Dr. Trojano would like to share some updates you may find useful to prevent illness, as well as prepare your body if faced with an active Covid infection. To be clear, we have little to no data on the efficacy of nutritional & natural treatments of this specific infection (COVID-19) for obvious reasons (with one notable exception to be mentioned later). However, we can make educated decisions based on what we know of the human immune system’s response to natural supports when facing other viruses including other coronaviruses.
This virus is VERY different from influenza in terms of how it acts upon human cells. So, the few anti-viral medications (prescription) available are unlikely to be effective at all. There are some leads about medications that may end up being effective. These medications attack the virus from a different mechanism which we began to investigate during the SARS epidemic. The jury is still out on these potential treatments.
Natural therapies to prevent the virus, as far as we can assume, are likely VERY different from a protocol to treat it. That’s because once the virus infects the tissue (mostly the lungs is what we’re hearing about, but theoretically could be wherever the virus invades), it triggers the activation of a specific inflammatory mediator (NLRP3) which causes a massive inflammatory response (involving NFkB, IL1B and IL6 for those of you who are detail-oriented) that damages the local tissue. When this massive amount of inflammation damages the part of the lung tissue where oxygen is transferred to blood stream, the body becomes starved of oxygen and enters respiratory failure.
So, supplements like herbs and nutrients that would be traditionally used to prevent the viral infection, may not be helpful during infection, and may possibly even be harmful to the body because at that point, you actually want to switch gears from promoting the immune system response to squelching it. So that means that we need one plan of action for prevention, and second plan of action for active infection.
What does this mean for us? What might be helpful?
1) Typically, to prepare the immune system to stave off a viral infection, we want to up-regulate our TH1 T cell response (NK cells and CD8 cells) which can be done using herbs and nutrients like Berberine (from berberine-containing herbs), Sulforaphane (the anti-cancer nutrient packed into broccoli and other crucifers), and ginger. Whole Health likes to recommend using concentrated supplements of Astragalus root and beta-glucans from medicinal mushrooms for NK cell stimulation which have ample literature behind them to accomplish this. However, elderberry and echinacea are two others that also support T helper cell response.
2) We also want to upregulate our TReg cell response as this helps to regulate/balance the immune response and prevent over-activity of the immune system. We do this by ensuring we have healthy vitamin D levels. If you have not been regularly dosing Vitamin D3, you would want to start at a high dose typically – we routinely tell patients to dose 10,000iu per day for 3-6 weeks depending on their starting vitamin D level on labs and then have them drop down to 2,000-5,000iu daily for maintenance. Can you take too much vitamin D? Yes, D3 levels can be dangerous if they get too high. If you have been tested and are already on the higher end of the reference range or are high then reconsider the dosing. Generally 5,000iu daily for adults will help maintain levels in months other than June, July and August (in New England). Vitamin D3, as far as we can tell, is safe to continue taking even if you are infected.
Other recommendations to improve TReg cell function:
- Incorporate types of nutrients from food or in concentrated supplement form: sulforaphane (broccoli/crucifers), curcumin (turmeric), resveratrol (dark grapes, pomegranate).
- Maintain healthy gut microbiome and digestive tract. TReg production is largely dictated by microbiome activity, the balance of beneficial flora in your intestine. Good bacteria = good TReg. Taking a probiotic of Lactobacillus species and Bifidobacteria is helpful for this, as is eating naturally fermented foods like sauerkraut, kimchi, kombucha and the like.
- Get adequate sleep. Sleep is essential for immune system regulation – AT LEAST SEVEN HOURS per night (sorry to those of you with little kids…we realize this is probably not happening- and this includes some of us!). There is also a correlation between higher melatonin levels and reduced activity of the particular inflammasone (NLRP3) found in this virus. We have solid data on IF melatonin is helpful for the infection, but it is safe and usually well tolerated for short term use and we know our body’s produce less of it as we age, so it may be worthwhile – and you may sleep better with it as well!
- Manage stress. Easier said than done. W’ve had a lot of panic moments in the past few weeks ourselves, so this tip may sound like a joke. However, meditation and deep breathing exercises activate the parasympathetic (calming) state of your nervous system and reduce IL6, a key inflammation mediator involved in this virus’ mechanism of virulence.
3) Have a healthy level of key immune nutrients in your body all the time. The primary ones being Vitamin D (we already talked about), Vitamin C, Selenium and Zinc. The most essential of these that we routinely focus on in our illness prevention kits with patients are D, C and Zinc. Of all of these, Vitamin C is the most studied for many viruses, influenza, AND, believe it or not, COVIT-19. For prevention, take 3 grams of C per day divided over the course of a day (no more than 1 gram in an hour), 30mg of Zinc (citrate, picolinate. NOT zinc oxide), and Vitamin D was already mentioned. Selenium should not be dosed more than 200mcg per day. You can search the literature on these, but C, Zinc and D are routinely shown to reduce the incidence, duration & severity of respiratory illness.
4) Anti-viral herbs: We have no data on our “anti-viral herbs” for COVID-19, nor do we expect to have any data in the near future. However, there are herbs that have been shown to be clinically effective for a host of other viruses including other forms of the coronavirus. These herbs include: Astragalus, Goldenseal, Mahonia, Elderberry, Echinacea, Licorice root, and others. Our staff is taking several of these currently, BUT, out of concern about immune over-stimulation during active infection, please STOP all herbs if you do become symptomatic. You should also not take these herbs if you are pregnant or breast-feeding unless you have checked with us already.
During Active Infection:
This is the part we obviously know the least about. That being said, we do know that this virus triggers an inflammasone and subsequent cytokine storm that causes severe damage to infected tissue. So, our educated guess is that we want to use tools that help modulate that inflammatory response, specifically NFkB, IL6 and IL1beta. – Here are some possible helpful agents: catechins from green tea, resveratrol, pycnogenol, curcumin, vit C, sulphoraphane, Boswellia, Allicin, ALA, Astragalus, D3, vitE, EPA/DHA, quercetin, melatonin, ginger. (Noticing some repetition here?).
Now, the one thing that actually has been studied a bit so far for this disease is Vitamin C which looks promising. And we can absolutely be armed with vitamin C at home for both prevention and to tackle symptoms once they set in. The main thing is that high dose vitamin C reduces the severity of the symptoms and reduces likelihood of mortality. For home use (versus in a hospital setting), you’re looking at 6 grams daily, divided dosing.
Lastly, we want to stress that certain drugs seem to make the severity of the disease worse that are commonly prescribed in this country. That includes ACE inhibitors like lisinopril (used to control blood pressure and diabetes) as well as ibuprofen and other NSAIDS. If you are using these drugs regularly….. consider this a warning. You should contact your doctor about maybe finding an alternative. Acetaminophen seems to be fine to take.
- Eat as many bright colored and green vegetables & fruits as you can as well as onions and the white parts of citrus fruits (the tart part!). Consider taking concentrated nutrients listed above in supplement form, or herbs like Astragalus & medicinal mushrooms for TH1 support.
- Start taking Vitamin D…. No less than 4,000iu daily. There are virtually no exceptions to this unless you have previously tested high, have been taking large doses already (remember it can get too high) or have parathyroid disease.
- Start taking Vitamin C – 1 gram three times daily for prevention. If you take too much at once, you’ll get diarrhea. No biggie, just slow down your dosing.
- Start taking Zinc at 30 grams daily of zinc picolinate or zinc citrate. Avoid zinc oxide.
- Sleep a full 7-9 hours per night
- Eat fermented foods or take a probiotic.
- If you become ill, stop any herbs that you’re taking. Call your PCP about candidacy for testing. Ramp up your vitamin C intake to 6 grams daily or more. Continue Zinc and Vitamin D.
Lastly, we want to stress that a lot of this information is based on in-vitro information, preliminary information, or info based on treatment for other viruses. There is no proven cure, natural or otherwise for COVID-19, nor is there a guarantee of prevention by taking these measures, but you may decide that it’s worth it to you to take some extra level of precaution.