Vitamin D and proper immune response
A DEFICIENCY OF A CERTAIN compound can have effects on a number of systems and organs. For example, inadequate amounts can cause lethargy, fatigue, headaches, muscle cramps, dizziness, syncope, fever, tachycardia, tachypnea, hypotension, an increased blood urea nitrogen/creatinine ratio, a reduced level of alertness, and compromised cardiac, respiratory, muscle, renal and cognitive systems. One compound, many effects.
Compounds and deficiencies
Dehydration, or water deficiency, may cause any or all of the above symptoms. However, not all fatigue, headaches, muscle cramps, etc. are caused by a water deficiency. These can be caused by many factors but all are magnified by dehydration.
Deficiency isn’t an “all or none” situation. Having one drop of water more than is required for life does not equate to health. A human can survive on small amounts of water, but cannot perform optimally. The same is true for another molecule.
An insufficient amount of a different compound is associated with increased risk of breast/prostate/ovarian/colon cancers, decreased immune response, autoimmune diseases, tuberculosis, types 1 and 2 diabetes, depression, schizophrenia, Alzheimer’s disease, osteoporosis, sarcopenia, asthma in children, influenza, cardiovascular diseases and multiple sclerosis. One compound, many effects on numerous organs and systems. The compound is vitamin D.1,2
The body and vitamin D
Vitamin D is a prohormone — a precursor to 1,25 dihydroxy vitamin D, the active hormone form. Essentially all cells in the human body have vitamin D receptors (VDR).
The progression for the synthesis of vitamin D is:
7- dehydrocholesterol (secreted to the skin)
(converted by ultraviolet B)
Cholecalciferol (D3) (converted in the liver)
25-hydroxycholecalciferol (converted by kidney or ALL cells)
A more recent discovery, each cell has the ability to covert 25-hydroxy to the active form of 1,25-dihydroxy. Activation occurs as a response to many biologic stressors.
Calcium metabolism is the body’s priority role of vitamin D. Only after this function is handled is the additional vitamin D available for catalyzing the immune response.3 The potent hormone has the ability to access the DNA strands, akin to a Google search, and select the portion to appropriately respond to the stressor.
For example, if the biologic stress is a virus, vitamin D is activated, providing the key to unlock the needed information from the intracellular DNA to produce antiviral compounds: cathelicidin and B-defensin.1 This is the basic process for any and all cell types. If the stressor is a bacteria, bacteriostatic compounds are released. Vitamin D doesn’t directly address the viral or bacterial invader but instead acts as a dispatcher to facilitate the appropriate response.4
Vitamin D deficiency is associated with both greater susceptibility and poor COVID-19 outcomes. Vitamin D, just as with any single nutrient, should not be used in isolation. It is not a cure-all or a COVID-19-specific treatment. Rather, it is one of the crucial building blocks needed for a robust immune response necessary for prevention. Additionally, when properly included as part of treatment, it is associated with superior outcomes.5,6
Critical vitamin D topics include:
Deficiency — Deficiency is a worldwide problem. Although no ethnic group is immune, vitamin D deficiency is greatest among those with darker skin, breastfed infants, the elderly, and pregnant or lactating females.7,8 Frank deficiency of vitamin D will directly cause rickets in children or osteomalacia in adults. Rickets, an epidemic in the 19th century, has re-emerged as vitamin D deficiency is now widespread. Impaired bone mineralization is the hallmark of both rickets and osteomalacia.9
Toxicity — Vitamin D toxicity is rare, though it is possible with doses of 50,000 IUs per day for weeks, or load doses greater than 100,000 IUs. Toxicity causes hypercalcemia, hyperphosphatemia and depressed parathyroid hormone levels. The current U.S. RDA is 600 IUs/day, which is insufficient for most adults.1o,11 In a large 2014 study, healthy volunteers taking up to 20,000 IUs/day of vitamin D did not demonstrate any toxicity nor a blood level beyond the upper limit of normal.12
How much? — Reasonable supplementation will range from 1,000-5,000 IUs per day. The need goes down for those frequently exposed to ultraviolet B or noontime sunshine or those regularly visiting tanning booths. Greater amounts are necessary for people with dark, aged or covered skin. Obese people may require threefold in order to raise their blood levels of 25-hydroxy vitamin D to the optimal range of 50-60 ng/ml.12
Vitamin D is the great dispatcher — acting to catalyze specific immune responses required for a multitude of biologic threats, while decreasing the cells’ risk of succumbing to disease. However, it is only available to do this with adequate amounts as the body prioritizes it for calcium metabolism. With increasing worldwide vitamin D deficiency, we are seeing the reemergence of rickets and osteomalacia. Rather than suggesting that vitamin D is a cure-all, it is, more correctly, a response-all. One compound, many effects.
ALAN COOK, DC, has been in practice since 1989. He ran the Osteoporosis Diagnostic Center (1996-2019), participated in four clinical trials and lectured nationally. He is currently working with the Open Door Clinic system in a multidisciplinary setting and is providing video-based continuing education with EasyWebCE. Learn more at EasyWebCE.com.
- Tanner BS, Harwell SA. More than healthy bones: a review of vitamin D in muscle health. Ther Adv Musculo Dis 2015;7:152-159. https://doi.org/10.1177/1759720X15588521
- Christakos S, Hewison M, Gardner DG, et al. Vitamin D: beyond bone. Ann N Y Acad Sci. 2013;1287(1):45-58. doi:10.1111/nyas.12129
- Christakos S, Puneet D, Benn B, et. al. Vitamin D; Molecular Mechanism of Action. Ann NY Acad Sci 2007; https://doi.org/10.1196/annals.1402.070
- Lappe JM. The Role of Vitamin D in Human Health: A Paradigm Shift. J Evidence-Based Complementary & Alternative Medicine 2011;16:58-72.
- Oristrell J, Oliva JC, Casado E, et al. Vitamin D supplementation and COVID-19 risk: a population-based, cohort study. J Endocrinol Invest 2021:1-13. https://pubmed.ncbi.nlm.nih.gov/34273098
- Alcala-Diaz JF, Limia-Perez L, Gomez-Huelgas R, et al. Calcifediol Treatment and Hospital Mortality Due to COVID-19: A Cohort Study. Nutrients 2021;13:1760. https://pubmed.ncbi.nlm.nih.gov/34064175
- Hanley DA, Davison KS. Vitamin D Insufficiency in North America. J Nutr. 2005;135:332-7.
- Gallagher JC, Yalamanchili V, Smith LM. The effect of vitamin D supplementation on serum 25(OH)D in thin and obese women. J Steroid Biochem Mol Biol. 2013;136:195-200.
- Holick MF. Resurrection of vitamin D deficiency and rickets. J Clin Invest. 2006;116(8):2062-2072. https://doi.org/10.1172/JCI29449.
- Holick MF. Vitamin D Is Not as Toxic as Was Once Thought: A Historical and an Up-to-Date Perspective. Mayo Clin Proc 2015;900:561-564.
- Hossein-nezhad A, Holick MF. Vitamin D for health: a global perspective. Mayo Clin Proc. 2013; 88: 720-755
- Ekwaru JP, Zwicker JD, Holick MF, Giovannucci E, Veugelers PJ. The importance of body weight for the dose response relationship of oral vitamin D supplementation and serum 25-hydroxyvitamin D in healthy volunteers. PLoS One. 2014; 9: e111265
- Jackson RD, LaCroix AZ, Gass M, et al. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006; 354: 669-683.