Report: Vitamin D Insufficiency is Prevalent in Severe COVID-19

Deleted User

Deleted User wrote: »

I am always wary about "Just in case" Or "It cant hurt" thinking. Because quite often it _can_ hurt. Vitamin D supplements can be quite harmful. Especially if taken with other supplements. Calcium if memory serves is one example.

There's no evidence that vitamin D supplementation is dangerous at any sort of level that the average person would supplement at. The amount needed to cause an adverse calcification event is pretty extreme.

Deleted User wrote: »

But you just reminded me of another study I had not mentioned when you said you were taking it because your levels are "critically low". Sometime around 2015 a study was done on Postmemopausal Women who had been disagnosed with Vitamin D deficiency.

So if supplementing in people with low levels was going to work then you would hope this would be such a group where you would see results.

The women were split into a "placebo" "Low Level" and "High level" dosing.

The results were - quite surprising. In the high dosing group there was little effect on Vitamin D absorption. Something like 1% improvement. In the placebo group absorption went down 1% just to give you a comparison.

The shocker? Absorption in the low dosing group absorption went down 2%. Double that placebo group.

What that means I have no idea! It suggests supplementing does nothing at all or in fact makes things worse so the knee jerk thought of "YOu have low levels so you should supplement" might be a harmful one. Or it might suggest that our concepts for what being "deficient" even means are fundamentally flawed.

Interesting.

I had my levels checked before and after an extended period of supplementation and they went from critically low (~4ng/mL) to good (~45ng/mL) with an improvement in vitamin D metabolism from slow to normal.

Anyway, I believe the study you're referencing was looking at bone mineral density, rather than absorption. There was an increase in bone mineral density in high-dose (bolus) group and a decrease in both the 800IU group and the placebo group, with the decrease being very slightly higher in the 800IU group. The study explicitly states that the high dose was successful in raising and maintaining the serum level above 30ng/mL. Since this is a notable enough fact to be stated explicitly, it can be assumed that both the 800IU dose and the placebo were unsuccessful at reaching or maintaining a blood serum level of >30ng/mL.

So the takeaway from the study would actually seem to be that when blood serum levels of vitamin D reached 30ng/mL or more and stayed there, bone mineral density increased. YMMV but I think titling this study "High-dose vitamin D supplementation not associated with benefits for postmenopausal women" is completely baffling, considering that high-dose vitamin D managed to increase bone density in a cohort that is notoriously low in estrogen.

Deleted User

Deleted User wrote: »

There's no evidence that vitamin D supplementation is dangerous at any sort of level that the average person would supplement at.

I hope so. But I admit I have read a lot less about the harms of it than I have read studies about the benefits. I just vaguely remember reading things like if it is taken with Calcium it causes - gall stones or something. But my memory is vague on that to be honest.

Deleted User wrote: »

Anyway, I believe the study you're referencing was looking at bone mineral density, rather than absorption. There was an increase in bone mineral density in high-dose (bolus) group

Actually yes it was a study of calcium uptake while taking vitamin D. When I say absorption went up and even weirdly down - I meant of calcium not of the Vitamin D. I was mixing up two different studies in my head. That's what I get for relying solely on memory.

But it "did not translate into beneficial effects on bone mineral density" so I do not think the study you are thinking of can be the same as the one I am.

But the point here being that merely declaring something deficient and then supplementing it is not guaranteed to help. This study even showed a (thankfully tiny) net harm. The question should always be _why_ is there a deficiency. Simply noticing there is one and supplementing does not do that.

An analogy - Imagine a bucket half empty. You notice it is half empty so fill it up (supplement it). But actually the reason it is half empty is there is a hole half way up the bucket. So any supplements you add - simply fall out the hole again doing nothing at all. In fact the slow erosion of adding all the water might in fact increase the size of the hole over time.

A very lose analogy - so pinch of salt - but you get the point I trust that even if supplementation is going to cause a benefit a harm or nothing at all - it will entirely depend on why there is a supposed deficiency in the first place.

Which as I said before is always a lot of fun given there is no international - and sometimes even no national - consensus on what constitutes a deficiency in the first place.

But single studies are one thing. Large analysis and meta analysis are another. And they simply fail to show benefits over and over.

Deleted User

Deleted User wrote: »

But it "did not translate into beneficial effects on bone mineral density" so I do not think the study you are thinking of can be the same as the one I am.

It is the very same study. That's why the article title is so confusing. It states the opposite of what is reflected in the data, namely that of three groups of post-menopausal women—a low-estrogen group known to lose bone density—the only group that did not lose bone density was the group that reached and maintained a serum vitamin D level of 30ng/mL or more. And not only did they not lose bone density—their bone mineral density increased.

Edit: The conclusion they reached (that supplementation is not beneficial) was reached because there was no improvement along defined markers. But we know that vitamin K2 mediates the mechanism of calcium deposit. So it may be that a high level of vitamin D requires an additional supplementation (or intake from diet) of vitamin K2 in order that the additional calcium absorption from Vitamin D gets into more beneficial places (bones) rather than places they're not very useful (kidney stones are nasty).

Ultimately though I think we'd probably agree that we're only really just starting to understand the basics of micronutrients and how they interact on a cellular and genetic/epigenetic level, and we've barely even begun to look at how various micronutrients interact with each other within the complex system that is the human body. It's actually pretty crazy how much we don't know.

Deleted User

Deleted User wrote: »

It is the very same study. That's why the article title is so confusing.

The title is A) Not confusing and Not what you said it is above.

"Treatment of Vitamin D Insufficiency in Postmenopausal Women - A Randomized Clinical Trial"

I think the article title to which you refer is the title of an article about the study rather than the title of the study itself? I try to read studies directly rather than second or third hand reports on them.

Anyway their results in their own words were pretty clear that "We found no between-arm changes in spine, mean total-hip, mean femoral neck, or total-body bone mineral density, trabecular bone score, muscle mass, and Timed Up and Go or five sit-to-stand test scores." and that it "had a negligible effect on calcium absorption and no clinically meaningful beneficial effects on BMD" and "We found no between-arm differences for the absolute or annualized percentage change in lumbar spine, mean total-hip, or total-body BMD". Though they did note "High-dose cholecalciferol had a small, beneficial effect on femoral neck BMD."

They say "High-dose cholecalciferol therapy increased calcium absorption, but the effect was small and did not translate into beneficial effects on bone mineral density, muscle function, muscle mass, or falls. We found no data to support experts’ recommendations to maintain serum 25(OH)D levels of 30 ng/mL or higher in postmenopausal women. Instead, we found that low- and high-dose cholecalciferol were equivalent to placebo in their effects on bone and muscle outcomes in this cohort of postmenopausal women with 25(OH)D levels less than 30 ng/mL."

It's not a huge study but I would not be citing it myself as support for supplementation all the same. The point of my even mentioning it was just the interesting result that one supplementation group actually faired worse than both the other group and placebo. Only minutely worse of course so it's not all that significant - but it is interesting that simple knee jerk supplementation does not automatically have the effects one might guess at.

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Isn't everyone in Ireland a bit Vit D deficient? and doesn't this apply to most of the northern hemisphere during winter periods.

Thought this was one of the connection to increased seasonal spread for years?