RESEARCH UPDATE: Vitamin D Levels in COVID-19 Outpatients, Clinical Effect of Supplementation (J Clin Med 2021 May)

Analysis of "Vitamin D Levels in COVID-19 Outpatients from Western Mexico: Clinical Correlation and Effect of Its Supplementation. J Clin Med 2021 May"

Executive summary by DrV

1. Vitamin D deficiency is unacceptably common (80%) in patients presenting with Cv19 infection

2. Vitamin D levels inversely correlate with Cv19 symptoms at baseline, ie, more vitamin D = fewer symptoms

3. Treatment with vitamin D3 10,000 IU daily for 14 days was safe but insufficient to normalize or optimize serum 25ohD levels

4. Treatment with vitamin D3 10,000 IU daily for 14 days resulted in a reduction in Cv19 symptoms

5. Future studies should use higher doses in the range of 20,000 - 50,000 IU and would be wise to include measurement of serum vitamin D3 in addition to 25ohD in order to quantify the suspected antagonistic effect of vitamin D3 seen with bolus dosing (article by Vasquez 2020 and video discussion 2021)

Overview

• Citation: Athziri Sánchez-Zuno et al. Vitamin D Levels in COVID-19 Outpatients from Western Mexico: Clinical Correlation and Effect of Its Supplementation. J Clin Med 2021 May 28;10(11):2378. doi:10.3390/jcm10112378

• Design and population: randomized clinical trial conducted in 42 COVID-19 outpatients of both genders, diagnosed by real-time PCR without mention of cycle number/threshold; several other lab tests were performed; randomization was competent; 80% of patients were vitamin D deficient at baseline

• Intervention: 10,000 IU daily of vitamin D3 in soft capsule form for 14 days, n=22

• Findings:

  1. Symptoms pre-treatment: VitaminD-deficient persons were more likely to have symptoms whereas vitaminD-sufficient persons were more likely to be asymptomatic

  2. Symptoms post-treatment: VitaminD-supplemented persons had fewer symptoms

  3. Dose was insufficient: The finding that “the intervention group had median levels of total vitamin D of 20.2 ng/mL (12.2–45.9) before vitamin D3 supplementation (10,000 IU daily) for 14 days (average duration of COVID-19 pathogenesis). The administered supplementation was sufficient to increase total vitamin D serum levels significantly on day 14 (28.2 ng/mL)” actually shows that 10,000 IU per day for 14 days is insufficient to optimize vitamin D levels, either to physiologically normal defined as >32 ng/mL or optimal defined as >40 ng/mL per Vasquez et al 2004, 2005, 2017, 2020, 2021. Only n=7=31.2% of patients achieved vitamin D serum levels ≥30 ng/mL by 14 days of follow-up; again this proves that the dose was insufficient and/or that the semi-activated form of 25ohD should have been used

  4. Treatment with vitamin D3 10,000 IU daily for 14 days was safe as expected, given that this is roughly equivalent to ~15 minutes of sunbathing

Errors/missteps contained in this publication

1. The article is competently written and of sufficient clarity but would have benefited from professional proofreading to enhance clarity and smooth-out some of the grammar. For example, “organisms” should have been organizations. Despite a few minor imperfections in grammar (and contextualization), overall the article is quite excellent and the authors clearly worked very hard to produce a quality publication. In fact, this article is notably better than most articles in its thoroughness.

2. Their statement “<10 ng/mL is considered an indication of vitamin D deficiency, according to suggested laboratory reference values" indicates the authors’ lack of familiarity with the research/clinical literature on this topic, and their codification of absurdly low levels of 25ohD as normal, eg 11 ng/mL would be normal by their definition, is a disservice to patients, clinicians, and policymakers internationally. That 25ohD levels should be at least 32 ng/mL and preferably >40 ng/mL has been clarified by many authors including Vasquez et al 2004, 2005, 2017, 2020, 2021. To their credit, the authors later state “levels ≥ 30 ng/mL were considered as sufficiency” and by this standard 80% of patients were vitamin D deficient at baseline.

3. Using PCR without specification of cycle number/threshold makes the interpretation of this index essentially meaningless and thus any associated findings are uninterpretable (see video provided below).

4. Irrelevant lab testing, other than for curiosity, which even then might simply be misleading: The authors report that PCR positivity and IgG and IgM antibody seropositivity was not affected by treatment, but this finding is irrelevant if the PCR cycle threshold is not disclosed and given that antibodies are mostly or entirely irrelevant against viral infections as well-known in previous literature since the 1950s and as recently reiterated by the US FDA

5. 9.5% of patients received ivermectin, but this allocation was not detailed sufficiently

Previous contextualizing research and clinical practice

• Data presented in the above-reviewed study is consistent with the positive results of vitamin D supplementation against Cv19 documented elsewhere such as “Vitamin D treatment of severe hospitalized Cv19” in Journal of Clinical Endocrinology and Metabolism 2021 Jun reviewed in detail at https://healthythinking.substack.com/p/correction-of-preexisting-vitamin

Additional information

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.