Increasing Immunity to Fight COVID-19

The COVID-19 outbreak is a serious situation. A lot of what is happening is out of our control. In situations like these, I try only to focus on what I can control. For instance, proactive ways to boost immune system defenses against COVID-19. 

Below is an overview of suggested risk reduction strategies along with my thoughts on them. 

Zinc: COVID-19 appears to be susceptible to the viral inhibitory actions of zinc. Zinc may prevent viral entry into cells and appears to reduce COVID-19 virulence. Typical daily dosing of zinc is 15mg – 30mg daily, with lozenges potentially providing direct protective effects in the upper respiratory tract.

Vitamin C: 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 – 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. 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. Typical dosing of melatonin varies widely from 0.3mg – 20mg (the latter used in the oncological setting).

Vegetables and Fruits +/- isolated Flavonoids: Many flavonoids have been found, in vitro, to reduce NLRP3 inflammasome signaling, and consequently NFkB, TNF-a, IL-6, IL1B 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: baicalin and wogonoside from Scutellaria baicalensis (Chinese skullcap);  liquiritigenin13 from Glycyrrhiza glabra (licorice); dihydroquercetin and quercetin found in onions and apples; myricetin found in tomatoes, organs, nuts, and berries; apigenin (found in Matricaria recutita (Chamomile), parsley and celery. At least 5 to 7 servings of vegetables and 2 to 3 servings of fruit daily provide a repository of flavonoids and are considered a cornerstone of an anti-inflammatory diet.

Sambucus nigra (Elderberry): There is preclinical evidence that elderberry inhibits replication and viral attachment of Human coronavirus NL63 (HCoV-NL63), different than COVID-19, but a member of the coronavirus family. Sambucus appears most effective in the prevention or early stage of coronavirus infections. Of note, Sambucus significantly increases inflammatory cytokines, including IL-B1, so should be discontinued with symptoms of infection (or positive test). An evidence-based systematic review of elderberry conducted by the Natural Standard Research Collaboration concluded that there is level B evidence to support the use of elderberry for influenza which may or may not be applicable to COVID-19 prevention. Typical dosing of elderberry extract is 10mL– 60mL daily for adults and 5mL – 30mL daily for children.

Vitamin D: As vitamin D is produced by the skin when exposed to the sun (15 min a day), people in the southern latitudes tend to have more natural vitamin D than those from the north. This could be one reason viruses tend to be more seasonally severe in northern latitudes. In certain conditions, vitamin D has been found to decrease NLRP3 inflamasome activation and vitamin D receptor activation reduces IL-1b secretion. However vitamin D has also been found to increase IL-1b levels and should, therefore, be used with caution and perhaps discontinued with symptoms of infection.

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, 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.

Stress management: This may be difficult during these times but is essential for well-being. Psychological stress disrupts immune regulation and is specifically associated with increased pro-inflammatory cytokines such as IL-65. 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.

Obviously, anything we can do to improve our health can only help our bodies fight off any virus, including this one.

Stay safe, stay strong!