COVID-19 – Vitamins C & D may protect and treat patients and NHS staff
Dear Editor
COVID-19 – Vitamins C & D may protect and treat patients and NHS staff
It is unfortunate that the Recovery Trial is not investigating the value of vitamin C for COVID-19. [1] This vitamin is often disregarded as an ‘alternative or complementary medicine’ treatment. Strangely, its very large basic science background may be overlooked. Even so, the WHO lists vitamin C among its research priorities for strategies for supportive care of seriously ill patients and as an adjunctive intervention with biological plausibility for COVID-19. [2]
Vitamin C is a potent antioxidant and may be useful when given in very high doses as an adjuvant therapy for COVID-19. [3] Requirements for this vitamin increase significantly in severe infections (although doctors should be aware that high doses may precipitate haemolytic anaemia in patients with glucose-6-phosphate dehydrogenase deficiency). An anti-viral immune response has been detected for vitamin C through production of interferon in the early stages of influenza A. It also has an immunomodulatory effect on cytokine production. [3, 4] Vitamin C has been used in hospitals in China for patients with COVID-19 disease and some clinical trials are in progress. (If given with proton pump inhibitors, Vitamin C levels are lowered. [5] )
Vitamin D supplementation reduces the risk of acute respiratory infections and may be useful for COVID-19 disease. [6] Deficiency is common in countries with limited exposure to sunlight and levels may be particularly low if more melanin in the skin restricts the absorption of ultraviolet light. Possibly, this may be a contributory factor in some of the serious infections reported in certain NHS and social care workers. (Ultraviolet light is also useful in that it can inactivate the virus.)
3. Cheng RZ. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Medicine in Drug Discovery 2020; 5:100028 doi.org/10.1016/j.medidd.2020.100028
4. Hartel C, Puzik A, Gopel W, Temming P, Bucsky P, Schultz C. Immunomodulatory effect of vitamin C on intracytoplasmic cytokine production in neonatal cord blood cells. Neonatology. 2007;91(1):54-60.
5. Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013 Jun;4(3):125-33. doi: 10.1177/2042098613482484.
6. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020 Apr 2;12(4). pii: E988. doi: 10.3390/nu12040988.
Rapid Response:
COVID-19 – Vitamins C & D may protect and treat patients and NHS staff
Dear Editor
COVID-19 – Vitamins C & D may protect and treat patients and NHS staff
It is unfortunate that the Recovery Trial is not investigating the value of vitamin C for COVID-19. [1] This vitamin is often disregarded as an ‘alternative or complementary medicine’ treatment. Strangely, its very large basic science background may be overlooked. Even so, the WHO lists vitamin C among its research priorities for strategies for supportive care of seriously ill patients and as an adjunctive intervention with biological plausibility for COVID-19. [2]
Vitamin C is a potent antioxidant and may be useful when given in very high doses as an adjuvant therapy for COVID-19. [3] Requirements for this vitamin increase significantly in severe infections (although doctors should be aware that high doses may precipitate haemolytic anaemia in patients with glucose-6-phosphate dehydrogenase deficiency). An anti-viral immune response has been detected for vitamin C through production of interferon in the early stages of influenza A. It also has an immunomodulatory effect on cytokine production. [3, 4] Vitamin C has been used in hospitals in China for patients with COVID-19 disease and some clinical trials are in progress. (If given with proton pump inhibitors, Vitamin C levels are lowered. [5] )
Vitamin D supplementation reduces the risk of acute respiratory infections and may be useful for COVID-19 disease. [6] Deficiency is common in countries with limited exposure to sunlight and levels may be particularly low if more melanin in the skin restricts the absorption of ultraviolet light. Possibly, this may be a contributory factor in some of the serious infections reported in certain NHS and social care workers. (Ultraviolet light is also useful in that it can inactivate the virus.)
1. Grant ECG. https://www.bmj.com/content/369/bmj.m1626/rapid-response to Wilkinson E. RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials. BMJ 2020; 369: m1626 (Published 28 Apr 2020)
2. World Health Organization (2020) A Coordinated Global Research Roadmap: 2019 Novel Coronavirus. March, 2020, p 36-37. https://www.who.int/blueprint/priority-diseases/key-action/Coronavirus_R...
3. Cheng RZ. Can early and high intravenous dose of vitamin C prevent and treat coronavirus disease 2019 (COVID-19)? Medicine in Drug Discovery 2020; 5:100028 doi.org/10.1016/j.medidd.2020.100028
4. Hartel C, Puzik A, Gopel W, Temming P, Bucsky P, Schultz C. Immunomodulatory effect of vitamin C on intracytoplasmic cytokine production in neonatal cord blood cells. Neonatology. 2007;91(1):54-60.
5. Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013 Jun;4(3):125-33. doi: 10.1177/2042098613482484.
6. Grant WB, Lahore H, McDonnell SL, Baggerly CA, French CB, Aliano JL, Bhattoa HP. Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths. Nutrients. 2020 Apr 2;12(4). pii: E988. doi: 10.3390/nu12040988.
Competing interests: No competing interests