[Music] so let’s look at covid then and this is uh um basically uh a systematic review and metaanalysis of vitamin D there were hundreds of studies done during do covid I have to say most of them were abysmally badly designed and perhaps need to be ignored but this looked at all of them and the quote from the paper is vitamin D supplementation did not reduce major health related outcomes like mortality ICU admission rates or mechanical ventilation but it goes on to say the studies differed significantly with respect to their design the drug dosage and the population characteristics so are some of them from a malnourished population some of them from an adequate nourished population the intrinsic heterogeneity of the included studies and small sample sizes make it difficult to interpret and extrapolate this data to a large population so we’re not getting no general advice based on the studies that have been performed now what has been um recently shown and I think it’s important uh to see is that giving large dose is is not the answer you can’t get someone who is deficient in vitamin D and just shock their system with a huge dose so this was looking at a single high dose of vitamin D in Co on length of stay um or the actual severity of the disease and it was 200,000 international units of vitamin D given as a bolus and what they found was that it did indeed increase the blood level up to the sort of level we seen giving statistically important um positive results but there was no difference there was no statistical difference in inhospital mortality admission to the Intensive Care Unit length of Hospital stay or the need for mechanical um ventilation so this again is people have been using studies like this to build a story vitamin D is not important so this was a little bit later um and that talked about vitamin D where are we now let’s look at it and see we’ve seen all of these studies being rushed into print and they seem to be so wildly different one from the other and coming up with different conclusions so they reviewed 11 of these randomized control trials um and its impact in Co again they said they were so different Wild different one from the other five did have a placebo control uh six were open label in other words they were just giving the vitamin D everybody knew whether they had it or not or single blinded where either the doctor or the patient knew and the other person didn’t know um there was a wide range of sample sizes some of them had only 30 patients in their study and others had up to five uh five or 600 so various lab measures of vitamin D were used now I have to tell you there’s really only one validated measure some were using vitamin D itself looking at that in the blood that has a half life of one day that is very inaccurate 25 hydroxy is the um the measure of choice because it’ll probably last up to three weeks in the blood 125 dihydroxy is the hormone that vitamin D eventually becomes and it again has a shorter halflife so because of the right the variety of outcome measures then you have another complication Factor um some looked at mortality some looked at length of Hospital say some looked at the need for intensive care the res resolution of symptoms or whether they cleared the virus some looked at at at a number of these some looked at only one of these so the conclusion where we are now is the lack of a consistent protective signal from randomized control trial reporting so far is reflected by the absence of any recommendation so nobody has been able to say you need to take vitamin D and this is how much you need to take this is how much you have in your blood because there have been such wildly different results from clinical trials um this is a a very recent study that has looked at the really most severe outcome meas is mortality and that was what was so disturbing and concerning in the initial stages of the pandemic and this metaanalysis quite clearly shows that there is a significant reduction in mortality so there 19 randomized control they found trials they found and and they weren’t biased there is we talk about bias in a minute so they seem to be free of bias and there was a significant reduction in all cause mortality because some people who died of covid were actually dying from the diseases they already had um whether they had heart disease they could have a sudden Cardiac Arrest Etc but vitamin D seems to reduce all cause mortality um by about 28% but when you looked at the very severe cases with people who had severe disease did they die or not the reduction was dramatic it was uh 43% reduction so there is definitely a role to play of the vitamin D alone [Music]
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