Vitamin D Supplementation During the COVID-19 Pandemic

Siuka, Darko; Pfeifer, Marija; Pinter, Bojana

doi:10.1016/j.mayocp.2020.05.036

Cited by 33 publications

(28 citation statements)

References 3 publications

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“…Additional authors recommend vitamin D supplements to boost the immune systems of patients diagnosed with COVID-19 (2 p , 35, 69, 71, 74, 75, 118, 120, 125, 230-233). However, most authors recommend widespread daily vitamin D supplementation (most often with 1,000-5,000 IU per day) to prevent and decrease the severity of COVID-19, at least until the pandemic abates (1,5,12,28,34,36,42,64,65,107,109,113,114,116,121,124,127,165,171,172,178,190,192,197,198,210,214,219,222,(234)(235)(236)(237)(238)(239)(240)(241)(242)(243)(244)(245)(246)(247)(248) (Figure 8).…”

Section: Covid-19-specific Recommendations Of Expertsmentioning

confidence: 99%

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

Benskin

2020

Front. Public Health

130

135

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As the world's attention has been riveted upon the growing COVID-19 pandemic, many researchers have written brief reports supporting the hypothesis that vitamin D deficiency is related to the incidence and severity of COVID-19. The clear common thread among the top risk groups-vitamin D deficiency-may be being overlooked because of previous overstated claims of vitamin D benefits. However, the need to decrease COVID-19 fatalities among high-risk populations is urgent. Early researchers reported three striking patterns. Firstly, the innate immune system is impaired by vitamin D deficiency, which would predispose sufferers to viral infections such as COVID-19. Vitamin D deficiency also increases the activity of the X-chromosome-linked "Renin-Angiotensin" System, making vitamin D deficient individuals (especially men) more susceptible to COVID-19's deadly "cytokine storm" (dramatic immune system overreaction). Secondly, the groups who are at highest risk for severe COVID-19 match those who are at highest risk for severe vitamin D deficiency. This includes the elderly, men, ethnic groups whose skin is naturally rich in melanin (if living outside the tropics), those who avoid sun exposure for cultural and health reasons, those who live in institutions, the obese, and/or those who suffer with hypertension, cardiovascular disease, or diabetes. And thirdly, the pattern of geographical spread of COVID-19 reflects higher population vitamin D deficiency. Both within the USA and throughout the world, COVID-19 fatality rates parallel vitamin D deficiency rates. A literature search was performed on PubMed, Google Scholar, and RSMLDS, with targeted Google searches providing additional sources. Although randomized controlled trial results may be available eventually, the correlational and causal study evidence supporting a link between vitamin D deficiency and COVID-19 risks is already so strong that it supports action. The 141 author groups writing primarily about biological plausibility detailed how vitamin D deficiency can explain every risk factor and every complication of COVID-19, but agreed that other factors are undoubtedly at work. COVID-19 was compared with dengue fever, for which oral vitamin D supplements of 4,000 IU for 10 days were significantly more effective than 1,000 IU in reducing virus replication and controlling the "cytokine storm" (dramatic immune system over-reaction) responsible for fatalities. Among the 47 original research studies summarized here, chart reviews found that serum vitamin D levels predicted COVID-19 mortality Benskin Evidence Linking Vitamin D, COVID-19 rates (16 studies) and linearly predicted COVID-19 illness severity (8 studies). Two causal modeling studies and several analyses of variance strongly supported the hypothesis that vitamin D deficiency is a causal, rather than a bystander, factor in COVID-19 outcomes. Three of the four studies whose findings opposed the hypothesis relied upon disproven assumptions. The literature review also found that prophylactically correcting possible ...

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Section: Covid-19-specific Recommendations Of Expertsmentioning

confidence: 99%

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

Benskin

2020

Front. Public Health

130

135

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“…The relative lack of randomized trial data, particularly with respect of vitamin D supplementation in the community, does not necessarily imply that vitamin D supplementation is not justified on pragmatic grounds. A group of doctors from Slovenia [ 77 ] have pointed out that the European Centre for Disease Prevention and Control recommends that ‘Public health authorities should recognise that extra-scientific factors (e.g. feasibility of implementing scientific advice, time pressure, socio-political factors, institutional factors, economic interests, pressure from neighbouring countries, etc.)…”

Section: Randomized Controlled Trials Of Supplementary Vitamin D In Cmentioning

confidence: 99%

Vitamin D and COVID-19: evidence and recommendations for supplementation

et al. 2020

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Vitamin D is a hormone that acts on many genes expressed by immune cells. Evidence linking vitamin D deficiency with COVID-19 severity is circumstantial but considerable—links with ethnicity, obesity, institutionalization; latitude and ultraviolet exposure; increased lung damage in experimental models; associations with COVID-19 severity in hospitalized patients. Vitamin D deficiency is common but readily preventable by supplementation that is very safe and cheap. A target blood level of at least 50 nmol l −1 , as indicated by the US National Academy of Medicine and by the European Food Safety Authority, is supported by evidence. This would require supplementation with 800 IU/day (not 400 IU/day as currently recommended in UK) to bring most people up to target. Randomized placebo-controlled trials of vitamin D in the community are unlikely to complete until spring 2021—although we note the positive results from Spain of a randomized trial of 25-hydroxyvitamin D3 (25(OH)D3 or calcifediol) in hospitalized patients. We urge UK and other governments to recommend vitamin D supplementation at 800–1000 IU/day for all, making it clear that this is to help optimize immune health and not solely for bone and muscle health. This should be mandated for prescription in care homes, prisons and other institutions where people are likely to have been indoors for much of the summer. Adults likely to be deficient should consider taking a higher dose, e.g. 4000 IU/day for the first four weeks before reducing to 800 IU–1000 IU/day. People admitted to the hospital with COVID-19 should have their vitamin D status checked and/or supplemented and consideration should be given to testing high-dose calcifediol in the RECOVERY trial. We feel this should be pursued with great urgency. Vitamin D levels in the UK will be falling from October onwards as we head into winter. There seems nothing to lose and potentially much to gain.

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“…Considering the observations presented, it is suggested that vitamin D deficiency may be the common variable among elderly individuals and patients with underlying diseases, populations more susceptible to complications and mortality by COVID-19. That may justify the use of vitamin D supplementation as a measure of maintenance and expression of the immune response, which are important for reducing the risk and severity of viral infection as well as for mitigating the symptoms of this disease (163)(164)(165).…”

Section: Vitamin Dmentioning

confidence: 99%

Zinc, Vitamin D and Vitamin C: Perspectives for COVID-19 With a Focus on Physical Tissue Barrier Integrity

et al. 2020

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Some nutrients play key roles in maintaining the integrity and function of the immune system, presenting synergistic actions in steps determinant for the immune response. Among these elements, zinc and vitamins C and D stand out for having immunomodulatory functions and for playing roles in preserving physical tissue barriers. Considering the COVID-19 pandemic, nutrients that can optimize the immune system to prevent or lower the risk of severe progression and prognosis of this viral infection become relevant. Thus, the present review aims to provide a comprehensive overview of the roles of zinc and vitamins C and D in the immune response to viral infections, focusing on the synergistic action of these nutrients in the maintenance of physical tissue barriers, such as the skin and mucous membranes. The evidence found in the literature shows that deficiency of one or more of these three elements compromises the immune response, making an individual more vulnerable to viral infections and to a worse disease prognosis. Thus, during the COVID-19 pandemic, the adequate intake of zinc and vitamins C and D may represent a promising pharmacological tool due to the high demand for these nutrients in the case of contact with the virus and onset of the inflammatory process. Ongoing clinical trials will help to clarify the role of these nutrients for COVID-19 management.

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Vitamin D Supplementation During the COVID-19 Pandemic

Cited by 33 publications

References 3 publications

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency

Vitamin D and COVID-19: evidence and recommendations for supplementation

Zinc, Vitamin D and Vitamin C: Perspectives for COVID-19 With a Focus on Physical Tissue Barrier Integrity

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