COVID-19 Strategy: Focus on Vitamin D

May 18, 2020

References: ZME Science, SSRN, Vitamin D Council, Science, SSRN-Philipines

This might be the most important action you can take to build your immune system up to fight COVID-19.  Yes, most important is just to not get it by lowering your risk of exposure, social isolation, hand washing, avoiding face touching, etc.  But focus here, Vitamin D appears to play a central role in your immune system.  Here is how.

First of all, the biology of Vitamin D.  You make it in your skin when UVB rays from the sun hit a cholesterol molecule and break one chemical bond open.  At age 20, a Caucasian American will make 20,000 IU of Vitamin D in June (sun directly overhead) with 20 minutes of mid-day sun.  At age 70, that same person will only make 5,000 iu in 20 minutes. Skin pigment protects the degradation of folate by sunlight but slows down Vitamin D production.  Africans living in Tanzania, getting optimal sunlight, have D levels of 40-55 ng living on the equator. 

But living in northern cities, mostly indoors, African Americans have Vitamin D levels of 5-15 ng (personal research of roughly 500 ER patients).  That is severely deficient.  (To convert nanograms to nanomoles, the unit used in European studies, multiple ng by 2.5: 12 ng equals 30 nmoles).  It is becoming widely accepted that Vitamin D has been the driving force of human populations' skin pigment.  Folks living further north in Vitamin D deficient environments succeed only if they develop lighter skin, allowing them to generate D.  That's why folks from Ireland, Scotland, Norway, Finland, and Russia sunburn so easily too.

You won't get rickets (severe Vitamin D deficiency) if your D level is above 12 ng, so some consider that as sufficient.  However, there is clear and compelling evidence that you need a level of 32 ng to turn on cathelicidin, your natural antibiotic.  Optimal levels of D then become 40-80 ng to defend against virus assaults.  You can't protect yourself against virus infections when your D level is below 30 ng.  In Wisconsin, Caucasians drop their D levels down to 20 ng during winter and rise up to 45 ng during the summer.  That's why influenza shows up in winter.  And goes away in summer.  A meta-analysis of 17 studies has shown that Vitamin D is strongly associated with viral infections.  The higher the D, the less viral infections.

This week's focused study is from Indonesia.  780 lab-confirmed cases of COVID were reviewed for Vitamin D levels and mortality.  The majority of folks with insufficient low levels of D, with preexisting conditions, died.   Another study from the Philipines put it into risk ratios.  Folks with healthy levels of D had a 19.6 fold risk reduction of death.  Did you get that?  Read it again.  19.6 fold.  This observation explains part of why folks with skin pigment appear to be more vulnerable, why nursing home residents are more vulnerable, why northeast American States have done worse while southern, sunny states have done better.  It suggests that the virus will calm down a little during the summer but roar back in November (just like influenza did in 1919).  It suggests that Africa will not be as severely affected.....unless you are really crowded, poor, diabetic, overweight.

But here is the rub.  Vitamin D isn't a drug.  It is a hormone tasked with turning on genes.  That takes a while.  Drugs work in 20 minutes.  DNA and genes take days to weeks to start working.  Fundamentally, Vitamin D turns stem cells into mature cells.  It is stored in fat tissue. Overweight folks are almost always more deficient.  If you just start taking a dose of 5,000 IU a day (5 minutes of sunshine in a young Caucasian), it will take over a year before you come to a new plateau. Because of the phenomenon of soaking up into fat tissue, you need a loading dose to get started.  Most folks who haven't been taking Vitamin D need at least a 100,000 IU loading dose.  African Americans need two loading doses, back to back.  Each dose will raise your blood level about 14 ng (on average).   To optimally protect yourself, you want to be on Vitamin D for several months before you get exposed and to have an optimal level when you are exposed.  If you are elderly, your skin just doesn't make it anymore, and your dermatologist yells at you for being out in the sun.  You just have to take it as a supplement.  And best of all, a blood level to guide your decisions.  Remember, 19.6 fold increased risk of dying.  Plain and simple.

www. What will work for me.  I'm older, living up north, with some propensity to be diabetic in my genes.  If I get ill with COVID-19 and have no D, I'm toast.  Taking it once a month has been touted as adequate because it simplifies taking it.  The problem with that is remembering.  There is some evidence that taking D every day is actually better.  I suspect it is mostly because you get in the habit and remember to do it.

Pop Quiz

1.  To fight viruses optimally, you want Vitamin D to be what level?     Answer:  At least 32 ng or 80 nmoles.  Much higher than many recommendations for preventing rickets.

2.  Folks living in northern cities have normal levels of D?     Answer:  False

3.  African Americans with skin type 6 (very dark) need the same amount of sunlight to make sufficient Vitamin D.  T or F.    Answer:  Horribly false.  Proably need up to 6 times as much sunlight, which you can't get when you live indoors, in a cold climate, far up north where for 6 months a year you make no vitamin D at all.

4.  How well does Vitamin D sufficiency protect you from dying with COVID-19?    Ratio of 19.6

5.  What should you do with Vitamin D to get started?   Answer: Get a blood level, take a loading dose of 100,000 a day for every 14 ng you are below 50 ng and then take 5,000 iu a day