What’s Novel about COVID-19?
As an emerging infection, it’s important to note that there are no controlled studies on specific therapies for COVID-19. However, as information emerges about how this virus works, we feel responsible to share that information. We’re NOT experts in treating this virus, but have had many years of experience working with patients to treat infections, including viruses, so we’re drawing on that here, as well as sharing what we’re learning. We’ve decided to turn this post into a “living post” that is updated as new information emerges.
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 has been 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).
there is now emerging evidence that Vitamin D could be increasing only soluble
ACE2, which would not increase viral access to cells, but instead act as a decoy, as described in this article
from the journal Clinical Science. In this video interview
with Dr. Heather Zwickey, professor of immunology at The National University of Natural Medicine, she discusses ACE2 receptors, medications that increase their expression, and vitamin D’s role in ACE2 binding, which starts at 15:25. So far, I’ve been unable to find any reference to vitamin A with regard to soluble ACE2, so our advice on that stands for now.
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, at last until we know more.
If you’ve been living north of Georgia for the past 6 months, and you’re not taking vitamin D, you’re likely deficient, and 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). If just starting vitamin D, it may make sense to double the suggested dosing range for 3-4 weeks to achieve sufficiency more quickly.
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. Here’s an interview with Dr. Josef Penninger
, a molecular immunologist at Life Science Institute at the University of British Columbia that discusses some of the nuances of ACE2 receptors, as well as the newly emerging belief that there are now two strains, an S-type, which is more mild, and a more recent mutation, an L-type, associated with more pronounced symptoms.
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 if it is significant enough to affect outcomes. We’ve seen many advising acetaminophen as a safer alternative to addressing fever, but here’s our take on that:
Acetaminophen depletes a crucial antioxidant: glutathione. In fact, we feel acetaminophen should be severely limited for any condition because it has a poor safety profile in general.
What CAN you do for a fever?
A fever is your body’s way of fighting infection, and lowering it allows the cause of the illness to live for a longer period of time, so we usually don’t advise patients to attempt to lower it. Most healthcare professionals would say to only treat a fever if it rises above 103 degrees, but temperatures up to 107 degrees are not associated with any lasting damage to the body, according to Medline Plus, a service of the Natural Institutes of Health and U.S. Library of Natural Medicine. If you feel you must address a fever, try drinking cool water and putting cold packs under your arms, or sitting in a lukewarm bath.
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 develop some of the more concerning classical symptoms (cough, shortness of breath, loss of sense of taste/smell).
- Larch Arabinogalactan
- High-dose vitamin A
**We’ve removed elderberry from the avoid list below after doing some additional research, some of which we’re sharing here:
- Dr. Mark Iwanicki, ND, explains in this 5 minute video that, although elderberry has been found to raise IL-6, it has numerous other balancing effects on inflammation.
- Dr. Elisa Song further elaborates and makes a few really great points: cytokine storms are RARE and anyone experiencing one will most likely be hospitalized and too ill for any type of herbal therapy.
- Elderberry has possibly the most research behind it for use with RNA viruses, though to be clear, none on this particular virus. Dr. James DiNicolantonio covers the depth of research available on elderberry in this 2 minute video.
Considered safe and beneficial during active COVID-19 infection:
- Vitamin C
- Vitamin D
*I am aware that many other remedies are worth considering here, but there is no way to make this into an exhaustive list, so we’re including a focused list that prioritizes the remedies we feel are most important. For The Institute for Functional Medicine’s recommendations that include quercetin, curcumin, PEA, green tea, resveratrol and others covered in this post, click here.
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 for coronavirus prevention (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 oral high doses (above 3000 mg/day) may potentially cause harm, we recommend keeping your daily dose to 3000 mg, in divided dose, or less if you develop diarrhea or loose stools. Liposomal vitamin C can be dosed twice daily for round-the-clock vitamin C protection. Vitamin C helps stimulate production and function of white blood cells, and helps your body produce important proteins that bind invading microbes (antibodies) to neutralize them.
Update: In Wuhan, doctors have been using high dose intravenous vitamin C for those who are sick as well as for those in the hospital. Nearly all patients with symptoms received 50-100 mg/kg/day for mild symptoms and 100-200 mg/kg/day for severe forms. Many hospitals in the US are now using intravenous vitamin C in the ICU.
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, because of shortages from our suppliers, we’re 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, and since it has been difficult to keep in stock, we recommend reserving it for fighting infection, not prevention. Most of the time, patients report that if they’re 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 600-3000 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 (though we typically don’t use silver as a long-term remedy), increasing to 1 tbsp twice daily with signs of infection (or more – neither of these brands 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. It does make sense to deliver treatment directly to the area most affected, so we are now stocking home-use nebulizers for those in need.
Many researchers now believe 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 10-30mg 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 helps improve sleep, but doesn’t cause drowsiness the following morning, and we offer 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 (silver throat spray and other natural antiseptic throat sprays are available). I find vitamin C drinks soothing (I now prefer LiquiMins Power Pak over EmergenC because it’s buffered with minerals, tastes great and only contains 1g of sugar). For prevention, I’m currently taking melatonin 5-10mg, zinc, vitamin C and a probiotic.
Addendum: treating active infection
Many stories are emerging on natural interventions that may help shorten the duration and severity of COVID19. We’re including links here, though as stated previously, we are NOT experts in treating this infection. We simply want to ensure that you are able to access important information if you or a loved one becomes ill.
The EVMS Medical Group is providing guidance for healthcare providers treating COVID-19 patients. This approach to COVID-19 is based on the best (and most recent) available literature and the Shanghai Management Guideline for COVID. Their continually updated article can be found here.
Jill Carnahan, a well known functional medicine doctor, pulls together information from many sources that illuminate what we are learning about how this virus behaves in the body. She is also continually updating her blog that can be found here.
Lastly, for now, here is a link to the clinical trials currently underway to determine effective treatments, including MANY natural interventions! It’s exciting to see.
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!