What’s Novel about COVID-19?
As an emerging infection, we’re beginning to understand what makes this virus unique. This allows us to be more strategic in our efforts to prevent and treat it. Here’s what we’re learning:
This virus uses ACE2 receptors on cells to gain entry. Different substances interact with and increase the number of receptors or bind and potentially block them, including Vitamins A and D, Zinc, ibuprofen and anti-hypertensive drugs. Also, certain conditions can increase the number of these receptors on the cell surface: cardiovascular disease, diabetes and hypertension, conditions increasingly seen with aging and associated with worse outcomes. Let’s drill down a bit…
While optimal levels of vitamins A and D are critical for a healthy immune response, there is emerging concern that high-doses of these vitamins during active COVID-19 infection may increase the number of ACE receptors on cell surfaces, allowing for more access points into the cells where these receptors are present (they’re especially abundant in the epithelia of the lung, small intestine, kidneys and blood vessels).
Vitamin A is important for the health of the respiratory tract and mucus membranes, both of which play a central role in overall immune response However, in practice, I only see vitamin A deficiency in maaaaybe 5% of the nutrient tests I review, so aside from what’s in your multivitamin, this is a good one to leave out if you’re not sure you need to supplement extra.
If you’ve been living north of Georgia for the past 6 months, you should consider taking enough supplemental vitamin D to achieve a sufficient serum level to support overall immunity (50-80 ng/mL, which usually requires 3000-5000 IU daily). However, if you begin to experience classical symptoms of COVID-19 (cough, shortness of breath, loss of smell/taste) or test positive, we recommend to either decrease the dose or discontinue altogether until you’ve recovered.
ACE-inhibiting drugs used for hypertension
There’s an urgent need for clinical trials to determine whether ACE-inhibitors (including drugs with the suffix “-pril”, angiotensin receptor blockers and thiazolidinediones) help or harm patients with active COVID-19. Meantime, here’s a link to an article
as well as a video
that discusses this very issue, as well as why we still aren’t sure.
It appears zinc can benefit in two ways: by lowering the virus’s ability to enter cells through ACE2 receptors and also inhibiting replication once it’s gained access. We recommend 30-50 mg/day, doubling the dose at the first classical signs of illness (shortness of breath, cough, loss of taste and smell).
Some observational studies
have demonstrated an increase in ACE2 receptors with ibuprofen use, however, it’s still too soon to say for sure it is significant enough to affect outcomes.
When this particular virus gets going in your body, it can create what is called a cytokine storm, which is when your immune system reacts vigorously and releases an enormous amount of chemicals (cytokines) and free radicals to destroy the virus. This is generally a good thing, however, what is concerning is that in some people, COVID19 triggers an extreme cytokine storm, causing (among other things) acute respiratory distress (ARDS) and lung injury.
Though there are not yet human clinical studies to prove this, there are concerns that some immune-boosting supplements, based on their specific mechanisms, could make this inflammatory, oxidative process much worse in some people.
Hence, until we know more, our recommendation is to stop these supplements if you have a positive test or develop some of the more concerning classical symptoms (cough, shortness of breath, loss of sense of taste/smell).
Avoid these if you get sick:
- Larch Arabinogalactan
- High-dose vitamins A and D (as described above)
Considered safe and beneficial during active COVID-19 infection:
- Vitamin C
Dosing: 30-50 mg/day, doubling dose if you get sick. This article
discusses zinc’s ability to inhibit the virus from gaining access into the cell, as well as its ability to inhibit viral replication once inside the cell.
Our favorites here (Ultra Flora Immune Booster and Ultra Flora Balance) include specific strains that benefit the respiratory system, the system that is of utmost concern in severe cases. Take 1-2 per day, preferably away from food.
Because there is some controversy over whether high dose (above 3000 mg/day) may potentially cause harm, we recommend keeping your daily dose to 3000 mg or less if you become ill and suspect it is COVID19. Some forms of vitamin C are acidifying and this may negatively impact patients who are in the phase where the cytokine storm has begun.
Research indicates that astragalus stimulates white blood cells to engulf and destroy invading organisms and cellular debris as well as enhance the production of interferon (a key natural compound produced by the body to fight viruses). Follow label directions for prevention and increase the frequency of dosing if symptoms appear.
Andrographis Plus by Metagenics
Over the years, we’ve trialed other brands of andrographis without the same success, so this is the only andrographis we typically stock (lately we are trialing a powder form that was recommended by an acupuncturist who has seen good results). Though you can take this as a preventive, I find that it truly shines at the first sign of infection. Most of the time, if I’m able to start taking this immediately at the first sign of infection, after 3-5 hourly doses, symptoms are completely resolved.
Used in hospitals to treat acetaminophen poisoning, NAC is also used as a mucus thinner that targets the lungs, improving respiration. Dosing is typically 600–1,800 mg, and in hospitals, if available, it can be administered as an IV or taken orally, as an aerosol spray.
Silver is an earth element that has broad-spectrum effects when targeting infections. Most brands taste like water, so it’s an easy thing to add, especially with kids. We’re now using 2 brands of silver with good success: Smart Silver from DesBio and Silvercillen from Designs for Health. We recommend 1 tsp twice daily as prevention, increasing to 1 tbsp twice daily (or more – neither will cause blue skin – this is a condition associated with colloidal forms of silver taken excessively over prolonged periods of time). We’ve recently heard from one of our providers that her husband, who had developed a severe upper respiratory illness (no testing done), responded well to nebulized silver. Obviously not everyone has access to a nebulizer, but this is interesting to note.
Many researchers now believe that one of the reasons younger people are not as affected by this virus is their melatonin status. Melatonin is a hormone that declines with age, which could explain some of why the risk of death with COVID-19 increases with age. Melatonin has been used for years as a natural therapy for cancer (usually 10-20mg is used if tolerated) because of its anti-inflammatory and anti-oxidative properties, not to mention that it can help with sleep, the loss of which impacts the immune system. We recommend using a dose that doesn’t cause drowsiness the following morning, and offer melatonin in a variety of doses to allow for this individualization.
Wrapping it up
With so many options, many patients have asked me what I do for myself as prevention and how would I address symptoms if they were to appear. Andrographis Plus is the herbal formula that helps me the most and the quickest when I’m fighting infection. At the first sign (typically a sore throat for me), I begin taking 1 andrographis hourly, and if available, I pair it with 1 tab of Essential Defense from Metagenics (recently on a long backorder but starting to trickle in) and Herbal Throat Spray from Medi-Herb (as often as I think about it when sore throat is present–it’s antiseptic and has a lovely numbing effect from the clove oil it contains) since most viruses start in the throat. I find vitamin C drinks soothing (I now prefer LiquiMins Power Pak over EmergenC because it’s buffered with minerals). And of course, I am currently taking melatonin 5-10mg, zinc, silver and a probiotic.
I hope you find this article helpful. Please feel free to reach out in the comments below with questions or comments. And above all, stay home and stay well!