Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Vitamin D (cholecalciferol) is used in the context of tuberculosis (TB) primarily based on scientific rationale, though the strength of evidence is modest. Historically, cod liver oil and sunlight exposure—both sources of vitamin D—were used as adjunctive therapies for TB before antibiotics were developed. This historical use was based more on empirical observation than mechanistic understanding.

Modern scientific interest centers on the immunomodulatory properties of vitamin D. Laboratory studies have shown that vitamin D can enhance the antimicrobial actions of macrophages, the immune cells responsible for engulfing Mycobacterium tuberculosis. Specifically, vitamin D induces the production of cathelicidin, an antimicrobial peptide that can inhibit TB bacteria in vitro.

However, clinical trials have produced mixed results. Some randomized controlled trials and meta-analyses suggest that vitamin D supplementation may slightly accelerate sputum conversion (the clearance of TB bacteria from the sputum) in patients with pulmonary TB, particularly in those who are vitamin D deficient or have certain genetic polymorphisms affecting vitamin D metabolism. Other studies, however, have found no significant benefit in terms of treatment outcomes or prevention.

In summary, while there is a plausible biological mechanism and some supportive clinical data, the evidence is not robust or consistent enough for vitamin D to be considered a primary or standalone therapy for TB. It may be considered as an adjunct in specific contexts, mainly in cases of documented deficiency.

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