there's been a lot of debate and
discussion about the potential role of
vitamin D in COVID-19 infections
vitamin D is a fat-soluble vitamin and
plays a key role in calcium absorption
bone health and immune function vitamin
D comes in two forms vitamin d3 which we
get from sunlight and animal products
and vitamin d2 which we can get from
milk fish and fortified cereals vitamin
D supplements also come in two two forms
vitamin d2 and vitamin d3 and while some
experts have suggested that vitamin d3
is better in terms of potency and better
absorption for general health purposes
taking either is okay vitamin D
deficiency has been associated with
cardiovascular disease various types of
cancers and autoimmune diseases like
type one diabetes multiple sclerosis and
inflammatory bowel disease it has also
been documented in the literature that
vitamin D plays a role in immune
modulation in a study from Denmark
researchers noted low serum levels of 25
hydroxy vitamin D have also been linked
to higher susceptibility to infections
such as tuberculosis influenza HIV RSV
and viral infections of the upper
respiratory tract so first up I want to
clarify a couple of misconceptions when
talking about vitamins and essential
nutrients in terms of our immune systems
I like to look at supplementation as
balancing our immune system rather than
boosting our immune system see when our
immune system is optimized and balanced
that means our body is ready for any
viral or bacterial infection and while
there are studies and literature that
supports supplementation in vitamin D
deficiencies there are no robust data to
suggest that vitamin D can prevent
infection so in this video I'm going to
go over vitamin D metabolism go over the
two types of vitamin D and how vitamin D
is playing
role in modulating your immune system
and how much vitamin D supplementation
should you really be taking and make
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vitamin D comes in two forms d2 and d3
which differ chemically in their
side-chains
vitamin d2 mainly comes from fortified
foods like breakfast cereals milk and
other dairy items vitamin d3 is made by
your own body
when UVB light from the Sun penetrates
7d hydro cholesterol in the skin vitamin
d3 is also found in some foods including
eggs and fatty fish such as salmon tuna
and mackerel both vitamin d2 and d3 are
then bound to a carrier protein called
vitamin D binding protein and then
metabolized in the liver into cal
seafood aisle also called 25 hydroxy
vitamin D when your doctor orders lab
tests to check your vitamin D levels
they are measuring your 25 hydroxy
vitamin D levels 25 hydroxy vitamin D is
then converted by an enzyme in the
kidneys into 125 dihydroxy
cholecalciferol also called calcitriol
calcitriol is the active form of vitamin
D and binds to vitamin D receptors for B
D RS which are found in many tissues of
the body including skin bone immune
system muscle and endocrine tissues it
is well known that these vitamin D
receptors are also found in B cells T
cells and antigen presenting cells and
that vitamin D can modulate the innate
and adaptive immune response in a study
published in the Journal of
investigative medicine Dr. Cynthia Aranow
observed vitamin d receptor is expressed
on immune cells B cells T cells and
antigen presenting cells and these
immunological
are all capable of synthesizing the
active vitamin d metabolites Dr. Aranow
also wrote vitamin D has numerous
effects on cells within the immune
system it inhibits B cell proliferation
and blocks B cell differentiation and
immunoglobulin secretion furthermore it
affects T cell maturation with a skewing
away from the inflammatory th17
phenotype and facilitates the induction
of T regulatory cells these effects
result in decreased production of
inflammatory cytokines and increased
production of anti-inflammatory
cytokines such as il-10 and in a study
from Austria researchers observed that
calcitriol or vitamin d3 has also been
described to inhibit T cell cytokines
such as interleukin 2 and interleukin 17
and toll-like receptors on monocytes
high-dose calcitriol supplementation in
healthy humans leads to a significant
reduction of the pro-inflammatory
cytokine interleukin 6 produced by
peripheral mononuclear cells so what
these studies are potentially suggesting
is that vitamin D plays an important
role in regulating t-cell function and
more importantly in decreasing
pro-inflammatory cytokines and
increasing anti inflammatory cytokines
through these vitamin D receptors I've
been saying now that COVID-19 cytokine
storms increases mortality and if
vitamin D plays a role in decreasing
pro-inflammatory cytokines and
increasing anti inflammatory cytokines
Lincoln vitamin D deficiency increase
the susceptibility for COVID-19
patients developing cytokine storms this
was actually suggested in a preprint
study at Northwestern University looking
into vitamin D and cytokine storms where
researchers noted our findings suggests
that vitamin D deficiency may be a
contributing factor to severe
COVID-19 one possible explanation
for this association is that the weak
response of the
immune system in the elderly may
increase viral load while a shortage of
memory b-cells leads to misfire and over
activation of the adaptive immune system
by producing a high level of cytokines
or cytokine storm these processes are
exacerbated by low levels of vitamin D
on the other hand vitamin D plays a role
in enhancing the innate immune system
while at the same time
partially suppressing adaptive immunity
and some of its complications such as
the induction of cytokine storms and
vitamin D potentially improving the
clinical outcomes of COVID-19 patients
was also supported in a recent study
from the Philippines where it was
observed that serum 25 hydroxy vitamin D
levels was lowest in critical cases but
highest in mild cases vitamin D status
is significantly associated with
clinical outcomes the results suggests
that it increased in serum 25 hydroxy
vitamin D level in the body could either
improve clinical outcomes or mitigate
worst outcomes while a decrease in serum
25 hydroxy vitamin D level in the body
could worsen clinical outcomes of COVID-19
patients in conclusion this study
provides substantial information to
clinicians and health policy makers
vitamin D supplementation could possibly
improve clinical outcomes of patients
infected with COVID-19 so if it's
understood and suggested that vitamin D
plays a role in decreasing
pro-inflammatory cytokines and improving
clinical outcomes in COVID-19 patients
is there any benefit in taking high-dose
vitamin D as some have suggested
professor Jutta Dierkes who is an expert
in vitamin d at the university of bergen
stated i wouldn't deny that vitamin D
supplements can have an effect on the
immune system people with a deficiency
can benefit from supplements
but if you have adequate vitamin D
levels a supplement won't have any
positive effect when it comes to vitamin
D dosage Dirkes does not recommend daily
doses of ten thousand international
units or higher these are amounts that
you would not be able to absorb
naturally and which could increase the
risk of side effects
several studies suggest that infrequent
very high doses of vitamin D have no
positive effect on the body it would
thus be better to take daily small doses
Dirkes says I don't recommend high doses
even for people with low levels of
vitamin D she says this was also
supported in a double blinded randomized
clinical trial looking at bone densities
at the University of Calgary where
patients took either 400 international
units four thousand international units
and ten thousand international units per
day for three years and researchers
observed using the 400 international
unit group as a reference point high
dose vitamin D supplementation which was
ten thousand international units per day
was associated with a significantly
greater loss of bone the researchers
went on to say there were no significant
differences in bone strength and either
the radius or tibia these findings do
not support a benefit of high-dose
vitamin D supplementation for bone
health and in a second study at the
University of Calgary looking at
postural balance and vitamin D
researchers noted we did not observe a
dose-response effect between vitamin D
supplementation and postural sway our
findings suggests that high dose four
thousand or ten thousand international
unit daily vitamin D supplementation
neither benefits nor impairs postural
balance compared with 400 international
units daily current recommendations of
400 international unit daily appear
adequate for maintaining balance in
non-us
parodic vitamin D sufficient healthy
older adults without a history of Falls
so how does one determine they are
vitamin D deficient the National Academy
of Medicine formerly the Institute of
Medicine considers a serum 25 hydroxy
vitamin D level of 12 to 20 nanograms
per milliliter as the normal range for
adequate exposure to vitamin D to
maintain bone health individuals with
levels less than 12 nanograms per
milliliter will usually be deficient and
ninety seven point five percent of
individuals with a serum level higher
than 20 nanograms per milliliter have
adequate vitamin D exposure most experts
will agree that appropriate diet an
adequate sun exposure it's enough to
maintain normal vitamin D levels and
this has been supported in the
literature from a study in Oslo
University in Norway researchers looked
into sun exposure and they suggested
that 30 minutes midsummer mid-day sun
exposure in Oslo given to the whole skin
surface it's equivalent to taking
between 10,000 and 20,000 international
units of vitamin D orally and the
recommended intake of 200 international
units of vitamin D played no role in
maintaining vitamin D levels this is an
agreement with other reports showing
that 1,500 international units per day
are needed to improve the vitamin D
status but if you're not getting
adequate sun exposure and you want to
take supplemental vitamin D how much do
you need so the important thing is to
first speak with your physician and get
appropriate blood levels drawn to
determine your level of vitamin D
deficiency and then from that point you
can determine how much supplementation
you need to take but if you're not
vitamin D deficient and you still want
to take supplementation there's no
international consensus on the optimal
level of
vitamin D supplementation however
according to the AAFP and the NIH the
recommended dietary allowances of 600
international units per day for persons
1 to 70 years of age in 800
international units per day for persons
older than 70 years are the allowances
needed for those with the greatest
biologic need not the minimum or average
needed across the population which has
been widely misinterpreted the estimated
average requirement is 400 international
units per day what the NIH has
recommended daily allowances don't take
into consideration our seasonal and
geographical differences see during
winter months when we get less sun
exposure the NIH s recommendations can
seem inadequate and as the Norwegian
researchers I talked about earlier have
suggested is 1,500 international units
per day is what is needed to maintain
normal vitamin D levels so even though
vitamin D toxicity is rare you can still
build up high levels of calcium in the
blood which can lead to nausea vomiting
constipation and if left untreated can
lead to kidney failure and calcification
of your major organs and soft tissues
but if you do insist on taking a high
dose of vitamin D supplementation than
what is recommended then what is the
upper limit of the dose you should be
taking so in a research letter in JAMA
researchers wrote the tolerable upper
limit is four thousand international
units per day and beyond this level risk
of toxic effects increases the
researchers also noted a randomized
clinical trial with high-dose vitamin D
supplementation found increased risk of
fractures and Falls and an increased
risk of kidney stones has been found
with vitamin D taken in combination with
calcium some epidemiologic
investigations have reported adverse
associations of Tide hydroxy vitamin D
levels with prostate cancer pancreatic
cancer and all cause mortality
so just to recap everything I went over
in this video the National Institute of
Health's recommended daily allowance for
vitamin D is 600 international units per
day but if you want to take a higher
dose of vitamin D supplementation then
my recommendation is the upper limit
should be between 4,000 and 5,000
international units per day while
sunlight is great at making vitamin D it
is also important you balance things out
so that you prevent developing sunburns
heat strokes and increasing your risk
for skin cancer in viral infections like
COVID-19 there are some studies and
literature which has suggested that
vitamin D plays a role in modulating
your immune response and decreasing
cytokine storms and if you are deficient
in vitamin D then supplementation can
help but it's also important to remember
there's nothing in the literature to
suggest that high dose of vitamin D can
act as a prophylaxis against any
infection including COVID-19 while
high-dose over-the-counter vitamin D
supplements exist my recommendation is
to first speak with your physician get
your blood vitamin D levels drawn to
determine your level of vitamin D
deficiency
before starting any of these high dose
vitamin D supplements so if you have any
questions or comments about the topic I
went over in this video send them to me
down below in the comment section or on
Instagram at ECA wellness and if you're
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