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Can vitamin D prevent COVID?We were burned to death before



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For clarity, this transcript has been edited.

Welcome to Impact factor, The amount of your weekly comments on new medical research. I am Dr. F. Perry Wilson from Yale University School of Medicine.

I have a love-hate relationship with Vitamin D.

A short search of my blog will show how I questioned the relationship between vitamin D and multiple sclerosis, kidney disease, schizophrenia, falls and childhood education.

Therefore, in the COVID era, it is not surprising that vitamin D reappears. Dr. Anthony Fauci had a sober and responsible voice during the pandemic and reported his personal use of vitamin D, which interested me. Vitamin D is also part of the presidential cocktail Trump received during his stay in Walter Reed.

I decided to study the data here. But before we do that, I want to tell you why I am inherently skeptical of vitamin D research. There are two main problems:

  1. Low vitamin D levels and So many things. Vitamin C deficiency can cause scurvy-very good. However, low vitamin D is related to various diseases from Alzheimer̵

    7;s disease to whooping cough. It is not only the most important vitamin in the world, but also a substitute for other important things.

  2. When we tested all these fascinating connections through randomized trials, given some people vitamin D and some placebos, they were almost always ineffective.

I play football here a bit like Charlie Brown. Vitamin D has burned us. A few examples:

Multiple observational studies have found that people with low vitamin D levels are more likely to develop cancer and cardiovascular disease. These are good studies, suitable for appropriate confounding factors-the entire transaction.

Then, we obtained randomized clinical trials with 26,000 patients. Both results have no effect.


Observational studies have shown that low vitamin D levels are related to the development of diabetes. Then, we conducted a trial of 2,400 patients with prediabetes. Vitamin D supplementation is ineffective.


Observational studies have found that low vitamin D levels are related to falls. Random trials did not find this effect. (However, exercise does prevent falls.)


Can vitamin D save lives? not really. The Women’s Health Initiative trial randomly assigned 36,000 postmenopausal women to vitamin D and placebo, and no survival benefit was seen.

Look, I am not saying that vitamin D is useless or that its benefits are limited. Random trials are rarely as dramatic as observational data.But I can’t think of another kind of exposure such There is a big disconnect between observation data and random data.

Why is that?

Because your vitamin D level is an indicator of your life style, it is difficult, really difficult to adapt. Of course, you can ask people how much sunlight and exercise they get, how their diet changes, and how much money they make, but these tools are simply too dull.

Ok. Keeping all this in mind, what do we know about vitamin D in COVID?

Just this week, Journal of Clinical Endocrinology and Metabolism, Our study from Spain found that 80% of 216 hospitalized COVID-19 patients were deficient in vitamin D. Only 40% of the controls are lacking. Of course, these controls were not hospitalized. In fact, he was still sick.



Hernandez JL et al. J Clinical endocrine metabolism. 2020.

But ok, learn better. As early as September, as of the record 10 years ago, we conducted this study from Chicago. The results showed that among the 489 patients who had been tested for vitamin D, patients with vitamin D deficiency suffered from COVID-19. The risk is 1.77 times higher.

The study conducted in PLOS One found that among 235 hospitalized patients, the mortality rate was 20% for patients with vitamin D content below 30 ng/mL, and 9.7% for patients with higher vitamin D content. I should point out that for some data weird, this article is labeled “Expression of Concern”.

Okay, so we conducted multiple observational studies-Anthony Fauci yelled-saying that we should consider vitamin D.

Why not? It is cheap and it has pretty good side effects (although my nephrologist is worried about kidney stones).

But when it comes to COVID, the multiple factors associated with low vitamin D levels are and also Related to COVID-19 infection and severity: older age, BMI, black people, poverty, comorbidities. It is really difficult to properly consider all these things statistically.

So I am not satisfied with vitamin D. I hope to conduct a random trial. Now we have one. Second, if you squint.

A randomized trial from Spain is this trial.

A small study (76 patients hospitalized with COVID-19) was randomly assigned a 2:1 ratio of vitamin D + azithromycin + hydroxychloroquine (not let me start taking it) to azithromycin + hydroxychloroquine. Of the 50 people in the vitamin D group, only one went to the ICU. Compare it with 13 of the 26 drugs in the non-vitamin D group.


The number of deaths in the vitamin D group was zero, and the number of deaths in the non-vitamin D group was 2. I should note that the non-vitamin D group has a higher risk at baseline, with more people with diabetes and high blood pressure. But honestly, it was the magnitude of this effect that surprised me. I mean, reduce the risk of ICU admission from 50% to 2%? This is just an amazing number. Therefore, we are in the following space: Is this a miraculous drug, or is there a problem with research we don’t know? Today, miracles are in short supply.

Just to add some cold water to the study, we have a study still in a preprint that uses Mendelian randomization to investigate whether vitamin D is causally related to the severity of COVID in more than 400,000 people.

In this study design, you compare people who are genetically prone to low vitamin D levels with people who are not low in vitamin D. This excludes lifestyle things.Interestingly, people who are genetically destined to have low vitamin D levels Less May be hospitalized or have serious illness due to COVID-19. Has not been peer reviewed, salt grains, etc.



Butler-Laporte G et al. doi.org/10.1101/2020.09.08.20190975

Bottom line? We know that people with low vitamin D levels are at high risk of adverse outcomes in COVID-19. We still don’t know whether vitamin D supplementation will change this risk. There is some hope here, but lifestyle vitamins have already burned us, so please continue to use 400 international units with caution.

F. Perry Wilson, MD, MSCE, associate professor of medicine, director of the Yale University Applied Translation Research Program. His scientific communication work can be found on The Huffington Post, NPR and Medscape. He tweeted @methodsmanmd and hosted a database of his communication work on www.methodsman.com.

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