Support the Immune System – so that it can protect you…

COVID-19: The Symptoms

Because COVID-19 is firmly on everyone’s radar, it can be so easy to forget that the common cold and the seasonal flu haven’t just disappeared – you can still get these.  So how can you tell the difference?

On 15th February 2020, The Lancet published “Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China” which documented the most common symptoms as fever (40 out of 41 patients), cough (31 out of 41 people) and fatigue (18 out of 41).  The CDC add shortness of breath to the list (1).  The Health Minister, Nadine Dorries, contracted the virus without being abroad or in contact with anyone else who had (more on that later), described her symptoms as “a persistent cough, achy muscles and intermittent night sweats.” (2)  Whilst GP Dr Clare Gerada documented “a temperature, dry cough and sore throat” (3) and anaesthetist Chris Gough confirmed these symptoms on his twitter feed (4).

The consensus seems to be that this is a ‘dry’ illness – so if you have a runny nose or a productive cough then it is more likely that you have a cold or the annual flu.  So, in a nutshell:

Some Context:

• The 2 previous coronavirus outbreaks in the last 2 decades resulted in a 10% mortality rate for SARS-Cov in  (2) and 37% for MERS-CoV (3), which bizarrely makes me feel grateful that it isn’t MERS that’s breaking out.  However, it should be noted that the published 3.4% mortality rate (4) from COVID-19 is probably exaggerated too….  Aside from celebrities, there are proportionately few members of the general public being tested – they’re just being told to self-isolate – despite WHO advising everyone to “test, test, test.” (5)  So how is it possible to clearly document exactly how many people are ‘infected’?  Add into this equation the fact that the only people who will be tested are those with the stated symptoms and the numbers are skewed even further – however not everyone will display symptoms (6).  Even the UK govt acknowledge that this means that the number of infected people are probably waaaaaaay higher than the figures being released (7).  Although this may be a startling fact, it also means that the mortality rate will be lower than the figures released:  As of 19.03.20 The Independent noted 144 deaths out of 3,269 confirmed cases (7) (this would provide a mortality rate of 0.04%) but,, taking into account the factors stated earlier, the actual number of people infected could be double (0.02%) or even triple these figures (0.01%) – either way those mortality figures are falling.  This in no way detracts from the grief and loss of the people who have died, but is and effort to reassure those who are currently in a panic about the current situation.
• As of today’s date there have been 10,456 deaths from COVID-19 worldwide (8).  This is tragic for those affected by this, but perspective is required – around 4 billion people per year die from air pollution (9) while 290,000-650,000 deaths are attributable to the seasonal flu (10)….
• Having said that, it is universally accepted that “at Risk” people should take precautions.  According to the figures coming out of Italy “the median age of the deceased is 80, the majority of victims are male, and they had an average of 2.7 pre-existing health conditions” (11) (12).  Because Italy has an ageing population (similar to the UK) (13) this has exacerbated the mortality rate in that country, leading to the scary figures being documented in the news.  If you fall into any of these categories then it would be sensible to take precautions and self-isolate.

The message here isn’t that we should ignore government advice and carry on as normal – it is that sensible precautions need to be taken but there is no need to panic (14) and there’s definitely no reason to resort to violence (15).  Now is the time to remember #bekind of less than a month ago (16) and look out for those vulnerable, at risk people mentioned above, rather than causing them even more distress and fear than they’re currently having to deal with (17).  Paradoxically it’s the panic buyers that are causing the problems in the stores.

For the rest of us, here’s an explanation of exactly what Boris Johnson meant when he was asking us to practice “social distancing”:

What does our immune system need?

• Vitamin A is extremely important for the immune system: it supports the thymus in the production of white blood cells as well as regulating the activation of specific immune cells; it is an active antioxidant and it plays a role in the formation of all our mucous membranes, which are the first line of defence for our entire body from the gastrointestinal tract to the eyes, ears and lungs.  Vitamin A also has mild anti-viral properties (18).
• Vitamin B6 helps in the production of antibodies needed to fight infections (19).  A B6 deficiency may also reduce your body’s production of white blood cells, including T cells. These cells regulate immune function, helping it respond appropriately.  Additionally, B6 helps your body make a protein called interleukin-2, which helps direct the actions of white blood cells (20).
• Vitamin C promotes resistance to infection, whether bacterial or viral, by helping white blood cells function better (21)
• Vitamin E can increase immunity, particularly in the elderly (22)
• Zinc is well recognised for its role in supporting immune function  (23, 24) and zinc levels are very important for a healthy thymus, often called the master gland of the immune system.  Zinc increases resistance to infection and is commonly taken in conjunction with vitamin C when dealing with coughs, colds and flu (25).
• Selenium is essential for an efficient immune system, displaying anti-bacterial and anti-viral properties (26).  Studies have demonstrated that increased blood levels of selenium are associated with enhanced immune response.  On the other hand, deficiency has been shown to negatively impact immune cells and may lead to a slower immune response (27).  Selenium may help strengthen the immune system in patients with influenza, tuberculosis and hepatitis C (28).

Where can you find these?

• Eggs – Vitamin A, Vitamin B6, Vitamin E
• Chicken – Vitamin B6, Zinc
• Garlic – Iodine, Prebiotic (feeds gut bacteria)
• Dark leafy greens (cabbage, cauliflower, kale) – Vitamin B6, Vitamin C
• Citrus fruits (lemons, limes, oranges) – Vitamin C
• Sweet potatao – Vitamin A & Vitamin C
• Peppers – Vitamin A & Vitamin C
• Onions – Selenium & Prebiotic (feeds gut bacteria)
• Avocado – Vitamin A & Vitamin B6
• Liver – Vitamin A & Selenium
• Tuna – Vitamin E & Selenium
• Almonds – Vitamin E
• Seafood – Zinc
• Nuts:
  • Peanuts – Vitamin E
  • Brazil Nuts – Selenium
  • Cashew Nuts – Selenium
  • Walnuts – EFAs
• Mushrooms – Selenium and Immune system
• Fish (halibut, cod, salmon, prawns, mackerel) – Selenium
• Sesame seeds – Selenium

Can I Do Anything Else?

• Probiotics – Kefir, sauerkraut, live yoghurt and miso.  Probiotics may help give your immune system a boost and inhibit the growth of harmful gut bacteria (29).  Also, some probiotics have been shown to promote the production of natural antibodies in the body. They may also boost immune cells like the IgA-producing cells, T lymphocytes and natural killer cells (30,31).  A large review found that taking probiotics reduced the likelihood and duration of respiratory infections (32).  Another study including over 570 children found that taking Lactobacillus GG reduced the frequency and severity of respiratory infections by 17% (33).
• Vitamin D.  Individuals with lower Vitamin D levels are more likely to contract upper respiratory tract infections than individuals with higher levels. This association is stronger in individuals with asthma or chronic obstructive airway disease (34).  It also enhances the innate immune response against various infections (35,36), especially tuberculosis, influenza and viral upper respiratory tract infections (37).  A study involving school children taking high dose vitamin D supplementation (1200 iu/day) showed a significantly reduced risk of influenza (38).  4000iu/day would be recommended for adults (39).

Cytokine Storms, Elderberry, Ibuprofen, and Tylenol, Oh My!

What follows is an advisory from Dr David M Brady which I thought you might find useful/interesting.  He is American so please excuse the alternative spelling, and note that Tylenol/acetaminophen in the USA is Paracetamol in the UK:

“OK, I can’t take it anymore! Sometimes I would love to just pull the plug on the internet, honestly. Amazing how things are taken out of context, go viral, and then doctors like me get hundreds of emails and texts in a panic about things like “cytokine storms”!

Cytokine Storm Issue: OK, this whole thing started from an isolated report about potential cytokine storm, a very rare occurrence and poorly understood phenomenon, with two patients in China, one who survived and one who didn’t. This morphed into a cockeyed theory being propagated across the internet that anything that is immune simulating, such as the herb Elderberry, could be dangerous because it could cause a cytokine storm. Firstly, this is totally BS and there is zero data that I am aware of showing this. Elderberry’s main anti-viral actions do not even involve cytokine responses at all, and rather involve its neuraminidase inhibition, similar to the drug Tamiflu. It also has an amphoteric effect (not in the strict acid-base definition, but in that it can correct from both sides of a metabolic process) on cytokines, meaning it upregulates then when necessary, and downregulates them when necessary.

The Elderberry and cytokine storm issue was commented on, most eloquently, by my brilliant friend and colleague, Dr. Peter D’Adamo, as follows:

“Should I worry about my supplements triggering a cytokine storm? No. We need to stop worrying about an herb or vitamin triggering a ‘cytokine storm, (CS) a massive immunologic overreaction that is seen at the end stage of certain viral infections. Most of the time CS is not triggered by the virus but rather another end-stage consequence, septic shock, and with it, multiple organ failure. Septic shock is triggered by molecules known as TLRs (toll-like receptors) that are usually activated in response to bacterial toxins known as lipopolysaccharides (LPS). Activation of TLR leads to the production of ‘inflamasomes’ (principally one known as NLRP3), which then trigger the release of cytokines. NLRP3 is inhibited by nitric oxide (NO) a small signaling molecule produced by virtually every cell in the body. Matter of fact, you might have benefited from elderberry, since it has been shown to enhance NO blockage of inflammasome activity and actually suppress TLR4. Dark pigmented fruits have been known to block LPS activation of inflammasomes for decades. So let’s get things straight. This is man-bites-dog stuff. If you’re headed for this type of consequence, a cytokine storm preceded by septic shock, I can assure you they we need not worry about the elderberry you’ve taken. In fact PubMed shows zero studies when ‘elderberry’ and ‘cytokine storm’ are entered as search terms. Zero. It’s the equivalent of waiting for a commuter train, seeing a brown bag lunch on the track and worrying that it might potentially derail your ride. I’ll put it in even simpler terms, virtually all rational natural therapies for Covid19 are not potent enough to do this level of harm. If they did, that would be bad, but then again we’d have some really great new drugs for a slew of other human ailments, like cancer.”

See this link which intelligently addresses the Elderberry issue and cytokine storm. Again, there is zero evidence that Elderberry induces such an event, and in-fact, it has an adaptogenic or amphoteric balancing effect on cytokines per need, and other anti-viral mechanisms.

“Don’t Take Ibuprofen and NSAID Medication” Issue:

This is on the internet and has some truth behind it, although the issue is based on limited anecdotal reports, mainly from the UK. Some have equated this to the Elderberry rumor, but in-fact is quite opposite. Those who have been given Ibuprofen, or similar NSAID compounds, have been seemingly recovering less well. This is not terribly surprising, as these drugs’ main mechanism of action is the suppression on the innate immune response, or in other words “inflammation”. That is what they do! Do you want a key element of your immune response dampened when you are trying to recover from a serious viral infection, even if it may alleviate some of your symptomatic discomfort? No. So instead they advise to use Tylenol, but is this wise?

“Use Tylenol (Acetaminophen) Instead” Issue:

This is an entire subject that makes my blood boil (No pun intended). Western medicine has fallen into a very lazy reactive situation when it comes to fever, and this flies in the face of the understanding of physiology, common sense, and certainly naturopathic medicine principles. The minute a person spikes a fever we should not be advising them to immediately reach for a bottle of Tylenol (acetaminophen)! Yes, it is an analgesic (pain reliever) and anti-pyretic (fever reducer), and may make you feel a bit less symptomatic. However, your body is spiking a fever for a reason! Your immune system is working hard to produce that elevated body temperature with a plan in mind, which is to make it too hot for the pathogen infecting you to want to stay around, or for it to survive in you. Why would you want to immediately sabotage your own immune response like that? We all understand that an uncontrolled and excessive fever can be deadly, but that does not mean we should immediately attempt to suppress any level of fever. We need to “control” a fever, not eliminate it. The magic number here is 103 degrees, as anything above that can become life-threatening. Keeping a fever in control by the use of hydrotherapy using a tepid bath with sponging or immersion in water lower than the temperature of the body (85–90 degrees Fahrenheit, or 29.4–32.2 degrees Celsius). This works just fine in most situations. Resort to fever lowering medications and seek medical attention only when there is difficulty in keeping the beneficial fever in a safe range.

Take Aways:

If you want to believe the unsupported rumor mill on the internet than immediately stop taking anything that may enhance your immune response and body’s ability to fight infection, including viruses. Good luck with that. Is Elderberry, or other herbs such as Andrographis, dangerous in viral infections? Not that we know of, and we have plenty of scientific evidence and hundreds, if not thousands, of years of traditional use to back up their value in such circumstances. If you are still not comfortable with the use of botanicals/herbals, then I would at least advocate that you consider taking some key vitamins and nutrients that support healthy immune function, such as quercetin and vitamins C, D, and A, and zinc. I would not use Ibuprofen or other NSAIDS if you think you may be suffering from COVID-19 infection. I would also not immediately use fever-suppressing therapies, such as Tylenol (acetaminophen), but instead manage the fever with tepid baths and only resort to medical suppression of a fever if it becomes necessary. Finally, I would really advocate that everyone relax and take a few deep breaths!”