4 ms·

>That trial has several issues. Which are what? >It's been shown to not be helpful in severe cases. That's a fairly strong assertion! Stronger than, "there

>That trial has several issues. Which are what? >It's been shown to not be helpful in severe cases. That's a fairly strong assertion! Stronger than, "there is no evidence that is helpful in severe cases" for example. You wouldn't happen to have a reference to back it up by any chance? Anyway, I'm wondering why vitamin D is held to a higher standard than the polyclonal antibodies or Remdesivir. Where is the evidence that they're helpful in severe cases? By the way, I'm not advocating for long-term, high-dose consumption (say over 2000 IU) consumption of vitamin D. Deva Boone (devaboone) 's blog points out that this can lead to dangerously high calcium levels and has been covered on here several times recently [0][1]: >Eventually we worked out what happened with Shannon: In 2013 she was diagnosed with mild osteopenia, a thinning of the bones that can be a precursor to osteoporosis. Her Vitamin D was low at the time, so her physician started her on over-the-counter Vitamin D supplementation at 5000 international units (IUs) daily. Five years later, she was still on this dose, and her blood Vitamin D level had risen to 79 ng/ml. This level is within what many labs call the normal range, between 30 and 100 ng/ml, but levels above 70 are almost always a result of high dose supplementation, and I have seen toxicity with levels between 70 and 100 ng/ml. (A better “normal range” based on what I have seen would probably be between 30 and 60.) Vitamin D builds up over time, so the longer someone is on a high dose, the more likely she is to develop toxicity. Shannon’s calcium levels began rising in the fall of 2018, when her severe symptoms developed. What we should be doing now is mass-testing the at-risk population to identify those people with blood levels below 30 ng/ml and then do what is necessary to bring them up into the 30 to 40 ng/ml range. Ideally that could be done with sunlight, or food high in vitamin D - for example oily fish, liver, dried-shitake, ... But for the at risk demographic, in practice one would probably need moderately high-dose supplements, combined with monthly testing until they're above 30 ng/ml, followed by a switch to a lower-dose maintenance dose. [0] https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-story?postId=5f39453f8d01fe00170023fe https://www.devaboone.com/post/vitamin-d-part-2-shannon-s-st... [1] https://news.ycombinator.com/item?id=24261948 https://news.ycombinator.com/item?id=24261948

phobosanomaly 6y ago
To quote from Deva Boone's blog, which you cite: https://www.devaboone.com/post/vitamin-d-and-covid https://www.devaboone.com/post/vitamin-d-and-covid "Isn't there at least enough evidence at this point to recommend it for everyone with Covid? No, not really. There is suggestive evidence from a small pilot study. There is likely an effect, though we can't yet say how large that effect is. A few doses of high-dose Vitamin D are probably not going to hurt, but there are harms to massive doses of Vitamin D - and if we give it to everyone indiscriminately we will see more of those. Also remember that younger patients were excluded from the assessment of mortality risk in the third study - because no one under 40 died in their study, despite the fact that most of them were deficient in Vitamin D." It's complicated. There's a lot of nuance, and there's a very real likelihood that Vit D deficiency may just be a proxy for an unhealthy lifestyle.
- delhanty 6y ago
  >there's a very real likelihood that Vit D deficiency may just be a proxy for an unhealthy lifestyle Seriously! You think that it might be possible that vitamin D deficiency doesn't exist at all and that people used to get rickets because of an unhealthy lifestyle. You're kidding right ...? In case, it's not clear, I repeat: >By the way, I'm not advocating for long-term, high-dose consumption (say over 2000 IU) consumption of vitamin D. What I am advocating for is: >What we should be doing now is mass-testing the at-risk population to identify those people with blood levels below 30 ng/ml and then do what is necessary to bring them up into the 30 to 40 ng/ml range. ... Actually, I agree that the evidence for supplementation with vitamin D for general health, and improving all-cause mortality isn't there. That's why I wrote: >Ideally that could be done with sunlight, or food high in vitamin D - for example oily fish, liver, dried-shitake, ... But there's a sharp difference between the general health, then general respiratory disease, then COVID-19. As Deva Boone writes: >But maybe Covid is different. Covid is a respiratory infection, and in meta-analyses severe Vitamin D deficiency does appear to increase the risk of respiratory infections. We also have a plausible mechanism through which Vitamin D could influence Covid. ... OK, now you quote Deva Boone: >No, not really. There is suggestive evidence from a small pilot study. There is likely an effect, Her position is disputed here [0] in the HN comments by kovach devaboone >Here is what the article states: "Therefore, a multivariate logistic regression analysis was performed to adjust the model by possible confounding variables such as hypertension and type 2 diabetes mellitus for the probability of the admission to the Intensive Care Unit in patients with Calcifediol treatment vs Without Calcifediol treatment (odds ratio: 0.03 (95%CI: 0.003-0.25) (Table 3). The dependent variable considered was the need to be treated or not in ICU (dichotomous variable).) CI:-0.30 - 0.03 p:0.08." The statement is worded in a confusing way, but that is a non-significant p value. Of course we should not put too much into "statistical significance" but it is interesting to note. kovach >The only reason that p value is a bit high in that second multivariate analysis is because of the uncertainty of how much all the different risk factors like hypertension, T2DM, age >= 60 etc. affect ICU admission numbers. But even with those variables controlled, the 95% confidence interval is 0.003-0.25, which at worst is a 4-fold reduction in ICU risk. > >We should also note that the Calcifediol treatment group had 14 patients ≥ 60 years old, and the non-Calcifediol group had 5. So the study looks even better with that in mind... Another thing about this study, is that it's actually megadosing. IIRC, something like 100,000 IU on day 1, 50,000 IU on day 3. That's probably safe in the short-term in a hospital setting as devaboone states. But further more, it's probably necessary in the context of keeping COVID-19 patients out of the ICU. If they have COVID-19 because they're low in vitamin-D, then a 5000 IU capsule is probably not going to be enough. That's why I'm advocating to mass-test the at-risk population, and supplement until they're above 30 ng/ml. [0] https://news.ycombinator.com/item?id=24410547 https://news.ycombinator.com/item?id=24410547

phobosanomaly 6y ago

To quote from Deva Boone's blog, which you cite: https://www.devaboone.com/post/vitamin-d-and-covid https://www.devaboone.com/post/vitamin-d-and-covid "Isn't there at least enough evidence at this point to recommend it for everyone with Covid? No, not really. There is suggestive evidence from a small pilot study. There is likely an effect, though we can't yet say how large that effect is. A few doses of high-dose Vitamin D are probably not going to hurt, but there are harms to massive doses of Vitamin D - and if we give it to everyone indiscriminately we will see more of those. Also remember that younger patients were excluded from the assessment of mortality risk in the third study - because no one under 40 died in their study, despite the fact that most of them were deficient in Vitamin D." It's complicated. There's a lot of nuance, and there's a very real likelihood that Vit D deficiency may just be a proxy for an unhealthy lifestyle.

delhanty 6y ago
>there's a very real likelihood that Vit D deficiency may just be a proxy for an unhealthy lifestyle Seriously! You think that it might be possible that vitamin D deficiency doesn't exist at all and that people used to get rickets because of an unhealthy lifestyle. You're kidding right ...? In case, it's not clear, I repeat: >By the way, I'm not advocating for long-term, high-dose consumption (say over 2000 IU) consumption of vitamin D. What I am advocating for is: >What we should be doing now is mass-testing the at-risk population to identify those people with blood levels below 30 ng/ml and then do what is necessary to bring them up into the 30 to 40 ng/ml range. ... Actually, I agree that the evidence for supplementation with vitamin D for general health, and improving all-cause mortality isn't there. That's why I wrote: >Ideally that could be done with sunlight, or food high in vitamin D - for example oily fish, liver, dried-shitake, ... But there's a sharp difference between the general health, then general respiratory disease, then COVID-19. As Deva Boone writes: >But maybe Covid is different. Covid is a respiratory infection, and in meta-analyses severe Vitamin D deficiency does appear to increase the risk of respiratory infections. We also have a plausible mechanism through which Vitamin D could influence Covid. ... OK, now you quote Deva Boone: >No, not really. There is suggestive evidence from a small pilot study. There is likely an effect, Her position is disputed here [0] in the HN comments by kovach devaboone >Here is what the article states: "Therefore, a multivariate logistic regression analysis was performed to adjust the model by possible confounding variables such as hypertension and type 2 diabetes mellitus for the probability of the admission to the Intensive Care Unit in patients with Calcifediol treatment vs Without Calcifediol treatment (odds ratio: 0.03 (95%CI: 0.003-0.25) (Table 3). The dependent variable considered was the need to be treated or not in ICU (dichotomous variable).) CI:-0.30 - 0.03 p:0.08." The statement is worded in a confusing way, but that is a non-significant p value. Of course we should not put too much into "statistical significance" but it is interesting to note. kovach >The only reason that p value is a bit high in that second multivariate analysis is because of the uncertainty of how much all the different risk factors like hypertension, T2DM, age >= 60 etc. affect ICU admission numbers. But even with those variables controlled, the 95% confidence interval is 0.003-0.25, which at worst is a 4-fold reduction in ICU risk. > >We should also note that the Calcifediol treatment group had 14 patients ≥ 60 years old, and the non-Calcifediol group had 5. So the study looks even better with that in mind... Another thing about this study, is that it's actually megadosing. IIRC, something like 100,000 IU on day 1, 50,000 IU on day 3. That's probably safe in the short-term in a hospital setting as devaboone states. But further more, it's probably necessary in the context of keeping COVID-19 patients out of the ICU. If they have COVID-19 because they're low in vitamin-D, then a 5000 IU capsule is probably not going to be enough. That's why I'm advocating to mass-test the at-risk population, and supplement until they're above 30 ng/ml. [0] https://news.ycombinator.com/item?id=24410547 https://news.ycombinator.com/item?id=24410547