Integrative approach to COVID

Within the next month, I’m going to start taking on a few sessions per week at my work’s acute care center, also called the respiratory clinic (COVID clinic). So far in my work, I’ve been seeing well patients or speaking to patients with respiratory symptoms over the telephone. Most symptoms that could potentially be COVID related, are to be seen in person at a separate clinic. It keeps patients feeling safe, while still enabling others to receive care, often in the same day. It also keeps patients out of urgent care and the emergency department.

Because I’ve been so excited by learning medicine separate from COVID, I haven’t spent much time understanding its disease process. But now that I’ll be taking on a few sessions per week in the respiratory clinic, I have the incredible opportunity to learn about COVID clinically.

Interestingly, there is a study going on at the clinic right now regarding patients taking N-acetyl cysteine after being diagnosed, to see if it decreases the severity and duration of symptoms. N-acetyl cysteine! An antioxidant that’s a precursor to an amino acid. This really got me excited. And sparked an interest to see what the supplement protocol was from other functional/integrative perspectives.

Most of COVID, unfortunately, is supportive care, especially in the outpatient setting in patients stable enough to be treated as an outpatient. Treating coughs, nasal congestion, fevers, body/muscle aches all individually. It’s much different in an inpatient setting, which I won’t go into here.

The MOST important thing you can do to protect yourself from COVID is to limit exposure to others and wear a mask when you go outside. Where I live, there is a mandated mask policy not only in my city but in my building. Masks are required EVERYWHERE, which is just sound and rational decision making. I have never once questioned if I should or shouldn’t wear a mask. If there’s one thing I can do to protect vulnerable populations, one that requires minimal effort, I OF COURSE am going to to do that.

Another tool we have in the toolbox now is the vaccine (questions about that here). Despite getting the vaccine, I still wear my mask and social distance. It’s a tool, but doesn’t suddenly make the virus disappear, as evidenced by the fact that there were 95,000 deaths from COVID in January alone. My goal and intent is to protect those who are more vulnerable than me.

I am a white, young person who is not food insecure without any pre-existing medical conditions – I am cardiometabolically well. If I got COVID, statistically I would very likely be okay and recover without dire consequences. I most certainly can’t say the same for others. COVID is NOT, in fact, the great equalizer, as we know that BIPOC, Latinx, and Indigenous communities are more at risk. The reasons for this cannot be addressed in a single paragraph and are multifactorial- physical and financial access to supermarkets and produce,  “cultural whiteness” of public health campaigns that inadvertently exclude these communities, labor conditions in the food industry that predispose people of color to a variety of health risks, more Black and Latinx employed as ‘essential’ frontline workers with minimal paid sick leave and basic protections like hand sanitizer.) Further, middle-class consumers’ reliance on these services increases, all while those who perform this “essential” work remain unprotected physically, socially, and financially, contributing to elevated infection and mortality rates (5).

It’s a complicated and devastating reality. Of which I don’t have a solution for. But I know I can donate money to local organizations, I can offer to buy vulnerable communities groceries or volunteer at food banks, and I can WEAR A MASK, wash my hands, and socially distance to protect others. Because again, this isn’t about me. This is about protecting other who are more vulnerable than me.

The information below does incorporate some supplementation as I found in my research. I will not pretend to present supplementation as accessible and affordable. As always, I recommend food first, which is also highlighted below.

This post is not all too evidence based. There are some references, but COVID is still so new that there isn’t a TON, a ton out there yet. So I went to sources I know and trust to see what they’re recommending to their patients.

It goes without saying that if you are diagnosed with COVID or start having symptoms, reach out to your healthcare provider. Especially if you have pre-existing conditions that leave you more vulnerable or start developing more severe symptoms – seek care right away!! Don’t try to go it alone. As with all of my posts, this is a compilation of others’ research and is not individualized care. It is NOT intended to diagnose or treat.

Compiled individual lists below followed by a list at the end of the most common denominators.

East Virginia Medical School ( 1 )

• vitamin C (500 mg)
• quercetin (250 mg-500 mg twice a day)
• zinc (75 mg-100 mg per day)
• melatonin (0.3 mg-2 mg) each night
• vitamin D3 (1,000-4,000 IU per day)

European Journal of Pharmacology ( 2 )

• Vitamin C: synthesis of collagen in connective tissue, antioxidant activity, regulation of DNA synthesis and histone methylation, immunomodulation, enhances innate immune system
  • 3000mg once daily (or 1.5g/kg a day – safe and no adverse effects)
• Vitamin D: immunomodulation by downregulating pro-inflammatory cytokines, reducing acute lung injury, modulation of innate and adaptive immune system, local “respiratory homeostasis” by induction of release of some antimicrobial peptides, preserving cell function, reducing cytokine storm, consolidation of cellular immunity
  • 2000IU daily
  • Regarding the protective effects of vitamin D in ALI, supplementation in deficient individuals may boost the immune system against COVID-19 and decrease its severity, especially when other co-morbidities exist 
• Melatonin: antioxidant activity, indirect enhancement of antioxidant enzyme activities, preventing release of pro-inflammatory cytokines
  • Unlike classical antioxidant agents such as vitamins E and C, which bind to one oxygen free radical, melatonin is able to bind with up to ten free radicals 
  • Because of significant impairment in melatonin production in people with chronic insomnia, taking melatonin may restore the normal sleep pattern and decrease anxiety during COVID-19 crisis
• Selenium: antioxidant activity, affects immune responses, anti-inflammatory activity
• N-acetyl cysteine: potential antioxidant, role in increasing number of immune cells
  • In a double-blind randomized placebo-controlled clinical trial, NAC at dosage of 600 mg twice daily dramatically attenuated influenza when compared with placebo in a population of 262 frail older adults.
• Zinc: maintenance of adaptive and innate immunity, important cofactor for several enzymes involved in function of immune system, regulation and formation of inflammatory responses

Institute of Functional Medicine ( 3 )

• Quercetin: 1gm po bid
  • Antiviral effects against both RNA (e.g., influenza and coronavirus) and DNA viruses (e.g., herpesvirus), role as an antioxidant and anti-inflammatory, modulating signaling pathways that are associated with post-transcriptional modulators affecting post-viral healing, Promote viral eradication or inactivation
  • Studied in COVID: reduction of symptoms
• Curcumin: 500-1000mg po bid
  • modulate the NLRP3 inflammasome,and a preprint suggests that curcumin can target the SARS-CoV-2 main protease to reduce viral replication.
• Green tea (EGCG): 4 cups daily (225mg po daily)
  • potentially targeting the SARS-CoV-2 main protease to reduce viral replication, has also been shown to prevent influenza in healthcare workers.
• NAC: 600-900mg po bid
  • promotes glutathione production, which has been shown to be protective in rodents infected with influenza. In a little-noticed six-month controlled clinical study enrolling 262 primarily elderly subjects, those receiving 600 mg NAC twice daily, as opposed to those receiving placebo, experienced significantly fewer influenza-like episodes and days of bed confinement.
  • Reduce progression from colonization to illness, reduce the severity and duration of acute symptoms
• resveratrol: 100-150mg po daily
  • Favorably modulate viral-induced pathological cellular processes
• Vitamin D: 5000IU daily in absence of serum levels
  • immune system modulator that reduces the expression of inflammatory cytokines and increases macrophage function, stimulates the expression of potent antimicrobial peptides, increases anti-pathogen peptides through defensins and has a dual effect due to suppressing superinfection.
  • Reduce progression from colonization to illness, reduce the severity and duration of acute symptoms and complications
• Melatonin: 5-20mg daily
  • inhibitory effect on the NLRP3 inflammasome
  • Favorably modulate viral-induced pathological cellular processes
• Vitamin A: 10,000-25,000IU/day
  • Favorably modulate cellular defense and repair mechanisms and viral-induced pathological cellular processes
• Vitamin C: 1-3g daily
  • supporting various cellular functions of both the innate and adaptive immune system, enhance chemotaxis, phagocytosis, generation of reactive oxygen species, and ultimately microbial killing, prevent and treat respiratory and systemic infections.
  • ^Vitamin C has been used in hospital ICUs to treat COVID-19 infection.
  • Favorably modulate cellular defense and repair mechanism, favorably modulate viral-induced pathological cellular processes
• Zinc: 30-60mg daily, in divided doses
  • suppresses viral attachment and replication.
  • Zinc deficiency is common, especially in those populations most at risk for severe COVID-19 infections, and it is challenging to accurately diagnosis with laboratory measures.
  • Supplementation with zinc is supported by evidence that it both prevents viral infections and reduces their severity and duration. Moreover, it has been shown to reduce the risk of lower respiratory infection, which may be of particular significance in the context of COVID-19.
  • Prevention, reduced severity of symptoms, reduced duration of illness, prevention of lower respiratory tract infection

Mark Hyman ( 4 )

OVERALL RECOMMENDATIONS

• hand washing, mask wearing, social distancing
• Eat a real, whole foods, unprocessed diet
• Enough protein (1g/kg) – amino acids = building blocks of immune system
• Gut healing foods

• • Eat prebiotic foods. Dandelion greens, Jerusalem artichokes, garlic, onions, leeks, asparagus, artichokes, bananas, apples, konjac root (try shirataki noodles), cocoa, burdock root, flax seeds, jicama root, and seaweed.
  • Eat probiotic foods. Grass-fed sheep, cow, or coconut yogurt, kefir, sauerkraut, tempeh, miso, natto, kimchi, pickles.
• Reduce processed foods, sugar, and refined carbohydrates
• Limit alcohol
• Prioritize sleep
• Daily stress management techniques
• Anti-viral / immune boosting herbs: ginger, garlic, turmeric, rosemary, chili pepper, oregano
• Flavonoid, anti-viral foods:
• Kaempferol (spinach, cabbage, dill)
• Quercetin (dill, onion, oregano, chili pepper, apples, leafy greens, broccoli)
• Hesperidin (oranges, grapefruit, lemon, tangerines)
• Oleuropein (olives, EVOO)
• Catechins and epicatechin gallate (green tea)
• Lauric acid (unrefined coconut oil)

Supplements

• Vitamin C: 1000-2000 mg a day
• Vitamin D3: 1000-4000 IU a day
• Zinc: 20 mg a day
• Quercetin Ascorbate: ¼ teaspoon twice a day
• Melatonin: 1-2 mg at night, sustained release
• Probiotics

Enhanced Immune Support

• NAC: (n-acetylcysteine) 600 mg twice a day
• Alpha-Lipoic acid :100 mg twice a day

Always hoping to bring a balanced approach to things, I did find another journal article that suggested “There’s little evidence yet [for the role of vitamins / supplements], except maybe in people who are deficient in vitamins and minerals ( 5 ).

This new study,  however, suggests that zinc and vitamin C are overall NOT EFFECTIVE at decreasing duration and length of COVID symptoms compared with standard of care.

 

Bringing it all together

• Wear a mask and limit exposure to others
• Eat a real, whole foods, unprocessed diet if access permits
• Eat enough protein (1g/kg) – amino acids = building blocks of immune system
• Gut healing foods
  • Eat prebiotic foods. Dandelion greens, Jerusalem artichokes, garlic, onions, leeks, asparagus, artichokes, bananas, apples, cocoa, burdock root, flax seeds, jicama root, and seaweed.
  • Eat probiotic foods. Grass-fed sheep, cow, or coconut yogurt, kefir, sauerkraut, tempeh, miso, natto, kimchi, pickles.
• Reduce processed foods, sugar, and refined carbohydrates
• Limit alcohol
• Prioritize sleep
• Incorporate stress management techniques into your daily life (logging of screens, deep breathing, time in nature, yoga, deep breathing, journaling, etc)
• Add in some anti-viral / immune balancing herbs to cooking: ginger, garlic, turmeric, rosemary, chili pepper, oregano

Vitamin C

• • vitamin C (500 mg) ( 1 )
  • 1000-2000 mg a day( 4 )
  • 3000mg once daily (or 1.5g/kg a day – safe and no adverse effects) ( 2 )
  • 1-3g daily ( 3 )
• The takeaway: I would go with the average and take 2,000mg per day
• Oranges, lemons, kiwi, strawberries, grapefruit, broccoli, pineapple, brussels sprouts, mango, cantaloupe, cauliflower

Vitamin D3

• • 1000-4000 IU a day ( 1 ) ( 4 )
  • 2000IU per day ( 2 )
  • 5000 IU a day in the absence of serum levels ( 3 )
• The takeaway: I take 2000IU per day
• Salmon, sardines, trout, cod liver oil, egg yolks, mushrooms, grass fed beef/dairy
• Go outside for 20 minutes a day without sunscreen

Zinc: 20 mg a day

• • 30-60mg per day in divided dosese ( 3 )
  • 75-100mg per day ( 1 )
  • Oysters, legumes, beef, lamb, pork, hemp seed, pumpkin seeds, cashews, almonds, grass fed dairy, eggs, quinoa, oats, brown rice, dark chocolate
  • I take 50mg per day

Quercetin: ( 4 )

• • 1gm twice daily ( 3 ) ( 4 )
  • 250 mg-500 mg twice a day) ( 1 )
  • dill, onion, oregano, chili pepper, apples, leafy greens, broccoli

Melatonin:

• • .3-2mg each night ( 1 )
  • 1-2 mg at night, sustained release ( 4 )
  • 5-20mg per day ( 3 )

N acetyl cysteine

• • 600mg twice daily ( 2 ) ( 4 )
  • 600-900mg twice daily ( 3 )

Curcumin: 500-1000mg po bid ( 3 )

Drink 4 cups of green tea per day! ( 3 )

Probiotic daily. Learn more about the importance of gut health here!

 

 

As always, this post is not aimed to prevent or treat! Ask your healthcare provider before making any diet, lifestyle, or supplement changes!!!