Staying Healthy in the Age of the Corona

By now, everyone in the world has heard of Covid-19, the new virus that is wreaking havoc across the globe. It’s been a few months since this virus came to light and we have some credible information about it. With this information, we can now consider solutions that can be effective in reducing our individual risk of the disease and of squashing this pandemic.

A Few Highlights (obtained from Center for Disease Control (CDC):

  1. This is a respiratory virus, which means it’s mainly spreading through airborne droplets from infected patients to others. So, wearing masks is an important deterrent to the spread of the infection.
  2. At this time masks are recommended only for at-risk populations – healthcare providers, home delivery workers, etc. However, any mask – even homemade cloth ones can create a useful barrier to the spread. I would encourage everyone to wear masks if leaving the home.
  3. Many patients are asymptomatic while still being carriers. This is a big reason why the virus spreads so quickly.
  4. Hence, social distancing is the only effective mode of “flattening the curve” of this pandemic at this time.
  5. This disease is more contagious than the flu. Every infected Covid-19 patient can transmit the disease to 2 to 3 other people.
  6. It is more deadlier than the flu. Covid-19 seems to be causing pneumonia 10 times more frequently than the flu virus does. Probably because we do not have immunity to this virus, yet.
  7. At-risk population is identified as the following: Elderly (over the age of 64); anyone (irrespective of age) with pre-existing chronic disease (diabetes, cardiovascular disease, metabolic syndrome, respiratory disease) and people taking certain medicines like ACE inhibitors and ARB’s (for hypertension), ibuprofen for pain, etc.
  8. Contrary to the experience in China and other Asian countries, in the US, 40% of hospitalizations are for people between the ages of 20 and 54. What is the cause for this?

As an integrative physician, I see a relationship between the points 7 and 8 above. In my view, it is no coincidence that we are seeing more severe cases of Covid-19 in the younger population in US. Barring the possibility of Covid-19 strain here in US being especially virulent, I feel that poor metabolic health of US adults is one of the reasons we are seeing more severe infections in younger adults here. This study published in February 2019 found that only about 12% of Americans over the age of 20 were metabolically healthy (that is, only 12% of adult Americans had optimal measures for waist circumference, blood sugar, blood pressure and lipids; and are not taking drugs to control these risk factors). Recent reports also indicate that millennials are suffering from higher incidence of mental and physical health problems.

If reports of contagiousness and spread from other countries hold true for the US, then, because of our chronic disease problem, I am afraid we will have far worse outcomes than in other countries.

This association between susceptibility to infections and individual health is nothing new. Throughout history, whenever an epidemic struck; it is the poor, the downtrodden, that pay the heaviest price – common factors being: living in overcrowded, unsanitary conditions; food scarcity or poor access to nutrient dense food; poor access to health care; comorbidity with other chronic diseases, etc. Which are all the same risk factors associated with this current pandemic as well. This study discusses the effects of poverty and health inequalities on epidemics.

Hence, in my view, optimizing each person’s metabolic health may be an important factor in defeating this pandemic. Although we are in the middle of the pandemic, implementing such “prevention strategies” can be effective and may even offer a cheaper way to avert a major tragedy. The good news is that we can achieve these goals in a relatively short period of time with timely, strategic public health education and initiatives. Given the seriousness of the pandemic, if I asked you to give up junk food and processed food, while taking some vitamin D or fish oil capsules; will you not make this change for a short period of time?

What I Think We Should Do?

The ideas and suggestions I have put forth here are a result of my analysis of the rapidly evolving situation coupled with my understanding of human physiology and the pathology of infections. Based on my training in Functional medicine and Ayurveda; I no longer view the human mind-body system as a passive entity, a sitting duck; waiting for a virus or a bacterium to unravel it. Our mind-body systems represent the pinnacle of evolution. Which means our systems are constantly interacting with the environment, learning from it, adapting to it and optimizing our own survival with each challenge thrown at us. So, I focus on aiding our system to fight this enemy or any other enemy (environmental toxins for instance). Using this approach in general, I routinely see that my patients begin to thrive within 4 to 6 weeks of following our protocols. Their immunity gets better and they do not succumb to infections like others around them. I have seen this benefit even in my patients over the age of 70.

Moreover, these same strategies will also help to reduce chronic disease burden by reducing chronic inflammation, optimizing blood glucose levels, enhancing respiratory status, enhancing digestive abilities, etc. Thus, creating the foundation for a healthier individual. As chronic inflammation decreases, the immune system will be able to mount an appropriate response should the person become infected with the virus. These strategies can and should be widely implemented as a public health initiative. Just as we are educating people about the correct way of coughing, sneezing and even when/how to wash our hands; we should also educate people about what to eat, when to eat, when to sleep, how much to exercise, and how to destress.

The preventive strategies I recommend are listed below. There are plenty to choose from in this list. Incorporating all of them is ideal, but remember to start slow. Even one or two changes that you make to your lifestyle, will have a profound impact on your health. Because your body is not saying, “I will wait for you to do all the right things by me and then I will get better.” Instead, your body is simply waiting for you to do one right thing so it can begin to heal itself and you!

These changes will be easier to incorporate as a family together and will benefit everyone in the family.

  1. First and foremost, food is medicine. Eating a whole food diet rich in fresh grass-fed meats, pasture raised eggs, whole grains, fresh vegetables and fruits. Choose organic when able. I highly recommend frequent consumption of chicken soup or broth or any bone broth which is full of essential nutrients (vitamins A, D, K; minerals like iron, selenium, zinc; glucosamine, and essential fatty acids, etc). Bone broth is beneficial for enhancing immunity and resilience by enhancing the first barrier to any invading organism – the mucosal lining of our inner organs (lungs, gut, etc). Consuming warm soups can be a wonderful way to provide the nutrients needed in a tasty and easily absorbable form.
  2. Avoid junk and processed food.
  3. Avoid sugary foods and beverages.
  4. Also avoid dairy products – this is from Ayurveda (India’s holistic medicine). Ayurveda states that foods like milk (and its derivatives) can enhance mucous secretions inside the body and make the organs susceptible for infections.
  5. Drink plenty of water. Preferably warm water in the form of teas, soups, etc. This recommendation is also from Ayurveda – warm liquids will ensure breakdown of mucous and helps to keep inner channels free of blockages.
  6. Ensure regular bowel movements – detoxification is very essential for health of the immune system and the body.
  7. Get adequate sleep and maintain regular sleep wake cycle. Ideal sleep time is from 10 pm to 6 am. Calming teas can be very helpful with inducing sleep (chamomile, lavender, hops, linden, passion flower, etc. are some of my favorites). Magnesium is a mineral that is an essential co-factor for many biochemical reactions. Many of us are deficient in it. Taking magnesium as a supplement calms our nervous system and helps with sleep.
  8. Exercise as able but daily movement is absolutely necessary.
  9. Specific breathing exercises known as “Pranayama” – a legacy of Ayurveda and Yoga. These specific breathing techniques help a person to exercise their respiratory system, thus maintaining efficient oxygenation, and enhances endurance and resilience of this system. The foremost exercise I recommend from this tradition is known as Nadi-Shodhan or alternate nostril breathing. Practicing this exercise for 7 minutes daily can benefit the respiratory system while also balancing the autonomic nervous system and thus helps to modulate stress. Click here to watch a video of this exercise.
  10. Practice additional hygiene measures – wash hands frequently for 20 seconds with soap and warm water; maintain at least 6 ft distance from others, cover your cough/sneeze using your elbow, wear a mask when going out, for milder symptoms, etc. With even mild symptoms – we should self-quarantine as first step, even from other family members, even before calling our doctors.
  11. Stress reduction – through meditation, breathing exercises, yoga, playing with pets/kids, spending time in nature.
  12. Neti pot sinus rinse once daily or as often as you can. Especially following suspicion of exposure to virus. This sinus rinse will literally wash the viral particles out. Do follow the proper guidelines for this procedure.
  13. Supplementation with nutrients and herbs (Reference 14): It is important to state that at this time there are no evidence-based studies that can provide us clear directions for integrative treatments of covid 19. Hence, I am extrapolating what we know with regard to integrative treatments for influenza and applying it to COVID-19. I like the following brands for their purity, quality consistency and scientific rationale for their nutrient combinations: Orthomolecular Products, Pure Encapsulations, Naturelo, Garden of Life, Nordic Naturals, etc. For Ayurvedic supplements, I recommend: Banyan Botanicals, Kottakal and VPK. Online sites like vitacost and lucky vitamin are also good sources for quality products. Trinergy Health carries products of the following companies for sale in store: Orthomolecular Products, Kottakal, VPK and Banyan Botanicals.

Here is What I Recommend at a Minimum:

  • Methylated multivitamin: This is to ensure adequate levels of all nutrients in the body and ensure their proper absorption.
  • Vitamin D: This versatile vitamin is traditionally thought of as being important for bone health. But of late we are recognizing its importance for regulating and balancing our immune system. Vitamin D stimulates production of AMP’s (Antimicrobial peptides like defensin and cathelicidin) which have anti-viral and antibacterial effects. On the other hand, Vitamin D also can have anti-inflammatory effect by modulating the production of inflammatory cytokines. This effect is crucial to prevent the cytokine storm responsible for sepsis and septic shock with flu and such infections. This anti-inflammatory effect is also why deficiency of Vitamin D is associated with many autoimmune conditions. (Reference 15). Vitamin D has also shown promise for mental health conditions like depression. Recent studies clearly demonstrate its efficacy in preventing and treating flu and other respiratory infections. By extension, we can make a case for optimizing Vitamin D levels in the general population and also use it in higher doses as in this report (Reference 16) for acute treatment of respiratory infections, including with Covid-19. Studies have also indicated that best benefit is with daily or weekly supplementation and not by super high doses taken monthly (References 17, 18, 27). I recommend a minimum of 5000 IU of D3 daily for adults and children over the age of 12. And 1000 to 3000 IU of D3 for children under the age of 12. Goal is to maintain a blood vitamin D level of at least 60 to 80 ng/ml. Considering that it costs about a penny for 1000 IU of D3 per day, this is a low-cost intervention at a population level. This vitamin is best used as prophylaxis as there are some preliminary (and contradictory) reports that Vitamin D can perversely exacerbate cytokine storm with Covid-19. Hence, from an abundance of caution, I am not universally recommending Vitamin D as treatment during Covid-19 infection state.
  • Omega 3 fatty acids: Fish oil contains 2 types of fatty acids – EPA and DHA. I recommend a minimum EPA of 1000 mg daily. If any mental health issues are present, then minimal EPA of 3000 mg daily. Omega 3 fatty acids have many benefits – maintain healthy mucosal lining of various organs – lungs, gut, etc, thus creating an efficient first line defense against any pathogen; reduce systemic inflammation; balance cholesterol levels, etc.
  • Probiotic: a broad-spectrum probiotic to help maintain healthy gut flora. Having a healthy microbiome in our system can be one of the most important allies we will have in fighting invading pathogens (viruses, bacteria or fungi). Many people with Covid-19 had diarrhea indicating that it affects the gut mucosa and the microbiome. Lactobacillus and Bifidobacterium are the strains that seem to have most benefit for respiratory infections. Consumption of probiotic rich foods – kombucha, kimchi, sauerkraut, kefir, and other fermented foods, should be encouraged.
  • Viracid: ViracidI love this formulation as this one capsule contains many of the immune support nutrients mentioned below. I have used it successfully for treatment of suspected flu recently. The patient recovered within 24 hours of onset of fever. This specific formulation is made by Orthomolecular products and is recommended for prevention as well as for treatment of viral infections, like influenza. Viracid contains Vit A, C, B5, Zinc, amino acid L-Lysine, herbs like elderberry, echinacea, astragalus, and andrographis. Based on current studies, this formulation is best used for prevention but not for treatment of Covid-19 infections. As it has elderberry in its formulation. Hepatic function has to be monitored when this supplement is taken for long periods of time as vitamin A can cause hepatic toxicity. For these reasons, I am recommending a dosage of 1 cap every day or every other day for healthy adults to be taken over the next 4 to 6 weeks as prophylaxis.
  • Chyawanprash (CP):chyawanprash especially, if Viracid is not an option. This is an Ayurvedic herbal formulation that is designed to support the immune system and the adrenal stress response system, among many other functions. This formulation contains close to 50 different herbs and can be taken by anyone and throughout the year. Recognized as a “Rasayana” or a rejuvenating formulation, CP is the foremost in this category of Ayurvedic formulations designed to revive health and vitality by rejuvenating each and every organ system in the body. One of the main ingredients is Amla (Indian Gooseberry) which is one of the most potent sources of Vitamin C. Studies show that consuming chyawanprash daily balances the immune system and helps a person fight infections in general. Many other benefits are attributed to daily consumption of this wonderful herbal formulation (Reference 19). Many Ayurvedic manufacturers make and sell this formulation.

The following are specific immune support nutrients I recommend (all these nutrients are present in adequate quantities in Viracid):

  • Vitamin C: Is gaining popularity as prevention tool for infections and also for treatment of cytokine storm when used in high doses. For prevention, I recommend a minimum of 1000 mg oral dose per day for adults; 500 mg per day for children. Reduce dosage if diarrhea is a side effect.
  • Zinc: This essential mineral is a must for healthy immune systems – it acts along with vitamin A in supporting the following parts of our immune systems – helper T cell, NK cells, macrophages and even supports antibody function.
  • Echinacea (Reference 24): Many beneficial effects noted with use of echinacea. Directly kills the virus, prevents viral entry into human cells, inhibits viral replication, etc. A combination of these beneficial activities could reduce the amount of prevailing viable virus, and their transmission, and also lead to amelioration of the virus-induced symptoms. People with rag weed allergies may be allergic to this herb and should use with caution.
  • Elderberry (References 25, 26): Another very useful herb for respiratory infections. Elderberry also inhibits viral attachment to respiratory mucosa, enhances cytokine (immune system molecules) production, especially TNF-Alpha, IL 6, 8 and 10; and helps the immune system mount an effective response to any invading microorganism. Studies have shown that elderberry has beneficial effects in the treatment of influenza A and B infections. However, recent reports have cautioned against use of elderberry once Covid-19 infection has set in as the cytokine effect may contribute to cytokine storm which is the pathway for multi organ failure. Hence, I would recommend this herb primarily for prevention.

In Conclusion

This is an unprecedented crisis of our lifetimes. It is natural for us to feel lost and scared. But we cannot give up hope. There is so much we can still do to help ourselves and our immune systems. Learning to live with the uncertainty of it all will be the biggest challenge. We have no choice but to learn to do just that – be aware of this uncertainty but be “ok” with it as well. Be aware of the fears but be “ok” with the fear. Mindfulness techniques can be very helpful in learning to hold such contradictory ideas and feelings in our minds and hearts at the same time. Practicing gratitude is another useful strategy. If you are like me, “doing something about it” (hence this article 😊) will provide some measure of comfort. Maintaining routines and incorporating rituals in daily lives will provide a semblance of normalcy. I am confident that we will all learn some means or the other to navigate this situation.

Meanwhile, wishing everyone health and courage during these difficult times!

Do not hesitate to call or text or email me with any questions or concerns.

Aruna Tummala, MD, ABIHM

List of all References:

  1. https://www.npr.org/2020/03/17/816501871/poll-as-coronavirus-spreads-fewer-americans-see-pandemic-as-a-real-threat
  2. https://www.researchsquare.com/article/rs-17453/v1
  3. https://science.sciencemag.org/content/early/2020/03/13/science.abb3221
  4. https://www.mailman.columbia.edu/public-health-now/news/stealth-transmission-fuels-fast-spread-coronavirus-outbreak
  5. https://www.statnews.com/2020/03/16/lower-coronavirus-death-rate-estimates/
  6. https://www.epicentro.iss.it/coronavirus/bollettino/Report-COVID-2019_17_marzo-v2.pdf
  7. https://www.bloomberg.com/news/articles/2020-03-18/99-of-those-who-died-from-virus-had-other-illness-italy-says?utm_campaign=pol&utm_medium=bd&utm_source=applenews
  8. https://www.medrxiv.org/content/10.1101/2020.02.25.20027664v1.full.pdf
  9. https://www.nationalgeographic.com/science/2020/03/uk-backed-off-on-herd-immunity-to-beat-coronavirus-we-need-it/
  10. https://www.technologyreview.com/s/615375/what-is-herd-immunity-and-can-it-stop-the-coronavirus/
  11. https://www.technologyreview.com/s/615391/coronavirus-uk-social-distancing-science-isolation-covid/
  12. https://medium.com/@tomaspueyo/coronavirus-the-hammer-and-the-dance-be9337092b56
  13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170985/
  14. https://www.sciencedirect.com/science/article/pii/S1550830720301130?via%3Dihub&fbclid=IwAR0xyVxX5WlOx0etgbyJY_GSNFxWw5XJ8wAO9B4b_K9T2ksbx-XWUCtL1UE
  15. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6121423/
  16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/
  17. https://www.bmj.com/content/356/bmj.i6583
  18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463890/
  19. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6571565/
  20. https://journal.chestnet.org/article/S0012-3692(16)62564-3/fulltext
  21. https://nypost.com/2020/03/24/new-york-hospitals-treating-coronavirus-patients-with-vitamin-c/?fbclid=IwAR2HIMeqcEF2ruTRgIVSGSDNgdXe6_6IOqg7IC62bMNZj7vlgmF1A8BhHPA
  22. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979858/
  23. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD006895.pub3/full
  24. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4058675/
  25. https://pubmed.ncbi.nlm.nih.gov/11399518/
  26. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3056848/
  27. https://www.bmj.com/content/356/bmj.i6583