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What to Do about the Coronavirus—An Integrative Medicine Approach

It seems as though every conversation I had this week included references to the coronavirus—whether to get worried, what to do if it reaches Minnesota, and—as of March 6th, what to do about it now that it is here.

COVID-19 is more than just a garden-variety viral infection.  Its mortality rate—especially for older people and those with underlying illnesses—is probably around 1-3%. (By comparison, influenza’s mortality rate is closer to 0.1%.)  One of the reasons it’s hard to know the exact rate is that it’s not a severe illness for younger people and the number of cases is probably much higher than recorded.   About 80% of the cases are mild—cough, fever—and I suspect that some people who have it don’t even know they have something besides a cold.  The lack of severe symptoms, couple with the fact that people can be infectious before they feel sick makes person-to-person spread more likely.  And it doesn’t help that the virus appears to live on hard surfaces for up to 48 hours.

While the conventional medical world has emphasized handwashing and other public health measures, it has not offered much else in the way of prevention.  This surprises me as my integrative medicine sources have been buzzing with natural strategies.

To be sure, hygiene and avoidance are critical.  But you may be surprised to know that a tremendous amount of research has been done on natural treatments for pandemic-causing infections including the coronavirus family.  I have compiled a short list of evidence-based interventions to keep you healthy.  None of these are very expensive and all of them are safe.  I hope this helps you move past raw fear to empowerment and courage.

General Measures

The most important thing you can do to stay well is to keep your immune system strong.   Eat a healthy diet with as many vegetables and as little added sugar and alcohol as possible. 

Smoking appears to increase the risk of a more severe infection—27% versus 3% in one Singapore study,[1] so if you need yet another reason to quit smoking, this is it.

Get enough sleep; sleep deprivation dramatically weakens your immune system.[2],[3]  

While regular moderate exercise is immune-enhancing, intensive exercise can reduce immunity[4] so this may not be the year to train for a marathon. 

Supplements

In terms of supplements, my favorite is vitamin D.  We think of vitamin D as enhancing bone strength (which it does) but its effects on the immune system are significant, particularly for viral infections.[5],[6],[7]  Checking your vitamin D level and keeping it at least above 50 ng/ml is an easy step you can take to boost immunity.  The daily allowance recommended  by the Institute of Medicine for vitamin D is 400 international units (IU) for children up to age 12 months, 600 IU for ages 1 to 70 years, and 800 IU for people over 70 years. This is woefully inadequate and not supported by the evidence.[8]  The Endocrine Society recommends somewhat higher levels. 1500–2000 IU/day for adults, though they found that obese adults required 2–3 times more vitamin D to sustain a blood level of at least 30 ng/ml.   In my experience, even this higher dose is inadequate.  Researchers who have actually measured vitamin D levels have found that even 2000 IU a day does not maintain levels in even the normal range, let alone in the optimal range.[9]   In my professional experience, most people need at least 5000 IU a day during the winter to maintain these levels. If you can’t get your level checked, this is a pretty safe dose.  In fact, much higher doses than that have been found to be safe.[10]  The only contraindication for high dose vitamin D is sarcoidosis.

Zinc is essential for approximately 2000 enzymatic actions in the human body and its role in immune function is well-known.[11]  Zinc deficiency is not uncommon and particularly affects the elderly, vegans/vegetarians, and individuals with chronic disease such as inflammatory bowel disease.[12]  There is evidence that zinc supplementation may reduce viral infections.[13],[14] I recommend taking 15-30 mg. a day, and balancing it with copper 2 mg. to avoid a copper deficiency. Check any multivitamins, mineral or other combination supplements to make sure you don’t go above about 40 mg. a day.

Our understanding of our gut microbiome’s role in infection is evolving.  There is evidence that live and even killed probiotics can strengthen the response to viral infections.[15],[16],[17] Probiotics are an easy, safe and inexpensive intervention.  I recommend a multi-strain product with at least 20 billion CFU’s purchased from a reputable source such as a food co-op or Whole Foods.

Despite its reputation, the evidence for vitamin C for prevention of the common cold and other viruses is weaker. However, there is a trend toward protection in studies where participants were intentionally exposed to cold viruses and the duration of the infection seems to be shorter.[18]  This seems particularly true if you are already taking vitamin C and increase the dose when you get sick.[19]  Given its safety and low cost, taking at least 1000 mg. and probably more like 2000-3000 mg. a day for prevention can’t hurt.  The only real risk is of looser stools which can be eliminated with lowering the dose.

The most effective immune boosters in the plant world are mushrooms. They have been used for millennia in Chinese medicine[20] and in Eastern European traditional remedies.  Much of the research so far has shown activity in the test tube,[21],[22],[23] but there is evidence of effectiveness in humans as well. [24]  Each mushroom species hasdiffering properties and they may be synergistic.[25]  Your best bet may be to take a combination product such as those sold by  Fungi Perfecti (https://fungi.com/collections/host-defense-extracts) or Mushroom Wisdom (http://www.mushroomwisdom.com/).  These supplements are more expensive than the preceding recommendations, so if you are relatively low risk for serious illness, you may want to balance cost against protection.

Herbs are amazing defenses against any type of infection. They contain not just antibacterial and antiviral properties but many are immune-enhancing and anti-inflammatory, and are synergistic with each other and antibiotics.[26],[27]  A number of western herbal therapies have been used for fighting viral infections.  The list of options is huge, so I will just offer one. There is evidence for the effectiveness of elderberry in particular against other strains of coronavirus.[28],[29],[30],[31]  A preventive adult dose is a tablespoon of elderberry syrup or once capsule once a day. Reputable brands include Sambucol liquid or black elderberry capsules by Nature’s Way.  You can also make a tea or just eat elderberries.

I hope that you will find these recommendations useful and encouraging.  Please feel free to share it with others; I just ask that you credit me for it. And please send me your feedback!

Yours in health,

Laurie


[1] Liu W et al. Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease [published online ahead of print, 2020 Feb 28]. Chin Med J (Engl). 2020;10.1097

[2] Besedovsky L et al. The Sleep-Immune Crosstalk in Health and Disease. Physiol Rev 2019; 99:1325-1380.  Full text available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6689741/.

[3] Prather AA et al.  Behaviorally assessed sleep and susceptibility to the common cold. Sleep 2015; 38:1353-1359.

[4] Simpson RJ et al. Exercise and the regulation of immune functions. Prog Mol Biol Transl Sci 2015; 135:355-380.

[5] Martineau AR et al.  Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. BMJ  2017;  356: i6583.

[6] Beard J et al. Vitamin D and the anti-viral state. J Clin Virol 2011; 50:194-200.

[7] Edlich RF et al.  Pandemic preparedness for swine flu influenza in the United States. J Env Pathol, Toxicol and Oncol 2009; 28:261-264 (editorial).

[8] Vieth R and Holick MF. Chapter 57B- The IOM-Endocrine Society controversy on recommended vitamin D targets: In support of the Endocrine Society Position. Vitamin D 4th Edition Volume 1: Biochemistry, Physiology and Diagnostics.   pages 1091-1107. Academic Press, 2018.

[9] Sadat-Ali M et al. Maintenance Dose of Vitamin D: How Much Is Enough? J Bone Metab  2018; 24:161-164.

[10] Kimball SM et al. Safety of vitamin D3 in adults with multiple sclerosis. Am J Clin Nutr 2007; 86:645-651.

[11] Shankar AH, Prasad AS. Zinc and immune function: the biological basis of altered resistance to infection. Am J Clin Nutr. 1998;68(2):447s–63s.

[12] Siva S et al. Zinc deficiency is associated with poor clinical outcomes in patients with inflammatory bowel disease. Inflamm Bowel Dis. 2017;23(1):152–7.

[13] Allan GM and Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ 2014; 186: 190–199.

[14] Read SA et al. The role of zinc in antiviral immunity. Advances in Nutrition, 2019; 10: 696–710.

[15] Allan GM and Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ 2014; 186: 190–199.

[16] Hao Q et al. Probiotics for preventing acute upper respiratory tract infections. Cochrane Database Syst Rev. 2011 Sep 7; (9):CD006895.

[17] Kanauchi O et al.  Probiotics and paraprobiotics in viral infection: Clinical application and effects on the innate and acquired immune systems.  Curr Pharm Des 2018; 24:710-717.

[18] Allan GM and Arroll B. Prevention and treatment of the common cold: making sense of the evidence. CMAJ 2014; 186: 190–199.

[19] Ran L, Zhao W, Wang J, et al. Extra Dose of Vitamin C Based on a Daily Supplementation Shortens the Common Cold: A Meta-Analysis of 9 Randomized Controlled Trials. Biomed Res Int. 2018;2018:1837634.

[20] Aung SK: The Clinical Use of Mushrooms from a Traditional Chinese Medical Perspective. 2005, 7(3):375–376.

[21] Eguchi N et al. In-vitro anti-influenza virus activity of agaricus brasiliensis KA21. Biocontrol Sci 2017; 222:171-174.

[22] Ellan K.  Anti-viral activity of culinary and medicinal mushroom extracts against dengue virus serotype2: An in-vitro study. BMC Complement Altern Med 2019; 19:260.

[23] Benson, K.F. et al. The mycelium of the Trametes versicolor (Turkey tail) mushroom and its fermented substrate each show potent and complementary immune activating properties in vitro. BMC Complement Altern Med 19, 342 (2019).

[24] Nishihira J et al. Maitake mushrooms (Grifola frondosa) enhances antibody production in response to influenza vaccination in healthy adult volunteers concurrent with alleviation of common cold symptoms. Functional Foods in Health and Disease 2017; 7: 462-482.

[25] Wang L and Hou Y. Determination of trace elements in anti-influenza virus mushrooms. Biol Trace Elem Res  2011; 143:1799-1807.

[26] Aiyegoro OA and Okoh AI.  Use of bioactive plant products in combination with standard antibiotics: implications in antimicrobial chemotherapy.  J Medicinal Plants Res 2009; 3:1147-1152.

[27] For a well-researched and comprehensive review of herbs see Buhner SH. Herbal Antibiotics: Natural Alternatives for Treating Drug-Resistant Bacteria, Second Edition. North Adams, MA 2012. Storey Publishing.

[28] Chen C et al.  Sambucus nigra extracts inhibit infectious bronchitis virus at an early point during replication. BMC Vet Res. 2014; 10: 24. 

[29] Zakay-Rones Z et al. Inhibition of Several Strains of Influenza Virus in Vitro and Reduction of Symptoms by an Elderberry Extract (Sambucus Nigra L.) During an Outbreak of Influenza B Panama. J Alt Complement Med 1995 1:361-369.

[30] Weng JR et al. Antiviral activity of Sambucus FormosanaNakai ethanol extract and related phenolic acid constituents against human coronavirus NL63. Virus Res. 2019;273:197767.

[31] Zakay-Rones Z et al. Randomized Study of the Efficacy and Safety of Oral Elderberry Extract in the Treatment of Influenza A and B Virus Infections. J Int Med Res 2004; 32:132-140.