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New Study Claims to Show Vitamin D Doesn’t Help Against Covid. Here’s What They Did Wrong

by Rachel Nicoll and Michael Henein
26 November 2022 9:00 AM

Seven meta-analyses and systematic reviews (1,2,3,4,5,6,7) and three later clinical trials (1,2,3) argued that low vitamin D status increased susceptibility to COVID-19 and the risk of greater disease severity and mortality. Furthermore, there are five meta-analyses and systematic reviews of vitamin D supplementation for the prevention of acute respiratory infection (ARI) and COVID-19, as well as a later clinical trial, all showing that supplementation can protect against COVID-19 infection, disease severity and death. The evidence could not be much more conclusive than this.

Consequently, it was surprising to learn about Joliffe et al.’s recent randomised controlled trial of vitamin D to prevent ARIs and COVID-19, which concluded that: “Among people aged 16 years and older with suboptimal vitamin D status, implementation of a population level test-and-treat approach to vitamin D supplementation was not associated with a reduction in risk of all cause acute respiratory tract infection or COVID-19.”

Joliffe et al.’s U.K. study was a test-and-treat approach used to determine the effect of correcting suboptimal vitamin D status (25-hydroxyvitamin D (25(OH)D) < 75 nmol/L) on the risk of contracting ARIs and COVID-19. Those with 25(OH)D < 75 nmol/L (30 ng/mL) were randomised to six months of supplementary vitamin D at 3200 IU/day, 800 IU/day, or no supplements. The outcome was the percentage of subjects with confirmed ARI or COVID-19.

What was different about this trial that might have caused it to fail? Analysis of Joliffe et al.’s paper gives rise to a number of observations.

Of particular importance was the treatment of participants randomised to ‘No supplementation’. Instead of being given a placebo, as would be normal in a controlled study, they were given nothing and were informed that it was a vitamin D trial, thereby alerting them to the fact that vitamin D supplementation could be an important infection preventive in the middle of the COVID-19 pandemic. As a result, almost 50% reported taking their own vitamin D supplements. We do not know what level of supplementation these participants took and we can assume that if 50% reported supplementation, the actual number was probably higher. As Dr. David Grimes noted in a BMJ Rapid Response, this was therefore “a randomised uncontrolled study” [18]. Consequently, any comparison of the intervention arm with the ‘no supplementation’ arm was rendered meaningless. The authors sought to overcome this limitation by conducting sensitivity analysis, but this is no substitute for conducting a properly controlled trial.

Furthermore, the authors took the unusual step of retesting those who had baseline vitamin D levels of ≥75 nmol/L (≥30 ng/mL) after two months. If they now proved to have vitamin D levels of <75 nmol/L (<30 ng/mL), they were included in the study and supplemented for four months. These new participants amounted to 11% in the lower dose group and 20% in the higher dose group, which again risks distorting the results as they would have been less likely to benefit from vitamin D, as their second attempt at a baseline level would almost certainly have been only slightly below 75 nmol/L (30 ng/mL).

Following on from the first observation, most of the results depended upon all three groups actually telling the truth about the amount of supplemented vitamin D, whereas it is well known that participants respond to questionnaires in a manner designed to minimise criticism to themselves. For example, in the intervention arm, 90.9% reported that they took supplements at least six times a week. Based on the findings of other studies, this degree of adherence seems high. According to the authors, the fact that those retested showed a significantly higher vitamin D level compared with the ‘control group’ provides “objective evidence of a high level of adherence”. Though it indicates some adherence, it is not possible to make this kind of judgement merely from an increase from baseline levels. Elsewhere in sensitivity analysis, it appears that 94% claimed to have taken supplements “more than half the time”. How much more? If they only took the supplements for half the time, this would render a dose of 3200 IU/day an effective dose of 1600 IU/day.

The authors report that not even 60% were tested for vitamin D levels at the end of the trial, but there was no sub-group analysis to determine whether the supplements raised vitamin D levels to a level shown previously to be protective against ARIs and COVID-19. Interestingly, the ‘control’ group had a mean level of 66.6 nmol/L (26.6 ng/mL), suggesting that their supplementation was probably considerable; a recent large European study found that the U.K. had the second lowest mean vitamin D levels at 47 nmol/L (18.8 ng/mL). Given that the mean age of the participants in this Jolliffe et al. study was >60, this mean level of 66.6 nmol/L (26.6 ng/mL) was all the more remarkable since the elderly are known to have lower vitamin D levels.

What target blood level should have been attempted in this supplementation trial? While it is clear from a meta-analysis that baseline vitamin D levels of <75 nmol/L (<30 ng/mL) were associated with increased COVID-19 infection, hospitalisation, ICU admission, and mortality, few studies actually assess a minimum effective blood level to avoid these outcomes. Seal et al. show that the risk of hospitalisation or mortality continues to decrease up to at least a blood level of 150 nmol/L (60 ng/mL). This was considerably higher than the level achieved in Joliffe et al.’s higher dose supplementation group (102.9 nmol/L or 41.16 ng/mL). Another study by Borsche et al. conducted regression analysis to determine that zero COVID-19 mortality could be achieved at a vitamin D blood level of 125 nmol/L (50 ng/mL), again considerably higher than levels achieved in Joliffe et al.’s study. The Borsche et al. authors recommend raising serum vitamin D to 125 nmol/L (50 ng/mL) in order to save the most lives, even in patients with comorbidities.

The dosage may also have contributed to the apparent failure of this trial. Even the higher group dosage of 3200 IU/day (supposing that all participants took it every day) was considerably lower than the dosage used in many successful trials. Bergman et al. showed that 4,000 IU/day given for one year was effective in preventing respiratory tract infections in those who suffered frequently, while 4,000 IU/day for one month also achieved a lower COVID-19 infection rate, the risk reducing with increasing vitamin D levels, and a dose of 5,000 IU/day versus 1,000 IU/day in mild-moderate COVID-19 patients for two weeks reduced the recovery time for cough and gustatory sensory loss. Supplementation to achieve a vitamin D blood level of 75 nmol/L (30 ng/mL) also decreased the risk of COVID-19 infection, severe disease and mortality. These trials suggest that either a dose of at least 4,000 IU/day would be appropriate or that participants supplement to achieve a blood level of at least 125 nmol/L (50 ng/mL), as per the Borsche et al. study, but preferably 150 nmol/L (60 ng/mL), as per the study by Seal et al. As previously mentioned, without testing all participants at the end of the study, it is impossible to determine the true adherence to the allocated doses. Because many of these trial subjects were elderly, it is worth bearing in mind that they will need a higher dose of vitamin D for it to be effective.

An analysis of outcomes based on baseline vitamin D levels is sadly lacking. In fact, the authors state that outright vitamin D deficiency (<25 nmol/L or 10 ng/mL) at baseline was rare, and the study therefore lacked power to detect an intervention effect in this group, who are more likely to derive clinical benefit from supplementation.

In fact, Grant et al. warn of the problems of designing clinical trials of vitamin D in a similar manner to randomised controlled trials (RCTs) of therapeutic drugs, through failure to recognise that vitamin D is a nutrient with a unique metabolism requiring specific consideration in trial design. They show that RCTs of vitamin D can fail for several reasons, all of which are relevant in Joliffe et al.’s study: few participants have low baseline 25(OH)D concentrations; relatively small vitamin D doses; participants ingesting other sources of vitamin D; results being analysed without consideration of 25(OH)D concentrations achieved. Grant et al. recommend designing an RCT using adjustable vitamin D supplementation based on serum 25(OH)D concentrations to achieve target 25(OH)D levels, as was successfully carried out by Gönen et al.

Finally, a point about vaccination. Unfortunately, the Joliffe et al. study was conducted during the vaccine rollout. Those who had received one or more doses of the vaccine at baseline were 2.5%, while over 89% had received one or more doses by the end of the study. There is no discussion of what the impact of this might have been on the results and the authors state that they did not carry out a sensitivity analysis. Nevertheless, they claim that sub-group analysis showed that there was “no effect of vitamin D on risk of COVID-19 either before or after COVID-19 vaccination”.

Nevertheless, increasing evidence shows that vaccination inhibits both a normal innate and adaptive immune response, impairs type 1 interferon signalling and increases inflammation, making individuals more susceptible to COVID-19. We can see the impact of this in two U.K. studies, one showing that participants with two doses of the vaccine were 44% more likely to be infected with COVID-19 more than 14 days after vaccination and the other showing that vaccine effectiveness against COVID-19 turned negative after 80 days. Elsewhere, a preprint paper showed that vaccination could increase risk of Omicron infection by up to 27% after five months, with negative effectiveness for three doses against four out of five Omicron subvariants, and showing that a greater number of vaccinations could give rise to a higher risk of infection. A Lancet preprint study also found negative vaccine effectiveness against Omicron infection with two doses after 15 weeks and negative vaccine effectiveness against hospitalisation and death after a year. Furthermore, in the elderly, another preprint study found that impaired vaccine responses contributed to their increased susceptibility to COVID-19 infection. These findings suggest that Jolliffe et al. were unwise to ignore vaccination as a confounding factor, since the higher risk of COVID-19 infection in the vaccinated may have rendered their relatively small vitamin D dose ineffective.

Overall, this study by Joliffe et al., represents a wasted opportunity and proposes conclusions which are not warranted by the study methodology. We consider that raising vitamin D status in those with sub-optimal levels remains a valid means of protection against ARIs and COVID-19.

Rachel Nicoll and Michael Y. Henein and researchers in the Department of Public Health and Clinical Medicine and Heart Centre, Umea University, Sweden. This article was first published as an editorial in the Journal of Clinical Medicine.

Tags: COVID-19Randomised controlled trialThe ScienceTreatmentsVitamin D

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46 Comments
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peyrole
peyrole
4 years ago

Heil Johnson!

35
0
iane
iane
4 years ago
Reply to  peyrole

Well, yes, but remember there is only one true god: and He resides in heaven No 10!

8
0
Richard Austin
Richard Austin
4 years ago
Reply to  iane

Possibly God is actually Goddess Nut Nuts?

3
0
Tillysmum
Tillysmum
4 years ago
Reply to  Richard Austin

That woman has a lt to answer for.

1
0
RickH
RickH
4 years ago

No comment is needed to diagnose the sickness. It’s called a ‘police state’.

52
0
awildgoose
awildgoose
4 years ago
Reply to  RickH

This is straight from the North Korea and USSR playbooks.

41
0
James Kreis
James Kreis
4 years ago

Meanwhile in big, bad authoritarian Russia where traditional family values are still encouraged and vaccination is a matter of personal choice, their magnificent churches are full with Easter worshippers.

70
0
Epi
Epi
4 years ago
Reply to  James Kreis

Always wanted to go to St Petersburg

5
0
Cecil B
Cecil B
4 years ago

The police did the same in our mosque

17
-2
Londo Mollari
Londo Mollari
4 years ago
Reply to  Cecil B

They wouldn’t dare do that to a mosque.

15
0
jcd
jcd
4 years ago
Reply to  Cecil B

Which one was that?

6
0
Tenchy
Tenchy
4 years ago

After recent events I thought the police couldn’t sink any lower, but clearly they can.

61
0
Waldorf
Waldorf
4 years ago

We may be getting into the terrain of underground churches developing.

28
0
MikeAustin
MikeAustin
4 years ago
Reply to  Waldorf

That would be secure encryption.

8
0
Ken Garoo
Ken Garoo
4 years ago
Reply to  MikeAustin

That’s the key to it.

0
0
Monro
Monro
4 years ago

Each individual who has failed to inform themselves of the facts and slavishly followed the grosser reich ordnungs is complicit in this grotesque fascism…….

Last edited 4 years ago by Monro
18
0
MikeAustin
MikeAustin
4 years ago

Matthew 18:20. “For where two or three gather in my name, there am I with them.” How much more so with a congregation.
Dare I put words into Jesus Christ’s mouth: “For where two or three move to stop gatherings in my name, there I will not be with them.”

12
0
Stevey
Stevey
4 years ago
Reply to  MikeAustin

The church has always faced persecution. As Catholics we are used to it.

10
0
RickH
RickH
4 years ago
Reply to  Stevey

The churches have done more than their fair share of persecution. As non-believers have been used to over history.

1
0
davews
davews
4 years ago

Those seated admittedly were not social distancing. Most were masked. Otherwise the service was fully legal and this is another case of the police over stepping their mark. I wish more churches opened for services instead of cowardly resorting to Zoom imitations.

33
0
Londo Mollari
Londo Mollari
4 years ago

I hope that I would not have complied. Posting videos of this sort of nonsensne helps a person prepare for the real thing.

12
0
karenovirus
karenovirus
4 years ago

Non story put up by The Sun on government orders but at least the Polish worshippers are putting up a fight saying no regulations were broken. Film footage auto linked to dreary Drakeford droning on about something.

Similarly Local Live (mirror group news) has lead item #6.
‘Covid house party breaches across County as neighbours call Police’
As evidence they cite Police “numerous reports of Covid breaches” before a very lengthy repetition of current lockdown regulations for which neighbours might report you if they could be arsed.

Intented to be a scare story when the real news is that people are gathering in public and at home which will hopefully encourage others to do the same.

Story is awarded the usual 223k imaginary ‘likes’ when it probably didn’t get 223k page views.

Last edited 4 years ago by karenovirus
14
-1
Martin Fleet
Martin Fleet
4 years ago

The policeman said ‘this gathering is lawful and then ‘corrected himself’ and said it is unlawful…..so he knows what he is doing and that he is in the wrong

9
0
karenovirus
karenovirus
4 years ago
Reply to  Martin Fleet

The audio sounds edited ‘is lawful’ cut a tad too soon ?

4
0
LilyVLibre
LilyVLibre
4 years ago
Reply to  Martin Fleet

So all crime was eradicated with the introduction of Covid and mask wearing along with the flu, giving hundreds of police that we never knew existed the opportunity to earn some overtime by criminalising, abusing and harassing people just because they can.

17
0
BJs Brain is Missing
BJs Brain is Missing
4 years ago

Seen enough yet?

21
0
Richy_m_99
Richy_m_99
4 years ago

And you wonder why the “Kill the Bill” movement is spreading.

The police have lost all respect of the public over the past year, and are unlikely to be able to restore any kind of respectability.

23
0
Annie
Annie
4 years ago

Christ is with the persecuted. Not with the cowardly, grovelling zoombies.

16
0
LilyVLibre
LilyVLibre
4 years ago

The only religion now permitted is the Cult of Covid. Fail to kneel and off with your head! Or you could just pay a ridiculous fine!

18
0
Igol
Igol
4 years ago

Didn’t the courts establish that you don’t have to comply with PACE requirements to provide details as the Coronavirus act makes no provision for anyone to provide details?
Also there is no right of entry, so did they walk into a ‘private’ session as the church (if following the rules) presumably closed the doors and said they were no longer open?

13
0
marebobowl
marebobowl
4 years ago

This action by Boris Johnson and his thugs is unforgivable. Don’t blame the police, blame him. He should step down immediately. Religious freedom is at the forefront of a democratically run country. Religious persecution has no place in this country. If this country is no longer a democracy, legally tell us what it is called. Dictatorship comes to mind. Where on earth has the Catholic Church been for the past one year? Where has this country’s civil rights attorneys been? Now look at what is happening. Please stand up for our freedoms. To the professional legal experts, solicitors, barristers, judges, your silence has been deafening

15
0
SueJM
SueJM
4 years ago
Reply to  marebobowl

Yes…. there are many things which have no place in this country and yet here we are in just one short year. If we ever return to some form of democracy there are a lot of factions which will have to earn respect from scratch. The upside is, hopefully, many more folk will be wide awake and a truer democracy than ever before will eventually prevail. Many lessons learned. Optimistic?!

5
0
Richard Austin
Richard Austin
4 years ago

Once again the Police break the law. I suggest that all Christians go to Batley Grammar School or join a BLM protest in order to worship. What kind of country are these b@stards in Government creating? I find it hard this is the party I voted for but I do not find it hard at all to know for a 100% fact I will never vote for them or the pathetic “Opposition” again.

7
0
10navigator
10navigator
4 years ago

‘Police speak’ for ‘now.’———“At this moment in time.” Morons!

2
0
Alkanet
Alkanet
4 years ago

Am I the only one who’s offended that these police actually entered the altar sanctuary? I half blame the priest and congregation for not physically expelling them for this reason alone.

6
0
Horsham Bren
Horsham Bren
4 years ago

The police raid of the Balham church on Good Friday, during which they suspended divine service and sent the congregation packing, was illegal under English law

Section 36 of the Offences against the Person Act 1861 is clear on this point

Despite the many statutory instruments enacted to control the current pandemic, none of these suspends the provisions of the aforementioned act, as far as I can tell

The case is almost certainly justiciable; not least by virtue of the added weight of Article 9 of the European Convention on Human Rights and Article 18 of the Universal Declaration of Human Rights. If due process is followed, the officers involved are liable to up to two years in one of Her Majesty’s hotels!

Here is the text of Section 36 of the Offences against the Person Act 1861:

Whosoever shall, by threats or force, obstruct or prevent or endeavour to obstruct or prevent, any clergyman or other minister in or from celebrating divine service or otherwise officiating in any church, chapel, meeting house, or other place of divine worship, or in or from the performance of his duty in the lawful burial of the dead in any churchyard or other burial place, or shall strike or offer any violence to, or shall, upon any civil process, or under the pretence of executing any civil process, arrest any clergyman or other minister who is engaged in, or to the knowledge of the offender is about to engage in, any of the rites or duties in this section aforesaid, or who to the knowledge of the offender shall be going to perform the same or returning from the performance thereof, shall be guilty of a misdemeanor, and being convicted thereof shall be liable, at the discretion of the court, to be imprisoned for any term not exceeding two years

7
0
Tillysmum
Tillysmum
4 years ago
Reply to  Horsham Bren

Who will take them to task over this bullying? If we do not it will continue and worsen.

1
0
www
www
4 years ago
Reply to  Horsham Bren

https://www.dailymail.co.uk/news/article-9435037/Outraged-Polish-Catholic-worshippers-slam-police-shutting-Good-Friday-service.html ANOTHER ONE TODAY
why don’t ours fight back?

0
0
Ken Garoo
Ken Garoo
4 years ago

Pastor Pawlowski, head of a church in Calgary, had a visit from a local Karen, backed up by numerous police. This is how he dealt with it.

https://www.liveleak.com/view?t=uTFTG_1617494852

Chapeau!

1
0

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