Is there a role for vitamin D in COVID-19? [PODCAST]

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“As we continue to deal with the COVID-19 pandemic causing spiking numbers of cases, the scientific and medical communities continue to search for effective treatments and preventive measures. We have clearly established the importance of wearing masks, physical distancing, and frequent handwashing.

As of this article’s writing, there are over two hundred fifty articles on PubMed about the connection between vitamin D and COVID-19. As the research studies are undergoing, evidence is mounting that adequate vitamin D levels may be a protective factor against COVID-19 infection and severity. Here’s what the research shows.”

Teresa Fuller is a pediatrician.

She shares her story and discusses her KevinMD article, “Is there a role for vitamin D in the treatment of COVID-19?”

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Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. My name is Kevin Pho, founder and editor of KevinMD. Today on the show, we have Teresa Fuller. She’s a pediatrician, and she wrote the KevinMD article “Is there a role for vitamin D in the treatment of COVID-19?” Teresa, welcome to the show.

Teresa Fuller: Thank you, Kevin.

Kevin Pho: All right, we’ll get into the article in a little bit, but first off, can you share your story and your journey to where you are today?

Teresa Fuller: Yeah, so I attended medical school at Howard University, where I obtained my MD/PhD, and did residency training at the University of Maryland. And then I finished that in 2002. So for the past 18 years or so, I’ve been practicing. I started out initially practicing in hospital pediatrics. I was really interested in acute care medicine. But then about 10 years ago, my focus in pediatrics changed to preventive care.

And as I developed an interest in prevention, and even more specifically in integrative and holistic medicine, I started to learn its applications in pediatrics. And so I would say over the second half of my career, I’ve been working in preventive care. I’m in a primary care practice. And I try to incorporate holistic and integrative therapies with my patients, just basically integrating your basic traditional medical care with a lot of prevention.

Kevin Pho: Excellent. And what would you say you’re doing differently from, I guess, a pediatrician who doesn’t focus so much on holistic and preventive care? So what are some of the things that you think that you would do differently?

Teresa Fuller: What I usually tell my patients is that I just try to make sure they’re aware of some of the things they can do additionally to support the body, to support health, in addition to our regular things. So usually when I’m meeting parents, for example, I tell them, “There are things that you can do, such as things that you may not know about, like certain vitamins, minerals, probiotics, that help to support the body and help even in an illness.” So to me, I feel like it’s really not very different from what other general pediatricians do. It’s just that I feel like I have a bit of a larger toolbox.

Kevin Pho: And we’re speaking in the last week of January, and we’re in the midst of what possibly is the worst wave of the pandemic. Now, tell me what you’re seeing in your practice about how the pandemic is affecting the families and the children that you see.

Teresa Fuller: Well, it has definitely made a big difference. I think the biggest way, I would say, families are affected is by the change for the children, children not being in school, many of them. So they’re having to take school at home, and trying to find things for them to do when there are so many things unavailable now. So many of the sports and other activities that kids would do just aren’t available. So the biggest impact is on parents trying to find ways to really help their children with their development and just general healthy activities in the midst of this.

I’m thankful that the kids are doing very well with this, though, as far as when they get the infection. We’re finding that most of them do very well, even when they’re infected with COVID. But we are seeing increasing numbers.

Kevin Pho: And what kind of advice are you giving to these families, especially for those with kids who aren’t going to school and may feel increased anxiety and stress from not being with their peers?

Teresa Fuller: Yeah, it has been a challenge. I really tell parents one of the main things: Try as much as possible to still keep your kids on a schedule, because now that they’re taking school at home, sometimes they’re not even getting up and getting ready in the morning. They kind of get up from bed and turn the computer on. And then after the school hours, there’s just a lot of time where there’s not structured activity.

So one thing I’m telling parents to do is make sure you’re structuring that day for your child. Make sure you keep the routine of getting up, getting breakfast, making sure they get ready, sitting up, having a quiet place for school and study, and then keeping a routine in the evening, as well as a regular bedtime. Because we’re finding that so many of the kids are really off. Part of, I think, the reason that they’re dealing with some of the mental health challenges is a lack of sleep and things like that. So keeping that schedule is important.

Kevin Pho: Wonderful. And let’s transition now into your KevinMD article, “Is there a role for vitamin D in the treatment of COVID-19?” Now, I’m certainly interested in this topic. On my Facebook physician groups, I hear a lot of questions about vitamin D. I know Dr. Fauci himself also recommends it, and he himself takes vitamin C and D to help his immune system fight off COVID, but there haven’t really been a lot of long-term studies regarding the relationship specifically between vitamin D and the potential prevention of COVID. Now, for those who didn’t read your article, can you just walk my audience through it and share the story of why you decided to share it?

Teresa Fuller: Sure. So the way I first got interested in it: Well, way back in the beginning of the pandemic, it’s kind of funny, the first time I heard about vitamin D related to COVID was from my 20-year-old son, who was doing his own research, and he let me know that vitamin D is important in preventing cytokine storm. And it’s just funny to hear that from your son. But I had already been familiar with the importance of vitamin D and the immune system. So I knew that was the case, but I didn’t formally look into it at that time. I would just hear a blip about it here and there.

But what really got me interested was when I read about a study. There was a doctor in the U.K. who was looking at the physicians who were dying from COVID early in the pandemic. And he had found that 14 physicians, U.K. doctors, had died from COVID-19, and what they had in common was that they were all darker-skinned physicians of various ethnic backgrounds. And he, I guess in his studies, had learned that vitamin D was important. So he made a formal recommendation, and found that immediately after he put that out, for physicians and health care workers to take vitamin D, there were two more deaths, and after that, no more deaths.

And when I read that, I got very interested and started to wonder how much is known about vitamin D with COVID. At that time, that was probably around June or so, when I started looking into it. And I found that there were already about 200 or more articles on PubMed looking at the role of vitamin D, or the connection between vitamin D and COVID. And so that’s really where I got interested, where I started the research for it.

Kevin Pho: So what is the role of vitamin D in helping boost the immune system?

Teresa Fuller: Well, fortunately, that is much more studied. That’s been studied for quite a few years, I mean, going back decades. And they have found some good studies finding that vitamin D can reduce the risk of viral infections. And basically, the mechanisms that it seems to do that through are lowering viral replication, or lowering viral replication rates, and reducing inflammatory damage to the lungs. So that has been established.

And although the causality is still being debated, they found that vitamin D deficiency is associated with increased susceptibility to infection, infectious diseases, and especially upper respiratory infections. And so finding that connection, I think, is what prompted a lot of scientists to look into this pretty early, about whether vitamin D had a role in COVID.

Kevin Pho: So what are some of the striking findings from some of these studies?

Teresa Fuller: Some of the findings were really, the preponderance of the evidence is showing, that when there’s a deficiency, they were finding increased, well, poorer COVID outcomes, I should say. I think what started the interest was some of the information that was happening with COVID. One was that they found that it spread, in the northern hemisphere anyway, starting towards the end of 2019, and that’s a time when we’re getting into the winter months, and vitamin D levels are at their lowest. And so that was just kind of some anecdotal evidence.

But there were some studies done. For example, an analysis across Europe found that COVID-19 mortality was significantly associated with vitamin D status. So the lower the vitamin D levels, the higher the COVID-19 mortality. So those kinds of population studies were being done.

Another significant thing that was found is that the populations that were being found to have more significant infections from COVID, or poorer outcomes, were the same populations that tend to have lower vitamin D levels. So those would be populations such as, by ethnicity, Black and brown people, who typically have lower vitamin D levels, who were having worsening outcomes, and also people just of older age, people who had underlying medical conditions like diabetes, people who were obese, and even males.

Kevin Pho: We’re speaking to Teresa Fuller. She’s a pediatrician, and she wrote the KevinMD article “Is there a role for vitamin D in the treatment of COVID-19?” So what should we do in primary care? Should we take vitamin D prophylactically? Should we test people and treat only those who have low vitamin D levels? So for people who are interested in boosting their immune system and potentially fighting off COVID, what’s your recommendation?

Teresa Fuller: Absolutely. I think we should do both of those things. Interestingly enough, after you published the article, I was connected to a group of physicians and scientists who were already doing this. They were already looking at the role of vitamin D and making recommendations. And in fact, a group of over 200 physicians and scientists put out an open letter to governments, public health officials, and other physicians, trying to make recommendations for increasing this, a recommendation to give vitamin D.

So what we should do as primary care physicians: One, when we can, when it’s practical, we should definitely be measuring vitamin D levels in our patients. And I’ve been doing that more, especially with my teenage patients, measuring and finding, of course, that most of them have low vitamin D. And that’s because we already know that at least 40 percent of the population is low in vitamin D generally. And that’s even higher in people of color. So I think we should be measuring levels when we can. But it is safe to recommend vitamin D even in the absence of measuring levels. It’s very safe to give a small daily dose of vitamin D. And so we should be recommending that to our patients.

Kevin Pho: And what is the daily dose of vitamin D that you would recommend?

Teresa Fuller: If it’s an adult, it’s very safe to take 1,000 to 2,000 units. Our official recommendation in that open letter was a minimum of 2,000 IU of vitamin D3 daily. But if it’s a child, we have to go with the lower recommendations for children. So for infants, 400 IU is recommended, and for over one year old, it’s 600 IU. But of course, if I have a teenager who is deficient, then I’ll recommend higher levels, depending on what level they have.

Kevin Pho: And what are the downsides of taking too much vitamin D?

Teresa Fuller: It is hard to take too much, but I have had one or two patients where I saw a level of vitamin D that was over 100. And over 100 is what is considered too high a dose. And so we do have to make sure. In a rare situation where a patient is taking too much, or where a patient reports to me that they’re taking large amounts of vitamin D, I will test their level, because I want to make sure they’re not overdosing and getting into a toxic level.

Kevin Pho: And my final question, Teresa: What’s your take-home message you want to share with the KevinMD audience?

Teresa Fuller: I would say what I’ve learned from this, and what I would recommend, is that we make sure that we’re following the science, because as physicians, we are scientists, and there’s a lot of science being done that we often don’t hear about in our medical journals or in conferences. So because the science research really lags behind our medical practice, I think what we should do is make sure we’re looking out for the science. Take some time and check into those PubMed articles and see what’s going on in the research, so that we can better improve our ability to take care of our patients.

Kevin Pho: Thank you so much for your time and insight, and thanks again for being on the show.

Teresa Fuller: Thank you.

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