D if you're as risk of a cytokine storm hurting you.

That said, however, vitamin D is also associated with strong anti-inflammatory properties of other markers, so really -- it's super hard to predict what will happen. As far as I know, no one has observed a connection between Vitamin D and cytokine storms directly, so the whole thing is kind of hypothetical.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4631349/

Well, vitamin D actually reduces the cytokin storm, so I don't really get why his/her doctor advised against it in the first place...

https://www.cambridge.org/core/journals/epidemiology-and-inf...

Hmm, I consider that paper to be pretty weak evidence -- as elsewhere, it shows a hypothesized connection via some intermediaries: they show Vitamin D inhibits inflammatory cytokines, but then presume that this inhibition must therefore help avoid hypercytokinaemia (cytokine storms), despite hypercytokinaemia being an edge case/failure mode of the immune system that is not particularly well-understood.

The paper I shared in my previous post cites work showing that Vitamin D promotes other kinds of inflammatory cytokines.

So, yeah. Vitamin D might reduce the likelihood of a cytokine storm, and circumstantial evidence relying on mechanism-of-action suggests that it does -- but this hasn't been demonstrated conclusively.

What is known, however, and which this paper reiterates, is that if you're deficient in Vitamin D, you're more likely to suffer from respiratory tract infections. Take a supplement!

The paper you cited only deal with cell lines (i.e. in-vitro studies), whereas you can find good quality in-vivo RCT studies about both low grade inflammation and cytokines storm. Hell, you can event find meta-analysis for specific conditions and related inflammatory state (CHF, type 2 diabete, ...)

For example :

- Heart failure meta analysis: https://www.ncbi.nlm.nih.gov/pubmed/29348609 - Type 2 diabete meta analysis: https://www.ncbi.nlm.nih.gov/pubmed/29490085 - Type 2 diabete meta analysis: https://www.ncbi.nlm.nih.gov/pubmed/29945132

Hell, we even have preliminary human studies dealing with just that: clinical outcome for patients admitted in intensive care unit, with or without a single mega-dose of vitamin D: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/

> Hell, we even have preliminary human studies dealing with just that: clinical outcome for patients admitted in intensive care unit, with or without a single mega-dose of vitamin D: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/

Thank you, this is what I was looking for! Great outcome.

The other three papers you cite are also all correlations of Vitamin D with inflammatory factors, not with disease outcomes. I must have missed the study that looks specifically at cytokine storms as a dependent variable. Could you point it out to me?

I don't know if I had COVID-19 since I couldn't get a test. I had dry cough for 4 weeks since early May. It didn't go away.

I increased Vitamine D supply by taking a supplement and eating more fish (salmon, herring). The cough became better but became much better only when I also added Echinacea.

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