Vitamin D Defense Against Coronavirus

Introduction

Vitamin D is an important vitamin that contributes to the optimum functioning of the human body. Apart from keeping our bones healthy and strong, one of the well-explored effects of vitamin D in the regulation of the immune system. It prevents autoimmune diseases and strengthens the defense against bacteria and viruses. Vitamin D insufficiency has been found to significantly compromise respiratory immune response function, greatly increasing the risk of COVID-19 severity and mortality. Not just susceptibility to viral infections, but a severe deficiency of vitamin D was found in patients with ARDS – Acute Respiratory Distress Syndrome – The cause of fatality during the past coronavirus infections.

The novel Coronavirus, 2019-nCoV, is contagious and more infectious than initially predicted.  It is causing health and economic problems worldwide. COVID 19 is a respiratory tract infection with symptoms similar to flu or a common cold. Mortalities occur due to ALI (Acute lung injury) and the more severe form, ARDS ( Acute respiratory distress syndrome) characterized by lung edema and accumulation of inflammatory cells. It is heartbreaking to see the trend of COVID-19 infections multiplying at such a fast pace. When it comes to this pandemic, it is not only important to focus on physical barriers but physiological barriers as well.  Is there something that could alleviate the situation?

The Sun God’s chemical gift to humanity, vitamin D, is asking for due recognition. With our indoor lifestyles, vitamin D deficiency is a global pandemic, including India. We are seeing the effects of deficiency of vitamin D on our health – a weakened immune system! The role of vitamin D goes beyond bones and it is a non-negotiable cellular necessity today and not just an optional vitamin. Supplementation h become a must as food does not have enough vitamin D.

The defense offered by vitamin D goes way beyond our imagination.  Starting from the time of viral entry into the body to the intra-cellular anti-inflammatory effects, up to the genes where it can enhance the production of helpful proteins, vitamin D can do it all.

How Can Vitamin D Help to Protect?

Vitamin D appears to play a very important role in regulating the immune system It can help prevent and control the progression of COVID-19 in multiple ways including modulating the innate and adaptive immunity, preventing viral replication and down-regulating the inflammatory cytokines. To share just a few mechanisms –

  1. It upregulates or increases the production of anti-microbial peptides by the immune cells like cathelicidin and beta-defensins. These are like natural antivirals and antibiotics and are involved with the direct inactivation of viruses.
  2. Vitamin D suppresses the production of cytokines by the immune cells and this helps suppress the inflammation. This is akin to nipping the problem at the bud.
  3. Vitamin D is a genetic modulator and influences the genes to suppress the production of Renin – he root protein that cascades to an inflammatory end product Angiotensin 2.

Vitamin D is not an optional supplement. In today’s time, it is a non-negotiable cellular necessity.

Proper vitamin D supplementation to the population could help control this pandemic. The past infections with enveloped viruses like SARS, H1N1 influenza, MERS have all thrown enough light on the unique role vitamin D can play in preventing and also treating them.

What is the Right Blood Level of Vitamin D?

Vitamin D is ‘the vitamin’ which can be quantitatively checked with a simple blood test that all labs are doing. The Endocrine Society has recommended 30-100 ng/ml blood levels of vitamin D as sufficient to maintain good health. Some interesting points to note –

  •  Vitamin D deficiency is so rampant, that we as doctors do not see even the lower limit ie 30ng/ml unless and until they are taking some vitamin D supplements. This level is just sufficient to prevent rickets and not really to strengthen our immune functions.
  • 40 ng/ml is the minimum desired level of vitamin D for overall health and has also been shown to be protective against common colds and flu.
  • Higher levels of more than 50 ng/ml, have been found to influence our immune system better. People whose blood levels of vitamin D are at least 50- 60 ng/ml, are better protected from the ravaging effects of the deadly viral infections, COVID-19 being the present one.
  • Our farming forefathers werehealthier than us with vitamin D blood levels beyond 80 ng/ml

Some Frequently Asked Questions About Vitamin D for Immunity

1. I eat a balanced diet so do I need vitamins?

Ans: Vegetarian food, unfortunately, does not contain vitamin D. Other food sources like egg yolk, deep-sea cold-water fish, some mushrooms, do not contain enough vitamin D to meet the need. We Indians are a predominantly vegetarian community and despite staying in a tropical country, are having significant vitamin D deficiency today.

2. How about sunlight?

Ans: Our ancestors were predominantly hunting and farming community and would get 90% of the vitamin D requirement with their healthy outdoor lifestyles. As far as we the urban Indians are concerned, sun phobia, indoor lifestyles, AC culture, and sunscreens do not allow our skin to get adequate sun exposure to be able to make necessary vitamin D. It is found that if we are in the full sun (10 am – 2 pm) with 70% of skin exposure, the body can take around 10000 to 15000 IU in 15 – 20 minutes. How many of us are ready for it regularly that too in the face of pollution that limits these beneficial rays?

3. Are the multivitamin pills adequate?

Ans: The RDA or the recommended daily allowance for vitamin D has been for maintaining healthy bones. The routine intake of 1000 IU per day of vitamin D is not enough for boosting the immune system. It is too petty a dose and serves just to prevent rickets. A 21st-century evaluation and research have validated that we need 10000 international units per day for physiological benefits for the whole body. No wonder, we get vitamin D capsules, tablets and sachets each containing 60000 IU of vitamin D. One salient point about vitamin D to be noted is that being a fat-soluble vitamin, it needs not to be taken every day.

4. So how much vitamin D should one take for immunity?

Ans: Given that majority are below 20 ng/ml of vitamin D when checked and if they start taking vitamin D in routine doses, it will not bring the levels up that help the immune system. Today we are standing at a crossroads where an immediate boost to the immune system is the need of the time. To make this happen, we will need a loading dose to be followed by the regular maintenance dose.  The aim should be to quickly build and maintain at least 50 to 60 ng/ ml of vitamin D blood levels.

The recommendations below are for adults in the context of and specific to this situation with COVID-19. It is necessary to translate to proper levels of vitamin D safely and quickly to meet the crisis. Regimens that give at least 6 Lakh IU vitamin D for 2 months have been found to achieve this target. For severe deficiency, a single injection of vitamin D given intramuscularly has been found to give that immediate boost safely with healthy levels maintained for 1 to 2 months.  Oral regimens to give the desired 6 lakh units over 2 months are being advised with good intention –

  • If not supplementing at all for 6 months or more –
    • vitamin D 60k IU twice a week for 2 weeks to be followed by 60k once a week for the next 6 weeks
    • vitamin D 60k IU daily for three days to be followed by 60k weekly for a total period of 2 months.
    • If taking some form of vitamin D supplement (1000-5000 IU per day) – it can be replaced with vitamin D 60K IU once a week for two months.

It is advisable to get the blood levels checked after these 2 months of taking vitamin D. The doses can then be adjusted to maintain levels around 60 ng/ml

5. Is vitamin D toxic?

Ans: Levels greater than 150 ng/ml are referred to as being toxic which does not happen with the doses that are being recommended above. What we are talking of higher than usual doses over 6 to 8 weeks, do not result in blood concentrations that are even remotely considered as toxic. COVID-19 is toxic to death and not restoring healthy levels of vitamin D would be inappropriate in the present scenario.

Vitamin D Defense Against Corona

We are facing a sinister illness that can kill within days. Most who are tested and eventually ended up on a ventilator had very low vitamin D levels. In light of so much evidence of its beneficial role and given that the majority of the population is chronically deficient in vitamin D, knowing that the cost of vitamin D is extremely low, and it can be easily taken orally by masses, it would be inappropriate to not recommend this.

People who are working in the front lines should be made aware of this and they start taking vitamin D in higher than otherwise doses to quickly bring up their levels. If it is giving them and their patients protection from the virus, it could be one of the best tools in this fight that can obviate the need for many people getting admitted to ICUs. I would urge the doctors to make use of this extremely important tool for themselves, their staff and patients. With almost no risk at all, with proven safety and the potential to greatly reduce the severity of the disease, it can be used in conjunction with the therapies being used, to provide synergistic benefits in controlling the infection.

A vitamin D supplementation program to protect the masses could potentially have a dramatic impact on overall health worldwide. We lose nothing by correcting the vitamin D levels to the needed 50-60 ng/ml which is safe. The Indian majority needs Vitamin D – an affordable, easily implementable and scientifically proven immune-modulator. This effective tool should not be left untried in a crisis of monumental proportion. It may be too late for many if we don’t act. Time to act is now.

Salient Points To Remember Regarding Vitamin D

• We lose nothing by improving the vitamin D status as food does not have enough vitamin D.
• Vitamin D deficiency is a global pandemic as is Coronavirus infection.
• Nobody has been found with the minimal desired level 40 ng/ml unless taking Vit D supplements
• Vitamin D is a well-proven powerful immuno-modulator. At least 50 – 60 ng/ml blood levels of vitamin D are needed for the same.
• None of the other vitamins or anti-oxidants can provide a high degree of immune protection which vitamin D provides.
• Vitamin D is well tolerated and is effective in oral doses, being cheap and affordable too.
• Considering potential benefits & no toxicity 10000 IU /day can be safely recommended for adults.
• It will be very helpful if we take vitamin D to strengthen ourselves from inside. Oral loading dose for 3 days is needed to get immediate protection. This is to be followed with a maintenance dose
• All doctors and health care professionals with a risk of exposure and the corona positive and quarantined people with doing better with just one injection of vitamin D as an added protection.

References: Vitamin D Defence against Corona

Dancer RC, Parekh D, Lax S, et al. Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS). Thorax. 2015;70(7):617–624. doi:10.1136/thoraxjnl-2014-206680

Gorman S, Zafirau MZ, Lim EM, et al. High-Dose Intramuscular Vitamin D Provides Long-Lasting Moderate Increases in Serum 25-Hydroxvitamin D Levels and Shorter-Term Changes in Plasma Calcium. J AOAC Int. 2017;100(5):1337–1344. doi:10.5740/jaoacint.17-0087

Grant, W.B.; Lahore, H.; McDonnell, S.L.; Baggerly, C.A.; French, C.B.; Aliano, J.L.; Bhattoa, H.P. Vitamin D Supplementation Could Prevent and Treat Influenza, Coronavirus, and Pneumonia Infections. Preprints 2020, 2020030235 (doi: 10.20944/preprints202003.0235.v1).

Beard, J. A., Bearden, A., & Striker, R. (2011). Vitamin D and the anti-viral state. Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology, 50(3), 194–200. https://doi.org/10.1016/j.jcv.2010.12.006

Adrian R Martineau. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ 2017; 356
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Quraishi SA, De Pascale G, Needleman JS, et al. Effect of Cholecalciferol Supplementation on Vitamin D Status and Cathelicidin Levels in Sepsis: A Randomized, Placebo-Controlled Trial. Crit Care Med. 2015;43(9):1928–1937. doi:10.1097/CCM.0000000000001148

lley Gorman, Mark Zafir, Ee Mun Lim, Michael W Clarke, Gursimran Dhamrait, Naomi Fleury, John P Walsh, Martin Kaufmann, Glenville Jones, Robyn M Lucas. High-Dose Intramuscular Vitamin D Provides Long-Lasting Moderate Increases in Serum 25-Hydroxvitamin D Levels and Shorter-Term Changes in Plasma Calcium. Journal of AOAC INTERNATIONAL, Volume 100, Issue 5, 1 September 2017, Pages 1337–1344

Cristiana Cipriani, Elisabetta Romagnoli, Alfredo Scillitani, et al., Effect of a Single Oral Dose of 600,000 IU of Cholecalciferol on Serum Calciotropic Hormones in Young Subjects with Vitamin D Deficiency: A Prospective Intervention Study, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 10, 1 October 2010, Pages 4771–4777

Glade MJ. A 21st-century evaluation of the safety of oral vitamin D. Nutrition. 2012;28(4):344–356. doi:10.1016/j.nut.2011.11.006

Papadimitriou DT. The Big Vitamin D Mistake. J Prev Med Public Health. 2017;50(4):278–281. doi:10.3961/jpmph.16.111

Schwalfenberg G. Vitamin D for influenza. Can Fam Physician. 2015 Jun;61(6):507. PMID: 26071153; PMCID: PMC4463890.

Weydert J. A. (2014). Vitamin D in Children’s Health. Children (Basel, Switzerland), 1(2), 208–226.

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Dr. Renu Mahtani

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