COVID-19 Crackdown: Immune Support During A New Pandemic
There is a high level of interest in the development of integrative strategies that can augment the ability of public health measures to prevent Covid-19. While integrative therapies have yet to be validated in human clinical trials, now is the time to be proactive and to take aggressive steps toward improving health and immune function. Using the best in-vitro evidence and an understanding of similar viruses such as MERS and SARS, I am outlining these recommendations for your consideration. Many of these therapies have been supported by numerous physicians at various critical care hospitals around the country, as evidenced by Dr. Paul Marik’s EVMS Critical Care Covid-19 Management Protocol (see link at end). Nevertheless, I stress that these are supplemental considerations to be used in addition to the recommendations outlined by the Center for Disease Control and the Oregon Health Authority.
- Follow all CDC recommended guidelines and Kate Brown’s Executive Order 20-12.
- Wash hands frequently, especially before eating or touching your face. Washing hands with warm water and soap for at least 20 seconds is one of the best methods of preventing infection.
- Avoid touching your eyes, nose, and mouth. Use of a mask will help you to follow this guideline.
- Try to observe the six foot distance recommendation.
- Stay home if you become sick unless you are going to see the doctor. When shopping, obtain enough food for a week in order to minimize your outings. If necessary, there are services that will shop for you and deliver your food for a fee.
- Remain physically active. Hike, go to a field and throw the frisbee or go for a long walk. Moderate exercise, sunlight and oxygen can all boost the production of macrophages, the kind of white blood cells that phagocytize, or “eat” bacteria and viruses.
- Nasal Irrigation, Neti Pot, etc: Routine nasal irrigation can help to clear nasal secretions and wash away viral organisms before they have the opportunity to take hold, thereby preventing many infections from colonizing your respiratory tract in the first place. Remember coronaviruses are spread through respiratory droplets. A neti pot, therefore, is an excellent sixty second amendment to your daily (or better yet twice daily) prophylactic therapies. Add a pinch of probiotic to the water for additional support.
- Load up on foods and spices with antiviral properties. These include coconut oil, raw garlic, oregano, ginger, kimchi and other fermented foods, walnut, pomegranate, green tea, apple cider vinegar, and medicinal mushrooms (shiitake, maitake, reishi, cordyceps, turkeytail).
- Eat lots of colorful fruits and vegetables. Fruits and vegetables contain flavonoids (a family of compounds that give fruits their colors) which have antiviral properties. Many flavonoids have been shown to modulate the compounds that trigger “cytokine storms”. This phenomenon involves an unregulated and excessive production of pro-inflammatory cytokines that often leads to death in Covid-19 cases. These cytokines include IL-6, IL1B, TNF alpha and NFkB.
- Stay well-hydrated. This means water, not soda or coffee. Divide your body weight (in pounds) in half and drink that number in ounces of water daily.
- Avoid simple sugars and processed/junk food. Your blood reveals lab evidence of impaired immune function within 30 minutes of eating simple sugars (glucose, refined sugar, and fructose). Sugar has been shown to cause up to a 50% reduction in your white blood cells’ ability to kill germs. This effect is most noticeable 2 hours after ingestion, but may still present 5 hours after consumption of sugar..
- Get adequate sleep. A restful night of sleep has been demonstrated to increase your white blood cell count. On the other hand, lack of satisfying sleep may lead to increased inflammation in our body which may make us more susceptible to illness. One study found that those who receive less than 5 hours of sleep increase their risk of contracting the common cold by 350% when compared to folks who sleep at least 7 hours a night. Adequate sleep also ensures the production of melatonin (see below) which may play a role in reducing corona virus virulence.
- End hot showers with a cool spray – first briefly, then for a longer periods lasting up to 2 minutes, with water as cool as you are able to tolerate. One study demonstrated that this therapy could reduce colds and flus by up to 50% provided that it was implemented daily for at least six weeks. Because of the longstanding usefulness of water based treatments at improving immune function in viral respiratory infections, including the Spanish Flu of 1918, I strongly believe the use of these therapies to be pivotal in boosting immune strength. The next point delineates a venerable hydrotherapy treatment that can easily be done at home.
- Warming Sock Treatment- Put a pair of THIN cotton socks in a bowl of cold water. Fill up a tub with HOT water and soak your feet in the water for at least ten minutes. Wring out the socks WELL and put them on. Over the socks put on a pair of wool socks (or any hiking sock that will keep you warm when it is wet. Do NOT use cotton socks). Go to bed. In the morning the socks should be dry. This treatment will engage the natural ability of the body to heal itself. The gentle chill in the feet will awaken the body’s natural response, inducing increased blood flow to the feet. En route to the feet the blood will pass through all the organs that filter the blood including the lymph glands and the spleen. In this way, the therapy both invigorates and cleanses the blood.
Supplements for prevention: In general both myself and my colleagues at Bear Creek Naturopathic Clinic recommend the following supplements as a method of improving immune vitality and responsiveness. We consider the nutrients listed below as being for prophylaxis purposes only. If you are suffering from symptoms or if you test Covid-19 positive, you will likely require a more robust protocol and should seek the advice of a licensed health care provider.
- Zinc and Quercetin. Zinc appears to be beneficial at inhibiting viral replication. It is dependent on the presence of an ionophore such as quercetin to transport it into cells. It is pertinent to note that one of the primary rationales for using hydroxychloroquine (Plaquenil) to reduce the mortality of Covid-19 patients lies in the fact that this drug is an outstanding ionophore for zinc. Plaquenil, however, has now become backlogged due to demand; many physicians, both MD and ND alike recommend quercetin as an alternative. In addition, preclinical data suggests that quercetin has broad anti-viral properties (including against coronavirus) and is able to act upon viruses at multiple stages of their life cycle. It also increases the activity of your ACE2 enzyme (see below). I recommend taking 1000 mg of quercetin daily in divided doses along with 50 mg of zinc glycinate.
- Vitamin D. Vitamin D has many immune stimulating properties. Much of the population, especially the elderly, has sub-optimal vitamin D levels. Low vitamin D levels has been shown to increase the risk of developing upper respiratory tract infections and a recent study in the Irish Medical Journal stated that “vitamin D deficiency is common and may contribute to increased risk of respiratory infection including Covid-19”. It also has been shown to reduce IL-1B secretion. I recommend 5000 IU daily with a small amount of oil. Spend time in the sun! Your body produces a tremendous amount of vitamin D when skin is exposed to the sun. 40 minutes of sun exposure in a swim suit generates 20,000 IU of vitamin D. Start out with 10 minutes of exposure a day (without sunblock) and work up slowly to one or two hours a day.
- Vitamin C. Like flavonoids, vitamin C has demonstrated the ability to shorten the frequency, duration, and severity of the common cold and incidence of the pneumonia. During an infection, a white blood cell absorbs so much vitamin C that the concentration of vitamin C in the immediate area of the white blood cell drops to near zero. Typical dosing ranges from 500 to 3000 mg three times daily. Because the enzymes that transport Vitamin C increase during times of illness, you can consume additional Vitamin C if you have flu-like symptoms. To lend credence to this therapy, the American Association of Naturopathic Physicians just released a position paper endorsing the use of IV Vitamin C for active Corona viral infections. (see link at end)
- Melatonin. Melatonin has been shown to reduce inflammatory cytokines. It decreases substantially after age 40. One article has suggested that this may be one reason why children do not commonly present with symptoms and older adults do. Melatonin may also reduce oxidative lung injury. Doses typically fall between one and twenty mg although the latter dose tends to be best indicated in the oncology setting.
- Vitamin A. Vitamin A has been shown to have anti-viral properties. I recommend 50,000 IU per day with a small amount of oil. Vitamin A should not be consumed in doses over 10,000 IU per day if you are pregnant.
- Curcumin. In order to appreciate the benefits of curcumin one must understand a bit about ACE2. Angiotensin Converting Enzyme-2 plays a significant role in the pathogenicity of Covid-19 in that the virus binds strongly to this enzyme and uses it as a port of entry into specific lung cells called Type II pneumocytes where the virus can then reproduce. Because ACE2 acts as a beacon of entry for the virus, it might seem reasonable to assume that ACE2 is a bad thing. This in fact is not the case. ACE2 also floats freely in the bloodstream, where it just as effectively binds to the virus. In this case however, since the ACE2 is not part of any cell, it effectively inactivates the virus simply by never letting go. Folks with active, resilient ACE2 levels, early research indicates, seem to resist progressing to advanced disease. Another reason ACE2 may be of benefit is that it coverts a highly inflammatory enzyme known as angiotensin-2 into the anti-inflammatory enzyme angiotensin 1-7. Studies from China do seem to indicate that high levels of angiotensin-2 are associated with advanced Covid-19 disease, suggesting that these poor folks do not have enough ACE2 to keep their angiotensin-2 levels from triggering a “cytokine storm”. Curcumin is an herb that increases the production and activity of ACE2. It is best to take curcumin with oil and ideally, with a small amount of lecithin. Eggs are high in lecithin so I recommend taking at least 1500 mg with your eggs each morning.
- N-acetyl Cysteine. NAC is part of several major detoxification pathways in the body and is the primary amino acid used to make glutathione. Glutathione is the most common antioxidant in the body and is necessary for the regeneration of vitamin C. When a white blood cell attacks and engulfs a microbe, that microbe is exposed to potent reactive oxygen species (ROS) such as peroxides and hydroxyl radicals within the white blood cell. The result of this exposure is the death of the microbe. However, the white blood cell must protect itself from these oxidants. It uses vitamin C to do so. In the process the benefits of vitamin C are exhausted. Glutathione is used to “recharge” the vitamin C. Without it the white blood cell will itself become oxidized by its own ROS. Lung tissues boast the second highest concentration of glutathione in the body. Given the susceptibility of lung tissue to Covid-19 induced injury and death, glutathione may be one of the most important nutrient to supplement. Take 500 to 1000 mg NAC three times daily to boost your glutathione levels.
It is important to understand that given the integral role of inflammatory cytokines -namely NLR3P, IL-1B, IL6 and IL-18 in the pathogenicity of Covid-19 as well as the difficulty in determining who might be susceptible to a “cytokine storm”, it may be prudent to avoid the use of certain immune stimulants if you have symptoms or test positive for Covid-19. Pre-clinical evidence has demonstrated the ability of the following supplements to increase these cytokines: Echinacea, Vitamin D, Elderberry extract, mushroom isolates and larch arabinogalactans. It is essential to consult a lisenced naturopathic physician under these circumstances.
(1) Dr. Paul Marik’s EVMS Critical Care Covid-19 Management Protocol
(2) American Association of Naturopathic Physicians position paper on high dose IV vitamin C
Dr. Daniel Smith practices at Bear Creek Naturopathic Clinic. His office is on 2612 Barnett Ave. He specializes in naturopathic oncology, but still maintains a strong family practice, treating all manner of conditions. He can be reached at 541-770-5563 or at firstname.lastname@example.org. If you would like to schedule an appointment, please ask specifically for Dr. Dan.