Thread by @whidbeydietgirl, 1: In 2010 the Institute of Medicine, now National Academy of Medicine,considered [...]

1: In 2010 the Institute of Medicine, now National Academy of Medicine,

considered vitamin D intake at

10,000IU/day
NOAEL
No Observed Adverse Effect Level

&

4000IU/day
Safe Upper Intake Level

FOR ADULTS ages 19yrs & older. (55p PDF in below link) https://download.nap.edu/cart/download.cgi?record_id=13050&file=403-456">https://download.nap.edu/cart/down...

Dietary Reference Intakes for Calcium and Vitamin D

Download a PDF of "Dietary Reference Intakes for Calcium and Vitamin D" by the Institute of Medicine for free.

https://download.nap.edu/cart/download.cgi?record_id=13050&file=403-456

2: May 20, 2020 The Lancet published this review of Vitamin D as related to COVID-19
https://www.thelancet.com/pdfs/journals/landia/PIIS2213-8587(20)30183-2.pdf">https://www.thelancet.com/pdfs/jour...

3: Back in March 2020 Grant, et al. published this next paper recommending Vit D supplements at:

10,000IU/d ONLY for A FEW WEEKS, then 5000IU/d in order to help fix Vit D deficiency & then maintain adequate levels for the immune system.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231123/pdf/nutrients-12-00988.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

4: Back in Feb 2017 BMJ published this study by Martineau, et al about Vit D Supplementation to Prevent Acute Respiratory Infections (Meta-Analysis) highlighting the importance of DAILY dosing of Vit D WITHOUT bolus dosing normally Rx for severe def. #__ffn_sectitle">https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310969/ #__ffn_sectitle">https://www.ncbi.nlm.nih.gov/pmc/artic...

Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and...

Objectives To assess the overall effect of vitamin D supplementation on risk of acute respiratory tract infection, and to identify factors modifying this effect.Design Systematic review and meta-an...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310969/#__ffn_sectitle

5: The daily dosing

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👆🏻" title="Rückhand Zeigefinger nach oben (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach oben (heller Hautton)">of Vit D appeared to help even though the amount of time in studies would not have allowed for reaching optimal 25(OH)D blood levels.

6: We know Vit D is fat soluble. So it’s not unreasonable to think bolus dosing might allow for fat stores to grab up Vit D leaving inadeq blood 25(OH)D for immune cells to use. But why would daily AND bolus not provide a benefit? I don’t know.

7: We know that obesity is a risk factor for Vit D deficiency. Brinkmann, et al. published this next study looking at Severe Vit D Def in Chilean Children staying Weight-Excess Interferes w/response to Vit D Suppl’n & a Lower Increase in 25(OH)D levels. https://pubmed.ncbi.nlm.nih.gov/26363859/ ">https://pubmed.ncbi.nlm.nih.gov/26363859/...

[Severe vitamin D deficiency in children from Punta Arenas, Chile: Influence of nutritional status...

Chilean schoolchildren from Punta Arenas have high prevalence of WE and VD deficiency, with a majority in the range of severe VD deficiency. WE interferes in the response to VD supplementation,...

https://pubmed.ncbi.nlm.nih.gov/26363859/

8: With the above study & knowledge that obesity increases risk for Vit D def & obesity is ALSO a top risk factor for COVID-19, how can we NOT test 25(OH)D blood levels in all obese pts seeking healthcare of any kind during this pandemic, most importantly those dx’d w/COVID-19?

9: This NEJM 7yr study

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">w/WHI participants often used to claim Vit D leads to kidney stones. Many data support kid stones due to other factors (including dehydration) but even still...is the risk of kid stones in SOME more imp than an OPTIMAL immune system during this pandemic?

10: https://www.nejm.org/doi/full/10.1056/NEJMoa055218?query=recirc_curatedRelated_article">https://www.nejm.org/doi/full/...

Calcium plus Vitamin D Supplementation and the Risk of Fractures | NEJM

Original Article from The New England Journal of Medicine — Calcium plus Vitamin D Supplementation and the Risk of Fractures

https://www.nejm.org/doi/full/10.1056/NEJMoa055218?query=recirc_curatedRelated_article

11: 2008 Melamed, et al. in Arch Int Med: 25(OH)D levels & Risk of Mortality in Gen Pop. Lowest quartile 25(OH)D levels [<17.8ng/ml] independently assoc’d w/all cause mortality in gen pop. Observational using NHANESIII data but adds to pos D studies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2677029/pdf/nihms-110651.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

12: What is the $ of hospitalized Covid-19 pts? Do hospitals now have protocols to

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">blood levels of 25(OH)D in all COVID-19 pts, whether admitted or sent home from ER? Could someone please provide a good argument for NOT testing? Or for NOT automatically giving supplements?

13: Is it serum calcium you worry about? How often do you check serum calcium in a hospitalized Covid-19 pt? Wouldn’t you catch an increase in blood calcium? I’m just making my case for repleting Vit D stores in ALL COVID-19 pts.

14: Don’t forget importance of Vit K2 for preventing soft tissue calcification. See next paper by Shea & Holden in Adv. Nutr. 2012. It is easy to add a Vit K2 suppl if you have concerns about calcification. But IOM said 10,000IU had NOAEL (1st in thread).

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373853/pdf/jci-127-88887.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

15: Remember people, vitamin D is a HORMONE produced under the skin w/UVB sun rays & warmth, having actions on Vitamin D Receptors throughout the body. Monocytes & other immune cells use 25(OH)D to create 1,25(OH)2D locally as they fight off intruders. This is not some “fad.”

16: Dexamethasone-hopeful tx for COVID-19 was found to Enhance 1,25(OH)2D Effects by Increasing Vit D Receptor Transcription

Dex up-regulates VDRs
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196110/pdf/zbc36228.pdf

VitD">https://www.ncbi.nlm.nih.gov/pmc/artic... ALSO up-regulates VDRs.
“autoregulation of VDR by 1,25(OH)2D” in

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)"> review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373853/pdf/jci-127-88887.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

17: More to come...stay tuned. I apologize for not always giving credit to those who first posted articles on Twitter. I can’t see names when creating a thread. Will highlight the many scientists, doctors & individuals working to assure COVID-19 pts do NOT die deficient of Vit D.

If an oncologist prescribes a new cancer patient 5000IU/d Vit D & 3yrs later pt still on 5000IU/d, why aren’t we hearing Dr’s promote Vit D repletion during this pandemic? Does anyone disagree w/ prescribing 10,000IU/d for 2-3wks then 5000IU for rest of 2020? Incl published data.

19: Let me add I understand Vit K2 is critical to prev calcif’n & more data welcome. Zinc, Mg & others imp too.

But can we agree, as a hormone, with VDRs thru-out body, Vit D may possibly be the most critical to focus on from a global perspective? And NOW?

Thank you in advance

20: For anyone reading this...I am NOT saying Vit D will CURE or prevent infection when it comes to COVID-19. I am saying vitamin D plays a VERY important part in our immune systems. And I believe it is unethical to let COVID-19 pts die deficient in Vit D. That’s all.

This NOT YET peer-reviewed study by Merzon et al. from Israel is another study from this pandemic looking at 25(OH)D blood levels and severity of COVID-19. https://www.medrxiv.org/content/10.1101/2020.07.01.20144329v1">https://www.medrxiv.org/content/1...

Low plasma 25(OH) vitamin D3 level is associated with increased risk of COVID-19 infection: an...

Aim: To evaluate associations of plasma 25(OH)D status with the likelihood of coronavirus disease (COVID-19) infection and hospitalization. Methods: The study population included the 14,000 members...

https://www.medrxiv.org/content/10.1101/2020.07.01.20144329v1

22.Judd & Tangpricha Curculation 2008
Vit D Def & Risk of CVD

Reassurance regarding supplementing CV19 pts w/VitD.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">Nobody is suggesting 10,000IU/d for several YEARS. I would disagree w/that anyway. But 10,000IU for 2-3 wks then 5000IU/d thru pandemic?

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2726624/pdf/nihms-128580.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

23: Dancers et al. Jan 2007
Vit D in Autoimmunity

There are many systems involved w/autoimmune disease. Depending on dosing of Vit D &/or patient charact’s RCT studies may not show a diff. But some obv do.

Vit D is not a CURE but a piece of the puzzle.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5247472/pdf/fimmu-07-00697.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

24: Figure 2 from above article by Dancers, et al.

Easy to imagine a cytokine storm looking at all these immune cells & other molecules.

25: @anahadoconnor
Biggest issue w/

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">are studies showing no diff in Covid-19 infections by Vit D level. MOST here not claiming ppl will NOT get infected w/25(OH)D optimal, just that ppl may SURVIVE an infec’n. I will address IOM 2011 paper in sep tweet. https://www.nytimes.com/2020/06/10/well/live/coronavirus-vitamin-d-immunity.html?referringSource=articleShare">https://www.nytimes.com/2020/06/1...

Exploring the Links Between Coronavirus and Vitamin D

Sales of vitamin D to promote immune health have soared, but studies of vitamin D and Covid-19 have yielded mixed results.

https://www.nytimes.com/2020/06/10/well/live/coronavirus-vitamin-d-immunity.html?referringSource=articleShare

26: Heaney (study in tweet 27)
2003 Human s. 25(OH)D resp to ext oral Vit D3 dosing

67 men; Oct-~Mar x 2yrs; intake ~5mcg/d(~40IU); no subj w/sun vacation plans.

Subj’s w/doses 5500IU or 11,000IU/d initial status rel VitD repletion (~70.3nmol/L or ~28.12ng/ml) had NO Ca++ >nml.

27: Heaney et al. Am J Clin Nutr 2003;77:204-10.

https://watermark.silverchair.com/204.pdf?token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAAo4wggKKBgkqhkiG9w0BBwagggJ7MIICdwIBADCCAnAGCSqGSIb3DQEHATAeBglghkgBZQMEAS4wEQQM_c_3eSd5n4MsXiDUAgEQgIICQT65X4FtFdWf7SiQ9jluJ5Ob2V7LZ44YnMn5qRSQHM-CTSCLxy-1MIJDg50kNppPfpjyexND3j8dfAJpnkVhLxGEA6XOqnKgKsFNmUPefUBmgRyQaF5TklYIFKNcpgs_Fbdfry_KAS5EgY1Jm8VbfDORDc6vzvF0RopuCvPEjEIyFvcIo9Z8yqoFuepPbUoWIjT7tmZw3upw-moV7fSSldltAsu8mDfeKpr6nVDfSxpB2B0YH4tR7Nl6bqXew0h40t7IDjwEWG9widJ0fF8PMKdNgdO0Un9dKLdTmkrKIdPe9JnkdkclJyiIEbqEkGXpcYwyFk0yEXCj77XtWk9cJ_6iBP5POaCTV9Ru4PExOjh118YdG_FWwYITD0nr-IYBWCe6bHkMe-uYfbXsstKAw4vOEviGef6kr3rx8YkmOo2I7kiqO6qfSOLJw7Kld1fAy95IxtyLVrfzawhPCaYh83GocIXQM6kIcnug5_CvRwn3tsZ7aFzt1EgHlzCJCMGVtkMfbKLCbkLFSZbNeo7iIrJ6Ny0HwxVwjAkbfCjiMYedJSvwEUHJ6SQMItYIe398JH4vdMFqgiVXvExkts-UON4LYgXDmi8aQpCfumaeY87mNvpLqMk35xEobAxZsEiK-mRnQZzctw2PqbgF9tDA1MYmCfbrpqTknELZnHu3eHni1ojnXd_eAvn5XiCMVN-TLwHFjaXUUPuIhLHb8rILSeE2ECNeH5gV7iiBJPWxukxFBoboMISF57dBgXDxPlJ0sJc

Thank">https://watermark.silverchair.com/204.pdf... you, @wbgrant2 for pointing me to this article for research on dosing of over the counter Vitamin D3. Dr. Grant’s review article attached to tweet #3 of this thread.

28: W/26 & 27 reg serum Ca++, why isn’t someone at CDC recom’ng that all ppl in top AT-RISK groups for COVID-19 take the upper limit level of 4000IU/d otc Vitamin D3? Or 2000IU/d & the v. low risk of tox is even lower? For ppl testing 25(OH)D Dr can incr dose prn for actu. level.

29: CKD is the only top risk factor group that MIGHT require caution w/direction to Neph or PCP re: tweet 28. Still, I’m not sure it’s so bad for CKD pts to have 2000IU/d VitD DURING this pandemic. Just thinking risk of calcification over time versus death from COVID-19.

30: Mirzakhani et al. 2016

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5127689/pdf/jci-126-89031.pdf">https://www.ncbi.nlm.nih.gov/pmc/artic...

31: Preeclampsia...another multisystem complex disease...RCT ref in 30 of thread shows a benefit to preg women w/25(OH)D bl levels 30ng/ml & higher.

We may not have RCTs for Vit D & COVID-19 yet, but who wants to risk preeclampsia AND COVID-19 in preg women w/level <30ng/ml NOW?

32: Nahas et al. 2018

Studies cont to show benefit to immune system w/diff disease states, also FLU, w/Vit D suppl. This

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">w/only 1000IU/d.

COVID-19 pts deserve at MIN a suppl of otc VitD @ 2000IU/d if 25(OH)D not

https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">’d.

If checking, prob a higher dose.

https://journals.lww.com/menopausejournal/Abstract/2018/08000/Isolated_vitamin_D_supplementation_improves_the.9.aspx">https://journals.lww.com/menopause...

32: Nahas et al. 2018Studies cont to show benefit to immune system w/diff disease states, also FLU, w/Vit D suppl. Thishttps://abs.twimg.com/emoji/v2/... draggable=

w/only 1000IU/d.COVID-19 pts deserve at MIN a suppl of otc VitD @ 2000IU/d if 25(OH)D not https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">’d.If checking, prob a higher dose. https://journals.lww.com/menopause..." title="32: Nahas et al. 2018Studies cont to show benefit to immune system w/diff disease states, also FLU, w/Vit D suppl. Thishttps://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">w/only 1000IU/d.COVID-19 pts deserve at MIN a suppl of otc VitD @ 2000IU/d if 25(OH)D not https://abs.twimg.com/emoji/v2/... draggable="false" alt="✔️" title="Fettes Häkchen" aria-label="Emoji: Fettes Häkchen">’d.If checking, prob a higher dose. https://journals.lww.com/menopause..." class="img-responsive" style="max-width:100%;"/>

33: Bergman et al 2015

Post hoc analysis of RCT trial...VitD suppl for pts w/freq RTIs.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4553208/#!po=80.8824">https://www.ncbi.nlm.nih.gov/pmc/artic...

34: Karl Pfleger created this next document. It’s a compilation of much of the research that links VitD to immune health. Tells the VitD story w/studies.

http://agingbiotech.info/vitamindcovid19/

Remember">https://agingbiotech.info/vitamindc... in USA, IOM 2010 report, 10,000IU/d noted as NOAEL & 4000IU/d noted as Upper Limit Level.

35: forgot to link to Karl in 34.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="☺️" title="Lächelndes Gesicht" aria-label="Emoji: Lächelndes Gesicht">

@KarlPfleger

On-going study on CV19 & VitD by ASU & SCNM, testing 25(OH)D bl levels & daily dosing of OTC Vit D to replete & continued maintenance dose.

Beautiful study. But why should others wait for results of this open labeled study?

Fix VitD deficiency NOW. https://clinicaltrials.gov/ct2/show/NCT04407286">https://clinicaltrials.gov/ct2/show/...

Vitamin D Testing and Treatment for COVID 19 - Full Text View - ClinicalTrials.gov

Vitamin D Testing and Treatment for COVID 19 - Full Text View.

https://clinicaltrials.gov/ct2/show/NCT04407286

37: One thing I love about the study in 36 (sorry, forgot to add above)...it is open label & all ppl meeting inclusion criteria will actually RECEIVE Vit D supplements.

It is unethical to NOT fix Vit D deficiency during this pandemic.

Many thanks to the investigators for this.

38: Goncalves-Mendes et al 2019 Front Immunol

So...the influenza vaccine works better in elderly who have adequate VitD?

And

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">is an RCT, if you wondered.

Still want to call VitD suppl’s “a fad” people? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375825/#!po=63.3333">https://www.ncbi.nlm.nih.gov/pmc/artic...

Impact of Vitamin D Supplementation on Influenza Vaccine Response and Immune Functions in Deficient...

Background: Immunosenescence contributes to reduced vaccine response in elderly persons, and is worsened by deficiencies in nutrients such as Vitamin (Vit-D). The immune system is a well-known target...

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375825/#!po=63.3333

39: Charoenngam & Holick
JULY 2020, Nutrients

Immunologic Effects of VitD on Human Health & Disease
(from Special Issue VitD on Immune Function) https://www.mdpi.com/2072-6643/12/7/2097">https://www.mdpi.com/2072-6643...

Immunologic Effects of Vitamin D on Human Health and Disease

Vitamin D is responsible for regulation of calcium and phosphate metabolism and maintaining a healthy mineralized skeleton. It is also known as an immunomodulatory hormone. Experimental studies have...

https://www.mdpi.com/2072-6643/12/7/2097

40: Link to Special Issue-VitD on Immune Function from 39:

https://www.mdpi.com/journal/nutrients/special_issues/VitaminD_Immune_Function

8">https://www.mdpi.com/journal/n... Published Papers included in this Special Issue of Nutrients

Vitamin D on Immune Function

Special Issue in journal Nutrients: Vitamin D on Immune Function

https://www.mdpi.com/journal/nutrients/special_issues/VitaminD_Immune_Function

41: @JohnMashey posted this paper from Nature...Scientific Reports (2019) 9:19713

Study of VitD deficiency in older adults in China & US.

Ethnic minority & lower-income ppl data reviewed.

https://abs.twimg.com/emoji/v2/... draggable="false" alt="👇🏻" title="Rückhand Zeigefinger nach unten (heller Hautton)" aria-label="Emoji: Rückhand Zeigefinger nach unten (heller Hautton)">

https://twitter.com/johnmashey/status/1284964952332103680?s=21">https://twitter.com/johnmashe... https://twitter.com/johnmashey/status/1284964952332103680">https://twitter.com/johnmashe...

https://twitter.com/johnmashey/status/1284964952332103680?s=21

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