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Chris Kresser

1a479e8cf51ae59288822bdedd01bd7c?s=47 DoctorAkil
March 24, 2021

Chris Kresser

The Role of Vitamin D and Supportive Nutrients in the COVID-19 Pandemic



March 24, 2021


  1. The Role of Vitamin D and Supportive Nutrients in the

    COVID-19 Pandemic Chris Kresser, M.S. L.Ac Presented at the 2021 IHH-UCSF Symposium on Nutrition and Functional Medicine
  2. Koch’s Postulates

  3. None
  4. None
  5. None
  6. None
  7. Chaudhary et. al. Implications of magnesium deficiency in type 2

    diabetes: a review, Biol Trace Elem Res. 2010 May;134(2):119- 29. doi: 10.1007/s12011-009-8465-z. Epub 2009 Jul 24. Sources: Li et. al. Vitamin D Deficiency, Obesity and Diabetes, Cell Mol Biol (Noisy-le-grand) 2015 Jun 10;61(3):35-8.
  8. None
  9. don’t get enough vitamin C 39% don’t get enough vitamin

    A 43% don’t get enough Calcium 44% don’t get enough Magnesium 52% don’t get enough vitamin K 67% don’t get enough vitamin E 89% don’t get enough Choline 92% don’t get enough vitamin D 94% don’t get enough Potassium 100% Source: Drake, Micronutrient Inadequacies in the US Population: an Overview, Oregon State University 2018-2021 Linus Pauling Institute.
  10. The RDA was designed to prevent disease, not promote health.

  11. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5537775/#app1-nutrients-09-00655 “A low proportion of the U.S. population has an

    adequate diet.”
  12. None
  13. None
  14. Vitamin D

  15. Vitamin D COVID-19 ?

  16. CRP, TNF-A, etc. Ace2 Receptor Barrier Function Antimicrobial Peptides T-Helper

    Cell responses Blood Vessels Cytokine Storms Gut Microbiome
  17. Sources: Gruber-Bzura, Vitamin D and Influenza—Prevention or Therapy?, Int. J.

    Mol. Sci. 2018, 19(8), 2419. Bergman et. al. Vitamin D and Respiratory Tract Infections: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, PLoS One 2013 Jun 19;8(6):e65835. doi: 10.1371/journal.pone.0065835. Print 2013. Surman et. al. Vitamin Supplementation at the Time of Immunization with a Cold-Adapted Influenza Virus Vaccine Corrects Poor Mucosal Antibody Responses in Mice Deficient for Vitamins A and D, Clin Vaccine Immunol. 2016 Jan 6;23(3):219-27. doi: 10.1128/CVI.00739-15.
  18. None
  19. Source: Mercola et. al., Evidence Regarding Vitamin D and Risk

    of COVID-19 and Its Severity, Nutrients. 2020 Oct 31;12(11):3361. doi: 10.3390/nu12113361.
  20. Is reverse causality likely? Source: Bertoldo et. al., Serum 25-hydroxyvitamin

    D levels modulate the acute-phase response associated with the first nitrogen-containing bisphosphonate infusion, J Bone Miner Res. 2010 Mar;25(3):447-54. doi: 10.1359/jbmr.090819.
  21. Strength (effect size) Consistency (reproducibility) Specificity Temporality Biological gradient (dose-response)

    Plausibility Coherence Experiment Analogy Alternate explanations (not included in Hill’s original criteria, but some include now) 1 2 3 4 5 6 7 8 9 10 Image Source: Unknown author, CC BY 4.0, Wikipedia
  22. Criterion Evidence Temporality 25D deficiency precedes C19 diagnosis Strength 25D

    deficiency associated with C19 mortality with 7.6 OR (P < 0.001) Dose-response Large decrease in SARS-CoV-2 seropositivity as 25D increases from <20 to 50 ng/mL Consistency 13 of 16 observational studies (more now) found inverse relationship Plausibility Several established immunological mechanisms proposed Coherence Experimental and obs. evidence has shown that vitamin D reduces risk of many diseases Experiments Limited evidence to date, but what does exist largely supports causality Analogy Vitamin D supplementation reduces the risk of acute RTIs Alternate explanations Reverse causation unlikely based on current evidence; association still present after adjusting for confounding factors Source: Annweiler et. al., Point of view: Should COVID-19 patients be supplemented with vitamin D?, Maturitas. 2020 Oct;140:24-26. doi: 10.1016/j.maturitas.2020.06.003. Epub 2020 Jun 8.
  23. Vitamin D deficiency = 4.6x more likely to be positive

    for SARS-CoV-2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7716744/
  24. All patients who died were in the lowest vitamin D

    group. https://www.mdpi.com/2072-6643/12/12/3773
  25. More ultraviolet light = less COVID-19 Source: Gorman et. al.,

    Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update, Front Cardiovasc Med. 2020; 7: 616527.
  26. People that habitually took vitamin D had a 34% lower

    risk of infection. https://academic.oup.com/ajcn/advance-article/doi/10.1093/ajcn/nqaa381/6123965
  27. Figure 1: Mortality rates according to 25 (OH) D levels

    (a) and serum calcium tertiles, (b) in severe COVID-19 patients. https://www.tandfonline.com/doi/full/10.1080/07315724.2020.1856013
  28. Source: Pardhan et. al., Vitamin D Deficiency as an Important

    Biomarker for the Increased Risk of Coronavirus (COVID-19) in People From Black and Asian Ethnic Minority Groups, Front Public Health. 2020; 8: 613462.
  29. Up to 35% of overweight or obese people are deficient

    in vitamin D Source: DeLuccia et. al., The implications of vitamin D deficiency on COVID-19 for at-risk populations, Nutr Rev. 2020 Sep 25 : nuaa092.
  30. 43% of the elderly are deficient or severely deficient in

    vitamin D Source: DeLuccia et. al., The implications of vitamin D deficiency on COVID-19 for at-risk populations, Nutr Rev. 2020 Sep 25 : nuaa092.
  31. Source: Gavioli et. al., An Evaluation of Serum 25-Hydroxy Vitamin

    D Levels in Patients with COVID-19 in New York City, J Am Coll Nutr. 2020 : 1–6.
  32. 25D sufficiency reduced the risk of death by 82 percent.

  33. The risk of severe illness and death was >90% lower

    in patients that supplemented with vitamin D. https://pubmed.ncbi.nlm.nih.gov/33147894/
  34. Vitamin D supplementation reduced the risk of death by 89%

  35. D supplementation reduced risk of death by 87% https://www.mdpi.com/2072-6643/12/12/3799

  36. Calcifediol reduced ICU admission by 97% https://www.sciencedirect.com/science/article/abs/pii/S0960076020302764?via%3Dihub

  37. “We conclude that it is not plausible that the decreased

    ICU admissions in the treatment group were due to imperfect blinding, uneven distribution of prognostic risk factors, or a combination of the two.” https://www.medrxiv.org/content/10.1101/2020.11.08.20222638v2
  38. Vitamin D supplementation increased clearance of viral RNA and decreased

    fibrinogen levels. https://pmj.bmj.com/content/early/2020/11/12/postgradmedj-2020-139065.long
  39. Vitamin D supplementation had NO effect. https://jamanetwork.com/journals/jama/fullarticle/2776738

  40. The patients were not deficient in vitamin D Vitamin D

    was given too late in the course of the disease The form of vitamin D given did not increase serum levels of D fast enough The trial was underpowered The trial only included moderately ill patients Most patients in the treatment group were obese (BMI >30)
  41. Cases Time Normalize vitamin D levels R Value 0 1

  42. More research will only help if it is well-designed.

  43. What is a normal 25 D level? >10 ng/mL >20

    ng/mL >30 ng/mL
  44. None
  45. 1 Most observational studies support a role for vitamin D.

  46. The observational evidence meets most of Hill’s Criteria for Causality.

  47. The majority of experimental evidence supports a connection. 3

  48. 4 There are well-established, plausible mechanisms that explain the connection.

  49. 5 Vitamin D supplements have been shown to protect against

    other RTIs.
  50. Vitamin D deficiency is widespread and is an established risk

    factor for other diseases. 6
  51. 7 The populations at highest risk of COVID are also

    at highest risk of vitamin D deficiency.
  52. 8 Supplementation with vitamin D at appropriate doses is safe,

    effective, affordable, and accessible.
  53. 9 Supplementation with vitamin D would be prudent even without

  54. Normalizing vitamin D levels would be expected to provide benefit

    even if the virus mutates. 10
  55. None
  56. Magnesium Sources: Uwitonze et. al., Role of Magnesium in Vitamin

    D Activation and Function, J Am Osteopath Assoc. 2018 Mar 1;118(3):181-189. doi: 10.7556/jaoa.2018.037. DiNicolantonio, et. al., Magnesium and Vitamin D Deficiency as a Potential Cause of Immune Dysfunction, Cytokine Storm and Disseminated Intravascular Coagulation in covid-19 patients, Mo Med. 2021 Jan-Feb; 118(1): 68–73.
  57. 25(OH)D DVHD (1,25D) Magnesium Source: Dominguez et. al., Magnesium in

    Infectious Diseases in Older People, Nutrients. 2021 Jan 8;13(1):180. doi: 10.3390/nu13010180.
  58. 60% of U.S. adults don’t get enough magnesium. Sources: Dominguez

    et. al., Magnesium in Infectious Diseases in Older People, Nutrients. 2021 Jan 8;13(1):180. doi: 10.3390/nu13010180. Dominguez et. al., Magnesium and Hypertension in Old Age, Nutrients. Nutrients. 2021 Jan; 13(1): 139.
  59. Vitamin D Magnesium Source: Dominguez et. al., Magnesium in Infectious

    Diseases in Older People, Nutrients. 2021 Jan 8;13(1):180. doi: 10.3390/nu13010180.
  60. Vitamin A Source: Gröber et. al., The coronavirus disease (COVID-19)

    - A supportive approach with selected micronutrients, Nutrients. Nutrition, 24 Jan 2021, :1-22 doi: 10.1024/0300-9831/a000693.
  61. Source: Li et. al., Revealing the targets and mechanisms of

    vitamin A in the treatment of COVID-19, Nutrients. Aging (Albany NY). 2020 Aug 15;12(15):15784-15796. doi: 10.18632/aging.103888. Epub 2020 Aug 15.
  62. Vitamin K Source: Anastasi et. al., Vitamin K deficiency and

    covid-19, Nutrients. Scand J Clin Lab Invest. 2020 Nov;80(7):525-527. doi: 10.1080/00365513.2020.1805122. Epub 2020 Aug 11.15.
  63. Vitamin K levels in patients hospitalized for COVID-19 were <50%

    of controls (and even lower in those that died). https://pubmed.ncbi.nlm.nih.gov/33374341/
  64. Does SARS-Cov-2 suppress vitamin K? https://pubmed.ncbi.nlm.nih.gov/33023681/

  65. Vitamin D For prevention Blood Level 40-60 ng/mL Higher dose

    10,000 IU/d Form D3 (cholecalciferol) for prevention, calciferol in hospital (if available) Typical dose 5,000 IU/d Source: Brighthope et. al., Vitamin-D and COVID-19: time for the profession to take a stand, Adv Integr Med. 2021 Jan 21. doi: 10.1016/j.aimed.2021.01.003. Online ahead of print.
  66. Vitamin D For treatment Dose if infected and/or hospitalized 10,000

    IU/d Initial bolus dose 50-200,000 IU Sources: Gröber et. al., The coronavirus disease (COVID-19) - A supportive approach with selected micronutrients, Nutrition, 24 Jan 2021, :1-22 doi: 10.1024/0300-9831/a000693. Kimball et. al., Evaluation of vitamin D3 intakes up to 15,000 international units/day and serum 25-hydroxyvitamin D concentrations up to 300 nmol/L on calcium metabolism in a community setting, Dermatoendocrinol. 2017; 9(1): e1300213. Bacon et. al., High-dose oral vitamin D3 supplementation in the elderly, Osteoporos Int. 2009 Aug;20(8):1407-15. doi: 10.1007/s00198-008-0814-9. Epub 2008 Dec 20.
  67. Magnesium For prevention and treatment Form Glycinate, malate or citrate

    preferred Dose 300-500 mg/d
  68. Vitamin A For prevention Form Retinol (liver, cod liver oil,

    supplements, etc.) Dose 2,000-4,000 IU/d
  69. Vitamin A For treatment Follow-up dose (1 month) 10,000 IU/d

    Initial bolus dose 50-200,000 IU/d
  70. Vitamin K2 For prevention Form MK-4 or MK-7 Dose 1-2

    mg (1,000-2,000 mcg)/d
  71. Vitamin K2 For treatment Form MK-4 or MK-7 Dose 10-15

  72. ChrisKresser.com KresserInstitute.com