Vitamin D is part of the I-MASK+ Prevention & Early Outpatient Treatment Protocol for COVID-19 and MATH+ Hospital Treatment Protocol for COVID-19 of the Front Line COVID-19 Critical Care Alliance.
Several studies have shown that patients with Vitamin D deficiency develop severe COVID-19 in the form of cytokine storms.[1]
Cytokine storms manifest as Acute Respiratory Syndrome or ARDS, renal failure, abnormal blood clot formations, multi-system organ failure, shock, and death.
Once the cytokine storm starts, that’s when a serious conversation happens between the ICU doctor and the next of kin about intubation, dialysis, and the possibility of death.
Knowing that low vitamin D is crucial to COVID-19 survival, it is important to identify the population deficient in vitamin D.
People who are with deficient Vitamin D
- Black Americans – their dark skin prevents the absorption of vitamin D from sunlight
- Diabetics
- People with chronic liver disease- due to low production of vitamin D binding protein (DBP). DBP is essential to have normal levels of vitamin D.
- Chronic renal disease
- Cancer patients
- Patients with acute inflammation/infection
The deficiency is not limited to the above groups. It can also be seen in all age groups.
- In 34% of age ≥ 60 years old
- 22% of 20 years to 40 years old
- 21% of 40 years – 60 years old
According to a study from Boston University, [2]
COVID-19 patients with ’sufficient’ levels (30 ng/mL) of vitamin D were about 52% less likely to die after hospitalization, while rates of severe illness were about 13% lower in vitamin D-sufficient patients. They also noted that an estimated 42% of people suffer from vitamin D deficiency (<20 ng/mL), with a higher rate among the elderly
In contrast, there is a significant increase in Vitamin D levels during pregnancy and estrogen therapy. This mirrors the three times lower COVID-19 morbidity and mortality in females compared to males.
Why is that? Vitamin D is essential to the proper workings of the whole immune system.
How does vitamin D prevent severe COVID-19?
Vitamin D prevents severe COVID-19 by strengthening the innate and balancing the adaptive immune system.
There is a natural sequence in fighting infections., the innate immune system is the first line, and if needed, the adaptive immune system is called upon.
For any infection, an excellent innate immune system is essential. It is the first layer of protection not just against SARS-CoV-2 but also other viral, bacterial, fungal, and parasitic infections.
The adaptive immune system starts to work at the end of the innate immune system. Its function is to destroy the remaining pathogens and make a specific immune response in the form of antibodies and T-cells.
That way, if that pathogen shows up again, the adaptive immune system will be activated faster.
The adaptive immune system has a pro-inflammatory and inflammatory component. The pro-inflammatory works to fight the infection. The anti-inflammatory part contains the inflammation to prevent the adaptive immune system from destroying normal host cells.
Both anti and pro-inflammatory should be balanced. Too much anti-inflammatory and the pathogens win. Too much pro-inflammatory leads to an autoimmune response, destruction of host cells, and a cytokine storm.
That’s the gist of vitamin D’s effects on the immune system. The following is a bit technical, but I decided to include it to reflect the science. If you want, you can skip to the recommended doses of Vitamin D.
The Innate Immune System
The innate immune system is composed of physical barriers like the skin, the respiratory and gastrointestinal tract lining, and the endothelium, the inner lining of all blood vessels.
The macrophages, monocytes, dendritic cells, neutrophils, and mast cells are also part of the innate immune system.
Vitamin D stabilizes and strengthens the physical barriers and reduces the ability of SARS-COV-2 to infect them.
Vitamin D also enhances the immune response by producing several antimicrobial peptides like defensins, nuclear factor kappa beta (NFκβ), and cathelicidins with anti-bacterial, anti-viral, and anti-fungal properties.
NFκβ helps to produce defensins. Defensins disrupt the SARS-CoV-2 virus envelope that leads to its destruction.
Cathelicidins do the following:
- It attracts various immune cells to increase immune response (chemotaxis)
- Enhances macrophage phagocytosis
- Increases vascular permeability
- Activates B cells and T cells for proliferation
The effects of vitamin D on the innate immune system have been demonstrated to effectively prevent severe diseases with viruses like the rotavirus, dengue, the common cold, and influenza.
Vitamin D and the Adaptive Immunity
The adaptive immune system works after the innate system and starts about 7-10 days after the start of infection.
The macrophages initially phagocytose (eat) the viruses and present them to naive T cells to induce activation. The activated T-helper cells change into T helper 1 (Th1) or T-helper 2 (Th2) cells.
The Th1 response
When Th1 cells are activated, they activate macrophages by releasing interferon-gamma or IFN-γ. IFN-γ leads to the production of the following interleukins: IL-6, IL-1, IL-8, and transforming growth factor-beta or TGF-β.
TGF-β activates Th17 cells to secrete IL-17, IL-1, IL-6, IL-8, and IL-21. All of them are pro-inflammatory cytokines.
The Th2 response
The Th2 cell type immune response is anti-inflammatory and controls inflammation. A different set of interleukins are at play this time, like IL-4, IL-5, and IL-10.
IL-4 and IL-5 release antibodies towards the viruses, while IL-10 suppresses the activation of Th1 and the major histocompatibility complex II (MHC-II) in macrophages, thus reducing inflammation. IL-10 decreases the interaction between the macrophages and the naive T-cells.
The overall effect of the Th2 is the prevention of the over-activation of the adaptive immunity and thus prevent a cytokine storm.
If vitamin D is deficient, the change is skewed towards the Th1 formation, and excessive inflammation happens. That’s not good.
Usually, the immune response towards COVID-19 goes towards Th2; however, severe outcomes happen in 15-20% of COVID-19 patients who have Vitamin D deficiency.
Thus adequate amounts of vitamin D at 30ng/ml results in a controlled pro-inflammatory reaction and prevent a hyperimmune response.
What’s the recommended dose of Vitamin D?
Vitamin D intakes recommended by the Institute of Medicine and the Endocrine Practice Guidelines Committee [4]
| Life stage group | IOM recommendations
|
Committee recommendations for patients at risk for vitamin D deficiency
|
||||
|---|---|---|---|---|---|---|
| AI | EAR | RDA | UL | Daily requirement | UL | |
| Infants | ||||||
| 0 to 6 months | 400 IU (10 μg) | 1,000 IU (25 μg) | 400–1,000 IU | 2,000 IU | ||
| 6 to 12 months | 400 IU (10 μg) | 1,500 IU (38 μg) | 400–1,000 IU | 2,000 IU | ||
| Children | ||||||
| 1–3 yr | 400 IU (10 μg) | 600 IU (15 μg) | 2,500 IU (63 μg) | 600–1,000 IU | 4,000 IU | |
| 4–8 yr | 400 IU (10 μg) | 600 IU (15 μg) | 3,000 IU (75 μg) | 600–1,000 IU | 4,000 IU | |
| Males | ||||||
| 9–13 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 600–1,000 IU | 4,000 IU | |
| 14–18 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 600–1,000 IU | 4,000 IU | |
| 19–30 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| 31–50 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| 51–70 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| >70 yr | 400 IU (10 μg) | 800 IU (20 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| Females | ||||||
| 9–13 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 600–1,000 IU | 4,000 IU | |
| 14–18 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 600–1,000 IU | 4,000 IU | |
| 19–30 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| 31–50 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| 51–70 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| >70 yr | 400 IU (10 μg) | 800 IU (20 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| Pregnancy | ||||||
| 14–18 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 600–1,000 IU | 4,000 IU | |
| 19–30 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| 31–50 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| Lactationa | ||||||
| 14–18 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 600–1,000 IU | 4,000 IU | |
| 19–30 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
| 31–50 yr | 400 IU (10 μg) | 600 IU (15 μg) | 4,000 IU (100 μg) | 1,500–2,000 IU | 10,000 IU | |
Legend: AI, Adequate intake; EAR, estimated average requirement; UL, tolerable upper intake level.
Vitamin D is also good for other conditions/diseases
- Pregnancy outcomes
- Irritable Bowel syndrome
- Crohn’s disease
- Headaches
- Psoriasis
- Eczema
- Allergies
- Chronic Obstructive Lung Disease
- Asthma
- Non-alcoholic fatty liver
- Diabetes Mellitus
- Cardiovascular Disease
- Hypertension
- Hypercholesterolemia
- Rheumatoid Arthritis
- Benign Positional Vertigo (spinning sensation with head movement)
- Prevents Alzheimer’s disease and dementia
- Parkinson’s disease
- Autism spectrum disorder
- Executive functioning and cognitive Performance
- Weight control
- Frailty
- Cancer – colorectal, bladder, and breast
Vitamin D Toxicity
According to the Endocrine Society and the Institute of Medicine (IOM), vitamin D toxicity is extremely rare.
Vitamin D Sources
The sun – it’s free! The best is the midday sun for about 15-30 minutes. Sun exposure in the afternoon may put you at more risk for melanoma. [7]
Member’s Mark [Sam’s Club] Vitamin D-3 2000 IU – least expensive 0.03¢/count
Source Naturals Vitamin D-3 1,000 IU– lower dose – 0.06¢/count
Bronson Vitamin D3 10,000 IU (250 mcg)– only for severely depleted and under the guidance of a physician. Not for long-term use.
Knowledge about Covid-19 is rapidly evolving. Information may update as new studies are made. Stay current by subscribing. Feel free to share and like.
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Reference:
- Shah Alam M, Czajkowsky DM, Aminul Islam M, Ataur Rahman M. The role of vitamin D in reducing SARS-CoV-2 infection: An update. Int Immunopharmacol. 2021;97:107686. doi:10.1016/j.intimp.2021.107686
- Maghbooli Z., Sahraian M.A., Ebrahimi M., Pazoki M., Kafan S., Tabriz H.M., Hadadi A., Montazeri M., Nasiri M., Shirvani A. Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection. PLoS ONE. 2020;15(9)
- Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53-58. doi:10.1210/jc.2010-2704
- Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, Murad MH, Weaver CM; Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2011 Jul;96(7):1911-30. doi: 10.1210/jc.2011-0385. Epub 2011 Jun 6. Erratum in: J Clin Endocrinol Metab. 2011 Dec;96(12):3908. PMID: 21646368.
- McCullough P.J., Lehrer D.S., Amend J. Daily oral dosing of vitamin D3 using 5000 TO 50,000 international units a day in long-term hospitalized patients: Insights from a seven-year experience. The Journal of steroid biochemistry and molecular biology. 2019;189:228–239.
- Vitamin D Supplements Review from Consumerlab. (Needs membership)
- Moan J, Dahlback A, Porojnicu AC. At what time should one go out in the sun? Adv Exp Med Biol. 2008;624:86-8. doi: 10.1007/978-0-387-77574-6_7. PMID: 18348449.
Image credit: By DracoLumina17 – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=80132446
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