By Sagar Kamprath, MD, Assistant Professor, Family Medicine, UTMB
Stress runs deep in today’s pandemic-driven society adds fuel to the cycle of increasing inflammation and worsening immune function. Managing inflammation and optimizing the immune system is the underlying message in most illnesses with the current pandemic being no exception. However, through nutrition, supplementation, and breathing we may augment our immune system and give our bodies the tools it needs to stay sharp and fight off infection. Outlined below are some evidence-based measures which may be helpful for the current COVID-19 pandemic.
Vitamin D is an important regulator of human immune function and may stimulate the innate immune response to provide protection against infectious agents, specifically increasing the expression of the human cathelicidin antimicrobial peptide hCAP-18 which is important in defense against respiratory tract pathogens.1 Today people are spending less time outside in the sunlight which hampers the production of the active form of vitamin D. Recently it was noted higher vitamin D levels correlated with decreased number of COVID cases and mortality. In a British Medical Journal metanalysis looking at 25 RCTs, vitamin D supplementation (11,321 subjects) reduced the risk of acute ARI and reduced mortality. Similarly, an RCT of vitamin D supplementation of 1200 IU in Japanese schoolchildren reduced the incidence of influenza A with an NNT of 13. A study in nature with an N of 17,278,392 and 10,926 COVID-19 deaths, showed a positive correlation with increasing age, male gender, darker skinner ethnicities, and obesity. Interestingly these risk factors are those for vitamin D deficiency as well. High fructose corn syrup inactivates both 25(OH)D 1,25(OH)2D, which suggest consuming a diet low in processed sugars would be beneficial in maintaining proper levels of vitamin D. Also of note, countries below 35 degrees North latitude have lower mortality compare to above where people do not receive sufficient sunlight to retain adequate vitamin D levels again suggesting the role for vitamin D levels in determining outcomes for COVID-19.
Quercetin is a naturally occurring dietary flavonoid with antiviral properties and may disrupt the infectious mechanism of the coronavirus. It is an antioxidant found in many plant foods (including capers, red onions, apples, leafy greens, dill, cilantro, fennel, berries, sweet potato, tomatoes, broccoli, and tea) that can also be purchased as a supplement (often combined with vitamin C to increase absorption) taken up to 500 mg twice a day.
Zinc impairs replication in RNA viruses and may enhance cytotoxicity when used with a zinc ionophore such as quercetin or chloroquine. Zinc with hydroxychloroquine was associated with decreased rates of hospital mortality however treatment with hydroxychloroquine alone appears to be harmful. Long term zinc supplementation may result in copper deficiency and related issues.2
N-acetylcysteine (NAC), a glutathione precursor, at 600mg orally twice may help improve oxidative stress and inflammatory response in patients with upper respiratory tract infections. NAC assists the liver in reducing glutathione, which in turn helps the liver in removing toxins. A case report has noted that glutathione supplementation (2g) has improved dyspnea in COVID-19 patients. These may represent a novel treatment approach in blocking NF kappa-b and attenuating the cytokine storm seen in COVID-19.
Rates of anxiety and depression have gone up during the pandemic which subsequently attenuates our immune system. Spending time outside and physical activity can thus help strengthen our immune system and mitigate the cabin fever of COVID-19. Breathing techniques such as resonant breathing or 4-7-8 breathing can also help increase our parasympathetic tone, increase heart rate variability, and decrease stress. Fear, stress, and illness encourage a sympathetic tone and shallow breathing. Diaphragmatic breathing encourages full utilization of the airspace and an optimal pattern of breath.
The patient should sit in a supported position and breathe in and out slowly, preferably in through the nose and out through the mouth, while relaxing the chest and shoulders and allowing the tummy to rise.
They should aim for an inspiration to expiration ratio of 1:2. This technique can be used frequently throughout the day, in 5-10 minute bursts (or longer if helpful).
Other breathing techniques—such as diaphragmatic breathing, slow deep breathing, pursed-lip breathing, yoga techniques, Buteyko—are used in strategies to manage patients’ breathing patterns and breathlessness. 3
The Wim Hof Method (a variation of Tummo mediation) has also garnered attention with its deep breathing, breath retention, and cold exposure priming the immune system.
Each of the recommendations alone may not be enough to guarantee prevention or recovery, however combining components with an anti-inflammatory lifestyle and good lifestyle choices will set the stage for the body to be ready for any insults, viral or otherwise, that may come its way.
References
- Gombart AF. The vitamin D-antimicrobial peptide pathway and its role in protection against infection. Future Microbiol. 2009;4(9):1151-1165. doi:10.2217/fmb.09.87
- Frontera JA, Rahimian JO, Yaghi S, et al. Treatment with Zinc is Associated with Reduced In-Hospital Mortality Among COVID-19 Patients: A Multi-Center Cohort Study. Preprint. Res Sq. 2020;rs.3.rs-94509. Published 2020 Oct 26. doi:10.21203/rs.3.rs-94509/v1
- GreenhalghT, Knight M, A’Court C, Buxton M, Husain L. Management of post-acute covid-19 in primary care BMJ 2020; 370 :m3026 doi:10.1136/bmj.m3026