Bolstering Immunity Through Supplements
Natural Treatment and Prevention of COVID-19:
While we're NOT experts in treating this virus, we've had many years of experience working with patients to treat a variety of infections, as well as more recently, patients and loved ones who have contracted COVID-19. We've decided to turn this post into a "living blog" that is updated as we continue learning about this novel virus.
ACE2 Receptors Key to Viral Entry
This virus utilizes ACE2 receptors on cells to gain entry. Different substances interact with these receptors, including Vitamins A and D, Zinc, ibuprofen and anti-hypertensive drugs. Cardiovascular disease, diabetes and hypertension are associated with worse outcomes, as they can increase the number of these receptors/entry points on the cell surface. Sites for these receptors are especially abundant in the epithelia of the lung, small intestine, kidneys and blood vessels, giving rise to some of the common symptoms associated with COVID-19.
There is now evidence that Vitamin D increases 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.
A Look at Vitamin D and Other Supplements:
Vitamin D
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 (60-80 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. Some patients do better with higher dosing less often. For instance, taking 50,000 IU every 10-14 days, since vitamin D is fat-soluble and stored in the body. We offer emulsified liquid and capsules ranging from 1000-50,000 IU per serving to allow for individualized dosing. We've learned that taking 50,000 IU daily for the first few days of infection can effectively bump up immune response, lessening symptoms and shortening duration of illness.
Recent small group studies have shown decreased cases of severe illness, duration of hospital stays and death rates in those with higher levels of vitamin D. Larger studies are needed, but optimizing your vitamin D levels is inexpensive and has a litany of other health benefits. Here is a link that summarizes the most recent emerging science on vitamin D. We offer:
Vitamin D by Douglas Labs (5000 IU)
Bio-D-Mulsion Forte by Biotics Research (2000 IU)
Vitamin D Gummy by Pure/Douglas Labs (1000 IU)
Vitamin D3 Complete by Vitamin Research Group (2000 IU)
D3 Liquid 2oz. by Metagenics (1000 IU)
D3 5000 120gel caps by Metagenics (5000 IU)
Vitamin D3 by Ortho Molecular (50,000 IU)
Vitamin A
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, we only see vitamin A deficiency in maaaaybe 5% of the nutrient tests we review, and vitamin A has as yet unknown interaction with ACE-2 receptor sites, so aside from what's in your multivitamin, we don't recommend taking additional vitamin A unless there is a proven need.
Vitamin A by Carlson (10,000 IU)
Vitamin D3 Complete by Vitamin Research Group (3000 IU)
Vitamin A & D by Carlson (10,000 IU)
Zinc
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. (Read about these important roles here.) We recommend 30-50 mg/day, increasing the dose to 100-200mg daily at the first classical signs of illness (shortness of breath, cough, loss of taste and smell).
Zinc Supreme by Designs for Health (30 mg.)
Zinc Lozenges by Douglas Labs (23 mg.)
Zinc Gummies by Pure/Douglas Labs (12 mg.)
Reacted Zinc by Ortho Molecular (54 mg.)
Tri-Zinc by Biogenesis (30 mg.)
Probiotics
Our favorites here for coronavirus prevention (Ultra Flora Immune Booster and Ultra Flora BiomePro) 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.
UF Immune Booster by Metagenics (1 billion live org)
UF BiomePro by Metagenics (105 billion CFU)
Vitamin C
Because vitamin C is water-soluble, it's important to divide your dosing up into 2-3 doses minimum per day. 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. If you experience loose stools or diarrhea when taking vitamin C, you should back the dose down.
Of note: 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.
Liposomal Vit C by Mercola (1000 mg.)
Ultra Potent C 1000 by Metagenics (1000 mg.)
Stellar C by Designs for Health (600 mg.)
Chewable C by Nature’s Sunshine (250 mg.)
Vitamin C Gummy by Pure/Douglas Labs (250 mg.)
Liposomal Vitamin C by DesBio (500 mg.)
Liposomal Bio Quercetin by DesBio (500 mg.)
Vitamin C w/Flavonoids by Thorne (500 mg.)
Citrus Bioflavanoids by Nature’s Sunshine (500 mg.)
Astragalus Max by Douglas Labs
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). We recommend 1 daily for prevention and in cases of infection accompanied by fatigue, shortness of breath or spontaneous sweating, to increase the frequency of dosing to 2-3 times daily.
Astragalus has been shown to have additional benefits of lowering blood sugar with type 2 diabetes, improving blood flow to the kidneys, promoting apoptosis in various types of cancer cells and acting as an adaptogen during times of stress. In China, it's one of the most frequently used herbs for management of diabetes.
Astragulus Max-V by Douglas Labs (500 mg.)
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. Patients often 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. This is one I keep in stock at home since it's most effective in the earliest stages of infection. When I'm able to start this as soon as I feel the symptoms of an infection, I can knock it out. Every. Time.
Andrographis Plus 30T by Metagenics (200 mg.)
Essential Defense by Metagenics (blend)
Chuan Xin Lian by Evergreen Herbs
NAC
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 1-3 times daily, and in hospitals, if available, it can be administered as an IV or taken orally, as an aerosol spray.
N-ACETYL-CYSTEINE by Designs for Health (900 mg.)
NAC by Pure (600 mg.)
Silver
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 3 brands of ionized nano-particles of silver with good success: Smart Silver from DesBio, Silver Shield from Nature's Sunshine and Silvercillin from Designs for Health. We recommend 1 tbsp twice daily at first signs of infection (none of these brands will cause blue skin - this is a condition associated with colloidal forms of silver taken excessively over prolonged periods of time).
There is now data showing that masks with an ionized silver coating can inactivate the virus completely, a wonderful demonstration of the efficacy of silver against viral particles. I've done a lot of searching for any trials using ionic silver spray on your own to increase efficacy of masking, and while that is a tantalizing idea, there don't seem to be any trials yet done to determine if this would cause the mask fibers to break down in non-cloth masks, and no studies done to determine if applying to cloth masks confers any increased protection, so for now, I'm unsure about taking this approach. I do see that baking your mask at 150-160 for 30 minutes will inactivate any microbes, but washing with soap and water is still your best option for cloth masks because soap dissolves the fatty envelope around the virus, making it inactive.
We DO recommend spritzing the back of the throat and using ionized silver as a nasal wash for added protection against infection, or during active infection. We carry Silvercillin spray and have $3 nasal spray bottles to pair with the spray.
Silvercillin Spray by Designs for Health (75mcg.)
Silvercillin Liquid by Designs for Health (75mcg.)
Smart Silver by DesBio (10 ppm 50 mcg.)
Silver Shield by Nature's Sunshine
Melatonin
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 (dosing is usually 10-30mg) 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, ranging from 3mg to 20mg.
Melatonin by Xymogen (3mg.)
Melatonin Time Release by Bioclinic (5 mg. or 10 mg.)
Melatonin by Pure (20 mg.)
CBD Oil Sleep Gummies by CV Sciences (10mg cbd)
Nebulized Hydrogen Peroxide (H2O2)
Having now supported several patients through severe respiratory COVID symptoms, we can say with confidence that nebulizing hydrogen peroxide can help significantly. While updating this newsletter, I've also seen where some doctors are recommending this to prevent the virus from moving into the lungs.
H2O2 should first be diluted in normal saline, which can be purchased or made using the following recipe:
1/2 tsp salt (Celtic, Himalayan or regular table salt)
1 cup water
Mix until completely dissolved
How to make your H2O2/saline mix:
1-3/4 tsp of 3% FOOD GRADE H2O2
1 cup saline
Mix together and refrigerate unused portion to maintain stability and potency
Do NOT use the brown $1 bottles found at drug stores since they contain stabilizers, that when inhaled, can be harmful to the lungs.
Do NOT use the same dilution rate if using a higher concentration of hydrogen peroxide, such as 12% or 36%
If using 12% H2O2, dilute 1/4 tsp H2O2 in 5 ounces saline.
For 36% H2O2, dilute 1/4 tsp in 15 ounces saline.
Nebulizing instructions:
Fill nebulizer cup halfway and nebulize 5-6 times daily for about 2 minutes, refilling as needed. The mist should be alternatively inhaled through the mouth and nose to impact both the lungs and sinuses.
Innospire Nebulizer System (comes with 1 face mask)
Hydrogen Peroxide (food grade, 3%)
What can you do for a Fever?
Since fevers are your body's natural response to infection, most functional medicine healthcare professionals wouldn't recommend treating a fever unless it rises above 103 degrees, though temps 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. Some natural ways to address a fever are: drinking cool water and putting cold packs under your arms, or sitting in a lukewarm bath.
For those in the early stages of infection, drinking hot chamomile or peppermint tea can promote sweating, which works with the body's natural immune response.
Ibuprofen
Some observational studies have demonstrated an increase in ACE2 receptors with ibuprofen use, however, additional recent studies have not shown increased negative outcomes with its use during active infection.
Acetaminophen
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.
Aspirin
Researchers at the University of Maryland School of Medicine (UMSOM) found that aspirin takers were less likely to be placed in the intensive care unit (ICU) or hooked up to a mechanical ventilator, and they were more likely to survive the infection compared to hospitalized patients who were not taking aspirin. Long-term use of aspirin can impact the GI lining, so use with caution beyond short-term.
What About Cytokine Storms?
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.
One reason people can become so ill in the first place with COVID is that they went into the infection already inflamed, and the additional inflammation triggered by the immune reaction becomes chronic because the body is already depleted in its ability to quell inflammation. This is one factor in the lasting symptoms some are experiencing following vaccination. It can be extremely helpful to help the body resolve the inflammation, and our favorite remedy there is SPM active. For COVID recovery, we recommend 1 gel cap 2-3 times daily until symptoms resolve.
What about Quercetin, Vitamin E, Green Tea, Etc?
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.
Quercetin
Quercetin Phytosome by Thorne (250 mg.)
Quercetin 500mg by Jarrow
Quercetin 250mg by Pure
Liposomal Bio Quercetin by DesBio (100 mg.)
Quercetin-Bromalain Forte by Klaire Labs (200 mg.)
PEA
PEA Palmitoylethanolamide by Bioclinic (400 mg.)
PEA Discomfort Relief by Life Extension (600 mg.)
(PEA)+ With Meriva Curcumin by Enzyme Science (300 mg.)
Green Tea
Green Tea Extract by Vital Nutrition (275 mg.)
Resveratrol
Resveratrol EXTRA by Pure (100 mg.)
Liposomal Resveratrol Curcumin by DesBio (38 mg.)
Elderberry
Sambucus 4 fl oz by Integrative Therapeutics
Curcumin
Liposomal Resveratrol Curcumin by DesBio (100 mg.)
CurcumaSorb (Meriva) by Pure (500 mg.)
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. For prevention, I'm currently taking liposomal melatonin since it is essentially time-released, zinc (Reacted Zinc by OrthoMolecular shows superior absorption on micronutrient testing), liposomal vitamin C, vitamin D and UltraFlora BiomePro, a probiotic geared toward respiratory health.
I've also begun to nebulize H2O2 once daily since I'm continuing to consult in-office and it's a bit chilly now for open windows to dilute the air in my office.
Andrographis Plus is the herbal formula that helps me the most and the quickest when I'm fighting infection. At the first sign of infection, I begin taking 1 andrographis hourly, and I pair it with 1 tab of Essential Defense from Metagenics. For sore throat, and for COVID concerns, I use Silvercillen as well as Herbal Throat Spray (HTS) from Medi-Herb (as often as I think about it when I'm fighting a sore throat or am concerned about COVID, since both are antiseptic and HTS has a lovely numbing effect from the clove oil it contains). I find vitamin C drinks soothing (I prefer LiquiMins Power Pak over EmergenC because it's buffered with minerals and electrolytes, tastes great and only contains 1g of sugar, with zero artificial sweeteners and 1200 mg vitamin C).
Treating Severe, Active Infection
Many stories are emerging on natural interventions that may help shorten the duration and severity of COVID19. We're including links here to ensure that you're able to access important information if you or a loved one becomes ill and/or hospitalized with COVID.
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.
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 by email, phone, or below with questions or comments. And above all, stay safe and well!