DEEP DIVE RESEARCH ANALYSIS and COMMENTARY: Vitamin D treatment of severe hospitalized Cv19 in Journal of Clinical Endocrinology and Metabolism 2021 Jun
Today (17Jun2021) I take a second look at and provide a detailed "word for word" analysis of the most important study yet published on Cv19 treatment and prevention
DrV: Today (17Jun2021) I take a second look at and provide a detailed "word for word" analysis of the most important study yet published on Cv19 treatment and prevention.
What makes this potentially “the most important study yet published on Cv19 treatment and prevention”? Because this particular treatment
1) is immediately available and affordable internationally,
2) is safer than any known drug,
3) provides more collateral benefits (eg, alleviation of pain and depression) in addition to its “medical miracle” status against Cv19,
4) allows for both prevention and treatment, whereas most other treatments are appropriate only for either A) prevention but not treatment (eg, vaccines supposedly), or B) treatment but not prevention (ie, immunoglobulins/ convalescent serum), or C) cannot be used long-term or preventively due to excessive cost (eg, antiviral drugs) or adverse effects (eg, steroids),
5) provides more clinical benefits of A) major pathophysiological importance and B) major clinically-relevant endpoint importance, eg, reductions in B1) healthcare utilization and disease severity and B2) reductions in death
6) allows the management of this condition to be more democratically distributed among the population and among various healthcare professionals instead of the current mode of centralized control up to an including “vaccine passports” and other draconian social-personal controls.
Thus, if indeed this article stands up to scrutiny, it should change the standard of care and prevention for this heavily politicized and obfuscated condition.
RESEARCH ANALYSIS and COMMENTARY
Publication: Journal of Clinical Endocrinology and Metabolism is one of the most respected and influential journals in medicine, especially related to topics of endocrinology. The journal is published by Oxford University Press, which is a department of the University of Oxford. The journal is owned and managed by the Endocrine Society, an international organization of healthcare professionals, mostly medical physicians specializing in Endocrinology. This article is indexed in Pubmed  and Europe’s PMC .
DrVcommentary: This is a supremely well vetted and medically endorsed article and journal; because this article documents effectiveness of a nonvaccine treatment, it is at risk of being withdrawn for political reasons, which is part of the reason I am documenting it herein.
Population: 838 patients hospitalized with severe Cv19 were included in the final analysis after starting with 930 patients from which 92 were excluded because they had previously received vitamin D supplementation. 447 received vitamin D while 391 did not initially receive vitamin D; of those 391 initially untreated patients, 53 of them were eventually given vitamin D and were analyzed separately.
DrVcommentary: This is a massively large study; removing those 92 patients who’d previously received supplementation is completely reasonable per the study’s objectives and to improve/maintain the level of quality of the research.
The inclusion of the 53 patients in the “gray zone” is actually a strength of the study as it provides a third group wherein we would reasonably expect an intermediate clinical result. If found, this intermediate result would support the dose-response relationship that would strengthen the biological plausibility of and confidence in the findings. Conversely, we could find that such very-late intervention could be harmful.
Intervention: Vitamin D as semiactivated 25ohD; dosage was “532ug on day one plus 266ug on day 3, 7, 15, and 30”
DrVcommentary: My math on this is that 532mcg is approx (by factor of 40x) 21280 IU of 25ohD which has an approximate biological equivalence (by factor 3.2x) of 68,096 IU of vitamin D3. Is this a reasonable intervention for safety and effectiveness in this context? I think it is reasonable, even if I don’t see the reason for not giving treatment on the second day — what is the point in skipping days 2, 4, 5, 6, 8, 9-14 when dealing with an acute life-threatening infection? We don’t have enough comparative data to know if it is the perfect and ideal dosing schedule, and the dosing was not customized per patient need or response; other nutrients such as zinc and vitamin A should have also been used.
Why is the international medical/research community being so retarded in its use of interventions when by this time we clearly know that this patient population has multiple nutritional deficiencies and that all nutrients do and must function together?
Findings: Among 838 patients with severe hospitalized Cv19, administration of vitamin D (as semiactivated 25ohD) reduced ICU utilization from 21% to 4.5% (87% reduction = massive savings in healthcare utilization and expense) and reduced mortality from 15.9% to 4.7% (79% reduction in death).
DrVcommentary: Amazing reductions in A) illness severity / suffering, B) healthcare utilization, C) expenses, D) deaths [mulitplied by] affordability/inexpensive [mulitplied by] international availability [mulitplied by] immediate availability [mulitplied by] safety [mulitplied by] collateral benefits [mulitplied by] lack of drug/disease interactions
Design: Cohort/comparison among patients normally and equally treated within the same hospital with the same treatments; the only difference between the groups was +/- vitamin D treatment
DrVcommentary: Legitimate study design for the real world during a supposed pandemic. Crybabies will bemoan that it was not “double blind and placebo-controlled” but if you ask them how many acutely ill patients on multiple meds they have seen actually count and differentiate their pills, they won’t have an answer. In other words, DBPC is unrealistic in this setting.
Lack of clarity in description of patient characteristics: Bottom of page 10 and top of page 11 of the unformatted manuscript
DrVcommentary: The section is not well written and should be edited/proofed. This lack of clarity is inconsequential to the importance of the article.
Incorrect definition of sufficiency: “those with ≥20 ng/mL were considered to be vitamin D replete” on page 9 of the manuscript.
DrVcommentary: The authors are simply repeating dogma here; I cannot see that anyone who has legitimately studied this topic can conclude that a serum vitamin D level of 21 ng/mL is normal when it is clearly consistent with osteomalacia, severe pain, muscle weakness, depression, anxiety and immunosuppression as I have previously documented.
Devastatingly low baseline levels of vitamin D: "The study population had a relatively low vitamin D status as demonstrated by the median serum 25OHD concentration at baseline 13 ng/mL."
DrVcommentary: The widespread allowance of vitamin D deficiency in the population is nutritional neglect, medical malpractice, and political maleficence.
Multiple Mechanisms of Action / Biological Plausibility = well established: strengthens barrier defenses, reduces viral replication, reduces viral load and transmission/shedding, reduces excessive inflammatory response, cytokine storm, promotes immunotolerance, reduces acute lung injury (ALI) and acute respiratory distress syndrome (ARDS), enhances immune response, reduces collateral damage; protects mitochondria
Enviable Safety: As a normal and natural and necessary component of human physiology, vitamin D is safer than all other drugs
Affordability: Minimal treatment with 2,000 IU/d costs ~$15/y; I am reasonably assuming that this intervention cost less than USD$10 or about 8 Euros while saving hundreds-thousands of dollars/Euros per patient.
Availability: Available by supplement internationally; not patented
Collateral Benefits: Correction of vitamin D deficiency is proven to alleviate depression, anxiety, back pain, pain amplification, migraine, deficiency-induced immunosuppression, systemic inflammation
Implications: Nutritional neglect is medical malpractice; vitamin D supplementation/assessment must become the standard of care
See academia.edu/40429791 for PDF/videos
Dr Alex Kennerly Vasquez (introduction; brief Bio-CV) writes and teaches for an international audience on various topics ranging from leadership to nutrition to functional inflammology. Major books include Inflammation Mastery, 4th Edition (full-color printing, 1182 pages, equivalent to 25 typical books [averaging 60,000 words each]), which was also published in two separate volumes as Textbook of Clinical Nutrition and Functional Medicine (Volume 1: Chapters 1-4; Volume 2: Chapter 5—Clinical Protocols for Diabetes, Hypertension, Migraine, Fibromyalgia, Rheumatoid Arthritis, Psoriasis, Vasculitis, Dermatomyositis and most other major inflammatory/autoimmune disorders); several sections have been excerpted including Antiviral Strategies and Immune Nutrition (ISBN 1502894890) (aka, Antiviral Nutrition [available as PDF download] and Brain Inflammation in Chronic Pain, Migraine, and Fibromyalgia. Dr Vasquez’s books are available internationally via bookstores such as BookDepository, Amazon.com, Barnes and Noble, ThriftBooks, AbeBooks, BetterWorldBooks, WaterStonesBooks and his new Telegram channel is https://t.me/DrAlexVasquez.
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