NMU – 199 Vitamin D Treatment Guidelines for Covid-19 Patients

Nutrition / Natural Medicine Update No 199 (April 14, 2021)

with Dr. James Meschino

Topic: Vitamin D Treatment Guidelines for Covid-19 Patients

Source: The Spanish Society of Geriatrics and Gerontology Position Statement (February 8, 2021)

The link between sub-optimal vitamin D nutritional status and severity and mortality from Covid-19 has become so strongly tied together that on February 8, 2021, a position statement from the Spanish Society of Geriatrics and Gerontologists published their recommendations entitled, “Vitamin D supplementation for the prevention and treatment of Covid-19.” Quoting from their position statement they indicate that Covid-19 produces severe respiratory symptoms such as bilateral pneumonia associated with a rate of morbidity and mortality, especially in patients of advanced age. At this time, there is no known active treatment for this virus. Corticosteroid drugs and biological immunomodulators are being used to treat the inflammatory phase of the disease.

With respect to vitamin D, they state that vitamin D receptors are expressed by most immune cells, including B-lymphocytes, T-lymphocytes, monocytes, macrophages, and dendritic cells and that vitamin D stimulation of these immune cells produces anti-inflammatory effects, which help suppress the cytokine storm that typically causes death to occur in advanced Covid-19 cases. They also reinforce the fact that vitamin D also is required for certain immune cells (dendritic and T-T-reg cells) to fully mature and respond in appropriate ways to help ward off and fight viral and other infections.  They state that, in this context, some studies have reported that vitamin D treatment could be useful for the prevention and treatment of COVID-19. They go on to state that some preliminary studies have already shown promising results with vitamin D supplementation in hospitalized COVID-19 patients. They cite a meta-analysis study showing a lower mortality rate in patients given vitamin D supplementation (10.6%) compared to controls (23.9%). Two retrospective studies included in this meta-analysis showed a decrease in clinical symptoms in patients treated with vitamin D, and a third study demonstrated a lower rate of admission in intensive care units for Covid-19 patients given vitamin D supplements. A fourth study cited in the Meta-analysis showed a significant decrease in serum fibrinogen levels in Covid-19 patients given vitamin D supplements. As a rule, lower fibrinogen blood levels translate into a lower risk for developing abnormal blood clots and blood vessel inflammation. Another study (as I reported on last week) showed that patients with low blood levels of vitamin D, who were administered vitamin D supplements within a month before contracting Covid-19, had less severe symptoms, better recovery, and a lower risk of mortality than patients identified with low vitamin D blood levels who were not recommended to take vitamin D by their doctors, and who subsequently contracted Covid-19 within the next month.

Previous studies have indicated that the risk of developing many types of severe infections is much lower in people who have blood vitamin D levels between 80 and 140 nmol/L (30 -56 ng/ml), as I have reported on in previous updates. Based on the available evidence the Spanish Society of Geriatrics and Gerontologists have established recommendations for vitamin D supplementation for patients testing positive for Covid-19. The vitamin D recommendations are based on the patient’s vitamin D blood level; the lower the patient’s blood level of vitamin D, the more aggressive is the vitamin D supplementation protocol. As an example, for Covid-19 patients presenting with a blood vitamin D level below 25 nmol/L (which is not uncommon), they recommend 7,000 IU of vitamin D daily for the first 8 weeks, followed by 3,500 IU daily for the next 8 weeks. The goal in these cases is to quickly establish more ideal nutritional status of vitamin D, with the intention of improving immune competence and helping to prevent a life-threatening cytokine storm from occurring.

I have included the comprehensive vitamin D supplementation protocol they recommend, based on the patient’s vitamin D blood level, in the text below for those who are interested. I have also included the reference for this position statement in the text below.

Blood Level -25 Hydroxycholecalciferol and Recommended Oral Doses of Cholecalciferol (Regular Vitamin D Supplements):

Blood Level Less than 10 ng/mL = 25 nmol/L   – 8 weeks – 7,000 IU/d; then 3,500 IU/d for 8 weeks

Blood Levels between 11-20 ng/ml (27.5 – 50 nmol/L)    – 2 weeks – 7,000 IU/d; then 3,500 IU/d for 14 weeks

Blood Levels between 21-29 ng/ml (52.5 – 72.5 nmol/L) – 4 weeks – 7,000 IU/d, then 3500 IU/d for 12 weeks

Blood Levels between 30 – 40 ng/ml (75 – 100 nmol/L) – Single Dose – 50,000 IU; Later 3,500 IU/d for 12 weeks

Blood Level between 41-60 ng/ml (102.5 – 150 nmol/L) – 25,000 IU biweekly for 12 weeks

Reference:

Vitamin D supplementation for the prevention and treatment of COVID-19: a position statement from the Spanish Society of Geriatrics and Gerontology https://www.sciencedirect.com/science/article/pii/S0211139X21000044?via%3Dihub

Eat Smart, Live Well, Look Great,

Dr. Meschino