Reducing Coronavirus Risk

We are in unprecedented times. Watching or scrolling through the news, COVID 19 is front and center, and it has everyone around the world on edge. This global pandemic has Americans rushing to buy food and supplies as if we are facing a major world war. That’s the power of words like GLOBAL PANDEMIC and NATIONWIDE QUARANTINE. Reducing COVID-19 risk has to be one of the most searched google phrases.

There is no cure for coronavirus, and there are no FDA-approved treatments as of this blog's posting.

But that doesn't mean you are powerless in this fight. There are several natural remedies that can boost you immune system - giving you the tools to fight any infection, coronavirus or otherwise. Integrative and Function Medicine is well equipped to help you understand how to maximize your protection now, as well as anything else life can throw at you later.

What Is the Coronavirus?

COVID 19 is one of the many viruses classified as coronavirus. In this family, strains range from very mild (causing common cold symptoms) to severe with deadly potential like SARS (Severe Acute Respiratory Syndrome).

Coronavirus symptoms span a wide range - with some experiencing a small cold to others, for whom the virus is tragically fatal. Although the CDC is continually evolving their estimates, information so far suggests that most COVID-19 illnesses are mild.

Transmission typically requires contacting your mucus membrane to replicate (like the linings in your nasal passages and lungs). A study published last week revealed in can likely survive on surfaces for 2-3 days and may even survive in the air for 3 hours. Humans are most contagious during the early days of illness but can shed the virus for weeks.  The average incubation period is about 4 days, and initial symptoms include sore throat, with or without fever, muscle aches and cough.  Symptoms may worsen around day 8 and include cough and shortness of breath and may include a bilateral interstitial pneumonia.

Who is at Risk?

According to the CDC, early information out of China where this virus first started reveals that those at highest risk include adults over 60 and those with serious medical conditions including: heart disease, lung disease and diabetes. Although we are just learning about this particular virus, we have learned from Influenza and the flu that others may be at risk as well, such as those with neurological conditions, kidney and liver diseases.

"Hacking" the virus: Playing offense

The core of integrative and functional medicine is lifestyle. Even though there isn't an antidote, there are several steps you can take to ensure your immune system is as robust as possible. This improves the chances that, should you contract COVID-19, yours is one of the mild cases.

Wash your hands!

We have all likely heard the importance of hand washing. This is likely your best defense from becoming colonized with the virus.

• Wash your hands with soap and water for 20 seconds (sing the Happy Birthday song twice).

• Use alcohol based sanitizers (>60% alcohol) if you are unable to wash hands.

• Cover your cough with a tissue or sleeve.

• Stay at home if you are sick and avoid close contact with people that are sick.

• Avoid touching your face.

• Clean frequently touched surfaces such as computer screens, phones, TV remotes

• Irrigate your nose with a neti pot or similar apparatus can help prevent the virus from taking hold and colonizing.

Fuel your Immune System

Now more than ever, ensuring a diet that is anti-inflammatory and rich in phytonutrients and antioxidants is a must.

Some things focus on:

• Avoid processed and canned foods. This is very handy as many supermarkets are fully stocked with fresh food and out of canned items.

• Favor a lower sugar diet, opting for complex carbohydrates.

• Eat 4-6 servings of veggies and fruits daily.

• Eat organic and wild caught meats, or ensure adequate plant based protein intake if you are vegetarian.

• Include healthy fats (olive oil, avocados, nuts, seeds, coconut oil, omega 3 oils from wild caught fish).

Do not underestimate the power of basic lifestyle measures like sleep, exercise and meditation.

Research has shown that sleep disturbance can have significant influence on the risk of acquiring infectious diseases.

A randomized controlled trial showed the benefits of meditation or exercise for preventing acute respiratory infections.

Beyond Lifestyle: Immune Boosters

Aside from lifestyle and common sense practices, Integrative Medicine has so much to offer in terms of evidence-based solutions to help boost your immune system. For those of you who appreciate diving deep into the evidence and/or prefer to know the science behind all of your medical recommendations. I have done the dirty work for you.

Vitamin D

Vitamin D is a superstar, functioning more like a hormone than a vitamin.

Up to 90% of people are deficient, and low levels are linked to higher rates of colds, flu, and respiratory infection as viruses have a much easier time replicating.

Adequate vitamin D levels stimulate the potent antimicrobial peptides (AMPs) in immune cells in the respiratory tract, destroying viruses and other microbes.

In fact ,one study demonstrated that Vitamin D supplementation reduced risk of respiratory infection by up to 50% in deficient individuals.

Taking Vitamin D: Knowing your vitamin D level is important, so start by contacting your physician to be tested. In general Integrative Physicians will recommend levels 50-70 mg/ml for 25-hydroxy-vitamin D (a higher than labs list as normal). You can overdo it, so if you are low, add vitamin D gradually. A good rule of thumb: 1000 IU of D3 should add 10 points to your level.

Where to get it: High quality Vitamin D can be purchased in oral capsule form from reputable manufacturers. My favorite Vitamin D supplements can be found at here at Fullscripts.com (look for Orthomolecular's Vitamin K2 + D3) and here at Wholescripts.com (look for Xymogen D3) Case Integrative Health also provides Vitamin D injections in our clinic.

Zinc

Zinc supports immune function and has antiviral effects – it actually kills viruses on contact. A 2011 Cochrane Review (the gold standard for evaluating scientific evidence) revealed that taking zinc soon after the onset of cold symptoms significantly reduces both duration and severity.

Lozenges seem to be the most effective at fighting upper respiratory infections (over pills and sprays), with One study hypothesizing that dissolving zinc lozenges for 20-30 minutes every 2 hours would shorten the common cold by 6-7 days.

Taking Zinc: Generally, safe doses of zinc are 15-30 mg daily. More than that is not encouraged, as it can complicate other functions. As with all medications, it is important to consult your physician, know your levels and add zinc appropriately as recommended by your doctor.

Where to get it: Zinc can generally be purchased at the same places as Vitamin D. I recommend Pure Encapsulation Zinc 15 at Fullscript.com (although many apothecaries are on back-order).

Surf and turf lovers rejoice! Meat and shellfish have among the highest concentrations of zinc. Chickpeas, lentils, nuts, eggs, and whole grains are also good sources of dietary zinc. For higher concentrations, we add zinc to our anti-viral IV treatment at our clinic.

Vitamin C

Vitamin C is an antioxidant and has been clearly and directly linked to reduce the length and severity of colds.

A study done in Helsinki summarized randomized controlled trials (RCTs) of Vitamin C:

• Two studies showed that taking 8 grams on the first day of symptoms reduced the cold's duration by 20%.

• Three RCTs showed that Vitamin C prevented pneumonia.

• Two RCTs showed treatment benefit in pneumonia patients.

Taking Vitamin C: Vitamin C is very safe even at high doses though moderate doses of 2-3 grams per day can decrease the frequency and severity of colds. If you can tolerate it, Vitamin C can be taken in doses up to 6-8 grams daily (divided 2 or 3 times in the day) during a cold or flu.

Where to get it: Case Integrative Health administers Vitamin C intravenously for ultra-high doses, and also recommends oral supplementation from NuMedica Liposomal Vit C.

Vitamin A

Another one of our anti-oxidants, Vitamin A has been shown to reduce viral illnesses and enhance immunity as well. Among other functions, it has been shown to enhance antibody responses, increase lymphocyte responses and rebuild mucosal surfaces. It’s thought that deficiency of Vitamin A makes you more susceptible to infections since mucosal barrier is degraded.

• In one study, higher levels correlated to fewer detections of virus, suggesting strong anti-viral effects.

• A Chinese study of 1200 children showed that levels of Vitamins A, D and E were significantly lower in recurrent respiratory tract infection. Those with recurrent infections were noted to have 63% deficiency or insufficiency.

• A study on Ebola virus showed that Vitamin A supplementation was associated with reduced mortality in patients.

Taking Vitamin A: The recommended daily dosage of vitamin A is 5,000 IU per day, and it’s likely best to get your Vitamin A from foods. However, during cold and flu season, if you are starting to come down with cold/flu like symptoms or you are exposed to others who have a viral illness, temporarily taking 10-15 IU of Vitamin A daily is safe.

As long as you know that you have optimal Vitamin A levels, consider taking higher doses during the first 3 days of a viral illness, such as 50,000 IU daily for 3 days.

Where to get it: Vitamin A comes in two forms: retinol (active vitamin A which comes from animal-derived foods) and beta carotene and carotenoids (found in plant based products and need to be converted to the active form retinol. My preferred form of supplementation is retinol from Douglas Labs.

Elderberry

Elderberry has been shown to be both antiviral and anti-inflammatory. The berries have a chemical compound called anthocyanidins which stimulate immune responses and plant defense molecules like antimicrobial peptides may be present.

• One study showed that 15 ml of Elderberry syrup was shown to relieve symptoms an average of 4 days earlier with significantly less use of rescue medications.

• A 2019 meta-analysis showed that black elderberry (Sambucus nigra) supplementation was shown to substantially reduce upper respiratory symptoms.

• A preventative study on air travelers showed that travelers using 300 mg twice daily of a proprietary membrane filtered elderberry (Sambucus nigra L.) starting 10 days before air travel and continuing on to 4-5 days after arrival overseas showed significant reductions in cold symptoms as well as shorter duration of colds.

Taking Elderberry: Recommendations for dosing can vary. Generally, taking 100-200 mg of Elderberry extract 3 to 4 times daily during times of susceptibility are recommended and shown to be very safe.

Where to get it: Elderberry syrups, gummies, lozenges, and teas are good options to look for. Natures Way Sambucus Original lozenges are widely available at grocery stores and drug stores.

A word of caution... Since elderberry is a strong immune stimulant, some patients taking certain medications such as immunosuppressants, chemotherapy, diabetes medication, Theophylline, and diuretics may want to check with their health care providers before supplementing.

Oil of Oregano

Long hailed as nature’s antibiotic, this powerful oil has potent microbial properties, including antiviral, antibacterial and antifungal.

Oregano has been used on folk medicine for over 2000 years. A member of the mint family, Origanum vulgare has two primary compounds (carvacrol and thymol) which have been shown in studies to have strong antibacterial and antifungal properties.

• A study on norovirus supports antiviral properties of oregano and carvacrol.

• Check out this study on oregano’s potent antimicrobial potential.

Taking Oil of Oregano: Standardized dosing of oil of oregano is not well-established. You may want to consult with your health care provider, but typically you can safely take a high quality emulsified oregano supplement 50-150 mg twice daily at the onset of a cold or flu and continued for 7-10 days.

Some may not tolerate this potent herb, as it is used to treat digestive conditions such as SIBO (small intestinal bacterial overgrowth) and some may experience initial digestive upset if this is the case. Additionally, keep in mind that oil of oregano is like an antibiotic and too much can end up disrupting your microbiome. Taking probiotics or eating probiotic rich foods while on oil of oregano may be considered.

High quality oil of oregano is available from fullscript.com as A.D.P.

Garlic

Garlic’s medicinal compound, allicin, has been studied for its many health benefits, including its potent antimicrobial effects.

Allicin is activated in raw garlic after it has been crushed (it requires air to start the enzymatic reaction). I always recommend crushing garlic and letting it sit for at least 15 minutes before consuming RAW. Allicin is very unstable and breaks down quickly once the garlic is cooked.

• A study published in Molecules in 2014 showed that allicin could inhibit pathgens or kill cells outright, including MRSA (methicillin resistant Staphylococcus aureus).

• A double-blind placebo controlled survey for preventing the common cold with a garlic supplement was done including 146 volunteers randomized to get an allicin containing supplement versus placebo for a 12-week period. Those taking the active allicin were less likely to get a cold and were recovered faster if infected.

Taking garlic: During a cold or flu or when exposed to others who are infected, try to consume 1-2 cloves garlic in the raw form 1 or 2 times daily (and remember to crush first and let sit for 15 minutes before consuming.) Raw garlic is very pungent. If the taste is too much, try adding it to a vinaigrette or spread it on toast with some oil (garlic bread!)

Where to get it: Skip the canned goods isle and head ot the fresh food section of your local mega-mart. Bulbs hung in a cool dry place can be stored for weeks or months (just be sure to cut out the green shoot).

Final Thoughts

These are extraordinary times, and we are resorting to extraordinary measures. There is no cure for COVID-19, and current estimates are that a viable vaccine is still 12-18 months away. However we are not without tools in this fight. The data show we can significantly reduce our risk of either acquiring viral illnesses and/or significantly reduce the severity of infection without taking extra-ordinary measures.

And with the things we learn, new habits we make and old habits we refocus on, we will be better equipped to fight other infections in years ahead.

In short, watch your diet and eat your veggies, get outside and move with enough social distance from others, avoid large gatherings, follow other CDC guidelines and get enough rest. With tension levels rising, take care of yourself to mitigate the stressful effects with breathing, meditation, and other relaxing activities. Use supplements wisely.

To recap, supplements from reputable retailers such Fullscript and Wholescripts are good place s to start.

• Vitamin D to ensure levels of 50-70 (average doses are 2000-4000 IU daily)

• Vitamin A 10-15 IU daily during a viral illness or when exposed (consider 50,000 IU daily x 3 days if you have adequate vitamin D levels)

• Vitamin C 1000-4000 grams twice daily (depending on your bowel tolerance)

• Zinc 15-20 mg daily during a viral illness or when exposed

• Elderberry 100-200 mg 3-4 times daily

• Oil of Oregano 50-150 mg (emulsified oregano) twice daily for 7-10 days if tolerated (during a viral illness or when exposed )

• Garlic 1-2 cloves crushed and raw 1-2 times daily during a viral illness or when exposed

Here's to your Health,

Dr. Rana Mafee

Note: None of the information listed above is intended to supercede or replace a plan you have created with a healthcare professional already. As with any changes to diet or supplementation, you should consult with your healthcare provider before implementation.