Read on Twitter
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
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
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/journals/landia/PIIS2213-8587(20)30183-2.pdf
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
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
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. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310969/#__ffn_sectitle
5: The daily dosing 
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.
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/
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 
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?
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?
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/articles/PMC2677029/pdf/nihms-110651.pdf
12: What is the $ of hospitalized Covid-19 pts? Do hospitals now have protocols to 
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?
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/articles/PMC5373853/pdf/jci-127-88887.pdf
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 ALSO up-regulates VDRs.
“autoregulation of VDR by 1,25(OH)2D” in review
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373853/pdf/jci-127-88887.pdf
Dex up-regulates VDRs
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3196110/pdf/zbc36228.pdf
VitD ALSO up-regulates VDRs.
“autoregulation of VDR by 1,25(OH)2D” in
reviewhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC5373853/pdf/jci-127-88887.pdf
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
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
22.Judd & Tangpricha Curculation 2008
Vit D Def & Risk of CVD
Reassurance regarding supplementing CV19 pts w/VitD.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
Vit D Def & Risk of CVD
Reassurance regarding supplementing CV19 pts w/VitD.
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
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
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
24: Figure 2 from above article by Dancers, et al.
Easy to imagine a cytokine storm looking at all these immune cells & other molecules.
Easy to imagine a cytokine storm looking at all these immune cells & other molecules.
25: @anahadoconnor
Biggest issue w/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
Biggest issue w/
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
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.
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 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.
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 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/articles/PMC5127689/pdf/jci-126-89031.pdf
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?
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. Thisw/only 1000IU/d.
COVID-19 pts deserve at MIN a suppl of otc VitD @ 2000IU/d if 25(OH)D not’d.
If checking, prob a higher dose.
https://journals.lww.com/menopausejournal/Abstract/2018/08000/Isolated_vitamin_D_supplementation_improves_the.9.aspx
Studies cont to show benefit to immune system w/diff disease states, also FLU, w/Vit D suppl. This
w/only 1000IU/d.COVID-19 pts deserve at MIN a suppl of otc VitD @ 2000IU/d if 25(OH)D not
’d.If checking, prob a higher dose.
https://journals.lww.com/menopausejournal/Abstract/2018/08000/Isolated_vitamin_D_supplementation_improves_the.9.aspx
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
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
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 in USA, IOM 2010 report, 10,000IU/d noted as NOAEL & 4000IU/d noted as Upper Limit Level.
http://agingbiotech.info/vitamindcovid19/
Remember in USA, IOM 2010 report, 10,000IU/d noted as NOAEL & 4000IU/d noted as Upper Limit Level.
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
Beautiful study. But why should others wait for results of this open labeled study?
Fix VitD deficiency NOW. 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.
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?
Andis 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
So...the influenza vaccine works better in elderly who have adequate VitD?
And
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
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
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
40: Link to Special Issue-VitD on Immune Function from 39:
https://www.mdpi.com/journal/nutrients/special_issues/VitaminD_Immune_Function
8 Published Papers included in this Special Issue of Nutrients
https://www.mdpi.com/journal/nutrients/special_issues/VitaminD_Immune_Function
8 Published Papers included in this Special Issue of Nutrients
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://twitter.com/johnmashey/status/1284964952332103680?s=21 https://twitter.com/johnmashey/status/1284964952332103680
Study of VitD deficiency in older adults in China & US.
Ethnic minority & lower-income ppl data reviewed.
https://twitter.com/johnmashey/status/1284964952332103680?s=21 https://twitter.com/johnmashey/status/1284964952332103680
