20 ms·

Vitamin D deficiency and Covid-19 mortality [pdf]

360 points by black6 6y ago

ve55 6y ago
Although this is a notable finding it's important to remember that it doesn't lead to the conclusion that supplementing vitamin D will be very beneficial here. When vitamin D is produced in the body naturally via exposure to sunlight there's a huge amount of other things that occur as well, and we don't have a ton of good science to back up if curing a vitamin D deficiency via supplementation of pure vitamin D is really nearly the same as getting it naturally, which is a common problem for supplementing things and nutritional science and epidemiology in general. The extent that covid harms those that are metabolically unfit in many different ways much more than those that are perfectly healthy is still pretty under-discussed imo though, and this is yet another good data point in favor of it, even if Vitamin D is much more of a different proxy than some of the other large correlations we see with covid mortality.
- graeme 6y ago
  What about this section of the pdf? From a 2016 study on patients with other respiratory diseases. —————- High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial In the study, patients with vitamin D deficiency (<20ng/ml) were divided into three groups: A placebo group, and two groups that were given different doses of vitamin D. The single administration of 250,000 IU of vitamin D was compared with the single administration of 500,000 IU of vitamin D by injection. In addition, the vitamin D levels were increased to 45 and 55 ng/ml, respectively. While the length of stay of the placebo group at the ICU was 36 days, the 250,000 IU group averaged 25 days and the 500,000 IU group averaged 18 days. This is a smooth halving and means that vitamin D is useful not only in prevention but also in acute cases. https://www.sciencedirect.com/science/article/pii/S2214623716300084 https://www.sciencedirect.com/science/article/pii/S221462371... —————— Ah, the pdf has a second such study. Mortality almost half less —————— Intervention was carried out intramuscularly with 300,000 IU of vitamin D. Instead of 28 days only 18 days mechanical ventilation, instead of 29 only 19 on ICU, instead of 61% deaths only 36%. https://pubmed.ncbi.nlm.nih.gov/31531088/ https://pubmed.ncbi.nlm.nih.gov/31531088/
  - ve55 6y ago
    I haven't seen that one, that looks pretty impressive, especially for administering it in a single dose that is that large. That's definitely a good data point in favor that some of it is direct causation though.
    - throwanem 6y ago
      31 total subjects, only 13 vitamin D deficient initially, p = 0.03. This study at best suggests further, more rigorous research here may be warranted. It says nothing about causation, for all that its authors seem to feel otherwise - and that they feel otherwise suggests its results should be taken with more than the usual amount of skepticism.
      - graeme 6y ago
        Have a look at table 1. Only 5/31 subjects had “sufficient” vitamin d. In between deficient and sufficient there is the insufficient category, from 20-30 ng/ml. Though I agree further study is warranted. The highest vitamin D group actually had the highest mortality after 84 days. Though this group also had the most pre-existing heart conditions by far, so that could account for it. Ah, there was a second such study in the pdf. Mortality down by almost half. —————— Intervention was carried out intramuscularly with 300,000 IU of vitamin D. Instead of 28 days only 18 days mechanical ventilation, instead of 29 only 19 on ICU, instead of 61% deaths only 36%. https://pubmed.ncbi.nlm.nih.gov/31531088/ https://pubmed.ncbi.nlm.nih.gov/31531088/
    - mtgx 6y ago
      More studies referenced here, also showing ~55 ng/ml being optimum for maximum health benefits. The current recommendations are way below that. Well worth to watch the whole video: https://youtu.be/v3pK0dccQ38?t=4105 https://youtu.be/v3pK0dccQ38?t=4105
  - LegitShady 6y ago
    Those dosages are far higher than anyone supplementing vitamin d are likely to take.
- xutopia 6y ago
  The study showed that supplementing (though it was injection) to between "45 and 55 ng/ml" is "useful not only in prevention but also in acute cases". So yes... sunlight does probably way more benefits for us but supplementation if you are deficient is still showing significant effects.
  - James_Henry 6y ago
    Just to be clear, the study that you are quoting isn't about Sars-Cov 2. This is a quote from a 2016 paper on other respiratory diseases.
    - James_Henry 6y ago
      And here is the quote in context, not that this isn't about Covid-19: "High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial In the study, patients with vitamin D deficiency (<20ng/ml) were divided into three groups: A placebo group, and two groups that were given different doses of vitamin D. The single administration of 250,000 IU of vitamin D was compared with the single administration of 500,000 IU of vitamin D by injection. In addition, the vitamin D levels were increased to 45 and 55 ng/ml, respectively. While the length of stay of the placebo group at the ICU was 36 days, the 250,000 IU group averaged 25 days and the 500,000 IU group averaged 18 days. This is a smooth halving and means that vitamin D is useful not only in prevention but also in acute cases."
- BurningFrog 6y ago
  Technically true, but you should still eat vitamin D supplements. It's very cheap and safe, so worst case it has less effect than you hope. You can overdose, but you have to really crazy with the dosage. Also 1: Vitamin D supplements do cure rickets. Also 2: All of us who eat supplements should show up in the stats as high in vitamin D, so the data does partially cover that case.
  - zzz61831 6y ago
    It's not that safe, not like vitamin C safe. Especially not in doses sold in pills in pharmacies around the world.
    - newsbinator 6y ago
      I still can't figure out the safe + effective dosage of Vitamin D. I was taking 1,000mg a day and that didn't seem to move the needle on my Vitamin D blood work. In recent weeks I've been taking 4,000mg/day (with K2), which is 4x what I've had pharmacists recommend. I plan to keep that up for a couple more weeks while I'm under quarantine (recently flew from a high-risk country to a less high-risk country). After that I'll level off to 2,000mg a day. But I'm shooting in the dark. I have no idea if 2,000mg/day or 4,000mg/day is too much or not enough.
      - James_Henry 6y ago
        The safest way is to take an occasional test for your vitamin d levels. There are tests that you can take at home that aren't too expensive!
        secabeen 6y ago
        Yep. I work inside a lot, so I started taking 5000IU of D a day. After two weeks, I had my levels tested and it showed a level of 37. When fall comes around, and I'm outside even less, I'll probably up the dosage for a week or two, then test again. Target is between 50 and 70, so I definitely need more.
- sharpneli 6y ago
  In Finland we put Vitamin D in milk that’s sold on normal shops. And taking a supplement is heavily recommended. Though this is mostly because for 6 months of a year one simply cannot get it the natural way (too cold and sun is too low). And thanks to this we don’t have much deficiency, long time ago we used to have. Not saying it means it would help with covid. But the supplements definitely help with deficiency in a way that does cure/prevent rickets.
  - deleted 6y ago
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  - graeme 6y ago
    You had a very limited coronavirus outbreak it seems. Does Norway have the same vitamin D supplementation policies? Their outbreak was similar in size to Finland’s. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Finland https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Finland Edit: Interestingly, the source pdf notes the nordic countries have higher D3 levels than Mediterranean countries. And speculates this may help explain lower incidence up north. ———— The researchers around Petre Cristian Ilie have tested the number of Covid-19 deaths per 1 million inhabitants against the vitamin D level in 20 European countries and come to the following conclusion: The mean vitamin D level in the countries studied (mean 22.4 ng/ml, StDev ±4.24) correlates strictly with the number of Covid-19 infected per million population (mean 295.95, StDev ±298.73, p=0.004) and with mortality (mean 5.96, StDev 15.13, p<0.00001) The death rates in Spain and Italy are much higher than in Scandinavia. The researchers explain this with the statistically significant higher vitamin D level among the inhabitants of the Nordic countries: The study shows that in older people, the average blood vitamin D level in Spain is 10.4 ng/ml, in Italy, 11.2 ng/ml, while in the Scandinavian countries it is 18 ng/ml. The northerners obviously do have the better vitamin D levels, although the sun is not as intense there as in the south. This could either be because they are more active outdoors or because they get more vitamin D from food, e.g. fish, or both. Fat sea fish contains a lot of vitamin D. And southerners tend to spend their midday hours in the shade or indoors. Shadow, window glass and a longer way through the atmosphere (morning/evening, autumn/spring) reduce UVB radiation much more than UVA.
    - 6y ago
- mrfusion 6y ago
  > When vitamin D is produced in the body naturally via exposure to sunlight there's a huge amount of other things that occur as well Any further reading on that? On the other hand worth supplementation you don’t get the harmful uv rays.
  - nradov 6y ago
    There is no evidence that a brief daily exposure to UV rays is actually harmful in terms of all-cause mortality.
  - glofish 6y ago
    UV rays should not be considered harmful de-facto! Overexposure to UV rays is what causes trouble. Slathering on the sunscreen even when not necessary (like walking from point A to point B, or spending 15 minutes outside, is what causes the predominant vitamin D deficiency in the first place.
    - James_Henry 6y ago
      Are you sure the "predominant vitamin D deficiency" isn't caused by the prevalence of metabolic syndrome?
- nradov 6y ago
  One effect of sunlight exposure is to stimulate production of nitric oxide, which lowers blood pressure. Hypertension is one of the most common comorbid conditions for COVID-19 deaths. I don't know if there's a causal relationship but it could be worth further research.
  - disgruntledphd2 6y ago
    That's interesting. Do you have pointers to relevant research?
- ColanR 6y ago
  > Although this is a notable finding it's important to remember that it doesn't lead to the conclusion that supplementing vitamin D will be very beneficial here....we don't have a ton of good science to back up if curing a vitamin D deficiency via supplementation of pure vitamin D is really nearly the same as getting it naturally I don't know what you mean by 'a ton', but there is good evidence that Vitamin D supplements do provide much of the same benefit [0] [1]. > Ultraviolet radiation (either from artificial sources or from sunlight) reduces the incidence of viral respiratory infections, as does cod liver oil (which contains vitamin D). [0] https://pubmed.ncbi.nlm.nih.gov/16959053/ https://pubmed.ncbi.nlm.nih.gov/16959053/ [1] https://sci-hub.se/https://www.sciencedirect.com/science/article/abs/pii/S0306987709007634?via%3Dihub https://sci-hub.se/https://www.sciencedirect.com/science/art...
- ntsplnkv2 6y ago
  Personal anecdote - vitamin D supplements did absolutely nothing for my vitamin D levels. it wasn't until I committed to getting more sunlight that my levels increased.
  - function_seven 6y ago
    What was your daily IU supplementation, and how long did you supplement before checking your levels again? I take 5000 IU daily, but also wonder if I'd do better with more sunlight instead.
    - ntsplnkv2 6y ago
      I was taking 50000 IU a week. Checked multiple times over periods of months.
      - AuryGlenz 6y ago
        Hey, someone like me. I was upped to that dose 2x a week and then 3x. Now my levels are up and holding.
- ellyagg 6y ago
  It's frustrating that when this comes up, this comment is always the top one, because it's not true. We have dozens of RCTs suggesting that vitamin D supplementation prevents respiratory infections[1]. There is a very good chance people could mitigate C19 risk with supplementation. And I personally trust the vast majority of people to use reasonable enough dosing that overdose is unlikely, especially with appropriate messaging. Downplaying the risks of low vitamin D (way more prevalent than vitmain D toxicity) seems as dangerous as the early pandemic messaging in the US that masks are ineffective. 1. https://www.bmj.com/content/356/bmj.i6583 https://www.bmj.com/content/356/bmj.i6583
  - arkitaip 6y ago
    Dr. Rhonda Patrick on "Vitamin D may reduce susceptibility to COVID-19-associated lung injury": https://www.foundmyfitness.com/episodes/vitamin-d-covid-19 https://www.foundmyfitness.com/episodes/vitamin-d-covid-19
- throwaway6000 6y ago
  The Harvard Gazette: Study confirms vitamin D protects against colds and flu https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm... University of Colorado Anschutz Medical Campus: Vitamin D reduces respiratory infections https://www.sciencedaily.com/releases/2016/11/161116103005.htm https://www.sciencedaily.com/releases/2016/11/161116103005.h...
emdowling 6y ago
This conclusion (10x higher mortality if deficient in Vitamin D) is rather significant. How trustworthy is this source?
- James_Henry 6y ago
  Borsche and Glauner don't seem very trustworthy, but it is no secret that a vitamin D deficiency is correlated with higher mortality. The comorbidities that are associated with Covid-19 mortality are, pretty much, all correlated with vitamin D deficiency. The real question is, if someone is obese, or has diabetes, or has CKD, or is old, what is it that is making them more likely to die of Covid-19? Is it a vitamin D deficiency or some other related issue? and can supplemental vitamin D help? My guess is that it helps more than hurts to supplement vitamin D if you are deficient or insufficient. I'd also guess that it is no miracle cure like Borsche and Glauner seem to want people to think.
- russfink 6y ago
  From a technical writing style perspective, the thing going against this paper is the folksy way of writing. It also includes things called weasel words, such as saying very young doctor, versus young doctor, or even just doctor. The results are compelling, and I suppose it would not hurt to take a prophylaxis of vitamin D (5,000 units per the article?) as compared to a prophylaxis of something else, such as hydroxychloroquine (or Lysol!)
  - black6 6y ago
    https://hcqtrial.com/ https://hcqtrial.com/ "...an extensive discussion of the differences between the death rates of New York City and Lagos, Nigeria, which both received infected travelers around the same time. NYC's high rate has been linked to population density, poverty, overcrowding, and ethnicity. Lagos is a crowded urban center of about 22 million people with 30 families often in a single building sharing the same bathroom, and none of the factors mentioned favor reduced death rates in Lagos. Lagos further has lower quality of medical care. Yet NYC had a death rate 600 times higher. The younger population can only account for a small part of this difference. Mitchell concludes that there is a crossover prophylactic effect of antimalarial agents against COVID-19."
aauchter 6y ago
Interesting but a there's a decent chance of correlation not causation. Unhealthy people and people over 65 (i.e. those most susceptible to serious COVID complications) are the same group that are most likely to be Vitamin D deficient. The primary source of Vitamin D is sunlight. People over 65 tend to stay indoors, etc. People with darker skin are also more prone to D deficiency due to increased melanin, but also have higher rates of obesity, more likely to suffer from diabetes, are more likely to live in cramped conditions, etc. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/ https://www.cantonmercy.org/healthchat/42-percent-of-americans-are-vitamin-d-deficient/ https://www.cantonmercy.org/healthchat/42-percent-of-america... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/
- KerryJones 6y ago
  There's a lot more data here that specifically tested about vitamin-D levels in early and late stages: http://agingbiotech.info/vitamindcovid19/ http://agingbiotech.info/vitamindcovid19/ I agree that causation hasn't been completely proven, but there's a lot of data to support it could be causative.
- nostromo 6y ago
  From the paper: > After correction for age, sex and previous illnesses, the risk of death is 10 times higher for people with vitamin D deficiency. That said, it could still be correlative and not causative with some different underlying health issue.
  - wtetzner 6y ago
    > That said, it could still be correlative and not causative with some different underlying health issue. On the other hand, maybe Vitamin D deficiency is the cause or one the causes of those underlying health issues.
et2o 6y ago
Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in randomized controlled trials have never demonstrated it to be effective for any disease except rickets. There was just a large trial published in JAMA [1] examining its effectiveness for depression given solid observational data. It was not at all effective. The reason that Vitamin D is associated with many diseases but is not causative for anything is that Vitamin D level is highly correlated with other metrics of health such as socioeconomic status, active lifestyle, nutritional sufficiency, etc. We are wasting our time and money looking at Vitamin D again and again and again. 1. https://jamanetwork.com/journals/jama/article-abstract/2768978 https://jamanetwork.com/journals/jama/article-abstract/27689...
- tekgnos 6y ago
  This study used a tiny amount of Vitamin D (2,00IU/day) which is absolutely not enough Vitamin D to have any affect on someone who is deficient. Going outside in a swimsuit produces 10,000+IU equivalent. We evolved nude, outdoors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/
  - AQuantized 6y ago
    It's not a tiny amount, probably about 40% of what most adults should be getting optimally, and significantly better than having almost no intake, which is the case for a lot of people who rarely go outside and don't eat any fatty fish.
    - tekgnos 6y ago
      That's fair. The RDA at 400 is tiny.
- ericb 6y ago
  Just because it doesn't cure one thing, we shouldn't consider it for others? Should we toss our antidepressants because they don't cure respiratory infections? I believe there's a plausible mechanism in this case, and related studies on respiratory infections where an effect was found. Also, in terms of studies, often the no effect data is from bolus doses, which don't seem to do a good job moving the needle.
MontagFTB 6y ago
Supplementing with vitamin D should be easy enough to test. Given that most people get their necessary vitamin D by going outside, couldn’t the presence/lack of this vitamin be an indicator of other lifestyle choices that may affect the person’s ability to fight off the disease?
- James_Henry 6y ago
  Sure, but a bigger confounder is probably that vitamin D deficiency is associated with metabolic syndrome, CKD, obesity, diabetes, etc. These may be, for some people, indicative of lifestyle choices as well, but those choices are, I'd guess, not the direct cause of a person's inability to survive the disease.
dirtyid 6y ago
Everyone should try a Vitamin D cycle if only to see if makes a big difference in daily life, especially if you live in area with sad winters. It's one of the few supplements that dramatically improves mood for those deficient or sensitive to large doses.
- James_Henry 6y ago
  Vitamin D tests aren't usually too expensive (as far as medical tests go), so it might be worth just getting tested rather than trying to see what difference it is making (which can be tricky if you are someone sensitive to the placebo effect or if the effect of vitamin D supplementation isn't immediate or what not).
  - Jeriko 6y ago
    If you are trying to use it to treat mild depression specifically, a placebo effect is great! Placebo effects get a bad rap. If something improves your subjective quality of life that should be considered a win, especially for depression. Honestly the best thing vitamin D has going for it is being super inexpensive and safe. Because of that you can supplement vitamin D for almost any reason and expect to see at worst a very small cost (someone up thread said 3 cents a day, which seems in the ball park) and at best a significant subjective benefit (even if it's from a placebo effect).
    - James_Henry 6y ago
      Placebo effects can be great; they can mask underlying issues though. Also, if you actually have a vitamin D deficiency (or some other health issue), it could be good to know why. Perhaps your kidneys are having issues, for instance.
- jcampbell1 6y ago
  After having several kitesurfing vacations ruined by sunburns, I decided to just go to a tanning salon in the winter. It had a profound mood effect and respiratory effect almost immediately. Now I go a few times per month in winter regardless if I am going to the tropics. The UV does is completely metered. It may be a risky, but given that people that work outside have half the risk of melanoma as people who work indoors, I think regular low dose UV exposure may be a net positive even for cancer risk. Spending 5 minutes under UV lamps is a guaranteed way to get a huge dose reasonably safely, and you will know the effect almost immediately. The vitamin D seems to be maintained for 2-3 weeks after as well.
RosanaAnaDana 6y ago
I'm a simple person. I see two y or x axis on the same plot and I cast doubt.
tekgnos 6y ago
It is not surprising at all that Covid-19 matches what we already know about Vitamin D and Influenza. There are consequences for radically altering the environment in which humans evolved. We were nude outdoors and now we are clothed and indoors. When we do briefly go outside, we are all conditioned to slather on sunscreen, which blocks all Vitamin D generation. Why do people tend to get sick in the wintertime and not the summer? https://pubmed.ncbi.nlm.nih.gov/16959053/ https://pubmed.ncbi.nlm.nih.gov/16959053/
- baix777 6y ago
  Humans have being wearing clothes for about 170,000 years, indoors and outdoors, long enough for a evolutionary response. Along with fire, clothing is one of our great inventions and allows humans to live in colder climates than we could otherwise. We have, along with other creatures like lice, been evolving since we started wearing clothes. But why do people get more sick in the winter, when they are forced into close proximity with other people, making illness easier to spread, rather than the summer, when people are outdoors more, and can do things like walk to work in the warm summer sun rather than take the bus in the cold winter rain and snow? Stated differently, we naturally do more social distancing in the summer.
  - tekgnos 6y ago
    Sure, there has been evolution. Like the adaptation of white skin for humans in northern latitudes. Why was it so important to evolve pale skin for humans living in high latitudes? Social distancing in summer as a reason why people don't get sick is an interesting theory, any studies that support it?
- cwhiz 6y ago
  >Why do people tend to get sick in the wintertime and not the summer? There are lots of reasons for that. Vitamin-D is just one of those theories. There are also behavioral changes, such as people spending more time indoors and in sealed spaces. There is also the fact that certain viruses may survive better in colder, drier climates. There are also some theories that particles evaporate more quickly in the heat. Not to mention... humans started wearing closes about 100,000 years ago.
dlojudice 6y ago
"Pending results of such trials, it would seem uncontroversial to enthusiastically promote efforts to achieve reference nutrient intakes of vitamin D, which range from 400 IU/day in the UK to 600–800 IU/day in the USA. These are predicated on benefits of vitamin D for bone and muscle health, but there is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain." https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext https://www.thelancet.com/journals/landia/article/PIIS2213-8...
aplummer 6y ago
> The rapid increase of vitamin D levels in covid-19 infected patients with vitamin D deficiency (< 30ng/ml), as well as vitamin D supplementation for doctors, nursing staff and risk patients to a healthy blood level of 40-50ng/ml, is - in the authors' view - the only conceivable solution to effectively contain the corona pandemic. Research paper warning alarm sounding here.
- James_Henry 6y ago
  I don't know if this should really be considered a "research paper" even.
  - disgruntledphd2 6y ago
    This is a pretty poor article on an interesting topic.
nathwill 6y ago
the problem with vitamin D is there's a lot of confounders that D is a proxy for, particularly met-syn and old age, so until there's actual mechanistic descriptions for how D inhibits covid severity, i'm remaining cautiously-optimistic-bordering-on-skeptical about its curative powers.
KerryJones 6y ago
This isn't the first set of studies on Vitamin D3 and COVID-19, and very happy more is coming out that is supportive: http://agingbiotech.info/vitamindcovid19/ http://agingbiotech.info/vitamindcovid19/ Per Nicholas Taleb this is "optionality", very low risk and potentially very high reward.
hrasyid 6y ago
Is this a peer-reviewed finding? As someone without expertise in the area how do I evaluate its credibility?
- shock 6y ago
  How do you evaluate the credibility of anything in life? I'm not being facetious, it's a question I've been asking myself a lot lately after making decisions based on the information from a medical doctor, who, turns out, was not competent to make certain affirmations.
  - searchableguy 6y ago
    I have been asking that too. What steps should I take to verify information without becoming an expert in the field? What about more nuanced political topics?
- deckar01 6y ago
  It does not appear to have been peer reviewed. It is being hosted by a diet book author, which should be a red flag. The most reputable source they cite for correlating Vitamin D level with Covid-19 cases and deaths called the correlation "crude" [0]. It is a weak correlation. Their suggestion that there have been controlled studies on infected patients seems to be misleading. As far as I can tell from the sources they cited, none of them administered Vitamin D to Covid-19 patients. I think the trials they are citing were performed years ago on pneumonia patients, not on Covid-19 patients [1]. [0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202265/pdf/40520_2020_Article_1570.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202265/pdf/405... [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/pdf/main.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/pdf/mai...
- ColanR 6y ago
  There's other studies cited in this discussion. Those are peer-reviewed and do back up what the post is claiming.
tingletech 6y ago
Dr. John Campbell has a lot of videos about vitamin D and covid-19 -- here is one from last week https://www.youtube.com/watch?v=cv4iINxf4IM https://www.youtube.com/watch?v=cv4iINxf4IM
williesleg 6y ago
Please, if you plan on voting Biden, please stop taking any and all Vitamin D. The rest of you, pay attention to the science here.
archildress 6y ago
I think the findings are good and interesting but I wish we could dodge the politicized angle of this: "A lockdown would then be just as unnecessary as the justified fear of our elderly fellow citizens and the risk groups, which imposes an abnormal life on all of us."
macawfish 6y ago
I've been very frustrated in my attempts to raise this issue with the local health department where I live. I was brushed aside, and was told "correlation does not imply causation". I doubt that the person on the phone wanted to get into a conversation about dynamical systems or nonlinear data analysis, so I didn't even go there. Instead I sent a letter full of references to published research, and citing other letters (peer reviewed) urging public health officials to recommend safe levels of supplementation. I received 0 engagement. I should really send the letter every day until someone responds. Aside from all of the promising anecdotal evidence and population studies, there is plenty of established theory to understand just how Vitamin D might help lessen the load of Covid-19. Decades of published, reviewed research have shown that Vitamin D: - helps regulate calcium metabolism and ionization... disregulated calcium levels are also linked to poor covid outcomes - downregulates some of the same inflammatory cytokines involved in the positive feedback loops seen in bad covid cases - directly regulates the expression of ACE-2 genes - regulates the renin-angiotensin system - regulates circadian rhythm Other supplements that work with Vitamin D to help regulate calcium metabolism and ionization are also promising, including K2 and magnesium. https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v2 https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v... A friend of mine who's a doctor also told me that a lot of people with bad covid outcomes just have general electrolyte imbalances. To what degree is this pandemic just a manifestation of basic malnutrition on a massive scale? At this point, I've come to the conclusion that there is a systemic conflict of interest in many health systems around the world. It's most blatant in the US. Specifically: It seems that there are certain "neo-Malthusian" individuals high up in the chains of command who simply have no interest in implementing low risk, low cost measures that prevent loss of life, and instead use their power to further cater to the already privileged groups of people they deem fit for life. This goes beyond covid-19.
- y0ssar1an 6y ago
  In this case, the doctors really do know better. Vitamin D deficiency has been linked to just about every disease. That's because it's a marker of frailty, not a direct cause for most of these diseases. In other words, correlation does not imply causation. It sounds like you have too much confidence in published research and not enough confidence in your local health officials.
odysseus 6y ago
As I wrote at https://news.ycombinator.com/item?id=23025501 https://news.ycombinator.com/item?id=23025501 : 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.)
deleted 6y ago
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zaroth 6y ago
My wife just had a Vitamin D test which came at 15ng/mL, so we are chuckling right now that she is 100% going to die if she gets COVID. Dark humor aside, that is one hell of a chart. Really helps explain the huge drop in death rate over the summer. I must say it’s a bit of a missed opportunity to build up herd immunity while the sun is shining here in the northern hemisphere.
conorh 6y ago
I've mentioned this before, but my wife is a parathyroid surgeon (parathyroids are the glands that regulate the calcium in your neck) and would beg you to PLEASE monitor your calcium levels if you are supplementing with Vitamin D. She often sees patients on high doses of Vitamin D from well intentioned doctors, but with out of whack calcium levels because of it, and the patients can be very sick without understanding why. Often their doctors don't understand the processes either which is why they end up with her. I'll have her write a blog post about it at some point, but it is a real risk with possible severe long term consequences and she sees it a lot more often these days. She is getting her blog kicked off here (just yesterday actually) https://devaboone.com https://devaboone.com if you want to follow along.
- wpasc 6y ago
  Would you mind elaborating on what you mean by "wacky" levels? I can't tell from your comment if that means high or low. Asking as a Vitamin D supplement user who uses 2-3k IU a day
  - woko 6y ago
    Not a doctor, but I have had kidney stones. The answer is a loss of calcium, so high level found in urine test: if you had way too much vitamin D, then you would start releasing the calcium from your bones. I don't think that taking calcium supplements would help, because calcium metabolism (https://en.wikipedia.org/wiki/Calcium_metabolism https://en.wikipedia.org/wiki/Calcium_metabolism) is much more complex than that.
    - devaboone 6y ago
      Calcium metabolism is complicated, but there are a few things that are straightforward. 1. Vitamin D helps the intestines absorb calcium, so taking more Vitamin D can lead to more calcium being absorbed in your intestines, and thus more calcium in the blood. The excess calcium in your blood is caused by increased absorption from the intestines, not from bone release. (High calcium with parathyroid disease is caused by bone release, as well as increased intestinal absorption) 2. Taking calcium supplements along with Vitamin D will allow your intestines to absorb more of the calcium you are taking. 3. There are several reasons for having a lot of calcium in the urine. Primary hyperparathyroidism can do it, and in this case you will see high blood calcium levels also. If the blood calcium is low or normal (under 10.0 mg/dl), then you have another reason for high urine calcium.
ColanR 6y ago
Looks like this has been posted a lot on HN recently [0]. Previous Vitamin D & Covid-19 discussions that garnered some comments: https://news.ycombinator.com/item?id=23023703 https://news.ycombinator.com/item?id=23023703 https://news.ycombinator.com/item?id=22463713 https://news.ycombinator.com/item?id=22463713 https://news.ycombinator.com/item?id=23119949 https://news.ycombinator.com/item?id=23119949 https://news.ycombinator.com/item?id=23390264 https://news.ycombinator.com/item?id=23390264 https://news.ycombinator.com/item?id=23349962 https://news.ycombinator.com/item?id=23349962 https://news.ycombinator.com/item?id=23167802 https://news.ycombinator.com/item?id=23167802 https://news.ycombinator.com/item?id=23188675 https://news.ycombinator.com/item?id=23188675 https://news.ycombinator.com/item?id=23083619 https://news.ycombinator.com/item?id=23083619 https://news.ycombinator.com/item?id=22600685 https://news.ycombinator.com/item?id=22600685 [0] https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=true&query=vitamin%20d%20covid&sort=byPopularity&type=story https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=tru...
FreelanceX 6y ago
Would it be reasonable to hypothesize that, through lack of sun exposure and ensuing vitamin D deficiencies, lockdowns kill more people than they save? (that is, the increase in mortality would more than overcome the decrease in cases) We cannot know for sure of course, but is it unreasonable to even consider?
- amanaplanacanal 6y ago
  My state started locking down early, but at no time were people not allowed to go outside. Closing bars seems unlikely to contribute to vitamin D deficiency, for example.
  - FreelanceX 6y ago
    But strong lockdowns in which you're not allowed to walk outside unless you have a good reason happened in a lot of countries.
batrachom 6y ago
This article is (badly) written by un-qualified authors (two software developers). This would be enough to raise at least a few red flags on the conclusions drawn here. Has it even been peer reviewed? From a first look, there no way this work would have been published by any reputable journal. If there is any truth in what the authors claim, the best they could do is to work with field experts and/or submit their findings to a reputable journal for review and publishing. Someone's health might be on the line following pseudo-scientific works.
- cbsmith 6y ago
  Yeah, this seems to be mostly idle speculation than an actual study... and it ignores a preponderances of additional data (like, say... COVID-19 cases in the US).
- rtlfe 6y ago
  > This article is (badly) written by un-qualified authors (two software developers) Indeed the first sentence talks about "corona deaths." No qualified medical professional would write that in a paper.
  - unethical_ban 6y ago
    Is English their first language? .de and all.
- throwaway6000 6y ago
  The Harvard Gazette: Study confirms vitamin D protects against colds and flu https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm...
- kovach 6y ago
  Here is an old clinical practice guideline article (2011) from The Journal of Clinical Endocrinology & Metabolism talking about Vitamin D deficiency and recommendations for correcting it: https://academic.oup.com/jcem/article/96/7/1911/2833671 https://academic.oup.com/jcem/article/96/7/1911/2833671 You can see that prevalence of deficiency is very high, as this other peer-reviewed study confirms: https://pubmed.ncbi.nlm.nih.gov/21310306/ https://pubmed.ncbi.nlm.nih.gov/21310306/ In the first article, after correcting the deficiency, the maintenance dose that they give is: 600-1000 IU/d for children; 1500–2000 IU/d for adults; 3000–6000 IU/d for obese. As you can see that's much higher than the current RDA of 400 IU/d. And to correct the deficiency in the first place, the dose needs to be 2-3 times higher still for 8 weeks. So around half the people in the US need to be taking a very large dose for 8 weeks, and then a maintenance dose 4-15 times higher than the RDA. This is all from established studies done long ago that no one has disputed. But their recommendations have yet to be implemented in a lot of places, which might be why some countries fare better than others.
del_operator 6y ago
I’ve heard people talk in other offline conversations about COVID-19 induced hyper-coagulability. How much did that play a role in these cases?
deleted 6y ago
[deleted]
yelloworangefog 6y ago
People need to be really careful when sharing papers like these and repeating their conclusions without the appropriate disclaimers. That's always the case, and especially during a time when so many people are unable to consult their doctors and resorting to self-medicating based on hearsay and overconfidence in their own ability to interpret scientific papers. To be clear, I'm not saying vitamin D deficiency in relation to Covid mortality isn't a valid line of inquiry for the health community to take their research in. But from what I can tell, this is far outside the authors' areas of expertise. I'd say this kind of thing in particular has the potentially to be even more dangerous than irresponsibly discussing the effects of something like hydroxychloroquine, because so many people don't realize how dangerous vitamins and other such 'natural' remedies can be when taken without the supervision of a medical professional.
vinniejames 6y ago
"average age group of the 20 patients" == 60 years old Is 20 a high enough sample size for any meaningful conclusion from a study like this?
- throwaway6000 6y ago
  The Harvard Gazette: Study confirms vitamin D protects against colds and flu https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm... University of Colorado Anschutz Medical Campus: Vitamin D reduces respiratory infections https://www.sciencedaily.com/releases/2016/11/161116103005.htm https://www.sciencedaily.com/releases/2016/11/161116103005.h...
solumos 6y ago
> Vitamin D deficiency causes a 10 times higher death rate in Covid-19 patients according to recent studies. This is a hugely overstated conclusion - and none of the studies presented are able to make causal claims to back this up. This is a load of malarkey.
WhompingWindows 6y ago
If this work truly is very important, you will read about it from a reputable journal which properly vets this information. This isn't peer reviewed, it's just a website's PDF, there is no way to verify anything put onto this PDF.
- neilwilson 6y ago
  This reputable enough for you? https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext https://www.thelancet.com/journals/landia/article/PIIS2213-8...
  - WhompingWindows 6y ago
    I don't understand. The authors for your link are "Adrian R Martineau, Nita G Forouhi". The authors for the PDF of this thread are "Lorenz Borsche / Dr. Bernd Glauner".Were you trying to say others in the field are doing similar work? My point above was that posting a PDF online is not good enough in scientific circles. The charts themselves have a number of issues which I'd ask the authors, I don't know if they've properly adjusted for the risk factors and I'm not sure I agree with their choice of denominators.
thingamarobert 6y ago
I heard about this just the other day on an episode of the Radiolab podcast, if you're interested in listening to a nice narration to complement the article: https://www.wnycstudios.org/podcasts/radiolab/articles/invisible-allies https://www.wnycstudios.org/podcasts/radiolab/articles/invis...
gshotwell 6y ago
I've been maintaining a complete-ish repository of vitamin D covid research here: https://github.com/GShotwell/vitamin_d_covid https://github.com/GShotwell/vitamin_d_covid
kyuudou 6y ago
Something to consider when sunlight works and Vit D supplementation does not is how well your digestive tract is absorbing nutrients. Fast, food diaries, observe reactions especially on the skin.

360 points by black6 6y ago

ve55 6y ago

Although this is a notable finding it's important to remember that it doesn't lead to the conclusion that supplementing vitamin D will be very beneficial here. When vitamin D is produced in the body naturally via exposure to sunlight there's a huge amount of other things that occur as well, and we don't have a ton of good science to back up if curing a vitamin D deficiency via supplementation of pure vitamin D is really nearly the same as getting it naturally, which is a common problem for supplementing things and nutritional science and epidemiology in general. The extent that covid harms those that are metabolically unfit in many different ways much more than those that are perfectly healthy is still pretty under-discussed imo though, and this is yet another good data point in favor of it, even if Vitamin D is much more of a different proxy than some of the other large correlations we see with covid mortality.

graeme 6y ago
What about this section of the pdf? From a 2016 study on patients with other respiratory diseases. —————- High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial In the study, patients with vitamin D deficiency (<20ng/ml) were divided into three groups: A placebo group, and two groups that were given different doses of vitamin D. The single administration of 250,000 IU of vitamin D was compared with the single administration of 500,000 IU of vitamin D by injection. In addition, the vitamin D levels were increased to 45 and 55 ng/ml, respectively. While the length of stay of the placebo group at the ICU was 36 days, the 250,000 IU group averaged 25 days and the 500,000 IU group averaged 18 days. This is a smooth halving and means that vitamin D is useful not only in prevention but also in acute cases. https://www.sciencedirect.com/science/article/pii/S2214623716300084 https://www.sciencedirect.com/science/article/pii/S221462371... —————— Ah, the pdf has a second such study. Mortality almost half less —————— Intervention was carried out intramuscularly with 300,000 IU of vitamin D. Instead of 28 days only 18 days mechanical ventilation, instead of 29 only 19 on ICU, instead of 61% deaths only 36%. https://pubmed.ncbi.nlm.nih.gov/31531088/ https://pubmed.ncbi.nlm.nih.gov/31531088/
- ve55 6y ago
  I haven't seen that one, that looks pretty impressive, especially for administering it in a single dose that is that large. That's definitely a good data point in favor that some of it is direct causation though.
  - throwanem 6y ago
    31 total subjects, only 13 vitamin D deficient initially, p = 0.03. This study at best suggests further, more rigorous research here may be warranted. It says nothing about causation, for all that its authors seem to feel otherwise - and that they feel otherwise suggests its results should be taken with more than the usual amount of skepticism.
    - graeme 6y ago
      Have a look at table 1. Only 5/31 subjects had “sufficient” vitamin d. In between deficient and sufficient there is the insufficient category, from 20-30 ng/ml. Though I agree further study is warranted. The highest vitamin D group actually had the highest mortality after 84 days. Though this group also had the most pre-existing heart conditions by far, so that could account for it. Ah, there was a second such study in the pdf. Mortality down by almost half. —————— Intervention was carried out intramuscularly with 300,000 IU of vitamin D. Instead of 28 days only 18 days mechanical ventilation, instead of 29 only 19 on ICU, instead of 61% deaths only 36%. https://pubmed.ncbi.nlm.nih.gov/31531088/ https://pubmed.ncbi.nlm.nih.gov/31531088/
  - mtgx 6y ago
    More studies referenced here, also showing ~55 ng/ml being optimum for maximum health benefits. The current recommendations are way below that. Well worth to watch the whole video: https://youtu.be/v3pK0dccQ38?t=4105 https://youtu.be/v3pK0dccQ38?t=4105
- LegitShady 6y ago
  Those dosages are far higher than anyone supplementing vitamin d are likely to take.
xutopia 6y ago
The study showed that supplementing (though it was injection) to between "45 and 55 ng/ml" is "useful not only in prevention but also in acute cases". So yes... sunlight does probably way more benefits for us but supplementation if you are deficient is still showing significant effects.
- James_Henry 6y ago
  Just to be clear, the study that you are quoting isn't about Sars-Cov 2. This is a quote from a 2016 paper on other respiratory diseases.
  - James_Henry 6y ago
    And here is the quote in context, not that this isn't about Covid-19: "High dose vitamin D administration in ventilated intensive care unit patients: A pilot double blind randomized controlled trial In the study, patients with vitamin D deficiency (<20ng/ml) were divided into three groups: A placebo group, and two groups that were given different doses of vitamin D. The single administration of 250,000 IU of vitamin D was compared with the single administration of 500,000 IU of vitamin D by injection. In addition, the vitamin D levels were increased to 45 and 55 ng/ml, respectively. While the length of stay of the placebo group at the ICU was 36 days, the 250,000 IU group averaged 25 days and the 500,000 IU group averaged 18 days. This is a smooth halving and means that vitamin D is useful not only in prevention but also in acute cases."
BurningFrog 6y ago
Technically true, but you should still eat vitamin D supplements. It's very cheap and safe, so worst case it has less effect than you hope. You can overdose, but you have to really crazy with the dosage. Also 1: Vitamin D supplements do cure rickets. Also 2: All of us who eat supplements should show up in the stats as high in vitamin D, so the data does partially cover that case.
- zzz61831 6y ago
  It's not that safe, not like vitamin C safe. Especially not in doses sold in pills in pharmacies around the world.
  - newsbinator 6y ago
    I still can't figure out the safe + effective dosage of Vitamin D. I was taking 1,000mg a day and that didn't seem to move the needle on my Vitamin D blood work. In recent weeks I've been taking 4,000mg/day (with K2), which is 4x what I've had pharmacists recommend. I plan to keep that up for a couple more weeks while I'm under quarantine (recently flew from a high-risk country to a less high-risk country). After that I'll level off to 2,000mg a day. But I'm shooting in the dark. I have no idea if 2,000mg/day or 4,000mg/day is too much or not enough.
    - James_Henry 6y ago
      The safest way is to take an occasional test for your vitamin d levels. There are tests that you can take at home that aren't too expensive!
      - secabeen 6y ago
        Yep. I work inside a lot, so I started taking 5000IU of D a day. After two weeks, I had my levels tested and it showed a level of 37. When fall comes around, and I'm outside even less, I'll probably up the dosage for a week or two, then test again. Target is between 50 and 70, so I definitely need more.
sharpneli 6y ago
In Finland we put Vitamin D in milk that’s sold on normal shops. And taking a supplement is heavily recommended. Though this is mostly because for 6 months of a year one simply cannot get it the natural way (too cold and sun is too low). And thanks to this we don’t have much deficiency, long time ago we used to have. Not saying it means it would help with covid. But the supplements definitely help with deficiency in a way that does cure/prevent rickets.
- deleted 6y ago
  [deleted]
- graeme 6y ago
  You had a very limited coronavirus outbreak it seems. Does Norway have the same vitamin D supplementation policies? Their outbreak was similar in size to Finland’s. https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Finland https://en.wikipedia.org/wiki/COVID-19_pandemic_in_Finland Edit: Interestingly, the source pdf notes the nordic countries have higher D3 levels than Mediterranean countries. And speculates this may help explain lower incidence up north. ———— The researchers around Petre Cristian Ilie have tested the number of Covid-19 deaths per 1 million inhabitants against the vitamin D level in 20 European countries and come to the following conclusion: The mean vitamin D level in the countries studied (mean 22.4 ng/ml, StDev ±4.24) correlates strictly with the number of Covid-19 infected per million population (mean 295.95, StDev ±298.73, p=0.004) and with mortality (mean 5.96, StDev 15.13, p<0.00001) The death rates in Spain and Italy are much higher than in Scandinavia. The researchers explain this with the statistically significant higher vitamin D level among the inhabitants of the Nordic countries: The study shows that in older people, the average blood vitamin D level in Spain is 10.4 ng/ml, in Italy, 11.2 ng/ml, while in the Scandinavian countries it is 18 ng/ml. The northerners obviously do have the better vitamin D levels, although the sun is not as intense there as in the south. This could either be because they are more active outdoors or because they get more vitamin D from food, e.g. fish, or both. Fat sea fish contains a lot of vitamin D. And southerners tend to spend their midday hours in the shade or indoors. Shadow, window glass and a longer way through the atmosphere (morning/evening, autumn/spring) reduce UVB radiation much more than UVA.
  - 6y ago
mrfusion 6y ago
> When vitamin D is produced in the body naturally via exposure to sunlight there's a huge amount of other things that occur as well Any further reading on that? On the other hand worth supplementation you don’t get the harmful uv rays.
- nradov 6y ago
  There is no evidence that a brief daily exposure to UV rays is actually harmful in terms of all-cause mortality.
- glofish 6y ago
  UV rays should not be considered harmful de-facto! Overexposure to UV rays is what causes trouble. Slathering on the sunscreen even when not necessary (like walking from point A to point B, or spending 15 minutes outside, is what causes the predominant vitamin D deficiency in the first place.
  - James_Henry 6y ago
    Are you sure the "predominant vitamin D deficiency" isn't caused by the prevalence of metabolic syndrome?
nradov 6y ago
One effect of sunlight exposure is to stimulate production of nitric oxide, which lowers blood pressure. Hypertension is one of the most common comorbid conditions for COVID-19 deaths. I don't know if there's a causal relationship but it could be worth further research.
- disgruntledphd2 6y ago
  That's interesting. Do you have pointers to relevant research?
ColanR 6y ago
> Although this is a notable finding it's important to remember that it doesn't lead to the conclusion that supplementing vitamin D will be very beneficial here....we don't have a ton of good science to back up if curing a vitamin D deficiency via supplementation of pure vitamin D is really nearly the same as getting it naturally I don't know what you mean by 'a ton', but there is good evidence that Vitamin D supplements do provide much of the same benefit [0] [1]. > Ultraviolet radiation (either from artificial sources or from sunlight) reduces the incidence of viral respiratory infections, as does cod liver oil (which contains vitamin D). [0] https://pubmed.ncbi.nlm.nih.gov/16959053/ https://pubmed.ncbi.nlm.nih.gov/16959053/ [1] https://sci-hub.se/https://www.sciencedirect.com/science/article/abs/pii/S0306987709007634?via%3Dihub https://sci-hub.se/https://www.sciencedirect.com/science/art...
ntsplnkv2 6y ago
Personal anecdote - vitamin D supplements did absolutely nothing for my vitamin D levels. it wasn't until I committed to getting more sunlight that my levels increased.
- function_seven 6y ago
  What was your daily IU supplementation, and how long did you supplement before checking your levels again? I take 5000 IU daily, but also wonder if I'd do better with more sunlight instead.
  - ntsplnkv2 6y ago
    I was taking 50000 IU a week. Checked multiple times over periods of months.
    - AuryGlenz 6y ago
      Hey, someone like me. I was upped to that dose 2x a week and then 3x. Now my levels are up and holding.
ellyagg 6y ago
It's frustrating that when this comes up, this comment is always the top one, because it's not true. We have dozens of RCTs suggesting that vitamin D supplementation prevents respiratory infections[1]. There is a very good chance people could mitigate C19 risk with supplementation. And I personally trust the vast majority of people to use reasonable enough dosing that overdose is unlikely, especially with appropriate messaging. Downplaying the risks of low vitamin D (way more prevalent than vitmain D toxicity) seems as dangerous as the early pandemic messaging in the US that masks are ineffective. 1. https://www.bmj.com/content/356/bmj.i6583 https://www.bmj.com/content/356/bmj.i6583
- arkitaip 6y ago
  Dr. Rhonda Patrick on "Vitamin D may reduce susceptibility to COVID-19-associated lung injury": https://www.foundmyfitness.com/episodes/vitamin-d-covid-19 https://www.foundmyfitness.com/episodes/vitamin-d-covid-19
throwaway6000 6y ago
The Harvard Gazette: Study confirms vitamin D protects against colds and flu https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm... University of Colorado Anschutz Medical Campus: Vitamin D reduces respiratory infections https://www.sciencedaily.com/releases/2016/11/161116103005.htm https://www.sciencedaily.com/releases/2016/11/161116103005.h...

emdowling 6y ago

This conclusion (10x higher mortality if deficient in Vitamin D) is rather significant. How trustworthy is this source?

James_Henry 6y ago
Borsche and Glauner don't seem very trustworthy, but it is no secret that a vitamin D deficiency is correlated with higher mortality. The comorbidities that are associated with Covid-19 mortality are, pretty much, all correlated with vitamin D deficiency. The real question is, if someone is obese, or has diabetes, or has CKD, or is old, what is it that is making them more likely to die of Covid-19? Is it a vitamin D deficiency or some other related issue? and can supplemental vitamin D help? My guess is that it helps more than hurts to supplement vitamin D if you are deficient or insufficient. I'd also guess that it is no miracle cure like Borsche and Glauner seem to want people to think.
russfink 6y ago
From a technical writing style perspective, the thing going against this paper is the folksy way of writing. It also includes things called weasel words, such as saying very young doctor, versus young doctor, or even just doctor. The results are compelling, and I suppose it would not hurt to take a prophylaxis of vitamin D (5,000 units per the article?) as compared to a prophylaxis of something else, such as hydroxychloroquine (or Lysol!)
- black6 6y ago
  https://hcqtrial.com/ https://hcqtrial.com/ "...an extensive discussion of the differences between the death rates of New York City and Lagos, Nigeria, which both received infected travelers around the same time. NYC's high rate has been linked to population density, poverty, overcrowding, and ethnicity. Lagos is a crowded urban center of about 22 million people with 30 families often in a single building sharing the same bathroom, and none of the factors mentioned favor reduced death rates in Lagos. Lagos further has lower quality of medical care. Yet NYC had a death rate 600 times higher. The younger population can only account for a small part of this difference. Mitchell concludes that there is a crossover prophylactic effect of antimalarial agents against COVID-19."

aauchter 6y ago

Interesting but a there's a decent chance of correlation not causation. Unhealthy people and people over 65 (i.e. those most susceptible to serious COVID complications) are the same group that are most likely to be Vitamin D deficient. The primary source of Vitamin D is sunlight. People over 65 tend to stay indoors, etc. People with darker skin are also more prone to D deficiency due to increased melanin, but also have higher rates of obesity, more likely to suffer from diabetes, are more likely to live in cramped conditions, etc. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3447083/ https://www.cantonmercy.org/healthchat/42-percent-of-americans-are-vitamin-d-deficient/ https://www.cantonmercy.org/healthchat/42-percent-of-america... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6075634/

KerryJones 6y ago
There's a lot more data here that specifically tested about vitamin-D levels in early and late stages: http://agingbiotech.info/vitamindcovid19/ http://agingbiotech.info/vitamindcovid19/ I agree that causation hasn't been completely proven, but there's a lot of data to support it could be causative.
nostromo 6y ago
From the paper: > After correction for age, sex and previous illnesses, the risk of death is 10 times higher for people with vitamin D deficiency. That said, it could still be correlative and not causative with some different underlying health issue.
- wtetzner 6y ago
  > That said, it could still be correlative and not causative with some different underlying health issue. On the other hand, maybe Vitamin D deficiency is the cause or one the causes of those underlying health issues.

et2o 6y ago

Vitamin D has been endlessly promoted as a treatment for many diseases due to evidence from observational studies, but hundreds of millions of dollars in randomized controlled trials have never demonstrated it to be effective for any disease except rickets. There was just a large trial published in JAMA [1] examining its effectiveness for depression given solid observational data. It was not at all effective. The reason that Vitamin D is associated with many diseases but is not causative for anything is that Vitamin D level is highly correlated with other metrics of health such as socioeconomic status, active lifestyle, nutritional sufficiency, etc. We are wasting our time and money looking at Vitamin D again and again and again. 1. https://jamanetwork.com/journals/jama/article-abstract/2768978 https://jamanetwork.com/journals/jama/article-abstract/27689...

tekgnos 6y ago
This study used a tiny amount of Vitamin D (2,00IU/day) which is absolutely not enough Vitamin D to have any affect on someone who is deficient. Going outside in a swimsuit produces 10,000+IU equivalent. We evolved nude, outdoors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/
- AQuantized 6y ago
  It's not a tiny amount, probably about 40% of what most adults should be getting optimally, and significantly better than having almost no intake, which is the case for a lot of people who rarely go outside and don't eat any fatty fish.
  - tekgnos 6y ago
    That's fair. The RDA at 400 is tiny.
ericb 6y ago
Just because it doesn't cure one thing, we shouldn't consider it for others? Should we toss our antidepressants because they don't cure respiratory infections? I believe there's a plausible mechanism in this case, and related studies on respiratory infections where an effect was found. Also, in terms of studies, often the no effect data is from bolus doses, which don't seem to do a good job moving the needle.

MontagFTB 6y ago

Supplementing with vitamin D should be easy enough to test. Given that most people get their necessary vitamin D by going outside, couldn’t the presence/lack of this vitamin be an indicator of other lifestyle choices that may affect the person’s ability to fight off the disease?

James_Henry 6y ago
Sure, but a bigger confounder is probably that vitamin D deficiency is associated with metabolic syndrome, CKD, obesity, diabetes, etc. These may be, for some people, indicative of lifestyle choices as well, but those choices are, I'd guess, not the direct cause of a person's inability to survive the disease.

dirtyid 6y ago

Everyone should try a Vitamin D cycle if only to see if makes a big difference in daily life, especially if you live in area with sad winters. It's one of the few supplements that dramatically improves mood for those deficient or sensitive to large doses.

James_Henry 6y ago
Vitamin D tests aren't usually too expensive (as far as medical tests go), so it might be worth just getting tested rather than trying to see what difference it is making (which can be tricky if you are someone sensitive to the placebo effect or if the effect of vitamin D supplementation isn't immediate or what not).
- Jeriko 6y ago
  If you are trying to use it to treat mild depression specifically, a placebo effect is great! Placebo effects get a bad rap. If something improves your subjective quality of life that should be considered a win, especially for depression. Honestly the best thing vitamin D has going for it is being super inexpensive and safe. Because of that you can supplement vitamin D for almost any reason and expect to see at worst a very small cost (someone up thread said 3 cents a day, which seems in the ball park) and at best a significant subjective benefit (even if it's from a placebo effect).
  - James_Henry 6y ago
    Placebo effects can be great; they can mask underlying issues though. Also, if you actually have a vitamin D deficiency (or some other health issue), it could be good to know why. Perhaps your kidneys are having issues, for instance.
jcampbell1 6y ago
After having several kitesurfing vacations ruined by sunburns, I decided to just go to a tanning salon in the winter. It had a profound mood effect and respiratory effect almost immediately. Now I go a few times per month in winter regardless if I am going to the tropics. The UV does is completely metered. It may be a risky, but given that people that work outside have half the risk of melanoma as people who work indoors, I think regular low dose UV exposure may be a net positive even for cancer risk. Spending 5 minutes under UV lamps is a guaranteed way to get a huge dose reasonably safely, and you will know the effect almost immediately. The vitamin D seems to be maintained for 2-3 weeks after as well.

RosanaAnaDana 6y ago

I'm a simple person. I see two y or x axis on the same plot and I cast doubt.

tekgnos 6y ago

It is not surprising at all that Covid-19 matches what we already know about Vitamin D and Influenza. There are consequences for radically altering the environment in which humans evolved. We were nude outdoors and now we are clothed and indoors. When we do briefly go outside, we are all conditioned to slather on sunscreen, which blocks all Vitamin D generation. Why do people tend to get sick in the wintertime and not the summer? https://pubmed.ncbi.nlm.nih.gov/16959053/ https://pubmed.ncbi.nlm.nih.gov/16959053/

baix777 6y ago
Humans have being wearing clothes for about 170,000 years, indoors and outdoors, long enough for a evolutionary response. Along with fire, clothing is one of our great inventions and allows humans to live in colder climates than we could otherwise. We have, along with other creatures like lice, been evolving since we started wearing clothes. But why do people get more sick in the winter, when they are forced into close proximity with other people, making illness easier to spread, rather than the summer, when people are outdoors more, and can do things like walk to work in the warm summer sun rather than take the bus in the cold winter rain and snow? Stated differently, we naturally do more social distancing in the summer.
- tekgnos 6y ago
  Sure, there has been evolution. Like the adaptation of white skin for humans in northern latitudes. Why was it so important to evolve pale skin for humans living in high latitudes? Social distancing in summer as a reason why people don't get sick is an interesting theory, any studies that support it?
cwhiz 6y ago
>Why do people tend to get sick in the wintertime and not the summer? There are lots of reasons for that. Vitamin-D is just one of those theories. There are also behavioral changes, such as people spending more time indoors and in sealed spaces. There is also the fact that certain viruses may survive better in colder, drier climates. There are also some theories that particles evaporate more quickly in the heat. Not to mention... humans started wearing closes about 100,000 years ago.

dlojudice 6y ago

"Pending results of such trials, it would seem uncontroversial to enthusiastically promote efforts to achieve reference nutrient intakes of vitamin D, which range from 400 IU/day in the UK to 600–800 IU/day in the USA. These are predicated on benefits of vitamin D for bone and muscle health, but there is a chance that their implementation might also reduce the impact of COVID-19 in populations where vitamin D deficiency is prevalent; there is nothing to lose from their implementation, and potentially much to gain." https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext https://www.thelancet.com/journals/landia/article/PIIS2213-8...

aplummer 6y ago

> The rapid increase of vitamin D levels in covid-19 infected patients with vitamin D deficiency (< 30ng/ml), as well as vitamin D supplementation for doctors, nursing staff and risk patients to a healthy blood level of 40-50ng/ml, is - in the authors' view - the only conceivable solution to effectively contain the corona pandemic. Research paper warning alarm sounding here.

James_Henry 6y ago
I don't know if this should really be considered a "research paper" even.
- disgruntledphd2 6y ago
  This is a pretty poor article on an interesting topic.

nathwill 6y ago

the problem with vitamin D is there's a lot of confounders that D is a proxy for, particularly met-syn and old age, so until there's actual mechanistic descriptions for how D inhibits covid severity, i'm remaining cautiously-optimistic-bordering-on-skeptical about its curative powers.

KerryJones 6y ago

This isn't the first set of studies on Vitamin D3 and COVID-19, and very happy more is coming out that is supportive: http://agingbiotech.info/vitamindcovid19/ http://agingbiotech.info/vitamindcovid19/ Per Nicholas Taleb this is "optionality", very low risk and potentially very high reward.

hrasyid 6y ago

Is this a peer-reviewed finding? As someone without expertise in the area how do I evaluate its credibility?

shock 6y ago
How do you evaluate the credibility of anything in life? I'm not being facetious, it's a question I've been asking myself a lot lately after making decisions based on the information from a medical doctor, who, turns out, was not competent to make certain affirmations.
- searchableguy 6y ago
  I have been asking that too. What steps should I take to verify information without becoming an expert in the field? What about more nuanced political topics?
deckar01 6y ago
It does not appear to have been peer reviewed. It is being hosted by a diet book author, which should be a red flag. The most reputable source they cite for correlating Vitamin D level with Covid-19 cases and deaths called the correlation "crude" [0]. It is a weak correlation. Their suggestion that there have been controlled studies on infected patients seems to be misleading. As far as I can tell from the sources they cited, none of them administered Vitamin D to Covid-19 patients. I think the trials they are citing were performed years ago on pneumonia patients, not on Covid-19 patients [1]. [0]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202265/pdf/40520_2020_Article_1570.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7202265/pdf/405... [1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/pdf/main.pdf https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939707/pdf/mai...
ColanR 6y ago
There's other studies cited in this discussion. Those are peer-reviewed and do back up what the post is claiming.

tingletech 6y ago

Dr. John Campbell has a lot of videos about vitamin D and covid-19 -- here is one from last week https://www.youtube.com/watch?v=cv4iINxf4IM https://www.youtube.com/watch?v=cv4iINxf4IM

williesleg 6y ago

Please, if you plan on voting Biden, please stop taking any and all Vitamin D. The rest of you, pay attention to the science here.

archildress 6y ago

I think the findings are good and interesting but I wish we could dodge the politicized angle of this: "A lockdown would then be just as unnecessary as the justified fear of our elderly fellow citizens and the risk groups, which imposes an abnormal life on all of us."

macawfish 6y ago

I've been very frustrated in my attempts to raise this issue with the local health department where I live. I was brushed aside, and was told "correlation does not imply causation". I doubt that the person on the phone wanted to get into a conversation about dynamical systems or nonlinear data analysis, so I didn't even go there. Instead I sent a letter full of references to published research, and citing other letters (peer reviewed) urging public health officials to recommend safe levels of supplementation. I received 0 engagement. I should really send the letter every day until someone responds. Aside from all of the promising anecdotal evidence and population studies, there is plenty of established theory to understand just how Vitamin D might help lessen the load of Covid-19. Decades of published, reviewed research have shown that Vitamin D: - helps regulate calcium metabolism and ionization... disregulated calcium levels are also linked to poor covid outcomes - downregulates some of the same inflammatory cytokines involved in the positive feedback loops seen in bad covid cases - directly regulates the expression of ACE-2 genes - regulates the renin-angiotensin system - regulates circadian rhythm Other supplements that work with Vitamin D to help regulate calcium metabolism and ionization are also promising, including K2 and magnesium. https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v2 https://www.medrxiv.org/content/10.1101/2020.06.01.20112334v... A friend of mine who's a doctor also told me that a lot of people with bad covid outcomes just have general electrolyte imbalances. To what degree is this pandemic just a manifestation of basic malnutrition on a massive scale? At this point, I've come to the conclusion that there is a systemic conflict of interest in many health systems around the world. It's most blatant in the US. Specifically: It seems that there are certain "neo-Malthusian" individuals high up in the chains of command who simply have no interest in implementing low risk, low cost measures that prevent loss of life, and instead use their power to further cater to the already privileged groups of people they deem fit for life. This goes beyond covid-19.

y0ssar1an 6y ago
In this case, the doctors really do know better. Vitamin D deficiency has been linked to just about every disease. That's because it's a marker of frailty, not a direct cause for most of these diseases. In other words, correlation does not imply causation. It sounds like you have too much confidence in published research and not enough confidence in your local health officials.

odysseus 6y ago

As I wrote at https://news.ycombinator.com/item?id=23025501 https://news.ycombinator.com/item?id=23025501 : 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.)

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zaroth 6y ago

My wife just had a Vitamin D test which came at 15ng/mL, so we are chuckling right now that she is 100% going to die if she gets COVID. Dark humor aside, that is one hell of a chart. Really helps explain the huge drop in death rate over the summer. I must say it’s a bit of a missed opportunity to build up herd immunity while the sun is shining here in the northern hemisphere.

conorh 6y ago

I've mentioned this before, but my wife is a parathyroid surgeon (parathyroids are the glands that regulate the calcium in your neck) and would beg you to PLEASE monitor your calcium levels if you are supplementing with Vitamin D. She often sees patients on high doses of Vitamin D from well intentioned doctors, but with out of whack calcium levels because of it, and the patients can be very sick without understanding why. Often their doctors don't understand the processes either which is why they end up with her. I'll have her write a blog post about it at some point, but it is a real risk with possible severe long term consequences and she sees it a lot more often these days. She is getting her blog kicked off here (just yesterday actually) https://devaboone.com https://devaboone.com if you want to follow along.

wpasc 6y ago
Would you mind elaborating on what you mean by "wacky" levels? I can't tell from your comment if that means high or low. Asking as a Vitamin D supplement user who uses 2-3k IU a day
- woko 6y ago
  Not a doctor, but I have had kidney stones. The answer is a loss of calcium, so high level found in urine test: if you had way too much vitamin D, then you would start releasing the calcium from your bones. I don't think that taking calcium supplements would help, because calcium metabolism (https://en.wikipedia.org/wiki/Calcium_metabolism https://en.wikipedia.org/wiki/Calcium_metabolism) is much more complex than that.
  - devaboone 6y ago
    Calcium metabolism is complicated, but there are a few things that are straightforward. 1. Vitamin D helps the intestines absorb calcium, so taking more Vitamin D can lead to more calcium being absorbed in your intestines, and thus more calcium in the blood. The excess calcium in your blood is caused by increased absorption from the intestines, not from bone release. (High calcium with parathyroid disease is caused by bone release, as well as increased intestinal absorption) 2. Taking calcium supplements along with Vitamin D will allow your intestines to absorb more of the calcium you are taking. 3. There are several reasons for having a lot of calcium in the urine. Primary hyperparathyroidism can do it, and in this case you will see high blood calcium levels also. If the blood calcium is low or normal (under 10.0 mg/dl), then you have another reason for high urine calcium.

ColanR 6y ago

Looks like this has been posted a lot on HN recently [0]. Previous Vitamin D & Covid-19 discussions that garnered some comments: https://news.ycombinator.com/item?id=23023703 https://news.ycombinator.com/item?id=23023703 https://news.ycombinator.com/item?id=22463713 https://news.ycombinator.com/item?id=22463713 https://news.ycombinator.com/item?id=23119949 https://news.ycombinator.com/item?id=23119949 https://news.ycombinator.com/item?id=23390264 https://news.ycombinator.com/item?id=23390264 https://news.ycombinator.com/item?id=23349962 https://news.ycombinator.com/item?id=23349962 https://news.ycombinator.com/item?id=23167802 https://news.ycombinator.com/item?id=23167802 https://news.ycombinator.com/item?id=23188675 https://news.ycombinator.com/item?id=23188675 https://news.ycombinator.com/item?id=23083619 https://news.ycombinator.com/item?id=23083619 https://news.ycombinator.com/item?id=22600685 https://news.ycombinator.com/item?id=22600685 [0] https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=true&query=vitamin%20d%20covid&sort=byPopularity&type=story https://hn.algolia.com/?dateRange=pastYear&page=0&prefix=tru...

FreelanceX 6y ago

Would it be reasonable to hypothesize that, through lack of sun exposure and ensuing vitamin D deficiencies, lockdowns kill more people than they save? (that is, the increase in mortality would more than overcome the decrease in cases) We cannot know for sure of course, but is it unreasonable to even consider?

amanaplanacanal 6y ago
My state started locking down early, but at no time were people not allowed to go outside. Closing bars seems unlikely to contribute to vitamin D deficiency, for example.
- FreelanceX 6y ago
  But strong lockdowns in which you're not allowed to walk outside unless you have a good reason happened in a lot of countries.

batrachom 6y ago

This article is (badly) written by un-qualified authors (two software developers). This would be enough to raise at least a few red flags on the conclusions drawn here. Has it even been peer reviewed? From a first look, there no way this work would have been published by any reputable journal. If there is any truth in what the authors claim, the best they could do is to work with field experts and/or submit their findings to a reputable journal for review and publishing. Someone's health might be on the line following pseudo-scientific works.

cbsmith 6y ago
Yeah, this seems to be mostly idle speculation than an actual study... and it ignores a preponderances of additional data (like, say... COVID-19 cases in the US).
rtlfe 6y ago
> This article is (badly) written by un-qualified authors (two software developers) Indeed the first sentence talks about "corona deaths." No qualified medical professional would write that in a paper.
- unethical_ban 6y ago
  Is English their first language? .de and all.
throwaway6000 6y ago
The Harvard Gazette: Study confirms vitamin D protects against colds and flu https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm...
kovach 6y ago
Here is an old clinical practice guideline article (2011) from The Journal of Clinical Endocrinology & Metabolism talking about Vitamin D deficiency and recommendations for correcting it: https://academic.oup.com/jcem/article/96/7/1911/2833671 https://academic.oup.com/jcem/article/96/7/1911/2833671 You can see that prevalence of deficiency is very high, as this other peer-reviewed study confirms: https://pubmed.ncbi.nlm.nih.gov/21310306/ https://pubmed.ncbi.nlm.nih.gov/21310306/ In the first article, after correcting the deficiency, the maintenance dose that they give is: 600-1000 IU/d for children; 1500–2000 IU/d for adults; 3000–6000 IU/d for obese. As you can see that's much higher than the current RDA of 400 IU/d. And to correct the deficiency in the first place, the dose needs to be 2-3 times higher still for 8 weeks. So around half the people in the US need to be taking a very large dose for 8 weeks, and then a maintenance dose 4-15 times higher than the RDA. This is all from established studies done long ago that no one has disputed. But their recommendations have yet to be implemented in a lot of places, which might be why some countries fare better than others.

del_operator 6y ago

I’ve heard people talk in other offline conversations about COVID-19 induced hyper-coagulability. How much did that play a role in these cases?

deleted 6y ago

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yelloworangefog 6y ago

People need to be really careful when sharing papers like these and repeating their conclusions without the appropriate disclaimers. That's always the case, and especially during a time when so many people are unable to consult their doctors and resorting to self-medicating based on hearsay and overconfidence in their own ability to interpret scientific papers. To be clear, I'm not saying vitamin D deficiency in relation to Covid mortality isn't a valid line of inquiry for the health community to take their research in. But from what I can tell, this is far outside the authors' areas of expertise. I'd say this kind of thing in particular has the potentially to be even more dangerous than irresponsibly discussing the effects of something like hydroxychloroquine, because so many people don't realize how dangerous vitamins and other such 'natural' remedies can be when taken without the supervision of a medical professional.

vinniejames 6y ago

"average age group of the 20 patients" == 60 years old Is 20 a high enough sample size for any meaningful conclusion from a study like this?

throwaway6000 6y ago
The Harvard Gazette: Study confirms vitamin D protects against colds and flu https://news.harvard.edu/gazette/story/2017/02/study-confirms-vitamin-d-protects-against-cold-and-flu/ https://news.harvard.edu/gazette/story/2017/02/study-confirm... University of Colorado Anschutz Medical Campus: Vitamin D reduces respiratory infections https://www.sciencedaily.com/releases/2016/11/161116103005.htm https://www.sciencedaily.com/releases/2016/11/161116103005.h...

solumos 6y ago

> Vitamin D deficiency causes a 10 times higher death rate in Covid-19 patients according to recent studies. This is a hugely overstated conclusion - and none of the studies presented are able to make causal claims to back this up. This is a load of malarkey.

WhompingWindows 6y ago

If this work truly is very important, you will read about it from a reputable journal which properly vets this information. This isn't peer reviewed, it's just a website's PDF, there is no way to verify anything put onto this PDF.

neilwilson 6y ago
This reputable enough for you? https://www.thelancet.com/journals/landia/article/PIIS2213-8587(20)30268-0/fulltext https://www.thelancet.com/journals/landia/article/PIIS2213-8...
- WhompingWindows 6y ago
  I don't understand. The authors for your link are "Adrian R Martineau, Nita G Forouhi". The authors for the PDF of this thread are "Lorenz Borsche / Dr. Bernd Glauner".Were you trying to say others in the field are doing similar work? My point above was that posting a PDF online is not good enough in scientific circles. The charts themselves have a number of issues which I'd ask the authors, I don't know if they've properly adjusted for the risk factors and I'm not sure I agree with their choice of denominators.

thingamarobert 6y ago

I heard about this just the other day on an episode of the Radiolab podcast, if you're interested in listening to a nice narration to complement the article: https://www.wnycstudios.org/podcasts/radiolab/articles/invisible-allies https://www.wnycstudios.org/podcasts/radiolab/articles/invis...

gshotwell 6y ago

I've been maintaining a complete-ish repository of vitamin D covid research here: https://github.com/GShotwell/vitamin_d_covid https://github.com/GShotwell/vitamin_d_covid

kyuudou 6y ago

Something to consider when sunlight works and Vit D supplementation does not is how well your digestive tract is absorbing nutrients. Fast, food diaries, observe reactions especially on the skin.