Vitamin D improves survival in Covid-19 elderly patients
sciencedirect.com
sciencedirect.com
In my reading, this study is weak evidence. This was not a randomized, controlled trial, but historical analyses of a natural experiment. In itself, that's not a problem: we can learn a lot from natural experiments. But I don't think this instance is much of an "experiment."
As I understand it, all of the residents (96 in total) of a particular nursing home receive regular Vitamin D supplementation. Of the total residents, 66 got COVID-19. Among that group, they realized that 57 of them had received their Vitamin D supplementation either within a week of being diagnosed with COVID-19, or one month prior. That is the intervention group. The remaining 9 people are the "comparator" group. They found the intervention group had better survivability.
The main three reasons I consider this study weak evidence is that the number of people in the "comparator" group is very small (9!), and they - as far as I can tell - do not explain why these people did not receive their normal Vitamin D supplementation. The "comparator" group is supposed to have had a similar baseline, but there's still, to me, a strong possibility of a confounding factor. Finally, there were four total interventions: corticosteroids, hydroxychloroquine, "dedicated antibiotics" and the observation about Vitamin D. The more things you try, the less surprising it should be that there is a correlation along one of them.
Note: The study link is for treatment, not prevention.
My understanding: each patient receives a bolus dose every 2 to 3 months. The intervention group had that date within 1 mo before diagnosis (or 1wk after)
> Here, the "Intervention group" was defined as all COVID-19 residents who received an oral bolus of 80,000 IU vitamin D3 either in the week following the suspicion or diagnosis of COVID-19, or during the previous month
Under subheading 2.2: "All residents in the nursing-home receive chronic vitamin D supplementation with regular maintenance boluses (single oral dose of 80,000 IU vitamin D3 every 2–3 months),"
The comparator (not recent supplement) group was on a different schedule, and had received a supplement probably two months ago.
>Finally, there were four total interventions: corticosteroids, hydroxychloroquine, "dedicated antibiotics" and the observation about Vitamin D. The more things you try, the less surprising it should be that there is a correlation along one of them.
Are you referring to these lines: "use of corticosteroids and/or hydroxychloroquine and/or antibiotics (i.e., azithromycin or rovamycin), and hospitalization for COVID-19 were used as potential confounders."
You only run up against ( https://xkcd.com/882/ ) when you perform multiple statistical tests, not when you merely have a heterogeneous study population. Unless they were also testing these other interventions, that critique does not apply.
How do we know they weren't? Since this is not a RTC, but rather an analysis of historical data, we don't know how much they divided up this historical data looking for correlations.
That others have studied something does not preclude these researchers from "fishing" their data looking for a correlation. Since we don't know what process they used, we can't say. When considering the other weaknesses (such as the small number of "comparators"), it furthers my consideration of this study being weak evidence.
https://news.ycombinator.com/item?id=25133165
Which one is it?
As I pointed out elsewhere, a measured take: https://www.devaboone.com/post/vitamin-d-and-covid
On the flip side, given that they comparison group were receiving vit D3 occasionally, just not lately, it is possible that this underestimates the impact of vit D3 on a group that had long-term insufficient vit D3.
Nothing here to say that vit D isn't good for you, especially if you have a deficiency (such as from insufficient time in the sun), but not a stunning piece of info either.
Making it freely available and recommended for anyone who doesn't obviously get enough already is a reasonable strategy. It might not work - the correlation may not be causal. But it might be worth it anyway, because the downsides are minimal.
You could make roughly the same argument for wearing masks.
One of the tiny round capsules claims to have 2,000 IUs, which seems like a lot.
https://vitamindwiki.com/Dr.+Fauci+takes+6%2C000+IU+of+Vitam...
Source, UK NHS
https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
"Ten RCTs were included in the meta-analysis, and there was no evidence that face masks are effective in reducing transmission of laboratory-confirmed influenza."
and
"According to the GRADE approach, there was moderate quality of evidence involving >6000 participants that face masks are ineffective in reducing influenza transmission in the community."
and
"Reusable cloth face masks are not recommended. Medical face masks are generally not reusable, and an adequate supply would be essential if the use of face masks was recommended. If worn by a symptomatic case, that person might require multiple masks per day for multiple days of illness."
https://www.who.int/influenza/publications/public_health_mea...
I know the other factors: recirculated indoor air, humidity, etc.
The "take with meal" instruction is common with substances requiring fat for absorption/bioavailability. Dietary fat increases vitamin D3 absorption [5].
[1] https://pubmed.ncbi.nlm.nih.gov/23665342/ The influence of vitamin D supplementation on melatonin status in patients with multiple sclerosis
[2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4507736/ 25-Hydroxyvitamin D Concentration and Sleep Duration and Continuity: Multi-Ethnic Study of Atherosclerosis
[3] https://pubmed.ncbi.nlm.nih.gov/28652922/ The relationship between serum vitamin D levels and sleep quality in fixed day indoor field workers in the electronics manufacturing industry in Korea
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331570/ Association between Serum Vitamin D Levels and Sleep Disturbance in Hemodialysis Patients
[5] https://pubmed.ncbi.nlm.nih.gov/25441954/ Dietary fat increases vitamin D-3 absorption
More from doctors successfully treating covid with vitamins: https://youtu.be/LwlTQ52Wdro
So, broken clocks, and all that.
https://www.thenational.scot/news/18841488.boris-johnson-set...
In my anecdotal experience, there seems to be a huge variance in the amount of butter that people eat, among people who regularly eat butter.
Also, does it survive the heat of cooking?
Moreover, I'd argue older generations in particular are more susceptible to believing what the doctor says. Just having the research available and the vitamins on the shelf isn't going to have nearly the same uptake as a centralised push.
Maybe yes, but only to people in real need who cannot afford any of this or need help (e.g. elderly who are afraid to leave the house due to Covid).
In my opinion, the government's job is not to act like a nanny. There shouldn't be any need for it. They can and should expect a minimum of citizen participation and autonomy.
Is that such a bizarre idea to you?
what I've learned while figuring out what supplements I should be taking is that the entire recommended daily allowance is based on avoiding acute diseases like ricketss or scurvy, and not based on a model of what is optimal for our bodies. when you look at diseases by latitute or wonder why our annual influenza pandemic is during the winter months, it makes me wonder why there hasn't already been studies of supplements. it seems like a perfectly straightforward study.
"In the past five years, 74 cities have voted to remove fluoride from their drinking water, despite thousands of studies showing it prevents cavities." (2018)
So if the United States government attempted to distribute vitamin D to all people, a vocal minority of those people would respond "over my dead body" and immediately begin a nationwide campaign to prevent that distribution, including requesting emergency court orders to stop it. The US governments aren't typically what I would call "strong of will", and often fold on proven public health steps (such as masks) without trying to put up a fight.
Perhaps it's different in other countries?
Edit: The study linked below is pretty compelling. My comment appears to be incorrect.
https://www.sciencedirect.com/science/article/pii/S096007602...
Vitamin D supplementation is a low-risk, low-cost, side-effect-free (hard to OD) intervention. I see no reason governments should not encourage vitamin D supplementation (or, better yet, actively enable it via distribution of supplements as in the UK...at least during hospital stays). If it turns out that subsequent RCTs disprove the effects (despite the mountain of retrospective studies that show correlations in vitamin D levels and covid case trajectories), what harm will have been done?
If there's an effect of vitamin D it's likely very small.
Some are retrospectives some are randomized clinical trials.
Vitamin D has a major effect on the immune system that is well documented.
OP is right. Even if supplementation reduced the death rate by only 25%, the cost-benefit analysis says that it would absolutely have made sense for countries to issue free Vitamin D and promote its use.
It almost certainly won't reduce death rate by 25%. Very few medical interventions have an effect size that large.
Vitamin D levels in summer months are associated with 25% lower mortality rates for all causes. Vitamin D almost certainly influences the immune system to fight off Covid in the same way it does the seasonal flu and other pneumonia. There's hundreds more studies on Vitamin D. Read up when you get a chance.
Hell even if it was a 5% reduction we're talking an abundant vitamin that costs pennies to manufacture.
I believe you're referring to this one, the RCT run in a hospital in Spain, with a startlingly huge effect size:
https://www.sciencedirect.com/science/article/pii/S096007602...
It seems that giving all patients hydroxychloroquine and azithromycin was the policy at that hospital at the time the experiment was run, so the RCT didn't vary that between control and experimental groups; they just gave vitamin D pills to one group and not the other. Is there some problem with this?
So the intervention with vitamin D3 slashes the death rate from 55.6% to 17.5%, that's by a factor of over 3, or simply put three times less dead people.
All of these vitamin D studies seem to expose a single truth; serum vitamin D tests are too expensive. I suspect that these papers with inferred rather than measured vitamin D levels will continue until an easy and low cost vitamin D test is developed.
The reality is, there is a very weak body of evidence that maybe vitamin D provides a slight benefit. And yet, its proponents engage in the same hyperbole as the medical marijuana crowd.
Take it if you want, it's not going to hurt you at any kind of reasonable dose, but it's not some miracle cure that is going to solve everyone's health issues.
However that's just it, my specific medical condition (migraines) isn't everyone's. So many people in the "crowd" are going around telling everyone it will cure their depression, anxiety, and basically anything that's painful or uncomfortable for them. It's not a miracle cure, and has it's clear detriments.
The only form of Vitamin D that matters is D3. If you are not getting that, you're just ingesting a toxin that is useless at best.
Even if you are taking D3, it is not effective without K2. So, if you're just taking D3, again, it's useless at best.
Let's say you're taking D3+K2 as oral supplementation. How much are you taking? One of the richest natural sources of Vitamin D3 is Salmon. You'd have to eat a kilo (2.2 lbs) of Salmon just to get 8400 IU of D3. If you're taking a lot more (for example, 80,000 IU as used in this study), your liver has to deal with it... and it has not evolved to deal with that amount. The D3 produced in your body because of sun exposure doesn't have to go through the liver.
Nutrition science is hard but nutrition is easy. Just eat what people have been eating for hundreds of thousands of years. Supplements are almost always a bad idea.
You say this with authority (but no sources), but it does not appear to be true. D3 seems to be preferable, and more efficacious, but that does not mean that D2 does nothing.
https://www.healthline.com/nutrition/vitamin-d2-vs-d3
https://pubmed.ncbi.nlm.nih.gov/22552031/
https://pubmed.ncbi.nlm.nih.gov/23792937/
https://www.health.harvard.edu/newsletter_article/vitamin-d2...
Just eat what people have been eating for hundreds of thousands of years.
And spend 8 hours a day hunting, foraging, or working the fields, I suppose.
From your 3rd link:
Total serum 1,25(OH)2D did not change significantly with either treatment (p>0.05, post-treatment vs baseline).
From your second link:
only 3 of 10 possible studies included in the meta-analysis were randomized, controlled, double-blind, parallel intervention studies, which is the gold-standard design in nutrition research. Therefore, because of the lack of specific information surrounding the randomization and allocation of intervention to participants in all studies, there was an unknown degree of selection, performance, and detection bias.
A meta-analysis of RCTs indicated that supplementation with vitamin D3 had a significant and positive effect in the raising of serum 25(OH)D concentrations compared with the effect of vitamin D2 (P = 0.001).
[1] https://en.wikipedia.org/wiki/Ergocalciferol#Mechanism
[2] https://en.wikipedia.org/wiki/Cholecalciferol#Mechanism_of_a...
Most people don’t have access to that much sunlight, whether it’s because they have to spend most of the day working indoors, or, like me, they live in a polar region where you literally can’t get sun most of the year.
While it may be better for your liver not to have more to process, I highly doubt taking vitamin supplements is worse than living with a deficiency.
Also, in polar cultures, eating large amounts of vitamin D rich foods is exactly what people have been doing for thousands of years, without it causing health problems. And I can tell you from experience, that failing to get that vitamin D WILL cause health problems.
People have been living in the polar regions for at least 10,000 years and they never took supplements and never had vitamin deficiency.
> Let's say you're taking D3+K2 as oral supplementation [...] You'd have to eat a kilo (2.2 lbs) of Salmon
So, what's so bad about D3+K2 if you do not want to eat a kilo of Salmon a day?
I personally believe you don't need any exposure to direct sunlight to get required D3 as long as you eat food natural to humans, specially if the diet is close to that of indigenous groups living in similar environment for thousands of years. We store D3 in our fat and you can also get it when you eat animal fat.
However, if you really want to use sun exposure, I recommend an app called dminder which tells you, based on your location, if and when sun exposure will give you Vitamin-D.
I think 4000 IU is sun burn territory for a single sitting outside. But I only just scanned the website above.
I don't know how long it lasts, or if its cumulative, but I heard Vit D is stored in your fat so theres a bit of storage going on.
Perhaps therefore, sitting outside in Summer each day during lunch would be enough to get 5000 IU / week.
Not just specifically with COVID-19. In general, there's at least a few front page stories a month.
Google seems to confirm this: https://www.google.com/search?biw=1660&bih=865&tbs=qdr%3Ay&e...
It was recognized a century ago that tuberculosis patients who were taken outside in the sun did better than those who weren't.
>Bolus vitamin D3 supplementation during or just before COVID-19 was associated with better survival rate in frail elderly.
That's rather close to the headline.
Instead, we have an odd and vague dosage, "80,000 IU vitamin D3 every 2–3 months." I gather this study was constructed given the supplement regimen that was in-place. Why were the patients being supplemented that way? What standard of care is that?
Every time I try just 400 IU per day for a week it makes me dizzy and woozy. I eat plenty of meat and veggies with K2, and nuts and fish with magnesium. Vitamin-D containing foods like milk, eggs and fish are totally fine. I can bake all day in the sun and don't burn easily.
There's something different about synthetic D3, and I wish I could get all the benefits that people here claim.
I guarantee that you're consuming more than 400IU of Vitamin D in your regular diet. You can consume almost double that amount just by eating a decent sized salmon filet.
I doubt the miniscule amount of Vitamin D (10 micrograms) in your supplement is causing your problems. It's possible that you're allergic to the capsules themselves, or fillers, or something unique to the supplements.
> I eat plenty of meat and veggies with K2, and nuts and fish with magnesium. Vitamin-D containing foods like milk, eggs and fish are totally fine. I can bake all day in the sun and don't burn easily.
If you're getting plenty of Vitamin D from diet and sunlight, you don't need to supplement. I know the popular sentiment will beat the drum of "more is better", but it's not true. The goal is to get Vitamin D levels into an optimal range and keep them there, which, despite internet opinion, is entirely possible on a healthy diet with light sun exposure.
My point is that there are ways to generate supplemental vitamin-d without having to go get synthetic supplements.
I know Paul Stamets is held in high regard in certain circles, but be careful. He's a personal brand builder, first and foremost, and many of his claims range from dubious to pure pseudoscience. Even though he's become a figurehead for mushroom research, his own line of supplements is notoriously inferior to many other products on the market. Fun guy (hah) to listen to on podcasts, as long as you don't take him too seriously or get hooked by his disguised sales pitches for his products.
Have you tested your level in the winter? You may not need it.
I've been taking 5k a few times a week and haven't been sick longer than a day for perhaps a decade.
Holy shit that's a lot of vitamin D
Take HCQ + Zinc. Supplement with vitamin D. This is "verboten" to our benevolent technocratic overlords but it's plain science.