The past, like the future, is unknown and largely unknowable. Just when you think you have it pinned down it wriggles free and assumes new forms. History, like science, is revisionism.
Take D-day. One of the most amazing episodes on this most terrible of days was the ascent of a battalion of US army rangers on the Pointe du Hoc, a highpoint overlooking Omaha beach, to take a German battery. They succeeded but at terrible cost; of the 580 men 77 were killed, 38 MIA and 152 wounded.
Considered a pivotal element in the D-day invasion and a byword for bravery under fire, their story was told in the film ‘The Longest Day’ and passed into legend. Until, 15 years ago, the legend was exposed by careful research and a new truth emerged. Lt. George Klein, a self-proclaimed survivor of the ascent, made a good living touting his story around the world. Military historians discovered, however, that he was not on Pointe. On D-day, George was safely behind the lines in Ireland.
More seriously, the Hoc was not a strategic target. The guns had been moved elsewhere and commanding officer Lt. Col. James Rudder, who was aware of this, squandered his men’s lives. He also disobeyed direct orders to knock out German artillery at Maisy and, for reasons obvious to anyone who has read Catch 22, was made a war hero for his efforts.
Now let’s consider vitamin D. Here again many unnecessary deaths have been caused by the officer class, on this occasion setting RDA values so low they left crowds dying not on the beaches but in the beds of hospitals and clinics around the world. They did this partly because of their long-standing distaste for natural medicine; and here also, history is being re-written.
As recently as the 1970’s vitamin D was all about bones, and RDA values were designed primarily to prevent rickets.
Over the last half-century a more complex picture has emerged, placing vitamin D at the centre of an extensive network of genes, enzymes, receptors and risk factors for cancers (1, 2), Type 2 diabetes (3) and infective (4), degenerative (5) and auto-immune (6) diseases.
Due to D’s anti-inflammatory, immuno-regulatory and chemo-protective properties (7-9), and the fact that we can make it ourselves, its status has shifted from vitamin to hormone. At 40-60 ng/ml, the serum levels required to achieve its endocrine benefits are considerably higher than those needed to prevent rickets (10).
Despite this, many medical authorities hold the rickety old Maginot Line of 20 ng/ml (ie 11), while regulators warn that levels higher than 50 ng/ml may trigger adverse effects (12). As a result, the standard supplement recommendations of 5-20 mcg/day (200 to 800 International Units) are far too low to achieve optimal blood levels (10, 13).
Official guidelines, together with the fact that today’s ultra-processed diet has left us depleted in derma-protective phytonutrients (14-19) and therefore too delicate to cope with direct sunlight, have contributed to wide-spread hypo-vitaminosis D. In the temperate zones, most people are depleted in vitamin D for most of the year. And this has killed many more than the 2,400 brave souls who died on Hoc, and on Omaha Beach (20).
How did we get here? How can we make our way further inland? And what does this mean for supplementers?
One reason for the overly cautious advice about vitamin D is the widespread use of well-intentioned but poorly designed D+calcium supplements, which are supposed to protect against osteoporosis but do not (21). This is unsurprising, given that osteoid and bone economics involve over 20 micro-, phyto- and other nutrients and that most of us are depleted in most of them (ie 22).
Ca supplements do however carry a risk of adverse effects including kidney stones and, likely, vascular calcification (23). This could explain why high dose calcium supplements have been associated with increased mortality (24, 25).
When used without calcium, however, and especially when combined with K2, high dose vitamin D does not cause calcification problems (26-29). This makes biological sense, and undermines current regulatory guidelines and upper safety limits (USL’s). In the USA these are set at 4,000 IU’s day, while the more conservative UK brass hats are pinned down at 2,000 IU’s.
If the bureaucrats were ever to leave their sunless bunkers, sally up to the front lines and look to the skies, they might find enlightenment. In the sub-tropics and in the temperate zone during summer months you can make up to 10-50,000 International Units of D in your own skin in an hour or so of sunlight (27).
Once you check your ethnocentric attitudes at the door you find that people in vestigial cultures (such as Hadza and Maasai) have an average serum 25-hydroxyvitamin D concentration of 46 ng/mL (31). Urbanites can only achieve these levels with regular use of sunbeds (32, 33), or by supplementing with circa 10,000 IU’s day (my estimate and 29, 34).
The Hadza and Maasai show no signs of vitamin D toxicity, and indeed have better renal health into old age than we do (35). Given their higher intake of organ meats, fermented foods and prebiotic fibers they consume (36) and produce (37, 38), via their microbiota (39, 40), significantly more vitamin K than we do. This helps to explain their near-freedom from cardiovascular disease (41), and should provide guidance for supplement manufacturers everywhere; raise D, lose Ca, add K2.
Recent research indicates the true USL of vitamin D is above 10,000 IU’s (42, 43). Further context comes from clinical studies in which far higher doses of vitamin D were used therapeutically, and without toxicity. Hyperparathyroidism has been successfully managed with 50,000 to 200,000 IU of vitamin D daily (44), while rickets may require a daily dosage of 50,000 to as much as 300,000 IU in resistant cases (45).
It’s fortunate that vitamin D has a wide therapeutic index, because high-dose D has lately become very fashionable. A recent paper by Borsche et al (46) put the D in Covid and the cat among the pigeons with data suggesting that D has dose-related protective effects. The authors predicted that Covid mortality should fall to zero when plasma levels of D reach 50 ng/mL … which if true, would make the Maasai and Hadza almost totally immune and raises the question, can hunter-gatherers catch Covid?
It would be ironic if cultures once devastated by microbes imported by European colonisers were now resistant to a new, man-made virus which kills only modern consumers made sick, fat and malnourished by the Western food industry. This would be a potentially watershed study but it will never be done while Fauci, a latter-day George Klein, reigns. Rather than keeping the home fires burning (47) he is in fact paid handsomely for burning down the house (48, 49).
So is D really a cure for Covid? Well, it certainly has history. Sunbathing for tubercular patients is as old as Hippocrates, and was being used to treat TB well into the 20th century (50). Then came the antibiotics, of course, and the sun set on heliotherapy until 21st century science re-discovered the relevance of D to disease.
The many defects in the immune system caused by D deficiency clearly make people more prone to TB infection and to disease progression (51-56).
It seemed logical to monotherapy-minded researchers that D supplementation would find a role in TB treatment, but when prospective clinical trials were set up to look at this the results were disappointing (57, 58).
Not surprising. Immunosuppression makes infection more likely, but why would anyone think that repairing a very few components in a person with multiple nutritional and metabolomic problems, and a generally degraded immune system, could possibly be effective?
I believe it is the same with Covid. If you are D-deficient some of your defences are down, and your risks are up. But as the immune system has multiple nutrient requirements, and most people are depleted in most nutrients, how could one reasonably expect D to be the cure?
The authors of the cat ‘n pigeon paper (46) make the case that vitamin D3 depletion and deficiency is one of the main reasons for severe SARS-CoV-2 infections. They point out that fatality rates are higher in elderly people, black people, and people with comorbidities, who tend to have very low vitamin D3 levels (59-62). They could have added – but didn’t – that Covid fatality rates are also higher in the obese (63), in schizophrenics (64), and in those who wear the niqab or hijab (65); all of whom have low D status (66-68).
It doesn’t matter. None of this proves a causative relationship between D and Covid, and it certainly does not show that high D doses will reduce the risk of Covid death, except perhaps in the D-deficient. There are many variables at play here, and I believe the authors are making the same mistake that the earlier TB triallists did (69).
Nutritional status in Covid is critical but highly complex, and does not lend itself to monotherapy. That is a pharmaco-centric error of thought; and D is very far from being a panacea (70-72). D is important for immune function, at up to 10,000 IU/day, but so are many other dietary components. These range from vitamins A, B and C to Fe, Cu and Zn, via omega 3 PUFA’s, polyphenols, prebiotics, cyanogens and 1-3, 1-6 beta glucans.
While Borsche and his colleagues correctly flagged up nutrition, they did not go far enough. They took the Hoc, perhaps, but for those who want to go further inland I recommend the Health Protocol. The HP is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.
I cannot finish this post without mentioning a strangely wonderful controlled randomised trial which reported that D supplements fail to reduce the adverse effects of earthquakes (73). I am shaken by this news, but not stirred.
Next week: Borderline Personalities and edible passports.
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