Adequate Vitamin D Levels Cuts Risk of Dying from Covid-19 in Half, Study Finds
forbes.com
forbes.com
https://www.sciencedirect.com/science/article/pii/S096007602...
“Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”
This one was actually about giving some patients calcifediol/vitamin D doses as part of the treatment, and comparing what happened to those who received the vitamin injection and those who didn't.
tldr: "of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50 %).")
Performed at Reina Sofia University Hospital, Córdoba, Spain.
https://www.cnbc.com/2020/09/14/supplements-white-house-advi...
Study confirms vitamin D protects against colds and flu
https://news.harvard.edu/gazette/story/2017/02/study-confirm...
Is there still something these studies miss?
Let's just calculate the probability of the event that at most one of the 14 patients, who ended up in the ICU, were randomly assigned into the calcifediol group (despite having a 2/3 chance to be assigned there): It is (1/3)^14 for the probability that ALL of them were assigned to the non-calcifediol group. Then (1/3)^13 * 2/3, for the probability that the first ICU patient was assigned to the calcifediol, but all others to the non-calcifediol group. Then the same for the second ICU patient. We get the total probability 14 * (1/3)^13 * 2/3 + (1/3)^14 that at most one of the ICU patents was randomly assigned to the calcifediol group (and that is what happened). That is a probability of 1 : 160.000 (!!!). So extremely significant. It means that is mathematically almost impossible that calcifediol did not influence the ICU outcome (provided that there was no other problem in study design as study fraud, or a bias to not bring the calcifediol patients to the ICU or whatever). Why isn't this getting the attention it should??? The effect is very significant, numbers are definitely not too low to draw conclusions. If you take these numbers seriously, calcifediol treatment lowers mortality by an amount that Covid-19 really becomes comparable to regular flu in mortality. This is a complete revolution! Why isn't it getting more attention?
Those who post in blogger.com or medium.com don't have any responsibility to anyone. I think your opinion spreads the "they are all the same" message that is infantile.
2) is the study well-designed and big enough to detect the signal as being reproducible and significant?
3) did the study ask the question it now supposedly answers?
4) did the study employ methods that discriminate precisely and robustly, like use of random groups and correction for complicating variables? Or is it based mostly on observations? And did it overlook the a priori distributions of variables known to confound the outcome of interest?
If the article/study does not pass all these tests, it's unworthy of trust as an accurate test of its hypothesis or its claims of significance.
"I think the world is flat", is an opinion. You could say its accurate in so much as the subject of the sentence actually believes it. However, most people would say the "opinion" is wrong.
In most cases, Forbes contributors (not staffers) receive the same amount of fact-checking as Medium/Blogger writers: zero. Forbes has tarnished its brand so much with its contributor system that clinging to the Forbes brand as a differentiating factor would be the "infantile" opinion.
https://www.poynter.org/reporting-editing/2012/what-the-forb...
https://www.poynter.org/reporting-editing/2012/what-the-forb...
https://www.cjr.org/innovations/newsrooms_boost_traffic.php
Most articles on the Forbes website are by contributors.
From the discussion section: "In acquired immunity pathways, 1,25(OH)2D has more modulating effect. 1,25(OH)2D inhibits activation of B-cells [29] and immunoglobulin synthesis [29]. This hormone also promotes Treg cells, which are responsible for anti-infectious action by inducing IL-10 production. This leads to suppression of Th1, and Th17 cells and IFNγ, IL-17, IL-6, IL-23 and IL-2 production and makes Th2 cells predominant. Th2 cells limits inflammatory processes by inhibiting Th1 cell-mediated cytokines and tumour necrosis factor α (TNFα) [11, 30, 31]."
Yes this could all be correlative, but lets assume for a moment that the effect is causal and as significant as this study is finding. It may seem like the effect of Vitamin D on the adaptive immune system doesn't make sense ... decreasing the antibody response and pushing the T-cell population towards a more TH2-type response. So, at least in terms of the adaptive immune system, Vitamin D is actually ~calming~ the immune system down, at least with regard to severe inflammation.
One way to make sense of this result would be as another piece of evidence pointing to some people's immune hyper-activation('cytokine storm') as one of the forces behind severe covid19 disease. This tends to be happening in the second and third week of infection and leads to much more devastating results on the body, and in particular, the lungs with ARDS (2).
(1) https://journals.plos.org/plosone/article?id=10.1371/journal... (2) https://link.springer.com/article/10.1007/s10067-020-05190-5
Vitamin D3 transactivates the zinc and manganese transporter SLC30A10 via the Vitamin D receptor
https://www.sciencedirect.com/science/article/pii/S096007601...
One approach could be to have the government just start subsidizing vitamin D to $0 (up to a specific quantity per person per month) at private retailers, or offer a rebate or tax credit for any verifiable purchases of vitamin D.
Edit: To help address toxicity concerns, anything like this should also cover vitamin K.
The cost increase of alcohol-based hand sanitizer is just inane, especially now when it seems that production had caught up.
My questioned is motivated by the common knowledge that vitamins tend To be flushed through out of the body during urination.
The question of dose is a big one, but I personally don't go over 1500 IU of supplements a day (try the 1000 IU gummies IMO). I also only take it from November to February. The recommended daily dose is way less, and you can easily sit down and pop 20,000 IU of the stuff. Be careful! It is technically a hormone.
[1] https://www.sciencedaily.com/releases/2015/03/150317122458.h...
[2] https://pubmed.ncbi.nlm.nih.gov/28768407/ (two years later)
"... in a correct analysis of the data used by the Institute of Medicine, it was found that 8895 IU/d was needed for 97.5% of individuals to achieve values ≥50 nmol/L."
That just means there are some people who need a very high dose. For comparison, 4000IU/d gets me well over 50nmol/L, this is also the "generally considered safe" upper limit. There was a case reported on HN where 5000IU/daily caused issues with calcium levels. You gotta get your bloodwork done.
In my personal example, taking about 6000 UI (plus 300 mcg K2) for a year put me just under 200 nmol/l. I did an experiment and stopped taking it for 2 months (but kept taking K2). After testing again I had dropped to 70 nmol/l (top of the insufficient range) and had mild symptoms of muscle ache and fatigue. Needless to say, I've started taking it again (and will aim for 175 nmol/l).
There's just a whole lot of variables. If you're going really high-dose, check with your doctor. Even if you do need a high dose to catch up and level out, how would you know when to stop?
Search the string "devaboone" here on HN for more about the potential drawbacks of really high doses.
> My questioned is motivated by the common knowledge that vitamins tend To be flushed through out of the body during urination.
That's true for Vitamin C but probably not for most vitamins, they are all quite different. Vitamin A for instance can accumulate to hazardous levels and take a long time to go back to normal.
Plenty of them had been going to those weigh-in sessions before they stopped because of the virus, so apparently it isn't a universal thing.
Several were not aware of the advice about vitamin supplements either, so this discussion has had at least one benefit because now everyone is looking that up!
Otherwise this is like a gunshot victim with diabetes coming into the ER and the doctors focus on the diabetes.
Cures are unlikely any time soon. We only have effective cures for a tiny number of viral diseases. Waiting for a cure is unreasonable.
Q: How many people take vitamin d supplements now?
A: Not many
Q: How many would take it if it was given to them free?
A: A lot
Q: how much does it cost to give someone life saving ICU support?
A: a lot
Q: how much does it cost to give people some vitamin d?
A: not much
Yes, theoretically, without fraud, waste, and abuse, it would be cost efficient. But that isn’t even remotely a possibility.
Q: how many people take vitamin D?
A: not many
Q: how many would take it if they knew they need it?
A: a lot
Q: what can we do about it?
A: spend X on "marketing" so they know they should take it, or spend 1000*x on giving people stuff they can buy themselves
Additionally, vitamin D in oil is literally handed over to parents for children up to 2 years. It is recommended to continue with supplements beyond that.[2] The recommendations are based on age groups, diet habits (including the above mentioned milk products) and sun exposure.
It's worth mentioning that this is the case since before COVID was even a thing. Vitamin D deficiency is recognized as a general health issue for its known relation to various sickness.
[1] in Swedish: https://www.livsmedelsforetagen.se/nya-obligatoriska-regler-...
[2] also in Swedish: https://www.livsmedelsverket.se/livsmedel-och-innehall/narin...
IMHO, the variability of outcomes is largely nutritional and a bit genetic. But fixing these would mean admitting there are deeper problems in our society. So vaccines it is!
Much of this is media bias (Murdoch-style media will only report on sensationalist failures) but the past decades of withering of state capacity and the growth of elite self-dealing means that successful government interventions are increasingly rare.
The idea that government can actually help people seems to be a dead letter in the United States (less so in other English-speaking countries) and this is killing people now we are faced with a pandemic that can only be mitigated through collective (governmental) action.
1) Vitamin D deficiency causes increased mortality
2) Whatever causes increased mortality also changes or is correlated with Vitamin D levels
I think most people here know that correlation doesn’t mean causality. However in the case of Vitamin D, there’s a lot of studies pointing towards Vitamin D actually helping fight bad outcomes. Such as the clinical trial from Spain where they gave supplement Vitamin D to one group and compared the outcomes [0] That does seem to indicate that the Vitamin D really is helping.
https://www.sciencedirect.com/science/article/pii/S096007602...
This is new data then, because earlier studies were saying that Vitamin D supplements weren't improving circumstances, which would reinforce your perspective that people with inadequate Vitamin D levels had other issues.
This article doesn't specify what "getting" Vitamin D means, maybe the study does.
Let me know!
Here's the key sentence from the study results. They are claiming a significant association [0] between Vitamin D above and below a threshold [1] and clinical severity [2]. The word "getting" is a bit deceptive, because "getting enough" tends to be in reference to their base behavior. Eating fruit helps me get enough vitamin C, so a doctor might recommend adjusting my behavior if tests show I have vitamin C deficiency. Adjusting my behavior would hopefully result in me "getting enough".
This is pretty different when compared to the study showing treatment results from Spain (Per another commenter) [3]. Here's the key conclusions from that study:
> Our pilot study demonstrated that administration of a high dose of Calcifediol or 25-hydroxyvitamin D, a main metabolite of vitamin D endocrine system, significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.
Treatment (Administration) with a chemical known to modulate the Vitamin D system now shows a clinical effect (ICU treatment reduction, albeit they have some reservations about study size). There's a whole set of further study that would need to be done to directly prove that the mechanism of action is exactly what they think it is, but it provides another good checkpoint (And is at the right abstraction layer to start considering it as a treatment more generally).
[0] Correlated, with the implication it could be worth studying as a causative driver
[1] "Sufficiency" is just a way of saying the assayed value is at least a value determined to be healthy
[2] They've got a long list of different clinical conditions they saw in the two cohorts
[3] https://www.sciencedirect.com/science/article/pii/S096007602...
This is interesting to me. I know C-reactive protein is an important biomarker of inflammation, but I've never seen anything that indicates lowering CRP actually does anything. What I have seen is that interventions like exercise and statins lower CRP, and improve other markets of cardiovascular health.
One other interesting tidbit is this study [0], which suggests that vitamin D levels are inversely correlated with CRP levels, independently of COVID-19. This suggests to me that maybe the observed lower CRP levels in the COVID-19 patients might be a red herring.
---
This is the previous Spanish study that found supplementing vitamin D on hospitalisation cut ICU admission drastically. A difference of 2% vs 50%.
#2 is also right! Measuring Vitamin D is kinda like measuring how many bullets someone has while fighting a war. Of course it's going to be low. But the soldier starting off with fewer bullets is still at a huge disadvantage.
Start hoovering those tablets, fellow darker-skinned technocrats!
-https://news.ycombinator.com/item?id=24138590
-https://news.ycombinator.com/item?id=24261124
-And her part 3 (which links to tons of studies and is quite informative): https://www.devaboone.com/post/vitamin-d-part-3-the-evidence
My TLDR from reading those posts: Vitamin D overdosing is possible, can have some pretty severe consequences.
Vitamin D deficiency is correlated with tons of conditions. But this seems likely to be a correlation and not a causation. Simply because unhealthy people spend more time indoors than healthy people.
The relevant statement in her post from part 3:
"Vitamin D seems to reduce asthma attacks in adults with mild to moderate disease, and daily or weekly Vitamin D seems to prevent acute respiratory infection in those with Vitamin D less than 10 ng/ml (25 nmol/l). There is considerable excitement around Vitamin D's potential role in Covid treatment, though we do not yet have enough evidence to make a definitive conclusion"
From May: https://jamanetwork.com/journals/jama/fullarticle/2766522
"The authors evaluated gene expression in nasal epithelial samples collected as part of a study involving patients with asthma from 2015 to 2018. The nasal epithelium is one of the first sites of infection with SARS-CoV-2, and the investigators probed for the expression of the cell surface enzyme angiotensin-converting enzyme 2 (ACE2), which has been proven to bind to SARS-CoV-2 spike protein and promote internalization of the virus into human cells. Among a cohort of 305 patients aged 4 to 60 years, older children (10-17 years old; n = 185), young adults (18-24 years old; n = 46), and adults (≥25 years old; n = 29) all had higher expression of ACE2 in the nasal epithelium compared with younger children (4-9 years old; n = 45), and ACE2 expression was higher with each subsequent age group after adjusting for sex and asthma."
Testing a hypothesis like the above could be easier if you remember that the US can be divided up like the EU too - that way you have fairly geographically sparse but hopefully methodologically similarly recorded data.
The company I work at do data analysis on COVID-19. We cannot compare within EU as of now; only within the country. Even then, data (e.g. from hospitals) needs to be "standardized".
Policy makers and individuals want to focus on infection rate. Lower infection rate = less spreading = less trips to the hospital = the society is "winning"
Hospitals and doctors want to focus on death rate. At the point they get a patient, they are already infected. They want the lowest % of people possible to die, to show that their care is working.
Neither effort is in conflict with each other, and can be near perfectly parallelized. I.e. the hospitals trying a new medicine to lower death rate has no impact on a region trying to lower infection.
IIRC, same computations correctly predict flu season (and other viral diseases) for the last 10 years or so, but fail to predict covid-19 dispersion (and in particular, predicted a drop during the summer of the northern hemisphere, which did not happen) - which may indicate either that the model is borked, or that the primary dispersion vector is NOT, as commonly assumed, aerosolized -- in fact, there are quite a few pieces of evidence pointing in that direction. (Not that it's impossible, just that it's not the primary one).
Serum vitamin d concentration vs virus damage would be an interesting trial.
The spread data is not properly reflected in recommendations IMHO and likely for political and politically correct reasons.
"Study Suggests Reduced Mortality Risk For Covid-19 May Be Associated With Adequate Vitamin D Levels"
Whereas the current HN title claims that "study finds" that "Vitamin D Levels Cuts Risk" which is much stronger claim, which doesn't have to be true -- i.e. an editorialized title, not what HN typically prefers.
There are still a fair few hours of sun...
https://www.outsideonline.com/2380751/sunscreen-sun-exposure...
I now that even during France's confinement (which is over now), people were still allowed to leave their house for solitary outdoor exercise and walks.
Vitamin D productive begins immediately when the skin is exposed.
With vitamin d it’s about building up reserves while you can, and supplementing with food or vitamins.
My sister and mom tan, I burn. Weird thing though, when I was a kid I spent so much time outdoors. Like, all of the time.
That was before I got hold of a decent computer at like age 12 in 1989, and I started spending so much time indoors.
After 30 years or so of mostly staying indoors, I burn when UV rays hit my skin.
I'm willing to concede that my behavior is at least a part of the issue.
Not everyone seems to generate enough vitamin D from sun exposure.
Could this be due to where you live?
The winter in the UK can be very low light for quite long periods. The weeks-long ‘rain’ or whatever you call that semi drizzle is very dreary.
There is about 3x the rainfall per year where I live now but it’s short and sharp in comparison.
That being said, even in the summer, when I regularly go outside enough to get a pinkish hue to my skin, I still don't generate enough Vitamin D. In an ideal world maybe I'd have an explanation for it, but I just take a supplement and don't worry about it any more. Some research suggests that there is a high degree of variability in how much Vitamin D individuals generate from sunlight.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5372923/#:~:tex....
These seem like benefits everyone should be able to take advantage of. But not all people process sunlight the same way. And the current U.S. sun-exposure guidelines were written for the whitest people on earth.
Every year, Richard Weller spends time working in a skin hospital in Addis Ababa, Ethiopia. Not only is Addis Ababa near the equator, it also sits above 7,500 feet, so it receives massive UV radiation. Despite that, says Weller, “I have not seen a skin cancer. And yet Africans in Britain and America are told to avoid the sun.”
...
People of color rarely get melanoma. The rate is 26 per 100,000 in Caucasians, 5 per 100,000 in Hispanics, and 1 per 100,000 in African Americans.
...
How did we get through the Neolithic Era without sunscreen? Actually, perfectly well. What’s counterintuitive is that dermatologists run around saying, ‘Don’t go outside, you might die.’
At the same time, African Americans suffer high rates of diabetes, heart disease, stroke, internal cancers, and other diseases that seem to improve in the presence of sunlight, of which they may well not be getting enough. Because of their genetically higher levels of melanin, they require more sun exposure to produce compounds like vitamin D, and they are less able to store that vitamin for darker days. They have much to gain from the sun and little to fear.
https://www.sciencedirect.com/science/article/pii/S096007602...
Do talk to your doctor if you have one easily accessible, but if not, 1000-2000 units a day should not be a problem for anyone.
So to a first approximation, taking 1000 IU of vit D might be a good default recommendation for anyone if you can’t afford to get your blood work done.
I am not aware of any evidence supporting megadosing though.
Your body accumulates a store of vitamin D in the liver, which it rations out into your bloodstream over time. When you ingest or produce vitamin D, your liver buffers the amount that ends up in your blood, which does two things. 1) saves for a rainy day (literally and figuratively) 2) protects you from vitamin d toxicity over the short term. Which I’m told is quite nasty.
With a doctor’s supervision you can take large doses of vitamin d for a short time and your liver will soak it up. How fast your blood levels rise tells the doctor about how much more you need in the tank and/or if you are having absorption problems. They taper you off quickly as you approach a healthy blood level.
The main consequence of vitamin D toxicity is a buildup of calcium in your blood (hypercalcemia), which can cause nausea and vomiting, weakness, and frequent urination. Vitamin D toxicity might progress to bone pain and kidney problems, such as the formation of calcium stones.
It's not good to have too much either.
After researching the proper dosage of Vitamin D, I purchased the correct dosage, and not one that would lead to overdosing, and those dosages are absolutely available and people often just buy whatever the maximum is even if they don't understand the implications of using it.
You can say that about water too. You can literally die if you drink too much water because the electrolytes get diluted too much⁰.
I'm hoping this helps long-term; perhaps VitD deficiency is a contributor to rising levels of depression too?
Recently a large study was published where they gave a large group vit D to look for depression incidence and they could not find any effect. There's a lot of parameters that could affects the results so it doesn't mean there is none, but probably that it's not as simple as "give everyone vit D and we get rid of depression".
For me, I just noticed a few comments saying it helped their depression, was considering VitD already for Covid19 reasons, and figured the possible level of harm was almost zero so I'd give it a shot.
Not sure I'd expect a large randomised group to have a noticeable effect (can you link the study you mention, please) but perhaps "people who have reported depression, have been tested and found to be low in VitD" as a starting group and then see if it does better than placebo.
Thanks for your comment.
This was the study I was thinking of (they did not target people with depression) https://jamanetwork.com/journals/jama/article-abstract/27689...
Weirdly I couldn't find any studies on the effects of supplementing with vitamin D for depression, even though there's plenty of studies on the correlation, and even one study where they used it for treatment, without any control group...
I guess the lack of studies comes down to the morality of in vivo testing of treatments; the chances of someone untreated going off the rails is considered too great a risk.
> "Taking 60,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the U.S. Recommended Dietary Allowance (RDA) for most adults of 600 IU of vitamin D a day.
(https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...)
Not saying it's impossible, but that's the equivalent of buying the top result on amazon (https://www.amazon.com/Nature-Made-Vitamin-Strength-Softgels...) and taking 12 polls a day for several months. It's not actually impossible to get to toxic levels... but that's a serious commitment.
Edit: acute toxic dose not established, chronic toxic dose >50k iu/day. https://www.medscape.com/answers/819426-102369/at-what-dose-...
Edit2: this article lists 4000 IU/day as the generally recognized as safe level https://www.healthline.com/nutrition/vitamin-d-side-effects#...
So not Kirkland Signature, but sold there.
The skin produces up to 10,000 IU/day after exposure to UV light⁰. The same study I'm quoting shows toxicity levels at over 20000 IU/day for adults. One person in the study has taken 156,000–2,604,000 IU/day for 2 years!
So, as always, it's important to remember that this study was retrospective, not experimental in nature.
https://www.sciencedirect.com/science/article/pii/S096007602...
Even Melbourne in heavy lockdown was allowing/recommending limited time exercise outside.
Because of that, this sort of feels like "Vitamin D could save people[1] from the worst of Covid!
[1]Healthcare Wealthy Only"
Corrections welcome.
Talk to your doctor, but start now. Your downside risk is fairly minimal. It is estimated that 40% of more of the US population is deficient in Vitamin D.
The government should send every citizen $300 worth of vitamin D3 and remove all lifestyle restrictions.
PS: Early on people like Musk and Ford jump in to help by donating ventilators. Why aren't we seeing other organizations and individuals creating huge pushes to things like manufacture D3 and create widespread publicity for plasma donation? You listening Bill G?
edit: Some googling shows that they costs around 3 to 5 cents per pill in the US, so you're suggesting to send everyone 6000 - 10000 pills?
- given that a deficiency is bad, does it matter if you have more than just the normal amount? In other words, does this only matter if you have a deficiency?
- given that sunlight increases natural vitamin D production, could it be, not the vit D per se, but rather the sunlight exposure, that has the beneficial effect?
- could this even just be a case of healthy people getting out more, hence getting more sunlight and thus vitamin D, and healthy people also dying less from covid-19 (or almost anything else)?
What I would like to see is a study where they increase vit D levels, sunlight levels, both, or neither, and compare the mortality rates. If you don't feel it's ethical to do the neither option, you could compare to previous averages when neither was done. So far I have seen no evidence that this is being done, but hopefully soon?