8 evidence-based supplements Dr. Andrew Brandeis recommends to his patients to reduce, treat or manage symptoms associated with Coronavirus
As we face this global health crisis, I am convinced there are a number of reasonable, responsible measures (along with social distancing, hand washing, etc) to help manage and treat viral symptoms and ease the burden on our health care professionals. As a practicing ND for over 10 years, I believe appropriate supplementation should be included among these measures. The following article lays out my reasoning along with credible research for recommending Vitamins A, C, D, NAC, Quercetin, Selenium, Zinc and Citicoline (dosages below). The aim is to share with my friends and family, my patients, and my community a summary of the best, most credible, evidence-based recommendations for treating a variety of viral respiratory infections, and, perhaps, applying them to the management of COVID-19.
There’s a difference between public health and personal health. By design, a public health initiative is only as effective as its adoption rate. The challenge, therefore, in making any public health recommendations is to optimize for simplicity, thus prompting mass adoption. And, while state and federal recommendations (social distancing, hand washing, etc.) have been effective in controlling the spread of COVID-19, their effectiveness is focused on prevention and disease control, and not necessarily on bolstering an individual’s immune response to reduce symptomatic response to the virus.
So, while we know the basic ways to slow the spread of COVID-19, there is, perhaps, more that individuals can do at home to reduce their chances of developing serious symptoms. This is where lifestyle plays a role. I know from my own medical practice that patients with good hygiene, sleep, nutrition, exercise, and outlook demonstrated stronger immune systems and faster recovery times.
There is evidence that the addition of certain herbs and supplements may benefit overall health, support the immune system, and demonstrate antiviral activity. Further, some studies indicate that targeted supplementation may help treat or, in some cases, even prevent disease states. I asked myself:
How can we extrapolate from the available body of research to make reasonable recommendations in this time of pandemic and uncertainty?
What other remedies can people employ at home to reduce the transition from mild to severe symptoms? My research leads me to some hopeful results, including one lesser-known supplement that may reduce the most drastic symptoms of COVID-19.
As a licensed Naturopathic Doctor (ND) with over 10 years experience practicing medicine alongside medical doctors and as CEO of a supplement company, I have observed the powerful effects of pharmaceuticals and nutraceuticals when used properly.
With this in mind, I have compiled a list of the supplements I myself am now taking as well as recommending to friends and family; in addition, I have included the reasoning behind my choices and links to credible research. With the possible exception of Vitamin C, I’m not aware of any published research that suggests these are effective in the prevention or treatment of COVID-19 specifically; however, my reasoning below suggests that they may well be. Given the urgency of the situation, lack of available tests and treatments, and, finally, the pressures being placed on our overworked medical professionals and ER staff, I’m suggesting that these safe treatments be considered for use by individuals who want to be proactive in their approach to managing COVID-19 at home.
The CISA has deemed manufacturers of dietary supplements as an essential industry. This is an acknowledgement that there is an official recognized value in using them appropriately at this critical time. Hence, I recommend the following immune support supplements 2 times per day for my friends and family during. Of course, if you are considering taking this protocol yourself, especially if pregnant or nursing, please consult your healthcare provider first.
Vitamin C is perhaps the most popular of the antioxidants. For over half a century the medical community has recommended Vitamin C (ascorbic acid) with some very interesting results. Chief among them is its effectiveness as an antioxidant (simply put, antioxidants are molecules that fight free radical compounds that cause oxidative damage to a variety of functions throughout the body). By reducing oxidative stress (free radical damage) in cells, Vitamin C can protect against a number of chronic illnesses. In fact, it has even been used effectively in high doses in conjunction with some cancer therapeutics.
Most compelling to me, however, is Vitamin C’s ability to reduce or prevent symptoms of virus-induced respiratory infections, especially in the elderly with respiratory infections.
Additionally, there’s evidence that Vitamin C absorption in the intestines is upregulated or increased in times of need or in disease states. This is most clearly demonstrated by the slightly off-putting observation that when Vitamin C is taken orally in high doses, under normal conditions, it may cause diarrhea. In other words, you can generally tolerate more when you’re sick than you could when you’re not. This suggests, at least to me, that our requirements for Vitamin C may increase in order to provide support against certain illnesses.
Given Vitamin C’s safety, wide application in general health and well-being, and with its known ability to prevent oxidative damage and decrease virus-induced respiratory infections, I’m taking the above recommendations twice per day. Additionally, others are recommending very high doses administered intravenously as a hospital treatment for COVID-19 because it can shorten ICU stays.
NAC (N-Acetyl Cysteine) is a semi-essential form of the amino acid cysteine and has been shown to reduce mucus production and inflammation in the lungs of people infected with influenza.
One way COVID-19 causes lethal Acute Respiratory Distress Syndrome (ARDS) is through oxidative stress. Oxidative stress is exactly what antioxidants work to prevent and NAC is the precursor to Glutathione (GSH), the granddaddy of antioxidants. (Interestingly, GSH is expensive and not well absorbed in the gut, while NAC is inexpensive and well absorbed.)
Given NAC’s ability to reduce oxidative stress and mucus in the lungs and its proven track record of reducing symptoms associated with influenza, it’s reasonable to assume its usefulness in further managing the symptoms related to COVID-19.
Over the past few decades studies of Vitamin D have consistently shown two things: first, Vitamin D can be a powerful addition to certain treatment regimens combating a variety of disease states; and second, people don’t get enough of this essential nutrient.
The following sighted research makes a compelling argument, I feel, that Vitamin D provides support in maintaining immune system homeostasis as well as reducing the ability of certain viruses to cause cytokine mediated inflammation. And considering this, I have been recommending a moderate dose of Vitamin D to both patients, friends, and family who may be unaware of their current Vitamin D levels.
Similarly, the research regarding the possible benefits of Vitamin A supplementation is persuasive, if not entirely convincing. It has been shown to increase sIgA, the immune cells lining the respiratory tract of deficient people. It has also been shown to regulate many components of the immune system including inflammation and mucous production and increase immune response in a variety of viral infections. Important to note, Vitamin A should not be taken in high doses for extended periods of time.
Zinc, which is a micronutrient found in cells throughout the body, can inhibit viral replication thus decreasing the duration of symptoms associated with the common cold. Additionally, some zinc compounds have been shown to inhibit replication and RNA polymerase activity in coronaviruses. Moreover, zinc and Selenium can modulate the immune system’s response to infection and increase resistance to viral infection. And, as with Vitamin C supplementation, the possible benefits of zinc are especially true for elderly patients as it decreases incidence of infection in the elderly.
Used primarily to treat seasonal allergies (hay fever, for example), Quercetin is most effective in managing viral infections and reducing inflammation. Considering this, I took a closer look at this well-known supplement with a mind to its possible benefits in managing or treating COVID-19. I found the research encouraging. It is understood that quercetin can inhibit replication of the virus associated with the common cold as well as protect the lungs from free radical damage during influenza infection but, additionally, this article points to its possible benefits as an antiviral. This animal study shows that it reduces inflammatory cytokines in the lungs. The research is still ongoing and further testing is, of course needed; however, I find the above cited information promising. In fact, as this article suggests, others are also intrigued by the potential of quercetin as it relates to the treatment and management of COVID-19.
(I should add: Dihydroquercetin (DHQ) is a promising form of quercetin. This study used computer simulations to screen almost 700 million compounds against COVID-19 and dihydroquercetin came in at number 11 out of 687,000,000 (1–10 are not available treatments). One possible reason for this result is that quercetin acts as a protease inhibitor in COVID-19. However, I’d like to see more research on DHQ before recommending it in place of quercetin.)
Citicoline is perhaps the most exciting supplement for the prevention or management of COVID-19 symptoms. A naturally occurring compound, Citicoline has been used as a “brain boosting” supplement for years. Additionally, Citicoline has been shown in vitro, animal and human studies to inhibit PLA2. Phospholipase A2 (PLA2) is an enzyme that causes inflammation in cells, and we know that the coronavirus hijacks the PLA2 of invaded cells, leading to further inflammation and infection. We also know that inhibiting PLA2 impairs coronavirus replication.
Furthermore, Citicoline increases the secretion of surfactant in lungs, a substance that facilitates respiration. This is particularly relevant to managing COVID-19 symptoms, as the primary risks associated with COVID-19 are respiratory issues and respiratory failure. As of today, I am not yet aware of anyone who has yet used Citicoline in a COVID-19 positive or symptomatic patient. I suspect this will change soon and, hopefully, the results will confirm Citicoline’s effectiveness.
Thankfully, for most who test positive for COVID-19 the symptoms are unpleasant yet manageable. For others however, a positive diagnosis can be life-threatening (What’s your COVID-19 risk?). For these people, one thing is clear: time is of the essence. As of today there is no definitive, evidence-based, and widely available treatment for the virus. While the above supplement recommendations have not yet been rigorously tested (i.e., double-blind placebo controlled trials) for their effectiveness in treating or managing COVID-19, the research I have seen leads me to believe they may yield benefits in managing both the onset and progression of symptoms. Further, these are safe substances in proper doses. They have a proven track record in the management of other viral illnesses, and finally, they are generally inexpensive and available now. I am therefore suggesting these represent a reasonable treatment approach most people can and should accommodate.