• March 4, 2021
 Vitamin D’s role in Immune Response Associated with Covid 19

Vitamin D’s role in Immune Response Associated with Covid 19

Let me preface this by saying that this article is not maintaining that vitamin D is a cure, nor a preventative, for Covid-19.

However, what if adding Vitamin D supplements to your diet could protect you (and your family) from the complications associated with Covid-19? As always, please consult your care provider for your vitamin D levels and appropriate approach to supplementation.

What follows is a series of articles and data that show our world’s vitamin D deficiency may be part of the reason why a virus has been able to infiltrate and destroy our normalcy. I’ve highlighted a few elements that were new to me.

Most importantly, what the scientific community does know is that Vitamin D hugely impacts our immune response associated with Covid 19 [Kumar, R., Himani, Haq, A., Wimalawansa, S. J., & Sharma, A.; 2020]

VITAMIN D? How is it that possible, you say?

Well, here is the thing – most of the world is deficient , or insufficient, when it comes to Vitamin D [Amrein, Hoffman, et al.; 2020] . Most people don’t understand how this vitamin works in our bodies. It is a large part of our immune system response.

Doctors noted that many people with severe cases of Covid-19 had low levels of Vitamin D. According to Mercola, Grant, and Wagner (2020): “Vitamin D deficiency co-exists in patients with COVID-19. At this time, dark skin color, increased age, the presence of pre-existing illnesses and vitamin D deficiency are features of severe COVID disease.”

For years, the scientific community has published papers on how adequate levels of vitamin D in the body protects us from respiratory infections [Hughes, Norton; 2009; Martineau, Greenberg, Bergman, Dubnov-Raz, Esposito, Ginde, Goodall, et al.’ 2019].

Furthermore, several studies have also noted that children with lower levels of vitamin D are 11 times more likely to get infected with respiratory infection than those who have sufficient levels [Wayse et al, 2004). Taken a few steps further, when Covid patients were treated with Calcifediol ( the metabolized version of vitamin D in our bodies), there were no deaths and less ICU admitted patients – as compared to 2 deaths and 50% admitted to ICU for those not treated (Study can be found here)

MYTH: Dark Skinned People Have More vitamin D in Their Bodies.

Vitamin D deficiency may be related to populations who have higher skin melanin content and who use extensive skin coverage [Palacios, Gonzalez; 2014]. Dark skinned people are typically found (or evolved from) areas known for having more sun exposure. However, biologically, they are equipped with more melanin,the skin pigmentation, which protects from burning. In addition to protection from
burning, this mechanism also shields the body from UV-B rays necessary for Vitamin D production.

This means that a darker skinned person needs to purposefully seek out sun exposure beyond their body’s natural mechanism to protect from it. Vitamin D synthesis occurs faster in individuals with lighter Fitzpatrick skin types [Tsarias, Weinstock; 2010].

MYTH: Any Sun Exposure Helps With Vitamin D Production in the Body.

Vitamin D is produced most efficiently through the body’s (safe) exposure to UV-B rays. The increase in vitamin D production ‘depends mainly on the UVB dose; however, for small UVB doses the area of irradiated body surface is important’. [ Both, Schmedes, Philipsen, Thieden, Wulf; 2010]. “Twenty minutes of sunshine daily with over 40% of skin exposed is required to prevent vitamin D deficiency” [Naem, 2010].

MYTH: “I’m out in the sun on a. Morning Walk. This is enough Vitamin D”

Even in northern hemispheres, known for more sun exposure, one must be in the sun from the hours of 12pm-2pm, for a minimum of twenty minutes with 40% of our bodies exposed [Naem, 2010].

Calcifediol | A clinical trial with 1,000 patients from 15 hospitals will test the efficacy of the drug against Covid Translated article previously published here

The encouraging results of the pilot study with Calcifediol against the effects of the coronavirus, a pioneer in the world, and developed at the Maimonides Institute for Biomedical Research of Córdoba (Imibic) and the Reina Sofía Hospital, has motivated the start of a large clinical trial intended to treat about a thousand patients with Covid-19 in fifteen hospitals throughout Spain.

The effectiveness of Calcifediol has been demonstrated in the aforementioned pilot study, which, in the case of obtaining the same results with a larger sample, could lead to a reversal in the treatment of the coronavirus. And it is no wonder: of the 50 patients treated with oral Calcifediol, only one required admission to the ICU (2%), compared to 13 in the group that was not supplemented (50%). These data seem to support the hypothesis that the activation of the D hormonal system could reduce the risk of Acute Respiratory Distress Syndrome (ARDS) in patients affected by Covid-19.

This has been shown by the coordinator of the study, Manuel Quesada, and two of its researchers, Luis Manuel Training and José López Miranda. The initial design of this large trial, which has already started with around a hundred patients (and aims to reach 1,000) “will follow the protocol of the pilot study, with the administration of two Calcifediol tablets on the first day of admission. , another on the third day, one more on the seventh and, from there, one each week, ”they explained at a press conference.

And why was Calcifediol chosen? As López Quesada explained, “this drug allows very good absorption (close to 100%) and can rapidly increase serum concentrations of 25 (OH) D as it does not require hepatic metabolism. In this way, patients reach serum levels of between 40-60 ng / mL necessary to combat the hyperinflammation produced by the cytokine / chemokine storm.

This inflammatory storm generates one of the most serious and determining processes of the Covid-19 prognosis: Acute Respiratory Distress Syndrome (ARDS). “More than 40% of patients hospitalized for coronavirus pneumonia develop ARDS, of which up to 50% eventually die,” he noted.

«Activation of the vitamin D receptor produces an activation of our innate immune system, which may be beneficial in the treatment of ARDS, reducing the hyperactivation of the renin-angiotensin-bradykinin system, modulating the activity of neutrophils, as well as stimulating the maintenance of the integrity of the pulmonary epithelium and its repair in case of damage, “explained Dr. Luis Manuel Training.

Preventive treatment in residences

For his part, Dr. José López Miranda, has reported that “Covid-19 patients admitted to the ICU present a multi-organ complexity that greatly compromises their health. These results could be of great help to be taken into account in this second wave that we are facing throughout these weeks. We are talking about a treatment that has a very low cost per patient, without side effects at the moment and that could greatly help to relieve pressure in ICUs.

The Minister of Health and Families, Jesús Aguirre, has expressed his appreciation to all the professionals who work investigating against Covid. «The Imibic is a pride for Andalusia; it is a benchmark on the national and international scene ».Regarding the large multicenter clinical trial underway, Aguirre stressed that, if the  results of the pilot study are confirmed, “we are studying how to bring Calcifediol
to residences to minimize the impact of Covid on the elderly, administer preventive treatment for the elderly », Has pointed out.

SOURCES:
Amrein, K., Scherkl, M., Hoffmann, M. et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr 74, 1498–1513 (2020). https:// doi.org/10.1038/s41430-020-0558-y

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Cannell, J. J., Vieth, R., Umhau, J. C., Holick, M. F., Grant, W. B., Madronich, S., Garland, C. F., & Giovannucci, E. (2006). Epidemic influenza and vitamin D. Epidemiology and infection, 134(6), 1129–1140. https://doi.org/10.1017/S0950268806007175

Entrenas Castillo, M., Entrenas Costa, L. M., Vaquero Barrios, J. M., Alcalá Díaz, J. F., López Miranda, J., Bouillon, R., & Quesada Gomez, J. M. (2020). “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”. The Journal of steroid biochemistry and molecular biology, 203, 105751. https://doi.org/10.1016/j.jsbmb.2020.105751

Hernández, Nan, Fernandez-Ayala, García-Unzueta, Hernández-Hernández, López-Hoyos, Muñoz-Cacho, Olmos, Gutiérrez-Cuadra, Ruiz-Cubillán, Crespo, Martínez-Taboada, Vitamin D Status in Hospitalized Patients with SARS-CoV-2 Infection, The Journal of Clinical Endocrinology & Metabolism, , dgaa733, https:// doi.org/10.1210/clinem/dgaa733

Holick, M.F. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord 18, 153–165 (2017). https:// doi.org/10.1007/s11154-017-9424-1

Hughes, D. A., & Norton, R. (2009). Vitamin D and respiratory health. Clinical and experimental immunology, 158(1), 20–25. https://doi.org/10.1111/j.1365-2249.2009.04001.x

Jain, N., Varman, R., Tarbox, J. A., & Nguyen, T. (2020). Biomolecular endotype factors involved in COVID-19 airway infectivity: A systematic review. Auris, nasus, larynx, S0385-8146(20)30307-2. Advance online publication. https://doi.org/10.1016/j.anl.2020.11.006

Kumar, R., Himani, Haq, A., Wimalawansa, S. J., & Sharma, A. (2020). Putative Roles of Vitamin D in Modulating Immune Response and Immunopathology Associated With COVID-19. Virus research, 198235. Advance online publication.
https://doi.org/10.1016/j.virusres.2020.198235

Martineau A.R., Jolliffe D.A., Greenberg L., Aloia J.F., Bergman P., Dubnov-Raz G., Esposito S., Ganmaa D., Ginde A.A., Goodall E.C., et al. Vitamin D supplementation to prevent acute respiratory infections: Individual participant data meta- analysis. Health Technol. Assess. 2019;23:1–44. doi: 10.3310/hta23020.

Moozhipurath, R.K., Kraft, L. & Skiera, B. Evidence of protective role of Ultraviolet-B (UVB) radiation in reducing COVID-19 deaths. Sci Rep 10, 17705 (2020).

Naeem Z. Vitamin d deficiency- an ignored epidemic. Int J Health Sci (Qassim). 2010 Jan;4(1):V-VI. Palacios C, Gonzalez L. Is vitamin D deficiency a major global public health problem? J Steroid Biochem Mol Biol. 2014 Oct;144 Pt A:138-45.

Quesada-Gomez, J. M., Entrenas-Castillo, M., & Bouillon, R. (2020). Vitamin D receptor stimulation to reduce acute respiratory distress syndrome (ARDS) in patients with coronavirus SARS-CoV-2 infections: Revised Ms SBMB 2020_166. The Journal of steroid biochemistry and molecular biology, 202, 105719. https://doi.org/10.1016/j.jsbmb.2020.105719

Wayse V et al. Association of subclinical vitamin D deficiency with severe acute lower respiratory infection in Indian children under 5 y. European Journal of Clinical Nutrition. 2004;58:563–567.

Tsiaras WG, Weinstock MA. Factors influencing vitamin D status. Acta Derm Venereol. 2011 Mar;91(2):115-24. doi: 10.2340/00015555-0980. PMID: 21384086.

Commentary: Ultraviolet irradiation and oral ingestion as sources of optimal vitamin D Journal of the American Academy of Dermatology, Volume 62, Issue 6, June 2010, Pages 935-936

—— ARTICLES OF INTEREST —————

Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity Joseph Mercola, William B. Grant, Carol L. Wagner
Nutrients. 2020 Nov; 12(11): 3361. Published online 2020 Oct 31. doi: 10.3390/nu12113361
PMCID: PMC7692080
Article PubReader PDF–998KCitation
Vitamin D and COVID-19: It is time to act
Andrius Bleizgys
Int J Clin Pract. 2020 Oct 27 : e13748. doi: 10.1111/ijcp.13748 [Epub ahead of print]
PMCID: PMC7646035
Article PubReader PDF–590KCitation

Obesidad en tiempos de COVID-19. Un desafío de salud global
Miguel A. Rubio Herrera, Irene Bretón Lesmes
Endocrinol Diabetes Nutr. 2020 Oct 21 Spanish. doi: 10.1016/
j.endinu.2020.10.001 [Epub ahead of print]
PMCID: PMC7577699
Article PubReader PDF–630KCitation

A Basic Review of the Preliminary Evidence That COVID-19 Risk and Severity Is Increased in Vitamin D Deficiency
Linda L. Benskin
Front Public Health. 2020; 8: 513. Published online 2020 Sep 10. doi: 10.3389/
fpubh.2020.00513
PMCID: PMC7513835
Article PubReader PDF–3.0MCitation

“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”
Marta Entrenas Castillo, Luis Manuel Entrenas Costa, José Manuel Vaquero Barrios, Juan Francisco Alcalá Díaz, José López Miranda, Roger Bouillon, José Manuel Quesada Gomez

J Steroid Biochem Mol Biol. 2020 Oct; 203: 105751. Published online 2020 Aug
29. doi: 10.1016/j.jsbmb.2020.105751
PMCID: PMC7456194

Monica Riehl

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