As a glimmer of hope in what appears to be a completely broken medical system, Florida’s new Surgeon General, Dr. Joseph Ladapo, has issued a statewide public service announcement endorsing common-sense COVID prevention strategies such as optimizing vitamin D levels, physical activity, eating a nutrient-rich diet, and boosting the immune system with supplements.
Boost your Immune System with Zinc, Vitamin D and Vitamin C
The HealthierYouFL.org website encourages Florida citizens to talk to their doctor about how certain supplements or foods containing vitamins and minerals can boost your immune system, such as “zinc, vitamin D, vitamin C and quercetin. These are all well-known supplements that have been shown to have a positive impact on COVID-19 risk.
The Surgeon General also advocates the use of monoclonal antibodies in acute cases and for prevention in high-risk patients who have been exposed to COVID-19. Available treatment sites can be found at FloridaHealthCOVID19.gov.
Physicians should use clinical judgment when recommending treatment options for their patients’ individual health needs. This may include new treatment options with appropriate informed patient consent, including off-label use… ~ Florida Department of Health
Doctors should use their Clinical Judgment
Florida Health is even highlighting new treatment options such as fluvoxamine and inhaled budesonide. Importantly, Florida Health now states the following:
Physicians should use their clinical judgment when recommending treatment options for their patients’ individual health needs. This may include new treatment options when the patient has given consent, including use outside the approved range or in the context of a clinical trial.
No one could be happier about this than me. I’ve been calling for vitamin D recommendations since the early days of the pandemic – ideally statewide, but statewide is at least a start, especially since Florida is the Sunshine State. Instead, I have been vilified and attacked by the U.S. Food and Drug Administration (FDA) and mainstream media for reporting on the benefits of vitamin D.
The FDA specifically mentioned vitamin C, vitamin D and quercetin in their warning letter. Now that the Florida Surgeon General agrees, will they also be warned by the feds?
Ladapo was appointed Florida Surgeon General and Secretary of the Florida Department of Health by Governor Ron DeSantis on September 21, 2021, and it is refreshing to finally see meaningful COVID guidelines. In his acceptance speech, Ladapo said:
I am honored to have been selected by Governor DeSantis to be Florida’s next Surgeon General. We must make health policy decisions based on data, not fear …
I have observed the different approaches of governors across the country and have been impressed by Governor DeSantis’ leadership and determination to ensure that Florida residents have every opportunity to maintain their health and well-being while preserving their freedoms as Americans.
Vitamin D Papers top the List of most Popular Studies of the Year
On October 31, 2020, I published a scientific review paper in the journal Nutrients that I co-authored with William Grant, Ph.D., and Carol Wagner, Ph.D., both of whom serve on the GrassrootsHealth Expert Panel on Vitamin D. The paper was published on October 31, 2020.
By October 31, 2021, our article “Evidence Regarding Vitamin D and Risk of COVID-19 and Its Severity”-which you can download and read for free-was the second most downloaded study in this journal in the last 12 months. It was also #2 in citations and #4 in views.
The study with the most downloads in the past year and the most views was another vitamin D study by Bhattoa et.al, which found that vitamin D supplementation reduced the risk of influenza and COVID-19 infections and deaths. The co-authors of my article, Grant and Baggerly, were also co-authors of this article.
A third vitamin D study by Annweiler et.al. also ranked first among the most cited studies in the last 12 months. In this study, vitamin D supplementation was found to improve survival in frail elderly hospitalized with COVID-19.
Vitamin D is clearly the focus of many people’s attention, and I am glad that the Florida Surgeon General has also recognized its importance. While the mainstream media and many so-called health authorities still cling to the ridiculous claim that there is “no scientific basis” for recommending vitamin D for COVID, this is simply false.
As early as the end of September 2020, data from 14 observational studies – summarized in Table 1 of our paper – showed that vitamin D blood levels are inversely correlated with the incidence and/or severity of COVID-19. Many critics of vitamin D will argue that these correlations are not causal. However, there are statistical tools, such as the Bradford-Hill criteria, that can indeed be used to demonstrate a causal relationship if these associations are strong enough.
The Bradford-Hill criteria are a group of nine principles (i.e., strength of association, consistency of evidence, temporality, biological gradient, plausibility or mechanism of action, and coherence, with coherence still requiring experimental verification) that can be helpful in establishing epidemiologic evidence of a causal relationship between a suspected cause and an observed effect.
It has been widely applied in public health research and has shown that vitamin D insufficiency is indeed causal for COVID.
How Vitamin D Protects Against COVID
It’s important to know that your body is well-equipped to deal with just about any infection, provided your immune system is functioning properly, because it is your body’s first line of defense. Vitamin D receptors are found in a wide variety of tissues and cells, including your immune cells. This means that vitamin D plays an important role specifically in your immune function.
If vitamin D is lacking, your immune system is compromised, which in turn makes you more susceptible to infections of all kinds, including COVID-19. As explained in our article, getting enough vitamin D can reduce your risk for COVID-19 and other respiratory infections through several mechanisms, including the following:
- Reduction of the survival of viruses
- Inhibition of replication of viruses
- Reduction of inflammatory cytokine production
- Maintenance of endothelial integrity (endothelial dysfunction contributes to vascular inflammation and impaired blood clotting, two hallmarks of severe COVID-19)
Increase in angiotensin-converting enzyme 2 (ACE2) levels – Angiotensin II is a natural peptide hormone that increases blood pressure by stimulating aldosterone. ACE2 normally consumes angiotensin I, thereby lowering the concentration of angiotensin II. However, in SARS-CoV-2 infection, ACE2 is downregulated, leading to excessive accumulation of angiotensin II, which exacerbates the infection.
- Enhancement of overall immune function through modulation of innate and adaptive immune responses.
- Reduction of dyspnea
- Improving overall lung function
- Supporting the production of surfactants in the lungs, which promote fluid excretion
- Strengthening T-cell immunity, which plays an important role in the body’s defense against viral and bacterial infections. When vitamin D signaling is disrupted, it has a significant impact on the quantity, quality, breadth, and localization of CD8 T-cell immunity, leading to more severe viral and bacterial infections.
- According to a December 11, 202016 publication, a high-quality T-cell response actually appears to be much more important than antibodies in providing protective immunity against SARS-CoV-2, in particular
- Increasing the expression of antimicrobial peptides in your monocytes and neutrophils-both of which play an important role in COVID-19
- Enhancing the expression of an antimicrobial peptide called human cathelicidin, which helps defend against respiratory pathogens
In my view, vitamin D optimization is one of the simplest, least expensive, and most effective strategies to reduce the risk of severe SARS-CoV-2 infection and other respiratory infections.
Vitamin D optimization is especially important for dark-skinned people (who tend to have lower levels than whites if they do not spend much time in the sun), the elderly, and people with chronic pre-existing conditions. All of these are also risk factors for COVID-19, so population-wide optimization of vitamin D levels could significantly improve COVID outcomes in those most at risk.
How Vitamin D Affects Your COVID Risk
Currently, there are numerous studies showing that higher vitamin D levels have a positive impact on all stages of COVID-19. It:
Lowers the risk of testing positive for COVID – The largest observational study to date,17 which examined data from 191,779 American patients, found that of those who had vitamin D levels below 20 ng/ml (deficiency), 12.5% tested positive for SARS-CoV-2, compared with only 5.9% of those who had optimal vitamin D levels of 55 ng/ml or higher. This inverse association persisted across latitude, race/ethnicity, gender, and age groups.
Reduces risk of symptomatic disease-SARS-CoV-2-specific studies have found that COVID-19 is far more prevalent in individuals with vitamin D deficiency.
In one such study,18,19,20 82.2% of COVID-19 patients studied had vitamin D deficiency, compared with 47.2% of population-based controls. (The mean vitamin D level was 13.8 ± 7.2 ng/ml, compared with 20.9 ± 7.4 ng/ml in controls).
In addition, blood vitamin D levels were found to be inversely correlated with D-dimer levels (a measure of blood clotting). Many COVID-19 patients have elevated D-dimer levels, which are associated with blood clots. This was particularly true for the original SARS-CoV-2 virus, but although less common in subsequent variants, some blood clotting may still occur, albeit to a lesser degree.
Reduces severity of infection – Our vitamin D paper21 also includes data from 14 observational studies showing that vitamin D blood levels inversely correlate with the incidence and/or severity of COVID-19. This is quite logical given that vitamin D regulates the production of inflammatory cytokines-a lethal feature of COVID-19-and is an important regulator of the immune system.
Lowering the risk of hospitalization – A lower severity of disease would mean a lower risk of hospitalization, and that’s exactly what researchers have found.
A Spanish study22,23 found that baseline vitamin D levels were inversely correlated with risk of ICU admission, and that administration of supplemental vitamin D3 (calcifediol at a dose of 532 micrograms on the first day of admission, followed by 266 mcg on days 3, 7, 15, and 30) to hospitalized patients with PCR-confirmed COVID-19 reduced ICU admissions by 82%.
Reduces risk of death – COVID-19 patients with vitamin D levels between 21 ng/mL (50 nmol/L) and 29 ng/mL (75 nmol/L) had a 12.55-fold higher risk of death than patients with levels above 30 ng/mL in one study.24 A level below 20 ng/mL was associated with a 19.12-fold higher risk of death.
Another study25,26 found that the risk of severe COVID-19 and associated deaths virtually disappeared when vitamin D levels were above 30 ng/mL (75 nmol/L).
A third study27 found a significant difference in mortality depending on whether patients lived above or below the 35th parallel north. As the authors noted, adequate vitamin D supply “may be very important in preventing the cytokine storm and subsequent acute respiratory distress syndrome that is often the cause of mortality.”
Accelerates viral clearance – Although adequate vitamin D supply reduces the likelihood of infection and severe illness, oral vitamin D intake after infection may still contribute to faster recovery.
A study published in November 202029 found that oral vitamin D supplementation accelerated viral clearance in SARS-CoV-2-positive individuals with mild symptoms who also had low vitamin D levels.
Participants were randomized to receive either 60 000 IU of oral cholecalciferol (nano-liquid drops) or placebo for seven days. The target blood level was 50 ng/ml. Those who had not reached a blood level of 50 ng/ml after the first seven days continued to receive the supplement until they reached the target level.
At regular intervals, all participants were tested for SARS-CoV-2 as well as fibrinogen, D-dimer, procalcitonin and CRP, all inflammatory markers. The primary outcome of the study was the proportion of patients who tested negative for COVID-19 before day 21 of the study and changes in inflammatory markers.
Of the 16 patients in the intervention group, 10 (62.5%) had tested negative by day 21, compared with only five of the 24 control subjects (20.8%). Fibrinogen levels had also decreased significantly in the treatment group, indicating a lower tendency to clot.
How to Optimize Your Vitamin D Levels
For optimal health, immune function and disease prevention, you should have a vitamin D blood level between 60 ng/ml and 80 ng/ml throughout the year. In Europe, the target levels are between 150 nmol/L and 200 nmol/L.
If you live in a sunny area like Florida and get adequate sun exposure throughout the year, you may not need supplements. The DMinder app is a helpful tool for determining how much vitamin D your body can make depending on where you live and other individual factors.
Unfortunately, there are many people who do not get enough sun exposure for one reason or another, and in these cases, oral vitamin D supplementation may be necessary. Remember that the most important factor here is your blood level, not the dose, so get tested before you start so you know your baseline.
Below is an overview of how to determine if you need an oral supplement and what dosage is ideal for you:
- Measure your vitamin D level first – One of the easiest and least expensive ways to measure your vitamin D level is to participate in GrassrootsHealth’s Personalized Nutrition Project, which includes a vitamin D testing kit. Once you know your blood level, you can determine the dose you need to maintain or improve your level.
- Determine your individual vitamin D dosage – You can either use the chart below or GrassrootsHealth’s vitamin D* calculator to do this. (To convert from ng/ml to European measurement (nmol/L), simply multiply the ng/ml value by 2.5). To calculate how much vitamin D you are getting in addition to your supplementation from regular sun exposure, use the DMinder app.
Factors that can affect your vitamin D intake include your magnesium and vitamin K233 intake. Magnesium is needed for the conversion of vitamin D to its active form. If your magnesium levels are insufficient, orally ingested vitamin D may simply be stored in its inactive form.
Research from GrassrootsHealth40 shows that you need 146% more vitamin D to reach a blood level of 40 ng/ml (100 nmol/L) if you do not take supplemental magnesium, compared with taking vitamin D with at least 400 mg of magnesium per day.
It is best to take your vitamin D with magnesium and K2. According to GrassrootsHealth, “taking magnesium and vitamin K2 together has a greater effect on vitamin D levels than taking magnesium and vitamin K2 alone,” and “those taking both magnesium and vitamin K2 have higher vitamin D levels for a given vitamin D intake than those taking either magnesium or vitamin K2 or neither.”
Data from nearly 3,000 people found that 244% more oral vitamin D was needed for 50% of the population to reach a vitamin D level of 40 ng/ml (100 nmol/L) if they were not taking magnesium and vitamin K2 at the same time.
- Retest in three to six months – Measure your vitamin D level again in three to six months to assess how your sun exposure and/or supplement dose are working for you.
- Take activated vitamin D (calcitriol) if your level is low and you are sick with an acute infection such as COVID. The dose is 0.5 mcg the first day and then 0.25 mcg daily for seven days.
25. DMinder app