David Grimes is a physician in the UK who developed an interest in vitamin D decades ago, after he realized that his darker skinned and less sun exposed patients were especially prone to illness. He’s written multiple books on vitamin D and its central role in immune function. He believes that the main thing predisposing people to severe outcomes when they become infected with covid-19 is vitamin D deficiency, and argues that many of the people who died of covid-19 could have been saved, if only greater efforts had been made to ensure that they had sufficient levels of vitamin D in their blood streams.
In this conversation I talk to David about how he first came to develop an interest in vitamin D and why our immune systems have evolved to be so dependent on it. We then go through the evidence favouring its use in the current pandemic, from the observational data to the randomized trials. And finally we go through the practical details surrounding vitamin D supplementation, such as what doses are reasonable, whether it matters if you get it from the sun or from a capsule, and how frequently vitamin D supplements should be taken.
You can watch the interview here.
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Transcript please, a 1-hr video can’t be searched or researched for confirmation.
second
Agree
Thank you. Dr. Grimes is my new hero. I’m 62 and was diagnosed with MS at 36. Through DIY research into diet, changes in lifestyle, exercise and time outdoors I was symptom free within a year and have remained so. I supplement with D3 and K2 because though I am outside, not perhaps sufficient. When things started to happen in 2020 I was very much aware of what supplements I wanted to be sure I and friends and family would get, and to get outdoor exercise in nature. I very much appreciate the work you are doing and the guests you have included.
Same here! Plus a healthy diet of course… Thank you again Dr Rushwprth for this excellent content.
I wonder how many doctors with dark skins could have been saved if they’d taken Vit D early 2020?
Hela min familj har ätit D-vitamin i över 20 år. Säsongsvarierat med start i november med 2000 IE/dag som sakta ökades till 6000IE /dag från jan-maj. Det lite märkliga är att ingen varit förkyld eller liknande sedan dess. Bevisar kanske inget men rätt fascinerande.
Thank you for that, both of you.
Dr Grimes’ tale of the three doctors taking the initiative to safeguard their colleagues was striking. Presumably the government and NHS were just sitting twiddling their thumbs. Or worse.
When I was a little boy in Britain our parents gave us cod liver oil in winter.
WKPD tells me “According to the United States Department of Agriculture, a tablespoon (… 14.8 mL) of cod liver oil contains … 34 μg (1360 IU) of vitamin D.” It tasted pretty foul; some families preferred to take it in capsules. I wonder when the habit died out.
Me too, dearieme…my mum used to line us up, my brother and sister and I, for a tablespoonful of cod liver oil followed up by a tablespoon of orange juice. We hated the cod liver oil but the spoonful of orange juice right after mitigated it. After WW2 the Brits voted in a socialist government and a National Health Service which gave free bottles of cod liver oil and concentrated orange juice to parents of young children. Brilliant idea, but when the inevitable cuts came after the Tories got back in power, that was taken away. It got stopped quite abruptly as far as I can remember.
It’s willful ignorance. Our government should get out of the picture and let our scientists and doctors direct treatment.
You missed a significant downside of using vitamin D. People, and in particular the useless elederly will live longer and consume valuble resources in vain.
Giving cattle calcefediol make perfectly sense as you can sell the meat. Not so with the elderly.
(sorry but I’m so mentally exhausted after theese two years)
Know exactly how you feel , Rolf. Still, if too many folks take Vit. D in preference to the jab, the Gumint can always make the sale of vitamin C, D and Zinc illegal.
/sarc
Or very expensive!
Hi Rolf- It isn’t only the elderly who are useless! I am 77 and am the one questioning the narrative and trying to bring dissenting voices to the attention of my children, grandchildren and great-grandchild… also, if we are taking Vit D3 hopefully we are healthy and not a burden on our health services.
Keep sane
Excellent coverage by Dr Grimes. Facts of vitamin D (hormon)that every human being should be aware of.
Not even doctors seem be informed?
Med school emphasizes rickets and severe D-deficiency, but not nutrition for optimal health. Allopaths are in the treatment business, not the health business, with some exceptions.
Thankyou so much for the Vit D podcast. It explains so well the reasons why people with darker skins and the obese have been affected disproportionately by Covid 19. The tragedy is that more wasn’t allowed to be done to spread this information with disastrous results.
Dr. David Grimes mentions in an article (“Can we learn anything from the experience of Malaysia and Indonesia?”) that vaccines may increase the danger from infections because of reduction in levels of 25OHD. I agree with him that far, but I don’t agree with him that there is necessarily a cumulative impact from repeat vaccinations, because the data shows that 25OHD levels tend to rise after a drop during the acute phase of an infection. I see cumulative risk from the acute phase of the immune response post-vaccination _followed by a subsequent infection_. This risk will be repeated with each vaccination. Obviously, it will be worse in winter.
This is especially important for those who are D-deficient or D-insufficient before vaccination, which is 75% of the world population. Obviously, the danger is greater for the D-deficient than for the D-insufficient.
If 25OHD levels were about 20 ng/ml, then they might plunge to 16 ng/ml during the acute phase of the immune response post-vaccination. If that person were to be infected during the acute phase with any virus or bacteria, D-levels might again plunge to 11 ng/ml, which is severely D-deficient, for which the prognosis would be poor.
And there are also drops in zinc levels when any immune event like vaccination or infection occurs during the acute phase, with similar dangers to D-deficiency.
The elderly are particularly at risk for zinc and 25OHD deficiency, which compromises their immune systems.
I don’t know about the UK or the rest of Europe, but calcifediol (aka “25OHD”) is available by prescription in the US (brand name “Rayaldee”).
Calcifediol may be ordered online (brand name “Fortaro”). Delivery was 3-5 days for me.
Fortaro’s cost is $25 per bottle of thirty 10-mcg tabs.
Rayaldee’s cost is $1200 per bottle of thirty 30-mcg tabs.
https://www.drugs.com/price-guide/rayaldee
There is only one UK seller I could find, and this is marketed for research purposes only, not for consumption. Also at an eye watering cost.
What dose do you take, and is there any reason to purchase calcifediol rather than just supplement with ordinary D3?
“What dose do you take, and is there any reason to purchase calcifediol rather than just supplement with ordinary D3?”
Vitamin D is somewhat complicated and your questions require a complicated answer.
I don’t take 25OHD currently. My wife takes 10 mcg of 250HD weekly and 2,000 units of D3 daily.
Should I for some unfathomable reason choose to get vaccinated for anything, I would supplement with 50 mcg of 25OHD after three days. Similarly if I should have an active infection, as soon as nausea cleared.
D3 is dilatory, but preferable if you start with acceptable (40-60 ng/ml) levels of 25OHD. You fill the adipose tissue storage tank since the serum storage tank is full and the serum storage tank will get topped off from the adipose tissue storage tank’s accretions to serum via the liver.
If I were going to consume 2+ oz. of alcohol, I would supplement with 10 mcg of Fortaro since the liver would be occupied with clearing alcohol and would not process the D3 for >4 hours.
If I had liver dysfunction, including non-alcoholic fatty liver, I would use 25OHD instead of D3.
I also supplement with K2 at a ratio of 90 mcg K2 to 5,000 units D3. It all comes in a single tab.
K2 is supposed to help reduce juvenile arterial plaques and shunt calcium into the bones.
We also buy eggs and milk where the animals are kept in pastures to increase the K2 content.
All this is just for educational purposes, of course.
I hope that answers your questions somehow.
I thought of a few other possible reasons that someone might prefer 25OHD over D3.
If someone is obese, the competition between adipose tissue and the liver for D3 might make conversion to 25OHD very unlikely, so supplementation with 25OHD might be very preferable.
If someone has difficulty with intestinal absorption, such as occurs in Celiac or Crohn’s Disease, 25OHD might be preferable as it is more easily absorbed. The elderly sometimes also have problems with intestinal absorption for various reasons.
If someone has a genetic condition that prevents production of an enzyme that the liver uses to convert D3 to 25OHD, then supplementation with 25OHD might be preferred.
If someone has hypercalcemia or hyperphosphatemia or is being treated with calcitriol for any reason, then D3 might be preferred.
When supplementing with 25OHD, K2 supplementation is also necessary.
Barring some sort of genetic problem, immune cells will convert 25OHD to calcitriol for local use by VDRs in addition to serum calcitriol produced by the kidneys, if 25OHD levels are high enough, which seems to be 40+ ng/ml. And any excess calcitriol produced that finds its way into serum is metabolized by the kidneys.
Although calcitriol is about 10x more active than 25OHD, the serum concentration of 25OHD is so much higher than calcitriol that 25OHD still has a huge impact on VDRs relative to calcitriol. 25OHD is biologically active itself–it is not merely a precursor to produce calcitriol. The extra hydroxyl group on calcitriol is what gives it the extra activity similar to what the extra hydroxyl group does for HCQ. The molecular conformation necessary for a molecule to react becomes more likely. But if there are 1000 molecules of 25OHD for every molecule of calcitriol, then there should be 100 molecules of 25OHD in the necessary conformation for every molecule of calcitriol in the necessary conformation. I know this is very simplistic, but I don’t want to go into quantum chemistry explanations. (Not even sure I could any more, lol.) It’s enough to know that it’s a numbers game, I think.
Anticipating that you might want to know about pharmacokinetics comparing supplementing with D3 v. 25OHD….slow v. immediate…and possibly relative impact on serum 25OHD…31 ng/ml versus 69.5 ng/ml
“Mean 25(OH)D levels increased to 31.0 ng/mL with a slow increase in the vitamin D3 group.”
“Mean 25(OH)D levels increased to 69.5 ng/mL in the HyD group. This rise was immediate and sustained.” (HyD means “25OHD”)
https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.551
four problems I foresee…updating doctors via continuing education, timely availability of 25OHD (currently shipping is involved), hospital protocols, and a need for IV administration
Those “in the know” can order Fortaro before it’s needed, to be prepared.
For educational purposes only.
This may be the sort of thing you are looking for…
“Due to potentially poor absorption and obesity, it is prudent to use 0.014 mg/kg body weight. Amounts to one dose of 1 mg calcifediol for most people (55 to 85kg). Equivalent to a modest bolus dose of 3 mg of D3=120,000 IU. No toxicity develop levels under 150 ng/mL. Up to five times this dose will not cause adverse effects.”
https://www.linkedin.com/feed/update/urn:li:activity:6803351558714204160/
The recommendation is from Sunil Wimalawansa MD
Papers he authored…
https://scholar.google.com.au/scholar?hl=en&as_sdt=0%2C5&q=Sunil+Wimalawansa+&oq=Sunil+
So, for an acute illness or for prophylaxis for an upcoming open surgery, you might take a larger dose, say, 1 milligram of 25OHD, like Wimalawansa recommended. (Endoscopic surgeries may end up being open, so you may want to prophylax for those, too.) If you are doing supplementation to boost your immune health with no acute issue, you might take 20 mcg daily, as in the study of postmenopausal women.
But don’t forget your K2! I have seen no reports of toxic levels for K2 and would try to stay in the proportions for D3 and K2 generally found in milk and eggs from pasture raised cows and chickens.
The inactive form of vitamin d takes about two weeks to become active in the body. Calcitriol is immediately available to the body. When you are well its ok to wait for the body to make the vitamin d active but if fighting infection you may become depleted more quickly.
This is my understanding from reading. I have NIL medical qualifications.
julie,
“The inactive form of vitamin d takes about two weeks to become active in the body.”
I agree that D3 metabolism is dilatory.
There are three different vitamin D analogs–cholecalciferol, calcifediol, and calcitriol. Cholecalciferol has about 10% of the activity of calcifediol and calcifediol has about 10% of the activity of calcitriol, iirc. D3 is inactive compared to the other two. Calcifediol cannot be considered inactive, though.
” Calcitriol is immediately available to the body.”
…for endocrine purposes…immune cells have to make their own calcitriol for signaling the VDRs of their DNA and for signaling nearby cells…which requires adequate serum levels of 25OHD (>40 ng/ml)
“When you are well its ok to wait for the body to make the vitamin d active but if fighting infection you may become depleted more quickly.”
Yes, there is a drop of about 5-6 ng/ml of 25OHD (calcifediol) at the beginning of the acute phase of an infection or an immunization. The literature says a 25% drop.
“This is my understanding from reading.”
Mine, too.
” I have NIL medical qualifications.”
Then you should be able to tell if I have done my reading work.
Very interesting interview, agree whole heartedly , If I could make one observation? The statement that an email was sent out advising BAME Doctors to start taking Vitamin D and then there were no more deaths. Do we know how many, if any, Doctors took this advice?
There are multiple trials where vit D supplementation didn’t have the desired outcome, despite the correlation with high levels and good health status for a variety of conditions
Simple. Catching some rays doesn’t just produce vitamin D. Sun avoiders in, yes, Sweden die young. doi: 10.1111/joim.12251
So you’re saying that supplementing with D3 didn’t help people with high 25OHD levels? Is this an important point?
I’m not referring to covid
In general people look at VitD supplementation in people who have low levels, and it’s surprisingly ineffective
I like the point below about wrong version in wrong dose, very likely that plays its part. My point is that vitD status is a marker of sun avoidance and that taking a tablet doesn’t reproduce being in sunlight
“My point is that vitD status is a marker of sun avoidance…”
Maybe. You can live indoors and have adequate 25OHD levels if you supplement with 25OHD–even a bolus dose. You can live indoors and have adequate 25OHD levels if you supplement daily with 5,000 units D3 per 50 kg body weight. But if you live indoors generally and don’t supplement, your 25OHD levels are certain to be deficient.
“…taking a tablet doesn’t reproduce being in sunlight”
If you supplement with 25OHD, your 25OHD levels may be _higher_ than if you relied on sun alone.
In some trials the incorrect form (inactive) is used and dosage is also important. It appears to be more useful to build vit d over time than wait for illness and administer a huge bolus dose (particularly if inactive). Each single study would have to be looked at to ascertain why the lack of efficacy.
“In some trials the incorrect form (inactive) is used and dosage is also important.”
What is the “inactive” form? What is the dosage?
“It appears to be more useful to build vit d over time than wait for illness and administer a huge bolus dose (particularly if inactive).”
If you mean that supplementing with D3 in advance of potential illness is preferable to waiting until illness arrives to supplement, I totally agree.
I have seen a couple of studies that compared daily versus weekly dosing with D3 where there was no difference in calcifediol levels over time. I would expect bolus dosing with calcifediol to have immediate impact. D3 (cholecalciferol) has to be processed into calcifediol by the liver before it can impact any system. The rate of processing by the liver, liver dysfunction, and uptake competition by adipose tissue come into play.
Thank you so much for this informative talk by Dr. Grimes. I’ve been taking Vitamin D3 for years, and after listening to the podcast will share it will all my family and friends (most of whom are over 70).
I worked as a medical librarian for 25 years, and am astounded at the arrogance of the medical establishment that insists that the only acceptable evidence is from a randomized controlled trial. As Dr. Grimes points out, observation does provide us with useful information in many spheres.
At 43:58, I think Dr Grimes means 4 million, not 400k. But the overall point remains broadly the same.
In connection to the risk of confusing micro and milli, for the public this is mainly a theoretical risk I think( yes I have seen case studies of people that have achieved overdosing somehow)
The reason is that access to vitamin D is normally limited in potency.
For example in the UK all products by pharmacies & supermarkets sell tablets that contain 100 to 3000 IU.
These are sold in a container of 30 to 90 tablets. To achieve 400 000 IU when you were aiming for 400 you would have to eat ~110 tablets/day of the strongest stuff, more than one bottle of tablets at £12 (~140kr) per day. Any sane person would question themselves if the start eating that much.
Of course online you can get stronger stuff but it appears hard to overdose because vitamin D is stil sold with a old aim of daily recomended dose of 300-600 IU that is most likely 10 times to low based on the need for the immune system rather than bone.