With caveats that: I don’t know what I’m talking about; this is a simplification of one research group’s understanding; this isn’t medical advice.… tl;dr:
There are two forms of vitamin D: 1,25-D as an agonist in VDR activity, 25-D as an antagonist. (VDR is involved in immune response)
The common medical test tests only for 25-D (this is not good—the 1,25 to 25 ratio is important).
A low 25-D level can be indirectly caused by the body’s ‘desire’ to increase VDR activity—i.e. not as a consequence of vitamin D deficiency.
High doses of vitamin D may well be helpful in severe Covid-19 cases through dampening a dangerous immune response (cytokine storm...).
It’s important not to be deficient in vitamin D, but high doses in healthy people may actually dampen initial immune response.
Much more research is needed.
I’d be interested if anyone has any thoughts/critiques on the more technical issues—it’s really not my area. My personal takeaway is to take vitamin D supplements, but not to go crazy with them. In particular, on this view being deficient is not good, but it’s not likely to be what’s driving the seriously negative outcomes in the RCT.
So you are suggesting that the mechanism between the vitamin D pills and the outcome might not be through resolving vitamin D deficiency but some other more specific pathway.
Does that update is as to the robustness of the study?
What I take from the video is that the study is good, but isn’t really saying anything about vitamin D deficiency: it’s saying that high doses of D are useful in dampening immune response once the largest danger to the body is its own immune response—i.e. once it’s in/near a cytokine storm situation.
So I think it’s very likely that the high dose vitamin D is helpful in mid/late stage, but that this study says very little about the impact of your pre-existing levels of vitamin D. (again, ifthe video is correct: this is not my area)
If you buy the take in the video, you wouldn’t want very high doses of D while you’re still healthy. I suppose in an ideal world you’d want to experiment on yourself with different D supplement levels, and get your 25-D and 1,25-D levels checked.
Clinically, it seems to me that the main question is when you’d want to start giving vitamin D, and at what dosage. If the video’s take is correct, it seems likely that high doses for a healthy person isn’t likely to help (beyond the point where you’re comfortably not deficient), but that high doses in the more serious Covid-19 cases are a good idea.
You’d need research to get a clearer idea of dosages and starting points.
If this is correct, then the study’s implications for hospital treatment look good (but need more research).
If it’s correct, the corollary that those healthy people with good vitamin D levels are around 92% safer than baseline already does not seem to be valid. To conclude that, you’d need to have tested the ICU patients’ D levels while they were still healthy. On this model, low 25-D levels when you’re already sick can be part of the body’s response to the illness (often a counter-productive response).
Of course that’d be a great thing for someone to do some research on: for Covid-19 patients who happen to have had a recent vitamin D test when they were healthy, what is the correlation between the healthy D levels, and Covid outcomes? Have there already been studies like this? I don’t know, but I haven’t looked.
but there is a great body of work proving that Vit D is beneficial for treating respiratory infection in general [I can cite on request] so unless most respiratory infections secretly involved cytokine storm [which I don’t believe to be true] or Vit D is beneficial in other ways than what you suggest.
Oh that’s entirely plausible. I should have emphasised that this may well be something that’s going on; it certainly doesn’t make it the only thing. Again, I have no expertise in this area—so mainly I’d like people with more knowledge than I to watch the video and draw their own conclusions.
My main takeaway with respect to the RCT in the post is that measurements of the 25-D being low in patients can’t be taken as evidence of deficiency if the 1,25-D levels are simultaneously high. So it’s premature to draw conclusions about non-deficient healthy people being ~92% safer than baseline.
It still seems right to me that not being deficient is important, and that vitamin D treatment is important.
Thanks for the post (and indeed the others).
This is interesting and, I think, important w.r.t the RCT: video looking at the molecular biology of vitamin D (the first half is interesting too)
With caveats that: I don’t know what I’m talking about; this is a simplification of one research group’s understanding; this isn’t medical advice.… tl;dr:
I’d be interested if anyone has any thoughts/critiques on the more technical issues—it’s really not my area. My personal takeaway is to take vitamin D supplements, but not to go crazy with them. In particular, on this view being deficient is not good, but it’s not likely to be what’s driving the seriously negative outcomes in the RCT.
So you are suggesting that the mechanism between the vitamin D pills and the outcome might not be through resolving vitamin D deficiency but some other more specific pathway.
Does that update is as to the robustness of the study?
What I take from the video is that the study is good, but isn’t really saying anything about vitamin D deficiency: it’s saying that high doses of D are useful in dampening immune response once the largest danger to the body is its own immune response—i.e. once it’s in/near a cytokine storm situation.
So I think it’s very likely that the high dose vitamin D is helpful in mid/late stage, but that this study says very little about the impact of your pre-existing levels of vitamin D. (again, if the video is correct: this is not my area)
If you buy the take in the video, you wouldn’t want very high doses of D while you’re still healthy. I suppose in an ideal world you’d want to experiment on yourself with different D supplement levels, and get your 25-D and 1,25-D levels checked.
Clinically, it seems to me that the main question is when you’d want to start giving vitamin D, and at what dosage. If the video’s take is correct, it seems likely that high doses for a healthy person isn’t likely to help (beyond the point where you’re comfortably not deficient), but that high doses in the more serious Covid-19 cases are a good idea.
You’d need research to get a clearer idea of dosages and starting points.
If this is correct, then the study’s implications for hospital treatment look good (but need more research).
If it’s correct, the corollary that those healthy people with good vitamin D levels are around 92% safer than baseline already does not seem to be valid. To conclude that, you’d need to have tested the ICU patients’ D levels while they were still healthy. On this model, low 25-D levels when you’re already sick can be part of the body’s response to the illness (often a counter-productive response).
Of course that’d be a great thing for someone to do some research on: for Covid-19 patients who happen to have had a recent vitamin D test when they were healthy, what is the correlation between the healthy D levels, and Covid outcomes? Have there already been studies like this? I don’t know, but I haven’t looked.
but there is a great body of work proving that Vit D is beneficial for treating respiratory infection in general [I can cite on request] so unless most respiratory infections secretly involved cytokine storm [which I don’t believe to be true] or Vit D is beneficial in other ways than what you suggest.
https://www.lesswrong.com/posts/LwcKYR8bykM6vDHyo/coronavirus-justified-practical-advice-thread?commentId=KEAc428gk4F6Ys3tv
comment above suggested that the benefit is from Vit D prevent the pneumonia from covid from getting worse, and I found the argument persuasive
Oh that’s entirely plausible. I should have emphasised that this may well be something that’s going on; it certainly doesn’t make it the only thing. Again, I have no expertise in this area—so mainly I’d like people with more knowledge than I to watch the video and draw their own conclusions.
My main takeaway with respect to the RCT in the post is that measurements of the 25-D being low in patients can’t be taken as evidence of deficiency if the 1,25-D levels are simultaneously high. So it’s premature to draw conclusions about non-deficient healthy people being ~92% safer than baseline.
It still seems right to me that not being deficient is important, and that vitamin D treatment is important.