What does dark skin, obesity, age, and living above the 37^th parallel have in common?  These all put one at risk for having vitamin D deficiency/insufficiency.  This is not good on many levels.  Insufficiency/deficiency of D can cause one to be depressed and anxious. I remember working my DOD job in England, and how most office workers had a special lamp simulating UV ray in their workplaces.  There are many health reasons for the proper levels of D and K, and during this pandemic its even more important.

I’ll break this down in two ways:  Firstly, simply listing the benefits of adequate vitamin D3 and vitamin K2 levels, and secondly, by providing a little more complex explanation (for all you scientists out there).

As a therapist and a foodie, simply put, vitamin D effects mood. 40% of Americans are deficient in it (National Library of Medicine).  The connection of vitamin D and mood lies primarily in neurotransmitter serotonin (responsible for a sense of wellbeing: calm, cool, collected).  The opposite, of course, being anxious and depressed.  Vitamin D helps to metabolize and create serotonin (Oregon State University: https://ir.library.oregonstate.edu/concern/default/+609j712r).

Salmon, cod, mackerel, tuna (fatty fish), mushrooms, cheddar cheese, tofu, orange juice, fortified milk, and at least 10 minutes of direct sunlight per day (no sunblock until after the 10 minutes please) are all good sources.  We need 800-1000 IUs (International Units) per day.

Strong research also suggests that vitamin D3 and K2 work together (pleiotropically) to reduce symptoms and reduce mortality (as well as mitigate damage) for patients with COVID-19 (not to mention their efficacy in prevention of osteoporosis, coronary heart disease, and good dental health).  Like two other vitamins (A and E), vitamin D3 and K2 are fat soluble. This simply means these are stored in the body.  Sources of vitamin K2 are: natto ( a Japanese fermented soy  which is excellent in K2), dairy (grass fed high fat like English blue cheese, Norwegian Brunost cheese), egg yolks, organ meats, kimchi, sauerkraut.  I just bought a big jar of kimchi at the Asian store last week. Delicious with my sushi night menu.  Sausages, mashed potatoes and sauerkraut has been a favorite of mine since I was a kid.  It’s not hard to get these food sources.   K2 is a bacterium, and we need 90-120 mcg per day for optimal health.

Now a bit more detail on vitamin D3

Vitamin D comes in 2 forms: D3 (cholecalciferol), from the sun; and D2 (ergocalciferol) from plants.  Calcitriol is the active form of vitamin D in our bodies.  When I’m outside working in my garden/yard in the Georgia sun, I’m getting direct UVB rays.  From the God given sun, my body creates 7 Dehydrocholesterol, turns it into D3, and then binds to proteins (primarily in the liver).  Then it is converted to calcidiol (the storage form of vitamin D), and further converted to calcitriol (active form).  Voila!  While much of the process is taking place in the kidneys, vitamin D3 gets into other places of importance. As it relates to COVID-19 (and other respiratory infections), vitamin D activates in the immune system (lymph nodes, alveoli macrophages, and the alveoli themselves).  Hmmm, the alveoli cells are not only responsible for transporting oxygen in the blood but are the same exact cells which viruses like COVID-19 invade.  As vitamin D is activated in these cells, perhaps this has something to do with our lungs’ ability to fight infection.  So, aside from mood benefits, aid in strong bones (by signaling the intestines to absorb calcium), preventing rickets in children, vitamin D may assist in the prevention and treatment of viruses like COVID-19.

I won’t go into detail (I’ll let you do that with the citations), but here are 5 studies offered by Dr. Mike Hansen (Internal Medicine Pulmonary Disease and Critical Care Medicine, Vitamin D and COVID New Studies-Evidence for a Protective Role of Vitamin D in COVID, February 27, 2021) that support this hypothesis:

• Pubmed.gov, August 18, 2020 (Germany) “Vitamin D Insufficiency and Deficiency and Mortality from Respiratory Diseases in a Cohort of Older adults: Potential for limiting the death toll during and beyond the COVID-19 pandemic.” The article cited the study with 10,000 adults, ages 50-75 years old, over a 15-year period, where 44% were vitamin D insufficient, and 15% were deficient.  41% of respiratory mortality had low levels of vitamin D.
• British Medical Journal, 2017 PMID: 2820713. “Vitamin D Supplementation to Prevent Acute Respiratory Tract Infections: systematic review and meta-analysis of individual participant data.”  This was a meta-analysis of 25 randomized, double blinded, controlled trials.  There were 11,000 participants. Daily doses of vitamin D reduced the risks and had a protective effect.
• Quest Diagnostics Laboratories, September 17, 2020 (United States) “SARS COV-2 positivity rates associated with circulating 25-hydroxyvitaminsD levels.”  200,000 patients showed a strong inverse relationship between SARS COV-ranges.  2 positivity and vitamin D levels across latitudes, sexes, ethnicities, age.  With increases of vitamin D (1ng/ml), 1.6 percent lower positivity rates were observed.  A previous study found that for each 4ng/ml increase in circulation of 25 (OH) D levels, there was an associated 7% decrease in seasonal infections.
• Nature, July 8,2020. “Factors Associated with COVID-19 Related Deaths Using OpenSAFELY.  17,000,000,000 adults.  10,000 died of COVID-19.  These were all associated with being male, dark skinned, obese, with medical conditions, older.  These factors are also associated with vitamin D deficiency risk. 
• University of Chicago, September 30, 2020. “Association of Vitamin D status and Other clinical Characteristics with COVID-19 Test Results.”  Researchers studied a cohort of 489 persons who had vitamin D levels measured 1 year before COVID-19 testing.  The risk of testing positive was 1.77 times greater for vitamin D deficient patients from those who were not. 

Now a bit more detail on vitamin K2

Vitamin K assists in blood coagulation. It is also called menaquinone and has a bacterial origin.  Food sources (already mentioned above) are both animal and plant based.  According to a study in the National Institutes for Health Excellence (NICE), December 17, 2020, vitamin K2, while assisting the body in coagulation, in low levels, produces risk for thrombosis.  This can lead to heart attack and stroke.  A Netherland study (www.preprints.org :“Reduced Vitamin K as Potentially Modifiable Diagnostic Risk Factor in COVID-19”, May 29, 2020) noted that vitamin K helps coagulate inside and outside the liver. If one does not have optimal levels of vitamin K2, it stays in the liver, and does not produce the needed carboxylation for the rest of the body.  This deficiency can paradoxically lead to thrombosis. I say “paradoxically” because while vitamin K2 assists in coagulation, the risk of thrombosis occurs because we have elastic fibers throughout our bodies (including in our lungs and heart), and a deficiency in vitamin K2 leads to a lack of production of MGP (causing  breakage in these fibers).  This can be measured by the desmosine levels in the blood.  COVID-19 patients are particularly at risk because calcium will bind with these, creating calcification and scarring damage. This increases fibrosis in the lungs. In turn, this can lead to thrombosis (heart attack and stroke). 

So, Chuck, what does all this mean you may ask?  Glad you asked.  Aside from the apparent mental health benefits of vitamin D3, there appears to be a strong relationship between vitamin D3 and K2 deficiency and the number and severity of respiratory infections.  In these stressful times, just knowing that is an added mental health benefit.  Wouldn’t you agree?  This is correctable.  Get blood serums done (I did), and if deficient, in consultation with your doctor, get supplements for K2 and D3.   In the meantime, get adequate sunlight and eat the right foods.