Study of the effect of Vitamin D, Magnesium and Vitamin B12 on Covid-19 patients
medrxiv.org
medrxiv.org
- 40% of US Americans are B12 deficient https://www.livekindly.co/b12-deficiency-genetic-makeup/#:~:....
- 42% are Vitamin D deficient: https://www.cantonmercy.org/healthchat/42-percent-of-america....
- up to 50% are Magnesium deficient: https://www.sciencedaily.com/releases/2018/02/180226122548.h...
- 10 - 20% of women are iron deficient: https://www.aafp.org/afp/2007/0301/p671.html#:~:text=The%20p....
My unscientific conclusion is that the vast majority of people world-wide probably suffer from at least one and probably more significant nutrient deficiency. With that we are wasting our "performance potential" and, less capitalistic, our "well-being potential". The lack of any of just those nutrients I looked up can cause anything from debilitating brain fog, over physical and mental deterioration to numerous physical ailments...
Yet for most of them, taking them in excess causes the exact same problem. If I was filthy rich I would get nutrient levels measured once a week. (-;
How easy is it too get such tests (in UK), I'm surprised we don't seem to have anything like this as part of our health system. I've had blood pressure and height/weight taken a couple of times (I'm middle aged). But that's about all wrt biological metrics, seems lackadaisical?
That's not cheap...
I remember doing some tests once that had a cost breakdown and they would vary a lot in price (meaning some would be let's say, single digits, some others would be in the triple digits area - think USD/EUR price ranges)
As you say, this directly impacts day-to-day wellbeing. It's exactly the kind of thing that should, if it's even moderately effective, be provided free of charge for every human being.
I am not writing a peer reviewed article. Just wanted to throw out some numbers to engage with the thought of widespread deficiencies. If you want more reliable information there is lots of material available online.
Those links are to studies which do not support the 40% claim. They are basic science research about vitamin interactions in the human body. Please consider that if you can't find studies showing "widespread deficiencies," then perhaps they don't exist.
This sounds similar to what services like Viome (https://www.viome.com) do. Though, their intervals (at least Viome's) are much longer.
Really hope they're successful, seems like an unsolved problem.
If they could get that cheaper you could get people signing up out of curiosity. But when you see they want $200-$600 for this you start to get suspicious: what are you actually getting? Is it vetted by somebody? Etc.
Agreed. For whatever it's worth, I have a few friends who swear by it. I have no idea how dynamic our bodies needs are, but presumably you could make the price more reasonable by signing up, getting yourself on track, cancelling and then checking back in after 1/2/N years.
[citation needed]
Safe upper limit is considered 4000 IU daily which will get you up there (and beyond) easily and is very affordable.
For comparison, spending a while in the sun with your upper body exposed is easily 10,000 IUs for a light skinned person.
> Brown and black people likely have significantly lower "healthy" levels that don't warrant supplementation.
[citation desperately needed]
Dark-skinned people are generally advised to supplement.
About the desperately needed citations, let's start from these two:
https://pubmed.ncbi.nlm.nih.gov/17413106/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/
The first is a study in South Indians. Even among rural workers spending long hours in the tropical sun, the study finds >80% of people had Vit D levels below the 'sufficiency' level of 30 ng/mL, in this otherwise healthy cohort. 44% of them had levels below 20 ng/mL. While this study doesn't report bone density, other studies on rural Indians suggest the osteoporosis prevalence at ~ 1% of the non-elderly population. There are no long term follow up studies in the rural indian population, but it's a reasonable assumption that individuals with very low Vit D levels (ie, < 12 ng/mL) were more likely to develop osteoporosis later in life. The study also reports low dietary calcium and high intake of dietary phytate, which are suspected to reduce circulating vit D levels. Do these necessarily lead to long term harm? It doesn't seem like it. Other reports suggest that lower bone density among rural Indians is most strongly linked to lower lean muscle mass. Greater the load bearing exercise, the better the bone density.
The second study is among healthy blood donors in Nairobi, with 95% of subjects with Vit D levels between 12.73–22.07. In both studies, the participants live in tropical environments exposed to high levels of sunshine.
By setting the optimal level of Vit D at 30 ng/mL, it pathologizes these otherwise healthy subjects. The concern is that the long term supplementation required to achieve 30 ng/mL would have unintended consequences, such as inappropriate calcification. As the Nairobi study points out, while low levels of Vit D are linked high levels of parathyroid hormone, beyond a certain point increasing vit D levels are linked to higher PTH levels. PTH leaches calcium out of the skeletal reserves and raises calcium levels in the blood. The deleterious effects of Vit D hypervitaminosis are due to high circulating levels of calcium. The Nairobi study shows that the lowest PTH levels were associated with vit D levels ~ 30 ng/mL, while individuals with vit D of 50 ng/mL had PTH levels similar to those with Vit D levels around 15 ng/mL. From the figure in the paper, it looks like if the goal is to minimise PTH, vit D levels < 15 ng/mL are sufficient.
Which brings me to my initial assertion: brown and black people with plenty of sun exposure have naturally lower levels of circulating Vit D, with the average around 20 ng/mL. The Nairobi study points out that greater sun exposure did not significantly increase Vit D levels in this group. They do not seem to suffer greatly elevated levels of bone abnormalities due to this, or any other obvious health concerns. To me, this is suggestive that these levels are naturally equilibrated to be in the 20 ng/mL range, and attempts to push them higher might be deleterious. Setting the standard at 30 ng/mL unnecessarily pathologizes these otherwise healthy people, encouraging supplementation, which is not without health risks.
Dark skinned people who live in high latitudes probably need greater supplementation than their light skinned neighbours, which is reasonable.
https://doi.org/10.1007%2F978-0-387-77574-6_5
The authors suggest that 30 ng/mL seems like the sweet spot for most health outcomes. Higher levels (~ 50 ng/mL) might be beneficial for fighting cancer, but the risks associated with the prolonged supplementation is unclear, which is why they do not recommend it.
Something to keep in mind is that high levels of vit D are linked with high levels of circulating calcium, which is a problem. Protocols that advocate high Vit D doses, like the Coimbra Protocol for autoimmune diseases (100,000 IU per day), try to keep calcium levels low. The Coimbra Protocol tries to find the Vit D dose that minimises parathyroid hormone levels, and needs a diet practically calcium free to be safe. PTH causes calcium levels in the blood to go up, leading to kidney damage and inappropriate calcification.
Outside of an extreme setting like the Coimbra Protocol, while PTH is inversely linked to Vit D levels, beyond a certain point rising Vit D levels cause PTH levels to go up. This suggests that there exists a sweet spot of circulating vit D that minimises PTH levels.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/
This study among healthy subjects in Nairobi found that the lowest PTH levels were associated with a vit D level around 30 ng/mL.
During quarantine, you have far fewer people spending most of their waking hours in huge concrete coffins.
How many people even get to see the sun during a typical workday, much less spend time in direct sunlight?
In big cities like NYC people get sunlight during
their commute
Not sure when you think they're soaking up all this sunlight. Sitting in a train car? ...that's underground? Or inside a bus? Or is it when they are walking between tall buildings?
New Yorkers are not exactly known for their tans, even in summertime.
but get no sunlight when cooped up in a small apartment
Perhaps more relevantly, of course, most Americans do not live in places like NYC where they have difficulty accessing sources of sunlight. I live in a suburb of a different American city and we are getting much more sunlight during quarantine. It's much easier to take walks and sunlight breaks during the daytime.
I moved from Brazil to the UK 6 years ago and have since developed a semi-transparent quality on my skin.
1 month into the quarantine and I have a great tan and look like a healthy human. The healthy part is probably in part due to better sleep and a lot less exposure to pollution but sunlight definitely helps.
There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal. Yet there are many studies that show healthy individuals with serum levels < 10 ng/mL, and they do not seem to suffer the bone abnormalities expected.
There's a similar situation with Vit B12. Reference ranges were established from healthy individuals based on dietary intake, and there is no upper limit. It's also unclear what the bottom of the healthy range is either. A relatively recent investigation by the health authorities in India found that the dietary intake of B12 of the average Indian was less than a tenth of the US average, with no obvious ill effects. B12 deficiency diseases are practically unheard of in India, yet when tested against American references, a large portion of the population is "deficient". The Indian authorities eventually set the recommended intake of B12 to the WHO standard, which is a lot lower than the American or European levels.
The problem is that any apparently healthy individual may still develop a chronic disease decades down the line.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5440113/
> There's been a great deal of debate on safe Vit D levels, and the consensus (such as it is) is that a serum level of 30 ng/mL is likely optimal.
If you look at dark-skinned hunter-gatherer tribes which are living in a way closer to our common ancestors, the "natural" Vitamin-D levels in their relatively sunny environment is more like 40 to 50. The body seems regulate Vitamin-D production up that level, so that's probably closer to optimal than 30.
Sure. My impression is that sub 10 ng/mL levels warrant supplementation. However, I have also seen studies that included wrist X-rays of subjects to determine bone loss, and most subjects were sub-20 ng/mL with acceptable bone densities. This was a study in Indians, and another study in rural healthy Indians showed most were in the sub-20 ng/mL range, coupled with low dietary calcium intake, and no ill effect. While it's true that they may develop problems decades down the line, a longitudinal study like this demonstrates that Vit D related deficiency diseases are actually quite rare, and at levels far lower than would be expected from the serum levels alone. There's clearly more going on.
https://pubmed.ncbi.nlm.nih.gov/17413106/
On the Hunter-Gatherer levels, I'm guessing you're referring to the Masaai and Hadzabe study. However, is this the optimal vitamin D level?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180659/
This study from healthy black blood donors in Nairobi found much lower levels (95% CI 12.73–22.07), and these people had significant sun exposure as well. Rather importantly, they note that while parathyroid hormone levels are inversely proportional to Vit D serum levels, they start to go up with high levels of Vit D. Individuals with 50 ng/mL vit D had PTH levels similar to people with a Vit D serum level of 15 ng/mL. PTH causes calcium levels in the blood to go up, drawing them out from skeletal reserves. The health implications of high Vitamin D supplementation are linked to the inappropriate deposition of calcium. Keeping PTH levels low is likely beneficial. The Nairobi study found PTH levels were lowest in people with vit D levels around 30 ng/mL.
...in that particular polynomial fit.
> Keeping PTH levels low is likely beneficial. The Nairobi study found PTH levels were lowest in people with vit D levels around 30 ng/mL.
The minimum of the polynomial fit is around 35. If you look at the scatter plot, there are only six samples near 50 ng/ml and they're all over the place. You can not draw your conclusion from that. There's no significant deviation between 40-50 ng/ml.
My question is, why would the body stop producing Vitamin D around 40-50 ng/ml if 30 was optimal? Why not stop earlier?
> Keeping PTH levels low is likely beneficial.
Not sure where you get that.
Why does the body stop producing Vitamin D around 50 ng/mL, if it wasn't the ideal? Vitamin D toxicity only kicks in at extremely high levels, several orders of magnitude higher than are naturally produced. So why would nature even bother to set an upper limit at 50 ng/mL? It doesn't, though. Vitamin D3 is produced by a reversible photosynthetic reaction, and is constantly being degraded as well under sun exposure. 50 ng/mL possibly represents the upper limit at the speed with which D3 can be transported away from the dermis, and the limits of natural exposure levels. My feeling is that rather than an evolutionarily fine tuned level, this is a "good enough" local maxima as an upper limit for D3 production under natural conditions. If the Masaai were somehow exposed to 20 hours of full sun, their levels might very well be much higher.
As a thought experiment, if humans were exposed to 20 hours of sunlight, would we evolve fewer keratinocytes to keep vitamin D levels at the 50 ng/mL level? Or perhaps evolve less efficient enzymes to produce lower levels of the precursor? My impression is that there isn't a strong enough disadvantage to higher levels of Vitamin D for evolution to push in that direction. So rather than an ideal level, 50 ng/mL might simply represent the upper limit of what humans can produce under natural conditions.
The situation is more complicated with recommendations around vitamin D. The most obvious and extreme abnormality associated with low D is bone demineralization. This is largely alleviated by levels above 12 ng/mL. Yet when you look a cohort of healthy young Caucasian coast guards, their vitamin D levels are 30 ng/mL. So what do you set as the recommendation: the level required to prevent symptoms, or the levels seen in (some) healthy people, but with no obvious health advantages? Most groups have tended to split the difference: set the minimum at 20 ng/mL, and the “optimal” at 30 ng/mL. Is there a health benefit with supplementing if the level is below 10 ng/mL? Quite likely. Is there a health benefit supplementing if your level is at 20 ng/mL? Probably not.
The picture is even further complicated if you consider that the healthy cohort of young white coast guards in Hawaii is not representative of the population at large. Multiple studies have looked at healthy black and brown cohorts from tropical environments, and find most average around 20 ng/mL.
Vitamin D does wonders for my skin. Not once did a dermatologist suggest I could be deficient. I figured it out on my own.
Here is a good resource for research on vitamins and minerals and their applications:
https://www.informationisbeautiful.net/visualizations/snake-...
[1] https://ods.od.nih.gov/factsheets/VitaminD-Consumer/
[2] https://www.healthline.com/nutrition/how-much-vitamin-d-is-t...
I guess that might also be why people say to drink more water when you have diarrhea. The absorption of water that usually happens during digestion is not occurring.
Remember that half of all research papers are probably wrong and most of medical research is wrong, according to John Ioannidis:
"Why Most Published Research Findings Are False" by John P. A. Ioannidis:
https://journals.plos.org/plosmedicine/article?id=10.1371/jo...
Lighter reading on this topic:
"Lies, Damned Lies, and Medical Science" by David H. Freedman (who later wrote an excellent book on this topic, see below for link):
https://www.theatlantic.com/magazine/archive/2010/11/lies-da...
"A Researcher’s Claim: 90% of Medical Research Is Wrong" by Maia Szalavitz:
https://healthland.time.com/2010/10/20/a-researchers-claim-9...
And in these days of COVID, HCQ, Remdesevir, crisis, civil unrest and crime I cannot recommend enough David H. Freedman's book titled:
"Wrong: Why experts[1] keep failing us"
with the subtitle
[1]"Scientists, finance wizards, doctors, relationship gurus, celebrity CEOs, ... consultants, health officials and more"
https://www.amazon.com/Wrong-us-Scientists-relationship-cons...
Freedman examines thoroughly the issues that John P. A. Ioannidis has raised.
So I think this is misplaced skepticism, you shouldn't really dismiss studies so easily without thinking through the issues first. This would be much more relevant if the research was specifically about some random compound's small effect on Covid-19 without a prior reason to think it would be relevant at all - then the problems would indeed appear.
It's probably not a feasible solution to require these people eat healthy nutrient-rich foods due to economical and culture and personal choice reasons. Are vitamin supplements a feasible solution?
It actually causes me to select otherwise "lower-grade" cereals than I might otherwise purchase. Fancier/healthier, more "natural", choices are not fortified.
Alternatively, a multivitamin intrinsically yields the same results.
I think the root issue is that Medical treatment existed before the scientific method. This creates a huge industrial debt of "doing things the old way" and relying on authority/tradition.
I can only imagine deregulation is the solution. At least in the United States, medical is run by various cartels/factions. It would be nice to have input from scientists rather than authority.
Theoretically it is well possible (unless real studies indicate it's not) unnaturally huge dose of a particular nutrient may happen to be very beneficial. It is also possible deficiency in particular nutrients may happen to be beneficial too.
Although I'm not actually one of vitamin mega-dosing maniacs, I actually believe the chances the official RDAs (let alone ordinary rations) are optimal are fairly low.
So, the same eating pattern gets exploited day in day out and people end up deficient in the things you mentioned, plus potassium.
I'd say the largest public health issue related to this is that most people eat an overabundance of carbs. The next most important is that people don't eat a large enough variety of foods (or supplements) to get sufficient micronutrients.
FWIW older people are usually more often indoors and have both higher likelihoods of becoming hospitalized because of Covid and are more often indoors, thus prone to Vitamin D insufficiency.
If you have kidney problems, you might be deficient in Vitamin D even with a lot of sunshine.
https://www.davita.com/diet-nutrition/articles/basics/vitami...
If you look a table 2, the control group was on average 6 years older and had more co-morbidities. This suggests that there was some selection bias and that other undocumented factors could have greatly affected this experiment.
Doing multi-variate analysis with such a small sample size gives rise to huge uncertainties. In all, this study is only very weak evidence.
You're probably right, most things taken at 100x the normal dose for long period of time are toxic. (Water included)
While possible, it does seem unlikely.
Taking 100000 IU per day for months/years is not necessarily toxic, especially when reducing calcium intake.
I'm curious why an acute high dose would be preferable over a lower dose taken daily.
It's not quite an acute high dose. The body produces the equivalent of 10,000 IU per day in high sun exposure, so 60K per week tries to achieve that level. I believe the high dosage is simply convenience. The 2K IU daily dose is pretty common as well.
[1] - https://www.google.com/search?hl=en&source=hp&biw=&bih=&q=si...
Taking vitamin D for the average American will surely help in keeping good immunity, bone health, etc.
https://www.acc.org/latest-in-cardiology/clinical-trials/201...
I do wonder though if this is an important caveat though:
> among healthy participants.
.. since the rest of the discussion resolves around adding supplements to fight shortages. If "healthy" implies not have said vitamin D shortage then that is still a useful study but doesn't disprove the thesis that taking supplements is probably a good idea.
(I have already been taking all three as supplements for the last year due to other research suggesting that having a shortage of them worsens ADHD symptoms)
Turning round in a circle three times before you leave the house is almost entirely harmless, and there's no evidence that doesn't stop you getting coronavirus...
“Several studies have shown that megadoses of the vitamin can lead to outbreaks of acne and rosacea, a skin condition that causes redness and pus-filled bumps on the face. Yet, it should be noted that most of these studies focused on high-dose injections rather than oral supplements (5, 6, 7).
There is also some evidence suggesting that high doses of B12 may lead to negative health outcomes in those with diabetes or kidney disease. One study found that people with diabetic nephropathy (loss of kidney function due to diabetes) experienced a more rapid decline in kidney function when supplemented with high-dose B vitamins, including 1 mg per day of B12. What’s more, the participants receiving the high-dose B vitamins had a greater risk of heart attack, stroke and death, compared to those receiving a placebo (8).
Another study in pregnant women showed that extremely high B12 levels due to vitamin supplements increased the risk of autism spectrum disorder in their offspring (9).“
From: https://www.healthline.com/nutrition/too-much-vitamin-b12#he...
To play the devil's advocate, no, that's not true. What we have are just associations which could be spurious. It is often said the general population is deficient in this or that vitamin, but in the west at least we are no longer in danger of developing scurvy or rickets and beyond that there's actually not much evidence that vitamins improve our health.
(Note — not enough evidence means just that, and is certainly not evidence of absence)
Of course, take your vitamins, I've taken vitamin C and D long before this coronavirus and I've caught colds less frequently — but truth be told, I haven't isolated the variables, I have no idea why I felt better and it could be just coincidence.
The problem in believing diet can make a difference is that it may take resources away from investigating treatments that actually work.
In a clinical setting we are talking about high intravenous doses, which are supposedly meant to give the immune system a boost and not to fix prior deficiencies. There's not much evidence that high intravenous doses work either.
In the context of the population, keeping your distance, washing your hands, wearing masks and even if you catch the virus, minimizing the viral load you're exposed to, will probably do much more good than a healthy diet. If you do everything else, then fine, optimize your diet too, but often people get lost in minutiae, forgetting proper hygiene.
UPDATE: edited multiple times, sorry.
The odds of turning round in a circle three times helping are 0.000000001%. The odds of DMB helping are probably less than 50%, but more than 5% at this point. The cost is minimal.
Generally, one does an ROI calculation. To mix units and otherwise have zero rigor:
Return: P(treatment helps) * how much
Investment: P(treatment hurts) * how much + financial cost
My math on most cheap interventions, including vitamin D, are that they're obvious no-brainers, if done competently (e.g. not taking 600,000 IU per day, or sunburning oneself on a crowded beach -- dumb stuff like that always comes up in counterarguments).
Without math: There's evidence (although not proof) that they might help. They can't hurt.
I do a lot of things like that. When COVID19 first showed up, I was super-careful about contact transmission, large droplet, and aerosol, although I had no evidence which of those dominated. Were some of the things I did a waste? Indubitably. Was it a good idea to do that together? Without a doubt.
AFAICT Vitamin D supplementation may well be snake oil, as low vitamin D levels may be symptomatic of another condition which supplementing won't help.
Vitamin D pills cost $12 per bottle where I live. I would guess the economic damage from COVID19 is going conservatively going to be $10,000-$20,000 for a typical family. We can do the math.
If vitamin D has a 3% chance of reducing the economic impact by 3%, even health implications aside, we're best off with everyone taking it.
The evidence isn't strong enough to support even 50% odds of it working, but it's definitely strong enough to support greater than 3% odds.
Similar economics apply for in-hospital use, only even more so.
And yes, I'm aware of all the other correlations. Exercise, sunlight, time outdoors, wealth, and vitamin D all correlate pretty well. We need a robust set of RCTs.
Here in the UK you would expect the monetary cost to be zero. That doesn't mean you shouldn't look after your health, but seriously, wtf?
That's not to mention secondary effects, such as how that level of unemployment feeds into anxiety which inflames the current riots.
You can work the numbers however you like, but the number I gave is VERY conservative. The economic harm of COVID19 is astronomical here.
Much of that could have been mitigated with good policy, but in the US, it wasn't.
If a public health measure has even a slim chance of e.g. shortening the need for lockdowns by a few days, and costs several times more what vitamin D pills do, it's already economically worthwhile. The cost-benefit here (and in many other measures of possible benefit) is so incredibly ridiculously obvious that it's not even funny.
I have someone in another thread making similar arguments about hydroxychloroquine. How many meds and supplements should we take just in case?
There isn't such a thing. We know nothing. We have different levels of confidence in facts.
Even very basic facts ("am I alive") I can only say with pretty high confidence (we might all be living in a computer simulation or somebody's dream). And even things with strong scientific evidence occasionally get disproven. Studies with just one RCT are wrong all the time -- most medical and social sciences studies are wrong (it turns out p=0.05 is nowhere near sufficient in established research fields).
You work through decisions with uncertainty by calculating an expected gain or expected loss:
https://en.wikipedia.org/wiki/Expected_return
The argument for taking hydroxychloroquine is not the same. There is weak evidence it might do something, but the drug also has a whole slew of negative effects (https://en.wikipedia.org/wiki/Hydroxychloroquine#Adverse_eff...). If you compute the expectations of taking hydroxychloroquine prophylactically, it's definitely a very, very, bad idea. The downsides obviously outweigh the upsides.
If you do have a serious case of COVID19, it depends on what assumptions you plug into the equations. Which is to say, I wouldn't recommend hydroxychloroquine based on the last data I've seen (although I haven't followed this closely in a while), but reasonable people looking at the same data (again, ignoring anything from the past month or so) might recommend it. It's not an insane decision.
On the other hand, the data strongly supported ramping up the production of hydroxychloroquine and stocking up on it in case it is eventually shown to work. Hydroxychloroquine costs maybe 30c per pill, and dropping a billion dollars ($1/person) to make sure we have 3 pills per person is an obviously good idea. That's less than 1/1000th the stimulus package. Likewise, we should have used face masks immediately (including a massive push to surge manufacturing) before we knew what effect they had. We have enough data from e.g. influenza to where they were an obviously good idea from day 1. We should have done likewise for manufacturing of ventilators (which are turning out to be less helpful than we though), and for a slew of other things which /might/ be helpful down the line.
For most meds and supplements, we have zero evidence. There's no reason to believe they do anything, and if they do, the odds of it being negative are the same as the odds of it being positive. Don't do it. I think the one exception is zinc, where based on very incomplete data, it seems like it makes sense if you're sick.
Military, financial, and business are domains where there are sophisticated models for how one makes rational decisions with incomplete information (before "knowing"). If you wait for complete information before moving, a competitor or adversary will crush you.
Coincidentally, a lot of people were bothered by shutdowns happening before we knew how serious COVID was or how it spread. Those were also an obviously good idea. But the confidence interval for CFR ranged from a slightly more serious flu all the way up to maybe 8% at the time we shut down here. The _expected_ CFR was 3.4-3.6%, and the shutdown was an obviously good idea based on that incomplete information. But news sources omitted how little we actually knew.
Beer is mostly water and your body can literally collapse from to much of it. I made a quick search and I didn't find anything that proves what you're saying.
Nicotine patches also have been said to help.
Every study like this distracts from other studies, so it needs to be pushing towards correct.
It's pure association, it may very well be pure confounding. In favor of the authors: The only thing they really claim is that an RCT should be done. Which I guess is an okay'ish conclusion from such a study.
Larger randomized trials are in progress [1][2] but the results won't be published until July.
[1] https://clinicaltrials.gov/ct2/show/NCT04344041 [2] https://clinicaltrials.gov/ct2/show/NCT04351490.
This is often the first stage before an RCT. Don't see what's confusing about this.
> As the COVID-19 situation evolved, we decided from 6 April 2020, to start DMB on all COVID-19 patients above 50 years old upon hospitalization and before the onset of the primary outcome event. Patients admitted during this period who did not receive DMB before event onset were served as control. Therapy comprised a single daily oral dose of vitamin D3 1000 IU, magnesium 150mg and vitamin B12 500mcg for up to 14 days
Highlights:
"Significantly fewer DMB patients than controls required initiation of oxygen therapy subsequently throughout their hospitalization (17.6% vs 61.5%, P=0.006)."
"DMB combination in older COVID-19 patients was associated with a significant reduction in proportion of patients with clinical deterioration requiring oxygen support and/or intensive care support. This study supports further larger randomized control trials to ascertain the full benefit of DMB in ameliorating COVID-19 severity."
So while this is too small of a study to do anything but call for bigger studies, its additional evidence that vitamin deficiency may play a role in COVID-19 severity. Since taking a basic multi-vitamin is good anyway, it seems wise to do that.
Could you elaborate on that? I thought that taking vitamin supplements without a recommendation from a doctor is just a way to have very expensive piss. Most of the things that get in, are removed from the body without being absorbed.
You can get higher quality vitamins with forms that are more easily absorbed, for example chelated magnesium instead of magnesium oxide.
That said, I thought the evidence actually pointed to higher all cause mortality in people who take vitamins.
Citation absolutely needed
The caveat is excessive consumption of Vitamin A (and maybe others), in some specific circumstances. Keyword: excessive
My hypothesis would be that healthy people don't take vitamins because they never saw the need, putting already sick people in the second category. I doubt that taking vitamins can actually do much harm in low doses.
First result: https://www.sciencedaily.com/releases/2011/10/111010173019.h...
>After adjustment, use of multivitamins, vitamin B6, folic acid, iron, magnesium, zinc and copper, were all associated with increased risk of death in the study population.
The top three links showed association between beta carotene supplementation and risk of death.
A little further down, a study showing "higher plasma concentrations of vitamin B12 were associated with a 25% increased adjusted risk of all-cause mortality per 1-SD increase" https://jamanetwork.com/journals/jamanetworkopen/fullarticle...
>The use of multivitamins overall was associated with 2.4% increased absolute risk for death (hazard ratio [HR], 1.06; 95% confidence interval, 1.02 - 1.10).
https://www.medscape.org/viewarticle/751462#:~:text=The%20us....
The conclusion I personally draw from all this is: don't take a multi vitamin. Don't take any vitamins unless I have a good reason like a tested deficiency. If I think I could benefit from a supplement then I try to increase it in my diet instead.
If you read that link you'll see the findings for iron and calcium were replicated. (Not to mention this article is basically referencing a different article which is somewhere else, so we're missing the context)
The B12 issue, as the own article mentions, is not necessarily connected to a dietary excess consumption
> Participants within the highest quartile of vitamin B12 plasma concentrations (>455.41 pg/mL) were more likely to be older and have higher BMI and blood pressure.
OK so that's one mineral they called out from a long list that includes multi vitamins, B6, and magnesium, very common recommendations. What about the rest?
Point taken about the B12 study.
What about https://www.medscape.org/viewarticle/751462#:~:text=The%20us...
But sure, you could be extra sure that your Vit-D/Zinc/Mg (and other vitamins) levels are low by going to the doctor now, doing an exam and waiting for the results to come back.
Or you could go through your diet and estimate your nutritional intake and see if anything is missing (a lot of apps do that calculation)
With the caveat that (word of mouth, not researched) the FDA recommendations on vitamin D are substantially too low.
In the UK doctors recommend everyone takes a vitamin D supplement in the winter.
There's a consensus statement from 2010, here: https://www.nhs.uk/Livewell/Summerhealth/Documents/Concensus...
And there's discussion of the new guidelines (with links to the newer research) here: https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-...
Calcium absorption is one of the trickier vitamins to get tight.
If you’re taking vitamins specifically because you’re deficient, make sure you’re eating complimentary foods with them.
If you have a normal diet and you have deficiencies, don't just look to supplements.
What I do after working out (say 4x/week) or after hard day in the mountains during weekends is to take 1/2 a tablet of multivitamin after big meal. So around 5-7x/week. That tablet has 100% of all the vitamins and 30% of the minerals.
So I get 50% of vitamins, 15% of the minerals with a lot of fluids and fats, after proper effort on the body. This mix should be helping the body regenerate all the damage done by the workout. I can't get any overdose or even come close to it, unless I would be eating some very specific food like some seafood (and then overdose would come from it anyway, regardless of multivitamins).
The multivitamins I buy (cheap Swiss ones) are cca 3.5$ per 20 tablets, giving the price per dosage/piss somewhere around 8 cents. I certainly have much more expensive pissing activities even from cheapest beers, sodas (which I don't generally drink) or basically any liquid apart from tap water.
Yes, unless you have good reason to think you have a deficiency, supplements are a waste of time and money. And even if you do have reason to think you might have a deficiency there are often better (usually dietary) ways to address it.
Granted that might not be the best source, I reflected on that and the chemistry makes sense.
Vitamins primarily will leach out via osmosis. Osmosis works by gradients. This probably means an exponential decay of absorption relative to concentration and as you consume more, your body will waste progressively more and uptake will be less efficient per unit mass.
But it's not boolean/binary - your body doesn't suddenly stop everything after an arbitrary cutoff.
There's an elegance to this - it means there is a lot of leeway in consumption so it is hard to overdose. But it also means that if you "need" to increase bioavailability of a water soluble vitamin, you can simply consume more orally and it will increase. It just becomes progressively more wasteful to do via that means. (IV is more efficient in this manner)
So I suppose wasteful is not the same as pointless/useless
00:29:32 - In the Philippines, every standard deviation increase in serum vitamin D was associated with an 8 times more likely chance to have a mild rather than severe COVID-19 outcome and a 20 times more likely chance to have a mild rather than critical outcome.
00:30:37 - In Indonesia, 98.9% of patients with vitamin D deficiency died, 88% of patients with vitamin D insufficiency died but only 4% of patients with sufficient vitamin D died.
Alipio, Mark, Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19) (April 9, 2020). Available at SSRN: https://ssrn.com/abstract=3571484 or http://dx.doi.org/10.2139/ssrn.3571484
Raharusun, Prabowo and Priambada, Sadiah and Budiarti, Cahni and Agung, Erdie and Budi, Cipta, Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (April 26, 2020). Available at SSRN: https://ssrn.com/abstract=3585561 or http://dx.doi.org/10.2139/ssrn.3585561
See https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
As far as if that means you take that as a multi-vitamin pill vs D3 supplements alone I guess is up to the individual. But either option only costs a few dollars/pounds. Maybe I was a little loose with language saying multi-vitamin.
Mind you, if Vitamin-D, magnesium and B12 play a role, that's good news for me: I've been very strict about those 3 in the past 2 years(and coincidentally loaded up my magnesium stash yesterday).
It might give you some information if the intervention were really, really bad for patients or really really good. (So it could be used to establish possible harms). But definitely not useful farther than that except to justify larger studies.
I'm still hoping we catch a break one of these days.
"This study was conducted under difficult dynamic circumstances and is thus limited by the small sample size, and the lack of systematic biologic measures to support its findings. It is however a proof-of-principle effort with very promising results. Our findings would need to be further validated in a well-designed randomized study."
Leafy green vegetables are a good source of Mg, but most people don't eat enough of those.
Also, what difference are you feeling?
Differences:
- Sleep is considerably better.
- Haven't had a single muscle cramp even after something like a 30km walk + 60km bike + gym. Otherwise a common occurrence because genetically I have incredibly strong legs and virtually no body fat on my legs.
- Generally I'm less moody and far less likely to (╯°□°)╯︵ ┻━┻ when something stupid happens at work for instance.
- No exhaustion whatsoever.
I also saw a study that said that 95% of children diagnosed with ADHD are magnesium deficient [0]! Another found a "significant decrease of hyperactivity" in children who were given oral magnesium supplements over 6 months [1].
My wrists and hands have felt better, but I've given a lot of attention to them in addition to the supplements, with more upper body workouts (on top of running 10-15 miles a week) and stretches. I'm looking to get more ergonomic tools as well. While I can't say what is and isn't due to the supplements, I don't currently see a reason to stop taking them.
[0] https://pubmed.ncbi.nlm.nih.gov/9368235/ [1] https://pubmed.ncbi.nlm.nih.gov/9368236/
As for your hands, given that you are focusing on upper body workouts maybe one up your protein intake, see if that improves things. Unless you are a vegan, Icelandic yogurt(skyr) is a pretty solid solution(the unflavored kind). In terms of consistency, I'd say it's similar to Philadelphia cheese but almost tasteless. 1 yogurt a day (350g) made a dramatic improvement in my case. Not sure about the US(judging from the fact that you used miles), but you can find those in almost every grocery store in Europe at this point for around a euro.
Unfortunately you'll struggle to reach the recommended doses because our soils are depleted and quality of crops varies wildly.
https://www.scientificamerican.com/article/soil-depletion-an...
That there statement about the limits of the study should be taken to heart. People seem to get too fixated on the first results they hear and hold on to them more strongly than subsequent results which can often provide better data to make decisions on.
D looks like upper tolerable dosage is around 4000IU/day for 9+ years old. Some studies apparently see overt toxicity after several months of 50000IU/day dosages.
In the meantime, since vitamins are cheap and not dangerous at these doses, it seems a reasonable measure to go ahead and take them. They might help, there's weak evidence to suggest that they might, and they shouldn't hurt. However, it's important not to overdose. I know that at least vitamin D is dangerous if overdosed. Most people as they get older are low in vitamin D anyway.
In my mind this is something like masks were months ago. Maybe they help, maybe they don't, but the risk of wearing a mask or taking vitamins is pretty negligible, and there are common-sense reasons to believe they might be helpful. Until better experimental results are available, you should use common sense approaches to reduce your risks. They might not work, but the harm of doing them is negligible.
If you have too much over a long period of time it can cause calcification. You're probably not going to experience that under 10000 IU a day. Again, do your own research. I'm not an expert in this field.
There is no evidence that taking a basic mulit-vitamin has any benefit for average people. Depending on the composition of vitamins it can be harmful [1].
[1] https://www.cochrane.org/CD007176/LIVER_antioxidant-suppleme...
I've heard this, before, i've even seen studies linked.
The study you linked shows a 3-4% increase in morality rate, but with a error margin of 95%, that, uhh, doesn't add up to much.
The studies commonly linked usually test healthy people without any vitamin deficiencies in order to see if giving somebody "extra" vitamins has any benefit. A worthless measure when, as mentioned elsewhere in this thread, 40% of people have a vitamin deficiency of some kind.
I'm finding it kind of shocking how many people are disputing the value of basic multi-vitamins. It feels like we're being contrarian just for the sake of it.
Take a multivitamin. Worst case, your health stays the same and you pee out what you don't need. Best case, maybe you're less susceptible to the harsher symptoms of covid. Seems like a win/win.
At least take vitamin supplements with proven effect and decent uptake and not garbage filler pills designed to collect snake oil money.
See https://www.sciencedaily.com/releases/2017/02/170216110002.h...
Or you can trust a random person from the internet and supplement 40mcg K2 mk7 all-trans per every 1000IU of Vitamin D. That seems to be around the usual amount used in studies [1].
I'm not sure if this is the appropriate factor for high Vitamin D dosages of multiple tenths of thousands IU. Personally, I'd be wary of such dosages anyway.
[1] https://www.heise.de/tp/features/Schuetzt-Vitamin-D-vor-Covi...
I've seen multiple sources say that 1000 IU of vit D is usually insufficient to boost levels, with suggestions of up to 5000 a day. My mothers doctor put her up to 2000 a day because 1000 did nothing to her levels, which were already low.
> The most accurate way to measure how much vitamin D is in your body is the 25-hydroxy vitamin D blood test.
https://pubmed.ncbi.nlm.nih.gov/30611908/
> In summary, long-term supplementation with vitamin D3 in doses ranging from 5000 to 50,000 IUs/day appears to be safe.
https://www.mayoclinicproceedings.org/article/S0025-6196(15)...
> The evidence is clear that vitamin D toxicity is one of the rarest medical conditions and is typically due to intentional or inadvertent intake of extremely high doses of vitamin D (usually in the range of>50,000-100,000 IU/d for months to years).
You can find more sources by scrolling down to the "summary" section, https://www.foundmyfitness.com/episodes/jre-1474
P.S. I learned a fascinating factoid from that Vitamin D list. You might be aware that standing out in the sun for 20 minutes is a good way to generate Vitamin D. Supposedly the same process happens by leaving crimini mushrooms out in the sun for 20 minutes before eating them.
Early on in the lockdown I noticed that these vitamins were among the kind of weird items completely cleared out of stores.
People were very selective... initially all FHD laptops and Chromebooks were gone, along with power strips, ibuprofen, hair clippers, etc.
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7189189/ [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3308600/#:~:tex....
1. Vitamin D as a side effect of sun exposure is not itself the important indicator. Instead, some other biological response increases immune response simultaneously. Hence, D supplementation is itself copying the wrong response.
2. Vitamin D deficiency is caused by illness, hence it actually doesn't affect mortality and the relationship is not casual.
Don't screw around with sun protection. Despite what the internet says, people who work outside get it too.
I saw a statistic/study from China that found that only 1 in 7000 cases were exposed outdoors. The link could be as simple as people who spend a lot of time indoors get more exposure to the virus.
The only real action you can glean from that isn't to take supplements, it's don't do what caused those people to be vitamin D deficient which is usually staying indoors.
Maybe it's the vitamin D, maybe it isn't.
I haven't heard much about B12 or magnesium effectiveness, as I must admit being out of contact, but they are popular supplements even in non covid times.
Metanalyses have shown that Vitamin D supplementation is associated with a reduction in the rate of upper respiratory tract infections and its severity.
The problem with that is there are a million reasons Vitamin D might correlate to better outcomes even if it's just a total co-incidence - generally healthy people might spend more time in the sun, health-conscious people might be more likely to take vitamins, other conditions may cause a lack of Vitamin D, etc. There's no proof that supplementing would actually improve outcomes.
This is the first study I've seen that claims to show directly that a supplement given during a hospital stay directly improved outcomes. It's a tiny study, but interesting and hopefully leads to more studies.
Powerstrips are necessary for makeshift home offices which are now everywhere. Hairclippers are important for people who regularly like haircuts. I usually go months, but know plenty of people who go weekly or bi-monthly.
Even without research saying vitamins have an impact on this disease, I think people would be grabbing anything with the potential to help (vitamins and certain medicines).
The parent commenter seemed to indicate buying Chromebooks, powerstrips, and vitamins to require secretive information when all of these things make sense (like Nintendo Switch's becoming rarer with millions of bored people in quarantine).
Yes. See for example this video from John Campbell from March 9: https://www.youtube.com/watch?v=W5yVGmfivAk
But we also have dozens of RCTs showing that vitamin D supplementation suppresses respiratory infections!
Folks always act like we just take this study in isolation. That’s not how it should work. The totality of the evidence is quite strong for vitamin D versus C19.
Other common comment topics here (correlation vs causation, sun exposure, burden of proof for correcting deficiency, etc.) are all covered in the review already. If something important isn't covered, email me.
It is a real shame we can’t get our science moving faster (maybe slow so we don’t break things?).
Noon during winter Before 10 AM or after 3 PM during summer
[0]https://www.myfooddata.com/articles/high-vitamin-D-foods.php