About 45% of the US population has Vitamin D deficiency. It's higher among some populations (elderly as they are more likely to be home-bound, African American as darker skin inhibits UV absorption, obesity due to adipose tissue storage, etc). Those of us further North are more likely to be deficient as well due to decreased exposure during much of the year and being inside or bundled more in winter months.
> About 45% of the US population has Vitamin D deficiency. It's higher among some populations (elderly as they are more likely to be home-bound, African American as darker skin inhibits UV absorption
I believe Vitamin D deficiency is defined by reference to a single level which is assumed to be valid for everyone. In reality, the level at which a deficiency is experienced almost certainly varies both on an individual basis and between racial groups. We say African Americans have higher rates of Vitamin D deficiency, but this is based on the assumption that their average levels of Vitamin D should equal those of European whites, not on an assessment of when they experience problems.
The better measure of Vitamin D deficiency would be "are there signs of rickets?", but somehow that never gets used.
Of course some believe that Vitamin D is a substance only required to prevent rickets, while others have assigned it all kinds of different roles so they would be unlikely to accept absence of rickets as a standard.
> Of course some believe that Vitamin D is a substance only required to prevent rickets, while others have assigned it all kinds of different roles
The phrasing there is a little weird. Conceptually you wouldn't expect Vitamin D to have the function "preventing rickets", in the same way that the function of Vitamin C is not "preventing scurvy". Vitamin C does several things, and the different failures of those different things manifest as different symptoms of scurvy. Scurvy is what happens when you don't have enough Vitamin C, as rickets is what happens when you don't have enough Vitamin D.
> We say African Americans have higher rates of Vitamin D deficiency, but this is based on the assumption that their average levels of Vitamin D should equal those of European whites, not on an assessment of when they experience problems.
Couldn't you just survey average vitamin D levels in native West African populations, and compare it with African Americans?
Even if there was a difference in the requirements between native Africans and native Europeans, many African Americans also have varying levels of European heritage that would complicate the picture.
Off the top of my head, I'm not familiar with Vit D surveys in West Africa, but there have been some in East Africa. From these, it looks like lifestyle and diet are probably the biggest determinants of Vit D levels. For example, the pastoral Masai have phenomenally high levels of Vit D, while a related tribe of agriculturalists have significantly lower levels, with similar sun exposure. Another survey of young healthy urban participants in Nairobi found similarly low to mid levels of Vit D. Among South Indian rural farm workers, who have complexions comparable to the African subjects and similar levels of sun exposure had much less levels of Vit D. It was speculated that phytates in their diet impacted Vit D levels.
So are you claiming that there is something biologically different about the different races that means their normal biochemistry differs between one another?
> are you claiming that there is something biologically different about the different races that means their normal biochemistry differs between one another?
Yes, genetic variations meaningful to e.g. certain drug responses [1] correlate with race.
Fair question which, if asked without malice, doesn’t deserve a downvote.
Advice about healthy sun exposure to ensure adequate Vitamin D production generally notes that more exposure is required if you have Melanin in your skin (i.e darker skin).
"If you have dark skin – for example you have an African, African-Caribbean or south Asian background – you may also not get enough vitamin D from sunlight."
Skin colour is a poor dividing line between populations, though maybe on this vitamin D issue it might be more reasonable. There is no "black race." There are populations of various African origins, a much more complex and messier situation that the category "race" obscures. There is statistically more genetic diversity _within_ Africa than in the entire human population outside of Africa, so drawing a cline based on some "black" or "African" or "Negroid" basket of traits is fully 19th century quackery.
EDIT Put another way: "race" is a cultural category, with little biological meaning. The key question here is vitamin D responses in southern-adapted vs. northern lattitude adapted population groups.
That is already being studied between genders [0] as there are drugs that interact differently between men and women.
Even though the racial aspect of it can be taken a bit to the eugenics side by bad actors I believe that more studies should be performed to assess if there are or not significant physiological differences to account for during medical development.
Why wouldn’t there be variation depending on the genes and the phenotype of a population, which can be correlated with skin color? Talking about « races » on the other hand is not neutral.
The article wasn’t very detailed and I wasn’t able to figure out if you are more likely to catch COVID because you have a vitamin D deficiency or if catching COVID causes a vitamin D deficiency. Anyone know?
People who are more likely to be hospitalized due to COVID are also more likely to be deficient in vitamin D. There doesn't have to be a causal relationship at all.
The level of evidence isn't great yet, but its highly likely that Vitamin D can help modulate the immune system. There is a retrospective study showing a difference between patients that got Vitamin D and those that didn't (can't find the link, unfortunately), and
there is a small Spanish trial of 75 people where 50 got Vitamin D and 25 did not; in the group that did, 1 person needed oxygen whereas in the other group 12 people needed oxygen and one died - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/
People who are more likely to be hospitalized are also more likely to be deficient in vitamin D.
The control group seemed to be a healthy population sample, but hospitals are not a pool of healthy people. How about a hospital sample instead of a population sample?
Or maybe a 5th option: "People who are staying socially isolated spend less time in the sun, so the population has become more vitamin D deficient".
I know that I'm spending less time outdoors than I used to -- no more outdoor picnics/parties, no beach time this summer, I'm not even biking as much as I used to.
Unless social distancing in practice is not uniformly effective, and a large number of people both stay indoors to social distance, and are still quite likely to catch COVID because they are indoors with people who don't socially distance.
Plus being indoors means a confined space with less airflow, less air volume, and almost no upper range UV sunlight compared to being outdoors; these all are significant factors for likelihood of covid spreading.
Uhm, that seems a tad convoluted. Are you saying people that socially distance themselves are more likely to contract Covid-19 because the ones that don't are so often outside that they will contract it less probably?
And further, that's not the definition of social distancing. This would obviously include indoors. I won't sit at my kitchen table with the postman for a coffee while I am avoiding public gatherings.
I am sorry, my sarcasm-radar is quite broken. Are you joking?
This isn't really a 7th option because it overlaps with some of the previously mentioned ones, but perhaps individuals who don't supplement with vitamin D are more likely to catch Covid-19 because they also don't take other precautions like wearing masks.
Anecdotally it seems those I know who are most concerned about Covid-19 know all about the possible link with vitamin D and are taking supplements while also being careful by wearing masks, sanitising etc.
Recently I keep seeing references to protecting oneself by wearing a mask.
When did the narrative shift from "wear a mask to limit transmission to others in case you might be infected and asymptomatic" to "wear a mask to protect yourself"?
Assuming we are talking about the usual surgical / cloth masks here (not N95 etc), is there any evidence that they protect the wearer?
We all know that mask wearing and the science (or lack of it) to support it has become ridiculously politicised, but I'm curious if there's any evidence behind this particular shift.
This, and as someone who recently found out that they have a severe vitamin D deficiency, I was surprised to know that it's not something normally checked for in yearly blood tests.
Check the videos on Dr John Campbell's (PhD nurse educator in the UK) web site. The UK national health service has good medical records that can be cross-referenced and cross-linked every which way. Someone examined the historical records, found a reasonably large number of persons who had vitamin D levels checked before the pandemic, and checked those statistics vs the Covid-19 experience of the same people. (Imagine living in a country where that could happen.) IIRC, this did find some benefits wrt COVID-19 of not having a very low vitamin D level.
Or maybe low vitamin D levels are a symptom of the same "root cause" that leads to higher risk for Covid-19 and just supplementing vitamin D does not do anything to lower the latter.
Those vitamin D level statistics have been floating around for months. What's missing is a placebo-controlled study to see whether supplementation would make a difference. But that involves more than just clicking a bit of statistics.
That study is absolutely not missing, and it says exactly what you'd expect it to[0]. It's even being tested as an active treatment[1]. In fact, that study was also done with Influenza[2] and other lung borne ailments as well. It pretty obviously works, has tremendous explanatory power in the observed patterns of disease, and the fact that no government has sanctioned its use or its mass production ... well, I guess modernity kind of sucks. Better to pimp useless expensive garbage pharma companies can turn a profit on.
Unfortunately, [0] and [1] are still ongoing and [2] reads like a blog post of somebody ranting about a statistical error, followed by some anecdotal evidence and the demand for an actual study. There could still be something there, but summarizing all of that as "quite obviously works" is stretching it.
Yeah, that's very likely actually, since the biggest risk group, the elderly, are also one of the groups with the highest levels of vitamin D deficiency.
In this study here 84% of the elderly had some amount of vitamin D deficiency (Figure 3).
There must be very well controlled groups of elderly people who after some blood test have been taking supplements and checking their vitamine D levels. I wonder how the virus is affecting this group compared with the general population of the same age. If this group were doing well, I think it would be quite conclusive, since it would show that people under treatment (and therefore with some previous health problem) are doing better than supposedly healthy people with low vitamine D values.
I do the same. Getting enough sunlight is hard during wintertime.
Vitamin D deficiency has been linked to compromised immune systems, depression, rickets and several other things. More research is needed within several of those areas, but I believe it to be safe to assume that supplementing with vitamin D is good for you if you're deficient. If not, well, it's not like it's going to hurt you unless you overdo it.
I understand what you mean, but don't think your example really fits since an increase in vitamin D in either scenario would ultimately reduce the occurrences of patients showing low vitamin D levels. And this seems to be a fairly consistent finding across multiple studies that use different controls/stratification/etc.
Or do you mean people may be becoming deficient in vitamin D as a result of Covid? If so, would be interesting to know their prior vitamin D levels.
I'm not entirely sure you're replying to the correct comment, but just in case...
I mean the population of people who are more likely to be hospitalized due to COVID also happens to be the population of people that is more likely to be deficient in vit D, and neither of those things have to cause the other.
I know your point is that correlation does not mean causation (though maybe those are correlated?), however, that really makes it sound like guys like Ben & Jerry have blood on their hands.
rblatz is referring to a well known correlation: more nursery happen in summer. More ice cream gets sold in summer. Therefore, ice cream sales are correlated with murders.
This correlation is not random - it holds across geographic boundaries and time. But it is not causal - decreasing ice cream sales (By limiting supply, raising price, etc) will not reduce murders. Decreasing murders (By more police intervention, limiting arms sales) does not reDuce ice cream sales.
Similarly, vitamin D may be The ice cream analog. COVID 19 may be the murder analog, and if that’s true, we don’t yet know what summer’s analog here - could be obesity, or genetic factors, or something else. We don’t know.
I doubt anyone is saying with 100% assurance this is the -cause- but that it would be worth investigating further. If they'll change FDA recommendations for the blowhard in chief, we should also consider lack of certain nutrients as possibly something to look into as well.
I recall an article a few months ago that discussed the Vitamin-D link in more depth, and a plausible mechanism was already suggested: vitamin D regulates the immune system response. People with low vitamin D levels are more likely to experience severe cytokine storms.
The impact of Vit D in enhancing immune response (including flu and previous coronaviruses) has widely been studied and firmly established. Vit D can also suppress cytokine storm, which may substantially increase the chances of avoiding a severe case of COVID-19
The previous articles I read about Vitamin D & Covid (mentioned in German and Swiss news, not sure about the location of the cases) were related to critical cases in hospitals.
Meaning that if the conditions are right (e.g. area having a high virus density, long exposure to low levels, whatever...) you might anyway "catch COVID", but if your vitamin D level is OK then you might be less likely to end up in an hospital or even in intensive care (because by having good vitamin D levels your body can apparently fight better against the virus).
I think that none of the stats showed an absolute confirmation of this data.
Therefore, in my opinion, your sentence/question is a huge misunderstanding, but of course I might be wrong :)
> but if your vitamin D level is OK then you might be less likely to end up in an hospital or even in intensive care
But only as a form of correlation not necessary causation.
Which means if you make sure you don't have low vitamin D levels because you heard it is correlated with COVID your likelihood of having worse COVID systems might not change at all!
Becau you might have "something" which makes worse COVID systems more likely which also happens to cause low vitamin D levels. Or you might have something caused by your living habits which also makes low vitamin D levels more likely.
I.e. as far as I know studies could only find statistic relevance for correlation (in some cases) but no statistic relevance for causation.
Idk, but it might literally be as simple as unhealthy older people being more likely to have vitamin D deficit and also being more likely to have worse COVID syntoms.
If you ignore the extensive literature describing vitamin D's multi-pronged involvement in metabolism then your final sentence is entirely reasonable. Here's a very short summary of some of the effects whereby vitamin D may may be causatively involved in the strongly demonstrated (there are numerous accounts in the literature) inverse relationship between vitamin D levels and the severity of COVID infection. Incidentally the focus should be not on how much vitamin D is taken as a supplement but on the actual blood level. Tons of references on what this should be rather my quoting those levels here.
Thanks, I realized myself that what I wrote is flawed.
Even ignoring the literature you linked and just using common sense having a deficit puts a burden on your body and any additional burden when fighting some illness makes the fight harder. (Well, ok, there are some exceptions, humans are complex.).
Since vitamin D is cheap and readily available, we don't need to wait before making sure we have enough of it.
Grip strength is another proxy for health, specifically how likely you were to die anytime soon. Makes sense. But training your grip won't make you live longer.
"Hypertension markedly increases the risk of cardiovascular diseases and overall mortality. Lifestyle modifications, such as increased levels of physical activity, are recommended as the first line of anti-hypertensive treatment. A recent systematic review showed that isometric handgrip (IHG) training was superior to traditional endurance and strength training in lowering resting systolic blood pressure (SBP)"
AFAIU, catching any illness is likely to reduce your vitamin D levels. For one thing, the active metabolites are created by the liver and then the kidneys. https://www.cdc.gov/nutritionreport/99-02/pdf/nr_ch2b.pdf Illness can depress this process. See, e.g. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360762/ Furthermore, if you're bed-ridden then you're not likely getting sunlight, and it only takes a day or two of no sunlight for your serum levels to drop significantly.
Of course, none of this is to say that there's no reverse causative relationship aswell, but people really need to take these correlation observations with a huge grain of salt. And also take note of extremelyinconsistent results when controlled trials are attempted.
A slight technicality that I only recently learnt. You catch a virus . In this case it is Sars-CoV-2 . The virus causes a disease. In this case Covid-19.
So , how this ladders up (in my understanding at-least is this): People can catch the virus irrespective of Vitamin D levels. The virus can and will replicate in the body. The Vitamin D levels in the body determine the severity of the disease in the said body. This all feels intuitive but I am conscious that immunology is where intuitions go to die so someone please correct me if I am wrong :)
The paper found no relationship between vitamin d and the severity of the disease
To your question, either outcome is enough for you to optimize a diet or activity with adequate amounts of vitamin D because the process is healthier either way unless you were thinking to just try taking supplements
From other articles and study abstracts I read, it seems that an existing vitamin D deficiency is correlated with worse Covid-19 outcomes (worse symptoms, higher levels of death).
That doesn't mean what you (and possibly they) think that means.
Suppose that characteristic X (eg vitamin D deficiency) puts you at risk of doing worse at Y. If we pick a population based on how poorly they do at Y, we expect to see that X will be more common than it is in the general public. But within that population there is no reason to believe that having characteristic Y makes you do worse - it just made you more likely to do badly enough to be selected.
This can be seen quite precisely with a toy model. Suppose that we have a population evenly split between 2 subpopulations with a characteristic that varies on a normal distribution. However one population averages 1 standard deviation worse.
If we pick the bottom 5% of the population on that characteristic, we will find about an 80-20 split based on having the risk factor. The bottom 1% also has the same 80-20 split. Ditto the bottom 0.1%, 0.01%, and so on. The reason is that the sum total of how many are in the tail of the normal falls off exponentially fast, with the same exponent in both populations. So the ratio stays constant.
No amount of analysis of people in that tail will suggest that characteristic matters. But comparing the population in that tail to the general population, that standard deviation stands out like a sore thumb as a major risk factor.
Therefore the fact that about 50% of the general population has vitamin D deficiency while over 80% of those hospitalized with COVID-19 do suggests that vitamin D deficiency is a risk factor. But we should draw no conclusions from the fact that vitamin D deficiency doesn't indicate different outcomes within the population landing in the hospital.
(However other research found that patients given vitamin D once landing in the hospital were significantly less likely to wind up in the ICU or dead. We should definitely draw some conclusions from that!)
doubtful, the body stores vitamin d in fat cells and individuals that have have sufficient levels will also have some stored up. Vitamin D levels in the blood don't work like an on/off switch depending on how long you were in the sunlight on a specific day or even week.
The answer is simple: It's unclear, because the study design they did cannot answer such questions.
This is one of the most basic misunderstandings in interpreting scientific studies. If you have "we saw x where we also saw y" then it can mean anything from "x causes y" to "y cause x". And also "unknown factor z causes both x and y", "it's a random coincidence", "they looked into the data long enough with enough different methods to find something" or a combination of all of those.
There is a considerable volume of literature indicating a positive correlation between daily vitamin D supplimentstion and reduced respiratory infections. The quality of the studies isn’t great, but generally a positive impact was found for small doses, especially for children.
Staying home or in a hospital bed without sufficient sunshine exposure (which will likely happen to anyone feeling sick) will reduce vitamin D levels.
I don’t know what you consider “known way”, but this Hypothesis is mentioned in almost every discussion, and is not controlled or corrected for in any study I’ve seen.
(There is reason to believe vitamin D Supplementation is helpful, based on earlier studies related to viral respiratory diseases - but not yet enough data specifically for covid)
The studies with positive results are suggesting somewhere around a one binary order of magnitude reduction in risk of infection with possibly some reduction in severity of cases. I'd suspect that the health authorities would not be reluctant to promote a vaccine that had similar results if none better becomes available. Some hospitals are supplementing vitamin D for Covid-19 patients. Trump got it.
It is interesting that with this much evidence, public officials are not telling us to take VitD.
The masses are crazy though - VitD can be a little dangerous and I can see quite a lot of people taking '10x doses' to get '10x protection' and ending up in the hospital anyhow.
I saw an article posted someplace a couple of weeks ago telling the story of one person who suffered from too much VitD -- but that person wound up in the hospital only after taking 78000 units/day for about 8 months. That article would have been misleading then if one inferred from it that you really have to seriously knock yourself out to do any damage?
I assume the elderly would have higher rates of deficiency due to being indoors more, and that 45% number is also out of date during the pandemic when a lot of people are staying home.
The deficiency doesn’t have to do with being indoors. It has to do with how their body functions and absorbs sunlight. If the 45% number is low because of the pandemic itself then we wouldn’t be seeing such a huge decrease in deaths from the disease if it were a major factor.
Right. To clarify half life means the rate it divides in half so after 15 days about half of what you took 15 days ago is left, after another 15 days half of that is left or 25 percent of the original amount, and so on. So it stays in the body for months if you get enough vitamin D.
Nobody seems to be asking a related question: in a sunny country like Israel vitamin D deficiency should be less common, does that translate into fewer Covid-19 cases?
Well, there seem to be differences between different ethnic & religious groups, but on average vitamin D deficiency seems to be less prevalent in Israel: https://pubmed.ncbi.nlm.nih.gov/28647929/
There was a newspaper article (in Israel, where I live) on this subject. It noted that the two populations most mostly likely to suffer from covid are Haredim (ultra-Orthodox Jews) and Arabs, both of which tend to dress conservatively, and the latter of which have darker skin than the average Israeli, and thus might have less vitamin D in their systems.
Of course, these two populations also tend to be poorer and have larger families living together, so there are other factors to consider as well.
For example, Israelis are told to worry about skin cancer, and thus tend to use sunblock when going out in the summer. Which removes the chance of serious vitamin D generation, from what I understand.
I find the discussion of vitamin D to be very interesting, but it feels like we need a few more studies to determine whether this is the big one. But the more discussions I see, the more I think it might actually explain quite a lot.
Your profile says that we are both from the same town, the world is a small place! I would think that an HN meetup would be appropriate; my email is in my profile if you are interested.
A good point; I'm not sure. But Moroccans are typically not that dark.
I'm guessing (and this is truly a guess) that if vitamin D and/or exposure to sun has something to do with it, then skin tone is a factor but might well be outweighed by the others.
In some conservative Muslim countries -- often found in sunny areas -- girls have high rates of vitamin D deficiency because of the practice of being very covered up anytime they leave the house. I read some book authored by a woman from such a country and one of the details that stood out was a remark she made about how every woman who gets out of those countries remarks on how wonderful it is be able to just go outside without a veil and feel the sun on your skin.
Plus, as others have noted, some of those countries have very young populations and darker skin tones of local inhabitants impacts vitamin D production as well.
There are really going to be a lot of factors involved.
I don't see how it would mean fewer SARS-CoV-2 infections. It might mean fewer infections proceed to symptoms, hospitalizations, and death. Just from your source, their CFR is around 0.8%. That's not IFR, so it's hard to really do a serious comparison, but for the heck of it Canada's CFR is ~4.4%, Sweden's is ~5.1%, the US' is ~2.5%, Germany's is 2.2%.
Makes sense. Thank you!
Is it possible to know how certain the CFR measures are? I would have guessed that the CFR depends on the test coverage and maybe other factors as well; With what degree of confidence are the CFR figures treated?
however these are all countries with not too different level of health care, so that my armchair guess would be that this is a meaningful number (would have to be corrected for different age distribution, somehow)
CFR is just confirmed deaths divided by confirmed cases. It's absolutely certain, but that's also why it's not a great basis for a serious analysis of most things. We can comfortably say the numerator is roughly correct, but the denominator is likely too low because we probably missed a lot of cases, given limited testing capacity and just how asymptomatic COVID often is.
IFR is actual deaths divided by actual infections. It's the most important number, but also much harder to figure out, because the delta between confirmed cases and actual infections is, by definition, unknown.
So, in context, if we look at CFRs, it looks like Israelis are 3x less likely to die from COVID than Americans. Maybe that's vitamin D, or maybe instead Israel tested and identified every single person with COVID, whereas America missed two for very case they identified. If we could instead see the IFRs in that case, they'd actually be roughly the same, and it'd turn out (all other things being equal) that vitamin D was irrelevant.
> in a sunny country like Israel vitamin D deficiency should be less common, does that translate into fewer Covid-19 cases?
The first time I drove through Phoenix I was confused by the number of tanning salons. After living there for a few years, I learned the extreme heat drives people indoors and into cars. The same is true in e.g. Dubai.
Cases are not the factor recognized, what is being correlated is the severity and hospitalizations. A case without hospitalization is very different so a better number to evaluate health would be hospitalizations, especially extended hospitalizations and deaths. Fauci has said 20-40 percent of people who contract the virus may be asymptomatic. That means those people don’t even sniffle once and are not getting tested because they don’t ever get sick. This was shown early on in controlled groups on a military ship where they tested full populations even those not sick and found 40 percent of the people who had the virus were asymptomatic.
You are assuming that in a sunny country less people have vitamin D deficiency. Why would that hold true?
Yes, vitamin D is "made" by exposing skin to sun. But what about those people who have some kind of metabolic problem and are thus not making vit-D as much even when exposed to sun?
And how about a country, like Israel, where it is SO sunny and hot outside that most people are hiding from it because they are afraid of skin cancer and such?
That's a good point. The association between vitamine D and coronavirus could be hidding a confounding variable: time spent indoors. Spending time indoors increases the risk of contagion and viral load. Also it's correlated with lower sun exposure and lower vitamine D levels.
There was a 2010 study on this [0], using a small but supposedly representative sample of the Israeli population (195 people). I can't vouch for the quality, but the study found that almost 80% had vitamin-D insufficiency, including 27% that were deficient.
You’d need to correct for age distribution, which I guess is difficult to do. Many sunny countries have younger populations than for example Western Europe
there are likely too many variables to control for just by taking people off the street. If you had universal testing of every citizen and could then compare that across countries with varying level of sunlight (say Norway vs Israel) then you could probably make a great educated guess.
If you want to go the vegetarian option, shiitake mushrooms are good: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6213178/. Interestingly, the mushroom's D content is based upon how much exposure they have to UV.
Shameless plug -- I wrote an article about growing them at home, it's not too hard. We eat a lot of them: https://www.mushroom.guide
Exactly this. Vitamin D level is a proxy for general health. Studies that have controlled for other factors affecting health have not found a protective effect from vitamin D [1].
Hacker News is obsessed with vitamin D because it seems like a hack. A cheap and simple way to solve a tough problem that you can feel smart about having found.
The control group spent on average 36 days in the hospital, the group getting a single 500,000 IU dose of vitamin D3 spent an average of 18 days in the hospital.
This study isn't correlation, it was a double blind randomized control trial. However, it was a small pilot study and more research is needed.
The fact that this was based on only 31 people, showed a marginal effect (barely passed even the lenient p < 0.05 threshold) and doesn't seem to have been replicated in a bigger study despite being published 4 years ago should make you very sceptical about it. Sure, more research would be good, but nobody should be making any decisions based on this.
It’s rather poor form to link a 60 page report without specifying which section supports your argument. I skimmed it and didn’t see what you said, and the summary recommends vitamin d supplementation in general.
Further, this spanish RCT suggests vitamin D had incredibly strong effects in preventing patients from needing to go to the ICU.
That isn't what that paper says. From "limitations of the evidence":
>All 5 studies were assessed as being at high risk of bias
What is not here is any study controlling for the factors you mention and finding a zero correlation as you claim.
The conclusion, which I assume you are referring to, states:
>There is no evidence to support taking vitamin D supplements to specifically prevent or treat COVID-19. However, all people should continue to follow UK Government advice on daily vitamin D supplementation to maintain bone and muscle health during the COVID-19 pandemic.
Since vitamin D supplements are already advised for the general population, it is extremely unlikely they would be recommended for specifically COVID-19 without very high-quality evidence. Unless dosing recommendations can be given with good reason to believe those recommendations would be beneficial, the only effect that could come of a positive conclusion is risk compensation, i.e. increased risky behaviors, which is bad.
I am only one data point, but from my experience, it really is a hack. I had super crazy migranes, was always tired and felt unmotived. Then I started supplementing Vitamin D and now I feel so energetic, it is kind of scary.
There have been a lot of studies done on vitamin D supplements, and there is essentially no significant evidence that supplementation is useful for anything. The sole exception is rickets, which is caused by vitamin D deficiency.
There is also considerable debate over the comparative efficiency & effects of natural synthesis via sunlight vs ingesting supplements, compounded by the difficulty of accounting for things like exercising outdoors vs being sedentary indoors.
Annecdotal: I live in a fairly northern country, and I've heard quite a lot of people say their mood is more normal over winter if they supplement with Vitamin D.
I don't have any strong opinion one way or another on the efficacy of vitamin D. But people who say they feel better after taking it may themselves be experiencing a placebo effect. Placebo effects are real, and they can improve both mood and health. The mind is an amazing thing.
People in the UK are unable to get enough vitamin D if they spend lots of time outside from around now until March (equinox to equinox) next year because of the high latitude. The sun is too far low on the horizon.
Most of Canada and Alaska is lower in latitude than the UK.
Note that Vitamin D hangs around in your fat for a month or two anyhow.
Part of my family lives in Italy and we may have a genetic trait, because many suffer from vitamin D deficiency even those young and "living outside". Old members have classic consequences: osteoporosis.
Could it also be that vitamin D levels indicates some other pathology and maybe supplementation with vitamin D itself doesn't do anything for chances of getting infected?
(We are more speaking about servility of symptoms then becoming infected.)
But yes, it could totally be the case.
It also might not be the case.
It also might be anywhere in-between, like supplements help but the a negligible degree.
As long as we don't have statistically significant studies showing causation we can't say for sure.
But then what we can say for sure is that any deficit puts a burden on you body and any burden makes it harder for you if you get some other massive health problems. Even if just to a very small degree.
So if you have a vitamin D deficit you should fix it especially if you also have COVID (EDIT: or any potentially more dangerous illness).
But if you don't have a deficit it's questionable if taking vitamin D will do any help.
Well, yes Vitamin D does attenuate immune response. However the science on citokine storms is most probably wrong and not associated with covid, and at this point has become hard to stop the information train on. If there's one thing I've learned about people during covid is that the game of telephone played over a short time period to get something solved is a huge issue.
Worth noting case control studies like this have inherent bias because your sample is of very sick people. It’s like saying out of all car accidents a disproportionate amount of them were Uber drivers. Being an Uber driver won’t get you in an accident. Uber drivers just drive more. This is correlation at best.
That said, this was also the type of study that found the original link between smoking and lung cancer. So while being vitamin D deficient may not cause me to end up in the hospital if I get COVID, I’m going to be taking a supplement just in case.
It’s not “correlation at best”. It’s an almost canonical example of the Bayesian error: given a reverse probability (if you’re sick => you’re 80% likely to have deficiency), people make a reverse conclusion (if you’re deficient => you’re 80% sick)
In reality (due to Bayes theorem), we need to compute the probability of being sick when having deficiency as population_with_covid (1/47 for Spain) * 80% / population_with_deficiency. If, say, there’s 60% vitamin D deficient people in Spain, it’d give us 2% chance of getting a disease if you have deficiency. Not much!
I believe you are wrong about what we want to calculate.
It's not about whether you have a higher chance of getting infected if you are vitamin D deficient.
It's about whether you need medical attention in a hostpital if you do.
So if we have X people who got COVID, and out of those X people Y% needed to spend time in a hospital, and 80% of them had D vitamin deficiency, then it does not matter what is the Y% value.
The important thing is that the more severe cases had D vitamin deficiency, therefore you have a higher chance to get a severe case if you are deficient.
> So if we have X people who got COVID, and out of those X people Y% needed to spend time in a hospital, and 80% of them had D vitamin deficiency, then it does not matter what is the Y% value
It does matter because you need to know what the percent that didn’t need to spend time in the hospital. For instance, if 80% of the people that did not have to be hospitalized also had a Vitamin D deficiency, then there is nothing meaningful about the deficiency because it is the same between the two groups.
I could say pretty confidently that 80% of people hospitalized for COVID have brown eyes. Why? Because the overall population is about 80% brown eyed. We need to look at the difference first and foremost.
> The important thing is that the more severe cases had D vitamin deficiency, therefore you have a higher chance to get a severe case if you are deficient.
Even if we found a large difference, that is far too little information to assume causation. For instance, it could be that the elderly are more likely to be Vitamin D deficient due to being sedentary and spending most of their time indoors, and the elderly are more likely to be hospitalized due to their age. So it wouldn’t be Vitamin D deficiency, it would be age that was the underlying cause of both phenomenon. We need to be very careful about making these leaps in logic, since it can send us down pointless rabbit holes and have people spending time and resources on things that do not actually help.
Do you happen to be able to estimate how many people and of which qualifications you require in a team for how long to go trough all the available research, and make some useful and fairly certain prescriptions in a complex topic like this?
Is it even realistic for an average joe to look into it in their free time, and come to a useful conslusion in a realistic timeframe, or is everything so complicated nowadays that it's not worth it?
> Is it even realistic for an average joe to look into it in their free time, and come to a useful conslusion in a realistic timeframe, or is everything so complicated nowadays that it's not worth it?
In my personal opinion, no it isn’t. I would say that it would be useful to look into how scientific and medical research is conducted, how peer review works, etc. and you will see the incredible complexity and difficulty of building up a medical theory. I’d also look at skeptic explanations of how pseudoscience uses that complexity to push things that just aren’t true. Without a deep understanding of topic, and all the underlying scientific method, you are far more likely to come to a wrong conclusion than a correct one. Finding good scientific communicators, I’ve found, is the best way to get good information. People that do have the requisite knowledge and that will contextualize the sensational and just bad reporting of science and medicine. I would suggest Science Based Medicine [1] and Heathcare Triage [2] as a start.
Not sure why people think elderly stay in doors more. Elderly usually retire and spend much more time outdoors than those in the middle of life working 8 hours a day. However it is true that elderly absorb at a slower rate and someone already on their death bed and unable to walk would spend more time indoors. Those people are usually given vitamin d supplements though as when you are already sick doctors know you will be deficient and recommend vitamin D.
> An increasing number of older, community-dwelling adults have functional impairments that prevent them from leaving their homes…In total, 5.6% of the elderly, community-dwelling Medicare population (approximately 2 million people) were completely or mostly homebound in 2011.
> Older adults are the least active segment of our population, and are likely to spend less time outdoors than other age groups…One study in a large US national sample found that leisure time [physical activity] was related to higher Vitamin D levels in older adults [43]. Vitamin D deficiency is related to many chronic conditions including cancer, heart disease and bone health [36]. If older adults spent more time outdoors they may be more active and benefit from a healthy dose of Vitamin D.
It's really not worth noting. There's a real link between vitamin D's usefulness that's part of the broader picture which is why vitamin D articles are getting increasing attention not just in hacker news. Your comment would definitely be worth noting if this was an article siting that many very sick covid patients have had multiple marriages (because they're old).
Yes, that’s the point of the Uber example, and while it’s trivial to realize what the hidden correlation is in this case it’s pointing out there could be other hidden correlations in this case we don’t automatically know. For example, vitamin D deficiency can be a symptom of an underlying issue that is actually what causes sicker patients. Or what’s even more likely, vitamin D deficiency is more prevalent among elderly and African Americans, who have been disproportionately hit harder by COVID because they’re more vulnerable to disease in general (former) or are more likely to be unable to isolate due to being an essential worker (latter).
And before we start debating these specific possibilities, the point is to illustrate we can’t just assume more than the sampling method dictates. Different studies are needed.
Now that you’ve phrased it this way I see your point and I’ve actually been thinking this myself for a while now.
Also, you wouldn’t believe the amount of conversations I’ve had with people who are convinced it “only kills old people” who’s eyes glaze over when I explain that there are other outcomes besides living and dying.
Everyone in the world seems to believe it’s a magical death lottery that instantly switches the lights off for 0.01% of people who catch it, and the other 99.99% of people are therefore completely fine.
I know vitamin D is inexpensive to manufacture, but with all of this new demand, I really hope that there is testing going on. I would not be surprised if Amazon has a bunch of fake supplements mixed into their supply chain for example. The vitamin supplement industry is notoriously under-regulated.
Vitamin D is not a true vitamin in that vitamins are defined as critical nutrients we cannot manufacture and vitamin D can be manufactured in the body (by most people). It also available to some degree in various foods. It often gets added to milk in the US by the manufacturer and certain fish oils are high in vitamin D, like cod liver oil.
People can make a point of adding more dietary vitamin D or making sure to get a little more exposure to sunlight daily. It is absolutely not necessary for this to only be addressed by buying supplements in pill form and that is probably not even a best practice for improving vitamin D status.
(Edited. Not sure if for "typos" or because "God, I hate auto-corrupt so much sometimes.")
This really depends on where you are. For example, I live in Canada. In the winter, I only see the sun a few minutes a day. I start the workday in the dark and finish it after the sun has set. If I see the sun, I'm most likely while I'm in my car driving from my house to the grocery store during the weekend.
Keep in mind that sun exposure through a glass window will not be enough to trigger the production of vitamin D.
Unless I ate enough fish to make me sick, I'll get vitamin D deficiency. I have a lot of friends and family who are on prescribed vitamin D supplements, which are huge doses you take once a week or month.
Same here in Scotland. Apparently there's so little sunlight in winter here and it's so 'low quality' in terms of providing vitamin D that it's impossible to get enough from sunlight during winter here. The NHS actively encourage vitamin D supplements over winter.
Yes but at the same time surprisingly short amounts of sunlight exposure can do already large effects.
Also some food contains vitamin D naturally.
So while food supplements can be necessary it depends on the rest of your diet and if you maybe could do a short brake during the time the sun is up (like a short outside cofe brake ;=))
EDIT: To be clear this is not meant to discredit you. It's just that even for people living high in the north there are options. Through for some less then for others.
Thank you for giving details about the kinds of circumstances that may mean supplements are warranted. But do note it only adds to my point. It doesn't actually rebut it.
My statement was already qualified: vitamin D can be manufactured in the body (by most people).
I'm aware there are people who have a legitimate need to take supplements for some reason. No amount of qualifiers is ever enough to prevent the internet from completely ignoring your qualifiers and acting like "You are wrong! And this doesn't apply to me!"
The vast majority of people do not live that far north. People who do should be well aware they are, in fact, "a special case" for purposes of dealing with vitamin D deficiency.
For the boat loads of people looking to nail me to the wall over my very mild and qualified statement, why don't y'all try to get creative and look up data on vitamin D deficiency in girls in Muslim countries and then come up with some way to imply I am a misogynist* or I am anti-Muslim or something as part of this really, truly ridiculous pile on of people acting like I've said something crazy.
* If you don't know, I am probably the highest ranked woman here. I mean, that never prevents people from assuming I'm some rapey, misogynistic man. But at least try a little harder and don't give me really low hanging fruit for rebutting your argument like "Actually, I am a woman." because that's so very tired for so many reasons.
The context here is English speakers, not the whole earth. The vast majority of people on earth to not speak English or live that far north (or south), but this is hacker news which is a different population: we speak (or at least read) English. Those populations are heavily skewed to Northern Europe (Germany is mostly too far north and they are as far south as English is common), North America (half of the US is too far north, much less Canada). There are scattered areas elsewhere of course (India, New Zealand, Australia come to mind, I believe all get enough sun)
Funnily enough, this doesn't appear to be true. Your "scattered areas" comprise a solid majority of the world's English speakers: India and Pakistan alone have almost as many English speakers as the US, and adding in the Phillipines tips it over. Similarly, Nigeria has more English speakers than the UK.
That is to say, I don't think it's accurate to say that the English-speaking population is "heavily skewed" away from sunny areas.
On top of that the context is people taking vitamin D supplements worried about the supply chain. While im sure there are some people who supplement unnecessarily, the distribution of people who take vitamin D is definitely focused northwards.
Statements can be technically correct out of context while still being effectively wrong or misleading in context. It is hardly a nitpick.
If you had some evidence that the majority of people who take vitamin D supplements could get it from the environment, then I would agree its a nitpick. But that's very different than the majority of people in general.
Regardless of how valid the criticism is, there are eight comments jumping down my throat over a comment that already included a qualifier and further jumping down my throat over my saying "Yeah, I realize that. I did use a qualifier."
I don't intend to reply further to any of this silliness. The number of people who feel the need to state yet again that I am wrong is really just crazy. It has no basis whatsoever in any real need to clarify what is true here. If that was what was going on, it would have stopped when I posted my comment saying "Yeah, I covered that with this qualifier -- I realize supplements make sense for some people" after the first three comments overlooked my qualifier to act like I am wrong and stupid.
But I am done arguing this. If people wish to add another twenty comments urgently and strenuously repeating the point that "Due to some nitpick or other, you are so very, very wrong here!" they can have at it. But I'm not replying further to this completely ridiculous thread.
A qualifier, that is poorly written is not a “get out of jail free card” for being wrong.
Those 8 comments are there to teach you a lesson. I hope you are paying attention.
I like to pick nits. No personal insult is intended, I thought your comment was very good, but I found a tiny nit to pick and since I was stuck in a car (my wife was driving) for several hours...
> According to a 2011 study, 41.6% of adults in the US are deficient. This number goes up to 69.2% in Hispanics and 82.1% in African-Americans
That's not exactly "most people". That's for the US where a lot of states are very temperate and the sunlight is present during winter.
Imagine how bad it gets up north.
It's true that the body will produce vitamin D in the right conditions, but unless you get those conditions it won't. Taking supplements is the easy road, especially at prescription levels.
Vitamin D is not water soluble, so you won't urinate it out. This means that you can get prescribed an injection or a big pill and be fine for weeks.
There is not enough UV-B in sunlight for your body to manufacture vitamin D when the sun is less than fifty degrees above the horizon. This means that for the majority of the northern half of the United States and all of Canada, you can't make _any_ vitamin D from the end of fall to the beginning of spring.
Vitamin D is also special in the sense that it's a hormone.
> People can make a point of adding more dietary vitamin D or making sure to get a little more exposure to sunlight daily.
Getting sufficient vitamin D from diet alone is difficult. UV exposure also has risks, which may be higher for some. The required exposure time is measured in minutes a day. If you are still deficient it may be better to supplement, rather than getting exposed to UV for more time.
Even during summer in the Northern hemisphere, one would need to be out in the midday sun shirtless for a couple hours each day to get enough vitamin D that way. It’s just not feasible for most people, and doesn’t work in the winter unless you’re the Iceman.
Yes depending on your country the vitamin D supplement might not actually contain any relevant amount of vitamin D. (Or it might not contain them in forms you body can easily process.)
Redressing nutritional deficiencies to protect against disease doesn't work like taking antibiotics. It takes time for the body to incorporate the missing nutrient into underperforming systems and get them back up to speed and you typically need other nutrients along with the one you are obviously deficient in to make proper use of it.
Generally speaking, I wouldn't expect much in the way of good results to give massive doses of vitamin D to people so sick they have been hospitalized with Covid-19. But I think there is plenty of evidence to suggest that a good recommendation is "If you are vitamin D deficient and would like to actually survive the pandemic, raising your vitamin D status is the smart thing to do."
I mean, you should do that anyway, even if there were no pandemic. It's just a hair more urgently life threatening at the moment.
It's sound advice generally to say "If you are vitamin D deficient, you should seek to remedy that." It's sound advice with or without a global pandemic happening around you.
Can you elaborate on your knowledge in the first graph? I thought I remember reading that scurvy patients recover pretty quickly, and according the the NHS[0], it's about 48 hours to start feeling better and 2 weeks to recovery. Maybe scurvy is different, or perhaps we are assigning different timelines to the "it takes to to incorporate the missing nutrient", but that does seem to be in opposition with your statement.
(Please note - this is not a "show your sources" challenge, I'm genuinely trying to understand the recovery process from malnutrition better. My guess would have been that the malnutrition is quickly remedied, but the 2nd order damage might take longer. Is that what you meant, and I just misunderstood?
Can you elaborate on your knowledge in the first graph? I thought I remember reading that scurvy patients recover pretty quickly, and according the the NHS[0], it's about 48 hours to start feeling better and 2 weeks to recovery.
Scurvy is vitamin C deficiency. Vitamin C is water soluble.
Vitamin D is fat soluble. Fat soluble vitamins generally work on a longer, slower time scale. It takes longer to incorporate them into the body and longer to become deficient.
People who are deficient in vitamin C may simply not be getting enough of it in their diet. Because vitamin D can actually be manufactured in the body, it tends to correlate to other underlying issues.
People with other underlying issues tend to require more time to recover from anything, medically speaking. They may even have inherent challenges in absorbing vitamin D properly or using it properly.
I have a genetic disorder that predisposes me to deficiency in all fat soluble vitamins, including vitamin D. I'm sure my firsthand experience with being slow to heal and my body being slow to adequately resolve nutritional deficiencies (on the order of months of supplementation to fix things) is on the fairly extreme side, but most Covid-19 patients in danger of dying from it are elderly and have underlying health issues. So I would expect my experiences to be somewhat similar to their situation.
I'm not a doctor. I'm a former homemaker who spent years homeless.
But based on those stellar credentials, if I am understanding your question correctly, the answer is "both." It is both slower to access and also the reason you can wind up vitamin D toxic in a way that doesn't generally happen with water soluble vitamins.
You can get get too much of water soluble vitamins and they can do bad things to the body, but those bad things aren't described as "toxicity" because you don't build up excessive stores of them in the body like you can with fat soluble vitamins. Off the top of my head, some people who take way too much vitamin C end up harming their dental health by harming the tooth enamel and a certain B vitamin when taken in excess is associated with, iirc, kidney stones.
Rickets is most commonly caused by vitamin D deficiency. I suspect the comment which you replied to made an honest mistake confusing scurvy with rickets.
When I google both scurvy and rickets, my impression is that no such error was made. Materials about scurvy match the remark made above. Materials about rickets do not.
Most people treated for scurvy feel better within 48 hours and make a full recovery within 2 weeks.
Most children with rickets see improvements in about one week.
Skeletal deformities will often improve or disappear over time if rickets is corrected while the child is still young. However, skeletal deformities can become permanent if the disorder isn’t treated during a child’s growth period.
Thank you for that, though it doesn't fundamentally change my point of view.
Please keep in mind that my point of view is probably not adequately expressed in a single internet comment. It boils down to: for best results, we should be generally trying to address vitamin D deficiency as a means to try to halt the pandemic and not waiting for people to end up hospitalized with Covid-19 before checking their status and trying to do something about it.
I'm not saying it's "useless" to give supplements at that point. I'm just saying I would expect vastly better results if you have more lead up time to redress the issue rather than waiting until you are deathly ill from the current pandemic before you think taking action makes sense.
Not sure that this is true. It might be. But more likely being active enough such that you get the 15 minutes of sunlight daily needed to maintain normal vitamin D levels is better advice.
You are inferring that I am recommending supplements as the means to redress this. I am not and have suggested otherwise elsewhere and, wow, has it gotten ridiculous levels of push back:
It would be instructive to know the vitamin d deficiency rate of the typical 2019 hospitalized population. Or the rate of, say, hospitalized patients in taiwan or new zealand (no covid) compared to their general populace’s.
I’m a big proponent of the idea that vitamin d will likely help against covid 19 but this headline is missing some crucial comparative context.
——
Edit: I’m rather wrong in the part below. Patient only refers to people receiving treatment, so this is an accurate use. Keeping it there for posterity. I believe the rest of my comment still stands.
The headline is inaccurate. The study looked at hospitalized patients. That is a group in much worse health. And all manner of health conditions are correlated with low vitamin d.
Its not a hard analysis to do but then they wouldn't be able to publish as easily. The scientific process is not about progress, its about publish or perish. D is perfect for this type of non-sense science as it is correlated with so many things and each one can get dozens of papers out of it.
I wrote this whole long comment talking about all the issues in trying to design a good trial to figure this out, but here's one trial I think will give us some more info, it seems better designed than the other ones I've seen (sample size remains a problem):
It was March or April when the NIH released a bunch of papers on diseases on either Kaggle or Github (can't exactly remember). I decided to dig into all the data for fun ("fun", it was all in json and you had to manually parse the bitch to read it all). There's a fuckton (in the scientific sense) of studies that show a really good relation to Vit D deficiency and generally being sick as shit (flu, URIs, sinus infections, gastro problems, etc). While Vit C might be good for recovering, D is what you want to focus on in general disease prevention (a wide gamut at that). Outside of that 60k paper release, there are lots of studies on the mental health of folks regarding low and regular Vit D levels (low Vit D levels lead to more, worse and prolonged depression & anxiety).
What I've really taken away from this crazy year, why the hell is there all this research (decades worth, not a handful of years, I'm talking about roughly 40+ years worth) on good levels of Vit D levels leads to a statically healthy life and this fact is being completely shit on/ignored? Perfect? No. But, statistically speaking, you're sickly if your Vit D levels are low, regardless of Covid.
This is unrelated to my parent comment: perhaps I wasn't clear that being outside (in the sun) has a larger impact on your Vitamin D levels than supplementation.
Therefore the study's conclusion is invalid if the two groups studied were measured one before and one after lockdown kept them inside - since we would expect Vitamin D levels to drop, for this reason.
"low Vit D levels lead to more, worse and prolonged depression & anxiety"
This isn't entirely accurate, and I'm going to quibble a bit with it and cite a study, but TLDR exercising outside during the daytime is probably better than just supplements of D.
To be clear I myself take Vitamin D because it may have benefits, including for mental health, so this isn't me trying to say D couldn't help with depression, just that that particular statement is a little misleading in that we don't have the best evidence for it.
There's definitely some evidence that Vitamin D levels are correlated with worse depression scores, but no studies about deficiency causing it to be worse; I suspect few people would choose to sign up for a study to make they depression worse, tbh. Anyway, the closest are studies of supplements to Vitamin D levels in depressed people, and the results there are mixed.
For example a study called "Effect of vitamin D supplement on depression scores in people with low levels of serum 25-hydroxyvitamin D: nested case-control study and randomised clinical trial" in the British Journal of Psychiatry found no statistically significant differences in depression inventories.
I believe there is some meta analysis that shows that Vitamin D supplementation may benefit people with clinically significant depression scores. But if you are badly depressed, you should consider moderate mixed aerobic and anaerobic exercise outside during the day, which gets you sunlight for vitamin D, exercise, and light exposure.
Regardless of whether Vitamin D makes a difference, exercise and light exposure both can help with depression (or in the case of the latter at least Seasonal Affective Disorder, which can cause or exacerbate depression), and the evidence there is more substantial. For the record, light therapy boxes seem to help with SAD even when they generally have low UV so little chance that it's vitamin D that's making the difference.
A thing I couldn’t find in the article: were the population based controls patients who were hospitalized in 2019, or merely members of the local population?
Even bigger issue than base rate is that this is a retrospective study, so I suspect heavy measurement bias. Patients that are likely to have a Vitamin D level checked are different than hospitalized patients. Vitamin D levels are not checked routinely in hospitalized patients. I know this because I'm a hospitalist, but also because during the height of the local pandemic this 900+ bed hospital only had 216 patients with a vitamin D level checked. Presumably at least 1000 COVID patients moved through that hospital during this time, more likely several thousand.
It says 'patients', feeling a bit squiffy and calling in sick doesn't make you a patient (not even an out-patient), medical treatment or attention does.
The study has a demographic breakdown table that has some details about other conditions the covid and the control population had. One thing that stood out to me was: 'Immunosuppression'. The COVID population had this condition at 8x the rate the control group had and this condition may be induced deliberately. That seems like it could be an alternative explanation to low vitamin D.
Please don't be a jerk when correcting people, no matter how annoying another comment is or you feel it is. It's great to provide correct information, and also enough.
The study is linked to this article.. people should try reading or at least scanning it before dismissing or speculating on it. In particular read the discussion and look at Table 1.
I'll point out one important thing, the non-vitamin-D-supplement taking patient group, and the control group (which also is not taking supplements), both have a median age of 61.
How long does it take for Vitamin D levels to fall to "deficient" levels from healthy levels? If you don't supplement and stay quarantined inside for a week in the winter, what effect does that have on your levels?
We are under lockdown pretty much here. So I havent' gone out to bars and shops in months. But I still try to go outside, even if just for a walk in the park most days.
You'd have to be spectacularly unlucky catching it outside if you are keeping a reasonable distance from other people and avoiding hanging around crowds for prolonged periods.
In large dense American cities there are risks with even going outside on a walk. There are stories of people who didn’t leave their homes except on walks but caught COVID-19. There was a NYT columnist who got it and hadn’t done anything except go on walks in NYC. That seems statistically odd to me, because there can’t be that many NYT columnists.
Consider that to go outside, many in a large city must leave their flat, walk down a shared hallway, walk past other people’s front doors, use an elevator, etc.
There’s also a lot of people on the sidewalk, many without masks, who will walk right past you, often talking loudly on a cell phone. It’s often not possible to avoid walking close to these people due to small sidewalks and busy city streets.
Obviously the risk is lower than other activities but it’s not the same as going outside in the suburbs or driving somewhere. In my city, on a 40 minute walk I pass several hundred people. In my building here, none of the other residents wear masks and to enter and exit I must walk past their front doors.
So I would say it’s quite safe. But it’s not quite as safe in big, dense American city as in the suburbs.
A second anecdote. I live in NYC. I've been going on walks, hanging out in the park, going out to eat, stayed in a couple of cabins over the weekend, taken ride shares, dined inside, and traveled on airplanes twice. I don't have the antibodies and I've never tested positive.
My wife goes to work in an office every single day. Doesn't have antibodies, never tested positive.
I'm guessing they from the US. Here we have had absolutely terrible communication from all authorities regarding outdoor activities. It's heavily frowned up to do anything outside of staying inside.
It's surely possible to take too much, but it's a lot. A typical over the counter tablet is 500-1500 IU of Vitamin D. Here[1]'s a study giving an oral dose of 100,000IU to a hundred people, and here[2]'s a paper suggesting muscular injections of 600,000IU in 10 people showed no evidence of metabolic abnormality. The Mayo Clinic[3] site says:
> Taking 60,000 international units (IU) a day of vitamin D for several months has been shown to cause toxicity. This level is many times higher than the U.S. Recommended Dietary Allowance (RDA) for most adults of 600 IU of vitamin D a day.
That's 100x the recommended dose, every day, for months. Were you using powdered vitamin D instead of protein powder by mistake or something?
Deva Boone’s blog (an MD featured often on HN) describes a case where an extra 5000IU supplement caused neurological problems.
IIRC, there was no regard to other sources - e.g. she might have gotten 30,000 other IU per day from Milk and another amount from fish. Very unlikely - much more likely that something else made it toxic in that case.
Regardless, it is clear that the upper safe limit has significant variance and is not well characterized.
(Personally have been on 10,000IU daily for the past 7 years with no ill effects and possibly good effects, n=1 standard disclaimer)
How much a person can take without producing symptoms varies. My threshold was much lower than average probably because of chronic infections, e.g., Lyme disease.
Anyone taking substantial doses of vitamin D (>2000IU daily) should probably be getting regular blood tests to monitor their vitamin D levels. Vitamin D can accumulate in fat and the liver.
"population based" means that the control population is adjusted to match the experiment population.
In other words, you could read the line as "Vitamin D deficiency was found in 82.2% of COVID-19 cases and 47.2% of controls, when accounting for age (p<0.0001)."
Vitamin D is critical to strong bones. Please note that bone marrow is where a lot of our immune cells are produced, such as white blood cells.
It is also critical to the ability of the body to absorb and utilize calcium. Inability to properly absorb calcium tends to also foster a magnesium deficiency and vitamin K is the other vitamin you should be taking when taking calcium supplements to make sure you are able to absorb it and make use of it.
Vitamin K is critical to the clotting process, as is calcium. Calcium is necessary to start the cascade of chemical processes that lead to clotting.
I have a genetic disorder and I have a long history of being prone to nose bleeds. Tendency to bleed is a common problem for my condition, which is also known to be associated with osteoporosis at very young ages (sometimes starting in the teens), though bleeds that this population most often is concerned with is lung bleeds.
When an online friend of mine was dealing with lung bleeds in their child with the same condition, I did some looking around for info and found that calcium is critical to the clotting process. I don't know if that info helped her help her child, but as a consequence I eventually began taking 600 to 1000 mg of calcium carbonate in response to gushing nose bleeds (as opposed to the constant low-level blood seepage in my nose that was my norm for years). This practice stopped my nose bleeds cold in twenty minutes without other intervention and after six months I stopped having nose bleeds.
Covid-19 significantly impacts blood health. Anyone interested in understanding the role of vitamin D deficiency in Covid-19 should be curious about the relationship between vitamin D and blood health.
Covid-19 was initially talked up as primarily a respiratory infection, but ventilators were not performing very well for helping the sickest of the sick with this condition and there was a shockingly high mortality rate for people who ended up on ventilators -- high even for what is "normal" for people who typically end up on ventilators. Everything seems to point to the idea that the way Covid-19 impacts the blood is a critical detail of why it is so deadly in some populations.
If you have reason to believe you are vitamin D deficient, you should address that. If you address it, you most likely also need calcium, magnesium and vitamin K as well in order to redress the negative impact this has had on your health. They work together and not getting enough of any one of those tends to negatively impact your status for all of them.
(I am not a doctor. This is not medical advice. I am someone with a serious medical condition running my mouth on the internet. Please leave me alone with your bizarre delusions that leaving comments on this topic means I am "practicing medicine without a license" while you refuse to acknowledge the obvious inference that your concern is rooted in "Damn. That woman knows too damn much and we aren't happy about it for various reasons.")
Truth right here. Mark these words - in 2021 you're all going to be hearing about Vitamin D from every corner of the world if you haven't heard already.
You're right about the lead time - I turned vegan in May 2017 and began to have symptoms of osteoporosis around 14 months later - great joint pain. Turned out my vitamin D levels had plummeted to critical as I didn't take care to replace the Vit D that comes in an omnivorous diet, and had some periods of not going out enough for work reasons. I currently take 10,000 iu/s a day of Vit D3 under medical supervision, and the recovery has taken longer than the decline.
There are numerous studies now showing a correlation between vitamin D deficiency and serious COVID-19 symptoms. I don't understand why public health officials aren't doing more to conduct widespread vitamin D level tests, and give out supplements when needed. Those interventions could save many lives at a low cost today while we work on more effective vaccines and treatments.
Trump got vitamin D infusions in the hospital.
It's also something that taking a daily pill for will not have immediate effects. If you take OTC supplements today you won't see your levels increase for days or weeks.
A megadose to bump vitamin D levels has been used for years, perhaps decades, and verified to affect blood levels - a friend’s doctor recommended to them a while ago 60,000IU per month, 20,000/week or 1000/day. I don’t know the exact logic, but it’s not new.
Whether or not such a bump gives the same benefits as slow ramping (and if it delivers then more quickly or not) is something I haven’t found any studies on - but I have found in the past studies indicating sun exposure is better than supplements for the same attained blood vitamin D levels (not surprising, as vitamin D is far from the only result of sun exposure)
Well I've read things that suggest eating covid won't hurt you. May be similar to HIV where the official advice is not to slosh it around your mouth endlessly but either spit or swallow immediately?
Public health officials don't actually care about public health. Another critical issue they've willfully chosen to ignore is the dramatic comorbidity of COVID-19 and obesity.
We are told to mask up and social distance, but nobody in the public health sphere has suggested eating less.
Public health agencies have been encouraging people to lose weight and exercise more for decades. I doubt that COVID-19 is going to motivate people where diabetes and heart disease have failed.
I joined orange theory a few weeks ago and have been working out consistently. It has already had such a positive impact on my life. Wish I would have made this decision many years ago.
Vitamin D Deficiency: Consequence or Cause of Obesity?
As someone who dropped several dress sizes by improving my nutritional status with zero intent to slim down, I am of the opinion that obesity is caused by eating empty calories. You keep eating and eating because you aren't getting enough nutritional value. Your constant hunger subsides if you actually eat nutritious foods that actually meet your nutrient needs.
I used this theory to also help one of my sons drop several sizes without doing anything else. He had really gotten quite large and it was negatively impacting his back issue. His brother told me "It's because he sucks down chocolate pop tarts all day." so my response to that was "Let's get you some good quality dark chocolate. You are likely craving the actual chocolate for some reason and chocolate pop tarts don't have all that much." He slimmed down dramatically after that and it was the only thing we did different.
The laws of thermodynamics apply - calories in calories out.
The real difficulty though, is that for some, to be in a calorie deficit is intolerably difficult.
So while I agree with your hypothesis, and also believe that the cure is "simple" I think it's important to not forget the individual in all of this.
A huge deal of it is behavioural and educational too - a lot of people think that because they spray olive oil on to their pan, instead of drizzle it, it has zero calories!
Sure, the point I'm trying to make is that it's easier to cut calories by improving nutrition. I think we eat more calories than we consume when those calories aren't delivering the nutrients we require.
Just refusing to eat more than X amount of calories is an approach that fails for a lot of people. Relying on so-called will power fails for a lot of people.
I think this is a useful distinction to make and doesn't actually contradict the idea that "You get fat from eating too many calories, more than you are burning." Instead it helps answer the question for some people concerning "Yes, but why do you keep stuffing your face when you are so unhappy with the results?"
Laws of thermodynamics are not helpful in this context. Simplest example is: in the absence of glucose/glycogen, our body converts fat to ketones for energy and/or protein to glucose. But unused glucose gets converted to fat and stored, whereas unused ketones get peex out - there is no process to store them again.
Unless you check ketones, a body in ketosis used to HIIT will seem to defy cico balance. And many times even when not in ketosis.
Popular thermodynamics (Carb=Protein=4, Fat=9, etc) is useful as a first order approximation but requires so many wrong assumptions that it cannot be assumed to hold in any particular case.
So, you are essentially saying that regardless of degree caloric surplus, if one is in a state of ketosis they will perpetually loose fat?
It sounds to me like should that be the case (which, sorry I'm rather dubious about), a particular portion of energy conversion is not yet understood rather than the first law of thermodynamics being violated.
I don't claim to be an expert in this area however, so I'll be willing to read any scientific papers you may have to hand on the subject (and while this may come across as sarcastic - it's just my inability to express what I am saying adequately via typing - I'm a true believer that every day is a school day)
Not at all, and I did not say anything of the sort.
What I said was: circulating glucose either gets used or get stored as fat. Which means that counting glucose calories for thermodynamic calculations would actually make some sense (but see below).
Circulating fat get stored as fat, or converted to ketones for use. The difference is, unused ketones get peed whereas unused glucose gets stored.
Ketosis means fat gets converted to ketones for use - but only as much as the body means necessary for activity as that point. If your fat intake exceeds your use, you will likely gain fat.
Thermodynamics is of course never violated. But the “calories in - calories out” statement is not that useful with regard to body weight.
If you drink petrol, you will not gain wait (not be able to use it for energy - you’ll just excrete it) despite being more energy dense than fat (fat is 9kcal/gr, petrol is 12kcal/g). Similarly, plain paper (and indeed the wood it is made of) is a carbohydrate at 4kcal/gr, and yet you won’t derive any energy from it and again excrete it. Does that violate any law of thermodynamics?
No. What it does show is that the assumption that our metabolism is a perfect combustion machine (Which is at the base of the CICO weight theory) is wrong.
The conversion efficiency of different food is measured (and documented) as “Atwater factors”, the value of which was first measured over 100 years ago and assumed constant, but turned out in recent studies to vary among people and and even for same person in different times by 50% or so.
Similarly, for the same physical activity, same person may have a difference of 50%in energy expenditure (e.g. depending on how high feet are lifted while running)
Thermodynamics is not violated, but if you try to reason using it with the appropriate error bars, it turns out that you can’t say much. Statistically, the average is close enough to work for most people, most of the time, but that “most” is 70% or so.
With respect to ketosis - ketones are “use it or lose it” like heat. Once the body converts fat to ketones (a process which is NOT immediate), they are either used or peed out.
If your activity level is close to constant (as most sedantry people are), the body is very good at having very tight control on levels produced, little are wasted and you are close to what you consider “thermodynamic equilibrium” even though it’s not. If you are used to large varying activities, the body will produce more ketones just in case and pee them out if unused - thus you will only consider it “thermodynamic equilibrium” if you consider pee energy content as well.
I’m an electrical engineer, not a biochemist. But I did try to understand nutrition “science” and realized it is at most cargo cult pseudo science.
I don’t have a list of handy references, but at the very least google Richard Feinman’s famous “a calorie is not a calorie” (it’s not the physicist - and note the spelling of the name is different)
However, back in the real world, where caloric and macronutrient labeling is off by up to 20% and NEAT is highly variable, you're pretty much going to have to either eat less or move more if you want to lose weight - some strategies of doing so may be more efficient than others.
For sure. But I lost weight, a lot of it, by moving more or less the same and eating a lot more "caloric content" (switching from mostly carbs to mostly fat), which many people consider "violating thermodynamics", which is nonsense.
If you don't change the ratios of your macros, and you don't make your expenditure vary much throughout the day, then -- yes, eat less, or move more.
It’s worth noting that almost all studies supplementing vitamin d have shown one thing; it increases vitamin d levels and causes you to absorb more calcium. No cancer or disease benefits shown yet.
What we do know is eating healthy and getting outside to do exercise definitely helps chronic diseases and this also happens to increase vitamin d levels.
This was a retrospective study. Meaning the 'general population' they drew from were people with vitamin D tests during the period (Jan-Mar 2020) already drawn for some reason.
Spains Lockdown was particularly strict - would being locked inside for a month with less sun cause noticable Vitamin D deficiency?
I'd guess that Vitamin D deficiency is a symptom of the same health/lifeystyle/diet that raises the likelyhood of being hospitalized with Covid-19, rather than a cause of it - but I'm no expert.
"Vitamin D insufficiency is highest among people who are elderly, institutionalized, or hospitalized. In the United States, 60% of nursing home residents and 57% of hospitalized patients were found to be vitamin D deficient."
I've seen people argue _against vitamin D supplementation_. WTF? I mean, sure, it's not "proven" to work, and there haven't been any "gold standard" studies. But why not just have everyone take 5000IU a day for the duration? What's the downside here?
The argument is generally: Vitamin D has a lot of complex interactions in the body and is fat-soluble. That makes it very easy to overdose, and the recommended doses are substantially higher than normal dietary intake. Most studies on vitamin D don't really differentiate between vitamin D from supplementation and vitamin D from going outside, meaning that the protective effect might be from the activity not the vitamin.
If everyone takes 5K IU/day, then you'd expect issues from about half of people (if baseline of 50% of people are low is correct). Those issues are nontrivial.
I personally think that most people (especially those who spend a lot of time indoors) should probably supplement, and most of the reaction is overstated.
One important negative effect of Vit D supplementation is that it reduces magnesium absorption (due to increasing calcium absorption, which is a magnesium antagonist).
It’s no big deal if you have sufficient magnesium, but for people who have low magnesium (which is common) it can make the problem worse.
This may explain the fatigue/lethargy at least one commenter here reported after taking fairly high-dose Vit. D supplements.
IMO this doesn’t mean you shouldn’t take them, but they should be taken with caution and ideally with clinical nutritional profile testing so magnesium or any other deficiencies can be addressed.
Vitamin D supplementation has side effects, or at least it does for me. On three separate occasions I've tried to take some X,000 IU pill and spent the next 24-48 hours extremely lethargic and unable to summon the willpower to do anything. Very similar to depression.
I am also have this troubles even from 500 IU (form or vendor of pills doesn't matter) after that i have massive headache with slow pulse in head and unable to concentrate.
> 25OHD levels are lower in hospitalized COVID-19 patients compared to population-based controls and these patients had a higher prevalence of deficiency. We did not find any relationship between vitamin D concentrations or vitamin deficiency and the severity of the disease.
That second part is really important. Look, I am taking a multivitamin as a result of what I’ve read but mostly because for me there is no harm in taking a multivitamin. But I have yet to see a definitive study that says vitamin D makes COVID better.
Just a stray thought from someone who knows little about vitamin D, but is there any way that vitamin D could be used up by cells with replicating viruses, and that's why the levels are low in patients?
That sounds really interesting! Do you happen to have a link to that? I'm not "challenging", I would just be interested in reading that, if you happen to remember where you saw it.
Since I see many confused comments below, keep in mind that while causal relations are unclear (a very hard thing in anything metabolic), the correlation is well established and uncontested, and holds across sub-population characteristics including age, sex, race etc.
It's interesting because this study was done in Spain, which reportedly only has about a 33% Vitamin D deficiency in the general population: https://pubmed.ncbi.nlm.nih.gov/21179052/
I keep seeing studies saying this but the only way I know about it is because the links run up to the top page on HN. It even gets pretty short shrift among some of my more COVID-skeptic follows on Twitter. Seems like just total silence from media and public health officials on it.
Public health officials are not saints. They are common people, like all of us. There is a high chance that HN readers know about the latest news way before "public health officials".
But this isn't "latest" news at this point, these studies have been coming out for awhile now, and given that low/moderate doses of vitamin D are a relatively low risk thing to take, a campaign to educate the public and at least get people to ask their doctors about it could make a big difference to the hospitalization rate.
I've heard people ask "Will all of this go away after the election," and we're seeing the same hysteria over COVID-19 in places like Canada and VIC, Australia, so my gut response would be 'no' ...
But you cannot deny there is an extreme US-centric political angle to this; especially when you see stuff like this getting pulled or "fact checked" on major media platforms (who have shown their political colors).
Maybe the American Media Propaganda machine is just bleeding out into the rest of the world? I cannot say, but I do think that COVID-19 is a case of mass hysteria, possibly the largest we've ever seen.
I do not deny many have gotten sick and died, but I also think this is nowhere near as bad as people are making it out to be. The elderly should have been protected. The rest of us should have been allowed to make our own choices about risk. And the "long COVID" stories might be true or might be purely psychological.
Vitamin D is involved in the regulation of the body's immune system and inflammatory response. There's a known correlation between low vitamin D readings and inflammatory diseases. Severe COVID complications seem to be primarily inflammatory in nature. It seems to me that folk that are prone to inflammatory problems are likely to both measure low on a vitamin D test and be prone to having a severe reaction to COVID.
A low vitamin D reading doesn't necessarily mean you are vitamin D deficient. There are two forms of vitamin D in the body, inactive and active, and the more common/cheaper blood test only measures the inactive form. The active form is what affects the body, though.
High levels of active vitamin D can cause serious damage to your body. It's probably not a good idea to supplement vitamin D without consulting a doctor.
Very unlikely given what we know about biochemistry. Vitamin D is fat-soluble so your body stores it in fat.
Because of this, levels are generally stable over a period of months. Although there are health conditions that cause vitamin D levels to fall (particularly chronic kidney disease), it's highly implausible that COVID-19 itself could cause vitamin D deficiency directly.
Even if COVID-19 were to cause kidney issues and you didn't see sunlight for two weeks, it wouldn't move someone with adequate vitamin D levels into the deficient range. The time period is simply too short.
It's a correlational study, so that'd be difficult. Although an experimental double-blind study was posted here a couple of weeks ago that had impressive results.
>I'm sure there is a very good reason for this 50 year old, really high impact, supposedly peer reviewed, journal of medicine to have a single line Wikipedia page.
Is this a serious comment? Take a look at their editorial board:
Ugh, I'm a complete idiot. I always just run sources that I don't really know that much about through the first pass filter of who is the publisher of the article and how are they related to the journal and the authors. Then do a Wikipedia search to see if they at least have visibility there.
This failed the sniff test in my book, but clearly I was wrong.
Over 99% of Covid-19 patients are going to die in the next 100 years. If only we could add about 50-60 years to their lifespans, we could cure Covid-19!
So years saved
85+: 383k
75-85: 825k
65-75: 990k
55-65: 580k
45-55: 340k
35-45: 170k
25-35: 80k
<25: 27k
So total years: 3.4 million, an average of 16 years per death.
At $60k a year that's $200b.
At $130k a year that's $440b
As the cost to the US economy is estimated in the 10T range, it seems a poor use of funds.
However that assumes more intervention would save more lives.
With an IFR of 0.9% (even assuming no collapse in health system, but IFR estimates also overread) you'd be looking at 2.5-3 million dead overall depending how many got it. That still would come out at 5T tops, so on a financial basis better to just let it rip.
However the big assumption is that there would be no cost to economy without intervention as many people decide to stay at home, as confidence is lost and people stop spending, and that runs into a recession anyway. The 2008 recession cost $70k per person [3], that's 23T.
It also assumes that the 5T could be spent elsewhere in saving lives.
Most people with depression are D deficient too. Either D deficiency causes EVERYTHING or this means nothing. Science is broken and has been for a long time.
Does anyone here have any idea of the percentage of Covid related fatalities that DON'T make it to the hospital before death? Asking here since HN is filled with people of erudition. And because am not a medical researcher and have no idea where they hang out.
It doesn't say when they took the blood sample that was used. The issue being, if someone is ill they typically don't go outside. They also likely eat less. At some point vitals are going to tail off.
I'm not disputing the value of Vitamin D. But without details this could be a simple case of correlation.
I feel silly responding to a downvoted comment, but here goes anyway: Correlation does not imply causation, but it wiggles its eyebrows suggestively and points “look over there!” (Thanks Xkcd)
In this case, we are in a position of not knowing very much about what causes/prevents COVID. Based on this study, we can learn Vitamin D seems to be involved, and there is an obvious causal mechanism that one can hypothesize might exist, even if not proven. Even if there’s only a 10% chance that vitamin D supplementation could be helpful, knowing it as a possibility could be useful to many, and justify action even if uncertain about the causality.
Dr John Campbell (a PhD nurse educator) who has been putting out youtube videos of research-based plain English explanations of various aspects of the COVID-19 pandemic, has been beating this drum regularly for eight or nine months. One of his videos did mention that vitamin D deficiency is very high in Spain, particularly in some specific regions of Spain, so don't jump to conclusions about the amount of risk reduction from adequate vitamin D levels. Dr Fauci is reported to be taking 6000 units per day, way higher than the recommended daily allowance in the USA.
It’s all kind of obvious when you stop and think about it. Humans as a species used to get far more sunlight.
Is it a coincidence when you consider a disease from a nocturnal animal was able to jump over?
Humans have become more nocturnal in the sense that while we don’t sleep during the day, we often fear going outside. This has consequences.
Now a step too far on the cynicism side might be to point out how coincidental it is that a bunch of racists came to power across the globe and not too long after a pandemic happens that seems to disproportionately target people who can’t absorb vitamin D very well.
