
Vitamin D looks powerful, underutilized for Covid-19 - lisper
http://agingbiotech.info/vitamindcovid19/
======
Alex3917
For what it's worth, I've been curating research on over-the-counter
interventions for Covid-19 here:
[https://www.reddit.com/r/covid19stack](https://www.reddit.com/r/covid19stack)

The research on vitamin D has been discussed extensively there over the last
couple months.

This article (and the linked citations) misses a bunch of the most important
theorized mechanisms of action, most notably that vitamin D plays a role in
regulating blood clotting and having adequate levels may prevent the kind of
sudden deaths from stoke we've been seeing in people who seemed to have gotten
over the disease with otherwise mild symptoms.

~~~
kpfleger
Author of the review here. Happy to have addition suggestions for papers to
include in the review. I looked at the Reddit group you linked and saw only
citations of Alipio et al and Grant et al (from several posts), both of which
I already cite. The review says of the Grant et al paper that it "broadly
reviews evidence for D to help with infectious diseases, pneumonia, and
inflammatory cytokines that damage the lungs and discusses some of the aspects
of COVID-19 infection that are known to relate to things known to be also
relevant to vitamin D." So not quite sure what it is that you are suggesting
be covered that is not.

The review is not meant to be a thorough description of the biology at the
intersection of vitamin D & COVID-19. The point of bring up the refs I have in
section 8 is to point out that there are good causal mechanistic biological
arguments for D's usefulness against C19, to help justify a call for
additional data gathering.

Your reddit group looks fine and all, but it isn't the same as a single
document that concisely collects all the best evidence for the potential of
vitamin D in a well organized way.

------
fattire
Dr. John Campbell, an educator in Northern England who's been doing daily
Youtube updates on Covid news since January I believe, has put out a few
videos from time to time related to vitamin D:

[https://www.youtube.com/watch?v=W5yVGmfivAk](https://www.youtube.com/watch?v=W5yVGmfivAk)
\- A month ago
[https://www.youtube.com/watch?v=GCSXNGc7pfs](https://www.youtube.com/watch?v=GCSXNGc7pfs)
\- 3 weeks ago
[https://www.youtube.com/watch?v=K-mHCn74E5o](https://www.youtube.com/watch?v=K-mHCn74E5o)
\- 3 days ago

He suggests vitamin D deficiency may play a partial role in explaining higher
mortality rates among people with darker skin (other important social
disparities notwithstanding).

~~~
neilwilson
Very important to remember that Dr John Campbell isn't a medical doctor. He's
a nurse with a PhD in learning.

I'm still waiting for the statistics where skin colour is correlated to income
levels. Then I suspect we'll see the real issue. Poorer people living more
densely.

~~~
DanBC
Ben Goldacre (and others) have done a rapid assessment of covid-19 risk.
[https://opensafely.org/outputs/2020/05/covid-risk-
factors/](https://opensafely.org/outputs/2020/05/covid-risk-factors/)

> Results: There were 5683 deaths attributed to COVID-19. In summary after
> full adjustment, death from COVID-19 was strongly associated with: being
> male (hazard ratio 1.99, 95%CI 1.88-2.10); older age and deprivation (both
> with a strong gradient); uncontrolled diabetes (HR 2.36 95% CI 2.18-2.56);
> severe asthma (HR 1.25 CI 1.08-1.44); and various other prior medical
> conditions. Compared to people with ethnicity recorded as white, black
> people were at higher risk of death, with only partial attenuation in hazard
> ratios from the fully adjusted model (age-sex adjusted HR 2.17 95% CI
> 1.84-2.57; fully adjusted HR 1.71 95% CI 1.44-2.02); with similar findings
> for Asian people (age-sex adjusted HR 1.95 95% CI 1.73-2.18; fully adjusted
> HR 1.62 95% CI 1.43-1.82).

He talks about it here:
[https://twitter.com/bengoldacre/status/1258372975004389379?s...](https://twitter.com/bengoldacre/status/1258372975004389379?s=20)

------
gremlinsinc
Not by me. I'm D-deficient, had gastric sleeve surgery, surprisingly it's the
only deficiency I have regularly. I often forget my D... but been taking it
religiously and asked my doctor if it's okay to add an extra 5000 iu per week,
and he said it was fine and a good idea because of how low I normally run.

I've got a new formulation coming soon though that has vitamin k mixed in w/
5000 ius, and a separate calcium/magnesium pill to make sure my bones stay
strong. Will get re-tested next month and see if I beat the deficiency. I'm
sure there's plenty of things but seemed like taking D probably is biggest
(other than distancing) due to my already extremely low normal levels.

~~~
httpsterio
I read somewhere that prolonged high doses of vitamin D might have adverse
effects on bone strength making them more brittle, but I'm unsure about the
source. I personally have celiac disease and hypothyroidism am also having
issues keeping the D up (heh heh). I take about 200ug daily with vitamin K and
I'm thinking about increasing it temporarily to double of that. Generally it
shouldn't be an issue with short term higher doses, but nearing a 1000ug daily
dose for prolonged periods (months) can be dangerous.

~~~
thornjm
(Med student here with only limited knowledge).

This is correct. The active form of Vitamin D (Calcitriol) can be both helpful
and harmful to bone health.

I think the mechanism is not fully understood but in short doses it stimulates
bone growth and is a treatment for osteoporosis. In chronic doses it actives
cells caused osteoclasts that reabsorb bone.

~~~
Harvesterify
Cholecalciferol is used in over the counter supplements, not calcitriol (which
is the active vitamin D form).

There also is a negative feedback for the conversion, that explain why there
are so few acute vitamin D poisoning.

------
Exmoor
Previous Vitamin-D/COVID discussion with many informative comments:
[https://news.ycombinator.com/item?id=23023703](https://news.ycombinator.com/item?id=23023703)

------
cpncrunch
Not a very good review. We know that sunlight exposure is associated with
lower all-cause mortality [1]. However, vitamin D supplementation has no
effect on mortality [2].

Current thinking is that it is the nitric oxide rather than vitamin D that
causes the benefit from sunlight [3].

So, if you want to have the best of both worlds, you should go out in the sun
rather than using vitamin D supplements.

[1]
[https://www.ncbi.nlm.nih.gov/pubmed/24697969](https://www.ncbi.nlm.nih.gov/pubmed/24697969)

[2]
[https://www.ncbi.nlm.nih.gov/pubmed/31405892](https://www.ncbi.nlm.nih.gov/pubmed/31405892)

[3]
[https://www.karger.com/article/FullText/441266](https://www.karger.com/article/FullText/441266)

~~~
macawfish
Not enough existing research controls for when in the day vitamin D is taken
or for other related nutrient levels (K, Mg).

Vitamin D is part of a whole complex network of signaling processes related to
(at the very least) regulating circadian rhythms and how is calcium absorbed
and used in the body.

I could see how taking vitamin D in the evening would actually be harmful if
it disrupts melatonin synthesis. Do existing studies control for this? If they
are, they're hard to find.

Until I see vitamin D studies controlling for those things, I take meta-
analyses like that with a grain of salt. And I'll keep taking vitamin D in the
mornings + magnesium in the evenings when I'm depressed in the winter. It sure
seems to help.

~~~
ethbro
Said as respectfully as I can, it seems like there's a lot of post-hoc
justification from the supplement crowd.

I.e. 'Well, no effect was observed because Y wasn't done simultaneously.'

Which isn't to say vitamins aren't under-studied and -prioritized.

But is to say, it feels unscientific to always quibble over experiment design
after the results show no effect.

~~~
zamfi
> it feels unscientific to always quibble over experiment design after the
> results show no effect.

Respectfully, _this is exactly what science is_. The process of finding
potential confounding variables and controlling for them in a new study is
critical.

The OP isn’t saying the original study is wrong, or falsified, or whatever,
just that it might not account for a particular effect. Someone should study
that effect!

There is a lot of _untestable_ post-hoc armchair experiment criticism from the
supplement crowd, but this isn’t an example of that!

~~~
ethbro
There are an infinite number of confounding variables in biological systems.
Ergo, there are an infinite number of reasons to dismiss any particular study.

OP's suggestions are tightly scoped and proceed from a basis, but there is a
point where you're dismissing concrete evidence on the basis of supposition.

------
jeffdavis
A double-blind study for respiratory infections (before covid-19):

[https://www.bmj.com/content/356/bmj.i6583](https://www.bmj.com/content/356/bmj.i6583)

------
synaesthesisx
There was some discussion about this on another thread:
[https://news.ycombinator.com/item?id=23079976](https://news.ycombinator.com/item?id=23079976)

Essentially, one of the theories is that severely low Vitamin D can cause a
hypercoagulable state and also increase the risk of the “cytokine storm” often
observed in Covid-19 patients.

------
jeffdavis
And if people hoard it and it's out of stock, you can just go outside!

~~~
samatman
It doesn't take hoarding, although that doesn't help. There are precious few
products that can stay on the shelves when everyone decides they need some at
once.

At northern latitudes, there isn't an available amount of sunlight, such that
dark-skinned people can synthesize a healthy amount of vitamin D. Indeed, this
is probably why light skin is selected for at those latitudes.

As a silver lining, I hope this crisis will provoke awareness of that fact. In
most parts of the US, people with dark skin should definitely be taking
supplemental Vitamin D. Really everyone should, unless they're a light-skinned
sun-worshipper living in the Sun Belt.

~~~
ianai
Light skinned people shouldn’t get their vitamin d from the sun. The skin
cancer risk far outweighs any benefit.

If it becomes scarce look up how to make vitamin d with mushrooms left in the
sun.

~~~
jennyyang
This is nonsense. 10-30 mins of sunlight a day without sunscreen for
caucasians is something on the order of 10,000 IU of Vitamin D. You can do
this safely without the worry of skin cancer.

~~~
ianai
Tell it to every derm I’ve talked to or read.

~~~
radford-neal
It might be good to exercise a bit of common sense before believing everything
a doctor tells you.

How likely is it that getting even small amounts of sunlight is horribly
dangerous? Do you believe in evolution? (For that matter, if you instead
believe in creation by a benevolent god, you get the same answer.)

------
thedudeabides5
If this is right, it means there's a natural non-intervention-based treatment
for COVID called "going outside and getting sun."

What a concept. Positively medieval!

Funny how you don't see many doctors or pharmaceutical companies trumpeting
this new treatment as a part of a treatment regime.

Obviously there are second order social-benefits to staying at home, but it's
just funny that so little attention has gone into something as simple and
reasonable as 'get more sun' compared to the billions spent on equipment,
drugs, and hospitalizations.

------
DanielBMarkham
As a layman observer of the scientific debate, the Vitamin D guys have been
quite persistent about the correlation between Vitamin D levels and deaths. Is
there causality? Beats me. The best I've heard by way of explanation is that
inflammation depletes Vitamin D stores. That idea is usually followed-up with
the additional theory that CV-19 causes inflammation and high platelet
activity, clogging up small blood vessels and producing most of the major
effects that are observed.

~~~
kpfleger
As with many comments in this thread, carefully reading the originally linked
review:
[http://agingbiotech.info/vitamindcovid19/](http://agingbiotech.info/vitamindcovid19/)
would help. One of the 3 recent preprints specifically noted repeated testing
of C19 patients and they did an ANOVA statistical test and determined that D
blood levels were not declining in the patients over the course of the
infection.

This doesn't prove causality, but it rules out the reverse causality you
hypothesize in this post. There is a good, concise (3-paragraph) sub-section
on the causality question in the discussion section called "Correlational data
supported by many pieces of causal evidence". Mandatory reading for anyone who
reacts with "correlation doesn't imply causation" as a criticism. Karl (author
of the review)

------
sirsuki
Here is a fantastic list of compelling resources about Vitamin-D:
[https://www.grc.com/health/Vitamin-D.htm](https://www.grc.com/health/Vitamin-D.htm)

------
tgafpc2
Sure, being healthy on many levels seems to be the best offense against C19
and lot's of other things.

------
whoisjuan
Can someone tell me why HN is so obsessed with Vitamin D? I see a Vitamin D
related article on the front page every few months. Also,
[https://hn.algolia.com/?q=vitamin+d](https://hn.algolia.com/?q=vitamin+d)
shows a lot of articles about Vitamin D with a lot of upvotes.

Note: I supplement with Vitamin D daily, so no hate at all, just curious.

~~~
drawkbox
Programmers tend to not go outside as much, in the batcaves creating value
many times in the dark of night.

~~~
mcswell
Bring up a picture of the sun on your monitor?

------
cleandreams
Vitamin D is under studied because it cannot be patented (my doctor told me).

~~~
pkaye
Why don't governments fund the research though?

~~~
qayxc
They do: [https://www.npr.org/sections/health-
shots/2018/11/10/6665455...](https://www.npr.org/sections/health-
shots/2018/11/10/666545527/vitamin-d-and-fish-oil-supplements-disappoint-in-
long-awaited-study-results?t=1588980441791)

[https://www.lifeextension.com/featured-
articles/2010/12/fede...](https://www.lifeextension.com/featured-
articles/2010/12/federal-government-funded-study-fails-to-recognize-value-of-
vitamin-d)

It's just that not everyone likes the results... If a doctor's cognitive bias
leans towards "alternative medicine", for example, they don't want to accept
certain findings, so they ignore them.

The real complaint those people have is "there's not enough (government-
funded) studies about [remedy] that fit my preconceived convictions". At least
that's my suspicion - I could be wrong of course.

------
ninetyfurr
Sunlight as a treatment for COVID-19? Where did I hear about this before.

~~~
tinus_hn
Perhaps irradiating yourself with UV rays might help after all!

