A vitamin D deficiency could make COVID-19 worse?

At the beginning of the year, a topic dominates the media, the economy and public life like hardly anything before. While we were confronted with a completely new type of virus at the beginning of the corona pandemic, little was known about its origin, route of distribution and treatment, science has not dealt with any topic so intensively in recent months. Many questions are still open today, but we already know a lot more about the SARS-CoV-2 virus. Among other things, studies observed that a lack of vitamin D could correlate with the course of COVID-19.

This is the result of a recent study from Spain, which observed 216 patients who were treated in hospital for the lung disease caused by the “coronavirus” [1]. The investigation period extended from March 10th to March 31st. At that time, Spain was considered one of the epicentres of the corona pandemic in Europe and around the world. It was found that 82.2 percent of hospitalized patients were vitamin D deficient. In contrast, 197 healthy volunteers from the same region were asked to analyze how often a vitamin D deficiency without COVID-19 occurs in this population group. It was also observed that “only” 47.2 percent of healthy people showed an undersupply of this vitamin.

Vitamin D Deficiency COVID-19
The present study observed that people with a severe course of COVID-19 had low to very low vitamin D levels more often [1].

Research that was published at the beginning of September already showed a correlation between a vitamin D deficiency and the COVID-19 risk [2]. The current study went one step further and examined other health markers such as markers of inflammation, ferritin and certain markers for the occurrence of thrombosis. These were previously also associated with the occurrence of the lung disease caused by the coronavirus [3]. The subjects of the Spanish study also had less favorable values ​​here and also had one increased occurrence of high blood pressure and cardiovascular diseases.

Co-morbidities such as high blood pressure, diabetes or obesity have already been linked to low vitamin D levels independently of COVID-19. However, along with a vitamin D deficiency, they could make the course of COVID-19 worse [4]. It is important to note that in the Spanish study, a vitamin D deficiency from a value of less than 20 nanograms per milliliter, converted 50 Nanomol pro Liter (nmol / L), was diagnosed. While the COVID-19 patients had an average value of 13.8 ± 7.2 nanograms per milliliter (34.5 ± 18 nmol / l), the average vitamin D level of the comparison persons was 20.9 ± 7 , 4 nanograms per milliliter (52.25 ± 18.5 nmol / l). This difference has a very high statistical significance.

Vitamin D Deficiency COVID-19
The current study observed that 82.2 percent of hospitalized COVID-19 patients were deficient in vitamin D, while the incidence in the comparison group was 47.2 percent [1]. According to data from the RKI, 56.6 percent of German adults have a vitamin D level of less than 50 nanomoles per liter, which was classified as a deficiency in the Spanish study [5].

According to the Robert Koch Institute (RKI), 56 percent of adults in Germany have a vitamin D value of less than 50 nanomoles per liter [6]. Due to the fact that the parathyroid hormone, which releases calcium from the bones, reaches a level of 75 Nanomol Vitamin D pro Liter decreases in a dose-dependent manner in the blood plasma, numerous research projects consider this value to be optimal [6, 7]. If we therefore assume a suboptimal supply of less than 75 nanomoles per liter, the number of those affected by a deficiency could be much higher.

Two further studies, which among others were under the guidance of Michael Holick who are considered to be one of the leading scientists in the field of vitamin D deficiency, concluded that vitamin D deficiency reduced the risk of a positive COVID-19 test 54.5 percent and that COVID-19 patients who have a had an adequate supply of vitamin D and had a 51.5 percent lower risk of dying from the disease [8, 9].

Can taking vitamin D protect against a severe COVID-19 course?

Researchers cannot conclusively answer this question at the moment. This is mainly due to the fact that for such an analysis a large number of otherwise healthy people with a vitamin D deficiency would have to take a defined amount and then observe the infection rate and the frequency of severe courses. We currently count around 600,000 people who tested positive in Germany, which corresponds to around 0.73 percent of the population. In order to collect enough data for such an analysis, one would not only have to examine a very large group of the population, but also let the study run for a few months.

As mentioned, the frequency of vitamin D deficiency also correlates with the occurrence of diseases such as diabetes, obesity and cardiovascular diseases. These problems are more common among people who already lead an inactive and unhealthy lifestyle. This alone can contribute to the fact that the immune system is weakened and consequently a severe course of a COVID-19 infection is the result. After all, people with these diseases are considered to be a risk group for SARS-CoV-2 infection [10]. The study by the Spanish researchers was also unable to determine a causal relationship between a vitamin D deficiency and the severity of a COVID-19 course from their data and the previously published studies [1].

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However, the protective effect of vitamin D on infectious diseases is indicated by the fact that the vitamin contributes to normal immune function. This is also confirmed by the European Food Safety Authority (EFSA) [10]. For this reason, it is certainly not a mistake to bring your vitamin D levels into an optimal range with the help of supplements. However, it is unlikely that this measure alone will be sufficient to protect yourself from a severe course of COVID-19. Therefore, nutritional supplements should always go hand in hand with an active and healthy lifestyle and a balanced diet.

Conclusion and summary

Several studies that have appeared in the past weeks and months seem to confirm that a vitamin D deficiency correlates with the course of a COVID-19 infection. More specifically, people with lower vitamin D levels are more likely to have severe symptoms and are at increased risk of death. However, it is so far unclear whether the severity of the course is triggered directly by the vitamin D deficiency or by concomitant diseases that also correlate with a low vitamin D level. In any case, it does not harm your health to aim for optimal vitamin D levels in the blood and also to adhere to a healthy and active lifestyle.

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Literature sources:

  1. Hernández, José L., et al. “Vitamin D Status in Hospitalized Patients With SARS-CoV-2 Infection.” The Journal of Clinical Endocrinology & Metabolism (2020).
  2. Meltzer, David O., et al. “Association of vitamin D status and other clinical characteristics with COVID-19 test results.” JAMA network open 3.9 (2020): e2019722-e2019722.
  3. Huang, Ian, et al. “C-reactive protein, procalcitonin, D-dimer, and ferritin in severe coronavirus disease-2019: a meta-analysis.” Therapeutic advances in respiratory disease 14 (2020): 1753466620937175.
  4. Biesalski, Hans K. “Vitamin D deficiency and co-morbidities in COVID-19 patients–A fatal relationship?.” NFS Journal (2020).
  5. Robert Koch Institute: “Answers from the Robert Koch Institute to frequently asked questions about vitamin D”, rki.de, as of January 25, 2019
  6. Holick, Michael F. “Vitamin D status: measurement, interpretation, and clinical application.” Annals of epidemiology 19.2 (2009): 73-78.
  7. Holick, Michael F., et al. “Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline.” The Journal of Clinical Endocrinology & Metabolism 96.7 (2011): 1911-1930
  8. Kaufman, Harvey W., et al. “SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels.” PloS one 15.9 (2020): e0239252.
  9. Maghbooli, Zhila, et al. “Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection.” PloS one 15.9 (2020): e0239799.
  10. Robert Koch Institute (RKI): “Information and assistance for people with a higher risk of severe COVID-19 disease progression”, https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Risikogruppen .html, as of October 29, 2020
  11. EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA). “Scientific Opinion on the substantiation of a health claim related to vitamin D and contribution to the normal function of the immune system pursuant to Article 14 of Regulation (EC) No 1924/2006.” EFSA Journal 13.5 (2015): 4096.

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