As a ray of hope in what appears to be
an utterly broken medical system, Florida’s new surgeon general, Dr.
Joseph Ladapo, has issued a statewide public service announcement in
support of commonsense COVID prevention strategies such as optimizing
your vitamin D, staying active, eating nutrient-dense foods and boosting
your immune system with supplements.
The HealthierYouFL.org website1
now urges Floridians to “Talk to your health care provider about how
certain supplements or foods containing vitamins and minerals might help
boost your immune system, such as zinc, vitamin D, vitamin C and
quercetin.” These are all well-known supplements that have been shown to
have a positive impact on your COVID-19 risk.
The surgeon general also supports the use of monoclonal antibodies in
acute cases, and as prevention in high-risk patients who have been
exposed to COVID-19. Available treatment locations can be found on FloridaHealthCOVID19.gov.
‘Physicians Should Use Clinical Judgment’
Florida Health even highlights emerging treatments such as
fluvoxamine and inhaled budesonide. Importantly, Florida Health now
states that:2
“Physicians should use their clinical judgment when
recommending treatment options for patients’ individualized health care
needs. This may include emerging treatment options with appropriate
patient informed consent, including off-label use or as part of a
clinical trial.”
Well, no one could be happier about this than I. I’ve been calling
for vitamin D recommendations since the earliest days of the pandemic —
ideally nationwide, but statewide is at least a start, especially
considering Florida is the sunshine state. Instead, I’ve been vilified
and targeted by the U.S. Food and Drug Administration and mainstream
media for reporting its benefits.3,4
The FDA specifically mentioned Vitamin C, Vitamin D and Quercetin in
their warning letter. Now that the Florida surgeon general
agrees, will they also be warned by the federal authorities?
Ladapo
was appointed Florida surgeon general and secretary of the Florida
Department of Health by Gov. Ron DeSantis September 21, 2021,5 and it’s refreshing to finally see COVID guidance that makes sense. In his acceptance speech, Ladapo said:6
“I am honored to have been chosen by Governor
DeSantis to serve as Florida’s next Surgeon General. We must make health
policy decisions rooted in data and not in fear ...
I have observed the different approaches taken by
governors across the country and I have been impressed by Governor
DeSantis’ leadership and determination to ensure that Floridians are
afforded all opportunities to maintain their health and wellness, while
preserving their freedoms as Americans.”
Vitamin D Papers Top List of Most Popular Studies of the Year
October 31, 2020, I published a scientific review7
in the journal Nutrients, co-written with William Grant, Ph.D., and Dr.
Carol Wagner, both of whom are part of the GrassrootsHealth expert
vitamin D panel.
As of October 31, 2021, our paper, “Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity”
— which you can download and read for free — was the second most
downloaded study from this journal in the past 12 months. It was also
No. 2 in citations and No. 4 for views.
The study with the most downloads in the past year and the all-time highest number of views was another vitamin D paper8
by Bhattoa et.al., which found vitamin D supplementation reduced the
risk of influenza and COVID-19 infections and deaths. The coauthors of
my paper, Grant and Baggerly, were coauthors on this paper as well.
A third vitamin D paper, by Annweiler et.al., also nabbed the No. 1
spot for most-cited study in the past 12 months. This study found
vitamin D supplementation improved survival in frail elderly
hospitalized with COVID-19.
Clearly, vitamin D has been on the forefront of many minds, and I’m
glad the Florida surgeon general recognizes its importance as well.
While mainstream media and many so-called health authorities still hold
on to the ridiculous claim that there’s “no scientific basis” for the
recommendation of vitamin D for COVID, that is just false.
As early as the end of September 2020, data from 14 observational studies — summarized in Table 1 of our paper9
— showed that vitamin D blood levels are inversely correlated with the
incidence and/or severity of COVID-19. Many critics of vitamin D will
claim that these associations are not causal. However, there are
statistical tools such as Bradford Hill that can actually prove
causation through these associations are strong enough.
The Bradford Hill criteria are a group of nine principles (i.e.,
strength of association, consistency of evidence, temporality,
biological gradient, plausibility or mechanism of action, and coherence,
although coherence still needs to be verified experimentally) that can
be useful in establishing epidemiologic evidence of a causal
relationship between a presumed cause and an observed effect.
It has been widely used in public health research and has determined
that the vitamin D insufficiency for COVID is indeed causal.10
How Vitamin D Protects Against COVID
It’s important to realize that your body is well-equipped to handle
just about any infection, provided your immune system is working
properly, as that is your body’s first line of defense. Vitamin D
receptors are found in a large number of different tissues and cells,
including your immune cells. This means vitamin D plays an important
role in your immune function specifically.
If vitamin D is lacking, your immune system will be impaired, which
in turn makes you more susceptible to infections of all kinds, including
COVID-19. As explained in our paper, having sufficient vitamin D in
your system can reduce your risk of COVID-19 and other respiratory
infections through several different mechanisms, including but not
limited to the following:11
Reducing the survival of viruses |
Inhibiting the replication of viruses12 |
Reducing inflammatory cytokine production |
Maintaining endothelial integrity (endothelial
dysfunction contributes to vascular inflammation and impaired blood
clotting, two hallmarks of severe COVID-19) |
Increasing angiotensin-converting enzyme 2 (ACE2)
concentrations — Angiotensin II is a natural peptide hormone that
increases blood pressure by stimulating aldosterone. ACE2 normally
consumes angiotensin I, thereby lowering the concentration of
angiotensin II. However, SARS-CoV-2 infection downregulates ACE2,
resulting in excessive accumulation of angiotensin II, which worsens the
infection |
Boosting your overall immune function by modulating your innate and adaptive immune responses |
Reducing respiratory distress13 |
Improving overall lung function |
Helping produce surfactants in your lungs that aid in fluid clearance14 |
Boosting T cell immunity, which plays an important
role in your body’s defense against viral and bacterial infections. When
vitamin D signaling is impaired, it significantly impacts the quantity,
quality, breadth and location of CD8 T cell immunity, resulting in more
severe viral and bacterial infections.15
According to a December 11, 2020, paper,16
high-quality T cell response actually appears to be far more important
than antibodies when it comes to providing protective immunity against
SARS-CoV-2 specifically |
Increasing expression of antimicrobial peptides in
your monocytes and neutrophils — both of which play important roles in
COVID-19 |
Enhancing expression of an antimicrobial peptide called human cathelicidin, which helps defend respiratory tract pathogens |
From my perspective, vitamin D optimization is one of the easiest,
least expensive and most impactful strategies to reduce your risk of
serious SARS-CoV-2 infection and other respiratory infections.
Vitamin D optimization is particularly important for dark-skinned
individuals (who tend to have lower levels than Caucasians unless they
spend extended time in the sun), the elderly, and those with preexisting
chronic health conditions. All of these are also risk factors for
COVID-19, so population-wide optimization of vitamin D levels could
significantly improve COVID outcomes among the most vulnerable.
How Vitamin D Influences Your COVID Risks
At this point, there’s no shortage of studies showing higher vitamin D levels beneficially impact all stages of COVID-19. It:
Lowers your risk of testing positive for COVID — The largest observational study17
to date, which looked at data for 191,779 American patients, found that
of those with a vitamin D level below 20 ng/ml (deficiency), 12.5%
tested positive for SARS-CoV-2, compared to just 5.9% of those who had
an optimal vitamin D level of 55 ng/ml or higher. This inverse
relationship persisted across latitudes, races/ethnicities, sexes and
age ranges. |
Reduces your risk of symptomatic illness — SARS-CoV-2-specific investigations have found that COVID-19 is far more common in vitamin D deficient individuals.
In one such study,18,19,20
82.2% of COVID-19 patients tested were deficient in vitamin D, compared
to 47.2% of population-based controls. (Mean vitamin D levels were 13.8
± 7.2 ng/ml, compared to 20.9 ± 7.4 ng/ml in controls.)
They also found that blood levels of vitamin D were inversely
correlated to D-dimer levels (a measure of blood coagulation). Many
COVID-19 patients have elevated D-dimer levels, which are associated
with blood clots. This was particularly true with the original
SARS-CoV-2 virus, but while less common with subsequent variants, some
blood clotting, just less intense, can still occur. |
Reduces infection severity — Our vitamin D paper21
also lists data from 14 observational studies that show vitamin D blood
levels are inversely correlated with the incidence and/or severity of
COVID-19. This is quite logical, considering vitamin D regulates
inflammatory cytokine production — a lethal hallmark of COVID-19 — and
is an important regulator of your immune system. |
Reduces your risk of hospitalization — Reduced severity would translate into a lower risk for hospitalization, and that’s precisely what researchers have found.
A Spanish study22,23
found baseline vitamin D levels inversely correlated with the risk of
ICU admission, and that giving supplemental vitamin D3 (calcifediol at
532 micrograms on the first day of admission followed by 266 mcg on days
3, 7, 15 and 30) to hospitalized patients with PCR-confirmed COVID-19
reduced ICU admissions by 82%. |
Reduces your risk of death —
COVID-19 patients with a vitamin D level between 21 ng/mL (50 nmol/L)
and 29 ng/mL (75 nmol/L) had a 12.55 times higher risk of death than
those with a level above 30 ng/mL in one study.24 Having a level below 20 ng/mL was associated with a 19.12 times higher risk of death.
Another study25,26
found the risk of severe COVID-19 and related deaths virtually
disappeared when vitamin D levels were above 30 ng/mL (75 nmol/L).
A third paper27
found a marked variation in mortality depending on whether the patients
lived above or below 35 degrees North latitude. As noted by the
authors, having adequate vitamin D “could be very important in
preventing the cytokine storm and subsequent acute respiratory distress
syndrome that is commonly the cause of mortality."28 |
Speeds viral clearance — While
having enough vitamin D in your system will reduce your odds of
infection and serious illness, taking oral vitamin D once infected can
still help you recover faster.
Research29
published in November 2020 found oral vitamin D supplementation in
SARS-CoV-2-positive individuals with mild symptoms who also had low
vitamin D, helped speed up viral clearance.
Participants were randomly assigned to receive either 60,000 IUs of
oral cholecalciferol (nano-liquid droplets) or a placebo for seven days.
The target blood level was 50 ng/mL. Anyone who had not achieved a
blood level of 50 ng/mL after the first seven days continued to receive
the supplement until they reached the target level.
Periodically, all participants were tested for SARS-CoV-2 as well as
fibrinogen, D-dimer, procalcitonin and CRP, all of which are
inflammatory markers. The primary outcome measure of the study was the
proportion of patients testing negative for COVID-19 before Day 21 of
the study, as well as changes in inflammatory markers.
Of the 16 patients in the intervention group, 10 (62.5%) tested
negative by Day 21, compared to just five of the 24 controls (20.8%).
Fibrinogen levels were also significantly decreased in the treatment
group, indicating lower levels of clotting. |
How to Optimize Your Vitamin D Level
For optimal health, immune function and disease prevention, you want a
vitamin D blood level between 60 ng/mL and 80 ng/mL year-round. In
Europe, the measurements you’re looking for are 150 nmol/L and 200
nmol/L.
If you live in a sunny locale like Florida and practice sensible sun
exposure year-round, you might not need any supplements. The DMinder app30 is a helpful tool to see how much vitamin D your body can make depending on your location and other individual factors.
Many, unfortunately, don’t get enough sun exposure for one reason or
another, and in these cases, an oral vitamin D supplement may be
required. Just remember that the most important factor here is your
blood level, not the dose, so before you start, get tested so you know
your baseline.
Here’s a summary of how to determine whether you might need an oral supplement, and your ideal dosage:
1. First, measure your vitamin D level —
One of the easiest and most cost-effective ways of measuring your
vitamin D level is to participate in the GrassrootsHealth’s personalized
nutrition project, which includes a vitamin D testing kit. Once you
know what your blood level is, you can assess the dose needed to
maintain or improve your level.
2. Assess your individualized vitamin D dosage — To do that, you can either use the chart below, or use GrassrootsHealth’s Vitamin D*calculator.
(To convert ng/mL into the European measurement (nmol/L), simply
multiply the ng/mL measurement by 2.5.) To calculate how much vitamin D
you may be getting from regular sun exposure in addition to your
supplemental intake, use the DMinder app.31
Factors that can influence your vitamin D absorption include your magnesium32 and vitamin K233 intake. Magnesium is required for the conversion of vitamin D into its active form.34,35,36,37 If your magnesium level is insufficient, the vitamin D you ingest orally may simply get stored in its inactive form.38,39
Research by GrassrootsHealth40
shows you need 146% more vitamin D to achieve a blood level of 40 ng/ml
(100 nmol/L) if you do not take supplemental magnesium, compared to
taking your vitamin D with at least 400 mg of magnesium per day.
Your best bet is to take your vitamin D with both magnesium and K2. According to GrassrootsHealth,41
“combined intake of both supplemental magnesium and vitamin K2 has a
greater effect on vitamin D levels than either individually,” and “those
taking both supplemental magnesium and vitamin K2 have a higher vitamin
D level for any given vitamin D intake amount than those taking either
supplemental magnesium or vitamin K2 or neither.”
Data42
from nearly 3,000 individuals revealed 244% more oral vitamin D was
required to get 50% of the population to achieve a vitamin D level of 40
ng/ml (100 nmol/L) if they weren’t concurrently also taking magnesium
and vitamin K2.
3. Retest in three to six months —
Remeasure your vitamin D level in three to six months, to evaluate how
your sun exposure and/or supplement dose is working for you.
4. Take activated
vitamin D (calcitriol) if your level is low and you come down with an
acute infection like COVID. The dose is 0.5 mcg on day one and then 0.25
mcg daily for seven days.
