The Lancet recently published a preprint of a study that created quite a stir, and was duly withdrawn until further review. Basically, researchers in Barcelona studied 900 hospitalized patients. An active group received a vitamin D analogue and one group functioned as a control, and the treatment group demonstrated a 60% reduction in mortality, and a quadruple reduction in risk of being admitted to the ICU. Wow! It has created an uproar, as researchers look at all the potential minor issues with study design and submission guidelines. 

As researchers continue to debate the fine points of this study and other studies which, so far, show a beneficial effect of vitamin D for COVID-19 outcomes, and while they are designing future studies to cinch a clearer relationship, I’d like to offer some input from the perspective of a healthcare practitioner trained in the use and clinical application of micronutrients for disease and for health maintenance. This is a point of view not often considered in research study design and critiques regarding micronutrients. 

Vitamin D deficiency is not uncommon. Especially among older adults, those living at higher latitudes, those with more skin pigment that can block sunlight’s action within the skin, and those who have digestive disorders or take medications that interfere with digestion, absorption and/or metabolism of vitamin D. Especially in the winter and spring months. 

The type of vitamin D used in this study was one that raises serum levels in the body extremely quickly. The forms we usually use as a supplement, commonly known as vitamin D2 or D3, take longer to safely correct deficiency levels- usually weeks to months. D3 is the more active form of the two. 

“Vitamin D” is actually a hormone in action, even though we typically categorize it as a nutrient. 

It has many roles in physiology, and some that are important in immune function which can include controlling hyperinflammatory reactions during infection, as well as helping to resolve immune responses after an infection. Which means, its greatest benefit is likely to be when used for a time period prior to viral exposure, in those who may be deficient already, and to prevent deficiency in those who are at risk. There has been previous research also showing benefit to vaccine immune response when issues such as vitamin D (and vitamin A) insufficiency have been corrected prior to vaccine administration. 

It is cheap and easy to administer, relative to most medications, and therefore should be seen as a simple intervention to offer to populations most likely to benefit. 

It may have its best role in preventing severe disease and death by using it to correct deficiency, and may not have such a big role as a therapy in those who are not deficient. So, correction, in those who need it, prior to viral infections is important. Treating patients who do not have deficiency, is likely not going to have much, if any, added benefit. 

Using high amounts can be harmful: they can increase blood calcium levels too quickly and cause kidney stones, heart and neurological problems, especially in elderly people. What’s a high amount? This could be anything over 3,000-4,000IU’s per day for an adult, particularly in someone who is not deficient in vitamin D. In a hospital setting, this might be a risk worth taking compared to the risks from severe COVID-19 disease, but possibly not for the general population, unless there is a demonstrated deficiency and it is under a primary health provider’s supervision. 

Insurance companies are extremely reticent about covering lab testing for vitamin D levels except under highly limited circumstances (which may cost insurance carriers anywhere from $15-$30 per test). Therefore, doctors may be loathe to order vitamin D tests for patients outside of these strict limits because out-of-pocket costs to the patient can exceed $150-$200 with a denied test. This needs to change. For now, self-directed, pre-pay options for lab testing are currently available for anywhere from $25-$85 for this test. 

Take away points: 

Testing for vitamin D should become a more routine screening practice, especially for adults over age 50. In absence of the ability to screen for deficiency first, routine supplementation with vitamin D at appropriate levels recommended by a patient’s primary care provider should be initiated, particularly in populations at higher risk of deficiency. 

I have included the following RDA chart for vitamin D supplementation from the National Institutes of Health: 

AGE	MALE	FEMALE	PREGNANCY	LACTATION
0-12 months*	10 mcg  (400 IU)	10 mcg  (400 IU)
1–13 years	15 mcg  (600 IU)	15 mcg  (600 IU)
14–18 years	15 mcg  (600 IU)	15 mcg  (600 IU)	15 mcg  (600 IU)	15 mcg  (600 IU)
19–50 years	15 mcg  (600 IU)	15 mcg  (600 IU)	15 mcg  (600 IU)	15 mcg  (600 IU)
51–70 years	15 mcg  (600 IU)	15 mcg  (600 IU)
>70 years	20 mcg  (800 IU)	20 mcg  (800 IU)

Since vitamin D is a fat soluble nutrient, it should be taken with a meal for best absorption. 

For more information, here is the Medscape article describing the Lancet preprint today: 

https://www.medscape.com/viewarticle/946314

And here is another article on the topic of Vitamin D that I wrote several years ago: 

https://themommyilluminati.com/tag/vitamin-d-deficiency/

By Cora Rivard, N.D./Seasons Natural Healthcare, LLC