Amid the rush to find effective treatments to counter Covid-19 attacks on the body, a recently published research paper has turned up a promising therapy. The active form of vitamin D, available by prescription as calcifediol, appears to significantly improve Covid-19 outcomes.
You probably learned in school that sunshine falling on the arms, shoulders, and legs builds up vitamin D levels in the body. Unfortunately, most of us don’t spend enough time in the sun for that to occur. Even if you are in the sun long enough, if you wear sunscreen or sunblock, vitamin D levels do not build up adequately. In California, the joke is that only lifeguards and farmworkers reach healthy vitamin D levels, and then only at the end of summer.
If you believe the 400 units of vitamin D you take in your multivitamin is doing the job, think again. Many of us need vitamin D supplements at doses that are considerably higher than those in a multivitamin to reach adequate D levels.
If you have diabetes, you are more likely to have a low vitamin D level. Moderate and severe deficiencies of vitamin D are widely prevalent worldwide. People with diabetes are especially affected. In the U.S. a 2012 Diabetic Medicine report regarding data from the 2001 to 2004 National Health and Nutrition Examination Survey found that 81% of adults with diabetes were deficient in vitamin D with levels below 30 ng/ml, the lower limit for normal.
Diabetes Increases Covid-19 Severity
A September 2020 study in Diabetologia found that having diabetes carries a 2.3 fold higher risk of death from Covid-19 (p = 0.001) after adjusting for age, sex, and other relevant comorbidities. Over one-third of the study’s participants were diagnosed with diabetes after being admitted into the hospital for Covid-19.
This study also found a 14% higher risk for death in those with higher glucose levels, regardless of whether someone had been diagnosed with diabetes or not (p <0 .001). Covid-19 damages beta cells that make insulin and causes more inflammation. This can raise glucose levels even without a diagnosis of diabetes.
Research evidence shows that having a low vitamin D level may increase the chance of getting Covid-19 and increase the risk for a more severe disease progression. Vitamin D regulates the immune system and the renin-angiotensin system. Both are critical determinants of the severity of a Covid-19 illness.
Essential to health, vitamin D plays multiple roles in regulating the immune system and assisting the body to overcome colds, infections, and viruses. One of D’s many active byproducts, called LL-39, helps disable viruses like Covid-19 and its relatives in the Coronavirus family by destroying a protective envelope that surrounds them.
Vitamin D directly regulates the inflammatory responses of the immune system. It does this by lowering pro-inflammatory cytokines and increasing anti-inflammatory cytokines. As vitamin D levels rise, inflammatory cytokines like interleukin 6 (IL-6) and inflammatory particles like C-reactive protein fall, while levels of anti-inflammatory IL-10 rise. Vitamin D’s actions counteract the excessive release of inflammatory cytokines or “cytokine storm” associated with more ICU admissions and deaths with Covid.
Reducing inflammation requires large doses of vitamin D given over several months. The ADA Diabetes Journal compared one group of 31 people with Type 2 diabetes and peripheral neuropathy who received 5,000 units of vitamin D once a week to 31 people given 40,000 units once a week. After 6 months, no changes in inflammatory levels occurred in the first group, receiving the equivalent of 700 units a day. Those getting 40,000 units a week, however, had much lower inflammatory IL-6 (p = 0.017) and much higher anti-inflammatory IL-10 (p = 0.014) levels. Interleukins are at least 11 cytokines that white blood cells release to either raise or reduce inflammation.
Interestingly in this study, better glucose control, measured by A1c, produced an identical response on inflammation by lowering IL-6 (p = 0.031) and raising IL-10 (p = 0.025).
As crucial as regulating the immune system is, vitamin D also regulates blood pressure through the renin-angiotensin system or RAS. Covid gains entry into cells by attaching to the angiotensin-converting enzyme 2 (ACE-2) on cell surfaces. When it does this, it raises levels of angiotensin II (Ang II). Ang II’s actions increase inflammation and blood pressure. On the other hand, vitamin D directly counters Ang II’s actions, lowering inflammation and blood pressure. In people with a D level below 25 ng/ml (less than 30 ng/ml is a deficiency), correcting this deficit significantly reduces systolic blood pressure by about 6 points and diastolic blood pressure by about 4 points.
A Faster, More Direct Way to Raise Vitamin D Levels and Lower Covid Severity
A well-conducted research study from Spain published late in August 2020, demonstrated significant benefit from calcifediol, a prescribed medication that is the active form of vitamin D. The researchers divided 76 people admitted to their hospital with a Covid-19 infection into a 2 to 1 random treatment protocol. Neither the researchers nor the patients knew who was getting the active treatment.
Shortly after being admitted, 50 people in the experimental group got high doses of calcifediol that more rapidly raised vitamin D levels in the body. The other 26 people received a placebo.
The experimental group received 0.532 mg calcifediol (equivalent to 100,000 units of vitamin D3) on their first day in the hospital, 0.266 mg (another 50,000 units) on the third and seventh day, and then weekly until discharge or admission to the ICU. Both groups received the hospital’s standard Covid protocol at that time with hydroxychloroquine, azithromycin, oxygen therapy, and more.
At the study’s end, 13 of the 26 placebo patients (50%) were admitted to the ICU, and two of them died. For those who got calcifediol, only one of the 50 people (2%) was admitted to the ICU, and none died. Calcifediol was used in this study because it is the active agent of vitamin D and requires no conversion in cells. It is more than three times as potent as vitamin D, more easily absorbs from the intestine, and more rapidly raises blood levels of vitamin D.
The authors concluded, “Our pilot study demonstrated that administration of a high dose of calcifediol…significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven Covid-19.” Although small, this study appears to have been very well conducted. More extensive confirmatory studies are needed.
A Boston University Study Agrees
In a September 2020 JAMA report, Boston University researchers measured vitamin D levels in 235 patients who were admitted to the hospital with COVID-19. They then followed them for clinical outcomes, including the severity of the infection, becoming unconscious, or having difficulty breathing resulting in hypoxia or death.
The researchers then compared outcomes between people who were vitamin D deficient to those who had a level of 30 ng/mL or more. Two-thirds of those admitted had a level below 30. Those with adequate D levels turned out to have a less severe course, less hypoxia, and lower CRP and lymphocyte levels. Among people older than 40 years, those with sufficient vitamin D were half as likely to die from Covid than those who were deficient.
A low vitamin D level even appears to raise the risk of catching Covid-19. A JAMA study looked at 489 people who had had their vitamin D level measured in the year before being tested for COVID-19. Those testing low in vitamin D turned out to be 1.77 times more likely to test positive for COVID-19 compared with those who had sufficient vitamin D.
In the winter months and at northern latitudes, people have lower vitamin D levels and more Covid infections. It is unclear how much of the increase in Covid and viral infections during the winter months might be attributed to a lack of social distancing or to a lack of vitamin D.
The risk of a severe outcome during a Covid infection rises when one has diabetes, excess weight, high blood pressure, cardiovascular disease, kidney disease, or is older. Is it only by chance that in each of these conditions vitamin D levels happen to be low? Anyone with one or more of these risks will want to exercise an abundance of caution to avoid getting this deadly virus and consider adding a vitamin D supplement to raise vitamin D levels.
Creating desirable levels of vitamin D is challenging. Therapy with supplements can take months to show optimal results. As mentioned, multivitamins typically supply 400 units of vitamin D daily. In adults, about 600,000 units spread over time are needed to bring a low level up to a healthy one.
To resupply vitamin D, adults can typically take 5,000 units a day or 30,000 units once a week for 4 months. Absorption is improved if D is taken with an oil like olive oil or a couple of fish oil capsules. After reaching desired levels, 2,000 units a day provide a good maintenance dose.
As you can see, it can take months and thousands of units of a D supplement to reach the desired levels needed to muster a combative response to Covid-19. Start a supplement now if you wish to raise your vitamin D level.
For a person deficient in vitamin D, doses of 5,000 to 6,000 units a day typically produce no side effects. Much larger amounts sometimes create issues. Massive doses of vitamin D can raise blood calcium levels. This may cause nausea, vomiting, constipation, loss of appetite, increased thirst, increased urination, mental or mood changes, or unusual tiredness.
If you want to know your vitamin D level, ask your physician for a test. If it is below 30 ng/dl, ask your doctor whether the vitamin D doses above are appropriate for you. This therapy is available over the counter without a prescription.
If you happen to get Covid-19, ask your doctor about a prescription for calcifediol to raise vitamin D levels quickly. A healthy vitamin D level strengthens the immune system and lowers the blood pressure to provide healthier outcomes.
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