Preventing COVID-19 and Boosting Immunity

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Preventing COVID-19

• Wash hands often with soap and water for 20 seconds. Use hand sanitizer with over 60% alcohol when soap and water are not available.
• Train yourself to never touch your face, nose, eyes, or mouth without clean hands. Use hand sanitizer when hand washing is not available.
• Contain cough or sneeze in tissue or elbow.
• Do not share utensils and drinking cups.
• A surgical mask which covers the mouth and nose will help prevent airborne droplet exposure. Keep nasal membranes moist with saline nasal spray during plane travel.
• Clean and disinfect surfaces frequently touched every day. Disinfect areas with body fluids. These includes doorknobs, counters, tables, bathrooms, sinks, phones, electronic devices and many more. Here is a list of CDC cleaning guidelines and cleaning agents which disinfect surfaces with SARS-CoV-2.
• Stay away from public gatherings and keep a distance from other people. Spreading the virus to others is of greatest concern in those younger than age 2 or over 65 years old, patients in a nursing home, pregnant mothers, or those with chronic diseases of the lungs, heart, kidneys, cancer patients (especially those on chemotherapy), and patients with diabetes. Anti-viral medication may be available in the near future which may reduce the duration of the illness. In mild cases, this is not necessary.
• Researchers found that individuals who reported sleeping less than 7 hours a night were 2.94 times more likely to develop a cold than those who slept 8 hours or more, and those who had sleep efficiency of 92% or less were 5.5 times more likely to develop a cold than those with an efficiency of 98% or better (24).
• Exercise during a viral infection is not recommended until symptoms begin to taper off, otherwise recovery from a cold may be prolonged.
• It is important to stay hydrated by consuming adequate amounts of fluids.

According to CDC, if you think you were exposed or have symptoms of COVID-19:

• Stay home during your illness, and reduce activity outside the home unless you need medical care.
• Stay away from public places including school and work.
• Avoid gatherings and public transportation
• Keep a distance from other people by staying in a separate room and use a separate bathroom.
• Limit contact with pets and animals since it is not known if they can transmit or carry the virus.
• The CDC suggests having someone else care for your pet. If there is no one else, wash hands before and after touching your pet and wear a facemask.
• If you are mildly ill, stay home. If you are sick, call your doctor ahead of time before visiting.
• If you have any cold and flu symptoms, wear a facemask around other people when sharing a ride in a vehicle or if your are in the same room as others.
• If you have fever and difficulty breathing, report to the nearest Emergency Room or call 9-1-1.
• If the sick person is unable to wear a facemask, then others in contact with the sick person in the same room should wear a mask.
• Cover your mouth and your nose with a tissue when you cough or sneeze. Throw tissues away in a lined trash can.
• Wash hands often and after coughs or sneezes with soap and water for at least 20 seconds. Use hand sanitizer with over 60% alcohol when soap and water are not available.

How Does Your Immune System Fight a Viral Infection?

A viral infection is a contagious illness which can be caused by about 100 different types of known viruses. Rhinovirus is the most common, but others include adenovirus, coronavirus, influenza virus, parainfluenza virus, respiratory syncytial virus, and many others. The body’s immune system recruits T- and B-lymphocytes which produce antibodies to bind the virus to prevent it from replicating. These cells tag viruses for other white blood cells to attack them. The body never builds up immunity to all of the viruses, which is why they are a frequent and recurring problem. Viruses may lead to serious bacterial infections such as sinusitis and pneumonia. Over-the-counter medicines ease symptoms, may increase blood pressure and/or heart rate, but do not reduce the duration of the illness.

How to Boost Your Immunity

Over 90% of upper and lower respiratory infections are due to viruses. Our clinic will provide you with the support and guidance to improve your immune system against Coronavirus Gainesville FL as part of our VIP Concierge Medicine Program. The program focuses on specific lifestyle modifications, wellness enhancements, nutraceuticals, and dietary changes to make a significant positive improvement in your immunity. We provide a multifaceted approach to help you lower the number of viral illnesses, and decrease the duration of these illnesses. We will develop a specific customized plan to improve immune system function.

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Supplements for Coronavirus Gainesville FL

There are not any supplements specifically known to reduce the symptoms or duration of COVID-19 viral infection. However, there is promising research available on some supplements which show evidence in improving the common cold and influenza viral syndromes. Some of these supplements seem to reduce cold and influenza symptoms, and others seem to decrease the duration of illness. Other Coronavirus strains are known to be a cause of the common cold. Therefore, it is possible that these same supplements may help improve the COVID-19 viral syndrome. More research is needed but several of the supplements are well tolerated with few adverse reactions. Hopefully, prevention practices will work but as Coronavirus Gainesville FL cases increase, these options may provide some benefit for immune system support.

When choosing one or more supplements, it is important to realize that the FDA does not provide strict regulation of supplements or herbs. Strength, purity or safety of these products are not guaranteed, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

Andrographis paniculata

• Andrographis paniculata was effective for symptoms of the common cold in children 4 – 11 years old in a study describing improvement in upper respiratory tract infection symptoms by days 2−3. It reported no side effects. A 100 mg capsule standardized to 10% andrographolides taken 3 times daily or equivalent was taken for 10 days and was more effective than a leading echinacea product. (1)
• Andrographis paniculata is beneficial for the common cold in adults by reducing most cold symptoms and the duration of the cold. 1200 mg of the herb standardized to 10% andrographolides divided three times per day for a duration of 3–8 days has been studied and tolerated well (5,6).
• For prevention of the common cold, Andrographis paniculata at a dose of 200 mg per day for 3 months has been studied and tolerated well but more studies are needed to confirm this benefit (7).
• Obtain approval from a primary care physician prior to taking and provide careful attention to monitoring for adverse effects of Andrographis paniculata. Andrographis paniculata has reported as well tolerated by multiple trials, but has been found to produce several

Andrographis paniculata Adverse Reactions and Interactions

• Gastric irritation and nausea (8)
• Hypoglycemia (low blood sugar) occurred when using AP as a favorable effect for treatment of diabetes as mentioned above (8), researchers found AP at a dose of 50 mg/kg significantly reduced blood sugar by 52.9% – 61.81% (9).
• Relaxed uterine smooth muscle and therefore should not be taken in pregnancy (11).
• In males, sperm count, motility, and morphology was improved with AP (10).
• Testosterone levels were increased with doses of 50 to 200 mg per kilogram in male rats (10).
• Reduced platelet aggregation by inhibiting platelet activating factor, and this mechanism differed from the mechanism by non-steroidal anti-inflammatory drugs (12).
• Allergic reactions, fatigue, headache, painful lymphadenopathy, nausea, and diarrhea in doses of 20 mg per kg per day as well as stomach irritation, bloating, nausea, vomiting and diarrhea has been reported. (13)
• Pruritis/rash, diarrhea, nausea, metallic taste, bitter taste, decreased/no taste, dry tongue, decreased sex drive, eyes sensitivity to light, decreased short term memory, dizziness, heartburn, tender lymph nodes, lymphadenopathy (14).
• Unpleasant sensations in the chest, headache, urticaria, nausea, vomiting, abdominal discomfort, dizziness, drowsiness and malaise, increased nasal discharge, epigastric pain, and blocked nose. However, AP was well tolerated among most participants. (14)
• Do not take AP if you are pregnant or planning to be pregnant, if you are taking diabetes drugs or insulin, if you are allergic to AP, or if you are taking anticoagulants such as aspirin, warfarin, non-steroidal anti-inflammatory drugs, or ticlopidine because of the potential increased risk of bleeding.

Pelargonium sidoides

• An herbal extract, Pelargonium sidoides, (also known as South African Geranium, Umckaloabo, Kaloba, Umcka, and Zucol) has been studied in both adults and children. It produced good results in several trials as a treatment for acute bronchitis. The following signs and symptoms were reported as better in the Pelargonium sidoides group over placebo: cough, sputum, rales/rhonchi, chest pain at cough, dyspnea, hoarseness, fatigue, fever, headache, and limb pain. The dose in the studies most commonly used was 30 drops or 1.5 mL, 3 times per day given before meals. Adults and children over 12 years were given a dose of 30 drops, children over 6 up to 12 years old were provided a dose of 20 drops, and children under 6 years old were given 10 drops per dose for duration of either 7 or 14 days. There were few adverse effects occurring at similar rates in both treatment and placebo groups (1-3), and another study showed that an adverse reaction of bleeding was felt unlikely (4). It is currently widely available but the use of this agent should be overseen by a physician.
• Patients should not take Pelargonium sidoides if they have an allergy to this herbal preparation or allergy to a similar plant family.

Echinacea

• Nahas, R performed a review of Echinacea clinical trials incuding 764 healthy adults and found that a dosage range of 2000-3000 mg of crude extract, or 6-9 mL in juice form, or 0.75-1.5 mL of alcoholic extract was generally used. This author found that cold symptom duration was significantly reduced in 3 separate studies by 1.5, 3, and 4 days, symptom severity was reduced in 4 of the 6 trials, but one trial showed no benefit. The author also found that 2 prevention trials revealed no benefit, and there was no standardized formulation or dosing established. (14)
• Jawad, M et al found that 3 doses of 0.9ml of Echinacea drops (corresponding to 2,400mg of Echinacea extract per day) held in the mouth for 10 seconds daily for 4 months appeared to prevent colds. During a cold (cold episode), participants were instructed to increase the dose to five doses of 0.9ml per day (4,000mg per day). The placebo group had 188 cold episodes or 850 episode days, compared to the Echinacea group which had 149 episodes, or 672 episode days. A 59% reduction in recurring cold infections in the Echinacea group compared with placebo was reported and 52% more subjects of the placebo group used medication during a cold than in the Echinacea group. (13)

Echinacea Adverse Reactions and Interactions:

• Adverse events reported in the Echinacea group compared to the placebo group was similar (13).
• Side effects according to Nehas, R include upset stomach, bowel problems, headache, rash, and the author also states that pregnancy and long-term use safety has not been tested (14).
• Tongue numbness with echinacea has been reported (29).
• Echinacea caused an increase in clearance of plasma midazolam levels (30).
• Echinacea has been found to have a significant negative impact on the effectiveness of HIV medications. Further drug interaction studies are needed (31).
• An increase in liver damage was reported to occur when acetaminophen was combined with echinacea and kava (32).
• In a systematic review by Izzo, AA et al, echinacea was reported to possibly change the clearance of caffeine (a CYP1A2 probe) and midazolam (a CYP3A4 probe) (33).

Garlic

• Josling P et al found that 146 volunteers who took either a garlic supplement with 180 mg of allicin once daily for 12 weeks had significantly fewer colds (24 vs 65), less reported sick days (111 days vs 366 days), and recovered faster when infected (4.63 days versus 5.63 days) compared to placebo but one drawback was that colds were reported by subjects instead of using a clinician reporter (15).
• Lissiman, E et al tried to locate additional trials relevant to the use of garlic for the common cold but did not locate further adequate clinical trials to support the findings by Josling P and concluded that more trials are needed to validate the findings (16).

Elderberry Extract

• Only cooked elderberry extracts should be used. Heating elderberry extract for 20 minutes destroys potential cyanide type toxins present in raw parts of the plant. Elderberry extracts are widely available over the counter from pharmacies and health food stores. Some elderberry product labels are not clear about how it was extracted or if it was heated. Few side effects were reported from taking elderberry extract if the extract was properly prepared. Nausea, vomiting, and abdominal pain has been reported in those who have consumed excessive amounts of the berries, juice, extract or other plant parts.
• Elderberry was determined to have both immunostimulant properties and antiviral activity (26).
• Zakay-Rones, Z, et al a performed a randomized, double-blind, placebo-controlled trial on influenza A and B starting within 48 hours of flu symptoms were treated with 15 ml of elderberry extract 4 times daily for 5 days, and symptoms were reported to last about 4 days less. Also the placebo group used more additional medication for flu symptoms compared to the elderberry group. The author believed a larger study is warranted to confirm results. (27)
• Patients with the flu with 3 or more typical flu symptoms took a slow dissolve lozenge with 175 mg of elderberry extract 4 times per day for 2 days and 28% of subjects in the elderberry group were symptom free within 48 hours, and 60% had only one or two mild symptoms by that time. In the placebo group, no subjects had complete recovery within 48 hours, and only 16% had improvement in 1-2 symptoms by that time. (28)

Zinc

• A review of controlled trials by Science, M et al suggested that oral zinc supplementation may shorten the duration of cold symptoms about 1.65 days. The positive effects were found to be greater with higher doses of ionic zinc daily (≥75 mg versus <75 mg). There was no significant effect seen among children (17).
• Nehas, R reviewed 5 trials including 13-24 mg zinc lozenges taken every 2 hours which were found to be associated with a reduced cold duration of 1.3-6.9 days with improved severity (18).

Zinc Adverse Reactions and Interactions

• Bad taste and nausea occurred more in a zinc supplemented group compared to placebo group (17).
• May cause bitter taste, nausea, impaired smell, loss of taste, and should be stopped after 6-8 weeks or copper deficiency may occur (18).

Glutamine

Athletes which train hard appear to compromise their immune system at times from a relative amount of overtraining. Glutamine may improve immune response in these overtrained athletes. 7 days following a marathon, runners were given a placebo or glutamine (0.1 g/kg body weight per day-7 grams per day in 70 kg person) dissolved in 250 mL distilled water. It was found that 32% less infections occurred in the glutamine group compared to the placebo group (21).

Vitamin C

• Douglas, RM et al authored a Cochrane Database Systematic Review which determined some important points in the use of vitamin C for the common cold (22). 7 separate studies that included 3294 cold episodes showed that vitamin C was no more effective than placebo at shortening the duration of cold except in one study with patients taking 8g of vitamin C daily at start of cold symptoms shortened colds more that subjects taking 4g daily.
• 30 prevention trials with 11,350 subjects revealed that vitamin C at a dose of 1 gram per day shortened colds by 8% in adults and 18% in children which may amount to a shorter cold episode by 1.5 to 2 days assuming a more severe cold runs 7 to 10 days, but vitamin C did not decrease severity of colds.
• After reviewing 6 trials, Douglas, RM et al found that vitamin C had the greatest benefit for colds in extreme athletes such as marathon runners, and if vitamin C was taken at 200 to 2000 mg daily by these athletes, it reduced the risk of getting the common cold in half.

Vitamin D

Does vitamin D provide protection against COVID-19?

There is ongoing debate over this topic. The current general consensus is that having an adequate level of vitamin D is important, but it is unclear if vitamin D can prevent or improve COVID infection. Having a low vitamin D level may put older patients or those with chronic disease at higher risk of COVID-19 complications. We support the supplementation of vitamin D or mild sun exposure to maintain 25(OH)D levels of 40–60 ng/ml. Vitamin D is also safe when taken according to medical authority recommendations. Therefore, if vitamin D has potential benefit, and it is safe, then why not?

An observational study (49) looking at patients with COVID-19 found that vitamin D levels were lower in critically ill patients and higher in mild cases. The conclusion of the research was that “Vitamin D supplementation could possibly improve clinical outcomes of patients infected with COVID-19.”

• The Institute of Medicine (IOM) and the Endocrine Society’s Clinical Practice Guidelines defined vitamin D deficiency as a 25(OH)D < 20 ng/ml, insufficiency as a 25(OH)D of 21–29 ng/ml and sufficiency as a 25(OH)D level of 30–100 ng/ml. For preventing and treating vitamin D deficiency their guidelines recommended vitamin D intake should be the following to maintain 25(OH)D concentrations of 40–60 ng/ml:
  • children < 1 y: 400-1,000 IU/d
  • children 1-18 years old: 600-1,000 IU/d
  • adults: 1,500-2,000 IU/d
  • Upper limits of vitamin D intake were also set as follows:
  • 2000 IU/day for children up to age 1 year
  • 4000 IU/day for children aged 1 – 18 years
  • up to 10,000 IU/day for adults aged 19 years and older.
• In some research vitamin D3 supplementation shows a benefit in reduction of cold symptoms and lower duration of colds. Others do not show a benefit. These mixed results against placebo when vitamin D is taken for upper and lower respiratory viral infections make it difficult to determine which type of patients it might benefit. Those deficient in vitamin D may develop more severe cold episodes for a longer duration than those with higher levels. To strengthen the case for vitamin D supplementation, there are few adverse reactions especially in the short term when taken in doses under 10,000 IU for adults and under 1000 IU per day for children over 3 years of age.
• G. Schwalfenberg published an article regarding the treatment of adult patients with vitamin D for influenza and found that treating patients with 50,000 IU of vitamin D3 with one single dose or 10,000 IU (2 to 3 times daily for 2-3 days) has had a significantly positive anecdotal effect with improvement and resolution of influenza symptoms in 2 to 3 days. He further describes that this dose of vitamin D3 taken once has not had any toxicity in research. (36)
• Shimizu Y et al tested 252 vitamin D insufficient or deficient subjects age 52-74 took 400 IU of vitamin D. The trend showed a benefit in lower duration of upper respiratory infection, lower severity and better quality of life (43).
• Rees JR et al found that a supplement of vitamin D3 1000 IU given to healthy subjects who were not vitamin D deficient did not reduce the number or lower the duration of cold episodes (42).
• An analysis of observational studies showed that vitamin D deficient patients were at a higher risk of developing pneumonia, but it was noted that confirmation research was needed (44).

Vitamin A

• A large review of studies in children deficient in vitamin A who took vitamin A supplements age 6 months to 5 years found a reduction in disease and mortality in these children due to measles and diarrhea (45,46).
• An analysis by Hu N et al with 15 randomized controlled trials including 3021 children with pneumonia showed that vitamin A supplements did not reduce the number of pneumonia episodes. However, it reduce the duration of fevers and cough. It also resulted in better chest xray appearance sooner and reduced the hospital stay (47).
• According to the NIH office of dietary supplements (48), vitamin A daily recommendations include the following: 1 IU retinol = 0.3 mcg RAE (retinol activity equivalents:
  • 0–6 months, 400 mcg
  • 7–12 months, 500 mcg
  • 1–3 years, 300 mcg
  • 4–8 years, 400 mcg
  • 9–13 years, 600 mcg
  • Over age 14, 700 mcg for males and 900 mcg for females
  • If pregnant, 750-770 mcg and if lactating, 1200-1300

Boosting Immunity

We design specific wellness programs to help you fight colds, viral syndromes, and reduce the risk of complications from these illnesses. There are specific changes that you can make which are known in research to improve the immune system significantly. This translates to fewer viral infections, and reduction in the duration of these illnesses. You are welcome to come in for a free consultation to discuss your options. You can schedule a free consultation below:

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Coronavirus Gainesville FL References:

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