UK slow to recognise vitamin D as covid fighter

By Jerome Burne

It’s no secret that none of us will be able to make any vitamin D from sunshine until about April. That, combined with lock-down and isolation, makes it a cert that without supplementing most of us are going to become more deficient over the next seven months.

It’s especially true for those with darker skin (BAME), who need longer sun exposure to make enough vitamin D than whites, along with anyone over 65 who, government stats show, are more likely to be deficient anyway.

But does it matter? This post is about why, in the time of covid, this is important, and deficiency could well be dangerous. The raised risk of infection within BAME communities and among the elderly provides a clue.

But why vitamin D? Isn’t that about bones and teeth? Yes, if you only listen to your GP and the NHS. But the idea that vitamin D can play a crucial role in fighting off infections and that it is hard to get enough from sunlight and food was being discussed ten years ago.

In fact, I wrote an article about it then, which said that it did more than protect bones, that it could also cut the risk of infections and that if we were supplementing we needed more than the recommended amount. Research had then just been published which found that by Easter every year 90% of the population’s vitamin D levels are seriously depleted. 

Three million elderly people in the UK are vitamin D deficient

All of this has been ignored with devasting consequences for BAME communities and the elderly. In fact, buried in the government’s health statistics there is data about the level of Vitamin D deficiency among the over 65. which is far worse than we have been told.

According to the latest government figures nearly 3 million people over 65 are dangerously deficient.  Twenty four per cent of them have a vitamin D level below 25nmol/l – (UK measurement, which is 10ng/mL in America) And since 18% of the population is over 65 that means there are over 2,850,000 people who have less than the absolute minimum for bones, let alone sufficient to help fight an infection.

So is anything being done about it? The short answer is: ‘Very little’, even though mounting evidence, covered below, suggests that increased supplementation could significantly cut rates of covid infections and deaths.

The advice given by NICE and the policy of NHS is not to routinely test or treat the elderly for mineral or vitamin deficiencies, while Public Health England (PHE) has made a deeply modest change to its advice, recommending that children and adults should supplement 10mcg (micrograms) or 400IU daily. 

Immune link to vitamin link known 10 years ago

The official line is that we still don’t know that vitamin D does anything for the immune system.  The National Pharmacy Association, for example, which should know about vitamins, warns: ‘There is no evidence that vitamin D reduces the risk of COVID.’

But in my article written in 2011, I quoted one of the most senior vitamin D researchers, Professor Michael Holick, as saying: ‘Vitamin D can turn genes on and off. That’s the reason it can improve resistance to infection. Healthy amounts boost the activity of the gene that makes a peptide which kills bacteria, viruses and fungi.’ Holick was then the director of the Bone Healthcare Clinic and the Vitamin D, Skin and Bone Research Laboratory at Boston University School of Medicine. 

So, had vitamin D been a drug, over the last ten years there would have been large sums devoted to investigating and testing it, but that has not happened. With the result that faced with a predicted rise in covid cases and deaths, there has been a belated scramble to establish what vitamin D can do.

‘The anti-viral and anti-inflammatory actions of vitamin D make it an interesting candidate,’ says Professor Adrian Martineau of Barts Health NHS Trust ‘but there is genuine uncertainty about whether it can support the immune system and so fend off the virus. We need a trial to resolve it.’

Trial results may be too late for many at risk

Martineau is heading a large trial of 5,440 volunteers to test the idea, which is due to start at the end of the month. The treatment group will get 3,200 IUs a day for six months.

It seems unlikely that the NHS will take any decisions about the widespread use of vitamin D supplements for prevention or treatment until the trial is completed and published, which could be many months away. This delay could have fatal results for many in the groups most at risk.

Meanwhile, other countries are not being so cautious. For instance, a White Paper has recently been published in Switzerland recommending supplementation for the general population “and especially adults aged 65 and older” of 200mg of vitamin C and 2000 1U of vitamin D.

It begins by clearly setting out the benefits of nutrition for a ‘well-functioning immune system as a modifiable factor to reduce the risk of virus infections.’ It refers to: ‘reviews that showed a benefit of vitamin D supplementation for preventing lung tract infection for all age group.’ One of these was a meta-analysis of trials involving over 11,000 people, which had found that supplementation reduced the probability of infection by 36%. 

Another trial referred to is an Israeli one, involving nearly 8,000 health care workers, which found that those with a low vitamin D level – below 75 nmol/L – were at double the risk of COVID infection.` It is striking that this is effectively three times higher than the deficiency level used by the NHS.

Those with higher vitamin D levels do better than lower

Elsewhere trials comparing survival between those getting higher and lower amounts of the vitamin consistently show that people with higher levels do better than those with lower – especially those with a deficiency level 25nmol/L

Many of them have been posted on a “wiki” site dedicated to vitamin D. A page run by Dr David Grimes, long-time vitamin D researcher and author of ‘Vitamin D and Cholesterol’ describing his research into the link between heart disease and latitude and how the risk rises the further north you go. 

Last month he posted a summary of results of recent studies from around the world that found a link between the level of vitamin D in the blood and the chance of getting or surviving covid. The results are only correlations but what stands out is that the level considered safe in the UK – 30nmol/L – is far lower than many other countries. Some consider 75nmol/L the point where immune system benefits kick in.

For instance: A study from the Philippines found that the disease was mild in 85% of those whose blood level was above 75nmol/L (30ng/ml) while among those below 75nmol/L (30ng/mL) just 5% had mild disease, for the rest it was moderate, severe or critical. 

The same crucial level of 75nmpl/L (30ng/mL) seemed to play a major role in whether you lived or died. An Indonesian study reported that of those above it, 96% survived but only 12% of those below did. And among those below 50nmol/L (20ng/mL) – a level your GP would consider adequate – just 1% 

GPs rate very low levels of vitamin D as OK

These and similar studies suggest that blood levels considered sufficient in the UK are too low and that there is good evidence for routinely testing those at risk – something NICE has consistently refused to recommend. So just how much vitamin D should we be getting?

 Official recommendations vary widely. In the UK it’s 400 IU (international units) or 10mcg (micrograms). The EU and many countries go for 400-600IU, the exception is Italy’s 2000 IU (50 mcg), in the USA is 1000 IU (25 mcg). 

 At the other end some vitamin D researchers and experienced clinicians, such as Professor Holick, recommend 4000 to 5000 IU (125 mcg) for daily maintenance.

If the UK trial using 3,200 IU (80mcg) shows a protective effect, will that amount be given to the millions of those over 65 who are deficient?

Until all this is clearer it makes sense to test what your own levels are at somewhere like GreenVits – Kiweno DIY Vitamin D test (- sends results to your smartphone in approx. 15 mins) or VitaminDtest.org.uk (NHS pathology lab). Then taking the sort of amount recommended by Professor Holick is very unlikely to be harmful.

Very high vitamin D levels may save lives

When it comes to treating severely infected patients there are a couple of trials suggesting that very very high doses can be effective. 

In one trial, 30 mechanically ventilated, critically ill patients with pneumonia were given 1,250µg (500,000iu) of vitamin D3. This significantly increased their haemoglobin concentrations, improving iron metabolism and the blood’s ability to transport oxygen properly. Like vitamin C, this change would rapidly reduce the damaging inflammatory immune reaction known as a cytokine storm.

‘Another high-dose study in Georgia US, gave ventilated intensive care unit patients with mean-baseline vitamin D blood levels below 50nmol/l either 1,250µg (50,000iu) or 2,500µg (100,000iu) of vitamin D daily for five days. It reported that hospital length of stay was reduced from 36 days in the control group to 25 days in the 250,000iu group and 18 days in the 500,000iu group. That’s a halving of hospital stay, and costs, in the high vitamin D group. 

But to use vitamin D most effectively clinicians don’t just need to know ‘how much?’, but also ‘in what combination?’ At the moment the trials used to test vitamin D and other nutrients are designed as if they were pharmaceutical-style magic bullets. But nutrients don’t work like that.

They are not lone anti-viral gunslingers; they are team players. To work best they need to be used in cocktails and combinations. All antioxidant vitamins need to be recharged after damping down a damaging oxidant and what does that? Another vitamin. 

Vitamins work best in combination

The most sophisticated and detailed protocol for treating covid patients has been developed by Dr Paul Marik, Chief of Pulmonary and Critical Care Medicine Eastern Virginia Medical School, Norfolk, VA. It runs to 34 pages and is available for download here. Evms Critical Care Covid-19 Management Protocol

Marik suggests that Vitamin D ‘may be a very powerful prophylactic and treatment strategy against covid’. As part of the treatment package for severely infected patients, he recommends 20 000 to 60 000 IUs in a single oral dose, followed by 20 000 IUs weekly until discharged from hospital.

For the early stages of an infection, he suggests combining quercetin (a plant compound) with zinc, which is essential for the immune response, while quercetin is antiviral and helps zinc enter cells. Vitamin C is part of the cocktail, improving the anti-viral action of quercetin as well as acting as an antioxidant, antiviral and anti-inflammatory agent.

A further development, just proposed in the BMJ, is for nutrients to be combined with the low carb ketogenic diet. The rationale is that high carbohydrate diets are linked with diabetes, which results in high blood levels of glucose and possibly insulin, and diabetics are more at risk for covid infection. But why?

The key factor, the paper suggests, is that high insulin and glucose brings down magnesium levels, which in turn make vitamin D less effective, raising the risk of infection for these patients and the elderly, who may well be magnesium deficient anyway for a variety of reasons.

So the authors suggest lowering glucose and insulin levels with a low carbohydrate diet and supplementing with vitamin D, magnesium and zinc. Although the paper doesn’t suggest vitamin C, it would be a good idea as it works closely with magnesium.

For decades the NHS has largely dismissed the benefits of supplements – repeating the mantra about getting all you need from a healthy balanced diet. But the virus has shown that they can play a role and that together with diet and lifestyle should be a far more central part of our health service.

Jerome Burne

Jerome Burne

Jerome Burne is the editor of HealthInsightUK. He is an award-winning journalist who has been specialising in medicine and health for the last 10 years and now works mainly for the Daily Mail. His most recent book “The Hybrid Diet” was written with nutritionist Patrick Holford, published 2018. Award: 2015: Finalist for 'Blogger of the Year' Medical Journalists' Association.

12 Comments

  • There is a recent interview with Professor Michael Holick in which he shows the evidence that higher blood levels of Vitamin D ( a potent steroid pro-hormone – not just a nutrient ) will help you to:

    * Reduce your risk of catching any coronavirus – by 50%
    * Reduce the severity of the illness

    Watch the Youtube video here:
    http://www.is.gd/VitaminD_BIG_news

    • Editorial

      Rufus, for those who don’t know him, is a tireless chapmption of Vitamin D. Over ten years ago he stared attending “scoping” exercises organised by NICE, designed to evaluate evidence for changing the levels reccomended for vitamin D. He presented dozens of paper but none were deemed strong enough to make a change. When he started the reccomended level for a supplement was 400 IUs and it still is. It might seem like a failure but it is a heroic example of how badly our nutritional regulators need educating or removing.

      See his story here:
      https://healthinsightuk.org/2019/09/12/citizen-researchers-fighting-for-truth-about-treatments/

  • There are three deficiencies strongly associated with COVID-19 severity -
    Vitamin C,
    which activates vitamin D by hydroxylation
    https://pubmed.ncbi.nlm.nih.gov/1655350/
    vitamin D (with vit C here)
    https://www.sciencedirect.com/science/article/pii/S2590098620300518
    and selenium
    https://www.mdpi.com/2072-6643/12/7/2098
    The vitamin D receptor in monocytes upregulates synthesis of the thioredoxin reductase protein, which is selenium dependent, fourfold.
    https://pubmed.ncbi.nlm.nih.gov/10619700/
    Vit D also upregulates another selenium-dependent enzyme, GPx.
    “Vitamin D elicits antioxidant effects through upregulating expression of antioxidative enzymes including superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT), ascorbic acid (AA), α-tocopherol, and glutathione (GSH) that can scavenge the free radicals.”
    https://www.mdpi.com/2072-6643/12/2/575/htm

    (dexamethasone, the only drug to reduce COVID-19 mortality, by 20% so far, activates the vitamin D receptor)

    Note that zinc deficiency is not associated with COVID-19.
    https://www.ijidonline.com/article/S1201-9712(20)30647-0/fulltext

    Thus it is logical that vit D, selenium, and vit C should be used together, and that one of these factors may not reduce mortality if the others are absent.

    • Editorial

      Be great if you could be put in charge of educational courses for dietitians – I have been told that ICUs have dietitians attached and at least some – information from a critical care doctor – firmly oppose high vit C doses (others too probably). The “science” is so obviously there, shouldn’t dietitians be required to do regular refresher courses to keep up.

  • Readers might like to know that https://www.grassrootshealth.net publish latest research on Vit. D. They do promote a product but that doesn’t diminish their information.

  • The reasons why vitamin / mineral supplementation will not be adopted should be clear to everyone by now. It isn’t and never was about “following the science” but about following the money. No money in anything natural, billions in patentable molecules and vaccines. It isn’t and never was about “evidence based medicine” but about eminence based medicine. Too many egos protecting too many reputations. Don’t forget that the much vaunted “peer review” merely protects the existing paradigm and status quo. When the system of “medicine” is fundamentally broken by vested interests, it can’t be fixed by reasoned argument or evidence. Patient benefit has long ago been supplanted and made secondary to the dogma of big pharmas mantra.

    • Editorial

      Of course you are absolutely right. The point is do we continue to passively accept it?. All sorts of things that we now don’t approve of – sending children up chimneys, slavery, women not having the vote – were at one time acceptable and supported by vested interests.
      A recent medical example is treatment for diabetes. The official one, supported by a 10 billion a year drug bill plus a high carbohydrate, low fat diet, is clearly a disaster with obesity and diabetes rates rising.
      In the last five years patients and some imaginative and brave doctors have been reversing the nutrition advice for their diabetic patients, putting them on a high fat low carb diet. The results have been impressive with drug use reducing if not stopped altogether and some patients effectively “cured”.
      A similar coalition between patients and doctors – hard to do – could make vitamins an acceptable part of treatment in day to day life and in infectious pandemics.
      What’s needed is getting doctors involved (hard as they are taught nothing about nutrition) and a campaign by patient groups

  • David P Richardson.

    Please have a look at the review paper in the British Journal of Nutrition by myself and Professor Julie Lovegrove published in August 2020 on Nutritional Status of micronutrients as a possible and modifiable risk factor for COVID 19: A uk perspective.

    This paper followed on from rapid response in the BMJ on April 18th on making nutrition a priority to help reduce risk of infection and death during the coronavirus pandemic
    BMJ 369,m1327

    Nutrition science seems to take a back seat in government and SAGE advice. We need an urgent call to action by health authorities to avoid nutrient deficience.

    • Editorial

      Thanks for posting here an would like to look at article but could you supply a link – getting to copy from BJN involves signing up to get lots of articles and doesn’t have an option for journalists and another link took me to a European journal. Other readers may have better luck or be better researchers but they’d probably appreciate it too

  • Is vitamin D the only benefit to the immune system provided by sunlight? I’ve read, for example, that a Georgetown University study found that it also helps activate T cells. If there are other benefits, might a study of vitamin D supplementation conducted at this time of year not get such positive results as a summer one, and wouldn’t such a study have to ensure all its subjects had both similar exposure to sunlight, and be of a similar skin tone to be comparing like with like. ‘BAME’ is a broad category, and a somewhat socially constructed one with no obvious biological significance.

    • Editorial

      I don’t know about activating T cells, however Rufus Greenbaum – rufus@nullgreenbaum.com might have details.
      You could also try Dr Dvaid Grimes – davidgrimes1@nullmac.com – who has been campaigning for greater use of vitamin D for years – he blogs at http://www.drdavidgrimes.com/ – and is a mine of information.
      But i do know of one other benefit of sunlight specifically, which is that it releases nitric oxide – vital for heart health – from stores in the skin, according to research published a few years ago. What’s interesting is that it does it via the other wavelength to the one that triggers the vitamin D precursor. This means, i presume, it is not a benefit you can get from a supplement.
      This is what I wrote about the stores in the skin in an article for the Daily Mail about 5 years ago:

      ‘A research team in Edinburgh has found that nitric oxide provides a new and important benefit from sunbathing, and one that has nothing to do with making vitamin D. The implication is that Cancer Research UK’s current advice to smear on two tablespoons of sun block every two hours when out in the UK sun, could be depriving you of protection from heart disease.

      That’s because the team, headed by senior dermatology lecturer Professor Richard Weller, has made a totally unexpected discovery. Our skin contains large stores of nitric oxide that is released into the blood when exposed to the UVA rays that form part of sunlight. To get vitamin D you need a different wave length – UVB. Professor Weller believes that Vitamin D’s reputation for heart protection has been piggy-backing on the benefits of UVA rays.

  • The pilot randomized study in the Reina Sophia hospital in Cordoba (Spain) is very persuasive: “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/

    In brief, both groups received best standard care (as it happened hydrochloroquine & azithromycine), intervention group received +calcifediol (=calcidiol) on entry +day 3 +day 7. Half control group needed ICU and 2 died, D group only 2% (two) needed ICU and none died.

Leave a Reply to DR DAVID P. RICHARDSON


WP-Backgrounds by InoPlugs Web Design and Juwelier Schönmann