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Our hearts go out to all of our readers impacted by COVID-19, whether through health or economic challenges, derailment of life plans, or loss of loved ones. The following excerpt from a recent article in our Journal presents ways that we can enhance our natural immunity with healthy dietary and lifestyle practices. It is our hope that this information will be of use in helping you deal with the unprecedented situation in which we find ourselves as a global community. We wish the best of health to you and your families. — Editors, Price-Pottenger Journal of Health and Healing
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Boosting immunity with diet and lifestyle
As yet, no specific diets, supplements, or lifestyle practices have been validated in clinical studies as helping to protect against COVID-19 or mitigate its severity. However, there are many natural strategies known to enhance general immunity and/or boost antiviral protection. A well-balanced, anti-inflammatory diet and healthy lifestyle habits are good places to start, and nutritional supplementation and herbal medicines can provide additional support.
Significantly, obesity is a major risk factor for hospitalization with COVID-19, and people with diabetes or heart conditions face greatly elevated risk of serious complications or death from the virus. Obesity, diabetes, and heart disease are widespread in the United States, and one thing all of them have in common is that dietary and lifestyle factors can play a major role in their development, as well as aid recovery. Among diabetic patients, the risk of severe illness from COVID-19 is less if blood sugar is well-managed.
Many articles in this Journal have elaborated on the dietary principles that support both balanced blood sugar and enhanced immunity. Diets high in sugar and refined carbohydrates promote metabolic diseases, including diabetes and obesity. In addition, such diets depress immune function. To boost immunity, limit sugars and refined carbohydrates; eschew nutrient-deficient, overly processed foods; and avoid pesticides and other endocrine disruptors. Also avoid genetically modified foods, which have been shown in animal studies to cause immune dysregulation, including upregulation of inflammatory cytokines. When possible, choose organic produce and pastured animal products.
Selecting a wide variety of nutrient-rich foods is also important. Eat a “rainbow” of brightly colored vegetables and fruits to obtain a broad range of flavonoids and other phytonutrients. Flavonoids have antioxidant and anti-inflammatory properties, and many have been found, in vitro, to reduce signaling of the NLRP3 inflammasome, a multiprotein complex in the innate immune system that results in the activation of highly inflammatory cytokines in COVID-19. Examples of flavonoids shown to have this effect include quercetin, found in foods such as onions, grapes, broccoli, and apples; myrectin, in tomatoes, oranges, nuts, and berries; curcumin, in turmeric root; and epigallocatechin gallate (EGCG), in green tea.
Animal protein can also play an important role in immune health. Compelling evidence shows that amino acids and other compounds found only in animal tissue—such as taurine, creatine, and carnosine—play a role in inhibiting inflammation, improving metabolic profiles, and enhancing immunity. Preformed vitamin A (retinol), critical to immune function, is also found only in foods from animal sources, including meat (especially liver), fish, dairy products, and eggs. Oily fish such as salmon are excellent sources of the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), which have immunoregulatory roles. To get the greatest benefits from animal products, choose pastured, organic meat and dairy and wild-caught, low-mercury fish.
Our stress levels greatly affect our immune system. Prolonged psychological stress can hinder the body’s ability to regulate the inflammatory response and promote the development and progression of disease. The overproduction of the stress hormone cortisol elevates blood sugar and inhibits communication between the white blood cells that protect us from infection. Chronic stress is also associated with increased production of proinflammatory cytokines, such as interleukin-6, which tends to be elevated in complicated cases of COVID-19 and is associated with adverse clinical outcomes.
During times of high stress, it is especially important to practice techniques that can help you relax and maintain physical, psychological, and emotional equilibrium. Activities such as meditation, breathing exercises, yoga, journaling, and creating art can help you maintain healthy immune function. Walking or simply spending time in nature can be highly beneficial. Because social isolation may increase inflammation and decrease immunity, staying socially connected online or by phone can provide physical as well as emotional benefit. Cultivating positive thoughts and emotions can also boost your immune system and general health.
Many of us are currently experiencing fear or anxiety about our health, finances, and/or the world situation. Stress and anxiety can lead to various issues, such as difficulty sleeping, creation or worsening of mental health conditions, or increased use of alcohol or drugs. If you are having stress-related difficulties, reach out to someone – a friend, a counselor, a doctor, or even a crisis center. Many health professionals who usually see clients in person are now taking telemedicine appointments.
Healthy sleep habits are critical to immune function. Although individual needs vary, many people require seven to eight hours of sleep per night for optimal functioning. While a couple of nights of poor sleep are unlikely to do much harm, chronic sleep deprivation can weaken the body’s ability to fight off pathogens. With regard to COVID-19, sleep deprivation also increases levels of a proinflammatory cytokine known as CXCL9, thus increasing risk of oxidative tissue damage. Tips to improve sleep quality include rising at the same time each day, keeping the bedroom dark, and turning off electronic screens that emit blue light – including phones, computers, and televisions – two hours before bedtime.
It may be difficult to maintain your customary exercise program at present, but finding a way to keep physically active is important for everyone, particularly older adults. Not only can moderate exercise help to counter the psychological effects of isolation and stress, but it reduces inflammation and directly mobilizes immune cells, including those that are capable of finding and killing virus-infected cells. It also increases the flow of blood and lymph as muscles contract.
Depending on your level of fitness, try to get at least 30 minutes of low- to moderate-intensity aerobic exercise five days per week. Walking and bicycling are good and can be done while physical distancing. Many fitness organizations and companies are currently offering free online workout classes and other resources for use at home. Staying physically active can also help keep your lungs healthy, although the World Health Organization warns that you not exercise if you have a fever, cough, and difficulty breathing.
Although we have as yet little to no clinical data regarding the actions of specific nutrients in relation to COVID-19 in humans, various nutrients are known to boost protection against other viral infections and/or decrease their severity or duration. Here are a few that may be useful against SARS-CoV-2 as well.
A mineral known for its immune-enhancing benefits, zinc reduces viral replication in other coronaviruses and may provide the same benefit in COVID-19. Specifically, it may block the virus from multiplying in the mucous membranes of the throat and nasopharynx (the upper part of the throat, behind the nose), as well as inhibit viral entry into cells.
Zinc lozenges have been shown to reduce the duration of colds when taken within 24 hours of symptom onset at dosages greater than or equal to 75 mg per day. This dosage is higher than the Food and Nutrition Board’s tolerable upper intake level (UL) for adults, which is 40 mg per day. (The UL is also meant to include zinc intake from food sources, such as oysters, beef, chicken, lentils, oatmeal, and shiitake mushrooms.) Recommended daily dosages of zinc for antiviral protection usually range from 15 mg to 30 mg. Daily dosages of 150 mg for one to two weeks during times of active infection are considered generally safe for persons with adequate copper status.
Zinc supplements can have some side effects, which may include nausea, especially if taken on an empty stomach. They can also interfere with the absorption of some pharmaceuticals, such as the antibiotic tetracycline. Moreover, taking large amounts of zinc—generally over 150 mg per day – on an ongoing basis can lead to toxicity and result in copper deficiency, anemia, and nervous system damage. Intranasal zinc is not recommended, as it has been linked with temporary or permanent loss of the sense of smell in some people.
This vitamin plays an important role in immune function, and it has both anti-inflammatory and antioxidant actions. Supplementation can lower your odds of developing an acute respiratory infection, especially if your levels are sub-optimal. In addition, recent research on COVID-19 patients worldwide found a strong correlation between vitamin D deficiency and increased risk of cytokine storm, as well as a correlation between deficiency and mortality from the disease.
It’s best to have your vitamin D levels checked with a hydroxyvitamin D (25[OH] D) blood test to determine the level of supplementation needed. While the Office of Dietary Supplements (ODS) considers 20 ng/ml (equivalent to 50 nmol/L) to be sufficient for most people, many healthcare providers suggest higher levels. The Grassroots Health Nutrient Research Institute, a nonprofit public health research organization, recommends a blood level of 40-60 ng/ml (100-150 nmol/L).
Even if you can’t get your vitamin D levels checked right now, supplementation is generally advisable, as many people are deficient. A daily intake of up to 4000 IU from all sources is considered safe for most adults by the ODS. Vitamin D toxicity may occur with extremely high-dose, long-term use, but has not been linked to intakes below 10,000 IU per day.
The preferred form of vitamin D supplement is D3, which is found in animal-based foods. Vitamin D is fat soluble, so supplements should be taken with a source of healthy fats. Foods that provide vitamin D3 include salmon, other fatty fish, beef liver, and egg yolks. Cod liver oil is an excellent source (in addition to containing vitamin A and the omega-3 fatty acids DHA and EPA).
Clinical trials are currently underway to evaluate the effectiveness of intravenous vitamin C in treating hospitalized patients with severe COVID-19. This therapy shows promise due to the antiviral and antioxidant properties of vitamin C and its potential to inhibit the production of cytokine storms characteristic of ARDS. Intravenous therapy has previously been seen to reduce complications in sepsis cases, and its recent use in patients with moderate to severe COVID-19 in Shanghai reportedly resulted in improvement in all cases and a reduction in length of hospital stay, compared to that of other patients.
Oral vitamin C supplementation cannot raise blood ascorbate levels as much as intravenous therapy, and its benefit in protecting against SARS-CoV-2 or mitigating its symptoms is unknown. However, we do know that vitamin C deficiency is associated with impaired immunity, and that the body’s need for this vitamin increases during infection. Oral supplementation has been used to shorten the duration and severity of the common cold and reduce the risk of pneumonia.
Typical dosages of oral vitamin C supplements range from 500 to 3000 mg per day, in divided doses, although higher amounts are often recommended during times of active infection. Liposomal products, in which the vitamin is encapsulated by a phospholipid bilayer membrane to protect it from damage during the digestion process, may provide greater bioavailability than unencapsulated ones. Side effects of high-dose vitamin C may include nausea and mild diarrhea, and can usually be eliminated by reducing dosage. In addition, supplementation at dosages over 1000 mg per day may raise urinary oxalate levels, potentially increasing risk of kidney stones in men who are predisposed to them.
Fruits and vegetables are rich in vitamin C, and some of the best sources include oranges, grapefruit, red and green peppers, kiwis, broccoli, strawberries, dark leafy greens, Brussels sprouts, and cantaloupe. Interestingly, liver, fish roe, and eggs are also good sources of vitamin C, and smaller amounts can be found in other meat and fish. This vitamin is water soluble and can be destroyed by heat, so raw foods contain the highest amounts. Cooking foods for shorter times and at relatively low temperatures can help to maximize vitamin C retention.
There are a great many herbal medicines that can boost immunity, combat viruses, reduce inflammation, or relieve the symptoms of respiratory infections. Often, the most effective herbs for an individual can best be determined through clinical assessment by a trained practitioner. Those listed below are among the herbs commonly used to protect against viral infections.
Astragalus root modulates immune response and has antioxidant and anti-inflammatory effects. In traditional Chinese medicine (TCM), it has a variety of uses, including tonifying the lungs, alleviating shortness of breath, and protecting against colds and flu (although it should be discontinued in acute infections accompanied by fever). It is also one of the most frequently used herbs for the prevention of COVID-19 in China. This root has traditionally been cooked into soup or made into tea. It is often combined with other herbs in TCM formulas, but can also be taken alone in tea, powder, or tincture form. The use of astragalus in combination with echinacea and licorice can have a synergistic effect to enhance immune function.12 Because of its potential immunostimulatory effects, it may be contraindicated for those with autoimmune diseases such as multiple sclerosis, lupus, and rheumatoid arthritis, who should discuss its use with their healthcare practitioner.
Echinacea is used widely to help ward off colds and flu. It promotes immune system function and has been shown to lower the risk of recurrent respiratory infections, reduce the occurrence of colds, and inhibit viral replication. An echinacea concentrate was found to be as effective as the anti-influenza drug oseltamivir (Tamiflu) in early treatment of the virus. Although echinacea can stimulate certain proinflammatory cytokines, it exhibits a net anti-inflammatory effect on cytokine production. (See the discussion on cytokine storms in the elderberry paragraph, below.) Echinacea is used in succus (expressed juice), tincture, tea, or powder form. As with astragalus, those with chronic autoimmune conditions may wish to avoid this herb or consult their healthcare practitioner before its use.
Licorice root is a powerful antiviral that is effective across a broad range of viruses, including those of the SARS group. It inhibits viral uptake, prevents viral replication, inactivates virus particles, and inhibits cytokine cascades. It specifically blocks viral attachment to ACE2 receptors. In addition, licorice is an immunostimulant and immunomodulant and acts as a synergist with other herbs, boosting their potency. The strong antiviral properties of licorice are due to a constituent called glycyrrhizin, which gives the herb its sweet taste. Deglycyrrhized licorice (DGL), which is frequently used for gastrointestinal ailments, is not effective for antiviral use. Long-term use of licorice (not DGL), especially when taken alone and in large doses, can cause serious side effects, including edema, hypertension, and potassium depletion. The root also has strong estrogenic activity. Licorice is thus best used in combination with other herbs and usually not for longer than four to six weeks. During pregnancy or with health conditions such as hypertension, hypokalemia, hyponatremia, and low testosterone, use should generally be restricted to ten days or less at low dosages. It is available in tincture, capsule, or powder form, and is frequently prepared as a tea. A clinical herbalist can help you determine a suitable formula to combat severe infections.
Elderberry is a popular herb used to prevent and treat influenza and other upper respiratory infections. It has antioxidant, anti-inflammatory, immune-protective, and antiviral qualities. It is known to reduce both symptoms and duration of colds and flu, and may be most effective in this regard when taken as soon as symptoms appear. The seeds contain compounds that can cause nausea and vomiting if the berries are eaten raw, but these compounds are deactivated by heat or fermentation. Thus, it is generally recommended that the berries be cooked (e.g., into syrup, a classic herbal remedy). It can also be taken in lozenge form, where it is often combined with ingredients such as vitamin C and zinc. Recently, concerns have been raised about whether elderberry could potentially induce or exacerbate cytokine storms due to its action on certain proinflammatory cytokines, and some health practitioners suggest discontinuing its use in active COVID-19 infection. Others believe this concern is unfounded for various reasons, including the fact that elderberry extracts have been shown to enhance both inflammatory and immunoregulatory cytokines, with a net noninflammatory gain. There is no evidence that elderberry causes cytokine storms in humans.
Garlic has well-documented immune-boosting and antiviral properties and can reduce the frequency and severity of colds and flu. It contains numerous antimicrobial compounds, but allicin, which is formed when fresh garlic is chopped or crushed, has been the most widely researched. Allicin can modulate the immune response to viral infections, inhibit viral multiplication, and block the release of proinflammatory cytokines. To maximize the allicin content in garlic, either eat it raw or let it stand for 10 minutes after crushing or chopping before you cook it. Aged garlic extract, which does not contain allicin, exhibits strong antioxidant properties. It can enhance immune cell functioning and reduce severity of colds and flu, and may help resolve virally induced inflammation. Aged garlic extract is available in capsules and liquid form.
With the passage of time, we will undoubtedly gain more knowledge about how to protect ourselves against and treat COVID-19. New therapies may arise, and new insights may light the way toward putting this pandemic behind us. In the meantime, we can adopt those dietary practices and lifestyle habits that best support our natural immunity while avoiding behaviors that pose unnecessary risk. It is also vital to our health to maintain emotional balance and social connection despite the challenges of the current situation. Fortunately, we have a wealth of information available from the fields of nutrition and natural medicine that can guide us in making wise choices.
Excerpted from Price Pottenger Journal of Health and Healing, Volume 44 Number 1, Spring 2020.
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About the Author
Roberta Louis is managing editor of the Price-Pottenger Journal of Health and Healing and was formerly editor of Well Being Journal and managing editor of Shaman’s Drum: A Journal of Experiential Shamanism and Spiritual Healing. She is the founder of the nonprofit Shaman’s Drum Foundation, located in the Pacific Northwest. Roberta is also a freelance writer and editor specializing in complementary and alternative healing methods, with a particular interest in plant medicines. She may be contacted at: [email protected]
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Excerpted from the Price-Pottenger Journal of Health and Healing
Spring 2020 | Volume 44, Number 1
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