Here are some best practices for protecting yourself from COVID-19 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 Echinacea, Elderberry, Astragalus, Berberines, and combinations. Which herbs are right for you as an individual? Do we have to be worried about Cytokine storms with herbs? Spoiler alert, it’s a 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 of COVID-19

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 who quickly clears a virus and one who becomes ill for a prolonged amount of time?

I would argue that the difference is the resting level of inflammation already present when exposed to the virus. Our goal is to make each immune system work smarter, not harder when 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, 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 important to keep resting levels of inflammation low.

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. Though it seems mysterious, it’s 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, pharmaceuticals, 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, medications, low-dose steroids, 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. 

Protein, like legumes, can be stored dry or in cans. Meat can be frozen. It is entirely possible to eat a whole-foods-based nutrition plan even if you have 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, 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 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:

• 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 we would normally spend commuting or getting ready for our workday. Sleep deprivation promotes cortisol production. Cortisol production suppresses the immune system functioning and causes us to crave sugar and refined carbohydrates if you can 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, your blood circulating, lymphatic system draining, stimulate heat, and even a sweat, all of which are great for keeping viruses away.

DO NOT overdo 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 two 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. You have enough charge in your batteries to still run your immune system.

Joy

Joy is an essential ingredient for immune function. Okay, many aspects of this whole deal are existentially terrifying. I can understand happiness being elusive. 

BUT, the depression that can come with social isolation is crippling to our immune systems. 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 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 or counselor. Many are offering telehealth services due to COVID-19.

Nutrient-based Immune Support

Please note that all of the nutrients listed below are safe for adults in healthy and immunocompromised states. Doses for children, pregnant, or lactating patients 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 autoimmunity and allergies.

Remember, we are trying to make the immune system work smarter, not harder. Vitamin D epitomizes this campaign. If you don’t take Vitamin D and live anywhere in the northern states, or if you avoid the sun due to a 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, including those who are pregnant or lactating: 5,000 IU
Children: Over age 2 – 1,000 IU.
Babies: 400 IU.  

Zinc

An essential nutrient for White Blood Cells, these “soldiers” find and kill infectious diseases. Zinc can be used on its own or is included in many immune-support formulas such as Integrative Therapeutics EHB or Priority One Biovegetarian. See combination formulas in the Herbs section. 

Please note that many people experience nausea and vomiting with Zinc if taken on an empty stomach. We recommend taking it in the middle of a meal to avoid these side effects.

Adults, including those who lactate: 50 mg daily, or as included in your immune-support formula
Pregnant Patients: 25 mg
Children: 10-25 mg depending on the size of child and tolerance
 

Vitamin C

A participant in hundreds of reactions in biochemistry, most of them about building healthy tissues and immune function. When we are sick, our body naturally increases Vitamin C that we absorb from foods and nutrients. This is why the old-school Naturopathic trick of using Vitamin C for bowel tolerance, or taking 1,000 mg of Vitamin C every hour until one develops bloating or loose stools, works well for threatening illness. 

The body will take up a boatload of Vitamin C when it is fighting infection. When it stops absorbing it, we know that the immune system is saturated and good-to-go. FYI, this intervention, like Echinacea, 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. You may tolerate Vitamin C “buffered” with other minerals not to 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 Patients: 1,000 mg twice daily, not advisable for pregnant patients 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 retinol, not carotenoid. 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 Patients: 10,000 IU daily
Children: 5,000 IU daily or as included in an immune-support formula
 
Probiotics as Immune Support

Beneficial bacteria, as found in a probiotic, uniquely stimulate the immune system. 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 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 prevent infection, choose a good quality probiotic from a doctor’s office or health food store-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.

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 “overreacting” to new stimuli. You are still safe to use nutrients as described above and herbs as described below. 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 important to understand what type of immune system you have to select the type of support that will work best. All immune systems can tolerate not all herbs. 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 Echinacea and Astragalus, are contra-indicated in these patient populations. This is where the misguided “information” on herbs causing “cytokine storm” originates. 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 taste, and most adults will prefer these over a herb’s liquid form.

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. They are great for those who 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/dropper-full twice daily as prevention. Increase to 2 capsules/dropper full twice daily if leaving the house or working in a public place. At the first signs of infection, take 3 capsules/dropper fulls four times daily.

Call your PCP to see if you should be tested for COVID-19. Children two years and older should use ½ of these doses. Pregnant and lactating patients should consult their physicians for dosing.

Echinacea

This herb is most useful in the prevention and at the initial signs and symptoms of a cold. Echinacea is the ONLY herb considered to be safe in pregnancy. It is one of two considered to be safe in lactation along with Astragalus. 

Unfortunately, Echinacea and Elderberry seem to have a gotten a lot of the bad press in COVID-19 coverage for their supposed ability to cause a “cytokine storm,” a severe inflammatory state associated with respiratory distress, high fever, and worse outcomes.

Though Echinacea does not directly cause the dreaded “cytokine storm,” it can amplify inflammation and make the reaction to an infection worse in an already over-stimulated immune system. The moral is, don’t be afraid of Echinacea unless you have good reason to be (i.e., severe allergies or an auto-immune disease that is currently active). 

Elderberry

Elderberry syrup is a beautiful thing. It tastes great so that you can get it into kids and picky adults. It is full of anti-oxidants and anti-viral properties.

It is easy to make yourself. I think Elderberry, like Echinacea, is very useful for prevention. Consider switching strategies should you develop cold or flu symptoms.

Astragalus

One of NIH’s favorite herbs for Lyme disease prevention and treatment, Astragalus, is ideal for the COVID-19 pandemic. It both upregulates the immune system and 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, Astragalus is also a galactagogue. It promotes milk production in lactating patients. Therefore, it is safe for use in this population. 

Berberines

Berberines are bitter-tasting antibiotic-like molecules found in Hydrastis, Goldenseal, Barberry, and Oregon Grape Root. Berberines are directly antiviral and can kill infections without stimulating the immune system, making them safe for those with over-reactive immune systems. These are the herbs for you if you have severe allergies, asthma, or active autoimmune disease. Berberines are not okay for those in pregnancy or lactation but are safe for all other adults. 

Combination Formulas & NENH Favorites

Integrative Therapeutics EHB (Echinacea, 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 antiviral herbs and nutrients. This one is not for the faint of heart. It contains a hearty dose of cayenne pepper, which acts as a “driver” to stimulate the herbs’ circulation through the body. It is also a HUGE tablet. Unless you have experience with it already, stick with EHB.
 

Wise Woman Herbals Immune Glycerite

The most excellent formula for picky adults and children, this product is both antiviral and supports respiratory health. It’s a great pick for COVID-19 prevention.

Parting Words on COVID-19

Don’t just hope for the best through the COVID-19 pandemic. Be proactive about protecting your 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. I am able through the Facebook page. However, I tried to include as much specific information on COVID-19 in this document as possible.

To order any of the nutrients, herbs, or combination products outlined in this presentation, please contact NENH at 207-873-9380 or [email protected]. Products may be shipped directly from the office, picked up curbside, or prescribed through Fullscript, our online dispensary.