Talk:Vitamin D/Archive 11

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COVID-19

Text and two references removed from article: "...and possibly COVID-19."

References

These references and others in the literature speculate that low vitamin D exacerbates severity of COVID-19 infection, and that some of the known COVID-19 severity risk factors (obesity, African and Hispanic...) are linked to having low vitamin D status. The connection may be true, but in my opinion premature until several clinical trials are completed and reviews confirm the connection. Nutrition research has been fraught with correlation getting ahead of proof of efficacy. Examples, selenium and vitamin E for preventing prostate cancer. Extraordinary claims require extraordinary evidence. At clinicaltrials.gov there are multiple clinical trials looking at exactly this question. When those are completed and published it will be appropriate to add content to this article. David notMD (talk) 13:08, 8 May 2020 (UTC)

Yes indeed, no multivariate analyses and no randomised, prospective placebo-controlled clinical trials or systematic reviews. Hence the "possibly", based on two different articles in reliable source journals, one an editorial and one a review. Your opinion may be right -- but consider the quality of this evidence related to some of the other Covid-19 associations and the comparison with influenza. Jrfw51 (talk) 17:27, 8 May 2020 (UTC)

BTW, Covid-19 (lower case) in NEJM, BMJ, Times and Guardian. Jrfw51 (talk)

Indeed they use covid-19. Though WHO (who named it), PHE, CDC, Nature, The Lancet use COVID-19. I don't think that 'possibly' overstates the connection, but tend to agree with David that this probably isn't evidence enough for the article. Vitamin D is said to be involved with pretty much every disease at one time or other. |→ Spaully ^~talk~  19:08, 8 May 2020 (UTC)

Page visits to Vitamin D have increased 1/3 in recent days. Vitamin C visits saw a doubling and then decline in March, when some news was being reported about C and COVID-19. David notMD (talk) 23:47, 15 May 2020 (UTC)

FYI - I was taken to task (and reverted) for adding information about vitamin C and COVID-19 to the Vitamin C article, as being premature, given the unfortunate tendency for nutrient and non-nutrient dietary supplements being touted as cure-alls. As with vitamin D, for vitamin C there are ongoing clinical trials listed at clinicaltrials.gov. David notMD (talk) 01:32, 9 May 2020 (UTC)

FYI, here's the set of clinical trials testing Vitamin D and Covid-19 that I found:

• 200 mild Covid patients. Done 2020-06. https://clinicaltrials.gov/ct2/show/NCT04334005?term=Vitamin&cond=Covid-19
• 1080 new Covid patients. Done 2020-12. https://clinicaltrials.gov/ct2/show/NCT04363840?term=Vitamin&cond=Covid-19
• 600 high-risk normals. Done 2021-08. https://clinicaltrials.gov/ct2/show/NCT04335084?term=Vitamin&cond=Covid-19
• 260 elders with Covid. Done 2020-07. https://clinicaltrials.gov/ct2/show/NCT04344041?term=Vitamin&cond=Covid-19
• 1008 Covid patients. Done 2020-08. https://clinicaltrials.gov/ct2/show/NCT04366908?term=Vitamin&cond=Covid-19

Gnuish (talk) 03:45, 13 May 2020 (UTC)

Those are the dates the trials are expected to be done, if recruiting goes as planned. Actual status as of today is that one trial is recruiting subjects and the other four not yet recruiting. Once "Done" the results will need to be analyzed and published. David notMD (talk) 09:55, 13 May 2020 (UTC)

Evidence of the association of low plasma 25-OH-vitamin D and COVID-19 infection here PMID:32397511. Clearly still preliminary, primary data. Jrfw51 (talk) 17:46, 15 May 2020 (UTC)

Yes, preliminary. Compared n=27 COVID-positive to n=80 COVID-negative. The positives were vit D defic, as serum 11.1 ng/ml was well below the 20 ng/ml definition of defic. Other observational studies reporting more severe course of disease and higher risk of death if low D. Begs question is D protective? Treatment? Both? All interesting (I've starting taking a D supplement), but I really, really want to see clinical trial results. David notMD (talk) 20:25, 15 May 2020 (UTC)

Here is a multivariate analysis showing no association.PMID:32413819 Jrfw51 (talk) 10:47, 20 May 2020 (UTC)

It is still observation rather than an intervention clinical trial (several of which are ongoing or starting soon). It looked at a small number of subjects (less than 500) and did subset analysis to see if serum vitamin D still indicative after race controlled for as a variable. I am still against any content in the article until clinical trials are reported. I am asking here how other editors feel about this topic. David notMD (talk) 11:40, 20 May 2020 (UTC)

Data from nearly 400,000 Biobank subjects. 494 diagnosed positive with COVID-19. Multivariate analysis of all subjects (not subset) adjusted for ethnicity, sex, month of assessment, Townsend deprivation quintile, household income, self-reported health rating, smoking status, BMI category, age at assessment, diabetes, SBP, DBP, and long-standing illness, disability or infirmity. Strengths: big data, good stats, shows the association has been considered. Limitations: primary data, not interventional, a topic of immense current interest that editors want to add to WP. Jrfw51 (talk) 14:57, 20 May 2020 (UTC)

Then this should not be the only observational study described and cited. David notMD (talk) 17:29, 20 May 2020 (UTC)

Agree. Added some text. Hope this is reasonable now. Jrfw51 (talk) 07:32, 21 May 2020 (UTC)

Added a sentence and ref to the list of trials at clinicaltrials.gov. David notMD (talk) 12:47, 21 May 2020 (UTC)

Evidence Supports a Causal Role for Vitamin D Status in Global COVID-19 Outcomes. There is also some data showing Vitamin D supplementation is useful for the treatment of COVID-19. This Google Doc was created by Dr Gareth Davies (PhD), Dr Joanna Byers (MBChB), Dr Attila R Garami (MD, PhD), to track all of the relevant studies, and to outline the mechanisms by which Vitamin D helps combat COVID-19. https://docs.google.com/document/d/1jffdZOSuIA64L_Eur8qyCQ12T7NXrHSKPxtMe134C0Y/edit?fbclid=IwAR2nzFz2X393A7VZ-t4H9ZgmQcmvGyUVRAD1etDd4ly3yOhxBW9xTtusTqY#heading=h.hrvlw7sle0sz There is too much information contained in this Google Doc to paste here, but a number of these studies should be useful references. These doctors published a summary paper here... https://www.medrxiv.org/content/10.1101/2020.05.01.20087965v3.full.pdf Tvaughan1 (talk) 23:57, 19 July 2020 (UTC)

A new peer-reviewed randomized controlled trial shows that giving large doses of Calcifediol (the active form of Vitamin D) to COVID-19 patients massively reduces the percentage of patients that will need ICU care, as well as reducing the mortality. https://www.sciencedirect.com/science/article/pii/S0960076020302764 Tvaughan1 (talk) 06:24, 4 September 2020 (UTC)

This appears to be the first published clin trial (actually, pre-pub and not yet found via PubMed). It was small (total of 75 subjects), and all subjects were getting hydroxychloroquinone and azithromycin as part of standard treatment at that time, but the results looked strong. The study did not assess the vitamin D status of the enrolled subjects. Dosing was 21,280 IU at start, then 10,640 on days 3 & 7 and weekly thereafter. My search at PubMed on vitamin D and COVID-19 yielded 38 reviews and no RCTs. David notMD (talk) 12:17, 4 September 2020 (UTC)

Interesting. Would be better to get a secondary source to review this.Jrfw51 (talk) 19:47, 4 September 2020 (UTC)

This study is better evidence than anything in the article now. It's the only peer reviewed randomized controlled trial (pre-) published on the topic, and the results are overwhelmingly positive. We would be doing Wikipedia readers a disservice not to mention it. Tvaughan1 (talk) 20:10, 4 September 2020 (UTC)

By itself, it does not meet Wikipedia's standard for medical research (WP:MEDRS). The article's authors wrote "This pilot study has several limitations as it is not double-blind placebo controlled." and also acknowledged that baseline vitamin D status was not measured. In my opinion, Wikipedia can wait until the authors' follow-up (larger) trial is completed, along with the other vitamin D trials in progress. David notMD (talk) 21:40, 4 September 2020 (UTC)

It doesn't need to be double-blind. It was a randomized controlled trial. Baseline Vitamin D level would be nice to know, but this study used a fairly massive dose of the active form of Vitamin D. In terms of Vitamin D as a treatment, post COVID infection there is less scientific evidence. In terms of pre-existing Vitamin D levels before COVID infection, there are many studies and peer reviewed meta-analysis https://www.medrxiv.org/content/10.1101/2020.05.01.20087965v3.full.pdf. Here is yet-another published study demonstrating that Vitamin D deficiency leads to worse COVID-19 outcomes... https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157 Tvaughan1 (talk) 23:09, 4 September 2020 (UTC)

The conclusion from the JAMA article: "In this single-center, retrospective cohort study, likely deficient vitamin D status was associated with increased COVID-19 risk, a finding that suggests that randomized trials may be needed to determine whether vitamin D affects COVID-19 risk." David notMD (talk) 07:53, 5 September 2020 (UTC)

The conclusion from "Evidence Supports a Causal Role for Vitamin D Status in Global COVID-19 Outcomes (a peer reviewed paper)... "Conclusions: Our novel causal inference analysis of global data verifies that vitamin D status plays a key role in COVID-19 outcomes. The data set size, supporting historical, biomolecular, and emerging clinical research evidence altogether suggest that a very high level of confidence is justified. Vitamin D prophylaxis potentially offers a widely available, low-risk, highly-scalable, and cost-effective pandemic management strategy including the mitigation of local outbreaks and a second wave. Timely implementation of vitamin D supplementation programmes worldwide is critical with initial priority given to those who are at the highest risk, including the elderly, immobile, home bound, BAME and healthcare professionals." Tvaughan1 (talk) 17:57, 5 September 2020 (UTC)

I have added the recent Castillo RCT as the results are clearly significant and important. I hope further studies and reviews will allow us to better fulfil WP:MEDRS. Jrfw51 (talk) 12:18, 5 September 2020 (UTC)

I consider this premature but will not revert it. Looking forward to more research being published. David notMD (talk) 14:18, 5 September 2020 (UTC)

At this point, with the most recent studies, the statement "there is only preliminary evidence of a direct association between vitamin D deficiency and COVID-19 infection" is clearly misleading. No one has claimed that adequate Vitamin D prevents COVID-19 infection... that's a red herring. The role of Vitamin D is to enable the immune system to successfully handle a COVID-19 infection, enabling a patient to avoid ICU care or death. It has been established in multiple peer reviewed papers that Vitamin D deficient patients have far worse outcomes than those with adequate Vitamin D. To include the above misleading statement, but bury all of the good evidence that Vitamin D levels minimize the rate of ICU care and death is irresponsible. The UK Biobank study mentioned in the next sentence only sought to determine if Vitamin D reduced the risk of infection - again... a red herring. As well, the UK "evidence summary" mentioned in the following sentence was weak compared to the much more thorough analysis of Gareth Davies (PhD), Attila R Garami (MD, PhD), Joanna Byers (MBChB), which established a causal relationship. The JAMA article established a causal relationship. People's lives are at stake. So let's not bury the best information we have. Vitamin D doesn't prevent infection, but it sure helps you survive it.Tvaughan1 (talk) 01:04, 6 September 2020 (UTC)

While I stated I would not revert, I support Zefr's revert. Wikipedia is intended to be a trailing indicator for health science, not breaking news. Physicians who are treating COVID-19 patients do not need a Wikipedia article to stay current. David notMD (talk) 03:06, 6 September 2020 (UTC)

No one suggested physicians use Wikipedia as a primary source for medical information. I really hope they don't. Wikipedia is an encyclopedia. The best available notable, relevant, authoritative information should be included. To clarify, there are 3 possible questions with regard to COVID-19 and Vitamin D. 1 - Does higher/adequate D level help to prevent infection? 2 - Does higher/adequate D level improve the outcome for those who become infected? 3 - Can D help as part of the treatment? The article currently focuses only on question 1. We leave readers totally in the dark as to question 2 and 3, despite solid information being available. I agree that there is no evidence that adequate Vitamin D levels can prevent infection. That's kind of a stupid hypothesis, in my opinion. It's not worth spending a lot of words on. I'm fine with the article mentioning briefly that there is no evidence that adequate Vitamin D helps to prevent a COVID-19 infection. For question 2, we have peer reviewed papers that show a strong causal relationship, and we have a wealth of studies that explain the biological mechanisms by which adequate Vitamin D helps the immune system respond better to respiratory viruses, and in particular COVID-19. For question 3 we now have a peer reviewed study that showed overwhelmingly positive results. Of course we also have tons of anecdotal evidence from many doctors who have been giving Vitamin D as part of their treatment regimen (including the CDC and a number of other organizations ok'ing it as an adjunctive therapy for COVID patients). Although the latter isn't good enough for Wikipedia, medical experts understand the many ways Vitamin D is crucial for the immune system, and when you look at the statistically certain, overwhelmingly positive result (there is no possible way to explain that result by random chance or ANY OTHER WAY), I believe it's worthy of a mention. Tvaughan1 (talk) 20:02, 6 September 2020 (UTC)

Here is another study (non peer reviewed preprint) The link between vitamin D deficiency and Covid-19 in a large population from Israel examining 52,405 infected individuals and comparing them with 524,050 control individuals. The study found "a highly significant correlation between prevalence of vitamin D deficiency and Covid-19 incidence", as well as "A significant protective effect was observed for members who acquired liquid vitamin D formulations (drops) in the last 4 months". Tvaughan1 (talk) 18:35, 8 September 2020 (UTC)

And now we have a peer-reviewed, published meta-analysis involving Vitamin D and COVID-19. https://www.frontiersin.org/articles/10.3389/fpubh.2020.00513/full . "Among the 47 original research studies summarized here, chart reviews found that serum vitamin D levels predicted COVID-19 mortality rates (16 studies) and linearly predicted COVID-19 illness severity (8 studies). Two causal modeling studies and several analyses of variance strongly supported the hypothesis that vitamin D deficiency is a causal, rather than a bystander, factor in COVID-19 outcomes." This article criticizes and questions the studies that are referenced in Vitamin D. "Three of the four studies whose findings opposed the hypothesis relied upon disproven assumptions." So, basically Vitamin D presents only bad analysis, while ignoring / suppressing the many higher quality studies. Tvaughan1 (talk) 19:53, 11 September 2020 (UTC)

Yes it's an interesting and extensive review of associations. Not itself a meta-analysis. Single author. It could be added to the first sentence about concerns and associations. I would also suggest that section is moved back to where it was. Research could continue to keep trials that are questionable -- like for having "pilot" in the title! Jrfw51 (talk) 13:45, 12 September 2020 (UTC)

I'm going to remove the UK Biobank / NICE study citations and all references to them. They are outdated, and a number of better studies have contradicted their preliminary conclusions. The UK Biobank study tried to correlate Vitamin D data from 2006-2010 with COVID status in 2020. Obviously, that's a far cry from measuring the Vitamin D levels today. The Benskin study and the https://www.sciencedirect.com/science/article/pii/S0960076020302764 are clearly more authoritative. Neither of these (and many other studies that were examined by Benskin) were not available when NICE made its preliminary recommendation. Tvaughan1 (talk) 21:02, 13 September 2020 (UTC)

I have updated this with some dates and new sources. In terms of quality of evidence, the NICE commissioned review is higher quality than a single author review, however recent and detailed. I accept the reservations about the Biobank data but we cannot discard that as the analysis is thorough. We need Balance and I think must stick with published peer-reviewed articles. Until there are secondary sources we can quote, in this Research section, good quality primary research trials (prospective/cohort) should be acceptable. When there are the RCTs and reviews/guidelines from bodies we can quote, this can be updated and moved back to the main section of the article. Jrfw51 (talk) 14:43, 14 September 2020 (UTC)

The NICE study was not peer reviewed. It was highly criticized (debunked, even) by multiple authors. These criticisms were summarized by Dr. Linda Benskin in the "Debate Over Reports Using “Big Data” (the UK Biobank and EPIC, see Results and Retrospective Chart Reviews That Are Neutral or Strongly Oppose the Hypothesis)" section of her paper. Besides comparing ancient Vitamin D blood test readings with COVID outcomes today, it should be obvious that if you're studying the causal relationship between Vitamin D and COVID-19, you don't adjust for dark skin or obesity, both of which lower Vitamin D levels. These are not confounders, they're causal factors. Given the wealth of valid criticism of the NICE study, it can only be regarded as misinformation today. We have no "balance" in the COVID-19 research section of Vitamin D. We have only the misleading conclusion that Vitamin D does nothing to help prevent COVID-19. Meanwhile multiple peer-reviewed articles, including RCT studies demonstrate a statistically unassailable correlation between Vitamin D levels and COVID-19 outcomes, and a peer-reviewed study also shows a statistically overwhelming positive benefit from Vitamin D as part of a COVID-19 treatment plan. Other Wikipedia articles, such as Coronavirus disease 2019#Research present solid peer reviewed research on COVID-19 as preliminary research, while we await more meta-analysis, and eventually, policy changes.Tvaughan1 (talk) 17:23, 14 September 2020 (UTC)

Yes but remember we are writing an encyclopedia here rather making than our own arguments. The distinction between confounding and causal factors is difficult. I supported and did include the Castillo peer-reviewed and published RCT, first in the main text and then in this research section.PMID:32871238 I think it is the key initial RCT with impressive benefits for 25(OH)D (calcifediol) supplementation cautiously presented. It has been reverted twice. Are there any other editors who are prepared to see this important early finding included in this Research section? Jrfw51 (talk) 19:35, 14 September 2020 (UTC)

The UK Biobank studies (one of which NICE relied on) were shot down in flames by multiple papers. Benskin summarized all of the flaws in her section "Debate Over Reports Using “Big Data”. Did you read this section, and follow the citations? These papers make it clear that these studies were severely flawed in many ways. The Benskin paper is a much better, peer reviewed analysis of more recent studies, during a time frame when COVID testing was much more widespread and accurate, measuring CURRENT Vitamin D levels (not levels from 10 to 14 years ago). In addition to Benskin and Castillo, we also have Evidence Supports a Causal Role for Vitamin D Status in Global COVID-19 Outcomes (peer reviewed). And we have this recent study published in the Journal of the American Medical Association... Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results. The weight and quality of the more recent evidence overwhelms the earlier, flawed evidence in the UK Biobank and NICE studies. In addition to sketchy data, there was very sketchy analysis of the data, and this was thoroughly criticized by multiple follow-up papers. Tvaughan1 (talk) 22:08, 14 September 2020 (UTC)

I reverted your deletion as currently the UK NICE evidence summary would be classed as high quality of evidence, being multi-authored by experts from a national body. Yes there have been further publications, and the Benskin single-author updated review has more data (but is not a meta-analysis) and has criticisms of some earlier conclusions. We cannot include the as-yet unpublished (and not peer-reviewed) medrxiv paper by Davies, Garami and Byers. When it is published it will add more weight. The Meltzer paper is in JAMA Netw Open (not JAMA); I have added that to the papers cited to show evidence of an association. Vitamin D levels are most recent, within a year, and not "current" levels. Regarding vitamin D levels and ethnicity, the effects of polymorphisms in the vitamin D-binding protein become important. See PMID:24256378. Sorting out whether this is causal or confounding is difficult! That's why we need the intervention studies such as that by Castillo. Jrfw51 (talk) 09:00, 16 September 2020 (UTC)

Yet another peer-reviewed, published study demonstrates the clear inverse relationship between vitamin D levels and COVID-19 infection rates. SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels "The association between lower SARS-CoV-2 positivity rates and higher circulating 25(OH)D levels remained significant in a multivariable logistic model adjusting for all included demographic factors (adjusted odds ratio 0.984 per ng/mL increment, 95% C.I. 0.983–0.986; p<0.001). SARS-CoV-2 positivity is strongly and inversely associated with circulating 25(OH)D levels, a relationship that persists across latitudes, races/ethnicities, both sexes, and age ranges."Tvaughan1 (talk) 19:46, 18 September 2020 (UTC)

An Italian study announced in Medscape... Low Vitamin D in COVID-19 Predicts ICU Admission, Poor SurvivalTvaughan1 (talk) 19:49, 18 September 2020 (UTC)

I've added the peer-reviewed, published study by Kaufman which is large, has multivariable analysis, and balances the other reports with nonrecent 25(OH)D levels. When other papers are published, they can be added. We need to continue to be alert for new review articles and any randomized, controlled trials. Jrfw51 (talk) 16:53, 19 September 2020 (UTC)

• We really need to be very strict about WP:MEDRS and cite the WP:BESTSOURCES for any material relating to COVID-19. This topic area is subject to discretionary sanctions: I have added a page banner above as a reminder. I have cleaned out a vast number of primary and other questionable sources that had accumulated in the article. Alexbrn (talk) 12:44, 1 October 2020 (UTC)

Yes I am very aware of the WP:MEDRS requirements. This is in the Research section of the article, where novel primary sources often and up, and all of the sources are published, peer-reviewed papers or reputable main-stream press reviews. Also the quality of the Frontiers Public Health article is in fact very good and I nuanced how this was presented for balance. There is debate here (see today's Times) and of course there is considerable interest. I have worked hard to try to keep this balanced with due weight. Please consider reverting or discuss further. Jrfw51 (talk)

There is no exemption to WP:MEDRS for a research section (though POV pushers of many stripes have tried to claim that!). A single author narrative review in a Frontiers journal is not an approrpiate counter to a strong WP:MEDRS. If and when we have more good sources they may be included. What you have reverted is a mess. Continue this and you risk getting sanctioned. Alexbrn (talk) 14:03, 1 October 2020 (UTC)

@Alexbrn: this was the what you have reverted:

(The COVID-19 pandemic raised concerns that, as vitamin D deficiency is a risk factor in respiratory infection ...,) the incidence, severity and outcomes of COVID-19 infection could be associated with differences in vitamin D levels, with possible benefits resulting from supplementation.

As of October 2020, there are increasing numbers of published reports of case series showing direct associations between vitamin D deficiency, COVID-19 infection and severity. As many other other factors can influence 25(OH)D levels, multivariate analysis of these findings has been performed in some studies to adjust for confounding factors such as ethnicity. In studies using UK Biobank data of people with vitamin D levels measured at least 10 years previously, associations of low 25(OH)D with a higher incidence of COVID-19 infection, severity and mortality were no longer significant when adjusted for ethnicity, obesity and lower socioeconomic status. A large US study showed that the association between lower SARS-CoV-2 positivity rates and higher 25(OH)D levels remained significant in a multivariable logistic model which adjusted for demographic factors including latitude, race/ethnicity, sex and age. Some of the variations in the prevalence of COVID‐19 and mortality rates between countries and ethnicities may be explained by differences in vitamin D metabolism and blood levels due to different frequencies of polymorphisms in the vitamin D-binding protein.

References

The first reference (Rhodes) is an editorial. The others are narrative reviews, of which the Frontiers is the fullest even if it is single author. I am aware of current discussions re Frontier journals, but I recommend you read this article, even if it doesn't stay. Some of these other reviews need to be included. There are two mainstream press articles giving balance (6 and 8).

I have no point of view, except that there is widespread scientific and lay debate at the moment. You deleted the different takes on ethnicities, where there is a balance needed, and the DBP polymorphisms have been shown to be relevant. You are threatening me with sanctions ... ? Perhaps you will selectively restore what you have slashed. You may think 8-10 citations are a mess -- and yes we would prefer one high quality systematic review -- but they take time. We have disagreed before, but there is great interest in this area at present and I think the page visits reflect this. Please restore the first sentence so it makes sense and add back some more of the rest. Jrfw51 (talk)

It is simply incorrect that these sources are reviews, they are nearly all primary sources, i.e. unreliable for non-trivial biomedical claims. Yes, this is a subject of great interest which is precisely why is it the responsibility of editors to uphold the highest standards rather than create a big blob of unreliable content, and why discretionary sanctions are in place to remove editors who do not adhere to Wikipedia's relevant WP:PAGs for this subject. If in doubt, raise this at WT:MED. Alexbrn (talk) 18:14, 1 October 2020 (UTC)

I meant the others in the first section. We do not need to cite all of these. The first sentence still needs correction. I will amend how I write about the associations to include only the Lancet Diabetes and Endocrinology commentary.Jrfw51 (talk) 20:30, 1 October 2020 (UTC)

I appreciate the full and frank discussion elsewhere. What do others think of this newly published review in an OK impact factor (5.3) journal? PMID:32755992 It reviews relevant mechanisms and will add to the scientific side of this article. Jrfw51 (talk) 11:36, 4 October 2020 (UTC)

Looks useable. Could be used to support some statement like "as of November 2020, it was still unclear whether vitamin D had any role to play in relation to COVID-19". Alexbrn (talk) 12:26, 4 October 2020 (UTC)

Thanks Alexbrn. This review concludes with "The pervasive actions of vitamin D on many organ systems have raised many possible interactions between it and the mechanisms by which the SARS-CoV-2 virus infects human beings. While the data are far from conclusive in attributing a role for vitamin D in influencing the risk and outcome of this disease, it is nevertheless also clear that more research would be timely and revealing." I think this is the basis of the wording we should use but will leave it to you to insert this as you think is appropriate. Jrfw51 (talk) 13:33, 4 October 2020 (UTC)

As I said elsewhere, the article Mechanisms in Endocrinology:Vitamin D and COVID-19 is a decent source, but we have to be clear that it isn't reaching any conclusions about COVID-19 that differ from the NIH and NICE statements from a couple of months ago. Its review of the mechanisms of effect of vitamin D on older respiratory diseases is very much on-topic for the article, particularly the Mechanism of action section, but also to add extra information to the Use of supplements section which is rather sketchy in the Infectious diseases sub-section. It's already in use in the COVID-19 section, but I would be very cautious about trying to read more into it than the text presently says. --RexxS (talk) 18:26, 4 October 2020 (UTC)

Now I know we cannot cite the Daily Mail, but maybe one day a scientific secondary review will catch up with this review in the doubtful popular press and we can update WP! Jrfw51 (talk)

I wonder if the fact that Vitamin-D was shown to have some effect/benefit with SARS-CoV (the first one) might rate a tiny mention and give suitable support to the as yet only weakly proven links with SARS-CoV-2 (the current novel one). EDIT: There is a companion page that has a section that this could link to so that the data could be placed in the correct place depending on the focus. Perhaps reciprocal links. Management_of_COVID-19#Vitamin_D Idyllic press (talk) 18:36, 26 October 2020 (UTC)

Just published - a peer reviewed, randomized controlled trial showing Vitamin D supplementation lessens the time to recovery in Vitamin D deficient patients. http://dx.doi.org/10.1136/postgradmedj-2020-139065 Tvaughan1 (talk) 18:32, 13 November 2020 (UTC)

The Spanish Ministry of Health and Families has released to the Governing Council the report of the technical committee of experts for supplement studies and nutritional intervention against Covid-19, in which it recommends the use of Calcifediol for elderly residents of social health centers to minimize the incidence of the infection and lessen its severity if it occurs. Tvaughan1 (talk) 18:41, 13 November 2020 (UTC)

The UK government is preparing to promote Vitamin D usage to lessen the severity and instances of COVID-19, following the lead of Scotland (and a number of other countries including New Zealand (funds Vitamin D), Switzerland, Israel and France). The UK is also preparing to supply Vitamin D to 2 million vulnerable and elderly people. I think it's time to list the countries that have made Vitamin D part of their official recommendations for combating COVID-19 in the COVID-19 research section. Tvaughan1 (talk) 21:08, 14 November 2020 (UTC)

Not if it involved misrepresenting sources, or using non-WP:MEDRS to imply health claims. As the Guardian piece you linked makes clear, the scientific view in the UK is still this: "In June, Nice said there was no evidence to support taking vitamin D supplements to prevent Covid-19, following reviews. The Scientific Advisory Committee on Nutrition (SACN), which is within Public Health England, reached similar conclusions." The most we can say is that the question is being kept under review, at the government's request.

Just because the Guardian article mentioned what NICE said in June doesn't make that the current scientific view in the UK. The Royal Society has reached a different conclusion: https://royalsocietypublishing.org/doi/pdf/10.1098/rsos.201912 Tvaughan1 (talk) 19:16, 1 December 2020 (UTC)

In general, I oppose doings "lists of countries that ..." as it implies the health effect is some kind of popularity contest, and is not how we present recommendations for any other condition here. It may be appropriate to note national responses in some of the COVID-19 articles however. Some of those sources above are very weak. Alexbrn (talk) 04:57, 16 November 2020 (UTC)

In terms of Wikipedia's hierarchy of reference quality, official government policy is at the top. Support for Vitamin D to minimize COVID is becoming rather widespread, and that fact is notable and relevant. Again, we're not talking about a novel drug being evaluated for safety and efficacy. We're discussing a naturally occurring Vitamin that people in sunny locations have naturally high levels of. Tvaughan1 (talk) 21:30, 19 November 2020 (UTC)

Yet another observational study showing that asymptomatic COVID patients had far lower prevalence of Vitamin D deficiency than critical COVID patients. https://www.nature.com/articles/s41598-020-77093-z Tvaughan1 (talk) 21:27, 19 November 2020 (UTC)

An in-vitro study shows another mechanism by which Vitamin D can inhibit SARS-CoV-2. LL-37 fights SARS-CoV-2: The Vitamin D - Inducible Peptide LL-37 Inhibits Binding of SARS-CoV-2 Spike Protein to its Cellular Receptor Angiotensin Converting Enzyme 2 In Vitro Tvaughan1 (talk) 18:04, 3 December 2020 (UTC)

A new retrospective study demonstrates that high dose Vitamin D3 therapy reduced mortality in COVID patients. High-Dose Cholecalciferol Booster Therapy is Associated with a Reduced Risk of Mortality in Patients with COVID-19: A Cross-Sectional Multi-Centre Observational Study "A total of 986 participants with COVID-19 were studied, of whom 151(16.0%)received cholecalciferol booster therapy. In the primary cohort of 444 patients, cholecalciferol booster therapy was associated with a reduced risk of COVID-19 mortality, following adjustment for potential confounders (ORadj0.13, 95% CI 0.05–0.35,p<0.001). This finding was replicated in a validation cohort of 541 patients (ORadj0.38, 95% CI 0.17–0.84,p=0.018) Tvaughan1 (talk) 23:56, 14 December 2020 (UTC)

Evidence of a dysregulated Vitamin D pathway in SARS-CoV-2 infected patient... "results provided computational evidence to implicate a dysregulated vitamin D pathway in the pathobiology of SARS-CoV-2 infection" Tvaughan1 (talk) 19:05, 26 December 2020 (UTC)

197 experts and leaders, including 106 Professors and 105 PhDs have signed an open letter to government authorities, agreeing that low Vitamin D levels promote COVID-19 infections, hospitalizations, and deaths. The signatories agree that "vitamin D’s influence on COVID-19 is very likely causal, not just correlation". The experts agree that "the preponderance of evidence indicates that increased vitamin D would help reduce infections, hospitalizations, ICU admissions, & deaths". The organizers of this effort have been working with British MPs (David Davis and Rupa Huq), and together they have convinced the British government to make Vitamin D part of their effort to combat COVID-19. https://www.express.co.uk/life-style/health/1374763/coronavirus-news-update-uk-global-pandemic-vitamin-d-campaign Tvaughan1 (talk) 05:36, 13 January 2021 (UTC)

The opposite of the kind of sourcing we want. Alexbrn (talk) 06:45, 13 January 2021 (UTC)

The open letter references the research that this large group of Vitamin D experts is basing their concensus conclusions on. They are outlining the scientific consensus among leading Vitamin D researchers.

• https://www.frontiersin.org/articles/10.3389/fpubh.2020.00513/full - published, peer-reviewed meta analysis
• https://febs.onlinelibrary.wiley.com/doi/full/10.1111/febs.15495 - Israeli study with 14,000 individuals
• https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239252 - US study with 191,779 patients
• https://www.sciencedirect.com/science/article/pii/S0960076020302764 - Spanish study showing the efficacy of Vitamin D as a COVID treatment (being repeated now with similar results).

I don't think it's appropriate to judge nutritional supplement guidance from a group of experts or from national governments under the same criteria we use for medical guidance to doctors for a novel drug (Remdesivir, etc.). Vitamin D is naturally occurring nutrient, available as an over-the-counter supplement, and it's used to fortify many foods in different countries. This group of experts is advocating for widely documented, widespread Vitamin D deficiency to be corrected through supplementation during the COVID pandemic. That's notable and relevant, and it shouldn't have to pass the same bar as a novel drug would to be mentioned in this article.

At a minimum, we should follow the policy from [WP:MEDSCI] that states "make readers aware of controversies that are stated in reliable sources. A well-referenced article will point to specific journal articles or specific theories proposed by specific researchers." Tvaughan1 (talk) 07:49, 13 January 2021 (UTC)

"in reliable sources" - sure. Are there any on the table? (not UK gutter press or primary research) Alexbrn (talk) 07:52, 13 January 2021 (UTC)

https://www.theguardian.com/lifeandstyle/2021/jan/10/does-vitamin-d-combat-covid also covered the work that the two MPs are doing to make Vitamin D supplementation part of the UK's national policy. And here is the NHS web page making Vitamin D available for free to "at risk" adults.Tvaughan1 (talk) 08:01, 13 January 2021 (UTC)

The Guardian is not MEDRS, but the NHS is! We already seem to be including the NHS/NICE position. What British MPs think is beside the point; that cohort includes homeopathy boosters and every other shade of loony you could imagine. Stick to WP:MEDRS please. Alexbrn (talk) 08:14, 13 January 2021 (UTC)

"What British MPs think is beside the point; that cohort includes homeopathy boosters and every other shade of loony you could imagine" sounds like WP:OR to me. I could make the same accusations regarding the ties to the pharmaceutical industry that you find with the people studying the topic at government health agencies, but you would reject this as WP:OR. Tvaughan1 (talk) 23:35, 13 January 2021 (UTC)

If I may step in. No, the NHS does NOT recommend VitD to prevent or treat COVID-19. Instead they would like to help clinically extremely vulnerable persons as they have "been indoors over the spring and summer" and therefore might "not have been getting enough vitamin D from sunlight."). --Julius Senegal (talk) 08:18, 13 January 2021 (UTC)

Vitamin D is not a drug, and we shouldn't be treating it as if it were. The consensus among those that have actually researched the issue is that governments should make it their policy to eradicate Vitamin D deficiency in their populations. It is believed by researchers that this would be protective against the rate of transmission and severity of COVID. Yes, that is a bold statement, but I challenge any doubters to show us Vitamin D research where the study authors concluded the opposite - that maintaining low population Vitamin D levels would lead to the same outcomes, or be protective against COVID. The [Vitamin D] article, as it exists today, mentions that some people think this, but that the US NIH, UK NICE and UK NHS have concluded that there is "not enough evidence to recommend" as a prophylactic or treatment for COVID. That is not the same as saying it wouldn't be beneficial, though a reader of this article could easily be led to conclude that. These agencies were using the same criteria a Vitamin (with documented, wide-spread deficiency) as they would for a novel drug. They also failed to include any of the best studies on the question in their reviews. So the researchers are taking their case directly to the government, and in many countries including Spain, the UK, Israel, France, New Zealand, Vitamin D is becoming part of the official policy (regardless of the excuse that NHS made for distributing Vitamin D when pushed by MPs and the Minister of Health, Matt Hancock). The government health agencies work for the government, not the other way around. Given the fact that there is very low cost, no chance of harm (every government health agency agrees 4000 iu/day is safe) and a very good probability of doing a great deal of good, government leaders would like to see more aggressive actions taken. They want the matter to be dealt with as a nutrition policy matter, not a drug review. In fact, it is being debated in the UK Parliament tomorrow. Again, WP:MEDSCI guides us to "make readers aware of controversies that are stated in reliable sources." WP:NEUTRALEDIT also guides us include active controversies. Tvaughan1 (talk) 23:30, 13 January 2021 (UTC)

Vitamin D is a pro-hormone, so nothing you should consume recklessly.

And wrong, the consensus is to help against a deficiency, but not in all countries. UK is prone to less sun light, yes, but others are not. And wrong, "it is believed" is a weasel word, I have shown you evidence against this.

In science the statement "not enough evidence" means something different: No proof for this hypothesis.

and wrong, 4,000 iU/day is not recommended by many health agencies. --Julius Senegal (talk) 07:50, 20 January 2021 (UTC)

PS: you have missed to mention the closure of the parliament's hearing: "Future decisions should and must be based on robust evidence". --Julius Senegal (talk) 07:52, 20 January 2021 (UTC)

Really there are several topics being discussed here. First, some researchers have investigated whether Vitamin D deficiency prior to contracting COVID leads to worse outcomes. I think we have more than enough WP:MEDRS to state this definitively (no reliable study indicates otherwise). The next question is whether supplementation to eliminate Vitamin D deficiency leads to better outcomes is harder to answer as studies take time. All indications are that this is true, but I'm fine with characterizing this question as a research topic still being studied. A further question is whether Vitamin D is useful as part of a COVID treatment regimen. Early indications are that this is true (especially when the fast acting Calcifediol is used), but I agree that this is an area of active research. Hopefully the follow-up RCT in Andalusia Spain will put this issue to rest. The last question is whether governments have made Vitamin D supplementation part of their official effort to improve public health, including possibly mitigating the negative effects of COVID-19 and other respiratory viruses. Some have, but some seem to be functioning as government bureaucracies are known to do. Tvaughan1 (talk) 23:28, 13 January 2021 (UTC)

I agree with this last assessment by Tvaughan1. The number of meta studies on these topics is growing. They may not be famous authors yet but the weight of numbers should count for something.

Here is a secondary source of sorts that has valuable information in the conclusion. Vitamin D and COVID-19: evidence and recommendations for supplementation

There are also reports of the State of Nebraska, USA increasing their daily dose recommendations to help with Covid-19. The city of Roma, Texas, USA has gone on record to say they want to achieve good blood levels in 70% of their population after they found 95% of city staff were deficient. The province of Andalusia has plans to give/recommend supplements to the vulnerable. In UK this has started and in Scotland this has been ongoing for a while and in Israel it has been a health department recommendations since their first studies were published. For some time already 5 towns in Brazil are providing for free 250ug (10'000IU) daily of Vitamin-D to all their residents to combat the epidemic. These things do not happen in isolation and require a LOT of motivation. What is a puzzle is why Wikipedia requires even more motivation than politicians. The other drug remedies seem to get a lot of coverage in Wikipedia and require a lesser burden of proof. Idyllic press (talk) 21:48, 17 January 2021 (UTC)

Here is a French report by 72 authors backed by 6 French national scientific societies in the Journal: La Revue du Praticien - Beneficial effect of vitamin D in Covid: what are the data? They recommend Vitamin D supplementation to reduce the prevalence of Vitamin D deficiency and insufficiency, and they recommend using Vitamin D as part of a COVID treatment regimen. Translated summary - "Even if the impact on the prevention and / or improvement of serious forms of Covid-19 is still the subject of studies in progress, we therefore recommend, pending the results of the controlled trials in progress, to obtain satisfactory vitamin D status as soon as possible in the event of infection with SARS-CoV-2 (recommendation grade 1B). We suggest prescribing in adults, as an adjunct to the standard treatment protocols available, a loading dose of vitamin D as soon as Covid-19 is diagnosed, for example 100,000 IU of vitamin D3 per os (200,000 IU in patients with obese patients and / or with other risk factors of severity of Covid-19) to be repeated after one week." Tvaughan1 (talk) 01:26, 18 January 2021 (UTC)

Here is a peer-reviewed study from Padua Italy, published in Nutrients... Effectiveness of In-Hospital Cholecalciferol Use on Clinical Outcomes in Comorbid COVID-19 Patients: A Hypothesis-Generating Study. The study used a cohort of very sick, older COVID-19 patients, many of whom had multiple comorbidities. Sadly the authors used the slower-acting form of Vitamin D, cholecalciferol, instead of the faster-acting form, calcifediol. "The primary endpoint in this study was a composite outcome of death from any cause and/or need for transfer to an ICU over an average of a 14 ± 10 day follow-up period after hospital admission. ...In a crude analysis, initially including comorbidity burden as a potential confounder, vitamin D treatment was observed to be associated with a 43% and 55% reduction, respectively, in the OR of the combined endpoint, but these effects did not attain statistical significance. ... However, our analysis revealed that when the comorbidity burden was considered as an effect modifier (rather than as a potential confounder) a significant effect modification by this variable was found for the vitamin D outcome linked to both the crude (p = 0.033) and propensity score 2-adjusted analysis (p = 0.039)." There was an 82% reduction in bad outcomes (the need for ICU care or death) in those with 3 or more comorbidities. Tvaughan1 (talk) 00:53, 20 January 2021 (UTC)

Why bring junk sources (primary work in a WP:CRAPWATCH journal) here? This is WP:NOTAFORUM. In general the process on Wikipedia is first to find the WP:BESTSOURCES and then summarize them, not to come here with a POV and cast around trying to see if some source can be used to bolster it. Alexbrn (talk) 06:03, 20 January 2021 (UTC)

I concur with Alexbrn. What we don't need are single cherry-picked papers of small size (e.g. methologically strange Italien study with 91 participants). There are tons of "studies" in all directions.

The best reliable sources are meta-reviews of meta-reviews, like those presented by NICE or SACN. --Julius Senegal (talk) 07:50, 20 January 2021 (UTC)

We know we are here to write an encyclopedia. Many of us are concerned that, in our desire to comply with WP:MEDRS on the question of the medical advice "should we take/give vitamin D to prevent or treat Covid-19?", we are missing out on describing the way this knowledge has been generated and the epidemiologic and scientific facts underlying this. It is undeniable that there is a great deal of interest on the evidence for or against the effects of vitamin D, and there is one good systematic review and meta-analysis which has been included. We are not going to be able to include primary studies in the text of this vitamin D article, however relevant, as there is strong policing for the established POV. There are now too many publications to detail the findings as new important primary studies. Any nuances such as type of vitamin D, spectrum of co-morbidities, timing of treatment, assessment of outcomes will be lost until further reviewed elsewhere. BTW the journal Nutrients has established itself with an IF of around 5 so it does not deserve the words used above. Jrfw51 (talk) 12:16, 20 January 2021 (UTC)

An excellent paper / meta review was just published in International Journal for Vitamin and Nutrition Research - The coronavirus disease (COVID-19) – A supportive approach with selected micronutrients by Uwe Gröber and Michael F. Holick Tvaughan1 (talk) 18:26, 26 January 2021 (UTC)

What's excellent about it? The journal is very low-impact, it's not a review and the author has a question mark over them. Alexbrn (talk) 18:34, 26 January 2021 (UTC)

This IS a review (see first page) of 202 papers (some not published) -- BUT it is not a meta-analysis or a systematic review and won't fit here. Let's wait for the good quality sources. Jrfw51 (talk) 21:21, 26 January 2021 (UTC)

This paper is scam. The author, a pharmacist, is publisher of a journal of "Orthomolecular medicine" and works in a private academy. So his "recommendation" are highly biased. To call this "excellent" must be some kind of joke. --Julius Senegal (talk) 10:03, 27 January 2021 (UTC)

Tvaughan1 mentioned above that the real problem is that vitamin D is not a drug, while this wiki page and part of the medical community treat it like it is a drug. This is the real problem. The natural dose is between 5000 and 10,000 IU/day, while the official maximum safe dose is 4000 IU/day. But as mentioned here: "Although current data support the viewpoint that the biomarker plasma 25(OH)D concentration must rise above 750 nmol/L to produce vitamin D toxicity, the more prudent upper limit of 250 nmol/L might be retained to ensure a wide safety margin." And 10,000 IU/day will typically yield calcidiol levels of around 250 nmol/l.

One can compare this to getting adequate exercise in a society of couch potatoes. If for generations the entire population stopped doing exercise, then exercise would likely be wrongly considered to be a potentially dangerous medical treatment. Health agencies would write that a limited amount of exercise is good for the body, but that there is no proven correlation with cancer and COVID. The guidelines would mentioned very low maximum safe limits for exercise, citing observations of people who collapsed and died during bouts of exercise. No correlation between exercise and heart disease will have been detected at the low levels of the RDA of exercise. Warnings of exercise overdose causing like fainting and even cardiac arrest would be widely published, so most people would stay well clear of the levels what in our society are regarded as healthy amounts of exercise. Under these conditions they would unlikely to ever find out the truth about exercise: "Prof Janet Lord, director of the Institute of Inflammation and Ageing, at the University of Birmingham, and co-author of the research, said: "The immune system declines by about 2-3% a year from our 20s, which is why older people are more susceptible to infections, conditions like rheumatoid arthritis and, potentially, cancer. "Because the cyclists have the immune system of a 20-year-old rather than a 70- or 80-year-old, it means they have added protection against all these issues."" Count Iblis (talk) 02:42, 29 January 2021 (UTC)

WP:NOTAFORUM. Note that WP:MEDRS applies to any biomedical content, not just "drugs". Alexbrn (talk) 04:18, 29 January 2021 (UTC)

A pre-print of the follow-up study on Calcifediol is now available here... https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3771318 Yes, this is a preprint, and yes, it's an original study. The paper is being peer reviewed, and it will be published soon. I'm mentioning it here in the talk section so that editors can start to think about appropriate edits. This follow-up study shows conclusively that Calcifediol significantly reduces the need for ICU care and mortality when given to incoming COVID-19 patients. Pre-existing Vitamin D levels were measured and of course they correlate strongly with outcomes. "In summary, calcifediol administered at hospitalization reduced the requirement for ICU admission and decreased mortality by more than 50%. Moreover, baseline 25(OH)D levels correlated negatively with ICU admission and mortality. These findings point to the relevance of an adequate vitamin D status as soon as possible in the setting of SARS-CoV2 infection." COVID-19 patients who died had significantly lower baseline 25(OH)D levels (9.5 ng/ml [6.5;15.5], compared to patients who survived (median [Q1;Q3 14 ng/ml [9;26], p<0.0001). By including the red herring that Vitamin D "was not associated with a higher probability of becoming infected with COVID-19", and including the conclusions from NICE and NIH that there is "not enough evidence to recommend", Vitamin_D#COVID-19 suggests that current research has not shown Vitamin D to be relevant to COVID outcomes or COVID treatment. That's the opposite of the WP:MEDSCI scientific consensus among researchers on this topic. The overwhelming majority of well-designed studies have shown a statistically significant relationship between Vit D status and COVID outcomes, and we have several studies (1st Cordoba study, SHADE study, and this follow-up) that show that Vitamin D (particularly the active form - calcifediol) is effective as a treatment. No one is arguing that having an adequate Vitamin D level, which enables an adequate immune and inflammatory response, prevents the COVID virus from infecting individuals. That's a total red herring. Even vaccines don't prevent infection... they prime the immune system to rapidly control and eliminate the pathogen (and such a fast and effective response will naturally mean fewer positive tests, little to no symptoms and little to no spread of the pathogen to others). WP:MEDDATE Tvaughan1 (talk) 18:11, 12 February 2021 (UTC)

Primary research. Let's wait for secondary sourcing in the normal way. Alexbrn (talk) 18:14, 12 February 2021 (UTC)

Preprints are nothing.

But this is interesting: doi:10.1136/bmjnph-2020-000151: "No evidence that vitamin D is able to prevent or affect the severity of COVID-19 in individuals with European ancestry". Do you see the problem? --Julius Senegal (talk) 08:23, 15 February 2021 (UTC)

PS: Also interesting: doi:10.1001/jama.2020.26848: "The study does not support the use of a high dose of vitamin D3 for treatment of moderate to severe COVID-19 in hospitalized patients." --Julius Senegal (talk) 12:54, 19 February 2021 (UTC)

Published today in Nutrients (a peer reviewed journal), Calcifediol Treatment and Hospital Mortality Due to COVID-19: A Cohort Study. "Conclusion: Among patients hospitalized with COVID-19, treatment with calcifediol, compared with those not receiving calcifediol, was significantly associated with lower in-hospital mortality during the first 30 days." Tvaughan1 (talk) 14:31, 21 May 2021 (UTC)

Primary source in weak journal - of no use here. Alexbrn (talk) 15:14, 21 May 2021 (UTC)

The follow-up Calcifediol treatment study from Barcelona is now peer reviewed and published. Calcifediol treatment and COVID-19-related outcomes "Results: ICU assistance was required by 102 (12.2%) participants. Out of 447 patients treated with calcifediol at admission, 20 (4.5%) required ICU, compared to 82 (21%) out of 391 non-treated (p-value<0.0001). Logistic regression of calcifediol treatment on ICU admission, adjusted by age, gender, linearized 25OHD levels at baseline, and comorbidities showed that treated patients had a reduced risk to require ICU (OR 0.13 [95% CI 0.07;0.23]). Overall mortality was 10%. In the Intention-to-Treat analysis, 21 (4.7%) out of 447 patients treated with calcifediol at admission died compared to 62 patients (15.9%) out of 391 non-treated (p=0.0001). Adjusted results showed a reduced mortality risk with an OR 0.21 [95% CI 0.10; 0.43]). In the second analysis, the obtained OR was 0.52 [95% CI 0.27;0.99]." "Conclusions: In patients hospitalized with COVID-19, calcifediol treatment significantly reduced ICU admission and mortality." Tvaughan1 (talk) 17:13, 8 June 2021 (UTC)

Yes, this is an important, interesting, observational, cohort study of calcifediol accepted for publication in a good journal PMID:34097036. Let's see what other reliable (secondary) sources respond to this. Jrfw51 (talk) 10:46, 9 June 2021 (UTC)

Recent Cochrane report - treatment of COVID-19

doi:10.1002/14651858.CD015043 „There is currently insufficient evidence to determine the benefits and harms of vitamin D supplementation as a treatment of COVID‐19. The evidence for the effectiveness of vitamin D supplementation for the treatment of COVID‐19 is very uncertain..“

Is there a particular reason why this is not in the article? --Julius Senegal (talk) 07:46, 11 June 2021 (UTC)

Well, it should be! Alexbrn (talk) 12:23, 11 June 2021 (UTC)

I've added this Cochrane review, checked Clinical Trials and included the Metabolism meta-analysis more accurately on calcifediol treatment. We need to watch this space for more updates! Jrfw51 (talk) 14:28, 11 June 2021 (UTC)

Update to section on Vitamin D and Cancer

The text that existed up to October 8, 2021, was out of date. Most references were from 2011 and 2014. The Wikipedia guidelines state that the references should be from the preceding five years. There has been considerable research on vitamin D and cancer during the past 15 years, resulting in many findings supporting the role of higher vitamin D level being associated with reduced incidence for a number of cancer types, and for vitamin D supplementation reducing the risk of cancer death although not cancer incidence. There are enough studies for useful meta-analyses of both observational and supplementation studies. The Wikipedia guidelines recommend tertiary sources, e.g., meta-analyses. All of the references chosen for this revision were published in peer-reviewed journals, are listed at pubmed.gov, and are open-access, permitting easy public access.--Jag8453 (talk) 20:06, 8 October 2021 (UTC)

Thanks for pointing this out. Now updated with conclusions from several meta-analyses and an umbrella review of them.Jrfw51 (talk) 10:05, 13 October 2021 (UTC)

Update to section on Vitamin D and Other Conditions

On October 11, 2021, the existing paragraph on vitamin D and diabetes was based on two papers, one from 2014, the other from 2016. Neither was very supportive of a role for vitamin D in reducing risk of diabetes or treating its adverse effects. Three meta-analyses published from 2019 to 2021 now report that vitamin D reduces risk of diabetes mellitus type 2 incidence and reduces values of some of the adverse effects.--Jag8453 (talk) 13:28, 13 October 2021 (UTC)

Cardiovascular disease

Vitamin D supplements not affecting cardiovascular disease outcomes doesn't preclude the possibility that deficiency may lead to more cardiovascular disease deaths, as I've read. Can someone add info on this? Thank you. Imagine Reason (talk) 18:01, 18 December 2021 (UTC)

Why disallow more information about the reported study?

Alexbrn has 3 times reverted my attempt to add a bit more information from the cited source on the recently reported study (and then accused me of revert warring). I added "according to a large meta-analysis in which 70% of daily treatment groups were of doses of 1000 IU per day or less". This is in the cited source, not OR. Alexbrn gave no real reason for reverting (claimed OR, and pointed out that I did have a misspelling in my first attempts). Why is it not OK to add some clarifiation about such an influential study? Dicklyon (talk) 06:35, 23 February 2022 (UTC)

Ledes summarize bodies and so should not cover information not included in the body. But my objection is, even more fundamentally, that the change you have been trying to force makes it look like the article's conclusion was scoped to a particular dosage (the implication being "it wasn't enough!") when the source itself generalizes the conclusion to all supplementation, very explicitly. Failing to WP:ASSERT in such situations causes POV problems. Alexbrn (talk) 06:48, 23 February 2022 (UTC)

This is uncertain, and controversial, including among scientists who have strong opinions. We had "vitamin D supplementation with or without calcium does not reduce skeletal or non-skeletal outcomes in unselected community-dwelling individuals by more than 15%" from the conclusion on the Bolland et al 2014 paper. The EurekAlert commentary is a news release and should not be included, but reports the updated Bolland 2018 systematic review PMID:30293909. A critique of this, Bischoff-Ferrari 2019 PMID:30683217 demonstrates the differences in interpretation of which data has been included in the reviews. All too much for the lead, I think! Jrfw51 (talk) 14:12, 23 February 2022 (UTC)

And PMID:30683217 is just a letter, so an unreliable source esp. put up against a review. Alexbrn (talk) 14:14, 23 February 2022 (UTC)

D3, calcium and vitamin K2

I made this a separate section David notMD (talk) 16:52, 24 March 2022 (UTC)

D3 should never be supplied with calcium, that is too dangerous. Even big amounts of K2 cannot really fully compensate the effects. Valery Zapolodov (talk) 15:53, 24 March 2022 (UTC)

Indoor lifestyle problems

The problem with this topic as treated by the medical community at large, is that a reversal of the burden of proof has occurred. This is the case not just for vitamin D but also for lifestyle issues. People used to live at latitudes corresponding to their skin color and they would spend long enough times outdoors for vitamin D under the skin to reach equilibrium between production and destruction, leading to an intake of between 4000 and 10,000 IU/day. Today we get far less vitamin D, we also get far less exercise, we eat lots of processed foods, we eat a lot less fruits, vegetables and whole grains. Instead of testing if not getting a few thousand IU/day of vitamin D is harmful, we now demand the evidence that getting more than a few hundred IU/day of vitamin D improves health. Similarly, we are testing if regular exercise improves health instead of testing if not getting a certain level of exercise causes health to deteriorate. We are testing if eating an apple a day more improves health, instead of testing if not eating large amounts of fruits and vegetables and whole grains has adverse health effects. A RCT did not find that eating 50 grams broccoli more per week had an effect on bladder cancer? Then we're going to tell people that if they don't like broccoli, they don't have to bother eating it. So, we're catering to the unhealthy, fast food-eating couch potatoes who can't be bothered to improve their lifestyles. Count Iblis (talk) 16:20, 4 June 2022 (UTC)

Who's "we"? Americans? In any case, our job here is to merely reflect reliable sources so as to give an accurate summary of current accepted knowledge on this topic. Alexbrn (talk) 16:24, 4 June 2022 (UTC)

But we do get high amount of D3 if we go to a tan salon with normal UV B light. USA has D3 in every milk by law. Anyway, what is up with you always bringing broccoli up? It is not the key prohormone in our body... Valery Zapolodov (talk) 05:22, 15 September 2022 (UTC)

Vitamin D and Omega-3 Trial

Results are out: Vitamin D reduces autoimmune disease in older age groups. Hazardous to Health (talk) 06:54, 4 June 2022 (UTC)

Misinformation channel (see John Campbell (YouTuber)), the opposite of a reliable source. Alexbrn (talk) 07:01, 4 June 2022 (UTC)

But the BMJ isn't a "misinformation journal", and JoAnn E. Manson can be assumed to not have forged the data that led to these results. Count Iblis (talk) 15:33, 4 June 2022 (UTC)

That would be PMID:35082139 which is a primary source. Given the turmoil in this topic area, we should shun unreliable sources. Alexbrn (talk) 15:38, 4 June 2022 (UTC)

Yes, usually one needs meta-analysis here. And again, 2000 IU is nothing (5000 IU is minimal) and there was no K2, which is really needed after 1000 IU (and if you want to maintain 90 ng/mL, which is just below overdosing you need 9000 IU every day, that is what your infamous Fauci does). They could have just checked tan salons with 50000 IU every session and that would be better. And Omega-3 is so low, it is just a joke. Besides what is the point of not using it with Vitamin E and niacin. Valery Zapolodov (talk) 00:45, 19 September 2022 (UTC)

Fraudulence in Vit D research

This is an interesting article by John Mandrola summarizing the problems in Vit D research. Therein are interesting meta-reviews and big RCTs mentioned, like VITAL. But I cannot find it here.

My suggestion is to make use of this data and incorporate it. --Julius Senegal (talk) 17:46, 4 April 2022 (UTC)

Its not just fraud but stupidity. I don't think this work would qualify as a credible source for the purpose of wikipedia but check out some of these links. I was looking for a list of vitamin D supplement formulas to make the point that most are likely to have other active components and trials do not use adequate placebo. IF they do they tend to fail. https://www.researchgate.net/publication/362404794_Live_and_Let_Dye_A_Confounding_Factor_in_Vitamin_D_Data_Covid-19_Treatments_and_Everything_Else

https://www.researchgate.net/publication/362303875_Vitamin_D_Towards_A_Conflict_Resolving_Hypothesis

This comes up in vitamin K too,

https://www.researchgate.net/publication/366642398_Recent_Vitamin_K_Literature_in_the_Conext_of_a_non-Monotonic_Response_Curve_Local_vs_Global_Optima_and_other_Speculation/stats

And again a wikipedia page on "list of vitamin D formulations" would form the basis for a new work as I think I can find side effects, including enhanced vitamin K uptake, with many of them.

69.131.199.208 (talk) 23:35, 5 January 2023 (UTC)

Anyone hit those links to determine if they would be reliable sources

or contain links or ideas suitable for the main article? 24.236.230.158 (talk) 17:54, 8 January 2023 (UTC)

Another study

Dynapenia in older people - https://doi.org/10.1007/s00223-022-01021-8 https://www.news-medical.net/news/20221213/Vitamin-D-supplements-reduce-the-risk-of-dynapenia-in-older-people-by-7825.aspx 2A00:1370:8184:9B6:59DA:D132:1E8E:A74D (talk) 16:09, 29 December 2022 (UTC)

Unreliable for Wikipedia's purpose, and quite probably a statistical freak in reality.[1] Bon courage (talk) 16:16, 29 December 2022 (UTC)

A lot has been published on muscle strength and vitamin D with varying findings. See some meta-analyses PMID:31729817, PMID:34405916. Jrfw51 (talk) 11:36, 30 December 2022 (UTC)

That talks about https://www.ncbi.nlm.nih.gov/pubmed/35082139?dopt=Abstract. Unrealted. 2A00:1370:8184:9B6:B686:A965:575D:B9E8 (talk) 17:24, 30 December 2022 (UTC)

Again, not WP:MEDRS. Bon courage (talk) 17:31, 30 December 2022 (UTC)

Again, not a review of WP:MEDRS sources is a separate requirement. 2A00:1370:8184:9B6:2E9A:E14E:374B:FF2B (talk) 10:09, 10 January 2023 (UTC)

Starting preparation for submitting for Good Article

Starting some ref, copyediting and content checking before submitting this for Good Article. I will submit after I reactivate and complete my GA submission for Vitamin E. If successful, vitamin D will be the last vitamin article raised to GA. Going forward, all improvements to this article are welcome. David notMD (talk) 17:02, 19 March 2023 (UTC)

“Generally” Recognized… 4K IU is safe.

I removed “generally” from the following phrase: “…it is generally recognized that daily supplementation of 4,000IU is safe.”

@Shibbolethink reverted my edit, commenting: “generally regarded as safe is a technical term supported by the source.”

Yes GRAS is a technical term, but GRAS is not the phrase used in the preexisting text. Additionally, the preexisting cited sources do not specifically support the preexisting text or “GRAS” and one of the two (“Why the IOM recommendations for vitamin D are deficient”) instead support my edit:

“the panel raised the upper-level intake “TUIL” to 4000 IU/day. (The report acknowledges that intakes up to 10,000 IU/day are probably safe for everyone and applied an uncertainty factor10 to that 10,000-IU figure to generate the 4000-IU TUIL. It is important to stress that the TUIL is not a limit but instead constitutes an assurance of safety for such an intake.)”

https://asbmr.onlinelibrary.wiley.com/doi/10.1002/jbmr.328

I’ve reverted to my version. JustinReilly (talk) 01:13, 22 February 2023 (UTC)

The sources were hopelessly old; have updated. Bon courage (talk) 06:41, 22 February 2023 (UTC)

That is true. 4000 or 5000 IU per 24 hours are safe even if taken with magnesium glycinate and Omega or other fat. More should be taken with K2 only. Of course it doesn't apply to the tan salons where you can get even 50000 UI and it will be safe. Valery Zapolodov (talk) 16:11, 30 April 2023 (UTC)

Vit D levels

@Zefr Hey, levels of Vit D is defined differently by different organizations and if you don't understand importance of it, then just back off a bit and stop reverting the edits. Kolma8 (talk) 23:45, 25 August 2023 (UTC)

The sentence was clear in the prior version. You are warring over sentence structure. You have been warned on your talk page for disruptive editing and violation of the 3-revert rule. Zefr (talk) 23:52, 25 August 2023 (UTC)

Telling someone to back off a bit and stop reverting and continuing to edit war yourself is not gaining the required consensus in support of your edits. MrOllie (talk) 23:57, 25 August 2023 (UTC)

D3 versus D subscript 3

In the article, why does it say "vitamin D3" and not "vitamin subscript 3" in, "The activity of calcifediol and calcitriol can be reduced by hydroxylation at position 24 by vitamin D3 24-hydroxylase, forming secalciferol and calcitetrol, respectively." ? It looks wrong to me, and yet there's a link supporting it. Polar Apposite (talk) 18:14, 26 September 2023 (UTC)

Looks you cannot follow links. https://www.enzyme-database.org/query.php?ec=1.14.15.16 Valery Zapolodov (talk) 16:55, 5 November 2023 (UTC)

Do μg and IU refer to D3?

Vitamin D is a group of secosteroids. Amounts in IU and μg and given throughout the article, but I only see one case that states which form it refers to (D3). At a guess they're all D3 but this should be explicit. According to this https://walrus.com/questions/converting-micrograms-mcg-of-calcitriol-to-international-units one IU of D3 is equivalent to one IU of D2, but it makes no sense to talk about an IU of calcitriol as no amount of it can be said to be equivalent to one IU of D3. The URL above does not look like a citable reference, despite looking very scholarly, so I won't edit the article, but someone more knowledgeable might want to, to say something like "all references to IU are to D3" and something similar for μg if that's true. Housecarl (talk) 00:31, 9 December 2023 (UTC)

Housecarl - New talk topics go to the bottom of the page, WP:TALK. This section of the article explains thoroughly the relationship between μg and IU for D3 and D2 food or supplement sources, which do not distinguish a possible difference in vitamin D production between the two substrates. Calcitriol is not expressed in the article in units of μg or IU. Zefr (talk) 17:28, 9 December 2023 (UTC)

My point was "Vitamin D" is a group of things and the quantities given do not identity which of those things they refer to. But now I see the Types section says "Vitamin D without a subscript refers to either D2 or D3, or both, and is known collectively as calciferol.[citation needed]". Housecarl (talk) 21:36, 9 December 2023 (UTC)

Absorption in the body from the sun

Vitamin D absorption from sunlight differs from absorption from supplements. When absorbing 3 minimum erythema doses (the time it takes for the skin to turn red), with the whole body exposed to UV light:

• Within 24 hours, serum vitamin D levels rose from 15 nmol/l to 149 nmol/l.
• After 1 week, serum vitamin D fell back to its initial value, while serum 1,25-(OH)2-D reached its peak.
• Between 2-3 weeks, serum 25-OH-D concentration reached its highest level, while serum 1,25-(OH)2-D fell back to its initial value.

The study does not mention the time it takes for serum 25-OH-D to return to its initial value.

In another study comparing the difference between 1 MED, 625μg D2 (25k IU) supplement, and 250μg D2 (10k IU) supplement, they found that vitamin D from the sun lasts significantly longer than supplements. Vitamin D from supplements returned to baseline levels within 2 days, whereas vitamin D from the sun returned after 7 days. EidenNor (talk) 08:02, 24 April 2024 (UTC)

References