COVID19: Vitamin D and the Sunshine at the End of the Tunnel

As a pediatric orthopaedist, I regularly discuss bone health with my patients, expounding on the multitude of benefits of vitamin D supplementation. Vitamin D, the sunshine vitamin, is a cheap, easily available nutrient that impacts bone quality and is known to boost immunity, which is especially relevant as we try to stay healthy during the COVID-19 pandemic.

What is profoundly interesting is that vitamin D deficiency, found in 40% of the US population¹, is thought to be a risk factor for COVID-19. Other risk factors for severe COVID-19 illness include obesity, older age, dark-colored skin, and diseases such as cancer, diabetes, cardiovascular and pulmonary disease. While there are risk factors that cannot be changed, correcting an underlying vitamin D deficiency is an easy and harmless way to mitigate one’s individual COVID-19 risk. What is also fascinating is that many of the above risk factors for COVID-19 infection are risk factors for vitamin D deficiency.²

In countries such as Finland, France, South Korea, and New Zealand, there are formal public health policy recommendations regarding vitamin D supplementation. These countries experience less vitamin D deficiency and lower COVID-19 rates than places like Italy and Spain, where there is no formal guidance for vitamin D supplementation.^3,4,5 A September 2020 study in Spain showed improved outcomes in hospitalized patients after vitamin D supplementation.⁵

Researchers found significantly lower vitamin D blood levels in patients who tested positive for COVID-19 compared to those who tested negative. There is increased disease severity and mortality in hospitalized patients with low vitamin D levels.^6,7 Generally, COVID-19 has affected those living in countries near the equator less, which may be due to increased sun exposure and boosted vitamin D levels.⁵

Considering the staggering number of COVID-19 related deaths, there is no time to waste discussing the “controversy” of vitamin D deficiency as a risk factor. Doctors in the UK are recommending large doses of vitamin D3 in the British Medical Journal as an easy and safe remedy to mitigate COVID-19 infection. In the UK, early in the pandemic, they provided supplement packets (vitamin D, vitamin C, zinc) for free to National Health Service staff as a strategy to boost immunity in the population. Newcastle Hospitals found that when very large doses of vitamin D3 were given to deficient patients, they recovered quicker from COVID-19 with less mortality. The UK has since revised their guidelines and recommends that people take vitamin D supplement year-round.^5,8

Because there is minimal risk involved, supplementing with large doses of vitamin D can be considered after consulting with your personal physician. Dosing should be based on weight and not on age, since vitamin D is distributed in the body; a larger person should, and does, require more than a smaller person. Vitamin D, although stored in the fat, is also metabolized in such a way that it is almost impossible to reach toxic levels at these suggested doses in healthy people. A good starting point is with maintenance doses of 2000 IU for those weighing more than 90 pounds. The standard RDA doses of vitamin D contained in multivitamins are insufficient to significantly boost blood levels for most people. We need to take more vitamin D in general and especially during winter months when most people will run particularly low. I have been supplementing my patients safely for years. This regimen is a simple way to correct vitamin D deficiency, boost the immune response, and stay healthy!

It is imperative that vitamin D be taken with calcium to optimize absorption. Patients with pre-existing kidney or liver issues may want to check first with their primary doctors before taking supplements. We must be careful with overstating the potential effects of vitamin D, but vitamin D deficiency is prevalent, and it is an easily addressed risk factor for COVID-19 that can be treated at home with over-the-counter supplements. With vaccination in progress, the light at the end of the tunnel can be seen, and vitamin D, the sunshine vitamin, is here to help!

References

1. Parva NR, Tadepalli S, Singh P, Qian A, Joshi R, Kandala H, Nookala VK, Cheriyath P. Prevalence of Vitamin D Deficiency and Associated Risk Factors in the US Population (2011-2012). Cureus. 2018 Jun 5;10(6):e2741. doi: 10.7759/cureus.2741. PMID: 30087817; PMCID: PMC6075634.
2. Martineau, Adrian R., and Nita G. Forouhi. “Vitamin D for COVID-19: a case to answer?.” The Lancet Diabetes & Endocrinology 8.9 (2020): 735-736.
3. Laird, E., J. Rhodes, and Rose Anne Kenny. “Vitamin D and inflammation: potential implications for severity of Covid-19.” Ir Med J 113.5 (2020): 81.
4. Ilie, Petre Cristian, Simina Stefanescu, and Lee Smith. “The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality.” Aging Clinical and Experimental Research (2020): 1-4.
5. Busby, Mattha. (Jan 21 2021) Does vitamin D combat Covid? The Guardian. Accessed: https://www.theguardian.com/lifeandstyle/2021/jan/10/does-vitamin-d-combat-covid
6. D’Avolio, Antonio, et al. “25-hydroxyvitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2.” Nutrients 12.5 (2020): 1359.
7. Panagiotou, Grigorios, et al. “Low serum 25‐hydroxyvitamin D (25 [OH] D) levels in patients hospitalized with COVID‐19 are associated with greater disease severity.” Clinical endocrinology 93.4 (2020): 508-511.
8. Busby, Mattha. (Jan 21 2021) Does vitamin D combat Covid? The Guardian. Accessed: https://www.theguardian.com/lifeandstyle/2021/jan/10/does-vitamin-d-combat-covid

Dr. Minkowitz is a board-certified pediatric orthopedic surgeon, Chief of Pediatric Orthopedics and Medical Director of Pediatric Bone Health at Morristown Medical Center and Atlantic Health System. She treats a broad range of pediatric orthopedic conditions including back pain, spine deformities including postural issues, fractures including sports injuries and sprains, infections, foot and limb deformities, slipped capital femoral epiphysis and hip dysplasia, amongst several other conditions. She has published extensively in the field, particularly on vitamin D metabolism and pediatric orthopedic infections.