Pearls of Integrative Medicine and COVID-19
Updated: Mar 25, 2020
I know this is a scary for time for all of us. Like you, I'm awake at night wondering what the future holds for myself and my family.
"Did I buy enough essential supplies?" "Do I have COVID-19 right now and I just don't have symptoms yet?" "Did that friend I had coffee with 14 days ago have it and infect me?" "How am I going to weather this financial storm?" "What can I do to keep myself healthy right now??"
I wanted to share some pearls of integrative medicine to help our bodies stay strong during this unprecedented time. Most importantly, I want to acknowledge the CDC's warning that there are NO known alternative/herbal treatments to prevent or "cure" this virus. I agree. We do not have enough evidenced-based studies on this illness and what protect against it or what might make it worse.
However, there are some tried and true modalities that throughout time have supported the body's immune system. I am going to list them here, but I want to advise and emphasize that this is NOT individualized--meaning, what might be safe for one person might be very unsafe for another. For example, some herbs interfere with blood clotting. Some may be dangerous to the liver of one person but not to another based on that person's unique medical history or meds they are taking.
Therefore, I advise all of you to contact me personally if you'd like to discuss in further detail which herbs/supplements are best for you and which should be avoided. If I'm not your PCP/family medical provider, please contact whoever is.
Also, I would like to thank and acknowledge Aviva Romm, MD, for the following thoughts which I will augment with my own. I will cite her resource below.
Most importantly, SOCIAL DISTANCE--this means each person has a 6 foot bubble of air safety inside and 10 ft outside (due to gusts of wind). Do not invade this space. This is the BEST way to keep yourself and others safe right now, since COVID-19 can be contagious even before someone is showing symptoms and after they are showing symptoms!
Wash your hands and hair frequently! Also, use hand sanitizer. Clean surfaces with bleach, Lysol or Cholorx, which are proven to kill the virus. Heat also may kill the virus.
Eat your ORGANIC (if possible) produce (raw is best!) Plants have powerful phytochemicals, nature's apothecary.
Drink LOTS of healthy fluids (now is NOT the time to be guzzling immune-suppressing alcohol or caffiene or sugary drinks). Lemon water with local honey is a great nutritional drink as are smoothies with spinach, yogurt, and blueberries.
Mediate, pray, laugh, journal, hug (only household members), exercise--these are all PROVEN methods of decreasing stress hormones cortisol and adrenaline (hormones that decrease white blood cells--immunity).
GET SLEEP--one of the most important ways to keep your immune system strong.
Zinc plays an important role in immunity, helping the body to fight invading bacteria and viruses, and may help the lining of the respiratory passages prevent against viral replication and inflammation. This has been demonstrated in clinical studies.
Best form: zinc acetate
Do: take daily during for prevention--it does not work as effectively if taken only for short duration while ill
Don’t: use nasal sprays which can alter sense of smell, or zinc tablets or pills, as they aren’t as well absorbed.
How much: A dose of 5 to 10 mg/day is typically enough, but you can take up to 45 mg/day for up to a few weeks (lower doses for pregnant women and breastfeeding women)
Pro Tip: zinc can cause nausea and vomiting, so preferably take your zinc supplement with a meal, though many combination lozenges that contain other herbs and honey, for example, are less nauseating.
Special considerations: Zinc supplements can interfere with the absorption of certain medications including quinolone or tetracycline antibiotics. It may also interfere with diuretics (like some medications for blood pressure) and medication used to treat Rheumatoid Arthritis – so check with your provider if you’re taking either before supplementing with zinc.
Vitamin D is a fat soluble vitamin that has an important effect not only on bone health, but on immune function and ability to fight infections. Low vitamin D can impact mental health such as exacerbate depression and anxiety.
Dose: The best form of vitamin D for maximal absorption is Vitamin D3, and supplementing between 1000- 2000 IU/day is a safe and ample dose for most people, and is safe during pregnancy and breastfeeding. Too much vitamin D can result in renal injury and even kidney failure. I always try to check a baseline blood level on my patients so they don't get toxic and so we have an idea of the best dose for them.
Per the Office of Dietary Supplements, up to 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating women is considered quite safe. Children’s doses are typically 400 to 800 iu daily.
Pro tip: For best absorption, try taking Vit D3 with a meal that also contains healthy fats, like salmon or avocado, though it can be taken any time. Food sources of Vitamin D include fatty fish such as salmon, tuna, and mackerel, and cheese, while egg yolks provide small amounts.
Breastfed infants not supplemented with formula should get 400 IU drops daily
Vit D is best absorbed when taken with Magnesium and Calcium Citrate--do not take calcium within 2-4 hours of your iron pill or thyroid medication as it can decrease their absorption.
Get sunshine for natural Vitamin D. 15-20 min a day minimum to the trunk or face is enough.
Vitamin C Most of you know this one, but to solidify it, a 2013 Cochrane Database Meta-analysis, based on 29 trial comparisons involving 11,306 participants, had to say:
Vitamin C appears to lead to a 50% reduction in the likelihood of catching a cold in athletes who “perform regular or acute bouts of intense exercise” compared to athletes who don’t take Vitamin C.
Cold duration may be reduced by about 8% in adults who take vitamin C regularly, and colds may also be less severe.
Dose: A typical adult dose is up to 2000 mg daily. This dose is also safe for pregnant and breastfeeding people. Oranges and grapefruits are important sources of Vitamin C, as are red and green peppers, kiwifruit, broccoli, strawberries, cantaloupe, and baked potatoes, so eat a wide variety daily.
L-Lysine: An essential amino acid that is safe and part of our normal diet. It decreases viral activity in some studies and can also help with anixety. I usually advise 1500 mg daily for prevention, and I increase this in patients when they have active viral illness. It is not only safe in pregnancy but encouraged.
What about Probiotics?
Evidence is scant as to whether or not probiotics aid in prevention or treatment of viral illnesses. However, the typical probiotic product containing an array of Lactobacillus and Bifidobacterium species is considered safe for most people. But if you have Crohn disease or ulcerative colitis or are immunodeficient, speak with your health care provider before supplementing.
I prefer to get my probiotics from food sources, which are more likely to contain living bacteria than a supplement--foods rich in probiotics are your fermented foods like yogurt, miso, keifer, etc)
Echinacea Echinacea is safe for most people and may have a mild benefit in prevention of upper respiratory infection prevention if taken daily (though scientific data on its effectiveness is lacking).
Well-designed studies of echinacea have not generally found it to be efficacious for the prevention of community-acquired viral respiratory illness. However, a 2014 systematic review found that the results of individual trials using echinacea for cold prophylaxis consistently had positive trends towards benefit despite lack of statistical significance. Post-hoc pooled data from 9 of 10 echinacea prevention trials (1167 patients) showed a 10 percent absolute risk reduction in cold incidence, which was statistically significant although of questionable clinical significance.
Shown to be generally safe use during pregnancy and breastfeeding.
Dose: 300 to 500 mg of dried herb in capsule or tablet, three times daily, or 2.5 to 5 mL of tincture (liquid extract) up to 3 times daily.
Use caution if: you have autoimmune condition such as lupus, those with autoimmune disease and/or are on immunosuppressive medications. Caution if allergic to ragweed family.
Astragalus: Traditionally astragalus is not used when you have a fever. However, it functions similar to echinacea.
"There’s an enormous amount of information and misinformation circulating on the internet about elderberry, COVID-19, and a phenomenon called ‘cytokine storm" says Dr. Romm. She goes on to say that "most of the evidence for elderberry is for the treatment of flu when taken during the first 72 hours of symptoms." When taken for influenza and other non-COVID-19 respiratory infections, it does seem to reduce duration of symptoms, though clinical data is lacking regarding prevention of illness. Due to potential concerns of safety, I do not recomend it for daily long-term use.
We have no evidence as to elderberry's effectiveness nor safety during a COVID-19 infection--and since coronavirus symptoms can mimic both flu and the common cold, it is prudent to assume you could have COVID-19. It is unlikey to decrease or treat symptoms of Covid-19 illness, according to Dr. Romm, so if you’re concerned about cytokine release syndrome or cytokine storm as a result of this herb, don’t use it. If you have lab confirmed influenza, RSV, or other non-COVID-19 respiratory illnesses, then elderberry is considered safe for most people for short term use.
Elderberry is known for its antiviral properties. It can be applied to the skin as well as taken orally to treat respiratory illnesses like the common cold and flu. It may reduce congestion and is commonly used in combination with vitamin C.
The following is some good info sourced from UptoDate as well as Mensah Medical.
Elderberry can trigger side effects and interact with other herbs, supplements, or medications. For these reasons, you should take elderberry only under the supervision of your health care provider. Some sources only recommended to use elderberry for about 5 days because studies of long term use have not been done and it’s unknown if taking elderberry supplements are safe when used for long periods of time. Other sources think it is likely safe up to 12 weeks, though I would rather be safe and stick to the shortest time possible. If you consume the leaves, stems, unripened fruit, or raw fruit of the Elderberry plant it will likely cause nausea, vomiting, or diarrhea and is considered unsafe.
Pregnant and breastfeeding women should not take elderberry. A Stanford medical study (see reference) showed possibilty that a pregnant woman’s immune system will actually overreact to the flu, rather than react sluggishly. This means that elderberry might not be the best first choice if you are pregnant, because it may overstimulate your immune system.
Patients with autoimmune diseases like rheumatoid arthritis, celiac, hashimoto’s, and lupus need to consult a physician before taking elderberry because it will stimulate their immune system. Elderberry interferes with medications that suppress the immune system and medications used to treat autoimmune diseases.
Patients on diuretics for hypertension, congestive heart failure, and renal issues need to consult their physician before taking elderberry. In general, diuretics help the body get rid of excess fluid and increase the amount of urine a person produces. Elderberry can also act as a diuretic, so patients on a diuretic while taking elderberry run the risk of dehydration.
Patients with diabetes must consult their physician before taking elderberry because it may lower blood sugar levels. Patients on prescription medication for diabetes who take elderberry may develop hypoglycemia, which is also known as low blood sugar.
Elderberry can interact with certain chemotherapy drugs. If you are undergoing chemotherapy, ask your oncologist before taking elderberry.
Elderberry may counteract the effectiveness of certain drugs for asthma and other respiratory conditions. This means that the prescribed medication will have less potency when taken with elderberry.
So the moral of the story: USE with caution during the uncertain times and in general and under the advise of your medical provider who knows your full medical history
What about Garlic? It is more specific to bacterial infections than viral infections. Nonetheless, many of us include garlic as well as ginger, also an antimicrobial herb, in our diets, to prevent secondary bacterial infections often following viral illness (after the immune system takes a viral hit, it is more prone to bacterial infections). Garlic and ginger are NOT safe in moderate or large amounts for those with blood clotting disorders. Garlic may cause upset tummies in some.
Oil of Oregano: There is limited data on anti-viral properties, but some studies do show effectiveness compared to a placebo. Like elderberry, it is unclear in actual COVID-19 how this may impact your body's immune response. Use caution with immune-activating herbs such as this and echinacea and potentially elderberry if you have an autoimmune disorder.
Oregano oil is generally safe to use, but it can have some side effects.
Avoid using it if you’re allergic to mint, sage, basil, or lavender. If you’re allergic to any of these, you’re likely allergic to oregano as well.
Don’t use oregano oil if you’re pregnant or breastfeeding.
Talk to your pediatrician before using it on a child.
Don’t take oregano oil if you have a bleeding disorder or are on any medications that alter clotting of your blood.
Warning: it tastes TERRIBLE and can make your tongue burn temporarily. Sold now?
Adaptogens, including ashwagandha and holy basil and medicinal mushrooms, particularly reishi (Ganoderma ludicum), according to Dr. Rom, "are widely used by herbalists to optimize immune health and resilience. Studies looking at reishi have found that it is able to regulate the immune system, calming an overstimulated immune response, while enhancing reduced immune function. Adaptogens and reishi mushroom have also been shown to improve a sense of well-being and reduce anxiety, which most of us can use in these times. While not recommended during pregnancy, and those who are on immunosuppressive medications should speak with their doctor before using, these herbs are generally otherwise safe for most people, including those who are breastfeeding. Doses vary per adaptogen or medicinal mushroom and products used."
Caution: Ashwagandah can impact thyroid function so discuss its safety and dose with your provider first.
Gargle. Some studies suggest that this practice has some benefit for preventing upper respiratory tract infections, especially if using warm salt water. How often and for how long should you gargle? Aim for 2 to 3 times daily for 15 to 30 seconds each time.
Humidify! Studies also show that there is decreased risk of respiratory infections when oral mucosa (tissue in mouth/throat) is moist, which helps keep it as an effective barrier. I suggest running a humidifier on high next to your bed each night--but disinfect it frequently so it doesn't spew spores of mold or grow nasty bacterial!
Make antibodies against other illnesses: Now more than ever is the time to not get a preventable illness that could land you or your child in the urgent care or ER, as it is possible that we may run into a situation where beds and staff and medical supplies are not available for everyone. Further, if you get sick right now, you will be more likely to get COVID-19 because your immune system is weak, fighting another infection already.
Therefore, I encourage those who can get immunized against other diseases do so, especially and influding the flu and pneumonia vaccine; we are still seeing a lot of flu, sometimes progressing to severe flu-related pneumonia.
While the flu vaccine has proven some years to have little effectiveness, it seems to be quite effective this year against flu B--and studies confirm that even if you do get influenza despite having the vaccine, you will likely have a much milder version and will be about 60% less likely to develop flu-related hospitalizations from illnesses such as pneumonia.
I also encourage all adults over the age of 65 and all adults between the ages of 19-65 with underlying medical conditions or who smoke to get their pneumonia vaccine (in addition to your childhood pneumonia vaccine).
Researchers analyzed flu test results from 3,630 children, aged 6 months to 17 years old, who were hospitalized with acute respiratory illness over two flu seasons in which influenza A(H3N2) viruses were the predominantly circulating virus.
They found the vaccine effectiveness against influenza-associated hospitalizations was 50% over the two seasons (49% for the first season and 51% the second), meaning that vaccination reduced the risk of hospitalization with flu by about half.
“Our findings support the use of vaccination to prevent severe flu illness in children during every flu season, regardless of which viruses are predominant.”
Flu vaccine is recommended during pregnancy and for children 6 months and older and adults.
STOP Smoking, chewing and vaping--it puts you at VERY high risk for coronavirus and severe pneumonia.
NOTE: THERE IS NO KNOWN TREATMENT OR CURE FOR COVID-19.
Supplements and herbs aren’t closely monitored by the FDA, and there may be issues regarding such attributes as purity, contamination, quality, and strength. Research the brand and be an informed consumer. It’s always wise to talk to your healthcare provider before using any herb, essential oil, or supplement. I always advise getting a third- party tested brand and getting organic.
Always feel free to set up a telehealth visit with me during these times of coronavirus if you want to discuss which of these ideas might be safest for you.
Havilah Brodhead, FNP
Owner of Hearthside Medicine Family Care
"Integrative Care for the Whole Family"
Thank you again to Dr. Aviva Romm, MD, from whom I shared this information along with my own pearls. You can reference her site here: https://avivaromm.com/