New England Naturopathic Health COVID-19 Update: Best practices for protecting yourself from viral infection Corrie Marinaro, ND

Objectives:

  • Understanding your individual risk and how to make the immune system work smarter, not harder
  • Review best lifestyle practices for your immune system including nutrition, rest and exercise recommendations
  • Review immune-supportive nutrients including Vitamin D, Zinc, Vitamin C and Vitamin A
  • Discuss probiotics as their own category of immune support
  • Review immune-supportive herbs including Echinachea, Elderberry, Astragalus, Berberines and combinations; which herbs are right for you as an individual?  And do we have to be worried about Cytokine storms with herbs? (spoiler alert: firm NO)

Disclaimer: use the following information with your own best judgment.  These strategies are intended for prevention first and foremost.  Should you develop flu symptoms, you may require testing and emergency treatment so please contact your physician for advice.
Understanding individual risk
Every immune system is unique.  The key to supporting yours is understanding how your individual immune system handles new threats.  What is the difference between a person that quickly clears a virus and a person who becomes very ill for a prolonged amount of time?  I would argue that the difference is the resting level of inflammation already present when that person is exposed to the virus. Our goal is to make each individual immune system work smarter, not harder, when it is presented with a new threat.
If you are the type of person that suffers from severe allergies, asthma, auto-immune disease, low white cell count or any chronic infection such as Lyme, Epstein Barr Virus or Mycotoxin Illness, your immune system has been compromised.  This not only means that you are more likely to become infected, but that your reaction to the infection will be more inflammatory and less effective. That doesn’t mean that you cannot protect yourself from infection with COVID-19, it just means that you need a more specific approach.
For this type of immune system, it becomes very important to keep resting levels of inflammation low, so that if you happen to come across COVID-19, your immune system is less likely to respond with an overblown inflammatory response.  The overblown inflammatory response is what’s being called the “cytokine storm” in the news and though it seems mysterious, its not. To minimize the potential for life-threatening inflammatory symptoms such as respiratory distress from COVID-19, we must take steps in lifestyle, nutrient support and pharmaceutical or natural interventions to keep an otherwise-irritated immune system calm.  If you use natural or pharmaceutical methods to control inflammation such as anti-histamine herbs or medications, low-dose steroids or anti-inflammatories, inhalers or the like, now is NOT the time to stop.  
Lifestyle-based immune support
Please note that the following strategies to keep inflammation levels calm apply to both healthy and immunocompromised individuals.
Nutrition: this is particularly challenging in the COVID-19 pandemic as we are being asked to shop minimally.  However, vegetables can be bought frozen or stored appropriately to maximize shelf life. Healthy starches such as whole grains and tubers can be maintained in the pantry or cold storage.  Proteins as legumes can be stored dry or in cans and meat protein can be frozen. So, it is entirely possible to eat a whole-foods based nutrition plan even if you are having groceries delivered or shopping minimally.
Foods that assist the immune system:

  • Brightly colored, anti-oxidant rich vegetables
  • High-fiber fruits such as apples and berries
  • Vitamin C rich foods such as citrus and bell peppers
  • Vitamin A rich foods such as carrots and sweet potatoes 
  • Foods that promote detoxification such as oats, chia and flax seeds, eggs, root veggies, leafy greens and garlic
  • Bone broth to support immune system function
  • Culinary, aromatic herbs such as thyme, oregano, sage, rosemary that are directly antiviral
  • Spicy foods to stimulate circulation and lymphatic drainage
  • Brazil nuts and pumpkin seeds which contain antiviral selenium and zinc

Foods that inhibit the immune system functioning:

  • Refined sugar
  • Refined flour
  • Alcohol
  • Soda
  • Fruit juice (including orange juice, just eat the orange!!!)
  • High fructose corn syrup
  • Artificial colorings, flavorings, sweeteners

Sleep: one benefit that most of us are getting from physical distancing is the extra sleep time that we would normally be spending commuting or getting ready for our work day.  Sleep deprivation promotes cortisol production. Cortisol production suppresses the immune system functioning as well as causes us to crave sugar and refined carbohydrates.  If you are able, get your 8+ hours and consider napping to be time well spent for your immune system.
Exercise: select exercise that will promote a happy mood, get your blood circulating and lymphatic system draining and stimulate heat and even a sweat, all of which are great for keeping viruses away.  DO NOT overdue the exercise. Over-exercising causes over-production of cortisol and puts us back in the immune-suppressed carbohydrate-craving boat. One way to tell if you are over-exercising is to check in with yourself 2 hours after your workout.  Are you exhausted? You did too much and are now depleted (don’t feel bad, many of us have been indoctrinated in the “no pain, no gain mentality” but now is not the time for that kind of thinking). Are you energized? You respected your body’s limitations and have enough charge in your batteries to still run your immune system.
Joy: an essential ingredient for immune function.  Okay, many aspects of this whole deal are existentially terrifying and I can understand happiness being elusive.  BUT, the depression that can come with social isolation is crippling to our immune systems and we must try to find strategies to overcome it.  Get outside if at all possible. Spend time with pets or consider fostering. Do something crafty or that engages your brain. Call your loved ones.  Check on your neighbors. Organize the closet you’ve been trying to get to for 15 years. Whatever it is, stay engaged. If you are experiencing symptoms of anxiety and depression that you are challenged in managing on your own, check in with your PCP and/or counselor, many are offering telehealth services.
Nutrient-based immune support:
Please note that all of the nutrients listed below are safe for adults in both healthy and immunocompromised states.  Doses for children and pregnant or lactating women are listed as well. All doses are assumed to be daily unless otherwise indicated.
Vitamin D: arguably the most important nutrient during a pandemic.  Vitamin D increases defensins and cathelicidins, both of which allow our immune system to respond EFFICIENTLY to a new viral threat.  Vitamin D also helps to keep levels of resting inflammation low and is particularly important for auto-immunity and allergies. Remember, we are trying to make the immune system work smarter, not harder and Vitamin D epitomizes this campaign.  If you don’t take Vitamin D and you live anywhere in the northern states, or if you avoid the sun due to history of skin cancer or easily-sunburned skin, NOW is the time to start. Please note that Vitamin D should always be taken with food for optimal absorption.  
Adults, pregnant and lactating women: 5,000 IU
Children: babies 400 IU, children over 24 months 1,000 IU
 
Zinc: an essential nutrient for White Blood Cells, the “soldiers” that find and kill infectious diseases.  Zinc can be used on it own and/or is included in many immune-support formulas such as Integrative Therapeutics EHB or Priority One Biovegetarian (see combination formulas in Herbs section).  Please note that many people experience nausea and even vomiting with Zinc if taken on an empty stomach, so we recommend taking it in the middle of a meal to avoid these side effects:
Adults and lactating women: 50 mg daily, or as included in your immune-support formula
Pregnant women: 25 mg
Children: 10-25 mg depending on size of child and tolerance
 
Vitamin C: a participant in hundreds of reactions in biochemistry, most of them pertaining to building healthy tissues and immune function.  When we are sick, our body naturally increases the amount of Vitamin C that we absorb from foods and nutrients. This is why the old-school Naturopathic trick of using Vitamin C to bowel tolerance, or taking 1,000 mg of Vitamin C every hour until one develops bloating or loose stools, works well for threatened illness.  The body will take up a boat load of Vitamin C when it is fighting infection and when it stops absorbing it, we know that the immune system is saturated and good-to-go. FYI, this intervention (like Echinachea) works best at the first signs of a cold. Please note that if you have an upper GI condition such as GERD, esophagitis or gastric ulcer, Vitamin C as ascorbic acid may be irritating to your stomach, but you may tolerate Vitamin C that is “buffered” with other minerals to not be acidic.
Adults: 2,000 mg daily for prevention, 1,000 mg every hour to bowel tolerance if cold or flu symptoms develop
Pregnant/lactating women: 1,000 mg twice daily, not advisable for pregnant women to take Vitamin C to bowel tolerance
Children over 2: 1,000 mg daily
 
Vitamin A: this vitamin is directly anti-viral as well as playing several important roles in a healthy immune response.  Please note that the form that is useful for the immune system is the retinol, not carotenoid, form. Please also note that Vitamin A (like Vitamin D) is fat-soluble and should be taken with food for optimal absorption.
Adults: 20,000 IU daily for prevention or as included in an immune support formula
Pregnant/Lactating women: 10,000 IU daily
Children: 5,000 IU daily or as included in an immune-support formula
 
Probiotics as their own category of Immune Support
Beneficial bacteria as found in a probiotic stimulate the immune system in a very unique way.  Probiotics up-regulate Secretory IgA, an antibody that protects all of our mucosal surfaces including the sinuses, throat, lungs and gut, from infection.  Given that COVID-19 is passed through saliva droplets that are inhaled, protecting these areas of the sounds like a great idea, doesn’t it?
If you choose to include probiotics in your daily routine or as prevention of infection, choose a good quality probiotic (from a Doctor’s office or health food store) that is purchased and stored refrigerated.  Remember it is not the quantity of colony-forming units (CFUs) that counts. There are several TRILLION bacteria in our body, so even the highest count probiotic is only a drop in the bucket. What is more important is that the probiotic offers diverse strains that will stimulate the immune system in diverse ways.
 
Probiotics are useful for most, but not for everyone.  If probiotics cause you to have gastric distress (bloating, cramping, diarrhea, etc…), you likely fall into the allergenic category and the immune system is “over-reacting” to new stimuli.  You are still safe to use nutrients as described above and herbs as described below. And when all of the madness is over, visit your friendly neighborhood ND to sort out your immune system and gut health.
Herbal Medicine as Immune Support:
When it comes to herbs, it is VERY important to understand what type of immune system you have, in order to select the type of support that will work best for you.  Not all herbs can be tolerated by all immune systems and if you have severe allergies or auto-immune disease, you must choose herbs carefully to avoid increasing inflammation in your system.  Herbs that directly stimulate the immune system such as Echinachea and Astragalus are contra-indicated in these patient populations and this is where the misguided “information” on herbs causing “cytokine storm” originates.  BUT, even if you do have severe allergies or auto-immunity, there are still herbs that will be useful to you, so read on.
Herbs are most commonly available as teas, capsules, grain-alcohol based tinctures and sweet-tasting glycerites.  Commercial-grade teas are generally not considered strong enough to have a substantial medicinal effect, but are a great idea if you are a tea drinker.  Capsules are convenient, do not have a taste and most adults will prefer these over a liquid form of herb. Grain-alcohol based tinctures are considered by herbalists to be the preferential form for any herb for potency and efficacy, but do have a taste issue for many.  Glycerites are sweet-tasting and are great for children or adults that don’t like to swallow capsules and either dislike the taste or do not want to take grain-alcohol based tinctures.
Dosing for herbs is relatively uniform across the species.  Adults should use 1 capsule/dropperfull twice daily as prevention.  Increase to 2 capsules/dropperfulls twice daily if leaving the house or working in a public place.  At the first signs of infection, take 3 capsules/dropperfulls four times daily and call your PCP to see if you should be tested for COVID-19.  Children two years and older should use ½ of these doses and pregnant/lactating women should consult their physicians for dosing.
Echinachea: This herb is most useful in prevention and at the initial signs and symptoms of a cold.  Echinachea is the ONLY herb considered to be safe in pregnancy and is one of two considered to be safe in lactation (along with Astragalus).  Unfortunately, Echinachea and Elderberry seem to have a gotten a lot of the bad press in COVID-19 coverage for their supposed ability to cause “cytokine storm”, which is a severe inflammatory state that is associated with respiratory distress, high fever and worse outcomes.  Though Echinacea does not directly cause the dreaded “cytokine storm”, in an already over-stimulated immune system, Echinacea can amplify inflammation and make the reaction to an infection worse. SO, the moral is, don’t be afraid of Echinachea unless you have good reason to be (ie, severe allergies and/or an auto-immune disease that is currently active). 
Elderberry: Elderberry syrup is a beautiful thing.  It tastes great so you can get into kids and picky adults, is full of anti-oxidants and anti-viral properties and is easy to make yourself.  I think of Elderberry like Echinachea, very useful for prevention and consider switching strategies should you develop cold/flu symptoms.
Astragalus: one of NENH’s favorite herbs for Lyme disease prevention and treatment, Astragalus is also ideal for the COVD-19 pandemic as it both upregulates the immune system and also acts as an adaptogen (an herb that helps with stress and anxiety).  Think of Astragalus if you need both emotional and immune support (this may apply to all of us). Interestingly, Astagalus is also a galactagogue, meaning that it promotes milk production in lactating women, so safe for use in this population. 
Berberines:  Berberines are bitter-tasting antibiotic-like molecules that are found in the herbs Hydrastis, Goldenseal, Barberry, Oregon Grape Root.  Berberines are directly anti-viral and can kill infections without stimulating the immune system, making them safe for those with over-reactive immune systems.  So, if you have severe allergies or asthma, or an active auto-immune disease, these are the herbs for you. Berberines are not okay in pregnancy or lactation, but are safe for all others. 
Combination Formulas and NENH favorites:
Integrative Therapeutics EHB (echinachea, hydrastis, berberine): our best-selling immune support formula, this product has a ton of herbs as well as immune-supportive doses of Vitamins C, A, zinc and selenium. 
Priority One Biovegetarian: this oddly-named formula is a powerhouse of anti-viral herbs and nutrients.  This one is not for the faint of heart as it contains a hearty dose of cayenne pepper, which acts as a “driver” to stimulate the circulation of the herbs through the body.  It is also a HUGE tablet, so unless you have experience with it already, stick with EHB.
 
Wise Woman Herbals Immune Glycerite: a most-excellent formula for picky adults and children, this product is both anti-viral and supports respiratory health, so a great pick for COVID-19 prevention.

Parting words:
Don’t just hope for the best through this pandemic, be proactive about protecting your individual immune system.  If you have learned something from this presentation, pass it on. The more knowledge we have as a community, the less fear and the more resilience.
I am happy to answer individual questions as I am able through the Facebook page, but have tried to include as much specific information in this document as possible.  To order any of the nutrients, herbs or combination products outlined in this presentation, please contact NENH at 873-9380 or [email protected] Products may be shipped directly from the office, picked up curbside or prescribed through fullscript, our online dispensary.