Over 80% of Covid-19 patients in a hospital study have Vitamin D deficiency
endocrine.org
endocrine.org
I don’t know what you consider “known way”, but this Hypothesis is mentioned in almost every discussion, and is not controlled or corrected for in any study I’ve seen.
(There is reason to believe vitamin D Supplementation is helpful, based on earlier studies related to viral respiratory diseases - but not yet enough data specifically for covid)
Meaning that if the conditions are right (e.g. area having a high virus density, long exposure to low levels, whatever...) you might anyway "catch COVID", but if your vitamin D level is OK then you might be less likely to end up in an hospital or even in intensive care (because by having good vitamin D levels your body can apparently fight better against the virus). I think that none of the stats showed an absolute confirmation of this data.
Therefore, in my opinion, your sentence/question is a huge misunderstanding, but of course I might be wrong :)
But only as a form of correlation not necessary causation.
Which means if you make sure you don't have low vitamin D levels because you heard it is correlated with COVID your likelihood of having worse COVID systems might not change at all!
Becau you might have "something" which makes worse COVID systems more likely which also happens to cause low vitamin D levels. Or you might have something caused by your living habits which also makes low vitamin D levels more likely.
I.e. as far as I know studies could only find statistic relevance for correlation (in some cases) but no statistic relevance for causation.
Idk, but it might literally be as simple as unhealthy older people being more likely to have vitamin D deficit and also being more likely to have worse COVID syntoms.
https://www.alliedacademies.org/articles/potential-mechanism...
Even ignoring the literature you linked and just using common sense having a deficit puts a burden on your body and any additional burden when fighting some illness makes the fight harder. (Well, ok, there are some exceptions, humans are complex.).
> No causal relationship was found between vitamin D deficiency and COVID-19 severity as a combined endpoint or as its separate component
Suppose that characteristic X (eg vitamin D deficiency) puts you at risk of doing worse at Y. If we pick a population based on how poorly they do at Y, we expect to see that X will be more common than it is in the general public. But within that population there is no reason to believe that having characteristic Y makes you do worse - it just made you more likely to do badly enough to be selected.
This can be seen quite precisely with a toy model. Suppose that we have a population evenly split between 2 subpopulations with a characteristic that varies on a normal distribution. However one population averages 1 standard deviation worse.
If we pick the bottom 5% of the population on that characteristic, we will find about an 80-20 split based on having the risk factor. The bottom 1% also has the same 80-20 split. Ditto the bottom 0.1%, 0.01%, and so on. The reason is that the sum total of how many are in the tail of the normal falls off exponentially fast, with the same exponent in both populations. So the ratio stays constant.
No amount of analysis of people in that tail will suggest that characteristic matters. But comparing the population in that tail to the general population, that standard deviation stands out like a sore thumb as a major risk factor.
Therefore the fact that about 50% of the general population has vitamin D deficiency while over 80% of those hospitalized with COVID-19 do suggests that vitamin D deficiency is a risk factor. But we should draw no conclusions from the fact that vitamin D deficiency doesn't indicate different outcomes within the population landing in the hospital.
(However other research found that patients given vitamin D once landing in the hospital were significantly less likely to wind up in the ICU or dead. We should definitely draw some conclusions from that!)
To your question, either outcome is enough for you to optimize a diet or activity with adequate amounts of vitamin D because the process is healthier either way unless you were thinking to just try taking supplements
People who are more likely to be hospitalized due to COVID are also more likely to be deficient in vitamin D. There doesn't have to be a causal relationship at all.
Or do you mean people may be becoming deficient in vitamin D as a result of Covid? If so, would be interesting to know their prior vitamin D levels.
I mean the population of people who are more likely to be hospitalized due to COVID also happens to be the population of people that is more likely to be deficient in vit D, and neither of those things have to cause the other.
Just like lowering ice cream sales won’t change the murder rate. Even though increased Ice cream sales is correlated with increase murder rate.
This correlation is not random - it holds across geographic boundaries and time. But it is not causal - decreasing ice cream sales (By limiting supply, raising price, etc) will not reduce murders. Decreasing murders (By more police intervention, limiting arms sales) does not reDuce ice cream sales.
Similarly, vitamin D may be The ice cream analog. COVID 19 may be the murder analog, and if that’s true, we don’t yet know what summer’s analog here - could be obesity, or genetic factors, or something else. We don’t know.
I thought you were kidding but no: https://slate.com/news-and-politics/2013/07/warm-weather-hom...
People who are more likely to be hospitalized are also more likely to be deficient in vitamin D.
The control group seemed to be a healthy population sample, but hospitals are not a pool of healthy people. How about a hospital sample instead of a population sample?
Those vitamin D level statistics have been floating around for months. What's missing is a placebo-controlled study to see whether supplementation would make a difference. But that involves more than just clicking a bit of statistics.
[0]https://clinicaltrials.gov/ct2/show/NCT04536298
[1] https://clinicaltrials.gov/ct2/show/NCT04385940
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/#:~:tex....
Unfortunately, [0] and [1] are still ongoing and [2] reads like a blog post of somebody ranting about a statistical error, followed by some anecdotal evidence and the demand for an actual study. There could still be something there, but summarizing all of that as "quite obviously works" is stretching it.
I know that I'm spending less time outdoors than I used to -- no more outdoor picnics/parties, no beach time this summer, I'm not even biking as much as I used to.
Anecdotally it seems those I know who are most concerned about Covid-19 know all about the possible link with vitamin D and are taking supplements while also being careful by wearing masks, sanitising etc.
When did the narrative shift from "wear a mask to limit transmission to others in case you might be infected and asymptomatic" to "wear a mask to protect yourself"?
Assuming we are talking about the usual surgical / cloth masks here (not N95 etc), is there any evidence that they protect the wearer?
We all know that mask wearing and the science (or lack of it) to support it has become ridiculously politicised, but I'm curious if there's any evidence behind this particular shift.
https://www.businessinsider.com/56-got-coronavirus-south-kor...
https://www.npr.org/sections/health-shots/2020/06/21/8808322...
Evidence seems to indicate there is such an effect - and contradicting the initial assumption that there isn't.
I would expect those that are leaving their homes are both more exposed to sun/less deficient in vitamin D and also more likely to contract COVID.
And likewise, those that are staying home are more deficient, but less likely to contract COVID.
Plus being indoors means a confined space with less airflow, less air volume, and almost no upper range UV sunlight compared to being outdoors; these all are significant factors for likelihood of covid spreading.
And further, that's not the definition of social distancing. This would obviously include indoors. I won't sit at my kitchen table with the postman for a coffee while I am avoiding public gatherings.
I am sorry, my sarcasm-radar is quite broken. Are you joking?
Are people that isolate more likely to get hospitalized with Covid-19 than those that do not?
PDF from April 2020: https://www.medrxiv.org/content/medrxiv/early/2020/04/10/202...
The impact of Vit D in enhancing immune response (including flu and previous coronaviruses) has widely been studied and firmly established. Vit D can also suppress cytokine storm, which may substantially increase the chances of avoiding a severe case of COVID-19
In this study here 84% of the elderly had some amount of vitamin D deficiency (Figure 3).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6178567/#:~:tex....
I do take Vitamin D supplements since they're cheap and available, just in case there is something to it, but I wouldn't bet on it.
Vitamin D deficiency has been linked to compromised immune systems, depression, rickets and several other things. More research is needed within several of those areas, but I believe it to be safe to assume that supplementing with vitamin D is good for you if you're deficient. If not, well, it's not like it's going to hurt you unless you overdo it.
there is a small Spanish trial of 75 people where 50 got Vitamin D and 25 did not; in the group that did, 1 person needed oxygen whereas in the other group 12 people needed oxygen and one died - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/
Grip strength is another proxy for health, specifically how likely you were to die anytime soon. Makes sense. But training your grip won't make you live longer.
Still taking the vitamin D tho...
I can't think of a mechanism for that effect, where something else wouldn't be probably better way to spend that effort. Like cardio training.
Of course, none of this is to say that there's no reverse causative relationship as well, but people really need to take these correlation observations with a huge grain of salt. And also take note of extremely inconsistent results when controlled trials are attempted.
So , how this ladders up (in my understanding at-least is this): People can catch the virus irrespective of Vitamin D levels. The virus can and will replicate in the body. The Vitamin D levels in the body determine the severity of the disease in the said body. This all feels intuitive but I am conscious that immunology is where intuitions go to die so someone please correct me if I am wrong :)
The masses are crazy though - VitD can be a little dangerous and I can see quite a lot of people taking '10x doses' to get '10x protection' and ending up in the hospital anyhow.
This is one of the most basic misunderstandings in interpreting scientific studies. If you have "we saw x where we also saw y" then it can mean anything from "x causes y" to "y cause x". And also "unknown factor z causes both x and y", "it's a random coincidence", "they looked into the data long enough with enough different methods to find something" or a combination of all of those.
[1] https://www.uspharmacist.com/article/vitamin-d-supplementati...
I believe Vitamin D deficiency is defined by reference to a single level which is assumed to be valid for everyone. In reality, the level at which a deficiency is experienced almost certainly varies both on an individual basis and between racial groups. We say African Americans have higher rates of Vitamin D deficiency, but this is based on the assumption that their average levels of Vitamin D should equal those of European whites, not on an assessment of when they experience problems.
The better measure of Vitamin D deficiency would be "are there signs of rickets?", but somehow that never gets used.
The phrasing there is a little weird. Conceptually you wouldn't expect Vitamin D to have the function "preventing rickets", in the same way that the function of Vitamin C is not "preventing scurvy". Vitamin C does several things, and the different failures of those different things manifest as different symptoms of scurvy. Scurvy is what happens when you don't have enough Vitamin C, as rickets is what happens when you don't have enough Vitamin D.
Ironically, its scientific name, "ascorbic acid" means precisely that: no-scurvy (a-scorbic) acid
Yes, genetic variations meaningful to e.g. certain drug responses [1] correlate with race.
Fair question which, if asked without malice, doesn’t deserve a downvote.
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
"If you have dark skin – for example you have an African, African-Caribbean or south Asian background – you may also not get enough vitamin D from sunlight."
Even though the racial aspect of it can be taken a bit to the eugenics side by bad actors I believe that more studies should be performed to assess if there are or not significant physiological differences to account for during medical development.
Skin colour is a poor dividing line between populations, though maybe on this vitamin D issue it might be more reasonable. There is no "black race." There are populations of various African origins, a much more complex and messier situation that the category "race" obscures. There is statistically more genetic diversity _within_ Africa than in the entire human population outside of Africa, so drawing a cline based on some "black" or "African" or "Negroid" basket of traits is fully 19th century quackery.
EDIT Put another way: "race" is a cultural category, with little biological meaning. The key question here is vitamin D responses in southern-adapted vs. northern lattitude adapted population groups.
Couldn't you just survey average vitamin D levels in native West African populations, and compare it with African Americans?
Even if there was a difference in the requirements between native Africans and native Europeans, many African Americans also have varying levels of European heritage that would complicate the picture.
So you would actually need more data on whether these people were deficient before they got sick with COVID.
Well, there seem to be differences between different ethnic & religious groups, but on average vitamin D deficiency seems to be less prevalent in Israel: https://pubmed.ncbi.nlm.nih.gov/28647929/
However Covid-19 cases don't seem to have been lacking in Israel https://www.worldometers.info/coronavirus/country/israel/
however these are all countries with not too different level of health care, so that my armchair guess would be that this is a meaningful number (would have to be corrected for different age distribution, somehow)
IFR is actual deaths divided by actual infections. It's the most important number, but also much harder to figure out, because the delta between confirmed cases and actual infections is, by definition, unknown.
So, in context, if we look at CFRs, it looks like Israelis are 3x less likely to die from COVID than Americans. Maybe that's vitamin D, or maybe instead Israel tested and identified every single person with COVID, whereas America missed two for very case they identified. If we could instead see the IFRs in that case, they'd actually be roughly the same, and it'd turn out (all other things being equal) that vitamin D was irrelevant.
There is a high correlation between skin pigmentation and the average UV index of a location.
Plus, as others have noted, some of those countries have very young populations and darker skin tones of local inhabitants impacts vitamin D production as well.
There are really going to be a lot of factors involved.
Yes, vitamin D is "made" by exposing skin to sun. But what about those people who have some kind of metabolic problem and are thus not making vit-D as much even when exposed to sun?
And how about a country, like Israel, where it is SO sunny and hot outside that most people are hiding from it because they are afraid of skin cancer and such?
The first time I drove through Phoenix I was confused by the number of tanning salons. After living there for a few years, I learned the extreme heat drives people indoors and into cars. The same is true in e.g. Dubai.
[0] https://www.ima.org.il/FilesUploadPublic/IMAJ/0/40/20233.pdf
Of course, these two populations also tend to be poorer and have larger families living together, so there are other factors to consider as well.
For example, Israelis are told to worry about skin cancer, and thus tend to use sunblock when going out in the summer. Which removes the chance of serious vitamin D generation, from what I understand.
I find the discussion of vitamin D to be very interesting, but it feels like we need a few more studies to determine whether this is the big one. But the more discussions I see, the more I think it might actually explain quite a lot.
Do they? I'm pretty sure that average israeli is mizrahi.
I'm guessing (and this is truly a guess) that if vitamin D and/or exposure to sun has something to do with it, then skin tone is a factor but might well be outweighed by the others.
Natural Vitamin D Content in Animal Products
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941824/
The Catholics were right. Eat fish on Fridays
Also, Carlson Labs is the highest rated Vitamin D supplement on LabDoor: https://labdoor.com/review/carlson-labs-vitamin-d3
You can use https://cronometer.com/ to track your micronutrients
An easy way to get more (beef) liver is to grind it, real cold, in your food processor and add to ground beef. At about 20% you can't taste it
Shameless plug -- I wrote an article about growing them at home, it's not too hard. We eat a lot of them: https://www.mushroom.guide
Hacker News is obsessed with vitamin D because it seems like a hack. A cheap and simple way to solve a tough problem that you can feel smart about having found.
[1] https://www.nice.org.uk/advice/es28/evidence/evidence-review...
Further, this spanish RCT suggests vitamin D had incredibly strong effects in preventing patients from needing to go to the ICU.
https://www.sciencedirect.com/science/article/pii/S096007602...
https://en.wikipedia.org/wiki/Vitamin_D#Use_of_supplements
There is also considerable debate over the comparative efficiency & effects of natural synthesis via sunlight vs ingesting supplements, compounded by the difficulty of accounting for things like exercising outdoors vs being sedentary indoors.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/
The control group spent on average 36 days in the hospital, the group getting a single 500,000 IU dose of vitamin D3 spent an average of 18 days in the hospital.
This study isn't correlation, it was a double blind randomized control trial. However, it was a small pilot study and more research is needed.
>All 5 studies were assessed as being at high risk of bias
What is not here is any study controlling for the factors you mention and finding a zero correlation as you claim.
The conclusion, which I assume you are referring to, states:
>There is no evidence to support taking vitamin D supplements to specifically prevent or treat COVID-19. However, all people should continue to follow UK Government advice on daily vitamin D supplementation to maintain bone and muscle health during the COVID-19 pandemic.
Since vitamin D supplements are already advised for the general population, it is extremely unlikely they would be recommended for specifically COVID-19 without very high-quality evidence. Unless dosing recommendations can be given with good reason to believe those recommendations would be beneficial, the only effect that could come of a positive conclusion is risk compensation, i.e. increased risky behaviors, which is bad.
I take 2000 IU every day and have for years. My doctor said my vitamin D levels were low, but they are now in normal range.
If you're low in vitamin D, you're more likely to have a severe immune response to COVID that requires hospitalization.
But yes, it could totally be the case.
It also might not be the case.
It also might be anywhere in-between, like supplements help but the a negligible degree.
As long as we don't have statistically significant studies showing causation we can't say for sure.
But then what we can say for sure is that any deficit puts a burden on you body and any burden makes it harder for you if you get some other massive health problems. Even if just to a very small degree.
So if you have a vitamin D deficit you should fix it especially if you also have COVID (EDIT: or any potentially more dangerous illness).
But if you don't have a deficit it's questionable if taking vitamin D will do any help.
Most of Canada and Alaska is lower in latitude than the UK.
Note that Vitamin D hangs around in your fat for a month or two anyhow.
That said, this was also the type of study that found the original link between smoking and lung cancer. So while being vitamin D deficient may not cause me to end up in the hospital if I get COVID, I’m going to be taking a supplement just in case.
An Uber driver is likely to spend more time in a car, and therefore more likely to be in a car accident.
Is a person more likely to spend time around sick people if they’re Vitamin D deficient?
Yes it’s correlation, but correlation specifically without known other causes (Unlike the Uber example).
And before we start debating these specific possibilities, the point is to illustrate we can’t just assume more than the sampling method dictates. Different studies are needed.
Now that you’ve phrased it this way I see your point and I’ve actually been thinking this myself for a while now.
Also, you wouldn’t believe the amount of conversations I’ve had with people who are convinced it “only kills old people” who’s eyes glaze over when I explain that there are other outcomes besides living and dying.
Everyone in the world seems to believe it’s a magical death lottery that instantly switches the lights off for 0.01% of people who catch it, and the other 99.99% of people are therefore completely fine.
The whole world’s gone mad.
In reality (due to Bayes theorem), we need to compute the probability of being sick when having deficiency as population_with_covid (1/47 for Spain) * 80% / population_with_deficiency. If, say, there’s 60% vitamin D deficient people in Spain, it’d give us 2% chance of getting a disease if you have deficiency. Not much!
It checks out even if you remove the probability aspect of it and use a simple implication.
It's not about whether you have a higher chance of getting infected if you are vitamin D deficient.
It's about whether you need medical attention in a hostpital if you do.
So if we have X people who got COVID, and out of those X people Y% needed to spend time in a hospital, and 80% of them had D vitamin deficiency, then it does not matter what is the Y% value.
The important thing is that the more severe cases had D vitamin deficiency, therefore you have a higher chance to get a severe case if you are deficient.
Right?
It does matter because you need to know what the percent that didn’t need to spend time in the hospital. For instance, if 80% of the people that did not have to be hospitalized also had a Vitamin D deficiency, then there is nothing meaningful about the deficiency because it is the same between the two groups.
I could say pretty confidently that 80% of people hospitalized for COVID have brown eyes. Why? Because the overall population is about 80% brown eyed. We need to look at the difference first and foremost.
> The important thing is that the more severe cases had D vitamin deficiency, therefore you have a higher chance to get a severe case if you are deficient.
Even if we found a large difference, that is far too little information to assume causation. For instance, it could be that the elderly are more likely to be Vitamin D deficient due to being sedentary and spending most of their time indoors, and the elderly are more likely to be hospitalized due to their age. So it wouldn’t be Vitamin D deficiency, it would be age that was the underlying cause of both phenomenon. We need to be very careful about making these leaps in logic, since it can send us down pointless rabbit holes and have people spending time and resources on things that do not actually help.
Genuine question:
Do you happen to be able to estimate how many people and of which qualifications you require in a team for how long to go trough all the available research, and make some useful and fairly certain prescriptions in a complex topic like this?
Is it even realistic for an average joe to look into it in their free time, and come to a useful conslusion in a realistic timeframe, or is everything so complicated nowadays that it's not worth it?
In my personal opinion, no it isn’t. I would say that it would be useful to look into how scientific and medical research is conducted, how peer review works, etc. and you will see the incredible complexity and difficulty of building up a medical theory. I’d also look at skeptic explanations of how pseudoscience uses that complexity to push things that just aren’t true. Without a deep understanding of topic, and all the underlying scientific method, you are far more likely to come to a wrong conclusion than a correct one. Finding good scientific communicators, I’ve found, is the best way to get good information. People that do have the requisite knowledge and that will contextualize the sensational and just bad reporting of science and medicine. I would suggest Science Based Medicine [1] and Heathcare Triage [2] as a start.
https://jamanetwork.com/journals/jamainternalmedicine/fullar...
> Older adults are the least active segment of our population, and are likely to spend less time outdoors than other age groups…One study in a large US national sample found that leisure time [physical activity] was related to higher Vitamin D levels in older adults [43]. Vitamin D deficiency is related to many chronic conditions including cancer, heart disease and bone health [36]. If older adults spent more time outdoors they may be more active and benefit from a healthy dose of Vitamin D.
People can make a point of adding more dietary vitamin D or making sure to get a little more exposure to sunlight daily. It is absolutely not necessary for this to only be addressed by buying supplements in pill form and that is probably not even a best practice for improving vitamin D status.
(Edited. Not sure if for "typos" or because "God, I hate auto-corrupt so much sometimes.")
Keep in mind that sun exposure through a glass window will not be enough to trigger the production of vitamin D.
Unless I ate enough fish to make me sick, I'll get vitamin D deficiency. I have a lot of friends and family who are on prescribed vitamin D supplements, which are huge doses you take once a week or month.
My statement was already qualified: vitamin D can be manufactured in the body (by most people).
I'm aware there are people who have a legitimate need to take supplements for some reason. No amount of qualifiers is ever enough to prevent the internet from completely ignoring your qualifiers and acting like "You are wrong! And this doesn't apply to me!"
https://engaging-data.com/population-latitude-longitude/
For the boat loads of people looking to nail me to the wall over my very mild and qualified statement, why don't y'all try to get creative and look up data on vitamin D deficiency in girls in Muslim countries and then come up with some way to imply I am a misogynist* or I am anti-Muslim or something as part of this really, truly ridiculous pile on of people acting like I've said something crazy.
* If you don't know, I am probably the highest ranked woman here. I mean, that never prevents people from assuming I'm some rapey, misogynistic man. But at least try a little harder and don't give me really low hanging fruit for rebutting your argument like "Actually, I am a woman." because that's so very tired for so many reasons.
I don't intend to reply further to any of this silliness. The number of people who feel the need to state yet again that I am wrong is really just crazy. It has no basis whatsoever in any real need to clarify what is true here. If that was what was going on, it would have stopped when I posted my comment saying "Yeah, I covered that with this qualifier -- I realize supplements make sense for some people" after the first three comments overlooked my qualifier to act like I am wrong and stupid.
But I am done arguing this. If people wish to add another twenty comments urgently and strenuously repeating the point that "Due to some nitpick or other, you are so very, very wrong here!" they can have at it. But I'm not replying further to this completely ridiculous thread.
Statements can be technically correct out of context while still being effectively wrong or misleading in context. It is hardly a nitpick.
If you had some evidence that the majority of people who take vitamin D supplements could get it from the environment, then I would agree its a nitpick. But that's very different than the majority of people in general.
That is to say, I don't think it's accurate to say that the English-speaking population is "heavily skewed" away from sunny areas.
> According to a 2011 study, 41.6% of adults in the US are deficient. This number goes up to 69.2% in Hispanics and 82.1% in African-Americans
That's not exactly "most people". That's for the US where a lot of states are very temperate and the sunlight is present during winter.
Imagine how bad it gets up north.
It's true that the body will produce vitamin D in the right conditions, but unless you get those conditions it won't. Taking supplements is the easy road, especially at prescription levels.
Vitamin D is not water soluble, so you won't urinate it out. This means that you can get prescribed an injection or a big pill and be fine for weeks.
Also some food contains vitamin D naturally.
So while food supplements can be necessary it depends on the rest of your diet and if you maybe could do a short brake during the time the sun is up (like a short outside cofe brake ;=))
EDIT: To be clear this is not meant to discredit you. It's just that even for people living high in the north there are options. Through for some less then for others.
> People can make a point of adding more dietary vitamin D or making sure to get a little more exposure to sunlight daily.
Getting sufficient vitamin D from diet alone is difficult. UV exposure also has risks, which may be higher for some. The required exposure time is measured in minutes a day. If you are still deficient it may be better to supplement, rather than getting exposed to UV for more time.
Yes depending on your country the vitamin D supplement might not actually contain any relevant amount of vitamin D. (Or it might not contain them in forms you body can easily process.)
https://retractionwatch.com/2020/10/26/paper-suggesting-vita...
This isn't a home run yet, even though I would like to believe that Vitamin D has protective nature.
Generally speaking, I wouldn't expect much in the way of good results to give massive doses of vitamin D to people so sick they have been hospitalized with Covid-19. But I think there is plenty of evidence to suggest that a good recommendation is "If you are vitamin D deficient and would like to actually survive the pandemic, raising your vitamin D status is the smart thing to do."
I mean, you should do that anyway, even if there were no pandemic. It's just a hair more urgently life threatening at the moment.
It's sound advice generally to say "If you are vitamin D deficient, you should seek to remedy that." It's sound advice with or without a global pandemic happening around you.
You are inferring that I am recommending supplements as the means to redress this. I am not and have suggested otherwise elsewhere and, wow, has it gotten ridiculous levels of push back:
Please keep in mind that my point of view is probably not adequately expressed in a single internet comment. It boils down to: for best results, we should be generally trying to address vitamin D deficiency as a means to try to halt the pandemic and not waiting for people to end up hospitalized with Covid-19 before checking their status and trying to do something about it.
I'm not saying it's "useless" to give supplements at that point. I'm just saying I would expect vastly better results if you have more lead up time to redress the issue rather than waiting until you are deathly ill from the current pandemic before you think taking action makes sense.
(Please note - this is not a "show your sources" challenge, I'm genuinely trying to understand the recovery process from malnutrition better. My guess would have been that the malnutrition is quickly remedied, but the 2nd order damage might take longer. Is that what you meant, and I just misunderstood?
Scurvy is vitamin C deficiency. Vitamin C is water soluble.
Vitamin D is fat soluble. Fat soluble vitamins generally work on a longer, slower time scale. It takes longer to incorporate them into the body and longer to become deficient.
People who are deficient in vitamin C may simply not be getting enough of it in their diet. Because vitamin D can actually be manufactured in the body, it tends to correlate to other underlying issues.
People with other underlying issues tend to require more time to recover from anything, medically speaking. They may even have inherent challenges in absorbing vitamin D properly or using it properly.
I have a genetic disorder that predisposes me to deficiency in all fat soluble vitamins, including vitamin D. I'm sure my firsthand experience with being slow to heal and my body being slow to adequately resolve nutritional deficiencies (on the order of months of supplementation to fix things) is on the fairly extreme side, but most Covid-19 patients in danger of dying from it are elderly and have underlying health issues. So I would expect my experiences to be somewhat similar to their situation.
Does that make sense? Did I answer the question?
Or is it that fat soluble nature moderates how quickly we can release the molecule, which is why we can store too much and suffer harm?
But based on those stellar credentials, if I am understanding your question correctly, the answer is "both." It is both slower to access and also the reason you can wind up vitamin D toxic in a way that doesn't generally happen with water soluble vitamins.
You can get get too much of water soluble vitamins and they can do bad things to the body, but those bad things aren't described as "toxicity" because you don't build up excessive stores of them in the body like you can with fat soluble vitamins. Off the top of my head, some people who take way too much vitamin C end up harming their dental health by harming the tooth enamel and a certain B vitamin when taken in excess is associated with, iirc, kidney stones.
Rickets is most commonly caused by vitamin D deficiency. I suspect the comment which you replied to made an honest mistake confusing scurvy with rickets.
Most people treated for scurvy feel better within 48 hours and make a full recovery within 2 weeks.
https://www.nhs.uk/conditions/scurvy/
Most children with rickets see improvements in about one week.
Skeletal deformities will often improve or disappear over time if rickets is corrected while the child is still young. However, skeletal deformities can become permanent if the disorder isn’t treated during a child’s growth period.
https://www.healthline.com/health/rickets#outlook
A really quick look suggests rickets is much, much more serious than scurvy which fits with what I said above.
I’m a big proponent of the idea that vitamin d will likely help against covid 19 but this headline is missing some crucial comparative context.
——
Edit: I’m rather wrong in the part below. Patient only refers to people receiving treatment, so this is an accurate use. Keeping it there for posterity. I believe the rest of my comment still stands.
The headline is inaccurate. The study looked at hospitalized patients. That is a group in much worse health. And all manner of health conditions are correlated with low vitamin d.
> 216 patients aged ≥18 years, with confirmed COVID-19 [admitted] from March 10 to March 31, 2020, and
> 197 sex-matched population-based controls recruited from the Camargo Cohort during their last follow-up visit on January-March of the past year
(I too missed it in the headline-linked article)
and the COVID-19 cases were from March 10-31, the difference could be explained by people being in lockdown and not going outside.
What I've really taken away from this crazy year, why the hell is there all this research (decades worth, not a handful of years, I'm talking about roughly 40+ years worth) on good levels of Vit D levels leads to a statically healthy life and this fact is being completely shit on/ignored? Perfect? No. But, statistically speaking, you're sickly if your Vit D levels are low, regardless of Covid.
This isn't entirely accurate, and I'm going to quibble a bit with it and cite a study, but TLDR exercising outside during the daytime is probably better than just supplements of D.
To be clear I myself take Vitamin D because it may have benefits, including for mental health, so this isn't me trying to say D couldn't help with depression, just that that particular statement is a little misleading in that we don't have the best evidence for it.
There's definitely some evidence that Vitamin D levels are correlated with worse depression scores, but no studies about deficiency causing it to be worse; I suspect few people would choose to sign up for a study to make they depression worse, tbh. Anyway, the closest are studies of supplements to Vitamin D levels in depressed people, and the results there are mixed.
For example a study called "Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial" in the British Journal of Psychiatry found no statistically significant differences in depression inventories.
I believe there is some meta analysis that shows that Vitamin D supplementation may benefit people with clinically significant depression scores. But if you are badly depressed, you should consider moderate mixed aerobic and anaerobic exercise outside during the day, which gets you sunlight for vitamin D, exercise, and light exposure.
Regardless of whether Vitamin D makes a difference, exercise and light exposure both can help with depression (or in the case of the latter at least Seasonal Affective Disorder, which can cause or exacerbate depression), and the evidence there is more substantial. For the record, light therapy boxes seem to help with SAD even when they generally have low UV so little chance that it's vitamin D that's making the difference.
Therefore the study's conclusion is invalid if the two groups studied were measured one before and one after lockdown kept them inside - since we would expect Vitamin D levels to drop, for this reason.
https://watermark.silverchair.com/dgaa733.pdf
Interesting that the controls were twice as likely to be Current Smokers (17% vs 7%).
It can’t be that hard right? It’s stuff that you can buy over the counter and that you’d have to use crazy amounts of to overdose.
https://www.sciencedirect.com/science/article/pii/S096007602...
the "brandykinin hypothsis" links poor COVID-19 outcomes to vitamin D deficiency as vitamin D is a regulator of the Renin Angiotensin System.
https://academic.oup.com/jcem/advance-article/doi/10.1210/cl...
I'll point out one important thing, the non-vitamin-D-supplement taking patient group, and the control group (which also is not taking supplements), both have a median age of 61.
What about other vitamins/minerals? I'm certain we can find some other deficiency among people more likely to get sick (not necessarily of Covid19).
> 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.
That's 100x the recommended dose, every day, for months. Were you using powdered vitamin D instead of protein powder by mistake or something?
[1] https://pubmed.ncbi.nlm.nih.gov/28328526/ [2] https://pubmed.ncbi.nlm.nih.gov/28492140/ [3] https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...
IIRC, there was no regard to other sources - e.g. she might have gotten 30,000 other IU per day from Milk and another amount from fish. Very unlikely - much more likely that something else made it toxic in that case.
Regardless, it is clear that the upper safe limit has significant variance and is not well characterized.
(Personally have been on 10,000IU daily for the past 7 years with no ill effects and possibly good effects, n=1 standard disclaimer)
Consider that to go outside, many in a large city must leave their flat, walk down a shared hallway, walk past other people’s front doors, use an elevator, etc.
There’s also a lot of people on the sidewalk, many without masks, who will walk right past you, often talking loudly on a cell phone. It’s often not possible to avoid walking close to these people due to small sidewalks and busy city streets.
Obviously the risk is lower than other activities but it’s not the same as going outside in the suburbs or driving somewhere. In my city, on a 40 minute walk I pass several hundred people. In my building here, none of the other residents wear masks and to enter and exit I must walk past their front doors.
So I would say it’s quite safe. But it’s not quite as safe in big, dense American city as in the suburbs.
https://www.news-medical.net/news/20200827/Coronavirus-can-s...
It’s possible the reporter caught it indoors, unless they surrounded themselves 24/7 while inside with multiple air purifiers.
My wife goes to work in an office every single day. Doesn't have antibodies, never tested positive.
We are under lockdown pretty much here. So I havent' gone out to bars and shops in months. But I still try to go outside, even if just for a walk in the park most days.
You'd have to be spectacularly unlucky catching it outside if you are keeping a reasonable distance from other people and avoiding hanging around crowds for prolonged periods.
So doesn't explain the whole observed effect
Edit: also the study was in Spain, not USA
> Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of population-based controls (p<0.0001).
You must adjust for age.
In other words, you could read the line as "Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of controls, when accounting for age (p<0.0001)."
They may have done that too for all relevant factors but we’d need to read the paper.
It is also critical to the ability of the body to absorb and utilize calcium. Inability to properly absorb calcium tends to also foster a magnesium deficiency and vitamin K is the other vitamin you should be taking when taking calcium supplements to make sure you are able to absorb it and make use of it.
Vitamin K is critical to the clotting process, as is calcium. Calcium is necessary to start the cascade of chemical processes that lead to clotting.
I have a genetic disorder and I have a long history of being prone to nose bleeds. Tendency to bleed is a common problem for my condition, which is also known to be associated with osteoporosis at very young ages (sometimes starting in the teens), though bleeds that this population most often is concerned with is lung bleeds.
When an online friend of mine was dealing with lung bleeds in their child with the same condition, I did some looking around for info and found that calcium is critical to the clotting process. I don't know if that info helped her help her child, but as a consequence I eventually began taking 600 to 1000 mg of calcium carbonate in response to gushing nose bleeds (as opposed to the constant low-level blood seepage in my nose that was my norm for years). This practice stopped my nose bleeds cold in twenty minutes without other intervention and after six months I stopped having nose bleeds.
Covid-19 significantly impacts blood health. Anyone interested in understanding the role of vitamin D deficiency in Covid-19 should be curious about the relationship between vitamin D and blood health.
Covid-19 was initially talked up as primarily a respiratory infection, but ventilators were not performing very well for helping the sickest of the sick with this condition and there was a shockingly high mortality rate for people who ended up on ventilators -- high even for what is "normal" for people who typically end up on ventilators. Everything seems to point to the idea that the way Covid-19 impacts the blood is a critical detail of why it is so deadly in some populations.
If you have reason to believe you are vitamin D deficient, you should address that. If you address it, you most likely also need calcium, magnesium and vitamin K as well in order to redress the negative impact this has had on your health. They work together and not getting enough of any one of those tends to negatively impact your status for all of them.
(I am not a doctor. This is not medical advice. I am someone with a serious medical condition running my mouth on the internet. Please leave me alone with your bizarre delusions that leaving comments on this topic means I am "practicing medicine without a license" while you refuse to acknowledge the obvious inference that your concern is rooted in "Damn. That woman knows too damn much and we aren't happy about it for various reasons.")
That said, I can totally imagine people downing a megadose of vitamin D, declaring themselves immune, and going out to lick doorknobs immediately.
Whether or not such a bump gives the same benefits as slow ramping (and if it delivers then more quickly or not) is something I haven’t found any studies on - but I have found in the past studies indicating sun exposure is better than supplements for the same attained blood vitamin D levels (not surprising, as vitamin D is far from the only result of sun exposure)
Public health officials don't actually care about public health. Another critical issue they've willfully chosen to ignore is the dramatic comorbidity of COVID-19 and obesity.
We are told to mask up and social distance, but nobody in the public health sphere has suggested eating less.
They are not serious people.
There would be a better outcome if people were physically active and not depressed/anxious(this reduces with socializing).
Put down the hamburger and go for a run instead of handing over the keys to the nanny-state that’s proven itself incompetent.
Abstaining from junk or doing exercise has an immediate effect on your metabolic health.
I mean vitamin D prevalence could be an indicator of something else..
On the other hand, it's been used as a supplement for a long time. So hopefully it's not outright dangerous in limited quantities.
Given that the obese are more likely to be hospitalized after getting COVID-19, this may be a reason they're seeing this.
This subject is taboo, so it doesn't get considered.
Vitamin D Deficiency: Consequence or Cause of Obesity?
As someone who dropped several dress sizes by improving my nutritional status with zero intent to slim down, I am of the opinion that obesity is caused by eating empty calories. You keep eating and eating because you aren't getting enough nutritional value. Your constant hunger subsides if you actually eat nutritious foods that actually meet your nutrient needs.
I used this theory to also help one of my sons drop several sizes without doing anything else. He had really gotten quite large and it was negatively impacting his back issue. His brother told me "It's because he sucks down chocolate pop tarts all day." so my response to that was "Let's get you some good quality dark chocolate. You are likely craving the actual chocolate for some reason and chocolate pop tarts don't have all that much." He slimmed down dramatically after that and it was the only thing we did different.
The real difficulty though, is that for some, to be in a calorie deficit is intolerably difficult.
So while I agree with your hypothesis, and also believe that the cure is "simple" I think it's important to not forget the individual in all of this.
A huge deal of it is behavioural and educational too - a lot of people think that because they spray olive oil on to their pan, instead of drizzle it, it has zero calories!
Just refusing to eat more than X amount of calories is an approach that fails for a lot of people. Relying on so-called will power fails for a lot of people.
I think this is a useful distinction to make and doesn't actually contradict the idea that "You get fat from eating too many calories, more than you are burning." Instead it helps answer the question for some people concerning "Yes, but why do you keep stuffing your face when you are so unhappy with the results?"
Unless you check ketones, a body in ketosis used to HIIT will seem to defy cico balance. And many times even when not in ketosis.
Popular thermodynamics (Carb=Protein=4, Fat=9, etc) is useful as a first order approximation but requires so many wrong assumptions that it cannot be assumed to hold in any particular case.
It sounds to me like should that be the case (which, sorry I'm rather dubious about), a particular portion of energy conversion is not yet understood rather than the first law of thermodynamics being violated.
I don't claim to be an expert in this area however, so I'll be willing to read any scientific papers you may have to hand on the subject (and while this may come across as sarcastic - it's just my inability to express what I am saying adequately via typing - I'm a true believer that every day is a school day)
What I said was: circulating glucose either gets used or get stored as fat. Which means that counting glucose calories for thermodynamic calculations would actually make some sense (but see below).
Circulating fat get stored as fat, or converted to ketones for use. The difference is, unused ketones get peed whereas unused glucose gets stored.
Ketosis means fat gets converted to ketones for use - but only as much as the body means necessary for activity as that point. If your fat intake exceeds your use, you will likely gain fat.
Thermodynamics is of course never violated. But the “calories in - calories out” statement is not that useful with regard to body weight.
If you drink petrol, you will not gain wait (not be able to use it for energy - you’ll just excrete it) despite being more energy dense than fat (fat is 9kcal/gr, petrol is 12kcal/g). Similarly, plain paper (and indeed the wood it is made of) is a carbohydrate at 4kcal/gr, and yet you won’t derive any energy from it and again excrete it. Does that violate any law of thermodynamics?
No. What it does show is that the assumption that our metabolism is a perfect combustion machine (Which is at the base of the CICO weight theory) is wrong.
The conversion efficiency of different food is measured (and documented) as “Atwater factors”, the value of which was first measured over 100 years ago and assumed constant, but turned out in recent studies to vary among people and and even for same person in different times by 50% or so.
Similarly, for the same physical activity, same person may have a difference of 50%in energy expenditure (e.g. depending on how high feet are lifted while running)
Thermodynamics is not violated, but if you try to reason using it with the appropriate error bars, it turns out that you can’t say much. Statistically, the average is close enough to work for most people, most of the time, but that “most” is 70% or so.
With respect to ketosis - ketones are “use it or lose it” like heat. Once the body converts fat to ketones (a process which is NOT immediate), they are either used or peed out.
If your activity level is close to constant (as most sedantry people are), the body is very good at having very tight control on levels produced, little are wasted and you are close to what you consider “thermodynamic equilibrium” even though it’s not. If you are used to large varying activities, the body will produce more ketones just in case and pee them out if unused - thus you will only consider it “thermodynamic equilibrium” if you consider pee energy content as well.
I’m an electrical engineer, not a biochemist. But I did try to understand nutrition “science” and realized it is at most cargo cult pseudo science.
I don’t have a list of handy references, but at the very least google Richard Feinman’s famous “a calorie is not a calorie” (it’s not the physicist - and note the spelling of the name is different)
If you don't change the ratios of your macros, and you don't make your expenditure vary much throughout the day, then -- yes, eat less, or move more.
It’s worth noting that almost all studies supplementing vitamin d have shown one thing; it increases vitamin d levels and causes you to absorb more calcium. No cancer or disease benefits shown yet.
What we do know is eating healthy and getting outside to do exercise definitely helps chronic diseases and this also happens to increase vitamin d levels.
I'd guess that Vitamin D deficiency is a symptom of the same health/lifeystyle/diet that raises the likelyhood of being hospitalized with Covid-19, rather than a cause of it - but I'm no expert.
"Vitamin D insufficiency is highest among people who are elderly, institutionalized, or hospitalized. In the United States, 60% of nursing home residents and 57% of hospitalized patients were found to be vitamin D deficient."
https://www.medscape.com/answers/128762-54281/what-is-the-pr...
If everyone takes 5K IU/day, then you'd expect issues from about half of people (if baseline of 50% of people are low is correct). Those issues are nontrivial.
I personally think that most people (especially those who spend a lot of time indoors) should probably supplement, and most of the reaction is overstated.
It’s no big deal if you have sufficient magnesium, but for people who have low magnesium (which is common) it can make the problem worse.
This may explain the fatigue/lethargy at least one commenter here reported after taking fairly high-dose Vit. D supplements.
IMO this doesn’t mean you shouldn’t take them, but they should be taken with caution and ideally with clinical nutritional profile testing so magnesium or any other deficiencies can be addressed.
Furthermore, it’s possibly the body uses more for some processes when in distress, which would complicate reasoning.
> 25OHD levels are lower in hospitalized COVID-19 patients compared to population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.
That second part is really important. Look, I am taking a multivitamin as a result of what I’ve read but mostly because for me there is no harm in taking a multivitamin. But I have yet to see a definitive study that says vitamin D makes COVID better.
https://journals.plos.org/plosone/article?id=10.1371/journal...
Initial test: https://new-wayland.com/blog/onward-to-100-nmol/
Surely the most plantlike phenomena in our bodies or are there other examples of such phenomena?
But you cannot deny there is an extreme US-centric political angle to this; especially when you see stuff like this getting pulled or "fact checked" on major media platforms (who have shown their political colors).
Maybe the American Media Propaganda machine is just bleeding out into the rest of the world? I cannot say, but I do think that COVID-19 is a case of mass hysteria, possibly the largest we've ever seen.
I do not deny many have gotten sick and died, but I also think this is nowhere near as bad as people are making it out to be. The elderly should have been protected. The rest of us should have been allowed to make our own choices about risk. And the "long COVID" stories might be true or might be purely psychological.
This is not a time of honor.
A low vitamin D reading doesn't necessarily mean you are vitamin D deficient. There are two forms of vitamin D in the body, inactive and active, and the more common/cheaper blood test only measures the inactive form. The active form is what affects the body, though.
High levels of active vitamin D can cause serious damage to your body. It's probably not a good idea to supplement vitamin D without consulting a doctor.
And behold: "most studies in Spain show a high prevalence of vitamin D deficiency" https://www.nature.com/articles/ejcn2010265
> One-third (33.9%) of the Spanish population may be at risk for Vitamin D deficiency.
So that doesn't explain the >80% from TFA.
Does the body wonders.
Because of this, levels are generally stable over a period of months. Although there are health conditions that cause vitamin D levels to fall (particularly chronic kidney disease), it's highly implausible that COVID-19 itself could cause vitamin D deficiency directly.
Even if COVID-19 were to cause kidney issues and you didn't see sunlight for two weeks, it wouldn't move someone with adequate vitamin D levels into the deficient range. The time period is simply too short.
Is this a serious comment? Take a look at their editorial board:
This failed the sniff test in my book, but clearly I was wrong.
Ugly solution but so is running out of ICU beds
That's about $130k per quality-adjusted life-year, or $60k per year for dialysis paitents. [0]
US Covid Deaths by age 85+: 63,864 75-85: 55,089 65-75: 45,015 55-65: 26,525 45-55: 11,093 35-45: 4,206 25-35: 1,628 <25: 462
Lets assume a 2:1 male:female death ratio and mid points for all groups except 85+ (which will use 85). Just an approximation
Life expectency [2], woman, man, combined
85: 7y, 5+10m, 6
80: 9+8m, 8, 9
70: 16+6, 14+3, 15
60: 24+6, 21+6, 22
50: 33+2, 29+8, 31
40: 42+6, 38+7, 40
30: 52+1, 48, 49
20: 61+9, 57+3, 59
So total years: 3.4 million, an average of 16 years per death.
At $60k a year that's $200b.
At $130k a year that's $440b
As the cost to the US economy is estimated in the 10T range, it seems a poor use of funds.
However that assumes more intervention would save more lives.
With an IFR of 0.9% (even assuming no collapse in health system, but IFR estimates also overread) you'd be looking at 2.5-3 million dead overall depending how many got it. That still would come out at 5T tops, so on a financial basis better to just let it rip.
However the big assumption is that there would be no cost to economy without intervention as many people decide to stay at home, as confidence is lost and people stop spending, and that runs into a recession anyway. The 2008 recession cost $70k per person [3], that's 23T.
It also assumes that the 5T could be spent elsewhere in saving lives.
[0] https://www.valueinhealthjournal.com/article/S1098-3015(10)6... [1] https://www.heritage.org/data-visualizations/public-health/c... [2] https://coolconversion.com/heath/life-expectancy-calculator-... [3] https://www.cbsnews.com/news/how-much-the-2008-financial-cri...
I'm not disputing the value of Vitamin D. But without details this could be a simple case of correlation.
https://www.nutraingredients.com/Article/2013/10/30/Vitamin-...
In this case, we are in a position of not knowing very much about what causes/prevents COVID. Based on this study, we can learn Vitamin D seems to be involved, and there is an obvious causal mechanism that one can hypothesize might exist, even if not proven. Even if there’s only a 10% chance that vitamin D supplementation could be helpful, knowing it as a possibility could be useful to many, and justify action even if uncertain about the causality.
Is it a coincidence when you consider a disease from a nocturnal animal was able to jump over?
Humans have become more nocturnal in the sense that while we don’t sleep during the day, we often fear going outside. This has consequences.
Now a step too far on the cynicism side might be to point out how coincidental it is that a bunch of racists came to power across the globe and not too long after a pandemic happens that seems to disproportionately target people who can’t absorb vitamin D very well.