Vitamin D helps
regulate immune function and prevent respiratory illnesses in general,
and data analyses show clear parallels between vitamin D levels and the
risk of infection, severity and mortality from COVID-19 as well
While U.S.
authorities are still trying to debunk (and even instill fear) of
vitamin D supplementation, British and Scottish authorities appear to be
embracing recommendations to improve public vitamin D levels
The British
Frontline Immune Support Team is providing health care workers with free
nutritional supplements known to bolster and regulate immune function
Public Health
Scotland and the British NHS are also assessing the evidence to
determine whether vitamin D should be prescribed to in-hospital patients
and as a prevention to high-risk groups
Darker skin
requires far more sun exposure to produce adequate vitamin D, so much so
that dark-skinned individuals living north of the equator are virtually
guaranteed to be chronically deficient
As health officials continue to expect a
second wave of COVID-19 this fall, spreading information about how to
prevent it is becoming crucial. One of the most important strategies in
this regard is to optimize your vitamin D level.
Vitamin D not only helps regulate immune function and prevent
respiratory illnesses in general, but mounting data analyses show clear
parallels between vitamin D levels and the risk of infection, severity
and mortality from COVID-19 as well.
While U.S. authorities are still trying to debunk (and even instill
fear) of vitamin D supplementation, British and Scottish authorities
appear to be embracing a more sensible approach.
The British Frontline Immune Support Team, founded "to make
available some of the best quality immune supportive products … to help
keep those on the NHS (UK National Health Service) frontline resilient
and strong," is already providing health care workers with free
nutritional supplements known to bolster and regulate immune function.
This includes liposomal vitamin C, vitamin D and zinc. As noted on frontlineimmunesupport.com, the group's fundraiser page:1
"Immune supportive packs are sent directly to each individual NHS
healthcare worker who signs up for this initiative — and they receive
all products for FREE. We currently have hundreds of NHS staff already
signed up ready to go; and with your contributions we can supply and
reach thousands more."
The Frontline Immune Support Team point out that vitamin D:2
"… plays a critical role in your immune defense system, both in
reducing flu-like days of illness if your blood level is sufficient, and
in helping your immune system respond when under viral attack. It
speeds up recovery from pneumonia.
Two in five adults have a level of vitamin D below 25nmol/l,
especially in late winter months such as February and March, that is
likely to almost double their risk of flu. A vitamin D level above 100
nmol/l correlates with the lowest numbers of flu-like days. The moral
of the story is to get your level up as quickly as possible."
Public Health Scotland and the British NHS are also assessing the
evidence to determine whether vitamin D should be prescribed to
in-hospital patients and as a prevention to high-risk groups.3
Vitamin D Level Correlates With Risk of Respiratory Infection
Clinical trials using vitamin D against COVID-19 are currently underway,4
but we don't need to wait for results to know that vitamin D
optimization is a good idea. SARS-CoV-2 is an enveloped virus, which
means it's more difficult for your immune system to identify and
destroy it.
However, as noted by The Frontline Support Team, we already know
higher vitamin D levels are inversely associated with infection by many
other enveloped viruses, including dengue, hepatitis, herpes, HIV,
rotavirus, respiratory syncytial virus and influenza.5,6
Vitamin D also strengthens cellular junctions, thereby making it
more difficult for viruses to gain entry through your eyes, ears, lungs
and mucus membranes. This in turn makes the infection less likely to
migrate down into your lungs.7 Importantly, vitamin D also strengthens the adaptive arm of your immune system, and its ability to produce antibodies.8 According to a June 17, 2020, report by The Guardian:9
"Public health officials are urgently reviewing the potential
ability of vitamin D to reduce the risk of coronavirus. It comes amid
growing concern over the disproportionate number of black, Asian and
minority ethnic people contracting and dying from the
disease, including a reported10 94% of all doctors killed by the virus …
The Scientific Advisory Committee on Nutrition (SACN) began this
work last month and is considering recent evidence on vitamin D and
acute respiratory tract infection in the general population. Evidence
will be considered on specific population groups, including those of
different ages and BAME [black, Asian, minority ethnic] groups.
In a parallel development, the National Institute for Health and
Care Excellence (Nice) is conducting a 'rapid' evidence review on
vitamin D 'in the context of Covid-19' with support from Public Health
England (PHE)."
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Vitamin D — 'Designer Drug' Against Viral Infections
Adrian Martineau, a professor of respiratory infection and immunity
at Queen Mary University of London, is currently leading the "Covidence
UK Study,"11 an effort to collect data about how vitamin D deficiency impacts your COVID-19 risk. If you live in the UK, you can sign up for the Covidence UK study here.
Martineau tells The Guardian that COVID-19 deaths among black, Asian
and minority ethnic (BAME) staff within the NHS raises important
questions about vitamin D status.12
"Vitamin D could almost be thought of as a designer drug for
helping the body to handle viral respiratory infections. It boosts the
ability of cells to kill and resist viruses and simultaneously dampens
down harmful inflammation, which is one of the big problems with
Covid," he told the paper.
Why People of Color Are at Increased Risk
There's a simple reason why BAME groups are more susceptible to
COVID-19. Darker skin requires far more sun exposure to produce adequate
vitamin D, so much so that dark-skinned individuals living north of
the equator are virtually guaranteed to be chronically deficient.
According to data collected by the National Health and Nutrition
Examination Survey (NHANES) between 2005 and 2006, and published in
2018, 82.1% of black American adults and 62.9% of Hispanic adults are
deficient in vitamin D.13
As noted in that paper, lower melanin levels are protective of vitamin D
deficiency, and the darker your skin, the more likely you are of
having a low vitamin D level.
The good news is that this predisposition is easily and
inexpensively remedied. The Frontline Support Team has made good
strides toward protecting health care workers, so far supplying about
750 NHS frontline staff with free supplement packs. But the general
public also needs it, too. At bare minimum, the public needs the
information.
Scotland Issues Guidance on Vitamin D
In Scotland, government COVID-19 guidance now includes taking a daily vitamin D supplement. As reported by the Scotland Herald:14
"Official Scottish Government guidance issued on June 3
states that everyone, including children, 'should consider taking a
daily supplement containing 10 micrograms of vitamin D.'
However, it is 'specifically recommended' to all pregnant and
breastfeeding women; infants and children under five years old; people
from minority ethnic groups with dark skin such as those of African,
African-Caribbean and South Asian origin, who require more sun exposure
to make as much vitamin D; and people who are confined indoors."
US Ignores Vitamin D Impact
In stark contrast, U.S. health agencies appear to have little
interest in helping the public support their immune system through
appropriate nutrition, but would rather have you rely on drugs and
vaccines.
The U.S. National Institutes of Health recommends15
getting your vitamin D from food and beverages only, despite the fact
that dietary intake of vitamin D is insufficient to reach and maintain
the level required to prevent viral illnesses and other chronic
diseases.
That said, some health experts are speaking out. Among them is
former CDC director Dr. Tom Frieden, who wrote an opinion piece for Fox
News in which he suggests vitamin D may reduce COVID-19 mortality
rates, especially in those who are deficient.16
He goes on to say supplementation has reduced the "risk of
respiratory infections, regulates cytokine production and can limit the
risk of other viruses such as influenza." Much of the damage from
COVID-19 occurs with a "cytokine storm," during which the body's
inflammatory system goes into high gear, damaging organs and increasing
mortality rates. He writes:17
"We can do lots of things to improve our resistance to
infection. These include getting regular physical activity, getting
enough sleep, stopping smoking and other tobacco use, and, for people
living with diabetes, getting it under control.
Taking a multivitamin that includes Vitamin D, or a Vitamin D
supplement, probably can't hurt, and it might help. As we continue to
work to mitigate the impact of COVID-19, anything we can do to
strengthen our resistance is a step in the right direction."
Similarly, Dr. John C. Umhau, a public health specialist at the NIH,
has argued that vitamin D is one of the "most studied and most
important host factor impacting survival from COVID-19."18
He also points out that "A government-sponsored research strategy to
address this issue has not been developed, as officials explained that
there was no mandate to explore an alternative to the existing
vaccination program."
Considering the hazards inherent in fast-tracking a COVID-19
vaccine, and seeing how previous attempts at creating a safe and
effective coronavirus vaccine have all failed, putting all of the
public health eggs in the vaccine basket is questionable in the
extreme.
What Science Says About Vitamin D
By now, there's a very long list of scientific evidences pointing
toward vitamin D optimization as being a crucial component for
preventing another spike in COVID-19 deaths.
In the video above, Ivor Cummins, chief program officer for Irish
Heart Disease Awareness, explains how higher levels of vitamin D may
reduce your risk of negative outcomes from COVID-19. Studies supporting
this view include but are not limited to the following:
A scientific review19
in the journal Nutrients concluded vitamin D can reduce the risk of
infection by lowering the rate at which the virus replicates and
reduce the pro-inflammatory cytokines that damage the lungs, leading
to pneumonia. Vitamin D
also helps increase concentrations of anti-inflammatory cytokines
that may help protect the lungs. The researchers recommended those at
risk take:
"… 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise
25(OH)D concentrations, followed by 5000 IU/d. The goal should be to
raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L)."
Vitamin D is an important component in the prevention and treatment of influenza20 and upper respiratory tract infections21
— While vitamin D does not appear to have a direct effect on the virus
itself, it strengthens immune function, thus allowing the host body
to combat the virus more effectively.22
As detailed in "Vitamin D Prevents Infections,"
research shows high-dose vitamin D supplementation lowers the risk
of respiratory illnesses and lung infections in the elderly by 40%.
As noted by an author of that study, "Vitamin D can improve the
immune system's ability to fight infections because it bolsters the
first line of defense of the immune system."
Importantly, vitamin D also suppresses inflammatory processes.
Taken together, this might make vitamin D quite useful against
COVID-19, because while robust immune function is required for your
body to combat the virus, an overactivated immune system is also
responsible for the cytokine storm we see in COVID-19 infection that
can lead to death. As noted by pulmonologist Dr. Roger Seheult in the
video below:
"What we want is a smart immune system — an immune system that
takes care of the virus but doesn't put us into an inflammatory
condition that could put us on a ventilator."
Research23
published in 2009 suggests fatality rates during the 1918-1919
influenza pandemic were influenced by season, with greater numbers of
people dying during the winter (when vitamin D levels are at their
lowest) than the summer. According to the authors:24
"Substantial correlations were found for associations of July
UVB dose with case fatality rates and rates of pneumonia as a
complication of influenza. Similar results were found for wintertime
UVB.
Vitamin D upregulates production of human cathelicidin, LL-37,
which has both antimicrobial and antiendotoxin activities. Vitamin D
also reduces the production of proinflammatory cytokines, which could
also explain some of the benefit of vitamin D since H1N1 infection
gives rise to a cytokine storm."
Research25
published in 2017 — a meta-analysis of 25 randomized controlled trials —
confirmed that vitamin D supplementation helps protect against acute
respiratory infections.
Importantly, this analysis also discovered daily or weekly
supplementation of vitamin D had the greatest protective effect in
those with the lowest vitamin D levels.26 In other words, large, infrequent bolus doses do not work well.
Those with severe vitamin D deficiency who took a daily or weekly
supplement cut their respiratory infection risk in half, whereas the
acute administration of high bolus doses of vitamin D had no
significant impact on infection risk.
Data analysis27
by GrassrootsHealth shows people with a vitamin D level of at least 40
ng/mL reduced their risk of colds by 15% and flu by 41%, compared to
those with a level below 20 ng/mL.
Findings from The Irish Longitudinal Study on Ageing (TILDA)28,29
suggest vitamin D deficiency could have serious implications for
COVID-19. The researchers recommend adults over 50 take a vitamin D
supplement year-round (not just in winter) if they don't get enough
sun exposure to optimize their levels.
According to the vitamin D review paper30
"Evidence That Vitamin D Supplementation Could Reduce Risk of
Influenza and COVID-19 Infections and Death," published in the
journal Nutrients, April 2, 2020:
"Through several mechanisms, vitamin D can reduce risk of
infections. Those mechanisms include inducing cathelicidins and
defensins that can lower viral replication rates and reducing
concentrations of pro-inflammatory cytokines that produce the
inflammation that injures the lining of the lungs, leading to pneumonia,
as well as increasing concentrations of anti-inflammatory cytokines …
To reduce the risk of infection, it is recommended that people
at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of
vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d.
The goal should be to raise 25(OH)D concentrations above 40–60
ng/mL (100–150 nmol/L). For treatment of people who become infected
with COVID-19, higher vitamin D3 doses might be useful."
A GrassrootsHealth review of an observational
study involving 212 COVID-19 patients in Southeast Asia identified a
correlation between vitamin D levels and disease severity. Those with
the mildest disease had the highest vitamin D levels, and vice versa.
In the initial study group of 212 patients (see Table 1 below), 55
had normal vitamin D levels, which was defined as greater than 30
ng/ml; 80 had insufficient levels of 21 to 29 ng/ml and 77 had
deficient levels of less than 20 ng/ml.
According to the research done by GrassrootsHealth, 40 ng/mL is
the lower edge of optimal, with 60 ng/mL to 80 ng/mL being ideal for
health and disease prevention. Despite that, the benefit of having a
vitamin D level above 30 ng/mL was clear.
In a study31,32
that looked at data from 780 COVID-19 patients in Indonesia, those with
a vitamin D level between 20 ng/mL and 30 ng/mL had a sevenfold
higher risk of death than those with a level above 30 ng/mL. Having a
level below 20 ng/mL was associated with a 12 times higher risk of
death.
Research33,34
posted on the preprint server MedRxiv June 10, 2020, reports a
combination of vitamin D3, B12 and magnesium inhibited the
progression of COVID-19 in patients over the age of 50, resulting in
"a significant reduction in proportion of patients with clinical
deterioration requiring oxygen support and/or intensive care
support."
Check Your Level Before You Start Downing Supplements
On the upside, news about vitamin D appears to be reaching the
masses. According to Foodnavigator-Asia, sales of the Japanese FANCL
brand of vitamin D were 2018% higher in April 2020 compared to April
2019.35 While that's a good sign, it's important to remember to get your vitamin D level tested before you start supplementing.
The reason for this is because you cannot rely on blanket dosing
recommendations. The crucial factor here is your blood level, not the
dose, as the dose you need is dependent on several individual factors,
including your baseline blood level.
Data from GrassrootsHealth's D*Action studies suggest the optimal
level for health and disease prevention is between 60 ng/mL and 80
ng/mL, while the cutoff for sufficiency appears to be around 40 ng/mL.
In Europe, the measurements you're looking for are 150 to 200 nmol/L
and 100 nmol/L respectively.
I recently published a comprehensive vitamin D report in which I
detail vitamin D's mechanisms of action and how to ensure optimal
levels. I recommend downloading and sharing that report with everyone you know. A quick summary of the key steps is as follows:
1. First, measure your vitamin D level — One of the easiest and most cost-effective ways of measuring your vitamin D level is to participate in the GrassrootsHealth's personalized nutrition project, which includes a vitamin D testing kit.
Once you know what your blood level is, you can assess the dose
needed to maintain or improve your level. If you cannot get enough
vitamin D from the sun (you can use the DMinder app36
to see how much vitamin D your body can make depending on your location
and other individual factors), then you'll need an oral supplement. 2. Assess your individualized vitamin D dosage — To do that, you can either use the chart below, or use GrassrootsHealth's Vitamin D*calculator.
To convert ng/mL into the European measurement (nmol/L), simply
multiply the ng/mL measurement by 2.5. To calculate how much vitamin D
you may be getting from regular sun exposure in addition to your
supplemental intake, use the DMinder app.37 3. Retest in three to six months — Lastly,
you'll need to remeasure your vitamin D level in three to six months,
to evaluate how your sun exposure and/or supplement dose is working for
you.
Take Your Vitamin D With Magnesium and K2
As previously detailed in "Magnesium and K2 Optimize Your Vitamin D Supplementation,"
it's strongly recommended to take magnesium and K2 concomitant with
oral vitamin D. Data from nearly 3,000 individuals reveal you need 244%
more oral vitamin D if you're not also taking magnesium and vitamin
K2!38
What this means in practical terms is that if you take all three
supplements in combination, you need far less oral vitamin D in order
to achieve a healthy vitamin D level.
Help Us Spread the Word!
Remember, while vitamin D is important for everyone, key target
populations are the elderly and people of color. It's now beyond evident
that COVID-19 affects the elderly far more severely, on average, than
younger individuals, and those living in nursing homes and assisted
living facilities seem to be at an extraordinarily increased risk of
dying from COVID-19.
Add to that the increased hospitalization rate and mortality among
people of color, and it should be easy to see that targeting these two
groups with commonsense strategies such as vitamin D optimization can,
and most likely will, have a tremendous impact on COVID-19 mortality
rates in the future. As Robert Brown with the McCarrison Society, a
nutrition think tank, told the Scotland Herald:39
"The biological pathways by which vitamin D can help reduce
severity of Covid-19 are well established and the real-life evidence
from within this pandemic is growing. What's needed now is for
government to be bold and act now to mitigate the risk of a second wave
returning in the winter."
That said, don't let government's failure to address vitamin D to
stop you from taking control of your own health. Vitamin D supplements
are inexpensive and readily available, as are vitamin K2 and magnesium.
If we can get the word out, we are likely to significantly quell any
reemergence of COVID-19, and eliminate most of the racial disparities
we see among patients with severe illness.
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