The Lancet article in full

[diogenes]

I've pasted the article in here for people to read, in case accessibility is lost:

Interest in a potential role for vitamin D in the prevention or treatment of acute respiratory infections dates back to the 1930s, when cod liver oil was investigated as a means to reduce industrial absenteeism due to the common cold. Meta-analyses of randomised controlled trials conducted from 2007–20 reveal protective effects of vitamin D against acute respiratory infections, albeit these effects were of modest size and with substantial heterogeneity.1 The striking overlap between risk factors for severe COVID-19 and vitamin D deficiency, including obesity, older age, and Black or Asian ethnic origin, has led some researchers to hypothesise that vitamin D supplementation could hold promise as a preventive or therapeutic agent for COVID-19.

From a mechanistic angle, there are good reasons to postulate that vitamin D favourably modulates host responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), both in the early viraemic and later hyperinflammatory phases of COVID-19. Vitamin D metabolites have long been known to support innate antiviral effector mechanisms, including induction of antimicrobial peptides and autophagy. Laboratory data relating to effects of vitamin D on host responses to SARS-CoV-2 specifically are scarce, but one study that screened four compound libraries for antiviral activity has reported an inhibitory effect of the active vitamin D metabolite 1,25-dihydroxyvitamin D (the steroid hormone and biologically active vitamin D metabolite) in human nasal epithelial cells infected with SARS-CoV-2.2 Vitamin D has also been shown to regulate immunopathological inflammatory responses in the context of other respiratory infections. The finding that these effects were mediated via regulation of the renin-angiotensin system (RAS) in an animal model3 has particular relevance in the context of severe COVID-19, where overactivation of RAS associates with poor prognosis.

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Epidemiological studies investigating links between circulating levels of 25-hydroxyvitamin D (25[OH]D; the biomarker of vitamin D status) and incidence and severity of COVID-19 are currently limited in number. Two ecological studies have reported inverse correlations between national estimates of vitamin D status and COVID-19 incidence and mortality in European countries.4, 5 Lower circulating 25(OH)D concentrations have also been reported to associate with susceptibility to SARS-CoV-2 infection6 and COVID-19 severity.7 Recently, we have shown that airway diseases are associated with dysregulated vitamin D metabolism,8 raising the possibility that vitamin D deficiency might arise as a consequence of pulmonary inflammation. Prospective studies can provide insights into the potential for reverse causality, but results from those published to date are conflicting: one retrospective longitudinal study from Israel reported independent associations between low pre-pandemic 25(OH)D levels and subsequent incidence and severity of COVID-19,9 but an analogous study in the UK showed no such associations.10 Both of these studies are potentially limited by the use of historic 25(OH)D measurements, which might not reflect concentrations at the time of exposure to SARS-CoV-2. They are also open to residual and unmeasured confounding. Mendelian randomisation studies offer one approach to overcome these problems, but they need to be very large to detect small or moderate effects which might still be of clinical significance. In our view, well powered randomised controlled trials of vitamin D supplementation for the prevention and treatment of COVID-19 are now needed to test for causality.

A number of hospital-based treatment trials have been registered to date, but it may prove challenging to detect a signal for vitamin D supplementation in severe COVID-19 for two reasons. First, patients tend to present to hospital in the hyperinflammatory stage of the disease, so it might be too late for them to benefit from any antiviral effects induced by vitamin D supplementation. Second, it could be hard to show the effect of a micronutrient over and above dexamethasone, which has potent anti-inflammatory actions and now represents the standard of care in severe disease. Prevention of SARS-CoV-2 infection also represents an ambitious target, given the highly infectious nature of the pathogen. Perhaps the best hope for showing a clinical benefit lies in a population-based trial investigating prophylactic vitamin D supplementation as a means of attenuating the severity of incident COVID-19, to the extent that it is either asymptomatic or does not result in hospitalisation. The design of such a trial should be informed by findings of meta-analyses of randomised controlled trials of vitamin D to prevent other acute respiratory infections, which suggest that the intervention would work best when given in daily doses of 400–1000 IU to individuals with lower baseline vitamin D status.

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.

[Fruitandnutcase]

Thank you for that, confirms what so many of us knew about vitamin D.

There are so many conditions for you need a good level of vitamin D. It makes me cross when I think of the endo I saw who, when I asked for my Vit D to be tested, said he didn’t know why it was fashionable for his thyroid patients to be wanting their vitamin D tested and if I could bring him evidence there was ‘anything in it’ he’d test it for me!

At least the value of vitamin D seems to be recognised for those of us with osteoporosis.

[tattybogle]

Thankyou.

[Hidden]

A ‘lowly vitamin‘ recognised - who would a’thawt it (apart from many on this Forum who are taking it and seeing what a difference a D can make! ) It’s another ‘brick in the Covid wall’ knocked out 👏

[HughH]

daily doses of 400–1000 IU

There seems to be a lot of research on the benefits of Vitamin D and there was also a good Irish study recently. Unfortunately they all seem to use a much too low normal range and amounts to supplement.

There is a very good Canadian website: vitamindsociety.org/index.php

They recommend a daily supplement of 4,000IU and some other sites recommend 5,000IU

The following is from the Benefits tab on the website:

(interestingly the lowest vitamin D status was found in Australian Dermatologists!)

Vitamin D Health Benefits

Optimal Vitamin D levels (100 – 150 nmol/L) play a positive role in making sure that your body functions the way it was developed. There are Vitamin D Receptors (VDR) located in tissue throughout your body and in all the major organs. Vitamin D interacts with over 3,000 genes.

GrassrootsHealth - Scientists’ Call to D*action

The benefit of an adequate vitamin D level to each individual will be better overall health and a reduction of illnesses. In addition to rickets, bone disease and osteomalacia/osteoporosis, vitamin D insufficiency is associated with many other diseases including: tuberculosis, psoriasis, multiple sclerosis, inflammatory bowel disease, type-1 diabetes, high blood pressure, increased heart failure, myopathy, breast and other cancers. It is projected that the incidence of many of these diseases could be reduced by 20%-50% or more, if the occurrence of vitamin D deficiency and insufficiency were eradicated by increasing vitamin D intakes through increased UVB exposure, fortified foods or supplements.

Scientists’ Call to D*action, endorsed by over 40 vitamin D Scientists (2011)

grassrootshealth.net/epidemic

Michael F. Holick, Ph.D., M.D.

A summary of the health benefits and disease incidence prevention

that could be achieved by raising the public's vitamin D levels to 125 nmol/L:

Rickets, reduced by 100%

Osteomalacia, reduced by 100%

Cancers, all combined, reduced by 75%

Breast Cancer, reduced by 50%

Ovarian Cancer, reduced by 25%

Colon Cancer, reduced by 67%

Non-Hodgkins, reduced by 30%

Kidney Cancer, reduced by 67%

Endometrial Cancer, reduced by 35%

Type 1 Diabetes, reduced by 80%

Type 2 Diabetes, reduced by 50%

Fractures, all combined, reduced by 50%

Falls, women reduced by 72%

Multiple Sclerosis, reduced by 50%

Heart Attack, men, reduced by 50%

Peripheral Vascular Disease, reduced by 80%

preeclampsia reduced by 50%

Cesarean Section, reduced by 75%

Holick, Michael F., PhD., M.D., Boston University School of Medicine,

textbook - Physiology, Molecular Biology, and Clinical Applications

(2nd Ed 2010 Humana Press). Page 12

Dr. William Grant released a study in 2010 which estimated that if

Canadians raised their vitamin D blood levels to105 nmol/L it would

prevent 37,000 deaths and save $14B in associated healthcare costs.

Grant 2010 – An estimate of the economic burden and premature deaths due to vitamin D deficiency in Canada

Natural Levels of Vitamin D

Sunlight = Vitamin D: Humans make 90 percent of their vitamin D naturally through sun exposure to the skin (without sunscreen). In Canada‚ our northern climate means UVB levels in sunlight are too weak 4-6 months of the year to makeany vitamin D naturally.

What is the intended, natural level of vitamin D that the human body was designed to operate with?

Humans evolved in the horn of Africa, close to the Equator over 30,000 years ago. They spent their days out in the full sun, with no clothing, hunting and gathering food. Their skin pigment evolved and protected them from sun burns and allowed the production of vitamin D through the skin. Nature never intended for humans to live and work indoors, in cubicles, without sunshine exposure.

Non-Human Primates: 125 – 200 nmol/L

Vieth 2004 – Why the optimal requirement for Vitamin D3 is probably much higher than what is officially recommended for adults

Maasai and Hadzabe, Tanzania: 115 nmol/L

Luxwolda 2012 – Traditionally living populations in East Africa have a mean serum 25-hydroxyvitamin D concentration of 115 nmol/L

Outdoor Workers – Lifeguards: 163 nmol/L

Haddad 1971 – Competitive protein-binding radioassay for 25-hydroxycholecalciferol

Outdoor Workers – Puerto Rico Farmers:135 nmol/L

Haddock 1982 – 25(OH)D serum levels in normal Puerto Rican population and its subjects with tropical sprue and parathyroid disease

Outdoor Workers – Nebraska: 122 nmol/L

Barger-Lux, Heaney 2002 – Effects of above average summer sun exposure on serum 25-hydroxyvitamin D and calcium absorption

Indoor Tanners: 95 nmol/L

Schwalfenberg 2010 – Addressing vitamin D deficiency in Canada: A public health innovation whose time has come

Average Canadian: 68 nmol/L

Statistics Canada – Langlois 2010 – Vitamin D status of Canadians as measured in the 2007 to 2009 Canadian Health Measures Survey

Dermatologists: 35 nmol/L

Czarnecki 2009 – The vitamin D status of Australian Dermatologists

GrassrootsHealth and over 40 Vitamin D Scientists recommend achieving an optimal Vitamin D level for disease prevention of 100-150 nmol/L using a 25(OH)D blood test. This is the natural levels that the human body had as it evolved over thousands of years. Everyone should have their vitamin D 25(OH)D blood serum levels tested and make sure they are within these guidelines.

Sources of Vitamin D

UVB Exposure

Natural Sunlight – 10,000 – 20,000 IU per day, in summer, 10am – 2pm

Tanning Bed with UVB – 10,000 IU per session

Food

Salmon – fresh, wild, 3.5 oz – 400 – 1000 IU

Salmon – farmed, 3.5 oz – 100 - 250 IU

Fortified Milk – 8 oz – 100 IU

[Marz in reply to HughH]

Suggested on Grassroots Health that a treatment dose is based on the test result. For every 10 points below 60ng/L 1000 iu's of VitD is required. eg a result of 20ng/L would require a dose of 4000 iu's. Divide UK result by 2.5 to obtain ng/L measurement. UK GP's prescribe too little ...

[jimh111]

It seems vert sensible to keep our vitamin D levels up for general health as well as COVID-19. Studies so far tend to look at average vitamin D levels rather than COVID-19 mortality in subjects with vitamin D deficiency.

Not very scientific but countries like Vietnam, Indonesia and India seem to have very low mortality rates. This could be due to most of the population having lives that are led outside in the sunshine. It could also be due to more youthful demographics or lack of testing, a COVID-19 death cannot be recorded without a posistive test.

Rather than wait for definitve research I would encourage everyone to keep their vitamin D level up with prudent sun exposure, vitamin D rich diet and supplements.

[bookish]

Excellent thank you. Worth watching Dr Seheult on Med Cram (medcram.com) - Update 97: Vitamin D & COVID-19 Immunity, The Endothelium, & Deficiencies, for those of you who haven't seen it.

[penny]

Every now and again I read an article in a ‘daily’ which mentions vitamin D In relation to Covid-19 but the doses recommended are always way too low and there are dire warning of fatal consequences of taking too much vitamin D. Why is there not a recommendation for wholesale testing and supplementation? As low vitamin D levels are linked to cancer risk, MS, RA severity of Covid-19 and many more diseases, it seems so obvious that there should be general supplementation. I read a study (can’t remember where) that stated vitamin D supplementation was 90% more effective than a ‘flu. jab in preventing ‘flu..

I was lucky enough to see a private doctor in our local town some years ago who not only diagnosed my hypothyroidism but was also a proponent of vitamin D and I’ve been taking D3, K2 and magnesium ever since.

Dr Cicero Coimbra has been successfully treating MS, psoriasis and many autoimmune conditions with high levels of vitamin D for over 20 years, without known adverse side-effects; we’re talking 200,000iu per day. He thinks that most of the world is deficient in vitamin D.

[Marz in reply to penny]

Grassroots Health have good advice - mentioned in my post above 🌻