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Covid-19: Public health agencies review whether vitamin D supplements could reduce risk

BMJ 2020; 369 doi: (Published 19 June 2020) Cite this as: BMJ 2020;369:m2475

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NICE Evidence Summary

Dear Editor

According to its website NICE “provides national guidance and advice to improve health and social care”. It does not specify that this must be based on evidence rather than common sense.

Emerging data strongly suggests that a vitamin D3 blood level of at least 75 nmol/L (30 ng/ml) is needed for protection against COVID-19 [ ]. Government recommendations for vitamin D intake – 400 IU/day for the UK and 600 IU/day for the USA (800 IU for >70 years) and the EU – are based primarily on bone health. This is woefully inadequate in the pandemic context. An adult will need to take 4000 IU/day of vitamin D3 for 3 months to reliably achieve a 75 nmol/L level. Persons of colour may need twice as much.

The NICE Evidence Summary adds nothing to this statement and does nothing to refute it. It shows no understanding of dosage requirements for vitamin D. It perpetuates the erroneous assumption that “For most people, 10 micrograms of vitamin D (400 IU) a day will be enough and people should not take more than 100 micrograms a day because it could be harmful.”

This is inaccurate by about an order of magnitude, and is based on a misreading of the data. The UK Scientific Advisory Committee on Nutrition (SACN) report of 2016 which set the recommended Upper Level (UL) intakes of 50mcg/2000iu per day says;
“Excessive vitamin D intakes have, however, been shown to have toxic effects (Vieth, 2006).” However, in 2006 Vieth clearly stated [ ], and documented, that; "Published reports suggest toxicity may occur with 25(OH)D concentrations beyond 500 nmol/L." To achieve that blood level requires a sustained intake of over 500mcgs (20,000 IU) per day.

The risk from not acting is therefore much greater than the risk from acting. There is no significant down-side to making vitamin D available to everyone, in appropriate doses (5,000 to 10,000 IU per day for an adult), now. That’s the common sense approach.

1. Downing D. HOW WE CAN FIX THIS PANDEMIC IN A MONTH. Orthomolecular Medicine News Service

2. Vieth R. Critique of the considerations for establishing the tolerable upper intake level for vitamin D: critical need for revision upwards. J Nutr. 2006;136(4):1117-1122. doi:10.1093/jn/136.4.1117

Competing interests: No competing interests

12 July 2020
Damien Downing
President, British Society for Ecological Medicine
London, UK