Potential Role of Vitamin D in the Elderly to Resist COVID-19 and to Slow Progression of Parkinson's Disease
Brain Sci. 2020, 10, 284; doi:10.3390/brainsci10050284
Casey A. Hribar1, Peter H. Cobbold 2 and Frank C. Church
Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27759, USA; casey_hribar at med.unc.edu
Department of Human Anatomy and Cell Biology, University of Liverpool, Liverpool L69 3EG, UK; pcobbold at fireflyuk.net
* Correspondence: fchurch at med.unc.edu
26 health factors increase the risk of COVID-19 – all are proxies for low vitamin D
CDC lists Neurologic conditions such as dementia, but not Parkinson's Disease specifically
- Parkinson's Disease 2.1 X more likely if low Vitamin D – Meta-analysis Nov 2018
- COVID-19 mortality for Parkinson’s is 1 in 5, speculates that vitamin D could help - March 18, 2021
- Parkinson patients: 60 pcnt taking Vitamin D – Dec 2019
While we are still learning more about COVID-19, caused by the novel SARS-CoV-2 virus, finding alternative and already available methods to reduce the risk and severity of the disease is paramount. One such option is vitamin D, in the form ofvitamin D3 (cholecalciferol) supplementation, due to its potential antiviral properties. It has become apparent that older individuals have a greater risk of developing severe COVID-19, and compared to younger adults, the elderly have lower levels of vitamin D due to a variety of biological and behavioral factors. Older adults are also more likely to be diagnosed with Parkinson's disease (PD), with advanced age being the single greatest risk factor. In addition to its immune-system-modulating effects, it has been suggested that vitamin D supplementation plays a role in slowing PD progression and improving PD-related quality of life. We completed a review of the literature to determine the relationship between vitamin D, PD, and COVID-19. We concluded that the daily supplementation of 2000-5000 IU/day of vitamin D3 in older adults with PD
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Those who have investigated vitamin D's impact on the immune response suggest that a serum level of
- 40-60 ng/mL (100-150 nmol/L) 25(OH)D3 may be necessary for respiratory infection prevention . This is in contrast to the roughly
- 30 ng/mL recommended for skeletal health and cognitive function, and
- 50-80 ng/mL for the prevention of other chronic conditions, including hypertension and cardiovascular disease [8,9].
The adverse effects of vitamin D3 supplementation are generally not experienced until serum concentrations of 25(OH)D3 exceed 150 nmol/L . The most common side effects experienced are poor appetite, nausea, vomiting, constipation, weakness, or weight loss. Excessive vitamin D3 supplementation may lead to increases in calcium, leading to disorientation, arrhythmias, confusion, fatigue, and gastrointestinal upset. Excess calcium may also lead to nephrolithiasis and kidney damage [8,9]. Despite these risks, the hypervitaminosis of vitamin D is rare, and would require excessive daily D3 supplementation for an extended period of time, making D3 a safe supplement in most populations.
By combining our knowledge of the antiviral properties of vitamin D with our understanding of vitamin D's impact on PD-related quality of life, it is logical to recommend vitamin D3 supplementation to this population for both improvements fn PD progression and potential COVID-19-related benefits, as shown in Figure 1. VitaminD supplementation is best achieved through D3 (cholecalciferol) supplements, which are widely available and relatively inexpensive. The favorable safety profile of D3 supplements also makes them an ideal choice for those deficient in vitamin D. We suggest a daily dosage of 2000-5000 IU/day of vitamin D3; however, higher doses may be needed for those with severs deficiency or in extraordinary situations where other clinical options are limited. Due to the ongoing benefits this may provide for people with PD, we recommend continuing this supplementation for as long as possible; potentially life-long, if feasible.
The ideal 25(OH)D3 concentration should be around 40-60 ng/mL, the physiological level , and routine serum monitoring may be beneficial to determine the lowest daily D3 dosage needed for optimal benefit. Longer-term supplementation is recommended rather than individual, large bolus doses, unless an initial bolus is required in severe deficiencies. Maintaining adequate vitamin D levels may also help improve immune responses to a COVID-19 vaccination when one becomes available, further reducing risk.