More Vitamin D and COVID-19


Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths




April 2, 2020; Vol. 12; No. 4

William B. Grant, Henry Lahore, Sharon L. McDonnell, Carole A. Baggerly, Christine B. French, Jennifer L. Aliano, Harjit P. Bhattoa. This study cites 157 references.




Neither UVB from the sun or supplemental vitamin D3 are the active form of vitamin D; both forms require a healthy liver and healthy kidneys to make the active form, 1, 25-dihydroxy vitamin D:




Our skin cells contain a molecule called 7-dehydrocholesterol (provitamin D3) which absorbs ultraviolet light B (UVB, wavelength 290-319 nm)



The absorption of UVB by provitamin D3 produces pre-vitamin D3 within the skin cells





Our body heat converts pre-vitamin D3 into vitamin D3 within the skin cell

(this is the same molecule as supplemental vitamin D3 )




Vitamin D3 exits the skin cell into the blood stream and travels to the liver where 25-hydroxy vitamin D (calcidrol) [25(OH)D] is produced


(this is what is measured in a standard blood vitamin D testing )




25-hydroxy vitamin D [25(OH)D] leaves the liver via the blood stream to the kidney




The kidney makes the active form of vitamin D 1, 25 dihydroxy vitamin D




This active form of vitamin D (1, 25 dihydroxy vitamin D) circulates throughout the body, binding to receptors in the nucleus of the cell influencing gene expression




“The seasonality of many viral infections is associated with low 25(OH)D concentrations, as a result of low UVB doses owing to the winter in temperate climates and the rainy season in tropical climates.”







“This article reviews the roles of vitamin D in reducing the risk of respiratory tract infections, knowledge about the epidemiology of influenza and COVID-19, and how vitamin D supplementation might be a useful measure to reduce risk.”




1) “The world is now experiencing its third major epidemic of coronavirus (CoV) infections.”

• A new CoV infection epidemic began in Wuhan, Hubei, China, in late 2019.

• Severe acute respiratory syndrome (SARS)-CoV, started in China in 2002.

• Middle East respiratory syndrome (MERS)-CoV, was first reported in 2012.



2) “The direct cause of death is generally due to ensuing severe atypical pneumonia.”




3) “Through several mechanisms, vitamin D can reduce risk of infections,”


• “Cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia, as well as increasing concentrations of anti-inflammatory cytokines.”



4) “Evidence supporting the role of vitamin D in reducing risk of COVID-19

includes that the outbreak occurred in winter, a time when 25-hydroxyvitamin D (25(OH)D) concentrations are lowest.”



5) Vitamin D deficiency contributes to acute respiratory distress syndrome.



6) “Case-fatality rates increase with age and with chronic disease comorbidity, both of which are associated with lower 25(OH)D concentration.”



7) The authors city 9 published reviews pertaining to the ways in which vitamin D reduces the risk of viral infections.

• “Vitamin D has many mechanisms by which it reduces the risk of microbial infection and death.”




8) Vitamin D reduces the risk of infection through 3 mechanisms:

• Physical barriers, the junctions:

•• Viruses disturb junction integrity, increasing infection by the virus and other microorganisms.


•• Vitamin D helps maintain tight junctions, gap junctions, and adherens junctions.


• Vitamin D enhances cellular innate (natural) immunity by induction of antimicrobial peptides: cathelicidin and defensins.


•• Cathelicidins exhibit direct antimicrobial activities against a spectrum of microbes, including bacteria, viruses, and fungi.


•• These “host-derived peptides kill the invading pathogens by perturbing their cell membranes and can neutralize the biological activities of endotoxins.”


• Vitamin D enhances adaptive (cellular) immunity.

•• This reduces the cytokine storm induced by the innate immune system.



9) Vitamin D reduces the production of pro-inflammatory cytokines and increases the expression of anti-inflammatory cytokines by macrophages.




10) “Serum 25(OH)D concentrations tend to decrease with age, which may be important for COVID-19 because case-fatality rates (CFRs) increase with age.”

• Older persons spend less time in the sun.

• Older persons have lower levels of 7-dehydrocholesterol in the skin.

Some pharmaceutical drugs reduce serum 25(OH)D concentrations, including, anti-epileptics, anti-neoplastics, anti-biotics, anti-inflammatory agents, antihypertensives, anti-retrovirals, and endocrine drugs. [Very Important]



11) Vitamin D supplementation can enhance endogenous antioxidation by increasing glutathione production.


• “The increased glutathione production spares the use of ascorbic acid (vitamin C), which has antimicrobial activities, and has been proposed to prevent and treat COVID-19.”



12) “A former director of the Center for Disease Control and Prevention, Dr. Tom Frieden, proposed using vitamin D to combat the COVID-19 pandemic on 23, March 2020.”



13) “Studies suggest that raising 25(OH)D concentrations through vitamin D supplementation in winter would reduce the risk of developing influenza.”




14) A study of 198 healthy adults examined the relationship between serum 25(OH)D concentration and incidence of acute RTIs (ARTIs):


• Maintaining 25(OH)D >38 ng/mL throughout the study was “associated with a significant twofold reduction in risk of developing ARTIs and with a marked reduction in the percentage of days ill.” [Important]



15) Other nutrients (in addition to vitamin D) associated with good health, were vitamin C, omega-3 fatty acids, and magnesium. [Important]



16) “Previous work suggested that higher UVB doses were associated with higher 25(OH)D concentrations, leading to reductions in the cytokine storm and the killing of bacteria and viruses that participate in pneumonia.”



17) The authors cite historical studies that suggest that darker skinned persons have much higher mortality rates and higher rates of chronic diseases than lighter skinned persons and suggest the disparity is at least partially linked to lower levels of vitamin D [melanin pigmentation reduces skin vitamin D synthesis].



18) A 2016 vitamin D3 trial in ventilated intensive care unit patients found:

Controls Supplemented w 250,000 IU Supplemented w 500,000 IU

25(OH)D Levels 21 ng/mL 45 ng/mL 55 ng/mL

Days in the Hospital 36 Days 25 Days 11 Days



19) “Vitamin D supplementation to raise serum 25(OH)D concentrations can help reduce hospital-associated infections.”

• “Concentrations of at least 40–50 ng/mL (100–125 nmol/L) are indicated on the basis of observational studies.”

• “Although the degree of protection generally increases as 25(OH)D concentration increases, the optimal range appears to be in the range of 40–60 ng/mL (100–150 nmol/l).”


• “From the literature, it is reasonable to suggest taking 10,000 IU/d for a month, which is effective in rapidly increasing circulating levels of 25(OH)D into the preferred range of 40–60 ng/mL.”


•• “To maintain that level after that first month, the dose can be decreased to 5000 IU/d.”


• “When high doses of vitamin D are taken, calcium supplementation should not be high to reduce risk of hypercalcemia.” [Important]

“During the COVID-19 epidemic, all people in the hospital, including patients and staff, should take vitamin D supplements to raise 25(OH)D concentrations as an important step in preventing infection and spread.” [Very Important]


20) “Vitamin D3 supplementation should be started or increased several months before winter to raise 25(OH)D concentrations to the range necessary to prevent acute respiratory tract infections (ARTIs).”



21) Patients who received 10,000 IU/d for a year, mean concentrations increased from 25 to 96 ng/mL. “No cases of vitamin D–induced hypercalcemia were reported.”



22) “Although 20 ng/mL seems adequate to reduce risk of skeletal problems and ARTIs, concentrations above 30 ng/mL have been associated with reduced risk of cancer, type 2 diabetes mellitus, and adverse pregnancy and birth outcomes.”

• “On the basis of the findings in several studies discussed here, as well as recommendations for breast and colorectal cancer prevention, the desirable concentration should be at least 40–60 ng/mL.”




23) “The U.S. Institute of Medicine noted that no adverse effects of vitamin D supplementation had been reported for daily doses <10,000 IU/d.”



24) Groups of people who were likely to have low concentrations of vitamin D and could benefit from higher concentrations include:

• Pregnant women

• The obese

• People with chronic diseases

• The elderly



25) For about half the population, taking 5000 IU/d of vitamin D3 would raise 25(OH)D concentration to 40 ng/mL.


• “Taking 6,235–7,248 IU/d as proposed to ensure that 97.5% of the population has concentrations >20 ng/mL would not exceed the 10,000-IU/d threshold.”




26) “Vitamin D supplementation is required for many individuals to reach 25(OH)D concentrations above 30 ng/mL, especially in winter.”



• “Daily or weekly vitamin D supplementation is recommended, as is the annual determination of serum 25(OH)D concentration for those with health risks.”



27) “Magnesium supplementation is recommended when taking vitamin D supplements. Magnesium helps activate vitamin D, which in turn helps regulate calcium and phosphate homeostasis to influence the growth and maintenance of bones.” [Very Important]

• “All the enzymes that metabolize vitamin D seem to require magnesium,

which acts as a cofactor in the enzymatic reactions in the liver and kidneys.”

• “The dose of magnesium should be in the range of 250–500 mg/d.”



27) “A recent review stated: ‘Although contradictory data exist, available evidence indicates that supplementation with multiple micronutrients with immunesupporting roles may modulate immune function and reduce the risk of infection’.”

• “Micronutrients with the strongest evidence for immune support are vitamins C and D and zinc.” [Key Point]



28) “To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d.” [Key]

• “The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL

(100–150 nmol/L).” [Key Point]

• “For treatment of people who become infected with COVID-19, higher vitamin D3 doses might be useful.”




I have reviewed many articles pertaining to vitamin D status and Immunology, pain, dementia, autism, and disc degeneration. My previous blog post was specifically on Vitamin D and Covid-19:


Vitamin D and Inflammation: Implications for Severity of Covid-19


This article supports supplementing to improve host health with:

Vitamin D3, about 5,000-10,000 daily

Magnesium, about 250-500 mg daily

Omega-3s. about 3000 mg daily of EPA + DHA

Vitamin C


And our final thought, the authors specifically state:

To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D 3 for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40–60 ng/mL (100–150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D 3 doses might be useful”.


As always, this blog post does not constitute medical advise, nor does it establish a doctor/patient relationship. This is informational based on a current literature review of published peer reviewed medical literature.

Vitamin D, RDA, COVID-19 and You!


Vitamin D, RDA, COVID-19 and You!


Many of you may not be aware of the growing research on the relationship between low levels of vitamin D and COVID-19 severity.


The importance of vitamin D with respect to immunity, cancer, neurologic diseases, joint pain, autoimmune disorders, depression, just to name a few, is vast in the literature. Its impact on respiratory diseases has long been well-known. So much so, I was surprised how little publicity vitamin D received when this new respiratory disease showed up (however see my last blog post on Vitamin D and COVID, May 2020)


I consider myself an orthopedic chiropractor, not a nutritionist, but I was quick to recommend to my patients to get their vitamin D levels up when COVID hit the scene. I’ve heard nothing but reinforcement about this since.


The latest discovery was that the RDA for vitamin D was wrong, by more than a factor of 10. The recommended 600 IU/day cannot raise D levels into the normal range. The actual calculated RDA was supposed to have been 8895 IU/day. This was pointed out in 2014 in the journal Nutrients. In the article titled “A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D” the authors pointed out

One of these recommendations is the Recommended Dietary Allowance (RDA). The RDA is the nutrient intake considered to be sufficient to meet the requirements of 97.5% of healthy individuals. The RDA for vitamin D is 600 IU per day for individuals 1 to 70 years of age and is assumed to achieve serum 25-hydroxyvitamin D (25(OH)D) levels of 50 nmol/L or more in 97.5% of healthy individuals.”

The authors concluded that:

The public health and clinical implications of the miscalculated RDA for vitamin D are serious. With the current recommendation of 600 IU, bone health objectives and disease and injury prevention targets will not be met”.


This was not the only such publication, and despite this dire observation no correction was ever made. Furthermore, medical doctors were cautioning patients not to take too much, and people became afraid to take more. Now, by some estimates, 42% of Americans are deficient, vulnerable to infection as well as many chronic and debilitating health issues. As low vitamin levels are worst among the elderly, and in part it helps explain their vulnerability.


As it is so unusual for someone with normal vitamin D levels to die from COVID, I have to ask the question, without such a mistake, why isn’t testing D levels a priority recommendation, particularly in nursing homes and communities for the elderly?


Because raising vitamin D levels can take time, it is probably not a valid treatment option once someone is sick, but I would recommend all communities, including ours, get it tested and respond appropriately.


This is by no means medical advice to you, nor am I making a “miracle cure” recommendation. I am simply pointing out some connections to this article and my previous COVID-19 and Vitamin D Blog post. I would recommend, before downing large dose of Vitamin D, to get tested and know exactly where you are. Then take some Vitamin D and in 90 days retest to see if the dosage you took made a difference and achieved the levels you were looking for. GO GET TESTED.


Dr. Garreth MacDonald

Chiropractic Physician

Cascade Health Center



Veugelers PJ, Ekwaru JP. A statistical error in the estimation of the recommended dietary allowance for vitamin D. Nutrients. 2014;6(10):4472-4475. Published 2014 Oct 20. doi:10.3390/nu6104472.

Omega-3 and the ‘COVID Storm’

Inflammation Resolution:

A Dual-Pronged Approach to Averting Cytokine Storms in COVID-19?

Cancer and Metastasis Reviews

May 2020

Dipak Panigrahy, Molly M. Gilligan, Sui Huang, Allison Gartung, Irene Cortés-Puch, Patricia J. Sime, Richard P. Phipps, Charles N. Serhan, Bruce D. Hammock. These authors are from the Harvard Medical School and the University of California, Davis.


In his 2008 book How the Immune System Works, Lauren Sompayrac, PhD, notes that the Innate Immune system (phagocytosis system) “rules” the Adaptive Immune System (antibody producing system); And that the primary cell of the innate immune response is the macrophage (there is a great picture on the cover of his book of a macrophage attacking a bacterium).


[Eicosa] is the Greek work for 20. Eicosanoids are hormone-like molecules that are synthesized from 20-carbon long polyunsaturated fatty acids. These fatty acids are classified as being either omega-6 or omega-3.

In their 1996 book Protein Power, physicians Michael and Mary Eades (MDs) state:

“Eicosanoids, a gang of at least 100 powerful hormone-like substances that control virtually all physiological actions in your body. The most important thing about eicosanoids is to keep them in balance.”


Eicosanoids “are the most powerful agents known to [hu]man, yet they are totally controlled by the diet.”


“Eicosanoids exert major effects on just about everything that goes on in the body.”

They continue to describe how the definition of health is one’s balance of inflammatory (bad) and anti-inflammatory (good) eicosanoids.


An important aspect of essential fatty acid biology is that the 20-carbon long omega-6 and omega-3 fatty acids are the precursors to a group of powerful but short-lived hormone-like compounds called “eicosanoids.” One category of eicosanoids is referred to as prostaglandins. Another group is referred to as leukotrienes. Clinical applications of this biochemistry are summarized here:


1) “Severe coronavirus disease (COVID-19) caused by the SARS-CoV-2 virus is frequently characterized by pulmonary inflammation.”

2) “Severe coronavirus disease (COVID-19) is characterized by pulmonary hyper-inflammation and potentially life-threatening ‘cytokine storms’.”

• “Life-threatening ‘cytokine storms’ involving the release of pro-inflammatory cytokines (e.g., TNF-α, IL-6, IL-1, IL-8, and MCP-1) may contribute to the rapid systemic organ failure observed in select critically ill COVID-19 patients.”

• “Controlling the local and systemic inflammatory response in COVID-19 may be as important as anti-viral therapies.” [Important]


3) Eicosanoids play a critical role in the induction of inflammation and proinflammatory cytokine production . [Key Point]


• “SARS-CoV-2 may trigger a cell death (‘debris’)-induced ‘eicosanoid storm’, including prostaglandins and leukotrienes, which in turn initiates a robust inflammatory response.”

• “SARS-CoV-2 causes massive cell death and cellular debris that activates inflammasomes, which in turn trigger a macrophage-derived ‘eicosanoid storm’, a surge of pro-inflammatory bioactive lipid mediators, such as prostaglandins and leukotrienes, that fuels local inflammation.” [Key Point]


4) “A paradigm shift is emerging in our understanding of the resolution of inflammation as an active biochemical process with the discovery of” resolvins which “resolve” inflammatory eicosanoids. [Key Point]


• Resolvins “counter pro-inflammatory cytokine production, a process called inflammation resolution.” [Key Point]


• Resolvins “and their lipid precursors [omega-3s] exhibit anti-viral activity at nanogram doses in the setting of influenza without being immunosuppressive.”

• Resolvins “also promote anti-viral B cell antibodies and lymphocyte activity, highlighting their potential use in the treatment of COVID-19.”

• Other eicosanoid derived molecules stabilize arachidonic acid driven inflammation and activate anti-inflammatory processes “preventing the cytokine storm.”

• Resolvins and other eicosanoid derived molecules “attenuate pathological thrombosis and promote clot removal, which is emerging as a key pathology of COVID-19 infection.”

• This resolution of inflammation in COVID-19 may reduce “acute respiratory distress syndrome (ARDS) and other life-threatening complications associated with robust viral-induced inflammation.”

• These anti-inflammatory strategies (“stimulating inflammation resolution”) may benefit COVID-19 management of “via debris clearance and inflammatory cytokine suppression.”

5) The resolution of inflammation is an active biochemical process, and hyperinflammation may result from a deficit in the active anti-inflammatory biochemical process.

• “Endogenous pro-resolution lipids [omega-3 fatty acids] can terminate the inflammatory response.”

6) Specialized pro-resolving inflammatory mediators including resolvins and other eicosanoid derived molecules “mediate endogenous resolution by stimulating macrophage phagocytosis of cellular debris and countering the release of proinflammatory cytokines/chemokines.”

• Loss of these inflammation resolution mechanisms will sustain pathologic inflammation.

7) Resolvins “promote anti-viral B lymphocytic activity in influenza, suggesting they may be a promising therapy for COVID-19.” [Important]


• Resolvins also “protect against primary influenza infection and promote adaptive immunity.”

8) Resolvins and other eicosanoid derived molecules “downregulate the transcription regulator NF-κB, the center of eicosanoid-induced cytokine storms, which promotes the induction of pro-inflammatory cytokines and prostaglandin synthesis via cyclooxygenase (COX).”

9) Resolvins and other eicosanoid derived molecules “terminate self-sustaining inflammatory processes, such as those induced by COVID-19, by broadly inhibiting proinflammatory cytokine production and promoting a return to tissue homeostasis.”

10) Resolvins and other eicosanoid derived molecules “act at significantly lower doses and are not immunosuppressive.” [Important Point]


• In contrast “conventional anti-inflammatory agents such as NSAIDs and COX-2 inhibitors, while limiting the eicosanoid storm, may be ‘resolution toxic’ as they indiscriminately inhibit eicosanoid pathways that produce resolution mediators and thereby prevent active resolution.”

[meaning they also inhibit the omega-3 eicosanoid pathways]


• Inhibiting the resolution mediator pathway with conventional anti-inflammatory agents such as NSAIDs and COX-2 inhibitors “may potentially facilitate COVID-19-induced tissue injury and progression of infection.” [A critical point: NSAIDs and COX-2 inhibitors may worsen the tissue injury and the progression of infection, which would include risk of death.]


11) “As demonstrated in many inflammatory disease models, selectively promoting endogenous inflammation resolution mechanisms clears inflammatory exudates more effectively and promotes a return to tissue homeostasis compared with classic anti-inflammatory agents [drugs].” [Key Point]


12) “Thus, activating endogenous resolution pathways [with omega-3 fatty acids] may be a novel therapeutic approach to limit severe organ damage and improve outcomes in COVID-19 patients.”


This article generated this publication (in part) in the lay press:


COVID-19 Supplements:

US Study Finds That Resolvins From Omega-3 Fatty Acids Could Prevent

COVID-19 Cytokine Storms

Thailand Medical News

May 13, 2020


“Resolvins are specialized pro-resolving mediators (SPMs) derived from omega-3 fatty acids, primarily eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).”

“Medical researchers from the Harvard Medical School, University of California-Davis, Virginia Commonwealth University and Institute for Systems Biology, Seattle have discovered that chemical molecules called resolvins … could help prevent the cytokine storms caused by the COVID-19 disease.”

“The research was published in the journal Cancer & Metastasis Reviews and the study was led by Assistant Professor Dr. Dipak Panigrahy and Dr. Molly Gilligan, both from Harvard Medical School.”

“The researchers studied the human body’s robust inflammatory response to the SARS-CoV-2 virus, which is now recognized as a hallmark symptom and observed that severe COVID-19 illness can result in excessive inflammation throughout the body, including the lungs, heart and brain.”

“Rather than blocking cytokines, medical staff could turn off virus-induced inflammation by broadly activating the body’s natural inflammation-clearing activities.”

“Resolvins and other SPMs stimulate macrophage-mediated clearance of debris and counter pro-inflammatory cytokine production, a process called inflammation resolution. SPMs and their lipid precursors exhibit anti-viral activity at nanogram doses in the setting of influenza without being immunosuppressive. SPMs also promote anti-viral B cell antibodies and lymphocyte activity, highlighting their potential use in the treatment of COVID-19.”

Dr. Gilligan notes, “We are now recognizing the importance of controlling this robust nflammatory response in COVID-19 infection in order to reduce associated organ damage and mortality.

Finding new ways to dampen the body’s inflammatory response to COVID-19 will likely be as important as finding effective antiviral therapies to control COVID-19 infection and reduce life-threatening organ damage. Moreover, these Resolvins have been found to be non-toxic and nonimmunosuppressive in ongoing clinical trials for other inflammatory diseases, making them even more promising candidates for rapid clinical translation.”

Among significant findings from the study are:

• A major effect of SARS-CoV-2 infection is a cytokine storm, which is a drastic increase in immune cell production of cytokines.

• COVID-19 disease can cause unchecked inflammation that can cause extensive organ damage, such as lung failure.

• Present therapeutic strategies in COVID-19 focus on inhibiting a single proinflammatory cytokine [with a drug] rather than broadly inhibiting the body’s inflammatory response.

• Resolvins are lipid mediators derived from omega-3 fatty acids and serve as the body’s natural “stop” signals to inflammation.

•• “The medical researchers found that increasing levels of these resolvins or lipid mediators in the body could be a new therapeutic approach to preventing life-threatening inflammation caused by SARS-CoV-2.”

•• “What is exciting for us is that these lipid mediators that ‘turn off,’ or resolve, inflammation are already in clinical trials for other inflammation-driven diseases, such as eye disease, periodontal disease and pain. The mediators can quickly be applied to turn off inflammation in COVID-19 patients.”

•• “What makes resolvins ideal is that there are basically derived from omega-3 fatty acids that are already proven safe for human consumption, are inexpensive, easily available and consumed.”

The article cautions “that if anyone suspects that they have contracted COVID-19 disease, do no attempt to self-treat but instead immediately report to local health authorities or a nearby hospital and also prior to consuming any supplements, always check first with a doctor.” And as this write-up is in NO WAY medical advice, I too recommend heading in to get checked if you have the symptoms.


Over the decades I have reviewed/read dozens of articles showing the health benefits of omega-3 fatty acids. Towards the end of last summer, I increased my intake of Omega-3 from about 3,000 mg daily to closer to 4,000-5,000 mg daily after reading the 2016 book “When Brains Collide: What Every Athlete and Parent Should Know About the Prevention and Treatment of Concussions and Head Injuries”, written by Michael D. Lewis, MD. But the reasons for that require another blog post.

This article adds that adequate levels of omega-3s may reduce the adverseness of the COVID-19 “eicosanoid and cytokine storms,” reducing symptoms, improving clinical outcomes, and possibly reducing deaths.

The bottom line is that this is another reason to take omega-3s, as eicosanoid balance is an important factor in optimizing host health.

My family and practice use the Nutri-West brand: 800-443-3333

See the summary graph below: