20 ms·

Vitamin D Insufficiency is Prevalent in Severe Covid-19

484 points by simonsarris 6y ago

JoeAltmaier 6y ago
Its not clear they compared to any control group?
- simonsarris 6y ago
  It's not a study, you can't have a control group in a retrospective review, you can only sort data from the data set. You can complain about the small N, though. > Among ICU subjects, 11 (84.6%) had VDI, vs. 4 (57.1%) of floor subjects. Strikingly, 100% of ICU patients less than 75 years old had VDI (n=11; Table 2).
  - JoeAltmaier 6y ago
    I guess I was really wondering about confounding variables. That quoted line makes it clear: 100% is pretty damning.
simonsarris 6y ago
I find this compelling: > Strikingly, 100% of ICU patients less than 75 years old had VDI [Vitamin D Insufficiency] Since mid-March I've been trying to keep track of Vitamin D/Sunlight suggestions and papers here: https://simonsarris.com/sunlight https://simonsarris.com/sunlight
- James_Henry 6y ago
  I feel like this is a very expected finding. It would be more compelling to see the covid-19 severity among patients with and without VDI but matched by egfr or one of the many many other confounders. A lot of things are correlated with severity of metabolic disease that could be the thing that makes covid-19 severe in this population.
- elric 6y ago
  This mess started towards the end of the winter, a long period of low sunlight and presumably lower vit D levels. What's the rate of VDI in 75 year olds in general towards the end of winter? I can't find any numbers, but I suspect it'll be close to 100% in any non-warm climate.
- virologist 6y ago
  But if someone is already in ICU doesn't it imply they have been on bed for a while and not able to generate vitamin D?
  - ip26 6y ago
    Breaking: 100% of ICU patients haven't seen the sun in days It just doesn't have the same ring to it.
- adrianmonk 6y ago
  Keep in mind: * The total number of patients in the entire study was 20. * The number of ICU patients was 13. * The number of ICU patients younger than 75 years was 10. It's interesting that 10 out of 10 patients in the ICU had low vitamin D, but it's not exactly a huge study.
cogman10 6y ago
Does make me wonder how much of this is VDI and how much of this is the general population having VDI.
- simonsarris 6y ago
  There are other papers that argue similar. On April 20, Alimentary Pharmacology and Therapeutics: low population mortality from COVID‐19 in countries south of latitude 35 degrees North supports vitamin D as a factor determining severity https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777 https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777 It also notes: > It could be argued that the virus spread later to the Southern Hemisphere and that countries there are simply behind those in the Northern Hemisphere but as time goes by this argument looks increasingly weak.
  - deleted 6y ago
    [deleted]
dontbenebby 6y ago
Is there any evidence multivitamins are harmful (not just that there's no proof they help improve health?) It's because of stuff like this I take one. Maybe I'm wasting money, but absent a harm I feel it's worth it to hedge my bets.
- superpermutat0r 6y ago
  It all depends on the context. There is no reason why your body should use the supplement vitamins or minerals if your diet is normal (not deficient). For example, a lot of people eat a bunch of animal products rich in calcium, D3, protein etc. and end up with diseases like osteoporosis, sarcopenia etc. Even with real food their bodies did not do anything with it. Intervention studies with supplements on these kinds of people show that they rarely help or help very little (not long-term). You need to make your body use the stuff you give it.
- lidHanteyk 6y ago
  Yes, vitamin D is well-known to be harmful in excess [0] and to be fat-soluble, meaning that it can build up gradually over time. You might not hear of such conditions very often, though, since getting excess vitamin D usually takes effort. [0] https://en.wikipedia.org/wiki/Vitamin_D#Excess https://en.wikipedia.org/wiki/Vitamin_D#Excess
  - teilo 6y ago
    It takes a LOT of effort. Like in excess of 50K UI a day for months. And then it needs co-factors to do harm, like excess calcium intake along with a K2-MK7 deficiency and/or a potassium deficiency (both of which are, unfortunately, very common). All in all, it's a very complex system that interacts with the body's buffering mechanisms.
    - robocat 6y ago
      From Wikipedia: “according to some research, the tolerable upper intake level (UL) is 4,000 IU/day for ages 9–71 (100 µg/day). Other research concludes that, in healthy adults, sustained intake of more than 1250 μg/day (50,000 IU) can produce overt toxicity after several months”
mindcrime 6y ago
Interesting thing... Vitamin D is one of those things that, when vitamins come up on HN, you will often hear the refrain that "it's the one vitamin that large numbers of people are actually deficient in and ought to supplement." I've heard that many times over the years and I have taken a Vitamin D supplement on and off (more off than on) over the years. When this COVID-19 thing first hit, I had a physical scheduled (by chance) just about the same time, and I'd heard about this Vitamin D / COVID-19 connection, so when I went in for my physical, I asked my doctor to order a Vitamin D test as part of my bloodwork. As it turns out, I was indeed very deficient in Vitamin D. I started taking 4000 IU a day and it's had a noticeable impact on my overall sense of wellbeing. It could, of course, be placebo effect even so. And I have no particular reason to think that it will make any difference one way or the other in terms of me getting COVID-19. But I thought it was worth pointing out one more anecdote that suggests that the old "Vitamin D is worth supplementing" refrain might just be true. If you're in doubt, and it's an option, do what I did... just ask your doctor to run a Vitamin D test next time you go in for a checkup / physical.
- derekp7 6y ago
  For generally fighting off viruses, I wonder if Vitamin D is the reason why many colds / flues tend to peak in the winter months and subside over the summer.
  - iak8god 6y ago
    Influenza viruses have a protective sheath that works better in cold weather and allows them to survive longer outside a host: https://www.nih.gov/news-events/nih-research-matters/flu-virus-fortified-colder-weather https://www.nih.gov/news-events/nih-research-matters/flu-vir...
- nosefrog 6y ago
  Same thing happened to me. I was in the single digits for Vitamin D, and my doc had me taking 10000 a day (or week) I think. Within a month, I started to feel way more energy in the afternoon (I used to feel dead by 1pm). I also mysteriously kept getting sick with small colds that winter before supplementing, and those also went away.
tbenst 6y ago
They’ve also been sitting inside a hospital for who knows how long. They cite another paper as saying ICU prevalence is 30-40%, but that’s an entirely different patient population. There is no control
pjkundert 6y ago
Relevant: vitamin D may actually be a marker of sunlight/UV deficiency (and a deficiency of other beneficial light-produced artifacts): https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure...
- mixmastamyk 6y ago
  Yes, though older folks can't produce it as well even if they get enough sun. Latitude is another big factor.
suthakamal 6y ago
Lots (most) people of colour are below their threshold of "VDI" (vitamin D insufficiency) and perfectly healthy. The fact that the study doesn't talk about base rates for ethnicities is pretty "striking" (to use a word they breathlessly, and wrongly, use).
- gridlockd 6y ago
  I would argue that they are not perfectly healthy. Non-severe Vitamin D deficiency has no acute effects, but lifetime risk for developing severe illness does go up.
mcsb4 6y ago
Anecdotelly, in Europe the countries worst hit by the virus have the most strict confinement: Italy, Spain and France. Makes you wonder if there is a correlation to Vitamin D insufficiency due to lack of sun light.
- namdnay 6y ago
  You’ve got the causality the wrong way round
  - aardvark291 6y ago
    Yeah, and Italy, Spain, and France are some of the sunnier countries in Europe (compared to Germany, UK, Belgium, Scandinavia, etc). If anything I would expect vitamin D deficiency to be less common there.
    - lawlessone 6y ago
      Diet seems to be the issue.
    - tdeck 6y ago
      Don't forget Ecuador which is literally on the equator and experiencing a major outbreak.
      - namdnay 6y ago
        It's the wet season in Ecuador
    - namdnay 6y ago
      I don't know about Spain, but in both Italy and France the regions most affected are the northern overcast places. The impact around the Med is much smaller, despite much much more retirees
- _ph_ 6y ago
  The confinement came after the virus hit them badly, not the other way around. So the confinement certainly didn't cause the virus outbreak.
oweqruiowe 6y ago
I had a doctor tell me he sees women in burkas with higher levels of vitamin D than me. IIRC it was like 5. Have taken 5000iu daily since :(
MattSteelblade 6y ago
I think it's worth pointing out the conclusion in their abstract and what the authors are trying to accomplish: "...we suggest that prospective, randomized controlled studies of VDI in COVID-19 patients are warranted."
- korethr 6y ago
  The alt-text of xkcd 552 comes to mind: "Correlation doesn't imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing 'look over there'."
kryogen1c 6y ago
this doesnt pass the correlation vs causation smell test for me. i suspect VID correlates well with COVID comorbidities, like a sedentary lifestyle, hypertension, and weight problems. the opposite is also probably true, that people with good vit D levels correlate with healthier lifestyles and fewer comorbidities.
- mixmastamyk 6y ago
  Perhaps. D has been long known to support the immune system however, including respiratory ailments. More study needed.
- wcarss 6y ago
  This systematic meta-analysis paper[1] may be more convincing. The popular youtube COVID-commentating Dr. John Campbell did a review of it about a month ago[2] and has some good comments on the meaningful statistical power and experiment design. The overall takeaway is this: in people with Vitamin D deficiency (which is very, very common), continuous daily supplementation can lead to up to a 70% reduction in contracted viral respiratory infections. It has a smaller effect the less deficient you are, and is not associated with any adverse effects. 1 - https://www.bmj.com/content/356/bmj.i6583 https://www.bmj.com/content/356/bmj.i6583 2 - https://www.youtube.com/watch?v=W5yVGmfivAk https://www.youtube.com/watch?v=W5yVGmfivAk
- mkolodny 6y ago
  Same here. Old people are less likely to get enough sunlight [0]. And old people are more likely to have severe COVID-19 symptoms. Similar story with ibuprofen and COVID-19 [1]. Researchers found a link between the two. But older people are also more likely to take ibuprofen. [0] https://health.clevelandclinic.org/some-sunlight-may-benefit-your-health-if-youre-older/ https://health.clevelandclinic.org/some-sunlight-may-benefit... [1] https://www.wired.com/story/the-ibuprofen-debate-reveals-the-danger-of-covid-19-rumors/ https://www.wired.com/story/the-ibuprofen-debate-reveals-the...
- q084yn39cptyth 6y ago
  It's not even correlational. They didn't even have a group of non-COVID patients to compare to, which would have been really easy. They could have looked at non-COVID ICU patients as well and did not. That would have at least been correlational.
tannerbrockwell 6y ago
If you get the test make sure it is the right one! 25 (OH) stays in the blood longer, so this is the more accurate test. (half life of 3 weeks in your blood). Many experts recommend a level of at least 30 ng/ml ... some actually suggest that 50 ng/ml! The scale on the test results is: Interpretive Data: Deficiency: <10 ng/mL Insufficiency: 10 to 30 ng/mL Sufficiency: 30 to 100 ng/mL Toxicity: >100 ng/mL "The majority of 25-OH vitamin D (25-D) in the circulation is derived from the conversion of 7-dehydrocholesterol in the skin that is irradiated with ultraviolet radiation in the UVB range (wavelength 290 nm to 315 nm).1-5 The extent of vitamin D formation is not tightly controlled and depends primarily on the duration and intensity of the UV irradiation. Levels produced typically reach a plateau within 30 minutes of exposure." [1] "Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year." [2] [1]: https://www.labcorp.com/test-menu/36721/vitamin-d-25-hydroxy# https://www.labcorp.com/test-menu/36721/vitamin-d-25-hydroxy... [2]: https://www.ncbi.nlm.nih.gov/pubmed/16549493 https://www.ncbi.nlm.nih.gov/pubmed/16549493
- hollander 6y ago
  I think 80 is a better level. People living in Spain and similar regions, who work outside most of the year, have levels up to 220 and they have no problems with it. You should not pursue that value via supplements. Taking 2000IU or 4000IU daily is healthy, but go much higher for longer periods and you end up with calcification of your bones. That's not reversible, and it might kill you in the end.
  - tannerbrockwell 6y ago
    I posted the correct test and got down voted. The other Vitamin D test is not accurate. If you ask for the test from your doctor, he has to specify the one I linked. You can decide for yourself what level you want to target. The other test is not accurate so you can't manage your levels...
rbalasub 6y ago
Maybe Vitamin D deficiency in folks living in the US (also ^ ) contributed to the high number of cases/deaths in the US. ^ Not discounting other factors
korethr 6y ago
Interesting. Okay, let's play with this. Let us extrapolate from the strong correlation found by this retrospective review, and postulate that Vitamin D Insufficiency (VDI) is indeed a major contributing factor in either the severity of a COVID-19 infection, or the chances of contracting it. (I am not claiming this is indeed true, correlation != causation, but I think strong correlations are certainly worth looking at and playing with). It is my observation that in my local area, the shelter-in-place order has resulted in more people spending more of their time indoors and not going outside as much. The park in my neighborhood is empty. I see less people on the bike trails visible from the roads I take to the grocery store. A nature park 20 minutes from my house, the kind that people go to to get out of the city and the hell away from other people, is closed with COVID-19 as the justification and scary signs threatening fines posted at all the entrances. And so on. With less people getting outside, and less often, that means more people are getting less sun exposure, and less vitamin D. Assuming that their diets aren't changing to make up for that, that means more people with VDI, and those already with VDI getting worse. As such, if VDI will make it easier to catch COVID, or make the symptoms worse once caught, I can't help but wonder if these shelter-in-place orders intended to slow the spread won't end up shooting us in the foot, setting us up for a 2nd wave more brutal than had people been encouraged and incentivized to get outside more. I really hope I'm wrong about that.
- fb1994 6y ago
  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/
- Angostura 6y ago
  Vitamin D is the only vitamin that the UK’s NHS recommends most people take - usually they recommend during winter. With the Covid lockdown they have extended the advice to say keep taking it.
crazygringo 6y ago
I don't doubt this at all. But at the same time, isn't it suspected that vitamin D insufficiency is linked with a worse immune system generally? (Anecdotally it made a big difference for me not getting winter colds ever since my doctor pointed out I had a significant wintertime deficiency and I started supplementing.) In other words, there's unlikely to be any unique link between vitamin D and COVID-19. That this just falls in the wide bucket of "unhealthier people are more affected by COVID-19", similar to obesity.
davidw 6y ago
So what's the ideal amount of sun exposure to produce enough for a white guy at 45 north? Is there anywhere reputable that calculates this kind of thing?
- hollander 6y ago
  You can read up on it in the book by Dr Holick. He recommends 4000IU daily, but if you're afraid that's too much, go with 2000IU/day. I take 4000IU daily since several years. Get a test before you start, so you have a base value. Test again after a month or two maybe three, and see what the change is. With sun exposure, the book recommends the following. Go sit in the sun on a sunny day, until you get a mild rose burn. How long does that take? Divide that time over a week, and you're safe. This rose-burn time depends on the time of year, how high is the sun in the skye? How clear is the skye? What is the time of the day? So this value changes a lot for people in norther Europe, compared to people living in Africa.
  - chrononaut 6y ago
    > Get a test before you start, so you have a base value. Test again after a month or two maybe three, and see what the change is. This is sound advice, but isn't there a chicken and egg problem right now? We're in a significant part of the pandemic, which I would imagine (assumption) that "routine" tests such as that may not be easy to come by. While at the same time there is notable evidence that VDI is prevalent in severe cases. By the time you get an answer to know the base line, it seems like it would be largely too late to make a possible difference in the short term? Is there a "safe" amount you could increase it without knowing your base line?
open-source-ux 6y ago
Interesting...in the UK, the NHS (National Health Service) recommendation is for adults to take a 10mcg (micrograms) vitamin D supplement daily (10mcg = 400IU). This advice was issued in 2016 after a science advisory body (Scientific Advisory Committee on Nutrition) published a 300 page report of the evidence on vitamin D and health. [1][2] The NHS also say more recently in response to the lockdown [3]: Consider taking 10 micrograms of vitamin D a day to keep your bones and muscles healthy. This is because you may not be getting enough vitamin D from sunlight if you’re indoors most of the day. There have been some news reports about vitamin D reducing the risk of coronavirus. However, there is no evidence that this is the case. Do not buy more vitamin D than you need. They also warn: Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart. If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people. Do not take more than 100 micrograms of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years. [1] Vitamin D and Health [PDF] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf https://www.gov.uk/government/uploads/system/uploads/attachm... [2] The new guidelines on vitamin D – what you need to know: https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-vitamin-d-what-you-need-to-know/ https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-... [3] Vitamin D: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...
deleted 6y ago
[deleted]
adatavizguy 6y ago
Linus Pauling really messed this one up. He went for the C but really wanted the D.
sabujp 6y ago
i loaded up on a bottle of costco vitamins and d3 supplement before we went on lockdown. There seems to be something in the multivitamins that i'm allergic to in high quantities, i.e. after taking them for 3-4 days straight I'll start getting hives. I reduced consumption to 1 mv tablet every 3 days and no problems so far. I'll probably increase d3 intake to 1 2000iu tablet per day and see how it goes.
- sudosteph 6y ago
  Weird that it took a few days for the allergy to kick in. Do you get hives from other stuff? I had a bad allergic reaction recently to wine (which was never a problem before), that started as bad hives and progressed to me nearly fainting. Doctor tested me as positive for a grape allergy, but negative to the shellfish allergy that caused hives as a kid. Anyhow, all of that is to say that the doctor prescribed me an epipen, because apparently it's possible to experience anaphalaxis without having breathing issues. And full-body hives is one sign of that. The near-fainting I experienced was likely due to low-blood pressure, which is another symptom. So just be careful. I had always thought hives weren't a big deal (other than being extremely annoying), but I'm definitely going to take them more seriously from here on out.
- timmytokyo 6y ago
  Dietary supplements are totally unregulated in the US, so who knows what you were putting in your body?
innomatics 6y ago
So VDI is prevalent in the severe disease, but it's also prevalant in the general population. Numbers in the study are very low and no significant correlation was found. Lots of interesting postulation in the discussion. Could be worth looking at in a larger study. Now cue the press stories, and panic buying...
jonny_eh 6y ago
Could this explain why the pandemic seems to be worse in NY compared to California and Florida?
- bagacrap 6y ago
  I think that's about public transit vs automobile usage
  - jonny_eh 6y ago
    SF public transit usage is high. Also, the burrow hit hardest in NY is Staten Island, which is very car heavy.
xmly 6y ago
It means you should eat a lot if you are sick..
BurningFrog 6y ago
PSA: The darker your skin is, the more Vitamin D you need, either from sunlight or food/supplements. Pale skin is an evolutionary adaptation to harvest more sunlight to convert to Vitamin D, from when humanity expanded to less sunny areas from Africa. I'm a little shocked that doctors don't seem to tell black people this. My "survey" is probably only 5 people, but still, people need to know.
- HeyLaughingBoy 6y ago
  In recent years there's been some question about whether there is a link between autism and Vitamin D deficiency in some African immigrants. Minnesota has a large population of Somali immigrants (ISTR the largest population outside Somalia itself) and in that community, autism has been nicknamed the "Minnesota disease" because of how prevalent it has become in children of immigrants. https://www.minnpost.com/politics-policy/2008/07/mysterious-connection-autism-and-minneapolis-somali-children/ https://www.minnpost.com/politics-policy/2008/07/mysterious-... It's an old article, but I haven't been able to find anything newer that isn't based on the same study in 2008. A similar "outbreak" was noted in Sweden.
gumby 6y ago
Nobody really knows what the “normal” level of Vit D is. My baseline level is lower than that of my white-skinned father and higher than that of my darker-skinned mother. Does he have too much? Certainly we all live at a latitude higher than where her ancestors lived and lower than where his did. Which of us has a “normal” level? Outside extreme deficiencies though, I’m not sure that the band isn’t relatively large. But it is documented that D supplements for people with low levels of D does seem to reduce the incidence of pulmonary infections in general. There was a good paper on the subject published last December in Lancet (IIRC — i failed to save it in Zotero). So even before COVID-19 became a concern I upped my daily dose.
throwaway122378 6y ago
Beaches closed. Parks closed. Hikes closed. Stay inside and deprive the rest of your vitamin D.
- StavrosK 6y ago
  It really is too bad that all our front doors lead directly to beaches, parks and hikes. How many people could have been saved if we had gardens, roofs and streets?
gregwebs 6y ago
This is a very weak study because it is retrospective: they just looked at existing medical records. And they only found 20 COVID patients that had vitamin D levels recorded. But the finding is compelling enough that we should demand better studies. Actually there already is a better study where they actually tested vitamin D levels of many COVID patients [1]. It found vitamin D was strongly associated with less severe outcomes: > Only 26% of the cases had 25(OH)D in the normal range, and virtually all of them (86%) had a mild outcome. ... Just over a third (38%) had 25(OH)D in the insufficient range, and only one of them (1.3%) had a mild outcome. ... Just over a third (36%) had 25(OH)D in the deficient range, and their distribution was pushed further toward severe and critical outcomes. Only one patient (1.4%) had a mild outcome, while 26% had an ordinary outcome, 40% had a severe outcome, and 33% had a critical outcome. Now we should demand a controlled trial where they actually give a vitamin D intervention: this would provide causal evidence. However, avoiding vitamin D deficiency is already very well studied and has so many benefits that I think it is worth everyone's time and effort to do so. Many people are advising high levels of vitamin D supplementation. However, there is reason to not overdo it on vitamin D supplementation and take just 1700 IU/day (or to just get sunshine) [2]. Of course, getting your vitamin D levels tested (with the help of by a doctor) is the safe way to go about this. [1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484 [2] https://chrismasterjohnphd.com/covid-19/update-on-vitamin-d-and-covid-19-using-the-first-observational-study-released https://chrismasterjohnphd.com/covid-19/update-on-vitamin-d-...
odysseus 6y ago
There is an app I've been using to track my Vitamin D for a few years now: http://dminder.ontometrics.com http://dminder.ontometrics.com (Not affiliated with the app, just happy with it.) It tells you the sun angle, peak hour of the day, and maximum time you should be in that day's sun based on your skin type, to avoid getting burnt while still getting enough D. Be careful though - you might get a little OCD about Vitamin D tracking with this app. I did, and mainly use it now for checking how long it is safe to stay outdoors. (Instead of full blown tracking.)
- noway421 6y ago
  This app seems amazing! Can't figure it out, does it send me a push notification of when to sunbath?
  - odysseus 6y ago
    Yes, if you want it to. Looking at my notifications screen in the app, it can notify about "D Window Events", and you can even specify the minimum angle of interest. It can also notify upon solar noon, sunrise and sunset (not the same as a D window of opportunity), and give a daily supplement reminder. Each of these is individually configurable.
kalium-xyz 6y ago
Unhealthy people are unhealthy
uberduber 6y ago
I've been sick for almost ten years and had low vitamin D levels. Last two years I've finally found some treatments that work for me, now that I'm healthier my vitamin D level has gone up to about 40 even though I rarely go outside and don't supplement. It's typically 5 without supplementation. Previously, I tried supplementing with 10,000IU daily, didn't help me feel any better and took a long time to get my levels up. Doctor even told me to lie outside in a bikini every day in the sun and not to burn myself. My doc's theory is that some process in sick people uses up their vitamin D and calcium, and that's what needs to be stopped. He says he has seen patients with Vitamin D deficiency where they are cured with supplementation and/or sun, but it's not very common. It's cheap, easy, and harmless enough though to try before moving on to other things.
qwerty456127 6y ago
> In an Institutional Review Board approved study performed at a single, tertiary care academic medical center, the medical records of COVID-19 patients were retrospectively reviewed. Subjects were included for whom serum 25-hydroxycholecalcifoerol (25OHD) levels were determined. COVID-19-relevant data were compiled and analyzed. We determined the frequency of VDI among COVID-19 patients to evaluate the likelihood of a VDI-COVID-19 relationship. Results: Twenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI. Does this mean they have checked 20 people, 13 (65%) of them were severe and all in the below-75 subset of these 13 people were deficient in vitamin D? Doesn't seem credible to me, I'd prefer some hundreds of people from completely different parts of the country. By the way, isn't almost everybody deficient in vitamin D anyway? (see doi:10.1101/2020.04.24.20075838)
- joshgel 6y ago
  But they didn't even check the Vitamin D levels. They only checked patients that had Vitamin D levels checked by physicians. So presumably this was a different population that was more sick by definition, because their physicans were checking them for Vitamin D deficiency. There aren't many good inpatient indications for checking Vitamin D. It's check for not good reasons sometimes, but most likely these patients were being followed by an outpatient doctor who was looking for something to explain some symptom, test result or problem that they were having.
Melting_Harps 6y ago
> Interesting thing... Vitamin D is one of those things that, when vitamins come up on HN, you will often hear the refrain that "it's the one vitamin that large numbers of people are actually deficient in and ought to supplement." Well, let me add to the narrative, as this was the concentration of my Undergrad studies. Vitamin D, and its analogues are not actually vitamins, they're steroid-hormones and behave as such; look at its molecular structure [1] and its synthesis in the presence of UV light (as this actually how you should be acquiring it). Most people are deficient in Vitmanin D, the recommended dose of 600 IU are actually not sufficient as many studies, research lends credence to as those that induced viable therapies were often upwards of 4000-10000 IU. The IOM is to blame for this, and a heated debate amongst researchers. I won't go into full detail on that, but Vitamin D is a critical precursor and reactant in many vital metabolic reactions, my personal concentration was in inducing apoptosis in certain cancer cells with calcitriol, EB 1089, CB 1093, and p53. My proposals were rejected for Independent Studies and I never undertook it in the lab, unfortunately. > Unfortunately the daily recommended value was established erroneously and should be much higher. Many research papers mention this... Exactly. My bible was a Vitamin D book with 100+ chapters detailing researchers that published papers detailing how their models were showing that such low IU of Vitmain D were insufficient, going against the IOM's RDL. If any of you are so inclined the 2nd Volume of Vitamin D by Feldman has been released [2], its expensive but still way less than what the last copies of vol 1 were that I paid back then. > Nobody makes any money if it turns out to be a good treatment, so nobody will fund the research You have no idea the amount of dismay I felt when I realized this was the case when I was in school; though I would argue they've fund(ed) it in the past, the problem is their is no way to place IP on Vitamin D itself and therefore Big Pharma's business model doesn't apply, so it can show favourable results but it will be killed because their is nothing to bring to Market as an exclusive seller like they do for drugs. Many therapies could have been explored since H1N1, 2009, but it falls on deaf ears and it takes pandemics like these to shake people into delving into Public Health more seriously. I hope changes are made by motivated students and researchers, ideally outside of Universities because I know I no longer have the patience or drive to try any more. 1: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fi.stack.imgur.com%2FjFnVM.jpg&f=1&nofb=1 https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2F... 2: https://www.amazon.com/Vitamin-Disease-Therapeutics-David-Feldman-ebook/dp/B078CQTBV1/ref=sr_1_3?dchild=1&keywords=vitamin+D&qid=1588203601&s=books&sr=1-3 https://www.amazon.com/Vitamin-Disease-Therapeutics-David-Fe...
trott 6y ago
It seems that the authors misunderstood the Boston study they are citing: > In a Boston homeless shelter, 100% of 147 COVID-19 positive subjects were asymptomatic [3]. That study actually excluded N=15 symptomatic people: > The original cases (N=15) were identified sequentially over a 5-day period, and each was expeditiously removed from the shelter population at the time of symptom recognition. These individuals predated the implementation of universal testing procedures and are excluded from this study. So, it's rather unsurprising that 100% of the remaining people were asymptomatic.
- nostrebored 6y ago
  90% asymptomatic cases isn't surprising?
  - alexanderhorl 6y ago
    Yes it has been known for a while (a while in covid terms) that a larg number has no symptoms.
pdx 6y ago
20 Patients in Study with COV19 * 65% of them went to ICU (13 patients) * 35% of them did not (7 patients) Of the 13 Patients in the ICU 84.6% (11 patients) had VDI Of the 7 Patients not in ICU 57.4% (4 Patients) had VDI Thin gruel indeed. But all they are saying is that it's perhaps worth doing a real study. That's fair.
saikiran91 6y ago
We all stayed indoors for months during to lockdown and now we might lacking Vitamin D.
Izkata 6y ago
Lots of people have been claiming that the currently-summer countries haven't gotten as hard hit. Their reasoning has been that the extra UV is killing the virus. I wonder if they were correct, but for the wrong reasons. Vitamin D in humans primarily comes from a chemical reaction with sunlight in the skin. Maybe there's an indirect effect there that explains what they were seeing?
- kijin 6y ago
  Vitamin D could also be a factor in the general, well-established trend of cold and flu being more prevalent in the winter.
wisdomdata 6y ago
Does anyone else see the irony of herding people off beaches to protect them from covid-19?
- EricE 6y ago
  When you have Karen’s instead of real leaders in charge....
xhruso00 6y ago
Advice: Get some sun exposure and better food instead of supplements.
baryphonic 6y ago
True story: my mom has plaque psoriasis and I was starting to develop symptoms as well (the condition seems to be heritable). I saw a dermatologist about it, and she prescribed a particular cream as well as doing 15 mins of UV therapy every day on the affected areas (knees and elbows were the worst). I wasn't the best at following medical advice at the time, but the cream helped some. About a year and a half ago, I started taking vitamin D after my doctor told me I was slightly deficient. Within two months, there was no indication of plaques on my knees or elbows, and the little nodules that would appear on my palmar surfaces on my hands and feet became much less frequent. I am convinced that supplementing vitamin D was much more effective than any cream, and definitely less obnoxious than holding my knees and elbows to the sun at an open window on a sunny day. When I get outside frequently, I notice that basically all of my symptoms go away. Long story short, take your vitamin D! Consult a doctor and don't take too much, since it's fat soluble and can build up to toxic levels in your system; also, since it is fat soluble, make sure your diet has enough good fats to help absorb it (guacamole and olive oil are two of my favorite supplementary foods with vitamin D).
- corpMaverick 6y ago
  I've got great results on using vitamin D for cluster headaches. https://n.neurology.org/content/82/10_Supplement/P1.256 https://n.neurology.org/content/82/10_Supplement/P1.256
chkaloon 6y ago
Unfortunately this study shows correlation but not causation. Hopefully more studies are under way.
aszantu 6y ago
fun fact: whale fat is highest in natural vitamin D, bio-availlable and all
semerda 6y ago
Most of us are Vitamin D deficient. We do not spend enough time in direct sunlight for an hour with all our limbs exposed. I've been taking 5000 IU for last 10 years to maintain ~55 ng/mL after finding out I was dangerously low at 12 ng/mL. And I used to live in Australia, the land of constant sunshine. I avoid listening to the FDA recommended dose which has historically been increasing every few years. Just get your blood work done and supplement to maintain around ~ 55 ng/mL. That's better than listening to generic advice. Btw. This pissed me off when BlueShield few years ago stopped covering Vitamin D blood tests because of this nonsense: Most People Don't Need Vitamin D Testing https://www.bcbs.com/news/press-releases/most-people-dont-need-vitamin-d-testing https://www.bcbs.com/news/press-releases/most-people-dont-ne... "The U.S. Preventive Services Task Force recently found the current medical evidence insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults." "The American Society of Clinical Pathology contributed the following recommendation to Choosing Wisely®, “Many people have low levels of vitamin D, but few have seriously low levels. Most of us don’t need a vitamin D test. We just need to make simple changes so we get enough vitamin D.”"
tdeck 6y ago
Question for those more knowledgeable: From the abstract it doesn't seem like they compared this group with other people in the ICU - could the lack of sun exposure for that population play a role? ICU patients with COVID-19 have likely gone from sheltering in place at home to experiencing symptoms that make them unlikely to venture outside to the hospital where they can't leave, all of which means less exposure to the sun. Is a few weeks of staying indoors enough to cause this?
CryptoPunk 6y ago
The brilliant authorities around the world have made it illegal to go to parks. In some places, it is illegal to be outside, in front of your own house. All this of course reduces vitamin D levels.
TurboHaskal 6y ago
Note that some doctors are clueless and diagnose a deficiency of vitamin D based on just one metabolite. Test for both, and don't damage yourself with excessive supplementation.
- tarruda 6y ago
  It seems difficult to reach excess vitamin D levels though. From [1]: "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." 5000-7000 IU per day is probably a safe amount, despite the official recommended daily intake being 600 IU. [1]: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108 https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...
hkai 6y ago
That study studied 20 people.
Havoc 6y ago
Plus staying indoors isn't helping either
koolhead17 6y ago
Will walking for 45 mins in morning help? Do we really need to buy pills and pay to pharma companies?
massaman_yams 6y ago
Interesting conclusions, but small sample size: N=20. Vitamin D at normal doses is quite safe, though, so I'll be supplementing my intake now even if broader long-term study shows this to be ineffective for C19.
ccleve 6y ago
From a few days ago: https://news.ycombinator.com/item?id=23086211 https://news.ycombinator.com/item?id=23086211 There is strong evidence that Vitamin D does nothing. Large scale studies of vitamin D supplements show no benefit. The article above argues that it is actually sun exposure that brings health benefits, and that vitamin D is just a byproduct. This makes sense. If vitamin D levels are strongly correlated with good health, it doesn't mean that it causes it. There might be some third factor.

484 points by simonsarris 6y ago

JoeAltmaier 6y ago

Its not clear they compared to any control group?

simonsarris 6y ago
It's not a study, you can't have a control group in a retrospective review, you can only sort data from the data set. You can complain about the small N, though. > Among ICU subjects, 11 (84.6%) had VDI, vs. 4 (57.1%) of floor subjects. Strikingly, 100% of ICU patients less than 75 years old had VDI (n=11; Table 2).
- JoeAltmaier 6y ago
  I guess I was really wondering about confounding variables. That quoted line makes it clear: 100% is pretty damning.

simonsarris 6y ago

I find this compelling: > Strikingly, 100% of ICU patients less than 75 years old had VDI [Vitamin D Insufficiency] Since mid-March I've been trying to keep track of Vitamin D/Sunlight suggestions and papers here: https://simonsarris.com/sunlight https://simonsarris.com/sunlight

James_Henry 6y ago
I feel like this is a very expected finding. It would be more compelling to see the covid-19 severity among patients with and without VDI but matched by egfr or one of the many many other confounders. A lot of things are correlated with severity of metabolic disease that could be the thing that makes covid-19 severe in this population.
elric 6y ago
This mess started towards the end of the winter, a long period of low sunlight and presumably lower vit D levels. What's the rate of VDI in 75 year olds in general towards the end of winter? I can't find any numbers, but I suspect it'll be close to 100% in any non-warm climate.
virologist 6y ago
But if someone is already in ICU doesn't it imply they have been on bed for a while and not able to generate vitamin D?
- ip26 6y ago
  Breaking: 100% of ICU patients haven't seen the sun in days It just doesn't have the same ring to it.
adrianmonk 6y ago
Keep in mind: * The total number of patients in the entire study was 20. * The number of ICU patients was 13. * The number of ICU patients younger than 75 years was 10. It's interesting that 10 out of 10 patients in the ICU had low vitamin D, but it's not exactly a huge study.

cogman10 6y ago

Does make me wonder how much of this is VDI and how much of this is the general population having VDI.

simonsarris 6y ago
There are other papers that argue similar. On April 20, Alimentary Pharmacology and Therapeutics: low population mortality from COVID‐19 in countries south of latitude 35 degrees North supports vitamin D as a factor determining severity https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777 https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777 It also notes: > It could be argued that the virus spread later to the Southern Hemisphere and that countries there are simply behind those in the Northern Hemisphere but as time goes by this argument looks increasingly weak.
- deleted 6y ago
  [deleted]

dontbenebby 6y ago

Is there any evidence multivitamins are harmful (not just that there's no proof they help improve health?) It's because of stuff like this I take one. Maybe I'm wasting money, but absent a harm I feel it's worth it to hedge my bets.

superpermutat0r 6y ago
It all depends on the context. There is no reason why your body should use the supplement vitamins or minerals if your diet is normal (not deficient). For example, a lot of people eat a bunch of animal products rich in calcium, D3, protein etc. and end up with diseases like osteoporosis, sarcopenia etc. Even with real food their bodies did not do anything with it. Intervention studies with supplements on these kinds of people show that they rarely help or help very little (not long-term). You need to make your body use the stuff you give it.
lidHanteyk 6y ago
Yes, vitamin D is well-known to be harmful in excess [0] and to be fat-soluble, meaning that it can build up gradually over time. You might not hear of such conditions very often, though, since getting excess vitamin D usually takes effort. [0] https://en.wikipedia.org/wiki/Vitamin_D#Excess https://en.wikipedia.org/wiki/Vitamin_D#Excess
- teilo 6y ago
  It takes a LOT of effort. Like in excess of 50K UI a day for months. And then it needs co-factors to do harm, like excess calcium intake along with a K2-MK7 deficiency and/or a potassium deficiency (both of which are, unfortunately, very common). All in all, it's a very complex system that interacts with the body's buffering mechanisms.
  - robocat 6y ago
    From Wikipedia: “according to some research, the tolerable upper intake level (UL) is 4,000 IU/day for ages 9–71 (100 µg/day). Other research concludes that, in healthy adults, sustained intake of more than 1250 μg/day (50,000 IU) can produce overt toxicity after several months”

mindcrime 6y ago

Interesting thing... Vitamin D is one of those things that, when vitamins come up on HN, you will often hear the refrain that "it's the one vitamin that large numbers of people are actually deficient in and ought to supplement." I've heard that many times over the years and I have taken a Vitamin D supplement on and off (more off than on) over the years. When this COVID-19 thing first hit, I had a physical scheduled (by chance) just about the same time, and I'd heard about this Vitamin D / COVID-19 connection, so when I went in for my physical, I asked my doctor to order a Vitamin D test as part of my bloodwork. As it turns out, I was indeed very deficient in Vitamin D. I started taking 4000 IU a day and it's had a noticeable impact on my overall sense of wellbeing. It could, of course, be placebo effect even so. And I have no particular reason to think that it will make any difference one way or the other in terms of me getting COVID-19. But I thought it was worth pointing out one more anecdote that suggests that the old "Vitamin D is worth supplementing" refrain might just be true. If you're in doubt, and it's an option, do what I did... just ask your doctor to run a Vitamin D test next time you go in for a checkup / physical.

derekp7 6y ago
For generally fighting off viruses, I wonder if Vitamin D is the reason why many colds / flues tend to peak in the winter months and subside over the summer.
- iak8god 6y ago
  Influenza viruses have a protective sheath that works better in cold weather and allows them to survive longer outside a host: https://www.nih.gov/news-events/nih-research-matters/flu-virus-fortified-colder-weather https://www.nih.gov/news-events/nih-research-matters/flu-vir...
nosefrog 6y ago
Same thing happened to me. I was in the single digits for Vitamin D, and my doc had me taking 10000 a day (or week) I think. Within a month, I started to feel way more energy in the afternoon (I used to feel dead by 1pm). I also mysteriously kept getting sick with small colds that winter before supplementing, and those also went away.

tbenst 6y ago

They’ve also been sitting inside a hospital for who knows how long. They cite another paper as saying ICU prevalence is 30-40%, but that’s an entirely different patient population. There is no control

pjkundert 6y ago

Relevant: vitamin D may actually be a marker of sunlight/UV deficiency (and a deficiency of other beneficial light-produced artifacts): https://www.outsideonline.com/2380751/sunscreen-sun-exposure-skin-cancer-science https://www.outsideonline.com/2380751/sunscreen-sun-exposure...

mixmastamyk 6y ago
Yes, though older folks can't produce it as well even if they get enough sun. Latitude is another big factor.

suthakamal 6y ago

Lots (most) people of colour are below their threshold of "VDI" (vitamin D insufficiency) and perfectly healthy. The fact that the study doesn't talk about base rates for ethnicities is pretty "striking" (to use a word they breathlessly, and wrongly, use).

gridlockd 6y ago
I would argue that they are not perfectly healthy. Non-severe Vitamin D deficiency has no acute effects, but lifetime risk for developing severe illness does go up.

mcsb4 6y ago

Anecdotelly, in Europe the countries worst hit by the virus have the most strict confinement: Italy, Spain and France. Makes you wonder if there is a correlation to Vitamin D insufficiency due to lack of sun light.

namdnay 6y ago
You’ve got the causality the wrong way round
- aardvark291 6y ago
  Yeah, and Italy, Spain, and France are some of the sunnier countries in Europe (compared to Germany, UK, Belgium, Scandinavia, etc). If anything I would expect vitamin D deficiency to be less common there.
  - lawlessone 6y ago
    Diet seems to be the issue.
  - tdeck 6y ago
    Don't forget Ecuador which is literally on the equator and experiencing a major outbreak.
    - namdnay 6y ago
      It's the wet season in Ecuador
  - namdnay 6y ago
    I don't know about Spain, but in both Italy and France the regions most affected are the northern overcast places. The impact around the Med is much smaller, despite much much more retirees
_ph_ 6y ago
The confinement came after the virus hit them badly, not the other way around. So the confinement certainly didn't cause the virus outbreak.

oweqruiowe 6y ago

I had a doctor tell me he sees women in burkas with higher levels of vitamin D than me. IIRC it was like 5. Have taken 5000iu daily since :(

MattSteelblade 6y ago

I think it's worth pointing out the conclusion in their abstract and what the authors are trying to accomplish: "...we suggest that prospective, randomized controlled studies of VDI in COVID-19 patients are warranted."

korethr 6y ago
The alt-text of xkcd 552 comes to mind: "Correlation doesn't imply causation, but it does waggle its eyebrows suggestively and gesture furtively while mouthing 'look over there'."

kryogen1c 6y ago

this doesnt pass the correlation vs causation smell test for me. i suspect VID correlates well with COVID comorbidities, like a sedentary lifestyle, hypertension, and weight problems. the opposite is also probably true, that people with good vit D levels correlate with healthier lifestyles and fewer comorbidities.

mixmastamyk 6y ago
Perhaps. D has been long known to support the immune system however, including respiratory ailments. More study needed.
wcarss 6y ago
This systematic meta-analysis paper[1] may be more convincing. The popular youtube COVID-commentating Dr. John Campbell did a review of it about a month ago[2] and has some good comments on the meaningful statistical power and experiment design. The overall takeaway is this: in people with Vitamin D deficiency (which is very, very common), continuous daily supplementation can lead to up to a 70% reduction in contracted viral respiratory infections. It has a smaller effect the less deficient you are, and is not associated with any adverse effects. 1 - https://www.bmj.com/content/356/bmj.i6583 https://www.bmj.com/content/356/bmj.i6583 2 - https://www.youtube.com/watch?v=W5yVGmfivAk https://www.youtube.com/watch?v=W5yVGmfivAk
mkolodny 6y ago
Same here. Old people are less likely to get enough sunlight [0]. And old people are more likely to have severe COVID-19 symptoms. Similar story with ibuprofen and COVID-19 [1]. Researchers found a link between the two. But older people are also more likely to take ibuprofen. [0] https://health.clevelandclinic.org/some-sunlight-may-benefit-your-health-if-youre-older/ https://health.clevelandclinic.org/some-sunlight-may-benefit... [1] https://www.wired.com/story/the-ibuprofen-debate-reveals-the-danger-of-covid-19-rumors/ https://www.wired.com/story/the-ibuprofen-debate-reveals-the...
q084yn39cptyth 6y ago
It's not even correlational. They didn't even have a group of non-COVID patients to compare to, which would have been really easy. They could have looked at non-COVID ICU patients as well and did not. That would have at least been correlational.

tannerbrockwell 6y ago

If you get the test make sure it is the right one! 25 (OH) stays in the blood longer, so this is the more accurate test. (half life of 3 weeks in your blood). Many experts recommend a level of at least 30 ng/ml ... some actually suggest that 50 ng/ml! The scale on the test results is: Interpretive Data: Deficiency: <10 ng/mL Insufficiency: 10 to 30 ng/mL Sufficiency: 30 to 100 ng/mL Toxicity: >100 ng/mL "The majority of 25-OH vitamin D (25-D) in the circulation is derived from the conversion of 7-dehydrocholesterol in the skin that is irradiated with ultraviolet radiation in the UVB range (wavelength 290 nm to 315 nm).1-5 The extent of vitamin D formation is not tightly controlled and depends primarily on the duration and intensity of the UV irradiation. Levels produced typically reach a plateau within 30 minutes of exposure." [1] "Vitamin D insufficiency is more prevalent among African Americans (blacks) than other Americans and, in North America, most young, healthy blacks do not achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of year." [2] [1]: https://www.labcorp.com/test-menu/36721/vitamin-d-25-hydroxy# https://www.labcorp.com/test-menu/36721/vitamin-d-25-hydroxy... [2]: https://www.ncbi.nlm.nih.gov/pubmed/16549493 https://www.ncbi.nlm.nih.gov/pubmed/16549493

hollander 6y ago
I think 80 is a better level. People living in Spain and similar regions, who work outside most of the year, have levels up to 220 and they have no problems with it. You should not pursue that value via supplements. Taking 2000IU or 4000IU daily is healthy, but go much higher for longer periods and you end up with calcification of your bones. That's not reversible, and it might kill you in the end.
- tannerbrockwell 6y ago
  I posted the correct test and got down voted. The other Vitamin D test is not accurate. If you ask for the test from your doctor, he has to specify the one I linked. You can decide for yourself what level you want to target. The other test is not accurate so you can't manage your levels...

rbalasub 6y ago

Maybe Vitamin D deficiency in folks living in the US (also ^ ) contributed to the high number of cases/deaths in the US. ^ Not discounting other factors

korethr 6y ago

Interesting. Okay, let's play with this. Let us extrapolate from the strong correlation found by this retrospective review, and postulate that Vitamin D Insufficiency (VDI) is indeed a major contributing factor in either the severity of a COVID-19 infection, or the chances of contracting it. (I am not claiming this is indeed true, correlation != causation, but I think strong correlations are certainly worth looking at and playing with). It is my observation that in my local area, the shelter-in-place order has resulted in more people spending more of their time indoors and not going outside as much. The park in my neighborhood is empty. I see less people on the bike trails visible from the roads I take to the grocery store. A nature park 20 minutes from my house, the kind that people go to to get out of the city and the hell away from other people, is closed with COVID-19 as the justification and scary signs threatening fines posted at all the entrances. And so on. With less people getting outside, and less often, that means more people are getting less sun exposure, and less vitamin D. Assuming that their diets aren't changing to make up for that, that means more people with VDI, and those already with VDI getting worse. As such, if VDI will make it easier to catch COVID, or make the symptoms worse once caught, I can't help but wonder if these shelter-in-place orders intended to slow the spread won't end up shooting us in the foot, setting us up for a 2nd wave more brutal than had people been encouraged and incentivized to get outside more. I really hope I'm wrong about that.

fb1994 6y ago
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4504358/
Angostura 6y ago
Vitamin D is the only vitamin that the UK’s NHS recommends most people take - usually they recommend during winter. With the Covid lockdown they have extended the advice to say keep taking it.

crazygringo 6y ago

I don't doubt this at all. But at the same time, isn't it suspected that vitamin D insufficiency is linked with a worse immune system generally? (Anecdotally it made a big difference for me not getting winter colds ever since my doctor pointed out I had a significant wintertime deficiency and I started supplementing.) In other words, there's unlikely to be any unique link between vitamin D and COVID-19. That this just falls in the wide bucket of "unhealthier people are more affected by COVID-19", similar to obesity.

davidw 6y ago

So what's the ideal amount of sun exposure to produce enough for a white guy at 45 north? Is there anywhere reputable that calculates this kind of thing?

hollander 6y ago
You can read up on it in the book by Dr Holick. He recommends 4000IU daily, but if you're afraid that's too much, go with 2000IU/day. I take 4000IU daily since several years. Get a test before you start, so you have a base value. Test again after a month or two maybe three, and see what the change is. With sun exposure, the book recommends the following. Go sit in the sun on a sunny day, until you get a mild rose burn. How long does that take? Divide that time over a week, and you're safe. This rose-burn time depends on the time of year, how high is the sun in the skye? How clear is the skye? What is the time of the day? So this value changes a lot for people in norther Europe, compared to people living in Africa.
- chrononaut 6y ago
  > Get a test before you start, so you have a base value. Test again after a month or two maybe three, and see what the change is. This is sound advice, but isn't there a chicken and egg problem right now? We're in a significant part of the pandemic, which I would imagine (assumption) that "routine" tests such as that may not be easy to come by. While at the same time there is notable evidence that VDI is prevalent in severe cases. By the time you get an answer to know the base line, it seems like it would be largely too late to make a possible difference in the short term? Is there a "safe" amount you could increase it without knowing your base line?

open-source-ux 6y ago

Interesting...in the UK, the NHS (National Health Service) recommendation is for adults to take a 10mcg (micrograms) vitamin D supplement daily (10mcg = 400IU). This advice was issued in 2016 after a science advisory body (Scientific Advisory Committee on Nutrition) published a 300 page report of the evidence on vitamin D and health. [1][2] The NHS also say more recently in response to the lockdown [3]: Consider taking 10 micrograms of vitamin D a day to keep your bones and muscles healthy. This is because you may not be getting enough vitamin D from sunlight if you’re indoors most of the day. There have been some news reports about vitamin D reducing the risk of coronavirus. However, there is no evidence that this is the case. Do not buy more vitamin D than you need. They also warn: Taking too many vitamin D supplements over a long period of time can cause too much calcium to build up in the body (hypercalcaemia). This can weaken the bones and damage the kidneys and the heart. If you choose to take vitamin D supplements, 10 micrograms a day will be enough for most people. Do not take more than 100 micrograms of vitamin D a day as it could be harmful. This applies to adults, including pregnant and breastfeeding women and the elderly, and children aged 11 to 17 years. [1] Vitamin D and Health [PDF] https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf https://www.gov.uk/government/uploads/system/uploads/attachm... [2] The new guidelines on vitamin D – what you need to know: https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-vitamin-d-what-you-need-to-know/ https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-... [3] Vitamin D: https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-d/ https://www.nhs.uk/conditions/vitamins-and-minerals/vitamin-...

deleted 6y ago

[deleted]

adatavizguy 6y ago

Linus Pauling really messed this one up. He went for the C but really wanted the D.

sabujp 6y ago

i loaded up on a bottle of costco vitamins and d3 supplement before we went on lockdown. There seems to be something in the multivitamins that i'm allergic to in high quantities, i.e. after taking them for 3-4 days straight I'll start getting hives. I reduced consumption to 1 mv tablet every 3 days and no problems so far. I'll probably increase d3 intake to 1 2000iu tablet per day and see how it goes.

sudosteph 6y ago
Weird that it took a few days for the allergy to kick in. Do you get hives from other stuff? I had a bad allergic reaction recently to wine (which was never a problem before), that started as bad hives and progressed to me nearly fainting. Doctor tested me as positive for a grape allergy, but negative to the shellfish allergy that caused hives as a kid. Anyhow, all of that is to say that the doctor prescribed me an epipen, because apparently it's possible to experience anaphalaxis without having breathing issues. And full-body hives is one sign of that. The near-fainting I experienced was likely due to low-blood pressure, which is another symptom. So just be careful. I had always thought hives weren't a big deal (other than being extremely annoying), but I'm definitely going to take them more seriously from here on out.
timmytokyo 6y ago
Dietary supplements are totally unregulated in the US, so who knows what you were putting in your body?

innomatics 6y ago

So VDI is prevalent in the severe disease, but it's also prevalant in the general population. Numbers in the study are very low and no significant correlation was found. Lots of interesting postulation in the discussion. Could be worth looking at in a larger study. Now cue the press stories, and panic buying...

jonny_eh 6y ago

Could this explain why the pandemic seems to be worse in NY compared to California and Florida?

bagacrap 6y ago
I think that's about public transit vs automobile usage
- jonny_eh 6y ago
  SF public transit usage is high. Also, the burrow hit hardest in NY is Staten Island, which is very car heavy.

xmly 6y ago

It means you should eat a lot if you are sick..

BurningFrog 6y ago

PSA: The darker your skin is, the more Vitamin D you need, either from sunlight or food/supplements. Pale skin is an evolutionary adaptation to harvest more sunlight to convert to Vitamin D, from when humanity expanded to less sunny areas from Africa. I'm a little shocked that doctors don't seem to tell black people this. My "survey" is probably only 5 people, but still, people need to know.

HeyLaughingBoy 6y ago
In recent years there's been some question about whether there is a link between autism and Vitamin D deficiency in some African immigrants. Minnesota has a large population of Somali immigrants (ISTR the largest population outside Somalia itself) and in that community, autism has been nicknamed the "Minnesota disease" because of how prevalent it has become in children of immigrants. https://www.minnpost.com/politics-policy/2008/07/mysterious-connection-autism-and-minneapolis-somali-children/ https://www.minnpost.com/politics-policy/2008/07/mysterious-... It's an old article, but I haven't been able to find anything newer that isn't based on the same study in 2008. A similar "outbreak" was noted in Sweden.

gumby 6y ago

Nobody really knows what the “normal” level of Vit D is. My baseline level is lower than that of my white-skinned father and higher than that of my darker-skinned mother. Does he have too much? Certainly we all live at a latitude higher than where her ancestors lived and lower than where his did. Which of us has a “normal” level? Outside extreme deficiencies though, I’m not sure that the band isn’t relatively large. But it is documented that D supplements for people with low levels of D does seem to reduce the incidence of pulmonary infections in general. There was a good paper on the subject published last December in Lancet (IIRC — i failed to save it in Zotero). So even before COVID-19 became a concern I upped my daily dose.

throwaway122378 6y ago

Beaches closed. Parks closed. Hikes closed. Stay inside and deprive the rest of your vitamin D.

StavrosK 6y ago
It really is too bad that all our front doors lead directly to beaches, parks and hikes. How many people could have been saved if we had gardens, roofs and streets?

gregwebs 6y ago

This is a very weak study because it is retrospective: they just looked at existing medical records. And they only found 20 COVID patients that had vitamin D levels recorded. But the finding is compelling enough that we should demand better studies. Actually there already is a better study where they actually tested vitamin D levels of many COVID patients [1]. It found vitamin D was strongly associated with less severe outcomes: > Only 26% of the cases had 25(OH)D in the normal range, and virtually all of them (86%) had a mild outcome. ... Just over a third (38%) had 25(OH)D in the insufficient range, and only one of them (1.3%) had a mild outcome. ... Just over a third (36%) had 25(OH)D in the deficient range, and their distribution was pushed further toward severe and critical outcomes. Only one patient (1.4%) had a mild outcome, while 26% had an ordinary outcome, 40% had a severe outcome, and 33% had a critical outcome. Now we should demand a controlled trial where they actually give a vitamin D intervention: this would provide causal evidence. However, avoiding vitamin D deficiency is already very well studied and has so many benefits that I think it is worth everyone's time and effort to do so. Many people are advising high levels of vitamin D supplementation. However, there is reason to not overdo it on vitamin D supplementation and take just 1700 IU/day (or to just get sunshine) [2]. Of course, getting your vitamin D levels tested (with the help of by a doctor) is the safe way to go about this. [1] https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484 https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484 [2] https://chrismasterjohnphd.com/covid-19/update-on-vitamin-d-and-covid-19-using-the-first-observational-study-released https://chrismasterjohnphd.com/covid-19/update-on-vitamin-d-...

odysseus 6y ago

There is an app I've been using to track my Vitamin D for a few years now: http://dminder.ontometrics.com http://dminder.ontometrics.com (Not affiliated with the app, just happy with it.) It tells you the sun angle, peak hour of the day, and maximum time you should be in that day's sun based on your skin type, to avoid getting burnt while still getting enough D. Be careful though - you might get a little OCD about Vitamin D tracking with this app. I did, and mainly use it now for checking how long it is safe to stay outdoors. (Instead of full blown tracking.)

noway421 6y ago
This app seems amazing! Can't figure it out, does it send me a push notification of when to sunbath?
- odysseus 6y ago
  Yes, if you want it to. Looking at my notifications screen in the app, it can notify about "D Window Events", and you can even specify the minimum angle of interest. It can also notify upon solar noon, sunrise and sunset (not the same as a D window of opportunity), and give a daily supplement reminder. Each of these is individually configurable.

kalium-xyz 6y ago

Unhealthy people are unhealthy

uberduber 6y ago

I've been sick for almost ten years and had low vitamin D levels. Last two years I've finally found some treatments that work for me, now that I'm healthier my vitamin D level has gone up to about 40 even though I rarely go outside and don't supplement. It's typically 5 without supplementation. Previously, I tried supplementing with 10,000IU daily, didn't help me feel any better and took a long time to get my levels up. Doctor even told me to lie outside in a bikini every day in the sun and not to burn myself. My doc's theory is that some process in sick people uses up their vitamin D and calcium, and that's what needs to be stopped. He says he has seen patients with Vitamin D deficiency where they are cured with supplementation and/or sun, but it's not very common. It's cheap, easy, and harmless enough though to try before moving on to other things.

qwerty456127 6y ago

> In an Institutional Review Board approved study performed at a single, tertiary care academic medical center, the medical records of COVID-19 patients were retrospectively reviewed. Subjects were included for whom serum 25-hydroxycholecalcifoerol (25OHD) levels were determined. COVID-19-relevant data were compiled and analyzed. We determined the frequency of VDI among COVID-19 patients to evaluate the likelihood of a VDI-COVID-19 relationship. Results: Twenty COVID-19 patients with serum 25OHD levels were identified; 65.0% required ICU admission.The VDI prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients. Strikingly, 100% of ICU patients less than 75 years old had VDI. Does this mean they have checked 20 people, 13 (65%) of them were severe and all in the below-75 subset of these 13 people were deficient in vitamin D? Doesn't seem credible to me, I'd prefer some hundreds of people from completely different parts of the country. By the way, isn't almost everybody deficient in vitamin D anyway? (see doi:10.1101/2020.04.24.20075838)

joshgel 6y ago
But they didn't even check the Vitamin D levels. They only checked patients that had Vitamin D levels checked by physicians. So presumably this was a different population that was more sick by definition, because their physicans were checking them for Vitamin D deficiency. There aren't many good inpatient indications for checking Vitamin D. It's check for not good reasons sometimes, but most likely these patients were being followed by an outpatient doctor who was looking for something to explain some symptom, test result or problem that they were having.

Melting_Harps 6y ago

> Interesting thing... Vitamin D is one of those things that, when vitamins come up on HN, you will often hear the refrain that "it's the one vitamin that large numbers of people are actually deficient in and ought to supplement." Well, let me add to the narrative, as this was the concentration of my Undergrad studies. Vitamin D, and its analogues are not actually vitamins, they're steroid-hormones and behave as such; look at its molecular structure [1] and its synthesis in the presence of UV light (as this actually how you should be acquiring it). Most people are deficient in Vitmanin D, the recommended dose of 600 IU are actually not sufficient as many studies, research lends credence to as those that induced viable therapies were often upwards of 4000-10000 IU. The IOM is to blame for this, and a heated debate amongst researchers. I won't go into full detail on that, but Vitamin D is a critical precursor and reactant in many vital metabolic reactions, my personal concentration was in inducing apoptosis in certain cancer cells with calcitriol, EB 1089, CB 1093, and p53. My proposals were rejected for Independent Studies and I never undertook it in the lab, unfortunately. > Unfortunately the daily recommended value was established erroneously and should be much higher. Many research papers mention this... Exactly. My bible was a Vitamin D book with 100+ chapters detailing researchers that published papers detailing how their models were showing that such low IU of Vitmain D were insufficient, going against the IOM's RDL. If any of you are so inclined the 2nd Volume of Vitamin D by Feldman has been released [2], its expensive but still way less than what the last copies of vol 1 were that I paid back then. > Nobody makes any money if it turns out to be a good treatment, so nobody will fund the research You have no idea the amount of dismay I felt when I realized this was the case when I was in school; though I would argue they've fund(ed) it in the past, the problem is their is no way to place IP on Vitamin D itself and therefore Big Pharma's business model doesn't apply, so it can show favourable results but it will be killed because their is nothing to bring to Market as an exclusive seller like they do for drugs. Many therapies could have been explored since H1N1, 2009, but it falls on deaf ears and it takes pandemics like these to shake people into delving into Public Health more seriously. I hope changes are made by motivated students and researchers, ideally outside of Universities because I know I no longer have the patience or drive to try any more. 1: https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2Fi.stack.imgur.com%2FjFnVM.jpg&f=1&nofb=1 https://external-content.duckduckgo.com/iu/?u=https%3A%2F%2F... 2: https://www.amazon.com/Vitamin-Disease-Therapeutics-David-Feldman-ebook/dp/B078CQTBV1/ref=sr_1_3?dchild=1&keywords=vitamin+D&qid=1588203601&s=books&sr=1-3 https://www.amazon.com/Vitamin-Disease-Therapeutics-David-Fe...

trott 6y ago

It seems that the authors misunderstood the Boston study they are citing: > In a Boston homeless shelter, 100% of 147 COVID-19 positive subjects were asymptomatic [3]. That study actually excluded N=15 symptomatic people: > The original cases (N=15) were identified sequentially over a 5-day period, and each was expeditiously removed from the shelter population at the time of symptom recognition. These individuals predated the implementation of universal testing procedures and are excluded from this study. So, it's rather unsurprising that 100% of the remaining people were asymptomatic.

nostrebored 6y ago
90% asymptomatic cases isn't surprising?
- alexanderhorl 6y ago
  Yes it has been known for a while (a while in covid terms) that a larg number has no symptoms.

pdx 6y ago

20 Patients in Study with COV19 * 65% of them went to ICU (13 patients) * 35% of them did not (7 patients) Of the 13 Patients in the ICU 84.6% (11 patients) had VDI Of the 7 Patients not in ICU 57.4% (4 Patients) had VDI Thin gruel indeed. But all they are saying is that it's perhaps worth doing a real study. That's fair.

saikiran91 6y ago

We all stayed indoors for months during to lockdown and now we might lacking Vitamin D.

Izkata 6y ago

Lots of people have been claiming that the currently-summer countries haven't gotten as hard hit. Their reasoning has been that the extra UV is killing the virus. I wonder if they were correct, but for the wrong reasons. Vitamin D in humans primarily comes from a chemical reaction with sunlight in the skin. Maybe there's an indirect effect there that explains what they were seeing?

kijin 6y ago
Vitamin D could also be a factor in the general, well-established trend of cold and flu being more prevalent in the winter.

wisdomdata 6y ago

Does anyone else see the irony of herding people off beaches to protect them from covid-19?

EricE 6y ago
When you have Karen’s instead of real leaders in charge....

xhruso00 6y ago

Advice: Get some sun exposure and better food instead of supplements.

baryphonic 6y ago

True story: my mom has plaque psoriasis and I was starting to develop symptoms as well (the condition seems to be heritable). I saw a dermatologist about it, and she prescribed a particular cream as well as doing 15 mins of UV therapy every day on the affected areas (knees and elbows were the worst). I wasn't the best at following medical advice at the time, but the cream helped some. About a year and a half ago, I started taking vitamin D after my doctor told me I was slightly deficient. Within two months, there was no indication of plaques on my knees or elbows, and the little nodules that would appear on my palmar surfaces on my hands and feet became much less frequent. I am convinced that supplementing vitamin D was much more effective than any cream, and definitely less obnoxious than holding my knees and elbows to the sun at an open window on a sunny day. When I get outside frequently, I notice that basically all of my symptoms go away. Long story short, take your vitamin D! Consult a doctor and don't take too much, since it's fat soluble and can build up to toxic levels in your system; also, since it is fat soluble, make sure your diet has enough good fats to help absorb it (guacamole and olive oil are two of my favorite supplementary foods with vitamin D).

corpMaverick 6y ago
I've got great results on using vitamin D for cluster headaches. https://n.neurology.org/content/82/10_Supplement/P1.256 https://n.neurology.org/content/82/10_Supplement/P1.256

chkaloon 6y ago

Unfortunately this study shows correlation but not causation. Hopefully more studies are under way.

aszantu 6y ago

fun fact: whale fat is highest in natural vitamin D, bio-availlable and all

semerda 6y ago

Most of us are Vitamin D deficient. We do not spend enough time in direct sunlight for an hour with all our limbs exposed. I've been taking 5000 IU for last 10 years to maintain ~55 ng/mL after finding out I was dangerously low at 12 ng/mL. And I used to live in Australia, the land of constant sunshine. I avoid listening to the FDA recommended dose which has historically been increasing every few years. Just get your blood work done and supplement to maintain around ~ 55 ng/mL. That's better than listening to generic advice. Btw. This pissed me off when BlueShield few years ago stopped covering Vitamin D blood tests because of this nonsense: Most People Don't Need Vitamin D Testing https://www.bcbs.com/news/press-releases/most-people-dont-need-vitamin-d-testing https://www.bcbs.com/news/press-releases/most-people-dont-ne... "The U.S. Preventive Services Task Force recently found the current medical evidence insufficient to assess the balance of benefits and harms of screening for vitamin D deficiency in asymptomatic adults." "The American Society of Clinical Pathology contributed the following recommendation to Choosing Wisely®, “Many people have low levels of vitamin D, but few have seriously low levels. Most of us don’t need a vitamin D test. We just need to make simple changes so we get enough vitamin D.”"

tdeck 6y ago

Question for those more knowledgeable: From the abstract it doesn't seem like they compared this group with other people in the ICU - could the lack of sun exposure for that population play a role? ICU patients with COVID-19 have likely gone from sheltering in place at home to experiencing symptoms that make them unlikely to venture outside to the hospital where they can't leave, all of which means less exposure to the sun. Is a few weeks of staying indoors enough to cause this?

CryptoPunk 6y ago

The brilliant authorities around the world have made it illegal to go to parks. In some places, it is illegal to be outside, in front of your own house. All this of course reduces vitamin D levels.

TurboHaskal 6y ago

Note that some doctors are clueless and diagnose a deficiency of vitamin D based on just one metabolite. Test for both, and don't damage yourself with excessive supplementation.

tarruda 6y ago
It seems difficult to reach excess vitamin D levels though. From [1]: "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." 5000-7000 IU per day is probably a safe amount, despite the official recommended daily intake being 600 IU. [1]: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-toxicity/faq-20058108 https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-h...

hkai 6y ago

That study studied 20 people.

Havoc 6y ago

Plus staying indoors isn't helping either

koolhead17 6y ago

Will walking for 45 mins in morning help? Do we really need to buy pills and pay to pharma companies?

massaman_yams 6y ago

Interesting conclusions, but small sample size: N=20. Vitamin D at normal doses is quite safe, though, so I'll be supplementing my intake now even if broader long-term study shows this to be ineffective for C19.

ccleve 6y ago

From a few days ago: https://news.ycombinator.com/item?id=23086211 https://news.ycombinator.com/item?id=23086211 There is strong evidence that Vitamin D does nothing. Large scale studies of vitamin D supplements show no benefit. The article above argues that it is actually sun exposure that brings health benefits, and that vitamin D is just a byproduct. This makes sense. If vitamin D levels are strongly correlated with good health, it doesn't mean that it causes it. There might be some third factor.