Integrative Functional Medicine: Supplements, Herbs, & Immunity for Covid Care

Updated: Sep 1, 2021

No integrative measures have been validated in human trials as effective specifically for COVID-19.

As an integrative medicine family practice provider, I am frequently asked about "alternative options" for treating or preventing covid. I love to incorporate natural options into my medical care and love helping folks sort through the weeds of what is safe and scientifically sound vs unsafe.

The following integrative and functional medicine pearls are in no way a substitution for vaccination and masking. Let me be clear that the leading organizations of integrative and functional medicine fully support vaccination as a principle line of defense. Myself and my family (those who are old enough) are all vaccinated. I encourage my patients to vaccinate as well. These are supplemental considerations to the current recommendations that emphasize vaccination, masking, regular hand washing, physical distancing, stopping non-essential travel, and obtaining testing in the presence of symptoms or possible exposure.

Clinical data in the context of human trials, alternative medicine, and covid is lacking. However, the potential benefit of many herbs/supplements is high based on existing and emerging data, and the risk of the treatments when used appropriately is low.

For questions on vaccine ingredients, safety, side effects, covid infection complications, covid symptoms, variants, covid & pregnancy, vaccine effectiveness, ivermectin, monoclonal antibody therapy, prescription options, and more, please check out my infoblog: https://www.hearthsidemedicine.com/post/integrative-medicine-updates-on-covid-care

For Starters!

There are 4 big risks when following a natural approach to not only COVID-19 prevention, but any potentially serious illness:

Foregoing practices that are known to be preventative, like those on the CDC website – including wearing a face covering (i.e. mask) – that we should all be diligently observing.
Not getting necessary medical treatment.
Taking harmful substances, or taking possibly harmful doses of otherwise generally safe substances.
Ignoring side-effects of supplements or contraindications that might be unique to your situation.

Below are summaries of integrative and functional medicine approaches that can be used to combat inflammation, repair lung injury or dysfunction, replete nutritional deficiencies, reduce chronic stress, and mitigate fatigue. This information is sourced from University of Arizona Integrative Medicine and Institute for Functional Medicine.

1. Food As Medicine

A low-glycemic, low-saturated fat diet can be used to modulate inflammation generally. At least 5–7 servings of vegetables and 2–3 servings of fruit daily provide a repository of flavonoids and are considered a cornerstone of an anti-inflammatory diet.

An anti-inflammatory diet combines traditional Mediterranean and Asian eating patterns and is characterized by high consumption of vegetables, fruit, legumes, fish, lean protein, whole grains, spices, nuts and seeds and low consumption of both refined grains and processed foods. Various nutrient components of an anti-inflammatory diet, such as monosaturated and polyunsaturated fatty acids and a diet high in plants. With any prolonged illness, COVID-19 included, mental health can be compromised. In a period as short as 10 days, a Mediterranean style diet may result in improved mood and cognition.

2. Nutritional deficiencies and Infection

Infection can lead to transient nutrient deficiencies, particularly of protein, B vitamins, vitamin C, copper, zinc, and iron. Likewise, nutrient deficiencies can make one more vulnerable to viral illnesses. Patients with COVID-19 are likely to have nutrient deficiencies, with one study reporting 76% of hospitalized patients with COVID-19 deficient in vitamin D, 42% deficient in selenium. Further, among patients with respiratory distress, 91.7% were deficient in at least one nutrient while 78.9% without respiratory distress had a deficiency of at least one nutrient. It takes up to 3 times as long to replete nutrients than it took to become depleted.

3 Supplementation--please discuss all these with your provider, as some of these suggestions are contraindicated in the context of certain health problems or if taken with certain medications. Please note that I do not go into dosages or safety for pregnant or pediatric patients or those with specific health conditions. The recommendations are highly generalized and ALL patients should discuss the safety of these recommendations with their health provider.

Initial prevention--not allowing the virus entry into the cells/preventing ACE2 Receptor Binding

Astragalus
Vit D--anti-viral, anti-inflammatory, and immune enhancing actions in the lungs.
Quercetin
*Elderberry--most effective in the prevention or early stage of corona virus infections. Significantly increases inflammatory cytokines, including IL-B1 so should be discontinued with symptoms of infection (or positive test). Typical dosing of 2:1 elderberry extract is 10 mL–60 mL daily for adults and 5mL–30 mL daily for children. 500 mg po qd (of USP standard of 17% anthocyanosides) for up to 12 weeks
Oregano oil
Antioxidants

Prevent Viral Replication

Zinc (as a supplement but also by eating zinc-rich foods)--Coronavirus appear to be susceptible to the viral inhibitory actions of zinc. Zinc may prevent coronavirus entry into cells and appears to reduce coronavirus virulence. Typical daily dosing of zinc is 15 mg–30 mg (note: can cause nausea)
Quercetin (helps with zinc transport/absorption)-found in apples/onions--Regular: 1 gm po bid; phytosome: 500 mg, bid Suggested Duration: Up to 12 weeks
Green Tea (helps with zinc transport)--4 cups daily or 225 mg po qd
Vitamin C-shortens the frequency, duration and severity of the common cold and the incidence of pneumonia. Typical daily dosing of vitamin C ranges from 500 mg to 3000 mg daily with even higher doses utilized during times of acute infection.

Improve Immunity

Vitamin D (too much can actually cause inflammation)--we advise getting baseline blood levels checked and checking intermittently to prevent toxicity; 1,000- 5,000 IU po qd; Children's doses are typically 400 to 800 iu daily
Probiotics

Reduce Inflammation

If infected, the goal is to reduce inflammatory process

Vitamin C (can help prevent progression to pneumonia)
Omega 3 Fatty Acids
Melatonin (may prevent inflammation in the lungs)--Typical doses of 1–10 mg/day melatonin appear to be safe for short-term use
Plant Flavonoids (7-10 cups of veggies a day!)
Quercetin (again!)
Garlic-Clinically studied daily doses of garlic supplements range from 600 to 900 mg dried garlic powder tablet, standardized to 1.3% alliin or 0.6% allicin) or 7.2 g of aged garlic extract
Green Tea (can decrease cytokines)
Curcumin (Also inhibits viral replication and may inhibit cytokine storm) 500-1,000 mg po bid (of absorption-enhanced curcumin)
Mycelium Mushroom Fruiting Bodies (cordyceps, lion's mane, reishi etc)
Oil of Thyme (inhaled via steam infusion)
Glutathione (250 mg to 1000 mg daily) --selenium, n-acetyl cysteine,and ginger are associated with increased pulmonary glutathione, improved pulmonary function and reduced inflammation
Resveratrol-100-150 mg po qd
N-acetylcysteine (NAC)--600-900 mg po bid
Vitamin A--Up to 10,000-25,000 IU/d ***Caution in pregnancy (high dietary intake of >10,000 IU/day of preformed vitamin A appears to be teratogenic); Vit A toxicity CAN occur if not monitored.
Chinese skullcap
Andrographis has been found to improve overall symptoms of acute respiratory tract infection, particularly cough and sore throat

Recovering from Infection

Boswellia
Cordyceps (.5 g – 3 g daily)- medicinal mushroom with antioxidant, antitumor, anti-inflammatory, and antimicrobial actions
Astragalus- Astragalus root extracts standardized to 40% polysaccharides or 3% astragalosides can be dosed at 320 mg – 500 mg daily and astragalus granules dosed between 4 g – 60 g daily-reduces inflammation.
Antioxidants
Avoid strenuous exercise but DO exercise to recover*
Avoid lung collapse via deep breathing exercises*
Avoid secondhand smoke and wildfire smoke when able
Melatonin-potent endogenous antioxidant, anti-inflammatory and immunomodulatory molecule

*Elderberry might affect insulin and glucose metabolism, so according to experts, people with diabetes should use it with caution. The safety of elderberry during pregnancy is not known, so experts recommend against the use of elderberry supplements by pregnant women

When NOT to take supplements:

*While Vitamin D, echinacea, elderberry, and medicinal mushrooms are reasonable to use for prevention of viral infections, they could be counterproductive if you’re actively sick with COVID-19 infection, so if you become symptomatic it seems prudent to discontinue taking these as supplements until you’re fully recovered (vitamin D in a prenatal or multivitamin is likely fine as it’s usually a low amount), or until moreevidence is published demonstrating that they are safe to use in the case of active infection.

*Breathing exercises: breathing exercises including diaphragmatic breathing (DB), pursed-lip breathing (PLB), yoga breathing relaxation techniques (RT), and body position exercises (BPEs) can help improve lung function if one is infected or in recovery. The strongest evidence is for PBL, with an improvement of shortness of breath found to be at 40%

*Exercise: Moderate exercise in covid-recovery improves immunity and reduces pulmonary fibrosis; recommend initially starting with aerobic exercise (i.e. walking or biking) for 10–15 min, 1–2 times per day on 3–4 days each week

4. Stress Reduction:

Chronic stress impacts immune system function and increases generalized inflammation, which leads to more frequent and severe viral infections,reduced vaccine effectiveness, decreased wound healing, and speeding of aging. Mind-body interventions, such as mindfulness meditation, or those combining mindfulness with gentle exercise, such as yoga and Tai Chi, lower the brain's stress response, and also trigger the brain's relaxation response. Sometimes therapy and medications are needed.

Lavender essential oil has potential therapeutic value in convalescence due to its stress-reducing and anxiolytic effects. Lavender aromatherapy has been found, in a variety of clinical contexts, to exert anxiolytic effects and to improve sleep quality.

Stress disrupts immune regulation and makes it harder for the immune system to work.

5. Sleep

Good sleep quality is essential for health, and the physical environment plays an important role in supporting healthy sleep. Exposure to full spectrum circadian sunlight from 8am to 12 noon reduces sleep latency (time to fall asleep), improves sleep quality and improves mood. In the absence of sunlight, full spectrum light boxes can also be effective in sleep support and in reducing depressive symptoms.

Shorter sleep duration increases the risk of infectious illness. One study found that less than 5 h of sleep (monitored over 7 consecutive days) increased the risk of developing rhinovirus associated cold by 350% when compared to individuals who slept at least 7 h per night. Important specifically to COVID-19 infection, sleep deprivation increases the covid inflammatory pathway. Sleep has a massive impact on how well the immune system functions. Sufficient sleep is one of the factors that determines whether your immune system responds to an annual flu vaccine by producing antibodies, so it is likely similarly important for covid antibody generation after vaccination.

6. Create a healing environment

Conversely elements of the physical environment that relax and counter these effects of stress include soothing nature sounds; diffuse light and full spectrum sunlight in the morning; natural fragrances from essential oils, such as lavender; social support and positive social interactions; and labyrinths, which unlike mazes, can induce a state of walking meditation. Nature sounds, such as running water or forest sounds have also been shown to reduce stress and bring on better sleep quality.Similarly calming music improves moods, reduces stress and activates dopamine reward pathways

7. Humidity and Mucous membranes

Relative humidity lower than 30% increases susceptibility to viral infection, likely due to drying of mucus membranes--keep a *frequently-cleaned* humidifier near your bed. If you have a woodstove, consider boiling water on top of it to add to humidity (and you may like to add thyme to it as well!)

8. Controlling your "underlying medical problems" and reducing your risks

We know that uncontrolled underlying medical problems such as high blood pressure, diabetes, poorly controlled asthma, obesity, uncontrolled sleep apnea, etc greatly increases one's risks of having severe covid or even getting covid in the first place. Work with your provider (that's our team if we are your PCP!) to get better control of these issues. Exercise to reduce overall inflammation (a major risk factor for poor immunity and infection) and to reduce high blood pressure. Cut back on your snacky snacks that are processed, high carb or high sugar. Get a sleep study and a CPAP if needed while working on the root cause of your sleep apnea (often obesity, sometimes mouth structure).

What about Essential Oils?

Essential oils beneficial in asthma and COPD may also be beneficial in COVID-19 disease. Specifically, oral administration of 1,8-cineole, a main constituent of eucalyptus oil, at 200 mg three times daily, improves pulmonary function in asthmatics.

A Word on Covid & Pregnancy

There has been a sharp increase in pregnant women being sent to the ICU or passing away from covid and having to deliver preterm babies they cannot meet as they are in quarantine from their babies.

Vaccines are particularly important for pregnant women, as they are at an increased risk for serious illness if they become infected with COVID-19. Pregnant women have altered immune systems, and that could make them more susceptible to COVID-19. Also, research shows that pregnant women with underlying comorbidities or medical health conditions are at higher risk of having worse outcomes if they are infected with COVID-19.

About the author

Havilah Brodhead is a board-certified family nurse practitioner and chief medical officer of Hearthside Medicine Family Care in Bend, Oregon, an integrative medical practice. She is mom to a 4 & 5 yr old and is married to co-owner/FNP Jeremy Brodhead. She has a special interest in disease prevention. Havilah loves incorporating natural, plant-based medicine and alternative medicine into her conventional medicine training. She has studied integrative medicine as well as functional medicine. Havilah loves to mountain bike, practice yoga, write, and spend time with her husband and two young daughters exploring Oregon when she is working at Hearthside Medicine.

Havilah Brodhead, FNP and Marie Mency, FNP/Women's Health are accepting new patients of all ages and take most insurances. We are able to see patients in person or via telehealth (in some cases) in Oregon and California (only via telehealth). We offer full family primary care to all ages.

Havilah Brodhead, FNP and Marie Mency, FNP/Women's Health are accepting new patients of all ages and take most insurances and can see patients virtually or in person in Oregon and virtually in California.

www.hearthsidemedicine.com

Bend, Oregon

541-316-5693

For questions on vaccine ingredients, safety, side effects, covid infection complications, covid symptoms, variants, covid & pregnancy, vaccine effectiveness, prescription options, antibody therapy and more, please check out my infoblog: https://www.hearthsidemedicine.com/post/integrative-medicine-updates-on-covid-care