“Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p < 0.001.”
Which sounds like as strong a signal as a study of this scale could hope to show.
It's useful to note that this study doesn't need to stand on its own as evidence. It contributes to a growing body.
As most of you may have already seen, there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint.
On top of the hint, we already have dozens of RCTs that vitamin D supplements suppress respiratory infections.
And now we have this study. Every study and line of evidence has flaws, which is why you look at the totality of the evidence.
From the evidence I've seen, low vitamin D is a bigger problem in modern societies than vitamin D toxicity. Vitamin D is available OTC and many people use it apparently responsibly. I would expect that to continue with appropriate messaging.
It would be great if we could pursue a consensus on this while it can still make a difference, even in the absence of perfect data. It was a mistake in the early US messaging to downplay the importance of masks even though we didn't have perfect data on it.
I don't think her point was that people shouldn't take Vitamin D to combat Covid. Her point is that people shouldn't be taking high dosages of Vitamin D as a preventative against Covid as the risks can outweigh the rewards. But for those who already have Covid, the risk and rewards may be significantly skewed in favor of Vitamin D, as per this study.
Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think. In an era where people are apparently seriously contemplating megadoses of hydroxychloroquine or I.V. bleach for COVID-19 prophylaxis, the caution seems warranted---even if the study results are promising.
> Another part of her point is that self-administering Vitamin D is far more dangerous than people, including many MDs, often think.
In absurdly high doses, sure. The Institute of Medicine certifies 4,000 IUs as the upper safe daily limit, although doctors will prescribe higher doses for people with a Vitamin D deficiency.
The Mayo clinic did a study of Vitamin D levels in 20,308 people across 10 years. The result was that 8% of people had Vitamin D levels higher than 50ng/ml (typically a sign of Vitamin D toxicity) but found no correlation between those levels of Vitamin D. They found one, one person out of 20k, who actually displayed symptoms of Vitamin D toxicity. Their blood levels of Vitamin D were over 350ng/ml. They had been taking 100k IUs (25x the suggested dose) as a routine daily supplement. I can only find one reported death from Vitamin D overdose, and it was a 10 year old boy who was mistakenly given 600,000 IUs of Vitamin D a day instead of growth hormone by a hospital in 2015.
Let's compare that to Tylenol (acetaminophen). Tylenol contains 500mg of acetaminophen. Maximum suggested daily dose is 8 tablets, so 4g. 25 times that is 100g. So someone abusing tylenol as hard as that person abused Vitamin D would be consuming 100g of tylenol a day. Medical literature suggests that you go to the ER immediately if you consume over 10g of acetaminophen. Of people who hit blood levels requiring treatment, 5% die and 58% have severe liver damage as a result. I can't find a good, easy correlation between the blood levels requiring treatment and amount taken, but I'm going to go out on a limb and guess that taking 200 Tylenols puts you there.
So if we compare the risk, relatively, Vitamin D requires you to take over 150 times your maximum daily dose for an extended period of time (dosing for children is lower than adults) to cause death. If you take 25x the amount of Tylenol once, there's a good chance you die or have severe long term outcomes.
Vitamin D is amazingly safe, provided you treat it like a medication and don't randomly swallow fist fulls of the capsules. Many people in the US (and some parts of Europe, especially in the north) should actually already be taking a supplement. Low Vitamin D levels are exceptionally common now. In the case of the US, obesity causes low Vitamin D levels, not going outside often enough causes low Vitamin D, and not eating foods containing vitamin D causes low Vitamin D. That's a disease practically tailored to our obese, couch-bound, junk-food inhaling residents. In northern Europe, I think they largely blame the seasonal changes in daylight patterns.
I'm all for calling out danger, I just don't see any here. I don't doubt that some people will manage to hurt themselves. I can already hear someone thinking "if 4,000 IUs keeps me a little safe, I can take 1,000,000 IUs and not wear a mask". If we're really that concerned that someone will harm themselves, we should be able to just add Vitamin D to the tracking system we use for Sudafed. Don't let anyone but more than 10k IUs per day. That's enough for 2 adults and a child at healthy doses, but low enough that taking that much every day is unlikely to harm you in the immediate future (and doesn't seem to be likely to harm you at all, but it is above the suggested dose).
And, also, you're talking about one expert opinion, perhaps this person doesn't live at 41 degrees south where our both too cold and too dark for half the year or more to get enough sun exposure and peoples diets are often quire poor.
That's why we need to look at the data in aggregate, and have localities / states set their own guidelines and encourage / incentivise doctors to do more testing and symptom analysis.
IIRC, calcium toxicity is serious, but only a consequence of sustained Vitamin D supplementation.
Also there's some Joe Rogan-esque "just take the 5000 IU bro" even though 4000 is the recommended supplement upper bound. And devaboone warns against even using that much.
> Taking more than recommended is ok, your body will flush it out.
This is not true. Vitamin D is fat-soluble, not water-soluble. Your kidneys can only filter out water-soluble vitamins. B vitamins are water-soluble; that's why there's practically no upper limit to how much you can take. Your kidneys will filter out the extra (assuming you aren't eating buckets full of the stuff).
Vitamin D toxicity occurs specifically because your body can't remove the excess vitamin D stored in your fat.
That's also why severe overdose happens over time, as opposed to instantly. You have to take a huge amount of Vitamin D at once to overdose (like millions of IUs) but you can cause toxicity using smaller doses over longer periods of time. If your body could flush it out, that wouldn't be true. Any excess would be removed and you would start each day "fresh".
What's the mechanism for "flushing out" excess Vitamin D? The Wikipedia article you've linked offers no such mechanism for dietary Vit D. If anything, the article suggests that toxicity is only really possible through oral supplementation.
In the Netherlands the recommended intake is 5 mcg, that's equivalent to 200 iu. As far as I understand the US recommends 600.
Both are very far below the 4000 that's often cited here. So I think that 4000 is not a recommended intake but a limit before it becomes risky. For normal people it doesn't make sense to then aim for that maximum dosage.
The last I heard, the human body needs/consumes ~700 IU of Vitamin D per day. So I think your US levels are actually the full intake.
One thing to consider is biological inefficiency. A 4,000 IU capsule contains 4,000 IUs, but that doesn't mean your body can't actually extract all 4,000 IUs.
That said, I think 1k IUs is considered a standard dose for people without a deficiency. 4k IUs are generally used by people who are currently deficient, or have other issues that cause the deficiency. Doctors will sometimes prescribe doses up to 10k IUs for deficient people.
Please don't go by what you last heard and instead read the linked paper to get an idea as to how the recommended dosage was arrived at and how statistical errors caused the recommended dosage to be too low.
Obviously no one should be taking health or nutritional advice from random sources on the internet, but where the hell did you pull that number out of? Current RDAs for most people is 600 IU: https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessiona...
Note, the Endocrine Society currently suggests a minimum 25(OH)D level of 30 ng/ml (75 nmol/liter) and suggests much higher levels of supplementation if you need to raise it: "to raise the blood level of 25(OH)D above 30 ng/ml may require at
least 1500 –2000 IU/d of supplemental vitamin D."
Holick, Michael F., Neil C. Binkley, Heike A. Bischoff-Ferrari, Catherine M. Gordon, David A. Hanley, Robert P. Heaney, M. Hassan Murad, and Connie M. Weaver. “Evaluation, Treatment, and Prevention of Vitamin D Deficiency: An Endocrine Society Clinical Practice Guideline.” The Journal of Clinical Endocrinology & Metabolism 96, no. 7 (July 1, 2011): 1911–30. https://doi.org/10.1210/jc.2011-0385.
It's also worth noting that studies have shown that without sun exposure, people may require even higher levels of supplementation to maintain their 25(OH)D levels:
Heaney, Robert P., K. Michael Davies, Tai C. Chen, Michael F. Holick, and M. Janet Barger-Lux. “Human Serum 25-Hydroxycholecalciferol Response to Extended Oral Dosing with Cholecalciferol.” The American Journal of Clinical Nutrition 77, no. 1 (January 2003): 204–10. https://doi.org/10.1093/ajcn/77.1.204.
"CONCLUSIONS: Healthy men seem to use 3000-5000 IU cholecalciferol/d, apparently meeting > 80% of their winter cholecalciferol need with cutaneously synthesized accumulations from solar sources during the preceding summer months. Current recommended vitamin D inputs are inadequate to maintain serum 25-hydroxycholecalciferol concentration in the absence of substantial cutaneous production of vitamin D."
I think there is definitely something here. I never get sick in summer, spring and rarely fall. I run and bike with exposed skin quite a bit. In winter I get sick all the time :(
I think this winter I will run an experiment on myself.
> there is a lot of observational evidence that people with low vitamin D have the worst C19 outcomes. Obviously, correlation by itself doesn't mean causation. But it is a hint.
It's a pretty useless one in this case. Old people are much more likely to have vitamin D deficiency. They are also more likely to die of COVID. The low vitamin D is a marker of frailty, not a cause.
This was not simply observational.
There will be no correlation between being given higher dose vitamin D and age in this trial, the results appear at first blush to be showing Vitamin D is working independant of age.
By the by this /exactly/ why a randomised trial has been the gold standard for medical treatment for so long. False correlations, confounding factors etc are all vastly less likely to skew the results. 2 groups chosen at random, nobody in the groups or treating them knows which is which. 1 group given treatment, 1 given a placebo. How much difference do we see in the 2 groups as a result of treatment.
It's a good question. It's always worth asking. It's always worth checking. The rabbit hole of stat analysis of treatments goes pretty deep from there. Ethical issues come in. Expense. But we all need to make the effort to understand it on some level or we're marks for snake-oil.
Yep, in broad strokes, randomisation removes any bias or confounding effects such as age, gender, behaviour, genetic disposition etc. The price you pay is in precision; randomisation and the best practice analysis (intention to treat) tend to produce weaker signals of effectiveness compared to the control treatment. But that price is worth paying because randomisation is really the only way to be sure that you are seeing a real effect caused by your treatment.
Wouldn't it be fairly easy to separate the elderly who aren't vitamin D deficient from the ones who are? Sounds like a basic measure that could be taken.
If the body can absorb vitamin D from supplements then it can absorb it from food as well so your statement is wrong. You can eat 2-3 eggs and you're done.
I don't think eggs have that much vitamin D, though. I googled: It said 2 eggs have 87iu.
To put this in perspective: I take 800iu as a maintenance dose to keep my vitamin D levels up. (I'm doing this under a doctor's supervision: I've been sick with low levels and she does blood tests occasionally to be sure). 2 eggs is simply not enough.
Yes, this is strong. Worth noting the limitations though:
> Randomization generated groups with comparable percentage of unfavorable risk factors as there was no significant difference in subjects with at least one risk factor, except for high blood pressure and diabetes mellitus, known risk factors for unfavorable disease progression [2], which were more frequent in patients not treated with calcifediol.
These are HUGE risk factors. Also:
> This pilot study has several limitations as it is not double-blind placebo controlled. On the other hand, in the first studies evaluating risk factors for severe disease and/or death from COVID-19, the possible role of obesity was not considered. Therefore, given the isolation characteristics of the patients, we did not collect the BMI, which would have allowed us to add obesity as a risk factor for severe evolution of COVID-19 [37] It is striking to consider that obesity shares with aging and black or asian ethnicity a surprising overlap as risk factors for severe COVID-19 and vitamin D deficiency.
Yeah, BMI would've been nice too.
Still, check out table 2. Even with these limitations, seems powerful.
The group receiving Calcifediol had more "no bad risk" patients:
"At least one prognostic bad risk factor(@)
Group receiving Calcifediol: 48%
Group without Calcifediol: 61.54%"
"@) Patients with at least one of the following risk factors (age >60, previous lung disease, chronic kidney disease, diabetes mellitus, hypertension, cardiovascular disease or Immunosuppressed and transplanted patients)."
That's what can be concluded from "at least one": (52% had no bad risk in D group, but only 38.46% had no bad risk in the other group). But it is also not clear where there were more patients with "multiple" factors! Or if they were those who had more problems at the end.
The whole paper contains neither raw data nor any graphs and only means and standard deviations, as far as I see? I would personally really like to see the graphs of distributions or to use raw data to check myself.
The critical question is how good the randomization was done.
Randomization doesn't ensure perfectly balanced groups-- it just ensures that the imbalances of variables you don't measure (including things that change after randomization not related to your intervention, with blinding) are drawn from a distribution that you can apply rigorous statistical reasoning about.
Yes, we can see some things are a little unbalanced. But the effect is so massive: we might see 4/5 of the control's rate of ICU admissions if the "one prognostic bad risk factor" determined outcome entirely; instead, we see 1/50 of the rate.
> we might see 4/5 of the control's rate of ICU admissions if the "one prognostic bad risk factor" determined outcome entirely
But we still don't know if the persons with multiple bad risk factors were those who ended with bad outcomes? As far as I understand, if it was like that or not can't be seen from the paper at all, and I can imagine that it could have happened. I would really prefer the more raw data to the tables with the selected means and deviations given.
You have to get very, very unlucky on the dice rolls to get samples that are so tilted-- to pick 26 people out of 76, and somehow come up with 13/14 of those requiring ICU in the smaller group, if vitamin D has no effect. Outside of deliberate rigging... (it might even be difficult to deliberately sort and get this much of an imbalance).
Indeed, checking that the two groups look similar after randomization is completely optional. This study does an OK job of doing so.
There's both known and unknown reasons why someone might be predisposed to have a bad outcome. The reason we randomize, rather than try and make "balanced" groups, is that it addresses both unknown and known factors.
Yes, you can, by chance, get more people who are going to have a bad outcome in one group; about 5% of the time you'll get a p<0.05 finding this way. :P
It’s actually pretty decent. It can make errors in the case of people with extreme muscle mass, or very low muscle mass for their size, or the very short, or the very tall.
But for most people, if you’re over 25 bmi you probably could lose some weight. And at a population levels the errors above average out, even in a smaller group.
People make a big deal over the exceptions to it while ignoring that it is broadly accurate and that exceptions are not as common.
Perhaps, but we don't have reliable data on that. The population of people with high muscle mass is small to begin with and thus hard to study. And the use of anabolic steroids and other PEDs is common in that group, which may be a larger factor in heart disease risk than muscle mass by itself.
At 6'1" BMI seems to say I should be between 140lbs and 185 lbs. I'm currently 165 lbs and feel pretty skinny -- I can't imagine being healthy at 140 lbs! The 185 seems about right -- I've been close to 180 lbs and felt like I could lose a few.
I guess people are downvoting because it’s not super relevant to the discussion, but I have a similar opinion that the BMI normal weight range is unreasonable for me.
I’ve been in these two modes:
1) genuinely overweight with too much fat and not enough muscle
2) nearly overweight according to BMI while very fit, with low fat and high muscle. got here from the other state by exercising a lot, losing fat and gaining muscle.
I think I would have to become totally sedentary again to get rid of my muscle
mass and actually reach the lower end of “normal weight” according to BMI, while starving myself and feeling feeble.
> nearly overweight according to BMI while very fit, with low fat and high muscle
Not knowing you personally, it seems statistically more likely to me that your idea of "fit, low fat, high muscle" is what's at fault here (as opposed to BMI). Sure, you could be an exception. But all things being equal, you probably aren't. (Also maybe I misunderstand - if you mean that BMI was saying you were at the high end of normal then ... isn't that just saying that you're fine?)
(Of course if a medical professional or academic specializing in such matters also thought BMI was inaccurate in your case then I would tend to view things differently.)
(Not OP)
I’m not an athlete anymore, but I used to be. It would be physically impossible for me to maintain my muscle mass and have a BMI considered normal, whilst also having a body fat percentage >5%. I know many other (pretty much exclusively taller men) people in the same situation.
I guess it would be interesting to see how those numbers interacted graphically. Are the "bad" areas (ie high muscle mass at reasonable fat percentage) associated with health problems according to experts? Or should people with significantly above average muscle mass be using a different scale instead?
The claim is that BMI does not differentiate between body lean mass and body fat mass. Things like hydrostatic testing are more accurate for determining body fat mass.
I understand the desire to be contrarian, but BMI is widely regarded as totally obsolete with cheap and accurate ways to actually measure body fat percentages.
It’s well understood that BMI is totally wrong for athletes or anyone remotely muscular.
I assure you that's not my motivation at all. I'm not an expert in that field so I tend to trust the metrics used by the health professionals I encounter.
> BMI is widely regarded as totally obsolete
That is not my impression at all, but again I'm not a subject matter expert here. If you have reliable (ie academic or medical) sources I would be interested in learning more about any current preferred metrics.
> totally obsolete with cheap and accurate ways to actually measure body fat percentages
What do you have in mind? With a bit of searching I haven't found much that's cheap. (Obviously you can take some tape or caliper measurements to improve your numbers but that's neither new nor particularly accurate.)
And pretty terrible in my experience (tested two, one noname and one branded, unfortunately forgot the manufacturer/model number).
First, there is a fundamental constrain that it measures impedance only through legs and a little bit of belly, but no upper body (at least here in .cz, no consumer-grade scales have hand electrodes). I do road cycling as the only sport, and therefore get extremely skewed results as I have strong legs, but the rest of the body is much weaker.
Second, the measurements are almost non-repeatable. You get tens of percent difference across measurements, god forbid if you suddenly have moist feet etc. However, both scales used firmware cheating to mask this noise: once you set up a "profile", it will remember the initial value, and then change the following measurements only slightly. However, set up a second profile (preferably with a slightly modified age etc. to prevent advanced firmware cheating) and you get completely different results.
It isn't anywhere near obsolete, not as far as I've seen in both scientific and medical contexts. BMI remains heavily used in many nutritional and disease related studies and remains a common metric in healthcare and public heath.
It's imperfect, but generally correct. More importantly, it's easy to measure. Accurate except for outliers isn't as much of an issue as you think it is, especially as these are generally already accounted for by its users.
I can believe it. I’m curious what typical body types were like in the hunter/gather societies human evolved in, and whether those are ideal for longevity and quality of life in modern society.
The kind of hunt that humans are believed to have practiced early on was persistence hunting, which consists of chasing prey over long distances until they are exhausted (the gazelle can outrun any human on a scale of minutes, but not on a scale of hours).
> and whether those are ideal for longevity and quality of life in modern society
This seems like the real question to me; I assume pre-agrarian humans were biologically optimizing to survive famine. Not being an expert on the subject, I wonder what sort of tradeoffs are associated with intense exercise regimes (and how the balance ultimately comes out with respect to modern society).
Lacking in raw physical power by comparison, sure. But what health issues do we avoid? Do new health issues arise? Optimality in a complex environment is inevitably a nontrivial trade off; we aren't forced to hunt animals with primitive weapons or contend with widespread famine in the modern world.
Assuming you're male, 140 is the lower bound, so, you know, much lower than that might be considered anorexic, but in the 140s is not necessarily unhealthy per se. That's why it's the lower bound.
I am your height and when I was in my 20s, I think I was in the 140s, later I was a little over 200, and now I am just about 185. So the range makes sense to me, but I've never been far from completely sedentary. I know a pro sports player at ~200 would be very skinny. I think Mariano Rivera was an example.
I understand the objections to BMI comparisons at an individual level (though I believe people think themselves a bit too exceptional too often), but as part of a larger study, I would think it'd make a good additional data point, no?
But then you couldn't easily extrapolate to the population. Well, you could, but you'd require the population to have an understanding of their body fat percentages. BMI isn't ideal, but it's quick and dirty, easy to collect and it should be relatively reliable for the population.
I'm 6' and 84kg (185lbs), I recently had a full health checkup. I do cardio and calaesthebics 90 mins a day during weekdays. I'm lean, not bulky. The top finding of the report. Overweight, consider a healthier diet and more exercise.
It's actually not bad, but it's even better if you couple it with a simple waist circumference measurement (adjusted for sex, and for ethnic background in some circumstances).
Important to note that surviving is something else than 'making a full recovery'. It's an obvious improvement, and it clearly shows in the day-to-day statistics, the ratio of fatalities to positive tests has been - very slowly - dropping.
It's actually a lot better. Even in countries with near constant sunlight, d vitamin deficiency bus prevalent. It's more related to our lifestyle than just geographic location.
Probably? At least in part. This study involved supplementation rather than skin production.
However, for those who can get skin production it is probably better, as there may be other effects we don’t know of. Plus it self limits, whereas one can overdo supplements.
Note that all patients received HCQ and azithromycin.
Quoting the article (which I hope all here will read),
"[typically] more than 40 % of patients hospitalized because of COVID‐19 pneumonia developed ARDS of which more than 50 % ultimately died."
That's a 20% fatality rate.
Of the 76 patients in this study - regardless of vitamin D treatment - only 2 died, and the rest were eventually discharged. This is an outstanding result.
None (!) of the hospitalized patients died in the vitamin D / HCQ / AZ group.
I will say that the average age - 58 - is rather young. Only 19 out of 76 were over 60.
"All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days) and for patients with pneumonia and NEWS score≥5, a broad spectrum antibiotic (ceftriaxone2 g intravenously every 24 hours for 5 days) was added to hydroxychloroquine and azithromycin."
They have since discontinued HCQ because they felt that studies had shown that it was ineffective. We shall see.
As with AIDS, it's the cocktail of drugs that appears to matter. What is effective pre-hospitalization (i.e. prophylactic) is different from the best protocol post-admission. And that, in turn, differs from the best course of treatment in the ICU. The improvement in outcomes over the last few months is a result of experience:
Greater than 70% of African Americans are suspected to be Vit D deficient. Definitely worth getting tested if you can [1] especially if you live in the more northern latitudes. Doubly so during winter.
[1] with the note that generally insurance is a real PITA with vitamin D testing. The trick usually is to list as a diagnosis code a previous history of low vitamin D. Yes it’s like a catch 22. You need prior testing showing low Vit D to get testing to show low Vit D.
Given the huge prevalence of low vitamin D (70+%) amongst African Americans this is maybe a classic example of a dysfunctional health system. A vitamin D supplement is a dirt cheap public health intervention with potentially big pay offs across such a large segment of the population.
Using online labs it's super cheap to get it done yourself for less than $50/test. Not worth dealing with insurance BS and your doctor's likely nonsensical ravings about it, just do it and reimburse using your HSA if you have one.
Cost of doctor visit + cost of inflated test (likely not covered or runs up against your deductible) > paying for it yourself.
If you want to argue that the American healthcare system is messed up and that they don't believe in agency for individuals to order their own tests and do their own research, I'm with you. But we live in the reality we got, so... just kinda is how it is.
You get a doctor's prescription (from a Florida doctor, good for anywhere in the country) and instructions to go to your nearest Labcorp for a blood draw. So make sure you have a Labcorp near you.
Yeah these all use basically the white labeled services behind them, and are all more or less good. Don't want to endorse any of them but I use one in the footnotes.
This is definitely not true. Elevated blood calcium and creatinine levels are definitely possible if you take too much, and people are sensitive at different rates.
I tried taking some Vitamin D alone, and I rapidly got a very uncomfortable sensitivity in my teeth. I thought maybe this has something to do with what it does to calcium.
So I tried a combination calcium + Vitamin D capsule, and it didn't seem to have the same effect.
Maybe the second one is safe, but I'm wondering what was going on and if there are potential drawbacks to either one.
That's weird I've been taking vitamin D (2000iu) per day and haven't had anything like that. I do get lots of calcium though via cheese and dairy products (I'm one of the few people I know that will actually drink a glass of milk fearlessly)
>generally insurance is a real PITA with vitamin D testing
FWIW, vitamin D has been among the things tested when I have my blood work for an annual physical and never had any insurance issue about it. And I do take supplements because it was low.
Primary care doc in MA here. I can tell you that we run into a lot of trouble with getting insurance to pay for these tests in people who don’t have a deficiency or insufficiency on record. I’m glad you haven’t had any problems with yours!
I suspect his doctor just knew to code it properly as low vitamin D for monitoring of replacement therapy. Since he legitimately has low D and is on replacement therapy there’s no issue. For first timers not sure if they are or not an experienced doctor will just label it this way anyway and tell you 9/10 it’ll work. 1/10 you’ll have to pay the fee. It’s just another example of our nonsensical health system at work.
I really have no idea although I'm very skeptical that my former primary care doctor would have done anything more sophisticated than checking a bunch of boxes on the blood work sheet and faxed it to the hospital lab. It certainly wasn't in response to any symptoms about anything; it just came in low in the lab results at some point.
Of course, may be a function of particular insurance provider policies.
I can tell you that the proper way to code various labs in order to get them paid for by insurers, seems like an intentionally opaque and always changing landscape. It does vary by insurer, and much of the time, I don't even know about a very expensive lab unless a patient informs me--I'm sure many just curse their bill (and maybe me) and go on with their day without giving me the feedback.
This is just one of the many frustrating parts of the way our medical system is set-up. As a doctor, I have even considered not seeing my own doctor for labs and using a private company, as others have mentioned in this thread. At least those companies provide price transparency.
I'm a pale white person and I'm deficient without supplementation. Anyone reading this that spends lots of hours indoors in front of a computer should probably have their vitamin D level checked. Easy to fix with the right amount of supplement, too much is not good either.
Is there a scientific classification system for evaluating how light vs. dark a person's skin is? I'd like to know how much my relatively darker skin is preventing vit D uptake / creation in the body
I learned about this from a dermatologist who specializes in skin cancer care. He says it is a very strong indicator for skin damage and cancer risk (sounded stronger than genetic/family history factors), but how it relates to vitamin D deficiency was not really in his domain.
I don't think skin color is very relevant if you live a modern sedentary life that implies most of your time is spent inside: you're probably deficient whatever your skin color is.
IMHO it would be best to test your vitamin D level anyway and act accordingly.
I think skin color is most likely correlated, without being the cause.
Populations with lighter skin colors tend to live at higher lattitudes, where there is less sun. Inherited genes probably compensate for this, while also transmitting the paler/darker skin allele.
I haven't been tested for Vitamin D deficiency. But... and I'm very easily wrong here, but... wouldn't taking a multi vitamin make this testing unnecessary for the most part?
I mean, don't get me wrong, it's always best to test, but diminishing returns and all, wouldn't most people most of the time be fine with just taking one?
Actually, even lighter skinned people can have lots of trouble generating sufficient vitamin D. My wife's family has the lightest skin possible but they all have vitamin D deficiency, if you have some kind of fatigue it is truly worth having your vitamin levels checked!
Non-white? I am white, was deficient and live in the tropics.
My doctor recommended me to follow a 400 UI/day regime for 3 months but I raised it to 5000 UI/day for a couple of days and started noticing an interesting change: The 20-year-old flat warts on my hands were gone a week after. Told my doctor but the idiot dismissed the relationship.
Deva is deep into writing part 3 at the moment (the physicians husband here) where she reviews these trials, what they mean and how they should be interpreted. I think she will be finished soon.
That previous commentary on part 2 hasn't explored the larger statistical significant over time. Yes, it _can_ cause problems, but there is far more evidence to show deficiency, and far less evidence to show that even when taken at high levels there aren't many cases of problems, and those problems are not very severe.
Thank you thank you thank you. There is a craze for popping Vitamin D related to the raft of observational studies, here... so many of which never find a causal link.
Take my own particular condition: an inherited vascular dysplasia which causes frequent nose and GI bleeds. People with low Vitamin D seem to have a worse time of it in OBSERVATIONAL studies.
But people with GI bleeds so bad they have daily diarrhea from hemorrhages and anemia that disables them to the point they can't work aren't going to be out in the sun, and aren't going to be able to absorb as many vitamins in their gut due to the havoc the hemorrhaging is yielding.
Thinking really hard about the direction the arrow of causality runs here is massively important. Is it:
LOW VITAMIN D ---> BAD BLEEDING?
Or:
BAD BLEEDING ---> LOW VITAMIN D
And as the consequences of overdosing show, this isn't like popping an extra Metamucil cracker a day or something - dire stuff can happen.
Can someone tell what is the equivalent dose of said calcifedol in regular D3? The article claims 0.532 mg have been used, which seems too large. From [1] I gather it's about 3x more potent, meaning we are talking about equivalent of 1.596mg of D3. Or, 10000% of RDA according to [2]. Is that right?
That’s about 60,000 IU? Not necessarily out of line for such interventions. In cases of deficiency doctors will often prescribe weekly doses of 50,000 I believe. Have also seen RCT on vitamin d and the flu where groups where given 250,000-500,000 IU’s in one shot.
....obviously nobody reading this should take anything near those doses without consulting a doctor and without knowing your current blood level, to be clear.
Again: those are medical doses, given either very temporarily or in weekly/monthly doses.
2k definitely ha san effect on a daily basis. To really know, there are two things you can do:
1. Get a vitamin d test. Fairly cheap online
2. Use the dminder app to track estimated D over time from supplements and sun exposure
I don’t think I was clear enough in my post: 60,000 is not a daily dose! Higher than 4000 IU daily over a long period can lead to excess, according to Deva Boone, a doctor who was posting here and wrote some articles on this topic.
60,000 is something I’ve read about where 1. A doctor wants to correct a large deficiency, and 2. Judges large, infrequent doses are best. (My guess would be for adherence)
Do not, do not. Do not take anything anywhere in that range on your own. Stick to sub 4,000 for a daily doses, and ideally get a blood test.
The amount used as an interventional or short term treatment can greatly exceed what is a prudent amount to take daily. Taking 50k/day long term is probably a bad idea.
> Serum 25OHD concentrations at baseline or during treatment are not available.
This is mind boggling. These 76 patients had extensive blood work done so why did the study design not include serum concentration testing before and after treatment?
Welcome to every Vitamin D study done ever. I follow some PHD/RD combination researchers on Twitter and they all get together each time one of these studies is done and bang their heads against a wall.
This follows quite a lot of observational evidence. There are currently 11 studies that have found an association between serum vitamin D and Covid severity. These are listed here:
Noteworthy that this is in combination with anti-viral drugs at hospital admission: hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days). Regardless, I'm going to assume this means being outside and getting sun is good for me.
To be clear, all patients received these supplemental drugs, as at the time they were considered the best standard of care. (Also to be clear: they're not anti-virals.)
Of the 75 patients in the trial, 50 people received additionally Vitamin D3 supplementation (in the form of calcifediol), and 25 did not.
Notably, though, diabetes and high blood pressure were substantially more frequent in the control group, which are HUGE risk factors. Also they didn't track BMI or obesity.
Still, check out table 2. Even with these limitations, seems powerful.
Wow! That link suggests diabetes doubles your risk, but that high blood pressure actually lowers your risk — but turns out to be only for folks over 70. Super weird!
> We similarly investigated the change in the hypertension hazard ratio (from 1.09 (1.05–1.14) adjusted for age and sex, to 0.89 (0.85–0.93) with all covariates included), and found that diabetes and obesity were principally responsible for this reduction (HR 0.97 (0.92–1.01) adjusted for age, sex, diabetes and obesity). Given the strong association between blood pressure and age we then examined the interaction between these variables; this revealed strong evidence of interaction (P < 0.001), with hypertension associated with a higher risk up to the age of 70 years and a lower risk above the age of 70 (adjusted HRs 3.10 (1.69–5.70), 2.73 (1.96–3.81), 2.07 (1.73–2.47), 1.32 (1.17–1.50), 0.94 (0.86–1.02) and 0.73 (0.69–0.78) for ages 18–39, 40–49, 50–59, 60–69, 70–79 and 80 or over, respectively). The reasons for the inverse association between hypertension and mortality in older individuals are unclear and warrant further investigation, including detailed examination of frailty, comorbidity and drug exposures in this age group.
ack those could definitely affect this, isn't that why they normally try to select otherwise healthy patients as a baseline? Bring in the unhealthy people for the big studies and they'll most likely be spread much more evenly
Hydroxychloroquine looked promising for a while, and was being studied in an RCT, but that RCT was ended before completion because of the release of an observational study that suggested strongly negative outcomes from Hydroxychloroquine.
Later, that observational study was retracted because it was discovered to be based on falsified data.
So, unfortunately, we don't know very much about Hydroxychloroquine's effectiveness and risks in use -- but we do know that it has become a massive political hot potato, as your comment indicates.
> but we do know that it has become a massive political hot potato
I posted this a few days ago and got an interesting swing of votes on that comment since then:
> So, unfortunately, we don't know very much about Hydroxychloroquine's effectiveness and risks in use
For effectiveness it looks like we actually do, thanks to an experiment Switzerland accidentally ran on their population over May and June [0]. On May 27, they banned use of hydroxychloroquine, and 13 days later the death rate among resolved cases nearly tripled. Just after the spike began, on June 11 they reversed the ban and 13 days later the death rate drops back down. The graph from that article [1] is very stark, comparing the rate from late March through early July.
That is quite a spike! Unfortunately the sharpness of the edge makes it pretty likely that a change in therapy is the cause -- time to death from hospital admission has a median of 10-12 days, but this is not a "wall", it's a median. The actual distribution is probably somewhat normal -- you'd expect a gradual increase and decrease around the intervention. We don't know how or when the Hydroxychloroquine was administered, but the mechanism of action seems to be prevention of infection early in the course of infection, generally before hospitalization.
To me, this seems more likely coincidental or a reporting change.
The "HCQ doesn't work"-narrative is entirely political, not scientific.
The original "quack treatment", which is prophylactic zinc+HCQ (as an ionophore) for at-risk groups, has never been shown to be ineffective in an RCT. It is still being studied.
Of course the studies that show it to be effective aren't of the best quality, but they aren't entirely meaningless either.
Azithromycin is a common antibiotic, not an anti-viral drug. This is an important distinction. Also hydroxychloroquine is an anti-malarial drug, which is also not an anti-viral.
Hydroxychloroquine is a zinc ionophore which helps zinc get into the cells in your lungs and slows the viral replication. It was not designed to be used this way, it just happens to work. This is mostly useful before your viral load is high. Same goes for Quercetin, also a zinc ionophore. They are good proactive measures to slow down the viral transcription before you reach a critical stage. It won't help everyone, especially if given late in their infection and especially if their immune system is compromised or otherwise dysfunctional.
Wiki says that "Hydroxychloroquine is being studied to prevent and treat coronavirus disease 2019 (COVID‑19), but all clinical trials conducted during 2020 found it is ineffective and may cause dangerous side effects."
That is mostly correct based on the studies I have been following. In most cases, by the time people are admitted to the hospital, the viral load is too high and their immune system has not been able to keep up. There is a whole lot more going on, all the way from interactions with ACE to VWF to clotting, that administering zinc ionophores late in the game may be a bit too late.
But it's awfully irresponsible to pretend it's good for society to spread it.
Not everyone has the scientific knowledge necessary to understand p-values and what they mean for research like this. It's a lot to ask that everyone know the standard for publishing in medicine is a p-value < 0.05, which corresponds to a 5% chance of the study's results being wrong. It's a lot to ask that everyone be aware that there were 130 different studies on hydroxychloroquine and to do the math from there to determine that we'd expect 6 or 7 of them to be wrong.
It's much better to say "just because it's not illegal doesn't mean it's a good idea" and just not share such thoroughly bad information.
millions of people take HCQ on a daily basis for their lupus. Ask any rheumatologist, the danger of Torsades de Points is only a concern for HCQ if the patient already has a serious heart condition, or if the patient has been taking HCQ for years.
Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes).
There are no safe drugs for a patient admitted to intensive care. We should not start administering anything in large scale just because most healthy people can tolerate it well.
> Millions more take HCQ as a malaria treatment. It is generally recognized as safe, if you do not have a heart condition (and even then a short course is unlikely to yield adverse outcomes).
COVID-19 can infect the heart and damage it. As safe as HCQ might be on its own, here it's adding extra load to a system that's already under stress.
Covid has severe effects on the cardiovascular system, with myocardial injury being a frequent occurrence of those covid patients admitted to hospital.
Wikipedia is pretty reliable for math, old computer hardware, and other dry technical subjects.
This is not one. This is a political subject. Wikipedia is a complete disaster for anything that even remotely touches upon modern politics. There are teams of people paid to impose an opinion on Wikipedia, relentlessly wearing down any neutral editor with 24x7 edits and every kind of bureaucratic fight. The people who edit for free are also pulled from a highly-biased population, with strong overrepresentation by unemployed single people with non-STEM degrees.
Simply put, "ineffective and may cause dangerous side effects" is a purely political attack on the US president.
Last year, the drug was handed out freely, with very little worry, to anybody claiming that they would visit a country with malaria. In many places it is non-prescription. Clearly, the "dangerous side effects" aren't such a big deal. You can get deadly "dangerous side effects" from aspirin (Reye syndrome) and from Tylenol/paracetamol/acetaminophen (complete liver failure).
>"ineffective and may cause dangerous side effects"
Dangerous on an individual level, not really. But at a population level if hundreds of millions of people start taking it, you're going to have high absolute numbers of bad side effects.
> is a purely political attack on the US president.
As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad.
Since it's ineffective in this case, there's no benefit to outweigh the downsides of "dangerous side effects" like their is with aspirin or Tylenol.
> As for ineffective, there isn't one single national health agency that recommends taking it for covid. Surely the entire globe isn't killing scores of their citizens by preventing the use of an effective treatment just to make the US President look bad.
I’d suspect that where you see other national leaders pushing HCQ, it’s largely not because Trump is doing it, but for similar reasons to why Trump is doing it. HCQ was the most ‘miracle cure’-y of the early proposed treatments. Most treatments being investigated promised modest reductions in the death rate, whereas some of the claims for HCQ were very extravagant (some people were even pushing it as a _prophylactic_). That’s a much more attractive public message than ‘this might reduce your chance of dying by 20%, if you’re on a ventilator’, so if you weren’t overly concerned with whether it was true or not, it might work politically.
I don't see national leaders pushing HCQ because Trump is doing it, I see them pushing against it because Trump is doing it and because they positioned themselves against him.
Trump has poisoned the well. If you bring up HCQ, you are immediately under suspicion of being an anti-science Trump-supporting conspiracy theorist. Guilt by association, reductio ad hitlerum, etc.
As for using HCQ as a prophylactic: That was the whole point right from the beginning. Didier Raoult can be credited with starting the HCQ hype, he has been prescribing HCQ+zinc as a prophylactic for at-risk groups. That's not as outlandish as you make it sound, HCQ has been used as prophylactic for malaria for the longest time and that is considered safe.
The studies that tested HCQ at a late stage (ICU) or without zinc are missing the point. HCQ without zinc doesn't work, zinc without HCQ is at least less effective, because the HCQ works as an ionophore, but if you already have a severe case of COVID, none of it is going to work. It's too late.
There are several studies that suggest that this prophylactic treatment works. There are no big RCTs that show it works, but neither are there big RCTs that disprove that it works.
See also this protocol for prophylaxis of COVID-19:
It includes zinc and quercetin as an ionophore and is thus politically uncontroversial. However, it's unknown to what extent quercetin really works as an ionophore in vivo.
> Last year, the drug was handed out freely, with very little worry, to anybody claiming that they would visit a country with malaria.
Well, for a start, no it wasn't (many if not most malarial areas mostly have resistant strains, and other drugs are more appropriate there). But anyone who was given it was warned beforehand (or at least should have been). It's not a safe drug. It is, however, safer than getting malaria, so you should probably take it if you're going to an area where it will be effective.
What you should probably not do is take it because a weird French doctor and some people on the internet said to.
The claim is that those people are among those editing the article, and there's some of the more motivated ones. It's not that everyone else doesn't matter, in fact the problem is exactly that the wider informed opinion of everyone that matters isn't automatically reflected in wikipedia pages.
Any sufficiently intense argument anywhere in the world risks corrupting a wikipedia page.
Yes, it just stops replication "within the glass" (that's the meaning of "in vitro") with the cell culture, not in living human patients, and even "within the glass" only when using the "the Vero E6 cell line which is derived from kidney cells of green monkeys."
"The mechanism of action of hydroxychloroquine is to block entry of the virus into cells. Viral entry requires a helper enzyme. In the Vero E6 cell line, this enzyme is cathepsin L which hydroxychloroquine blocks. However, in the human lung cell line, the helping enzyme is TMPRSS2. Hydroxychloroquine does not effectively block this enzyme and cellular entry of the virus occurs."
So, inspired by the reports of the experiments with wrong cells a French doctor made some false claims about his success when treating patients, which were then promoted by one person wanting to be reelected, and then the followers... the results can be seen in the comments here.
While neither azithromycin nor hydroxychloroquine are primarily thought of as anti-virals, both are hypothesized by some to have some anti-viral effect, and it's still unclear whether any potential effects they have on Covid-19 are via such anti-viral effects, or other effects.
Just because something helps with issues created by a virus doesn’t make it an anti-viral. For example it seems to be now that steroids are aiding those in the ICU with covid, but I don’t think anyone could plausibly call a steroid an anti-viral, as much as a bandaid can’t be called an antibiotic even if it helps heal a cut and prevent additional bacterial infection.
True, but if you look in the literature, you will find both of these compounds referred to as having some anti-viral effects, and their hypothesized mechanism(s) against Covid-19 may involve those effects.
For example, in <https://www.clinicalmicrobiologyandinfection.com/article/S11..., even though the study concludes other anti-virals are better, we see the footnoted, uncontroversial claim: "The antiviral properties of CQ were first explored against viral hepatitis as far back as 1963 [1]. Since then many observations from in vitro and animal experiments have suggested a beneficial role of HCQ and CQ in viral infections [2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13]." There are of course hundreds more such authoritative references to observed anti-viral activity.
Or regarding Azithromycin (AZM) in <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290142/>, we see: "It has been shown that AZM has significant antiviral properties. In contrast with CQ or HCQ, its antiviral activity has been shown in vitro and/or in vivo on a large panel of viruses: Ebola, Zika, respiratory syncytial virus, influenzae H1N1 virus, enterovirus, and rhinovirus [4–13]. Its activity against respiratory syncytial virus has been demonstrated in a randomized study in infants [10]. Azithromycin exhibited a synergistic antiviral effect against SARS-CoV-2 when combined with HCQ both in vitro [11] and in a clinical setting [13]."
That HCQ is mainly known as an antimalarial doesn't refute that it has, and is often tried for, antiviral effects. That AZM is mainly known as an antibiotic doesn't refute that it has shown broad antiviral effects as well.
(If you're stuck on 'antiviral' as some binary category, or mutually-exclusive with other categories, you're going to miss all the interesting incremental effects in real chemistry/biology. That sort of "sharply-bounded categories" thinking has killed a lot of people recently, as with those insistent on 'droplets vs aerosols' instead of a continuum including every size/variant of both.)
I always assumed getting sun(in moderation) was good for oneself. As much as I dislike the heat in general, I always have way more energy after spending a few hours in the sun. I assume(perhaps incorrectly) this was due to a Vitamin D bump.
Further, I've known two people in my life who get weird skin issues if they stay out of the sun too long. My wife is one of them! Really weird, considering how damaging the sun is considered.
All patients received hydroxychloroquine and azithromycin, i.e. the control group also, meaning the difference in outcome between the intervention and control groups is not due to these drugs.
The American media would have you believe that hydroxychloroquine and Z-packs are completely ineffective. Are we still in the "we don't know" stage? Is there any conclusive data to show that it helps/hurts/or does nothing in the beginning/middle/end stages of infection?
There are other drugs now that both work and have a large effect (20%). Hydroxychloroquine possible 5% increase in survival rate pales in comparsion. Given it's also poisonous I don't see why you would want to use it.
ReflectedImage says>"There are other drugs now that both work and have a large effect (20%). Hydroxychloroquine possible 5% increase in survival rate pales in comparsion. Given it's also poisonous I don't see why you would want to use it."<
Please name the other drugs that "both work and have a large effect (20%)".
>While some patients and their families have spent the past few weeks frantically trying to procure remdesivir, another Covid-19 treatment has been quietly been shown to be more effective. Although neither option appears to be the much-needed cure for Covid-19, a three-drug regimen offered a greater reduction in the time it took patients to recover than remdesivir did. People who took the combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin got better in seven days as opposed to 12 days for those who didn’t take it. Critically, the treatment has another leg up on Gilead’s: It clearly reduced the amount of the coronavirus in patients who took it, according to a study published in The Lancet on May 8.<
The point is they are not variables, but rather constants (everyone got them), and they were not introduced, but standard care at the time.
I suspect you have the wrong idea about how the results of the trial are supposed to be interpreted. The point isn't to compare to results outside the study. You should only compare the intervention group to the control group in the same study.
Because it's unethical to leave people who are sick with Covid-19 untreated, so they all got what were considered possibly effective treatments at the time.
No proper trial has shown any positive effect. At this point "don't know but probably not, and it's not risk-free" is probably a reasonable description.
Besides vitamin D, sunlight exposure also stimulates production of nitric oxide and thus lowers blood pressure. We also know that high blood pressure is a risk factor for COVID-19 so it seems plausible that there could be a connection.
This study doesn't show that a non-hospitalized person who is not taking hydroxychloroquine and azithromycin should expect better outcomes from Vitamin D. At best, one could argue that if you get hospitalized, it would be good to have built up some Vitamin D.
I'm still supplementing with Vitamin D, though, but may cut back having been reminded that it's a fat-soluble hormone (and not really a vitamin at all).
FWIW, I was told that when the Sun is above 45 degrees over the horizon you will accrue DNA damage, and it stacks up over your entire lifetime. There is no "reset" or "heal", it just adds up.
For that reason I'm doing my darnest best to stay in the shade between 9am and 3pm. Or covering clothing.
> you will accrue DNA damage, and it stacks up over your entire lifetime. There is no "reset" or "heal", it just adds up.
Sort of.
Every time your skin gets 'red' due to sun exposure... that's due to DNA damage.
However, cells have several mechanisms to repair DNA - otherwise we would be in serious trouble after a single radiation burn (which is what UV light does).
They might fully repair an event successfully. Or they might not - in which case the damage may be severe and the cell will either die due to its effects or detect and trigger apoptosis. If the error isn't serious, it might not be detected and be passed on to future cell generations. Those are the ones you need to worry about.
Specifically for the skin, given that skin cells divide quite frequently, they might be caught mid-division, which is a more vulnerable state.
As you get more exposure and more damage, the chances of defects not being properly repaired increase. So you are right that, if you keep letting your skin bake, chances are you will accumulate damage that can't be repaired(over a lifetime, that's a certainty).
Cancer is not the only issue. Have you seen how the skin of people that spent a lifetime working under the sun without adequate protection look like?
I'd be really interested to see a comparison of the relative risks between skin cancer and vitamin D deficiency.
A lot of what I've read lately suggests we're discovering a lot of benefits of vitamin D that were previously unknown, and some evidence that the recommended vitamin D levels should be higher than they are.
For a generation or so we've told people the sun is dangerous because of skin cancer, and obviously skin cancer is really bad. But I wonder if we have a case of need to weight risks that are high cost, low probability (skin cancer) compared with low cost, high probability (low vitamins D complications). What is the overall effect of these two things?
Short excerpt:
People don’t realize this because several different diseases are lumped together under the term “skin cancer.” The most common by far are basal-cell carcinomas and squamous-cell carcinomas, which are almost never fatal. In fact, says Weller, “When I diagnose a basal-cell skin cancer in a patient, the first thing I say is congratulations, because you’re walking out of my office with a longer life expectancy than when you walked in.” That’s probably because people who get carcinomas, which are strongly linked to sun exposure, tend to be healthy types that are outside getting plenty of exercise and sunlight.
> The most common by far are basal-cell carcinomas and squamous-cell carcinomas, which are almost never fatal.
My grandpa died due to complications from a basal-cell skin cancer. He was almost 90 years old. The cancer itself was a few decades old. He served in the Navy during WWII, and likely got it from years of tropical sun exposure with no sunscreen.*
So, yeah, as far as cancers go, that's one you'd rather get if given a choice.
* (Well, and the additional years of fishing and other outdoor activities. Obviously the cause can't be pinpointed like that, but it must have contributed)
This is not strictly true. You have lots of evolved repair mechanisms to fix the damage caused by sunlight. It's only when they get overwhelmed that you accrue permanent damage. It's still a probability game, though.
Note that if we didn't have UV repair mechanisms, we'd blister in a few minutes.
I think the tides have been turning on avoiding all sun exposure. While you obviously want to avoid getting burnt, the benefits of adequate sun exposure seem to outweigh the harms.
Rhee, H. J. van der, E. de Vries, and J. W. Coebergh. “Regular Sun Exposure Benefits Health.” Medical Hypotheses 97 (December 1, 2016): 34–37. https://doi.org/10.1016/j.mehy.2016.10.011.
"Since it was discovered that UV radiation was the main environmental cause of skin cancer, primary prevention programs have been started. These programs advise to avoid exposure to sunlight. However, the question arises whether sun-shunning behaviour might have an effect on general health. During the last decades new favourable associations between sunlight and disease have been discovered. There is growing observational and experimental evidence that regular exposure to sunlight contributes to the prevention of colon-, breast-, prostate cancer, non-Hodgkin lymphoma, multiple sclerosis, hypertension and diabetes. Initially, these beneficial effects were ascribed to vitamin D. Recently it became evident that immunomodulation, the formation of nitric oxide, melatonin, serotonin, and the effect of (sun)light on circadian clocks, are involved as well. In Europe (above 50 degrees north latitude), the risk of skin cancer (particularly melanoma) is mainly caused by an intermittent pattern of exposure, while regular exposure confers a relatively low risk. The available data on the negative and positive effects of sun exposure are discussed. Considering these data we hypothesize that regular sun exposure benefits health."
Hoel, David G., Marianne Berwick, Frank R. de Gruijl, and Michael F. Holick. “The Risks and Benefits of Sun Exposure 2016.” Dermato-Endocrinology 8, no. 1 (October 19, 2016). https://doi.org/10.1080/19381980.2016.1248325.
"This review considers the studies that have shown a wide range health benefits from sun/UV exposure. These benefits include among others various types of cancer, cardiovascular disease, Alzheimer disease/dementia, myopia and macular degeneration, diabetes and multiple sclerosis. The message of sun avoidance must be changed to acceptance of non-burning sun exposure sufficient to achieve serum 25(OH)D concentration of 30 ng/mL or higher in the sunny season and the general benefits of UV exposure beyond those of vitamin D."
This change in thinking has been a long-time coming. There have been results showing studies since the 90s showing lower melanoma mortality from those having more sun exposure, as described in this review:
Egan, Kathleen M., Jeffrey A. Sosman, and William J. Blot. “Sunlight and Reduced Risk of Cancer: Is The Real Story Vitamin D?” JNCI: Journal of the National Cancer Institute 97, no. 3 (February 2, 2005): 161–63. https://doi.org/10.1093/jnci/dji047.
Thanks for taking the time write it all out, much appreciated.
Do you know if the time of day makes a different? I avoid the Sun between 9am-3pm as that seems relatively easy to get sunburned during that time, but I wonder if the alleged benefits are tied to the same time window?
Yes, time of day actually matters greatly since it depends on UVB exposure. Here's some classic research from 1988 discussing the topic:
Webb, A. R., L. Kline, and M. F. Holick. “Influence of Season and Latitude on the Cutaneous Synthesis of Vitamin D3: Exposure to Winter Sunlight in Boston and Edmonton Will Not Promote Vitamin D3 Synthesis in Human Skin.” The Journal of Clinical Endocrinology and Metabolism 67, no. 2 (August 1988): 373–78. https://doi.org/10.1210/jcem-67-2-373.
Also, here's a web calculator that can help you calculate UV exposure required to get a desired amount of Vitamin D (and to avoid a sunburn) based on location, time of year and day: https://fastrt.nilu.no/VitD_quartMEDandMED_v2.html
"Parallel" generally means that different groups of patients receive different treatments. The opposite is a within-patient study, where all patients get all treatments over time (possibly varying the order to prevent order effects).
"Open-label" generally means "not blind at all." Basically, the patient knows what treatment is being administered.
"Double-masked" is usually synonymous with "double-blind," because "masking" sounds less violent than "blinding."
What did they actually do in the study? Well, §2.2.1 says the following:
> 2.2.1. Randomization and Masking
>
> An electronically generated randomization 2:1 list was prepared by
> independent statisticians. The list was accessible only to nonmasked
> specialists in the study in an attempt to minimize observation bias.
> The patients' data were recorded in the hospital's electronic
> medical record, with blind access by the technical data collectors
> and the statistician who carried out the study.
My takeaway is that... the authors don't do a great job of describing who had access to what information.
It sounds like those who analyzed the data didn't know which group was which, but in the case of unequal 2:1 group allocation it is typical for the larger group to be the treatment group. Why was unequal assignment used in the first place?
The descriptor "open-label" suggests that someone knew which patients were in which groups: was it the people who administered the treatment, or the patients, or both? Unclear.
The authors themselves write: "This pilot study has several limitations as it is not double-blind placebo controlled."
I frankly think its irresponsible and facile for anyone to suggest there are no downsides to high doses of Vitamin D. This stuff is available OTC and a lot of folks are just gonna dose themselves ad libitum here.
I think a responsible way to look at vitamin D right now is:
- There was an association shown between low serum levels and bad COVID-19 outcomes, but low vitamin D is an indicator of frailty, so it was how much of this relation was causal.
- Now we have some early data that sure makes it look causal and it seems to be a significant effect, but it's not watertight yet.
- We know that a big fraction of us have low vitamin D levels with other health consequences from it.
- Taking a moderate dose of vitamin D now seems like a reasonable hedge: low risk of health consequences, and a decent chance of health benefits even if it doesn't protect us from the pandemic.
We get 20,000 iu of Vitamin D in like 15 to 30 minutes of sun (if you're pale skinned). Pretty sure taking 5,000 iu every day isn't going to be harmful.
Also, fun side note: Vitamin D is produced as an oil on the skin and actually seeps through your skin overtime to enter the bloodstream. So don't take a shower after getting some sun, because you could be washing off your Vitamin D.
> We get 20,000 iu of Vitamin D in like 15 to 30 minutes of sun (if you're pale skinned). Pretty sure taking 5,000 iu every day isn't going to be harmful.
You cannot overdose on vitamin D from sun exposure because the metabolic process that creates it has a concentration limit.
You CAN overdose (experience toxicity) from too much supplementation. They are not equivalent.
Some people do get toxic side effects from supplementing 5000 IUs a day, over long periods of time.
Interesting, thank you for sharing. Didn't know that. Just what Dr. Hyman recommends in his book, sounds like it's also levels that build up, and there is seasonal sun so maybe years long 5000-10000 IU supplements is overkill and why he recommends 2000 maintenance.
> We get 20,000 iu of Vitamin D in like 15 to 30 minutes of sun (if you're pale skinned). Pretty sure taking 5,000 iu every day isn't going to be harmful.
Sarcasm: Yah, getting it from sun and from a supplement are biologically identical.
You absolutely can get too much vitamin D from a few thousand IU per day for a sustained time.
I looked into that when I was told to take 2,000 IU daily, since I had no idea what an IU of vitamin D involved. A web search said that people who were taking megadoses of vitamin D, which was mislabeled and actually 10 times stronger than what they thought they were getting, started developing problems in a month or so.
It's available right off the shelf. As long as people aren't taking an entire bottle all at once, it seems pretty safe to me. (Disclaimer: Dammit Jim, I'm a software engineer, not a doctor.)
The biggest issue i think it's availability. When this was hitting the new York area, vitamin d was impossible to find on the shelves. It's available now, but if we start putting out mass messaging to take vitamin d then supply will run dry again. Shady unsafe supplies will then start showing up to make a buck.
If the costs are low, then the free supply chain won’t cost much to create. If the public health savings are greater than the costs, it may be better to just mail free supplements to people than mail them postcards advising they go out and purchase them (advice most people will ignore, no matter how low the cost).
How many people will need to be paid to operate this free supply chain to provide a good that is perfectly well-supplied inexpensively privately now? How many to answer questions, field calls about missed shipments, lost pills, changes of address, etc?
The answer to every problem shouldn’t be “create a new government-funded agency to make this happen ‘for free’”. Mr Market isn’t the answer for every single thing, but sometimes it’s fine to let existing private supply chains operate. Supplying cheap dietary supplements seems to me like an area where that’s the case.
It may need to be added to SNAP/WIC; that’s a reasonable task for government to busy itself supporting this.
Why? If it’s cheap on a per-dose basis and has the potential for major social benefit (saved lives and avoided healthcare costs) that seems like exactly the sort of program that would be an efficient use of government resources. There’s a clear, measurable, and nearly immediate return on our investment.
Very small scale but sounds promising. I've been taking 2000UI/day for few years now since my doc found my vitamin D was pretty low, it's now far up in the normal range now. I didn't let him give me the massive doses that they want to give you for low vitamin D, and opted for just starting to take the supplement, when I went back in 3 months later everything was in the normal range. I don't actually get much sunlight as a den dwelling programmer so it's the next best thing.
Sounds great. What's important to understand with high vitamin D doses is that overdoses can occur unregulated by the body.
The regulation of vitamin D usually occurs before its synthesis after sunlight exposure. Supplementing synthesized vitamin D circumvents the regulation and allows vitaminosis to happen.
I have read wildly different recommendations for the dose. Typical package is 1000 IU, you take 2000 IU, others recommend upwards of 8000 IU due to possible issues with earlier studies leading to FDA/regulatory agencies recommendations. Again, rather stay below 5000 IU unless explicitly told otherwise by a doc. Always get blood work done to REALLY figure out your levels and how to fix them.
Again, why we can overdose with supplements but too much sunlight won't cause an overdose:
Sunlight + components ---> X (regulation) <---> Vitamin D ---> effect in body
Looks promising, but I would want to see a true double blinded RCT on a few thousand people before we say that Vitamin D is an effective treatment.
Also, there's going to be a confounding question based on this study: is it just Vitamin D, or is it Vitamin D in combination with HCQ / Azithromyacin?
That said, it probably wouldn't hurt you to supplement with Vitamin D this winter, even if it doesn't treat Covid.
In combo with other observational studies correlating Vitamin-D-deficiencies with the worst Covid-19 outcomes, the case is growing.
Vitamin-D in moderate amounts is pretty safe, so for those not already getting adequate sun exposure, it's a low-risk, high-potential-reward supplement.
It's difficult to imagine how the placebo effect could produce this result. Both arms of the trial were receiving HCQ and Azithromycin, so to the extent that there is a placebo effect, you'd think that adding a vitamin wouldn't change the result very much.
You should almost certainly be going outside for the other health benefits.
There's very little risk of transmission if you're outside and 2m away from other people, even if intermittently you're closer than that. Even more so if one or the other of you is masked.
Places to be more concerned about are bottlenecks like lobbies and elevators on the way to/from outside.
My understanding is that it hasn’t been shown for elevators. I think this is because of the required time to breathe in a minimal viral load. Do you have evidence otherwise?
You're in a confined space, breathing the same air as other people. Also, given the frequent traffic of elevators, consider what you may breath in from previous occupants. This sounds risky to me. I hate touching elevator buttons during normal times. I'd wear masks and gloves.
Well the absence of anything is the default, so the burden of proof is on the person making the claim. I had read that somewhere in studying transmissions in NYC where elevators are common. I don’t remember where, it was a while ago.
> Well the absence of anything is the default, so the burden of proof is on the person making the claim.
I'm not sure the concept of "burden of proof" is helpful in a collaborative fact-seeking discussion. It seems more relevant to adversarial debates and trials.
It really depends on what the potential hazards are for the claim being correct versus the claim being incorrect. If the claim is that you can't get it from sharing an elevator, I would say the hazards if that claim is wrong are much greater than if that claim is correct. So, from a risk-management perspective, without any evidence, it's much better to assume that you can get COVID-19 from sharing an elevator until enough evidence accumulates to demonstrate that you can't. If you assume you can, the worst that happens is that you wait for another elevator. But if you assume you can't and you actually can, then you get COVID-19.
If I live in a high-rise, then there are large problems in avoiding elevators that could be worse. If all residents were to use stairs, aside from cardiac difficulties of some, mobility issues, risks of falling when carrying large loads, etc, there’s also going to be great amounts of aerosols generated by the huffing and puffing of many people using the stairs all day long (possibly in close proximity for multiple people going up at the same time). This could be a far larger vector as you’d be in the stairwell longer than you’d be in an elevator (https://www.cdc.gov/coronavirus/2019-ncov/php/public-health-... suggests 15 minutes of exposure needed).
It’s not clear that “avoid elevators” is universally less harmful. Also given the 15 minutes suggested it’s not clear that elevators by default pose a risk, and the large numbers in use in the world make it surprising if they are indeed a major vector but are otherwise undocumented or not part of suggested guidelines thus far.
I’m asking for evidence which shows they are indeed a risk factor, which should also hopefully take into consideration mask usage and number of stories. This would be extremely useful for people to factor in if they need to move, for example.
A recent article in the Emerging Infectious Diseases Journal details how a large COVID-19 outbreak in China was traced back to one asymptomatic individual who infected a neighbor when they used the same elevator in their apartment building — though they were not in the elevator at the same time.
There is a lot of evidence that close quarters, inside contact is very risky for transmission; every country in the world is operating under that assumption, indeed most are passing laws based on this. There is zero reason to believe that elevators ... both close quarters and inside would some how be an exception.
You've claimed that elevators are an exception to the established guidelines without evidence and are now claiming that that other, well evidenced, claim some how needs additional support to be applied to elevators.
My understanding is that planes have very effective air filtration and movement systems. Choir practice likely would not, and involved people generating aerosols continuously.
I wonder how safe it is to queue at an airport, walk to the plane on a ramp among 100 yawning, coughing others, and reverse that process on the other side.
It may negate the safety of the actual airplane trip, or it may not.
I've been taking Vitamin D3 5000 IU and Vitamin K2 MK-7 100 mcg daily since February to boost my immune system, and I've noticed a radical difference in my colds.
I used to get a major cold every 2-3 month and they were really bad lasting two weeks with fever, fatigue, coughs, colds, really stuffy nose, etc. Now? The two colds I've had were over in a week and the symptoms were so incredibly mild - mostly a light runny nose - that I'm legit grateful when I get a cold.
Regardless of vitamin D's effect on covid-19, the supplement has already paid off big time as far as I'm concerned. I've started to take 1g of vitamin C for the same reason, i.e. to boost my immune system. I should add that I live in a Nordic country with long dark winters and that I can't/don't go outside as much as I should.
Just some random suggestions from someone on the internet, but colds don't usually cause fevers, so if you've been getting sick with a fever every 2-3 months you may want to get that checked out.
It's also surprising that you've gotten 2 colds in the past few months when it sounds like you have been taking precautions due to covid-19. Seems like any exposure where you could catch a cold could easily have been Covid-19 instead, so you may want to re-evaluate your mask use, physical distancing, and hygiene practices.
Are you sure you just aren't getting colds because of better hygiene, and less contact with others? Without controlling for social distancing, you can't reasonably conclude that it was the vitamin D.
I haven't had a cold since we initially locked-down in April, which is very unusual for me, but completely explained by social distancing.
Oh I absolutely believe that social distancing and better hygiene are the reasons why I've gotten so few colds this year but those actions can't fully explain the decrease in severity. My colds have gone from being absolutely miserable to barely noticeable and are over in a week or less. I could be totally wrong but I'm not willing to remove vitamin d/k/c from my diet just to validate the hypothesis.
Careful with Vitamin D. When you get a chance, go see your doctor and ask him to check your vitamin D levels. Don't forget to tell them you are taking suplements.
Ok, but you know what has a really really direct effect on colds?
I swear, it's like people don't understand why we measure R_t. propagation is sigmoidal phenomenon. A reduction in transmission by 10% can easily lead to a reduction in prevalence by nearly 100%.
The literature states 1000-2000 is safe for basically anyone, but you really shouldn't be taking more than that without actually going to a doctor and getting your deficiency confirmed. Just because you have darker skin, it doesn't mean taking a higher oral dose won't cause other issues.
IIRC daily doses above 2000 over a longer timespan can (infrequently) cause your vitamin B12 levels to fall off, and/or the amount of calcium in your blood to build up, so your doctor might want to schedule a follow-up appointment after some time has passed to make sure those levels still look okay, and adjust supplements for those variables accordingly.
If you have an easy access doctor around to ask, I completely agree with that!
If you're not going to see a doctor about this, for laziness/poverty/whatever reasons, I think the average risk from not taking Vitamin D is vastly bigger than the risk from taking it.
I got my D3 levels up to 478nmol/L according to the UK NHS Vit D blood spot service. Supplemented up to starting point of around 200-240nmol/L and then spent the summer outside with top off working on laptop. Never felt so good. Bought some Lizard flo tubes after that to bask under after I was craving a suntan one winter. Odd feeling, but I was also doing alot of magnesium sulphate (Mag oil) topically which helps and some zinc orally. The Mag oil stings the skin much like Deep Heat, so be warned and thinner skinned individuals will experience more pain.
The problem I see with this trial is that it’s open-label, small n, and has subjective endpoints (ICU admission as the primary outcome). The study is underpowered to detect mortality. Given the open-label nature of the trial, the subjective outcome with the small n makes this result less strong.
Why is this the case? Well, for this trial the physicians treating patients knew who got the Vitamin D and who didn’t, and thus they may have been more likely to admit those who didn’t to the ICU (subjective). Something like mortality is not as subjective, but there are too few study participants to detect a mortality signal in this trial.
If I had been conducting this small open label trial I would have picked some less subjective outcomes, like maybe P/F Ratio.
when i was doing the covid19 kaggle competitions in march and april, someone asked me what I learned.
I was like I dont know, the data is messy but the sun seems to have something to do with reducing fatalities. (I used weather data as additional covariates)
In general, the segment of the population that avoids sun exposure has twice as high an all-cause mortality rate as the segment that actively seeks sun exposure.[1] To put that in context that's on par with the health difference found between smokers and non-smokers.
Yeah we wear too much sunscreen, a significant number of people are vitamin D deficient. From the UltraMind Solution book, you need the active form cholecalciferol in your supplements. You can safely take 5000-10000 IU a day for 3 months to get up to the optimal levels, then 2000 IU a day for maintenance. The Ideal range is 50 to 80 ng/ml in your blood tests. Also just minimal outdoor sun exposure is the best way to get it, no sunscreen. 15 minutes if you're light skinned, 35 if you're really dark.
If you search "sunburn [location]" on wolfram alpha, you can get sun exposure guidance for that particular date and location, factoring in weather and your skin tone.
Since I began using this a few months ago I have not been burnt.
Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial
https://pubmed.ncbi.nlm.nih.gov/30541089/
"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
Yeah the time is dependent, I just try to think of like our evolutionary history, pre clothes and where your ancestors are from. So I try to sunbathe by the pool during the summer. But if you work indoors, cholecalciferol is useful and you can get the blood tests for your levels.
Aren't "open label" and "double-masked" contradictory?
"An open-label trial, or open trial, is a type of clinical trial in which information is not withheld from trial participants. In particular, both the researchers and participants know which treatment is being administered." (Wikipedia)
"Double-Masked Study. A type of clinical trial in which neither the participants nor the research team know which treatment a specific participant is receiving." (NIH)
This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003 - 0.25). For randomised trials, it makes no sense to say that the difference in baseline is not significant because we have already observed the outcomes. It is better to use ASDs and in such small trials, small differences in baseline matter a lot. In this case it's pretty obvious the effect of vitamin D would easily be non significant if you shift around some variables. Reeks of p hacking imo
> This is not a strong signal. The adjusted odds ratio is 0.03 (95% CI: 0.003 - 0.25)
Are you for real? Smallest effect in the 95% CI is a 4x reduction in ICU admission. Yes, it's probably closer to the bottom end of this range, but this is a fantastically different.
> For randomised trials, it makes no sense to say that the difference in baseline is not significant
For randomized trials, the baselines are not likely to be massively different. And, of course, the authors compared risk factors and ages to rule out some of the ways that the trial could be ridiculously tilted from the outset.
> In this case it's pretty obvious the effect of vitamin D would easily be non significant if you shift around some variables.
...??? The endpoint was pre-declared, and we're just comparing two pre-randomized groups. Exactly what variables would you shift around?
> Reeks of p hacking imo
If you're going to cast aspersions, be a little more concrete.
Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial
https://pubmed.ncbi.nlm.nih.gov/30541089/
"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
You know, at this point, I'm basically over debating the merits of vitamin d. Take it, don't take it, I don't really care, just please tell your doctor you're taking it.
To pharmaceutical companies or supplement companies, or the NIH: fund a well powered study, pretty please?
This seems pretty promising, though small n, result. Vitamin D is so ably we’ll well attested as a prophylaxis for pulmonary infections — in fact there was a large UK study published in January on this very facto.
Starting in February I went on a prophylactic supplement of Vit D, Vit C and aspirin because of the then-unnamed Covid-19 virus. The aspirin (actually started that in april) is because of the pervasive excess clotting and sudden strokes in young people showing up in ERs (less attested in the US than some other countries for reasons I’m not sure about). I’d never taken supplements before.
I’m immuno compromised so with my doctor we worked out the regime above plus some prescription drugs I won’t mention.
So far, so good, but I’m isolating' so this could be a case where I’m also preventing tiger attacks.
It can be, depending on the protocol. This was a double blind yet open label (?) study. I’ve never done an open label study so don’t know how they have to be powered (and I’m not a biostatistician so won’t render a guess)
I take 5000 IU pills, and they're labeled as 125 mcg. The 0.532mg pills they were getting would thus be around 4.25x as much, or a bit over 21,000 IU based on how D3 is usually labeled for over-the-counter purchase.
Though my pills are "cholecalciferol" not "calcifediol", so there's not a perfect 1:1 correspondance, but your body converts cholecalciferol into calcifediol, so based on nothing else my above calculation is probably not far off.
I don't know, but I take 5000 ius a day and because of my gastric sleeve I'm still somehow deficient. So upped it to 7500 ius by adding a multivitamin. I'm also O positive (which means I won the damn blood lottery for covid hehe), but overweight, so gotta hedge my bets as best as I can. I also take zinc.
As someone with low vitamin D this kinda sucks. Does anyone know how effective OTC vitamin D is at raising vitamin D levels and what kind of doses to take?
Dai (2018): Magnesium status and supplementation influence vitamin D status and metabolism: results from a randomized trial
https://pubmed.ncbi.nlm.nih.gov/30541089/
"Our findings suggest that optimal magnesium status may be important for optimizing 25(OH)D status. "
In my experience, it is certainly effective. I take 2000IU fairly regularly since last few years and it certainly helped to keep vitamin D level slight above minimum required.
3. When uvb is present, you can make sufficient vitamin d quite quickly
This would suggest you would want sunscreen for longer exposures, or with much uva exposure. And could get vitamin d from a briefer exposure pre sunscreen.
I can’t say how completely sunscreen blocks vitamin d however.
Actually, it seems I was wrong. I thought it was just UVA, but uvb also causes melanoma.
I’d delete the above comment if I could. The main point that you can get vitamin d from short exposure without sunburn is correct, but I was incorrect on the risk. But he fact I was wrong about uvb and melanoma also makes me think I may be incorrect on the risk of uva during periods without uvb.
Every year they issue a winter influenza vaccine instead of making vitamin D pills and artificial sunlight available. Young people never take the winter flu vaccine and are fine.
Anyone else notice that Calcifediol is the most expensive vitamin-D analogue on the market? What a huge surprise that the study chose that form of vitamin-D specifically.
oral Calcidefiol is significantly more potent than vitamin D3, and is a faster way to boost blood Calcidefiol, which is the purpose of ingesting vitamin D.
I assume that the researchers picked it (1) to increase the chances of seeing a significant effect, if there is one, and (2) because if hours are at stake in saving a person's life, the fastest boost may be needed.
It would be tragic if taking vitamin D supplements had a negative effect on Covid survivability.
I think that it is extremely unlikely, though possible unless a specific study has ruled this out.
EG: Perhaps vitamin D supplementation upon Covid-19 diagnoses is only effective if you have not been supplimenting.
Like: Maybe drinking alcohol at a party is helpful to court a new partner, unless you are an alcoholic already. Not the best analogy but I hope you'll take my point in good faith.
This test really doesn't hold a lot of useful data. It doesn't calculate any of the statistics of those that died which is kinda of important when age and previous health conditions are important. It doesn't gather BMI, physical activity levels, ethnicity, secondary/multiple infections, cause of death, type 1 or 2 diabetes, etc.
Medical trials are hard because of all the variables. I think it actually works against this trial having it randomized especially when there is no placebo group.
It shouldn't be hard to sit for a moment and think of some people who would certainly like for there not to be a treatment consisting of ~$3-5 worth of off-the-shelf, completely unpatentable medicines and vitamins.
There are absolutely some powerful vested interests in not seeing an easy treatment for this disease, or, by the same logic, pretty much any other disease either since there's nothing special about this one. (A not infrequent complaint on Hacker News.) I can't prove they're driving the discourse on treatment for COVID-19, but it sure isn't disproved by what I see happening out there.
You cannot fast-track a vaccine if there are other treatments available. Letting the word out that you can be cured from COVID-19 could make a lot of people lose much money. Both Vitamin D and the other one (it rhymes with byfroxymorophin) are cheap and out of patent.
There are seven results for American trials found on clinicaltrials.gov for Condition= "COIVD19" and Drug = "VitaminD" run by institutions like Harvard/MGH, Brigham, UNC, Arizona State University, etc.
"Don't go outside, you'll get COVID", sounds more and more like horrible advice. Before knowing the virus died in sunlight, I still couldn't fathom why people were avoiding going out to parks and stuff. It was totally non sequitor.
The concern was presumably crowds at parks. Viruses take a while to die from sunlight; it's not going to save you from breathing in the droplets from someone standing right next to you. (Not to mention choke points like public bathrooms, or in places like NYC, residential elevators to get to them.)
The likelihood of people being crowded in a park is much lower though due to inherint lower density. All the parks I saw closed their choke points (bathrooms, water fountains, etc) so I feel like being outdoors in a park is still much safer than staying indoors, going to grocery stores for example. But people were acting as though you could get it by just going outside. There was/is alot of fear mongering around leaving your house at all.
The point of staying at home isn't a matter of inside versus outside. It's about limiting potential exposure to infected people. Unsurprisingly it is very effective.
There's a major difference between daylight and getting baked under direct solar irradiation.
If the UV doesn't kill the virus the heat will. But even then, it's not immediate. If droplets containing viruses successfully land in your respiratory system (which is constantly sucking air), it doesn't matter how much sun there is outside, the virus is now cozy.
A beach could be perfect, except that there may be strong winds. You should hope they are not blowing droplets from your neighbor into you.
Similarly, if it's an overcast day, it doesn't really matter much.
Strong winds seem likely to be a good thing to me. Any exhalations from my neighbor are going to be quite dilute by the time they get to me in the wind.
You don't need masks if you are maintaining distance of 6 feet. Masks are for situations where distance can not be maintained such as trains and stores.
6 feet helps. Wearing masks helps. These things do not drop your chances to zero. 6 feet is not a universally applicable number. If you are standing directly down-wind of someone at a park, 6 feet isn’t going to help you. Droplets don’t magically disintegrate at 6 feet. Similarly, if you are up-wind, even 4 feet would be very effective.
All of the guidelines are about statistical safety, not about the physics of your particular situation. As always, use your noggin. Stay safe.
> "All of the guidelines are about statistical safety..."
this bit is correct, but the rest is falling for false equivalency by throwing around the same "helps" with every case.
just being outside is overwhelmingly helpful, meaning it overwhelms every other factor by a large margin. relative to that, wearing a mask outside is of such negligible help to be effectively unhelpful. distance also overwhelms masks, both indoors and outdoors. distance outside helps only a little bit, but distance inside helps materially (because the positional and velocity vectors available to droplets and their virii and the dangers to them outside are exponentially greater). masks by themselves indoors are helpful only in limited situations (when in the direct exhaust of others for prolonged periods).
> "...do not drop your chances to zero"
for real-world situations, boolean evaluations like this are nearly always misleading, no matter in which direction. your chances of dying in a bathtub aren't zero either but we don't worry about it. relative magnitudes matter.
We know the virus can transmit much further than that indoors, there was a string of infections from someone sitting in a restaurant and the HVAC vent they were sitting near blew it down the row and infected a couple people sitting down wind of them. The same rough thing can happen outside just with shorter distances because the wind is more randomized and will spread out the virus faster.
Considering that the risk of transmission seems to depend on how long you are inhaling shared air from an infected person, and their viral load, I don't think it makes sense to worry about intermittently going through someone else's exhaust plume.
I use a mask outside if I'm on a narrow sidewalk, but otherwise, I don't think there's much point. My favourite thing is the people who wear a mask over the mouth, but not the nose. Like worst of both worlds.
>I don't think it makes sense to worry about intermittently going through someone else's exhaust plume.
You're welcome to think that. But it's based on faith, not evidence. I admit that I don't evidence to prove that it's dangerous to a specific level either. I just prefer to err on the side of caution.
Not at all. We have the data. It's called summer. Also, I probably have a weaker immune system than most, and have several risk factors.
We have simply not seen the increases and flare-ups we would expect if what you're asserting is true. What worries me is October-November. This is for Toronto, Canada.
The beaches and parks are fully of people socially distancing-ish. The streets are full of a mix of people social distancing and not. Maybe half are wearing masks.
Get outside and take care of your physical and mental health! Winter is coming.
EDIT> I'm a physics and biology student. I am not completely unaware of the science.
This is what you choose to focus on, from my post? It's irrelevant as that was before social distancing. Also, we've learned more about this disease since then.
Our current local guidelines are that masks are only required indoors or when distancing is not possible, and that seems to be borne out by the evidence. Over the summer people have been out at the beach, out in the parks, and out on the streets while only social distancing-ish. If walking through someone's exhaust plume were as much of a threat as you guys are trying to make out, we would have certainly seen that in the numbers. We don't.
Not really. Super-spreader events outside are essentially unheard of - both the sunlight & plentiful air make transmission much harder.
Don't get up-close with crowds of strangers, sure, but growing evidence suggests 6' outdoors is safer than 20'-plus in any enclosed, recirculating-air indoors.
Now, if you go outside in order to enter some other indoors, with people who may be infected, you're creating risks.
It’s more likely to kill old and obese people, but there are still plenty of rarer cases of harm to younger fitter people (eg triathletes on oxygen post-infection). It’s not binary.
Truly obese people can benefit a lot from just walking, as they're not trained enough to need high intensity exercise to keep it up.
Gyms are pretty horrible places for spreading COVID and other respiratory infections, as they involve a lot of heavy breathing in confined spaces. They are probably a worse place to be than bars. Would the increase in fitness over a 6 month period for a typical obese person really reduce the risk by more than being in the gym increases it?
There was one RCT of gym access in Norway that showed no difference, but that's because there was only one case out of over three thousand during the entire study, in either arm, so it's difficult to say that means anything at all.
1. Weight loss is 90% in the kitchen, not the gym.
2. A gym seems kind-of a high infection risk. Lots of heavy breathing and sweating, wiping of faces, noses, and mouths, sharing of equipment, locker rooms... probably not the ideal place to welcome anyone, let along the (as you say, high-risk) obese amongst us.
Any chance your irritation at closed gyms is more personal, rather than a caring nature looking out for peoples' weight loss regimes?
Anyone can spread it, though. Kids seem to spread it less. Also, the longer this hangs around the more chances it will have to evolve into a form that can harm more demographics. We should want to get rid of Covid-19 as fast as possible.
Finally, although many people get asymptomatic infections, this isn't all about death rate. Many many people are suffering brutal damage even if they do survive. This thing targets multiple organ systems and can leave permanent damage.
Weight gain and loss is simple physics. If you want to reduce obesity, focus on the dietary input. Virtually nobody is active enough to burn the extreme number of excess calories consumed that leads to obesity and the maintenance of obesity.
I have always thought that diet and exercise are both needed. If you can cut your caloric intake by 250 calories a day, and increase your aerobic exercise to burn 250 more calories a day, you should be able to lose a pound a week, without going to extremes of diet or exercise.
Of course, someone who is obese will take a long time to get to a healthy weight if they are only losing a pound a week, but most people would have a hard time maintaining extremes of diet or exercise for a long period of time.
>All hospitalized patients received as best available therapy the same standard care, (per hospital protocol), of a combination of hydroxychloroquine (400 mg every 12 hours on the first day, and 200 mg every 12 hours for the following 5 days), azithromycin (500 mg orally for 5 days.
Fascinating how hydroxychloroquine is routinely used and considered standard of care in most countries where the drug has not been politicized.
>The best available treatment that at the beginning of the outbreak in our hospital, included the use of hydroxychloroquine/azithromycin therapy [23,24,26]. However, taking into consideration more recent data on the safety and efficacy of chloroquine and hydroxychloroquine in small randomized clinical trials, case series, and observational studies this treatment is no longer considered effective [32] in treating COVID-19.
calling it the "standard of care" in the present tense is very disingenuous. it was briefly considered to be effective at the beginning of the outbreak. it was determined relatively quickly that it was not actually an effective treatment. this has nothing to do with politics.
Doesn't that have more to do with the timing of the study than anything else? Studies showing that HCQ isn't effective didn't begin to emerge until June.
Experts and health authorities were adament to tell us that vitamins have zero effect against COVID. Not: we don't know and taking a Vitamin C can't hurt, unless you count an upset stomach. But: stop sharing fake health information, this is an infodemic! Just wash your hands.
So to add to the infodemic: selenium and iodine deficiency also increases severity. Take some iodized salt and Brazil nuts now, or wait 5 months for the authorities to understand that absence of evidence is not evidence of absence. And no matter what Youtube bans you for going against the WHO: tumeric is an efficient antiviral.
Any examples of the CDC, FDA, or NIH statements telling us that vitamins have zero effect on COVID? I’d also be interested in statements from the WHO, but that one I wouldn’t be at all surprised by.
Vitamin C is listed as fake news on WHO. Fact checker sites listed vitamin D as false, then switched to correct after research. Doctors, journalists, and health experts in Brazil and the Netherlands chided social media for not removing "fake" info on vitamin supplements.
I'll check some CDC sources later to contextualize these claims to the US.
Mayo Clinic: Debunking COVID-19 (coronavirus) myths. Extremely unlikely to work and might cause serious harm. [...] Supplements. Many people take vitamin C, vitamin D, zinc, green tea or echinacea to boost their immune systems. While these supplements might affect your immune function, research hasn't shown that they can prevent you from getting sick.
Notice the weird mind crinkle: Got to debunk it, and use "prevent you from getting sick" as the reason for it not working (and the subtle differences between: "No research has shown", "research hasn't shown", and "research has shown that it can't prevent you"). Even though plenty of research shows it prevents you from getting severely sick, when you do get sick. Willing to bet that garlic (a famous folk knowledge cure for the flu, smashed boiled garlic with hot water) is actually effective in recovery and severity, but the fact checkers present it as a "COVID cure" and of course that can be debunked. But it is a debunking based on a weird strawman we saw with masks: Masks are not protective to COVID because the eyes can catch it too. As if protectiveness and immune health is binary and anything else than 0 or 1 has to be a lie.
Could not find anything about the CDC, just https://www.cdc.gov/nutrition/infantandtoddlernutrition/vita... where they recommend Vitamin D for children under 2 years old, to prevent deficiency, but no where mention a recommendation for using it during a pandemic to keep your immune system healthy.
As for selenium deficiency and iodine deficiency, the research is slowly catching up:
> Certain micronutrients are seen as supportive for the treatment of and protection against viral diseases with some vitamins (A, B6, B12, C, D, and E) and essential trace elements (zinc, iron, selenium (Se), magnesium, or copper) discussed as particularly promising .
> However, the data base is very small and it is unknown whether certain vitamins or trace elements are deficient in patients with COVID-19, and whether the concentrations are related to disease severity or mortality risk.
> The collaborative research team from Germany hypothesised that Se may be of relevance for infection with SARS-CoV-2 and disease course of COVID-19 and that severe Se deficiency is prevalent among the patients and associates with poor survival odds in COVID-19.
As for turmeric, mentioned in relation to COVID a bannable offense on Youtube: It inhibits and suppresses Zika, Hepatitis, HIV, Noro, coxsackie, HBV, herpes, influenza, encephalitis, dengue, corona, and chikunya. It also suppresses cytokine signalling. But experts warn that it may interfere with the immune system when fighting COVID, and that it is neither a cure nor a treatment nor a helpful supplement. WHO lists it under hoaxes (except when discussing Chinese traditional medicine). And you are a bad person if you share this potential online, because you don't have a randomized trial to back up that it works against SARS-CoV-2.
MedicalNewsToday: In a rapid review of the evidence published on May 1, 2020, researchers from the Centre for Evidence-Based Medicine at the University of Oxford in the United Kingdom unequivocally conclude: “We found no clinical evidence on vitamin D in [the prevention or treatment of] COVID-19.” They also write that “[t]here was no evidence related to vitamin D deficiency predisposing to COVID-19, nor were there studies of supplementation for preventing or treating COVID-19.”
Potential Effect of Curcumin Treatment of COVID-19: Curcumin may have beneficial effects against COVID‐19 infection via its ability to modulate the various molecular targets that contribute to the attachment and internalization of SARS‐CoV‐2 in many organs, including the liver, cardiovascular system, and kidney. Curcumin could also modulate cellular signaling pathways such as inflammation, apoptosis, and RNA replication. Curcumin may also suppress pulmonary edema and fibrosis‐associated pathways in COVID‐19 infection.
WHO Fact or Fiction: There is no scientific evidence that lemon/turmeric prevents COVID-19.
“Of 50 patients treated with calcifediol, one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%) p value X2 Fischer test p < 0.001.”
Which sounds like as strong a signal as a study of this scale could hope to show.