Calming your Cytokine Storm

Seemingly, every news organization is devoting essentially all of their attention to a certain virus that is running free, while we stay locked up.

The better news is that the global medical community is also devoting much of their attention to figuring out how and why SARS-CoV-2 does what it does. The hope is that by unlocking the chain of symptoms and reactions, we can create treatments and ultimately, vaccines.

New information is coming out, basically every day, but one concept that is getting more and more attention is the natural physiological reaction called a cytokine storm. As with any storm, the cytokine variety can range in intensity from mildly discomforting to deadly.

While this term may be new to many of you, if you've ever worked with a Lyme Literate MD, chances are good that you've discussed a cytokine storm. You've just called it by a different name: a Herxheimer Reaction.

What is a Cytokine?

A cell receiving a cytokine storm

Put simply, a cytokine is a signaling molecule that is secreted by immune cells to stimulate some sort of action in the body. Any time our immune system is called into action, whether to fight infections or repair injuries, these cytokines help begin the process. There are many types of cytokines, capable of stimulating or stopping inflammation, as the body calls for. This makes cytokines vital to fighting and recovering from just about anything the world can throw at us.

The problem with these particular signaling molecules is that in some cases the inherent "shut off valve" in the body doesn't work. This means that what can start as a gentle shower of response can very rapidly increase 1000x into a sudden, severe storm (see what I did there?) This storm triggers a continuous reaction that overwhelms the body leading to severe disease and even death.

Two European doctors, Adolf Jarisch and Karl Herxheimer were among the first to formally observe this cytokine reaction occurring in the late 1890s. While treating patients for syphilis (a not-so-sly cousin of Lyme disease), they noted that several patients experienced worsening symptoms after treatments. The patients developed fevers, chills, headaches, muscle pain, and even rashes. The term Jarisch-Herxheimer Reaction was coined. Over time, doctors and scientists found that other infections caused the same reactions.

Today, many medical professionals are finding a similar cytokine rush in COVID-19 patients. Specifically, the SARS-CoV-2 virus triggers excess production of the inflammasomes NRLP3 and NF-kappa B. This leads to an increase in the cytokines IL-1b and IL-18 and IL-6. These signal the body to create inflammation. One of the side-effects of this reaction is an increased amount of fluid in the lungs (this is what causes the cough and shortness of breath associated with this infection). In many patients, the storm is controlled. In some, however, the infection multiplies so rapidly that the body releases far too much cytokine all at once. The resulting chain reaction fills the lungs with so much fluid that the patient essentially drowns.

Breaking the Chain

Because this whole process is a large chain reaction that feeds on itself, breaking any single link will stop the whole process in its tracks. Sadly, there isn't a medication that can instantly halt the reaction. But there are several things we do know about what drives the inflammation and the resulting cytokine reactions.

At our practice, we deal with cytokine storms daily. (For example: Lyme or Borrelia burgdorferi has been shown to increase the cytokines TNFa, IL-6, IL-8). Fortunately for those with chronic infections, the reaction rarely ever balloons and doesn't become fatal. We work with our patients to help them become adept at spotting a Herxheimer reaction that is starting, and taking steps to keep it "tolerable".

Below is some of what we've learned about reducing the storm:

Lifestyle:

We've known for decades that smoking and drinking in excess increase the risk for all sorts of diseases. We are just starting to understand the impact that other behavior choices have (such as sleep or meditation). However, studies have shown:

• Sleep deprivation increases NRLP3

• Excess stress (cortisol) activates NFKappaB while meditation and yoga can lower it

• Smoking increases NFKb

• Overeating / processed food increase NFKb

• Excess alcohol increases NFKb

Diet:

There are several compounds found in foods that have been proven to reduce NRLP3 and NFKappaB activity (the initial inflammasome in the cytokine chain reaction).

Specifically:

• Quercitin: found in apples and onions

• Resveratrol: found in purple grapes and blueberries

• Curcumin: found in turmeric

• Allicin: found in garlic

• Sulforaphane: found in cruciferous vegetables

• Specialized Pro-Resolving Mediators: found in foods high in essential fatty acids like fish and roe

Additionally, there are a host of other foods that can lower NFKb, including:

• Fats such as olive oil

• Fruits: cherries, pomegranates

• Vegetables: Soy, fennel

• Herbs and Spices: Basil, rosemary, cloves, ginger, cinnamon, capsaicin, cayenne, anise

• Seeds: Flax or sesame

• Other items such as: chocolate (!), honey, or nutritional yeast

• Tea: rooibos or green

Supplements:

Even with the perfect diet, it is sometimes necessary to supplement the essential vitamins and nutrients your body needs. Follow the link here (or click on the Fullscript Logo below), and type "Herx" into the search bar to easily find some of my favorite picks. These are recommendations I give to patients for Herxheimer reactions as well.

As shown in the food section:

• Quercetin – lowers NRLP3 and IL-b. Look to take 500-1000mg per day

• Resveratrol – lowers NRLP3 and IL-b. Look to take 100-150mg per day

• Curcumin – lowers NRLP3 and Il-b. Look to take 500-1000mg 2x/day

• Sulforaphane (or glucoraphanin) - Lowers NFkb. Look to take 30-100mg 2x/day

• Specialized Pro-resolving mediators - lowers inflammatory cytokines. Look for 1-4 grams/day

In addition, the following vitamins and minerals have been linked to lower levels of NKFb and NRLP3:

• Vitamin D: Look for 5,000iu daily

• Magnesium: Look for 400-800mg daily

• Chromium: Look for 200mg daily

• Zinc: Look for 25-50 mg daily

• EGCG (lowers IL-1b as well): Look to take 225mg per day

• Melatonin: 5-20mg daily

• Vitamin A: Take 10,000-25,000iu daily

Other Treatments:

Other potential options to help reduce an inflammatory cytokine storm:

• Molecular hydrogen: Most commonly delivered in gas form, emerging research is showing that hydrogen exerts antioxidant, anti-inflammatory and cytoprotective properties that are beneficial to the cell. Hydrogen has been shown to lower NFkb, IL-6, and IL-1b amongst others. Currently, there are four clinical trials in the world using hydrogen gas to treat COVID. Watch a video about why hydrogen is being used to support COVID-19 treatments here.
  

• Ozone: Ozone has been shown to lower inflammatory cytokines TNFa, IL-1b and IL-6. Major Autohemotherapy (IV ozone) is currently being used in 17 hospitals around the world to treat COVID-19.

• NAD IV therapy: Nicotinamide adenine dinucleotide (NAD+) is required for energy production in the mitochondria and emerging research is finding that increasing NAD+ levels help repair cells in part by reducing inflammation caused by cytokines. COVID clinical trials are underway in the UK.
  

• Phosphatidylcholine: One of the cell membrane's most important phospholipids, PC has been shown to lower NFkB. Can be given orally or by IV.

These are trying times, as we struggle with an infection that appears to be very contagious and at times, deadly. However, with each passing day, we're getting closer to unlocking the secrets of COVID-19 and finding that elusive cure. Spotting out-of-control cytokine reactions is an important step in helping successfully manage care for the sickest among us and reducing the impact, and fear that catching coronavirus brings.

In Health,

Disclaimer: None of the information listed above is intended to supersede or replace a plan you have created with a healthcare professional already.

None of the treatments listed above have been approved by the FDA to treat or cure COVID-19. Clinical trials for all procedures linked to in the blog are ongoing and may or may not ultimately prove effective.

Consult with your healthcare provider before beginning any new plan or supplements.

**Of note – While elderberry syrup has been found to be extremely helpful in treating influenza, it can increase IL-1b so it’s not advised to take this if you are having symptoms of COVID-19.