Vitamin D and COVID-19: Is There a Relationship?

Kenneth H. Cooper MD, MPH is the founder and chairman of Cooper Aerobics. He has reviewed the literature to determine if there’s any relationship between Vitamin D, COVID-19, and other factors.

The Dallas Morning News published an article titled “Illness Deadlier To People of Color” on June 3, 2020. It reported on a British study that found that people of darker skin were at a higher risk of dying from COVID-19 than those of lighter skinned British citizens. When the crucial question of “Why?” was raised, it was answered that the British study was not capable of answering that important question. In The Dallas Morning News on June 4, 2020, a report titled “COVID-19 research to begin” discussed a Texas Health and Human Services Commission study that will soon launch and analyze the impacts of COVID-19 for vulnerable populations. The data will include race, ethnicity and socioeconomic status.

They did not question the role that vitamin D deficiency is playing in the lives of people of color. This is because skin pigmentation affects the skin’s ability and ability to produce vitamin D when exposed to sunlight (including ultraviolet light). This could be why people of color are more likely to contract COVID-19 infections, and have higher mortality rates. Some study Believes that viruses like COVID-19 do not cause death or morbidity. Instead, the body’s overreacting immune response called the “cytokine storm”, is responsible. Research has shown vitamin D is essential for innate immunity. It boosts immunity against viral diseases, suppresses the cytokine storm, and helps with pulmonary disease.

Vitamin D & COVID-19

Northwestern University in Chicago recently conducted a study that analyzed data from clinics and hospitals across China, France and Germany. It found that patients from countries with high COVID-19 deaths rates (such as Spain and Italy) had lower vitamin D levels than those from countries less severely affected.

Another article published by The University of Chicago Medicine titled “Association of Vitamin D Deficiency and Treatment With COVID-19 Incidence,” stated that vitamin D deficiency if it is not adequately treated, is associated with COVID-19 Risk. It is important to pursue and study aggressively the issue of vitamin D deficiency in order to combat COVID-19.

The British Medical Journal published a large 2017 study that included 11,321 participants aged 0-95 years. It was titled “Vitamin D Supplementation To Prevent Acute Respiratory Tract Diseases: Systemic Review & Meta-analysis Of Individual Participant Data.” The results showed that vitamin D supplementation is safe and protects against acute respiratory infections. The most beneficial patients are those who are severely vitamin D deficient, and not those who receive large amounts of vitamin D.

Vitamin D Analysis

An analysis of vitamin D levels and respiratory health in the Busselton Healthy Ageing Study population, Western Australia, revealed that blood levels below 20 ng/mL causes asthma, wheezing, chest tightness, and bronchitis. A reduction in respiratory symptoms was due to higher vitamin D levels than 40 ng/mL. However, there was also an association with better lung function.

The Irish Medical Journal published an article titled Vitamin D and Inflammation: Potential Implications For Severity of COVID-19. Vitamin D is then transported to the liver, where it is converted to an active hormone. This increases calcium transport from the food and helps to maintain a strong skeleton. Vitamin D supports the immune system via a variety of immune pathways that involves in fighting SARS/CoV-2. Contrary to popular belief, those living in sunny, low-latitude countries like Spain and Northern Italy had higher vitamin D levels and more vitamin D deficiency rates. These countries also had the highest rates of infection deaths in Europe.

The COVID-19 Study

Study also revealed that Sweden, Finland, and Norway in the northern latitudes have higher vitamin D levels. This is despite having less UVB sun exposure. Supplementation and fortification are more common. It is important to note the correlation between lower vitamin levels and COVID-19-related death.

According to the authors of the study, “We call upon the Irish government to urgently update its guidelines and encourage all adults to use supplements during the COVID-19 crises.” Ireland is a country where there is a lot of vitamin D deficiency. Deficiency is more common in Ireland than in other countries.

Although this information does not directly relate to COVID-19, it is certainly related to pulmonary diseases. Because pneumonia and respiratory issues are the leading causes of death from COVID-19 infection, this meta-analysis “Vitamin D for prevention of exacerbations COPD” should be taken into consideration (Pak J Med Sci volume 32, 2017). These findings support the routine testing of vitamin D status in patients suffering from COPD. Supplementation should be for those with less than 25 ng/mL circulating vitamin D, but not those with higher levels.

COVID-19 Research in Ethnic Populations

A large study was published online on May 7, 2020 and published in Diabetes & Metabolic Syndrome’ July-August 2020 issue. It is titled “Vitamin D Concentrations In COVID-19 Illness in the UK Biobank.” The conclusion shows that there was no evidence to support a link between vitamin D levels and the risk of COVID-19 infection and that vitamin D concentrations may be responsible for ethnic differences in COVID-19 cases.

Vitamin D deficiency was defined as a level below 10 ng/mL, but not above 20 ng/mL in this study. However, other research has shown that vitamin D does not have a significant impact on the severity or prevention of COVID-19. It is best to be above 40ng/mL, and preferably between 50-60ng/mL.

In April 2020, a second study by Louisiana State University Health Sciences Center New Orleans entitled “Vitamin D Insufficiency Is Prevalent in Severe CoVID-19” was published in a manuscript. According to this article, 70% of COVID-19 deaths in Louisiana are due to African Americans despite only representing 32% of the population.

Research on vitamin D deficiency proves the same criteria. Vitamin D deficiency is the leading cause of high blood pressure (essential hypertension) that links to every COVID-19 risk factor for death. Vitamin D deficiency can also increase the likelihood of blood clots, and negatively impact both innate as adaptive immune responses. The authors state vitamin D deficiency “can contribute to our understanding of COVID-19 health disparities”–vitamin D deficiencies affect 80-90% of the African American population.

Vitamin D Response in Cooper Clinic Patients

The debate continues. However, I think the blood levels for 25-hydroxy vitaminD in these studies are not sufficient. It should be at least 40 ng/mL, andpreferably between 50-60 ng/mL.

We have measured the blood levels of 25-hydroxy vitaminD on 74,184 Cooper Clinic patients since 2007. These findings are consistent with our patient population. People of color have lower levels than people of other races unless they take vitamin D supplements. Patients with values below 40 ng/mL should take at least 2,000 IU (50 mcg), of vitamin D3 each day. We have seen 25-hydroxy vitaminD values rise from 30 to 40 ng/mL by following this recommendation over the years. I took blood levels of vitamin D and tittered the dose based on the results. Most patients responded well to taking 7,000 IU (175 mg) of vitamin D3 daily. This is the same dosage I have been using for many years. My most recent 25-hydroxy vitaminD blood level was 57.0ng/mL.

This chart can be confusing because of the many measurements.

There are many additional benefits to achieving the optimal blood level of 25-hydroxy vitaminD beyond what I have mentioned. It is a good idea to speak to your doctor about a vitamin D test. Even if it difficult to measure your vitamin D blood level; most studies recommend that you consume at least 2,000 to 4,000 IU of vitamin Vitamin D3 every day.

Imagine what vitamin D supplementation; which is affordable and easily accessible to all, could do to help reduce or eliminate the COVID-19 pandemic.