In a recent pilot study in a Spanish hospital (Castillo et al, 2020), Aug29th 2020 www.ncbi.nlm.nih.gov/pmc/articles/PMC7456194/
Covid patients were given 532 mcg of 25hydroxyD3 orally, followed by further doses at three day intervals. Two thirds of a total of 76 randomised patients were treated with VitaminD3 whilst one third of patients were in the placebo group of the trial.(i.e.26)were untreated . All 76 patients concurrently received best practice of other covid treatments. The results were as follows; only 2 percent of the 25hydroxyD3 treated patients needed to go into ICU Astonishingly, 50 per cent of the untreated by Vitamin D patients required treatment in ICU and, unfortunately 8% of those patients died. None of the treated patients died.
We can use this pilot study to propose a safe Vitamin D therapy, that would cost only about £2 to treat each person diagnosed as suffering from Covid 19. If it works, we can expect to save many, many lives as well as preventing the ICU units in our hospitals from becoming over-burdened.
At the very least , it would be worth trying on several thousand people, to either prove or disprove the effect Vitamin D has on the progression of Covid19 to serious illness. Currently, there are many hundreds of thousands of people taking Vitamin D, as a prophylactic against Covid.
By codifying this effort, with people that have been recently diagnosed with Covid, and tracking them, we can verify that the pilot study mentioned above was not simply a statistical fluke. There are hundreds of studies worldwide that have suggested that Vitamin D has beneficial effects. This proposal will take action, to verify that conclusion.
The procedure I suggest is as follows.
- Upon receipt of a positive Covid antigen test the name and contact details of the person is used in this suggested trial.
- 50 to 70 % of those positive adults , should be offered 10,000 IU ( 250 microgram) Vitamin D3 ( cholecalciferol ) to take orally on a daily basis for at least 14 days. Then to continue with 5,000 IU (125 mcg ) daily for 14 additional days.
- Track those that have and have not, taken the oral therapy. Perhaps weekly? Within 4 weeks we should know, if the treated group , have markedly different outcomes.
- At the end of 4 weeks, participants could drop to a daily maintenance dose of 400 – 4000 IU per day, which is a perfectly safe dose of this essential micro-nutrient. Many thousands of people are using that dose. By this time, each person will have recovered , or otherwise. 2000 – 4000 IU would be appropriate as a maintenance dose for most.
Some explanatory points.
This trial leads to a cumulative dose of vitamin D over 4 weeks of 210,000 IU; a commonly used loading dose. It has been so used over many years. It is part of standard medical procedure to administer this kind of dose for those found to be deficient in vitamin D. It is not an exceptional or unusual treatment and is perfectly safe for well adults. Children would be expected to use lower doses; dose requirements depends upon weight.
The aim of this therapy, I suggest , is to try to replicate the blood levels of 25hydroxyD3 which would have occurred in the pilot study mentioned above. Taken as a supplement, VitaminD3 ( cholecalciferol) is converted to 25hydroxyD3 ( calcidiol) at the rate of 50% every 24 hours, by an enzymatic reaction in the liver. Within 3 days blood levels of calcidiol will rise rapidly. In the pilot study above, Calcifediol ( i.e.calcidiol) was given orally to maximise the speed of take-up in the blood. Their patients had just arrived in hospital, they needed rapid blood level improvement..
In our trial, by utilising VitaminD3 supplement , the commonly available supplement found on supermarket and pharmacy shelves, as well as online, we have a resource immediately available, well-accepted, and more importantly, usable right now. This suggested strategy of therapy simply uses a higher dose than is commonly used. This dosing level is perfectly safe. Indeed , the 2011 report on Vitamin D issued by the Institute of Medicine , National Academy of Sciences, USA . states that 4000 IU is acceptable as a long term daily supplement and that up to 10,000 IU could be utilised.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3046611/
By using cholecalciferol ( VitD3 supplement) we have an additional advantage. Cholecalciferol as well as calcidiol, is used by our cells to activate genes within the nucleus when required. In a naturally sunny environment , cholecalciferol is manufactured in the skin by the action of sunlight and cholecalciferol is therefore always available to the cell whenever a receptor is expressed on its surface. However at our high latitude in the UK, sunlight is weak and UVB radiation is absorbed by the atmosphere during the winter period. Mid-October to Mid-April, sunshine cannot make Vitamin D3 in the skin. We rely on the small amounts found in food. Inevitably our levels decrease, unless we supplement. For this reason, Public Health England suggested that everyone in the UK take a VitD3 supplement over winter at a daily dose rate of 400 IU .They recognise that there is a problem. This suggested strategy I propose here, is simply a development of that recognition. We can use the actions of VitaminD3, on the human body, to fight against Covid. .
It would of course be possible to increase the complexity of this suggested trial. We could establish risk factors, the initial blood level of vitamin D etc. However, additional complexity will result in additional time. We urgently require results. I therefore suggest that we include quite a few thousand people in the trial. However we know that older people are more likely to be more severely affected. We could limit the participants to over 50s for example, if we wish to target the more at risk group.
This suggested trial, would only cost a few thousand pounds and can be done very quickly with the contact data of some of those tested positive. A few administrative personnel, a few desks and distribution of £2 worth of capsules to volunteers willing to try a well-established supplement that could save their lives. Results would start to emerge in a few weeks. Surely it would be well worth it. As stated above, the results in the pilot study were extremely good. i.e.25 times less likely to go into ICU if treated with vitamin D3. Only one person from 50 treated with calcidiol needed ICU , 13 people from the 26 untreated needed ICU
Of course, the standard method to establish whether a therapy is useful is a double- blinded, placebo-controlled, randomised trial. Those kind of trials are fine for drugs, but here we are talking about foods. Vitamin D3 is found in food ; it is a naturally occurring substance and is, in fact, a micro-nutrient. We should not worry too much about safety aspects in a month long trial, many millions of people are already supplementing themselves with this micro-nutrient.
In the body , VitD3 (cholecalciferol) is converted as required to a steroid hormone. It is used to regulate the expression of our genes . Over 2000 genes have vitamin D response elements. That is 10% of our entire genome. We can expect it to have a multitude of effects, one of which is on the immune system.
Those persons that might suffer from hypercalcaemia, should not be enrolled in the trial. That would include any known patients with hyperparathyroidism, sarcoidosis, granulomatosis and cancer or those with Williams syndrome. Hypercalcaemia is the only known toxic effect from overdose of Vitamin D3. Those with the conditions listed above might develop hypercalcaemia if treated with 10,000 IU of vitamin D3. They are very rare conditions. An average person sunbathing in strong sunlight can make 10,000 IU or more of vitamin D3 in their skin in an hour or less.
This suggested trial is simply the equivalent of a short sunbathing session every day for a month in terms of VitaminD3 repletion.
An additional point of interest to the reader may be the cost of VitaminD3 in supplements which is mostly manufactured from sheep's wool. The cost of manufacture is about £5 per gram. The common maximum daily dose over the long term would be about 0.1 milligram per person per day. That is 25 years supply of raw vitamin D manufactured for one person for a cost of only £5. It should not be beyond the scope of an efficient government to organise the safe dilution, packaging and distribution of such a cheap lifesaving nutrient to everyone. Bear in mind, Vitamin D3 is not patentable. Big pharmaceutical companies would not be very interested in establishing a supply chain. Currently, the cost of one years supply , online is about £10 – £20.
The Aug 2020 Spanish study I referenced above was not included in the SACN review of evidence published on 29th June 2020 by NICE.
Those that are currently supplementing with Vitamin D3, may need to consider their dose. Their blood level may already be partway towards the required level. They would probably not need the full 10,000 IU daily. However, those taking only a multi-vitamin will only be receiving 200 – 400 IU ( 5 – 10 mcg ) per day. An extra 10,000 IU (125mcg ) per day would be fine. Here I am talking about those adults that have just been diagnosed with Covid and would be considering going into the suggested trial, thus helping to replicate the pilot trial in Spain mentioned above.
I am hoping that someone with influence sees this, and proposes that action similar to this suggestion is taken. We urgently require something to be done. We here in the UK are in a high latitude country and we have a great deal of Vitamin D deficiency in our population. It is going to worsen all the way until next April, when the sun's higher elevation will once again allow us to make additional vitamin D3 in our skin.
I intend to try and interest people of influence in these facts and the opportunity that this represents for those people at risk. If any of you Mumsnet readers can pass this outline on, wherever you think it useful , please do so.
If anyone is interested, I set out much of the reasons behind this explanation of vitaminD in this older thread. It is a long read , but full of information.
www.mumsnet.com/Talk/general_health/2841497-If-you-are-vitamin-D-deficient-what-have-you-been-prescribed
I have posted quite a bit about Vitamin D on Mumsnet. Search my user name (Bettertobehealthy) or just get back to me if you need any more information.
Best of luck to us all.
BTBH (B.Sc.)
PS. If you read this and consider this post useful and it has drifted way down in the thread, please consider bumping it up so that others may read it.