Intergrative Medicine and COVID 19
March 23, 2020
The prevention aspect of Integrative Medicine lends itself well at times like this to help the human frame prepare to battle the Coronavirus when and if it shows up in your body. I recently received an email from my friends at the University of Arizona Center for Integrative Medicine regarding this exact topic. My good friend Dr. Victoria Mazes has given me permission to share this excellent document with you all.
Here are some of the highlights as copied:
"While the pathogenicity of COVID-19 is complex, it is important to understand the role of inflammation in this disease. The virulence and pathogenicity (including acute respiratory distress syndrome) associated with SARS corona viruses develops as the result of viral activation of cytoplasmic NLRP3 inflammasome.
This inflammasome within activated (upregulated NFkB) macrophages and Th1 immune cells releases proinflammatory cytokines, namely IL-1B and IL-18, which dictate the pathogenic inflammation responsible for the virulence and symptoms of COVID-19. Understanding this component of COVID-19 infection provides a mechanistic underpinning to several of the following."
The document goes through a few of the things as discussed last week including sleeping adequately, a high quality anti inflammatory diet, stress reduction and zinc. It further goes on to look at melatonin as an immune modulator.
Here is a segment directly copied from the PDF handout: (References are available at the PDF link)
• Adequate sleep: Shorter sleep duration increases the risk of infectious illness. One study found that less than 5 hours of sleep (monitored over 7 consecutive days) increased the risk of developing rhinovirus associated cold by 350% (odds ratio [OR] = 4.50, 95% confidence interval [CI], 1.08-18.69) when compared to individuals who slept at least 7 hours per night. Important to COVID-19, sleep deprivation increases CXCL9 levels. CXCL9 is a monokine, induced by interferon, and which increases lymphocytic infiltration, and which is implicated in NLRP3 inflammasome activation. Adequate sleep also ensures the secretion of melatonin, a molecule which may play a role in reducing coronavirus virulence (see Melatonin below).
• Stress management: Psychological stress disrupts immune regulation and is specifically associated with increased pro-inflammatory cytokines such as IL-65. Acute stress in mice increases IL-1B via NLRP3 inflammasome activation. Various mindfulness techniques such as meditation, breathing exercises, guided imagery, etc. reduce stress, reduce activated NFkB, may reduce CRP and do not appear to increase inflammatory cytokines.
• Zinc: Coronavirus appear to be susceptible to the viral inhibitory actions of zinc. Zinc may prevent coronavirus entry into cells and appears to reduce coronavirus virulence.Typical daily dosing of zinc is 15mg - 30mg daily with lozenges potentially providing direct protective effects in the upper respiratory tract.
• Vegetables and Fruits +/- isolated Flavonoids: Many flavonoids have been found, in vitro, to reduce NLRP3 inflammasome signaling, and consequently NFkB, TNF-a, IL-6, IL-1B and IL-18 expression. Some of the specific flavonoids which have been shown to have this effect, and which can be found in the diet and/or dietary supplements include: 1) baicalin and wogonoside from Scutellaria baicalensis (Chinese skullcap)2) liquiritigenin from Glycyrrhiza glabra (licorice)
3) dihydroquercetin and quercetin found in onions and apples
4) myricetin found in tomatoes, organs, nuts, and berries
5) apigenin (found in Matricaria recutita (Chamomile), parsley and celery.
At least 5 - 7 servings of vegetables and 2-3 servings of fruit daily provide a repository of flavonoids and are considered a cornerstone of an anti-inflammatory diet.
• Vitamin C: Like flavonoids, ascorbic acid inhibits NLRP3 inflammasome activation. Clinical trials have found that vitamin C shortens the frequency, duration and severity of the common cold and the incidence of pneumonia. Typical daily dosing of vitamin C ranges from 500mg to 3000mg daily with even higher doses utilized during times of acute infection.
• Melatonin: Melatonin has been shown to inhibit NFkB activation and NLRP3 inflammasome activation.20 In fact, the age-related decline in melatonin production is one proposed mechanism to explain why children do not appear to have severe symptoms and older adults do. Melatonin also reduces oxidative lung injury and inflammatory cell recruitment during viral infections. (AZIM PDF - see PDF for references)
One of the key pieces of the puzzle is to avoid over activation of your innate immune system. People love to use echinacea and elderberry for immune enhancement during cold and flu season, however, in the COVID-19 case, this is may be a net negative and actually promote cytokine overload and a worsening of disease. If you are actively ill with what looks like coronavirus, my colleagues recommend avoiding elderberry, echinacea, vitamin D, medicinal mushrooms and larch arabinogalactans.
"The information and understanding of COVID-19 continues to change rapidly. We encourage you to make integrative recommendations carefully and with consideration of the underlying mechanisms of both the COVID-19 infection and the intended intervention. It is also important to reiterate that there are no clinically evidence-based integrative prevention or treatment strategies for COVID-19 infection."
Here is the downloadable document from Az IM department: Link. It is an excellent document.