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Updated Supplement Recommendations for the Coronavirus Pandemic

By the team at Blum Center for Health:
Susan S. Blum, MD, MPH; Pamela Yee, MD; Elizabeth Greig MSN, FNP 

As the days turn into weeks, we are learning more and more about how this virus behaves, and what we might do to support our immune system to better protect ourselves.  From a Functional/Integrative medicine perspective, thus far we have been focusing on nutrients and herbs that have been well studied, in general, for their ability to support, modify or boost the immune system.  I have been talking and writing extensively on helping people to choose the right supplements.

Today, there is new information that I want to share with you.  Based on what we have learned about the behavior of this novel coronavirus, and in consultation with my team at Blum Center for Health, I am updating our recommendations. 

Here is your update on supplements (updated as of 4.3.20):

NEW INFO:  ACE receptors:  We have learned that this virus uses the ACE receptor on cells to gain entry.  This led to alarm bells in the Integrative Medicine community because we have read that one of the many actions of Vitamins D could be to increase the number of ACE receptors on the cells.  HOWEVER, now, after reading the most recent studies on this topic, it appears that what’s more important is the level of Angiotensin Converting Enzyme 2 (ACE 2) in the blood, and NOT the amount of receptors.  And since Vitamin D might help reduce the levels of ACE 2 (a good thing), it appears that the concern about ACE receptors is a thing of the past and we can safely take our usual doses of Vitamin D.

Cytokine storm:  When the virus gets going in your body, it can sometimes create something called a cytokine storm, which is when your immune system reacts vigorously and releases an enormous amount of chemicals (cytokines) and free radicals to destroy the virus. There is concern that in some people, among other things, the cytokine storm contributes to the lung damage that we hear about.  We have been reading about the possibility that some immune boosting vitamins might make the cytokine storm worse.  Many of you have been contacting us, asking for guidance on this.

  1. First, we must state that there are no studies that prove that any of the below supplements contribute to a cytokine storm.
  2. The Arizona University Department of Integrative medicine has made the recommendation, based on their understanding of how these supplements function, to stop the below vitamins and supplements if you develop symptoms of infection or a positive test because they could theoretically contribute to this cytokine storm.  
    • AU Integrative medicine recommends you stop taking these vitamins if you get sick. We share this with you because without knowing for sure, it is best to be cautious and follow these guidelines:  
      1. Elderberry
      2. Echinacea
      3. Larch Arabinogalactan
    • Everything else is considered safe to take, including:  
      • Zinc 
      • Vitamin C 
      • Astragalus
      • Andrographis
      • NAC
  • Mushroom extracts
    • We are having a debate about mushroom extracts because in general we recommend them for their support of the immune system and there really is no evidence that they would be harmful if you got the coronavirus.
    • Therefore, we still recommend you take the mushroom supplements that your provider has given you.  Best to choose only those that have the name of the mushrooms themselves on the ingredient list.


      NEW INFORMATION ADDED 4.3.20:
        

      • Supplements that decrease NLRP3 Inflammasone, can possibly help during cytokine storm:
        1. Curcumin:  500 – 1500 mg daily for prevention, double dose if you get sick.
        2. Melatonin:  1-3 mg daily for prevention, double dose if you get sick.
        3. Vitamin C continues to be great here:  2000 – 3000 mg for prevention, at least 6000 mg if you get sick.  Take as much as you can tolerate without digestive issues. 
      • Food that reduces the Inflammasone:
        1. Quercitin in apples and onions
        2. Oranges, parsley, celery, nuts and berries
        3. EGCG in green tea

PUTTING THIS TOGETHER

  • Supplements:  
    • Stick with Zinc (30 mg), Vitamin C (3 grams), and a probiotic, which you can continue even if you get sick.  There are reports from China about using high dose Vitamin C for treatment, and it seems reasonable to continue to recommend going up to 6 grams daily or more if you get sick (and can tolerate it; it can cause loose stools).
    • Stay on your usual dose of Vitamin A and D, but don’t add extra high doses.  
    • The jury is out on echinacea, elderberry and Larch arabinogalactans.  As of today (updated 3.23.20), probably best to avoid if you get sick until we have more clarity on these.  Stay tuned.
    • One more note:  if you develop a fever, consider not taking any fever suppressing medication because fever helps kill the virus.  However, it is dangerous to let your fever go over 103, and so if you need it, consider taking Tylenol (Acetominophen) instead of ibuprofen (Advil).  It appears that ibuprofen may make things worse. This is another area that is rapidly evolving, and if you can’t find Tylenol in the stores, you should speak to your doctor about other options.
  • Here are the things you should STILL DO for risk reduction:
    • Good gut health: which means lots of beneficial bacteria. Take a probiotic every day with at least 20 billion cfu of mixed strains lactobacillus and bifidus species. 
    • Balanced stress hormones: Get a good night’s sleep and don’t overwork yourself during flu season. Stress harms your ability to fight viruses.  Practice some form of mediation daily. Melissa, Blum Center’s Health Coachwrote a great blog with tips for managing stress during this time. 
    • Eat foods that are good for your immune system: Avoid processed foods and focus on fruits and veggies that are rich in antioxidants and vitamins. Support the removal of toxins by eating lots of cruciferous veggies, which boost the detox system in your liver.

Sending prayers and good wishes for you and all of us to stay safe and well during this challenging time.  I will be having a weekly LIVE webinar every Friday at 11 am EST to answer questions. Sign up here.

 

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