
Vitamin D Insufficiency is Prevalent in Severe Covid-19 - simonsarris
https://www.medrxiv.org/content/10.1101/2020.04.24.20075838v1
======
mindcrime
Interesting thing... Vitamin D is one of those things that, when vitamins come
up on HN, you will often hear the refrain that "it's the one vitamin that
large numbers of people are actually deficient in and ought to supplement."

I've heard that many times over the years and I have taken a Vitamin D
supplement on and off (more off than on) over the years.

When this COVID-19 thing first hit, I had a physical scheduled (by chance)
just about the same time, and I'd heard about this Vitamin D / COVID-19
connection, so when I went in for my physical, I asked my doctor to order a
Vitamin D test as part of my bloodwork.

As it turns out, I was indeed _very_ deficient in Vitamin D. I started taking
4000 IU a day and it's had a noticeable impact on my overall sense of
wellbeing. It _could_ , of course, be placebo effect even so. And I have no
particular reason to think that it will make any difference one way or the
other in terms of me getting COVID-19. But I thought it was worth pointing out
one more anecdote that suggests that the old "Vitamin D is worth
supplementing" refrain might just be true.

If you're in doubt, and it's an option, do what I did... just ask your doctor
to run a Vitamin D test next time you go in for a checkup / physical.

~~~
danenania
Does anyone know of a rule of thumb for how much time spent in direct sunlight
is equivalent to a Vitamin D supplement? Is an hour per day (on average)
sufficient?

~~~
mikedilger
I read Michael Holick's book (can't find it at the moment) he was the guy who
discovered the circulating form of vitamin D.. IIRC you get vitamin D from the
sun in rather large quantities. Just 15 minutes per day with only your face
and hands exposed with the sun up at 45 degrees or more will be enough. I'm
sure my data is not accurate, but it's in the ballpark. He has tables that
depend on how dark your skin is and what latitude you live at.

~~~
enitihas
Does one need exposure to direct sunlight, or sunlight coming via glass
windows works?

~~~
James_Henry
Glass windows block the part of the UV spectrum that is needed to make Vit D.

[https://www.nytimes.com/2019/02/08/well/live/does-
sunlight-t...](https://www.nytimes.com/2019/02/08/well/live/does-sunlight-
through-glass-provide-vitamin-d.html)

------
trott
It seems that the authors misunderstood the Boston study they are citing:

> In a Boston homeless shelter, 100% of 147 COVID-19 positive subjects were
> asymptomatic [3].

That study actually excluded N=15 symptomatic people:

> The original cases (N=15) were identified sequentially over a 5-day period,
> and each was expeditiously removed from the shelter population at the time
> of symptom recognition. These individuals predated the implementation of
> universal testing procedures and are excluded from this study.

So, it's rather unsurprising that 100% of the remaining people were
asymptomatic.

~~~
nostrebored
90% asymptomatic cases isn't surprising?

~~~
alexanderhorl
Yes it has been known for a while (a while in covid terms) that a larg number
has no symptoms.

------
gregwebs
This is a very weak study because it is retrospective: they just looked at
existing medical records. And they only found 20 COVID patients that had
vitamin D levels recorded. But the finding is compelling enough that we should
demand better studies.

Actually there already is a better study where they actually tested vitamin D
levels of many COVID patients [1]. It found vitamin D was strongly associated
with less severe outcomes:

> Only 26% of the cases had 25(OH)D in the normal range, and virtually all of
> them (86%) had a mild outcome. ... Just over a third (38%) had 25(OH)D in
> the insufficient range, and only one of them (1.3%) had a mild outcome. ...
> Just over a third (36%) had 25(OH)D in the deficient range, and their
> distribution was pushed further toward severe and critical outcomes. Only
> one patient (1.4%) had a mild outcome, while 26% had an ordinary outcome,
> 40% had a severe outcome, and 33% had a critical outcome.

Now we should demand a controlled trial where they actually give a vitamin D
intervention: this would provide causal evidence. However, avoiding vitamin D
deficiency is already very well studied and has so many benefits that I think
it is worth everyone's time and effort to do so.

Many people are advising high levels of vitamin D supplementation. However,
there is reason to not overdo it on vitamin D supplementation and take just
1700 IU/day (or to just get sunshine) [2]. Of course, getting your vitamin D
levels tested (with the help of by a doctor) is the safe way to go about this.

[1]
[https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484](https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3571484)

[2] [https://chrismasterjohnphd.com/covid-19/update-on-
vitamin-d-...](https://chrismasterjohnphd.com/covid-19/update-on-vitamin-d-
and-covid-19-using-the-first-observational-study-released)

------
kryogen1c
this doesnt pass the correlation vs causation smell test for me.

i suspect VID correlates well with COVID comorbidities, like a sedentary
lifestyle, hypertension, and weight problems. the opposite is also probably
true, that people with good vit D levels correlate with healthier lifestyles
and fewer comorbidities.

~~~
wcarss
This systematic meta-analysis paper[1] may be more convincing. The popular
youtube COVID-commentating Dr. John Campbell did a review of it about a month
ago[2] and has some good comments on the meaningful statistical power and
experiment design.

The overall takeaway is this: in people with Vitamin D deficiency (which is
very, very common), continuous daily supplementation can lead to up to a 70%
reduction in contracted viral respiratory infections. It has a smaller effect
the less deficient you are, and is not associated with any adverse effects.

1 -
[https://www.bmj.com/content/356/bmj.i6583](https://www.bmj.com/content/356/bmj.i6583)
2 -
[https://www.youtube.com/watch?v=W5yVGmfivAk](https://www.youtube.com/watch?v=W5yVGmfivAk)

------
simonsarris
I find this compelling:

> _Strikingly, 100% of ICU patients less than 75 years old had VDI_ [Vitamin D
> Insufficiency]

Since mid-March I've been trying to keep track of Vitamin D/Sunlight
suggestions and papers here:
[https://simonsarris.com/sunlight](https://simonsarris.com/sunlight)

~~~
virologist
But if someone is already in ICU doesn't it imply they have been on bed for a
while and not able to generate vitamin D?

~~~
ip26
_Breaking: 100% of ICU patients haven 't seen the sun in days_

It just doesn't have the same ring to it.

------
pjkundert
Relevant: vitamin D may actually be a marker of sunlight/UV deficiency (and a
deficiency of other beneficial light-produced artifacts):

[https://www.outsideonline.com/2380751/sunscreen-sun-
exposure...](https://www.outsideonline.com/2380751/sunscreen-sun-exposure-
skin-cancer-science)

~~~
mixmastamyk
Yes, though older folks can't produce it as well even if they get enough sun.
Latitude is another big factor.

------
BurningFrog
PSA: The darker your skin is, the more Vitamin D you need, either from
sunlight or food/supplements.

Pale skin is an evolutionary adaptation to harvest more sunlight to convert to
Vitamin D, from when humanity expanded to less sunny areas from Africa.

I'm a little shocked that doctors don't seem to tell black people this. My
"survey" is probably only 5 people, but still, people need to know.

~~~
HeyLaughingBoy
In recent years there's been some question about whether there is a link
between autism and Vitamin D deficiency in some African immigrants. Minnesota
has a large population of Somali immigrants (ISTR the largest population
outside Somalia itself) and in that community, autism has been nicknamed the
"Minnesota disease" because of how prevalent it has become in children of
immigrants.

[https://www.minnpost.com/politics-
policy/2008/07/mysterious-...](https://www.minnpost.com/politics-
policy/2008/07/mysterious-connection-autism-and-minneapolis-somali-children/)

It's an old article, but I haven't been able to find anything newer that isn't
based on the same study in 2008.

A similar "outbreak" was noted in Sweden.

------
qwerty456127
> In an Institutional Review Board approved study performed at a single,
> tertiary care academic medical center, the medical records of COVID-19
> patients were retrospectively reviewed. Subjects were included for whom
> serum 25-hydroxycholecalcifoerol (25OHD) levels were determined.
> COVID-19-relevant data were compiled and analyzed. We determined the
> frequency of VDI among COVID-19 patients to evaluate the likelihood of a
> VDI-COVID-19 relationship. Results: Twenty COVID-19 patients with serum
> 25OHD levels were identified; 65.0% required ICU admission.The VDI
> prevalence in ICU patients was 84.6%, vs. 57.1% in floor patients.
> Strikingly, 100% of ICU patients less than 75 years old had VDI.

Does this mean they have checked 20 people, 13 (65%) of them were severe and
all in the below-75 subset of these 13 people were deficient in vitamin D?
Doesn't seem credible to me, I'd prefer some hundreds of people from
completely different parts of the country.

By the way, isn't almost everybody deficient in vitamin D anyway? (see
doi:10.1101/2020.04.24.20075838)

~~~
joshgel
But they didn't even check the Vitamin D levels. They only checked patients
that had Vitamin D levels checked by physicians. So presumably this was a
different population that was more sick by definition, because their physicans
were checking them for Vitamin D deficiency. There aren't many good inpatient
indications for checking Vitamin D. It's check for not good reasons sometimes,
but most likely these patients were being followed by an outpatient doctor who
was looking for something to explain some symptom, test result or problem that
they were having.

------
semerda
Most of us are Vitamin D deficient. We do not spend enough time in direct
sunlight for an hour with all our limbs exposed.

I've been taking 5000 IU for last 10 years to maintain ~55 ng/mL after finding
out I was dangerously low at 12 ng/mL. And I used to live in Australia, the
land of constant sunshine.

I avoid listening to the FDA recommended dose which has historically been
increasing every few years. Just get your blood work done and supplement to
maintain around ~ 55 ng/mL. That's better than listening to generic advice.

Btw. This pissed me off when BlueShield few years ago stopped covering Vitamin
D blood tests because of this nonsense:

Most People Don't Need Vitamin D Testing [https://www.bcbs.com/news/press-
releases/most-people-dont-ne...](https://www.bcbs.com/news/press-
releases/most-people-dont-need-vitamin-d-testing)

"The U.S. Preventive Services Task Force recently found the current medical
evidence insufficient to assess the balance of benefits and harms of screening
for vitamin D deficiency in asymptomatic adults."

"The American Society of Clinical Pathology contributed the following
recommendation to Choosing Wisely®, “Many people have low levels of vitamin D,
but few have seriously low levels. Most of us don’t need a vitamin D test. We
just need to make simple changes so we get enough vitamin D.”"

------
pdx

        20 Patients in Study with COV19
          * 65% of them went to ICU (13 patients)
          * 35% of them did not (7 patients)
    
        Of the 13 Patients in the ICU 84.6% (11 patients) had VDI
        Of the 7 Patients not in ICU 57.4% (4 Patients) had VDI
    

Thin gruel indeed. But all they are saying is that it's perhaps worth doing a
real study. That's fair.

------
tbenst
They’ve also been sitting inside a hospital for who knows how long. They cite
another paper as saying ICU prevalence is 30-40%, but that’s an entirely
different patient population. There is no control

------
tannerbrockwell
If you get the test make sure it is the right one! 25 (OH) stays in the blood
longer, so this is the more accurate test. (half life of 3 weeks in your
blood). Many experts recommend a level of at least 30 ng/ml ... some actually
suggest that 50 ng/ml!

The scale on the test results is: Interpretive Data: Deficiency: <10 ng/mL
Insufficiency: 10 to 30 ng/mL Sufficiency: 30 to 100 ng/mL Toxicity: >100
ng/mL

"The majority of 25-OH vitamin D (25-D) in the circulation is derived from the
conversion of 7-dehydrocholesterol in the skin that is irradiated with
ultraviolet radiation in the UVB range (wavelength 290 nm to 315 nm).1-5 The
extent of vitamin D formation is not tightly controlled and depends primarily
on the duration and intensity of the UV irradiation. Levels produced typically
reach a plateau within 30 minutes of exposure." [1]

"Vitamin D insufficiency is more prevalent among African Americans (blacks)
than other Americans and, in North America, most young, healthy blacks do not
achieve optimal 25-hydroxyvitamin D [25(OH)D] concentrations at any time of
year." [2]

[1]: [https://www.labcorp.com/test-
menu/36721/vitamin-d-25-hydroxy...](https://www.labcorp.com/test-
menu/36721/vitamin-d-25-hydroxy#) [2]:
[https://www.ncbi.nlm.nih.gov/pubmed/16549493](https://www.ncbi.nlm.nih.gov/pubmed/16549493)

~~~
hollander
I think 80 is a better level. People living in Spain and similar regions, who
work outside most of the year, have levels up to 220 and they have no problems
with it. You should not pursue that value via supplements. Taking 2000IU or
4000IU daily is healthy, but go much higher for longer periods and you end up
with calcification of your bones. That's not reversible, and it might kill you
in the end.

~~~
tannerbrockwell
I posted the correct test and got down voted. The other Vitamin D test is not
accurate. If you ask for the test from your doctor, he has to specify the one
I linked. You can decide for yourself what level you want to target. The other
test is not accurate so you can't manage your levels...

------
oweqruiowe
I had a doctor tell me he sees women in burkas with higher levels of vitamin D
than me. IIRC it was like 5. Have taken 5000iu daily since :(

------
baryphonic
True story: my mom has plaque psoriasis and I was starting to develop symptoms
as well (the condition seems to be heritable). I saw a dermatologist about it,
and she prescribed a particular cream as well as doing 15 mins of UV therapy
every day on the affected areas (knees and elbows were the worst). I wasn't
the best at following medical advice at the time, but the cream helped some.

About a year and a half ago, I started taking vitamin D after my doctor told
me I was slightly deficient. Within two months, there was no indication of
plaques on my knees or elbows, and the little nodules that would appear on my
palmar surfaces on my hands and feet became much less frequent. I am convinced
that supplementing vitamin D was much more effective than any cream, and
definitely less obnoxious than holding my knees and elbows to the sun at an
open window on a sunny day. When I get outside frequently, I notice that
basically all of my symptoms go away.

Long story short, take your vitamin D! Consult a doctor and don't take too
much, since it's fat soluble and can build up to toxic levels in your system;
also, since it is fat soluble, make sure your diet has enough good fats to
help absorb it (guacamole and olive oil are two of my favorite supplementary
foods with vitamin D).

~~~
corpMaverick
I've got great results on using vitamin D for cluster headaches.
[https://n.neurology.org/content/82/10_Supplement/P1.256](https://n.neurology.org/content/82/10_Supplement/P1.256)

------
cogman10
Does make me wonder how much of this is VDI and how much of this is the
general population having VDI.

~~~
simonsarris
There are other papers that argue similar. On April 20, _Alimentary
Pharmacology and Therapeutics: low population mortality from COVID‐19 in
countries south of latitude 35 degrees North supports vitamin D as a factor
determining severity_

[https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777](https://onlinelibrary.wiley.com/doi/full/10.1111/apt.15777)

It also notes:

> It could be argued that the virus spread later to the Southern Hemisphere
> and that countries there are simply behind those in the Northern Hemisphere
> but as time goes by this argument looks increasingly weak.

------
MattSteelblade
I think it's worth pointing out the conclusion in their abstract and what the
authors are trying to accomplish: "...we suggest that prospective, randomized
controlled studies of VDI in COVID-19 patients are warranted."

~~~
korethr
The alt-text of xkcd 552 comes to mind: "Correlation doesn't imply causation,
but it does waggle its eyebrows suggestively and gesture furtively while
mouthing 'look over there'."

------
crazygringo
I don't doubt this at all.

But at the same time, isn't it suspected that vitamin D insufficiency is
linked with a worse immune system generally?

(Anecdotally it made a big difference for me not getting winter colds ever
since my doctor pointed out I had a significant wintertime deficiency and I
started supplementing.)

In other words, there's unlikely to be any unique link between vitamin D and
COVID-19. That this just falls in the wide bucket of "unhealthier people are
more affected by COVID-19", similar to obesity.

------
korethr
Interesting.

Okay, let's play with this. Let us extrapolate from the strong correlation
found by this retrospective review, and postulate that Vitamin D Insufficiency
(VDI) is indeed a major contributing factor in either the severity of a
COVID-19 infection, or the chances of contracting it. (I am not claiming this
is indeed true, correlation != causation, but I think strong correlations are
certainly worth looking at and playing with).

It is my observation that in my local area, the shelter-in-place order has
resulted in more people spending more of their time indoors and not going
outside as much. The park in my neighborhood is empty. I see less people on
the bike trails visible from the roads I take to the grocery store. A nature
park 20 minutes from my house, the kind that people go to to get out of the
city and the hell away from other people, is closed with COVID-19 as the
justification and scary signs threatening fines posted at all the entrances.
And so on.

With less people getting outside, and less often, that means more people are
getting less sun exposure, and less vitamin D. Assuming that their diets
aren't changing to make up for that, that means more people with VDI, and
those already with VDI getting worse. As such, if VDI will make it easier to
catch COVID, or make the symptoms worse once caught, I can't help but wonder
if these shelter-in-place orders intended to slow the spread won't end up
shooting us in the foot, setting us up for a 2nd wave more brutal than had
people been encouraged and incentivized to get outside more.

I really hope I'm wrong about that.

~~~
Angostura
Vitamin D is the only vitamin that the UK’s NHS recommends most people take -
usually they recommend during winter. With the Covid lockdown they have
extended the advice to say keep taking it.

------
adatavizguy
Linus Pauling really messed this one up. He went for the C but really wanted
the D.

------
Izkata
Lots of people have been claiming that the currently-summer countries haven't
gotten as hard hit. Their reasoning has been that the extra UV is killing the
virus.

I wonder if they were correct, but for the wrong reasons. Vitamin D in humans
primarily comes from a chemical reaction with sunlight in the skin. Maybe
there's an indirect effect there that explains what they were seeing?

~~~
kijin
Vitamin D could also be a factor in the general, well-established trend of
cold and flu being more prevalent in the winter.

------
uberduber
I've been sick for almost ten years and had low vitamin D levels. Last two
years I've finally found some treatments that work for me, now that I'm
healthier my vitamin D level has gone up to about 40 even though I rarely go
outside and don't supplement. It's typically 5 without supplementation.

Previously, I tried supplementing with 10,000IU daily, didn't help me feel any
better and took a long time to get my levels up. Doctor even told me to lie
outside in a bikini every day in the sun and not to burn myself. My doc's
theory is that some process in sick people uses up their vitamin D and
calcium, and that's what needs to be stopped. He says he has seen patients
with Vitamin D deficiency where they are cured with supplementation and/or
sun, but it's not very common. It's cheap, easy, and harmless enough though to
try before moving on to other things.

------
gumby
Nobody really knows what the “normal” level of Vit D is. My baseline level is
lower than that of my white-skinned father and higher than that of my darker-
skinned mother. Does he have too much? Certainly we all live at a latitude
higher than where her ancestors lived and lower than where his did. Which of
us has a “normal” level?

Outside extreme deficiencies though, I’m not sure that the band isn’t
relatively large. _But_ it is documented that D supplements for people with
low levels of D does seem to reduce the incidence of pulmonary infections in
general. There was a good paper on the subject published last December in
Lancet (IIRC — i failed to save it in Zotero). So even before COVID-19 became
a concern I upped my daily dose.

------
suthakamal
Lots (most) people of colour are below their threshold of "VDI" (vitamin D
insufficiency) and perfectly healthy.

The fact that the study doesn't talk about base rates for ethnicities is
pretty "striking" (to use a word they breathlessly, and wrongly, use).

~~~
gridlockd
I would argue that they are _not_ perfectly healthy. Non-severe Vitamin D
deficiency has no acute effects, but lifetime risk for developing severe
illness does go up.

------
wisdomdata
Does anyone else see the irony of herding people off beaches to protect them
from covid-19?

~~~
EricE
When you have Karen’s instead of real leaders in charge....

------
odysseus
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.)

~~~
noway421
This app seems amazing! Can't figure it out, does it send me a push
notification of when to sunbath?

~~~
odysseus
Yes, if you want it to. Looking at my notifications screen in the app, it can
notify about "D Window Events", and you can even specify the minimum angle of
interest.

It can also notify upon solar noon, sunrise and sunset (not the same as a D
window of opportunity), and give a daily supplement reminder. Each of these is
individually configurable.

------
open-source-ux
Interesting...in the UK, the NHS (National Health Service) recommendation is
for adults to take a 10mcg (micrograms) vitamin D supplement daily (10mcg =
400IU). This advice was issued in 2016 after a science advisory body
(Scientific Advisory Committee on Nutrition) published a 300 page report of
the evidence on vitamin D and health. [1][2]

The NHS also say more recently in response to the lockdown [3]:

 _Consider taking 10 micrograms of vitamin D a day to keep your bones and
muscles healthy.

This is because you may not be getting enough vitamin D from sunlight if
you’re indoors most of the day.

There have been some news reports about vitamin D reducing the risk of
coronavirus. However, there is no evidence that this is the case.

Do not buy more vitamin D than you need._

They also warn:

 _Taking too many vitamin D supplements over a long period of time can cause
too much calcium to build up in the body (hypercalcaemia). This can weaken the
bones and damage the kidneys and the heart.

If you choose to take vitamin D supplements, 10 micrograms a day will be
enough for most people.

Do not take more than 100 micrograms of vitamin D a day as it could be
harmful. This applies to adults, including pregnant and breastfeeding women
and the elderly, and children aged 11 to 17 years._

[1] Vitamin D and Health [PDF]
[https://www.gov.uk/government/uploads/system/uploads/attachm...](https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/537616/SACN_Vitamin_D_and_Health_report.pdf)

[2] The new guidelines on vitamin D – what you need to know:
[https://www.nhs.uk/news/food-and-diet/the-new-guidelines-
on-...](https://www.nhs.uk/news/food-and-diet/the-new-guidelines-on-vitamin-d-
what-you-need-to-know/)

[3] Vitamin D: [https://www.nhs.uk/conditions/vitamins-and-
minerals/vitamin-...](https://www.nhs.uk/conditions/vitamins-and-
minerals/vitamin-d/)

------
ccleve
From a few days ago:
[https://news.ycombinator.com/item?id=23086211](https://news.ycombinator.com/item?id=23086211)

There is strong evidence that Vitamin D does nothing. Large scale studies of
vitamin D supplements show no benefit.

The article above argues that it is actually sun exposure that brings health
benefits, and that vitamin D is just a byproduct. This makes sense. If vitamin
D levels are strongly correlated with good health, it doesn't mean that it
causes it. There might be some third factor.

------
tdeck
Question for those more knowledgeable: From the abstract it doesn't seem like
they compared this group with other people in the ICU - could the lack of sun
exposure for that population play a role? ICU patients with COVID-19 have
likely gone from sheltering in place at home to experiencing symptoms that
make them unlikely to venture outside to the hospital where they can't leave,
all of which means less exposure to the sun. Is a few weeks of staying indoors
enough to cause this?

------
TurboHaskal
Note that some doctors are clueless and diagnose a deficiency of vitamin D
based on just one metabolite. Test for both, and don't damage yourself with
excessive supplementation.

~~~
tarruda
It seems difficult to reach excess vitamin D levels though. From [1]: "Taking
60,000 international units (IU) a day of vitamin D for several months has been
shown to cause toxicity. This level is many times higher than the U.S.
Recommended Dietary Allowance (RDA) for most adults of 600 IU of vitamin D a
day."

5000-7000 IU per day is probably a safe amount, despite the official
recommended daily intake being 600 IU.

[1]: [https://www.mayoclinic.org/healthy-lifestyle/nutrition-
and-h...](https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-
eating/expert-answers/vitamin-d-toxicity/faq-20058108)

------
davidw
So what's the ideal amount of sun exposure to produce enough for a white guy
at 45 north? Is there anywhere reputable that calculates this kind of thing?

~~~
hollander
You can read up on it in the book by Dr Holick. He recommends 4000IU daily,
but if you're afraid that's too much, go with 2000IU/day. I take 4000IU daily
since several years. Get a test before you start, so you have a base value.
Test again after a month or two maybe three, and see what the change is.

With sun exposure, the book recommends the following. Go sit in the sun on a
sunny day, until you get a mild rose burn. How long does that take? Divide
that time over a week, and you're safe. This rose-burn time depends on the
time of year, how high is the sun in the skye? How clear is the skye? What is
the time of the day? So this value changes a lot for people in norther Europe,
compared to people living in Africa.

~~~
chrononaut
> Get a test before you start, so you have a base value. Test again after a
> month or two maybe three, and see what the change is.

This is sound advice, but isn't there a chicken and egg problem right now?
We're in a significant part of the pandemic, which I would imagine
(assumption) that "routine" tests such as that may not be easy to come by.
While at the same time there is notable evidence that VDI is prevalent in
severe cases. By the time you get an answer to know the base line, it seems
like it would be largely too late to make a possible difference in the short
term?

Is there a "safe" amount you could increase it without knowing your base line?

------
JoeAltmaier
Its not clear they compared to any control group?

~~~
simonsarris
It's not a study, you can't have a control group in a retrospective review,
you can only sort data from the data set. You can complain about the small N,
though.

> Among ICU subjects, 11 (84.6%) had VDI, vs. 4 (57.1%) of floor subjects.
> Strikingly, 100% of ICU patients less than 75 years old had VDI (n=11; Table
> 2).

~~~
JoeAltmaier
I guess I was really wondering about confounding variables. That quoted line
makes it clear: 100% is pretty damning.

------
innomatics
So VDI is prevalent in the severe disease, but it's also prevalant in the
general population.

Numbers in the study are very low and no significant correlation was found.

Lots of interesting postulation in the discussion. Could be worth looking at
in a larger study.

Now cue the press stories, and panic buying...

------
jonny_eh
Could this explain why the pandemic seems to be worse in NY compared to
California and Florida?

~~~
bagacrap
I think that's about public transit vs automobile usage

~~~
jonny_eh
SF public transit usage is high. Also, the burrow hit hardest in NY is Staten
Island, which is very car heavy.

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dontbenebby
Is there any evidence multivitamins are _harmful_ (not just that there's no
proof they help improve health?)

It's because of stuff like this I take one. Maybe I'm wasting money, but
absent a harm I feel it's worth it to hedge my bets.

~~~
0xebfc
Certain vitamins and minerals. Fat soluble vitamins can build up to the point
of causing problems. Excess of iron and magnesium may have negative effect
AFAIK.

~~~
elric
For most people, excess magnesium levels would be pretty hard to reach. Unless
you count loose stools as harmful, which some forms of magnesium supplements
can cause.

Combining calcium and vitamin D can be seriously problematic. And high doses
of calcium in general can make you more likely to end up with kidney stones --
those are not fun to pass!

Some supplements can even compete with each other for absorption (calcium &
magnesium come to mind), so taking them together in a multivitamin is probably
not the way to go.

------
massaman_yams
Interesting conclusions, but small sample size: N=20.

Vitamin D at normal doses is quite safe, though, so I'll be supplementing my
intake now even if broader long-term study shows this to be ineffective for
C19.

------
xhruso00
Advice: Get some sun exposure and better food instead of supplements.

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sabujp
i loaded up on a bottle of costco vitamins and d3 supplement before we went on
lockdown. There seems to be something in the multivitamins that i'm allergic
to in high quantities, i.e. after taking them for 3-4 days straight I'll start
getting hives. I reduced consumption to 1 mv tablet every 3 days and no
problems so far. I'll probably increase d3 intake to 1 2000iu tablet per day
and see how it goes.

~~~
sudosteph
Weird that it took a few days for the allergy to kick in. Do you get hives
from other stuff?

I had a bad allergic reaction recently to wine (which was never a problem
before), that started as bad hives and progressed to me nearly fainting.
Doctor tested me as positive for a grape allergy, but negative to the
shellfish allergy that caused hives as a kid.

Anyhow, all of that is to say that the doctor prescribed me an epipen, because
apparently it's possible to experience anaphalaxis without having breathing
issues. And full-body hives is one sign of that. The near-fainting I
experienced was likely due to low-blood pressure, which is another symptom. So
just be careful. I had always thought hives weren't a big deal (other than
being extremely annoying), but I'm definitely going to take them more
seriously from here on out.

------
rbalasub
Maybe Vitamin D deficiency in folks living in the US (also ^ ) contributed to
the high number of cases/deaths in the US.

^ Not discounting other factors

------
koolhead17
Will walking for 45 mins in morning help? Do we really need to buy pills and
pay to pharma companies?

------
chkaloon
Unfortunately this study shows correlation but not causation. Hopefully more
studies are under way.

------
saikiran91
We all stayed indoors for months during to lockdown and now we might lacking
Vitamin D.

------
CryptoPunk
The brilliant authorities around the world have made it illegal to go to
parks. In some places, it is illegal to be outside, in front of your own
house.

All this of course reduces vitamin D levels.

------
xmly
It means you should eat a lot if you are sick..

------
Havoc
Plus staying indoors isn't helping either

------
hkai
That study studied 20 people.

------
aszantu
fun fact: whale fat is highest in natural vitamin D, bio-availlable and all

------
Melting_Harps
> Interesting thing... Vitamin D is one of those things that, when vitamins
> come up on HN, you will often hear the refrain that "it's the one vitamin
> that large numbers of people are actually deficient in and ought to
> supplement."

Well, let me add to the narrative, as this was the concentration of my
Undergrad studies. Vitamin D, and its analogues are not actually vitamins,
they're steroid-hormones and behave as such; look at its molecular structure
[1] and its synthesis in the presence of UV light (as this actually how you
should be acquiring it).

Most people are deficient in Vitmanin D, the recommended dose of 600 IU are
actually not sufficient as many studies, research lends credence to as those
that induced viable therapies were often upwards of 4000-10000 IU. The IOM is
to blame for this, and a heated debate amongst researchers.

I won't go into full detail on that, but Vitamin D is a critical precursor and
reactant in many vital metabolic reactions, my personal concentration was in
inducing apoptosis in certain cancer cells with calcitriol, EB 1089, CB 1093,
and p53. My proposals were rejected for Independent Studies and I never
undertook it in the lab, unfortunately.

> Unfortunately the daily recommended value was established erroneously and
> should be much higher. Many research papers mention this...

Exactly. My bible was a Vitamin D book with 100+ chapters detailing
researchers that published papers detailing how their models were showing that
such low IU of Vitmain D were insufficient, going against the IOM's RDL.

If any of you are so inclined the 2nd Volume of Vitamin D by Feldman has been
released [2], its expensive but still way less than what the last copies of
vol 1 were that I paid back then.

> Nobody makes any money if it turns out to be a good treatment, so nobody
> will fund the research

You have no idea the amount of dismay I felt when I realized this was the case
when I was in school; though I would argue they've fund(ed) it in the past,
the problem is their is no way to place IP on Vitamin D itself and therefore
Big Pharma's business model doesn't apply, so it can show favourable results
but it will be killed because their is nothing to bring to Market as an
exclusive seller like they do for drugs. Many therapies could have been
explored since H1N1, 2009, but it falls on deaf ears and it takes pandemics
like these to shake people into delving into Public Health more seriously.

I hope changes are made by motivated students and researchers, ideally outside
of Universities because I know I no longer have the patience or drive to try
any more.

1: [https://external-
content.duckduckgo.com/iu/?u=https%3A%2F%2F...](https://external-
content.duckduckgo.com/iu/?u=https%3A%2F%2Fi.stack.imgur.com%2FjFnVM.jpg&f=1&nofb=1)

2: [https://www.amazon.com/Vitamin-Disease-Therapeutics-David-
Fe...](https://www.amazon.com/Vitamin-Disease-Therapeutics-David-Feldman-
ebook/dp/B078CQTBV1/ref=sr_1_3?dchild=1&keywords=vitamin+D&qid=1588203601&s=books&sr=1-3)

~~~
MattGaiser
So for all of us biochemistry muggles, what should we be taking and how much?

I just want to pip install vitamin-d and be on my way.

~~~
Melting_Harps
What's a muggle?

Honestly, if you live in CA like most here just sun bathe for 15-20 mins daily
on exposed skin, your body actually has a 'built-in' start-stop system that
will actually stop producing vitamin D innately due to a feedback loop. You
need to stop before your skin becomes irritated and begins to burn, obviously,
to avoid damage. 17 mins for me is the sweet spot for ideal blood serum
levels.

> what should we be taking and how much?

If taken as a dietary supplement that is way beyond me, as I'm not a physician
and its irresponsible to give medical advice as its specifically related to
you and your health.

But someone even mentioned the 10000 IU doses that can be administered in
severe cases with little to no harm and that's worth noting in terms of
toxicity risk.

Personally, I moved to CO from the coastal part of CA partly because of the
elevation difference and intensity of Sun in the Fall and Winter months to
mitigate my Vitamin D level decreasing and how it affects my health; so my
personal optimized blood serum wouldn't be compatible to your own, so even
that wouldn't work.

> I just want to pip install vitamin-d and be on my way.

Biohacker hat on: Get some Vitmain D pills and start with taking 1000 IU (as a
baseline) and increase the dosage incrementally on a weekly basis while
documenting your mood, and overall health and decide for yourself. You get
several types of endorphins from it, so when I started to find my effective
doses I noticed it alleviated my irritability and frequent headaches.

~~~
cwkoss
Muggle is a term from Harry Potter meaning non-wizard.

------
kalium-xyz
Unhealthy people are unhealthy

------
mcsb4
Anecdotelly, in Europe the countries worst hit by the virus have the most
strict confinement: Italy, Spain and France.

Makes you wonder if there is a correlation to Vitamin D insufficiency due to
lack of sun light.

~~~
namdnay
You’ve got the causality the wrong way round

~~~
aardvark291
Yeah, and Italy, Spain, and France are some of the sunnier countries in Europe
(compared to Germany, UK, Belgium, Scandinavia, etc). If anything I would
expect vitamin D deficiency to be less common there.

~~~
tdeck
Don't forget Ecuador which is literally on the equator and experiencing a
major outbreak.

~~~
namdnay
It's the wet season in Ecuador

------
throwaway122378
Beaches closed. Parks closed. Hikes closed. Stay inside and deprive the rest
of your vitamin D.

~~~
StavrosK
It really is too bad that all our front doors lead directly to beaches, parks
and hikes. How many people could have been saved if we had gardens, roofs and
streets?

