Introduction

As a response to the current pandemic, new theories and research examining the pathogenesis and treatment of COVID-19 are becoming available. Recently, research examining vitamin D status and its possible link to COVID-19 risk has been quickly evolving. Through a review of literature, we aim to summarize the available information and provide an update on research. At the present time, available literature specific to COVID-19 and vitamin D is limited and lacks rigorous placebo-controlled human trials. To help provide more information on the possible effects of vitamin D status, we have also included research examining the connection between vitamin D status, acute respiratory distress syndrome (ARDS), and acute respiratory infections. More information specific to vitamin D status and supplementation related to COVID-19 is necessary to improve evidence-based clinical decisions in patient care.

Examining the evidence

Outlined below are summaries of published research articles that support the use of vitamin D. Each section is split into its respective condition.

COVID-19

There appears to be a positive correlation between low vitamin D plasma concentration and positive testing for COVID-19. Considering vitamin D modulates inflammation, it is theorized that higher-risk groups may benefit from supplementation.

The role of vitamin D in the prevention of coronavirus disease 2019 infection and mortality.

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This study aimed to assess any association between vitamin D levels, cases of COVID-19, and COVID-19 related mortality. An analysis of literature pertaining to vitamin D levels in various European countries and their reported cases of COVID-19 was performed. A negative correlation between mean levels of vitamin D (average 56 mmol/L) and COVID-19 cases was found in each country, as well as a negative correlation between serum vitamin D levels and COVID-19 mortality rates were also observed. This study also noted that older populations tend to have lower levels of vitamin D.

25-hydroxy vitamin D concentrations are lower in patients with positive PCR for SARS-CoV-2.

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A retrospective analysis of vitamin D plasma concentrations was performed on a cohort of older adults being tested via the nasopharyngeal severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) PCR test. Lower vitamin D levels were found in patients who tested positive forSARS-CoV-2, compared to those who tested negative. The median value of serum vitamin D was 11.1 ng/mL in those that tested positive, whereas those that tested negative had a median value of 24.6 ng/mL.

Potential role of vitamin D in the elderly to resist COVID-19 and to slow the progression of Parkinson’s disease.

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A recent literature review compared relationships between Parkinson’s disease(PD), vitamin D status, andCOVID-19.The review found that vitamin D levels impacted Th2 and regulatory T cell response. Since Th1 responses are subsequently down regulated; this mechanism is thought to help decrease pro inflammatory cytokines. Additionally, vitamin D may help down-regulate ACE2 receptors and decrease the risk of COVID-19.This study suggests that vitamin D deficiency may increase the risk ofCOVID-19, particularly in elderly and PD patients who are susceptible to deficiency. Supplementation of vitamin D may, therefore, reduce the risk and severity of COVID-19, as well as improve symptoms of PD and quality of life.

Evidence that vitamin D supplementation could reduce the risk of influenza and COVID-19 infections and deaths.

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A literature review of vitamin D serum levels and how supplementation may reduce the risk for COVID-19 was performed. Vitamin D status was found to be low during the winter season which correlated with the timing of the outbreak. Based on the winter outbreak of COVID-19, it is theorized that lower vitamin D levels may increase the risk of contracting COVID-19.

Acute respiratory distress syndrome (ARDS)

Decreased levels of serum vitamin D3 correlate positively with diagnoses of ARDS.

Effect of vitamin D deficiency in Korean patients with acute respiratory distress syndrome.

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Through a retrospective analysis, serum levels of 25-hydroxy vitamin D3 were analyzed in a population of patients diagnosed with ARDS. Vitamin D deficiency was found to have an increased prevalence in patients with ARDS. Mortality rates were not associated with decreased levels of serum vitamin D3.

Vitamin D deficiency contributes directly to the acute respiratory distress syndrome (ARDS).

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Human, murine, and in vitro methods were used to observe vitamin D deficiency and its impact on ARDS prevalence and severity. Human models displayed correlations of vitamin D deficiency in subjects with ARDS. Murine models demonstrated increased alveolar inflammation and epithelial damage when vitamin D deficiency was induced. In vitro results expanded on this by showing tropic effects in cells.

Acute respiratory infection

VitaminD (any form, any duration) supplementation appears to result in a decreased prevalence of ARI orARTI. Decreased levels of serum vitamin D are associated with elevated risk of ARTI.

Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data.

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A systematic review and meta-analysis utilizing randomized controlled human trials sought to assess the effect and risk factors associated with vitamin D supplementation on the risk of acute respiratory tract infection (ARTI). An analysis of 25 randomized controlled trials (RCTs) found that vitamin D supplementation reduced the risk of ARTI in patients. Protective effects were found to be more beneficial in populations with baseline vitamin D levels less than 25 nmol/L, though patients with levels equal to or more than 25 nmol/L still experienced benefits. Vitamin D supplementation resulted in an overall reduction of ARTI.

Acute respiratory tract infection and 25-hydroxy vitamin D concentration: a systematic review and meta-analysis.

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An analysis of observational studies was completed in this systematic review and meta-analysis, focusing on identifying the connections between vitamin D concentration and ARTI. Serum level concentrations were found to have a non-linear, inverse relationship between vitamin D serum levels and ARTI risk. Notably, an increased risk of ARTI was observed at serum concentration levels of vitaminD below 37.5 nmol/L.

High-dose monthly vitamin D for the prevention of acute respiratory infection in older long-term care residents: a randomized clinical trial.

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A randomized controlled trial with a placebo group compared high and standard doses of vitamin D and its effects on acute respiratory infection (ARI) incidence. The high dose group received100,000 IU monthly. The standard dose group received a placebo if their daily regime included 400-1,000IU per day or a monthly dose of 12,000 IU for those taking less than 400 IU per day. Incidence rates ofARI in the high dose group were significantly lower than in the standard dose group. It is important to note that higher rates of falls, but no increase in fracture, were also observed in the high dose group.

The bottom line

Preliminary findings show that vitamin D status may be beneficial in determining the risk for COVID-19 and other respiratory illnesses. Compared to mean vitamin D levels in specific populations (e.g., elderly individuals), decreased serum vitamin D may indicate high risk for the conditions above. In light of the evolving information regarding the COVID-19pandemic, the goal of this review is to provide insights into the latest research on vitamin D status as it relates to COVID-19, ARDS, and ARI. These early findings are crucial to help strategize possible treatments and improve future clinical trials. Randomized placebo-controlled human trials are necessary in order to provide the level of evidence best suited to clinical practice. 

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The Northern Colorado Independent Practice Association goals are to:

Keep medical practices viable

Maintain patient-physician relationships

And to help practices provide the best care for their patients.

Read Dr. Fields’ interview with the physicians network below!

Dr. Jackie Fields is the kind of person who radiates peacefulness from the inside. As she speaks, it washes over those listening to her. She is a doctor of Family Medicine, and a specialist in Integrative/Functional Medicine. Her mission is to help her patients find better health and happiness while improving the community and the planet we all live in. Her passion for medicine and healing started at a young age, as she watched her father – a surgeon – care for his patients with tremendous love and compassion. Her mother, from Italy, created healing foods and taught that food was the source of health. As Dr. Fields was finishing high school her mother was diagnosed with an acoustic neuroma. By her first year in college, she accompanied her mom to Massachusetts General for a 12-hour brain surgery. While her mom was ill, she studied and learned about the research that renowned Dr. Bernie Siegel, a Yale surgeon, was doing on psychoneuroimmunology. His expertise lies in mind-body medicine and the relationship between the patient and the healing process. Around this time, she wrote him to ask about his approach to medicine and how she could get trained in this approach to medicine. Dr. Siegel responded immediately and became a mentor to her throughout medical school and her medical training.

As she finished college, Dr. Siegel became the first president of the American Board of Holistic Medicine and invited Jackie to the first national meeting! At this meeting, she was the youngest invitee and it was here she met many of her future mentors including: Dr. Andrew Weil, Patch Adams, Christiane Northrup, and Deepak Chopra. After meeting and connecting to these amazing paradigm shifters in medicine, it became clear medical school was her path and these fantastic mentors would inspire her to create the dream clinic that would serve people better in mind and body. Dr. Fields had a fascination with indigenous medicine, mostly because in these cultures it was evident that the mind was never separated from the body in treatment and the wisdom of plant medicine was not lost. This fascination led her to traveling around the world to learn and train with Indigenous healers. Her main travel destinations were mainly located in central and South America.

Dr. Fields proudly states that practicing Integrative Medicine has given her, “27 years of miraculous healing stories with her patients.” She believes in using allopathic medicine when necessary, but for chronic issues an integrative approach serves the patient much better. Her patients take an active part in their own healing and health journeys and take part in co-creating a plan to reach their own personalized health goals. Dr. Fields uses a functional and integrative medicine approach, as she likes to keep all options on the table for patients’ unique healthcare needs. She addresses each patient’s physical, emotional, social, environmental, and spiritual health issues individually. She also believes in creating a “big picture” view – and is willing to coordinate patients’ medical care with other providers to make sure her treatment plan takes all the patient’s health care needs into account.

“Integrative medicine is less harmful to the human body overall,” states Dr. Fields. It is important to empower and educate patients about what they can do to shift their health by changing their diets and lifestyle. Dr. Fields says, “Eighty percent of chronic disease can be healed with lifestyle changes…now that’s health care reform”. This approach is especially powerful when figuring out and helping people in their recovery from complex, chronic medical conditions. Some of the patients she sees may have already been to 10 different providers and have given up hope by the time they see Dr. Fields. After consulting with her about options, they realize there really is hope for them, by taking an integrative medicine approach. Her clinic includes all methods and modalities. While she is duel Board Certified in Family Medicine and Integrative Medicine, her integrative center has experts in nutrition, botanicals, supplements, acupuncture, homeopathy, physical medicine, holistic psychotherapy, and mind-body medicine.

Dr. Fields learned that even if a patient eats a nutrition diet, often chemicals in products they are using will cause adverse reactions. After years of research and consulting with pharmacists and experts, she formulated her own line of skin care products which is called “Dr. Fields’ Sacred Skin.” She has taken the Safe Cosmetics Pledge not to use any known carcinogens, hormone disruptors or toxic chemicals in her skin care products. More about her products can be found on the practice website (listed at the end of this article) and in her natural pharmacy located at her practice. A percentage of profits from these product sales goes towards funding The Healing Gardens Foundation. This foundation is a non-profit organization formed by Dr. Fields with the purpose of supporting education and research in integrative medicine and helping fund patients unable to afford these modalities.

The Healing Gardens Foundation created a vibrant and healing garden for all to enjoy, free of charge. It is planted in the form of a Native American medicine wheel to teach people where their medicine really derives from. The Gardens include a variety of plants with significant medicinal properties for healing. The Gardens are located at 315 Canyon Avenue, at the intersection of Olive Street and Canyon Avenue in Fort Collins.

So, what inspires such an inspiring woman? “Inspiring healers!” she exclaimed,  along with “competence and curiosity.” Her drive and passion is fueled and nourished by her family, local community, and the simple awe of what nature has to offer.                                                                                                                                                                                             

This article is directly from the UCHealth website.

What is convalescent plasma?

The management of COVID-19 has mainly focused on infection prevention, case detection and monitoring, and supportive care. There is no specific anti-SARS-CoV-2 (COVID-19) treatment recommended at this time because of the absence of evidence, according to the World Health Organization (WHO).

However, people who recover (convalesce) from COVID-19 make antibodies against the virus in the plasma component of their blood. And evidence shows that this convalescent plasma can be used as a treatment for patients with COVID-19 without the occurrence of severe adverse events.

UCHealth has already treated patients using this blood and is looking to identify potential donors of convalescent COVID-19 plasma to be able to treat more COVID-positive patients across the state.

Do I qualify?

COVID-19 convalescent plasma may only be collected from COVID-19 recovered individuals if they are eligible to donate blood.

You must have:

• Prior diagnosis of COVID-19 documented by a laboratory test.
• Complete resolution of symptoms at least 14 days before the donation.
• Meet all requirements for blood donation.
• More details are outlined in the FDA guidelines.

What if I had symptoms of COVID-19, but never got a test?

If you suffered from a respiratory illness over the last eight weeks and believe you may have been exposed to COVID-19, you may be eligible to donate plasma in the near future. Please fill out one of the forms below, depending on where you live. Then, if the opportunity arises for you to donate plasma, coordinators will follow up with you soon. Thank you.

What do I do next?

• In Northern Colorado: Contact Kaitlin Zobel: 970.495.8987, or fill out this form and someone will contact you. Details on their process and scheduling can be found here.
• Outside Northern Colorado: Contact the UCHealth convalescent plasma hotline: 720.848.8888, or fill out this form and someone will contact you.

Where can I find more information?

• The Colorado COVID-19 Convalescent Plasma Project Consortium
• UCHealth Today’s COVID-19 page.
  • UCHealth Today article: Donating plasma for COVID patients new push in fight against deadly virus
  • UCHealth Today article: ‘Huge’ milestone: Colorado’s first convalescent plasma recipient leaves ICU after 34 days on a ventilator