A lot of you have been asking about which supplements you should be taking (if any) during the COVID-19 pandemic, so I thought I would make a post about it.
First, it is important to be clear that the data supporting the use of supplements to enhance immunity is insufficient to make many strong recommendations. I personally take several supplements based on a relatively small data set in the context of my own personal philosophy of health which centers on measures to keep inflammation low and blood circulation high.
Thoughts and recommendations regarding supplements in the context of COVID-19
Several supplements have been touted as immune system boosters which might make intuitive sense during a viral pandemic. A handful of supplements even have a measure of clinical data to support such a claim. For example, in a randomized, 8-week study in 79 adults, supplementing with mushroom mycelium extract led to a 38% increase in the activity of natural killer cells (a type of white blood cell that protects against infection). (1) Similarly, elderberry extract contains compounds that inhibit some viruses' ability to penetrate into cells and has been shown to lower the intensity and shorten the duration of symptoms of certain respiratory infections. (2) That might sound good but I actually don't recommend patients take either mushroom extract and elderberry extract during COVID-19. Read on...
Immune-boosting may make intuitive sense but it is not at all clear that increasing immunity is a good idea in COVID-19. Many people who go on to develop the severe and sometimes deadly version of this disease experience an extremely large and broad immune response that involves the release of small proteins by immune cells, known as cytokines. When cytokine production goes too high, patients experience a kind of dangerous hyper-immunity referred to as a 'cytokine storm' that can lead to severe acute respiratory distress. These are the patients who wind up in the ICU or CCU requiring help breathing. We would not want to stimulate more immunity in patients at risk for developing a hyper-immunity response.
The other severe form of COVID-19 seen in adults involves hypercoagulation (the abnormal formation of blood clots in the body). These abnormal blood clots have been implicated as the cause of strokes, heart injury, and lung injury in about 30% of patients with severe COVID-19. (3, 4, 5)
Mushroom mycelium extracts and elderberry could aggravate or increase the risk of developing these problems by stimulating the production of cytokines. Elderberry, in particular, has been shown to increase the release of interleukin-1B, a cytokine that has been identified as part of the inflammatory reaction to COVID-19.
By contrast, Boswellia (frankincense), has been shown to decrease cytokine production in patients with asthma, and so might be helpful in lowering the risk for some of the more serious effects of COVID-19, especially in those with allergies and asthma. (6)
Similarly, NAC (N-Acetylcysteine) has been shown in both in-vitro and animal studies to boost levels of glutathione. Glutathione is the body's master anti-oxidant hormone. By scavenging reactive oxygen species, glutathione lowers inflammation and reduces the production of mucous in the lungs suggesting it may be helpful in lowering the risk of chronic diseases and could be a useful adjunct in managing patients with COVID-19. (7)
Another supplement that makes sense is Vitamin D, a hormone made by the body in response to sunlight. D helps immune cells to function better while also lowering generalized inflammation. (8) Low levels of Vitamin D, most likely the result of widespread medical recommendations to limit sun exposure, is considered to be epidemic the United States (9) and studies have linked low levels of D to increased susceptibility to respiratory infections and allergic asthma. (10) By contrast, supplementation with D has been shown to significantly reduce the risk of respiratory infections. (11)
Zinc is a mineral that also plays a role in immune function. It helps to increase communication between immune cells and also aids in the reduction of inflammation. Like Vitamin D, zinc deficiency is epidemic in the U.S., and supplementation with zinc has been shown to protect against coronaviruses that cause colds. (12, 13)
It is rare that Americans experience Vitamin C deficiency, but supplementation with C has been shown to have many beneficial effects including reduction of the severity and duration of, and susceptibility to respiratory infections. (14, 15, 16) Vitamin C is another antioxidant that helps lower oxidative stress which decreases inflammation. C has even shown efficacy for the treatment of acute respiratory deficiency syndrome (ARDS) such as that seen in some severe cases of COVID-19. (17)
Various B vitamins are also essential for proper immune function and are known to be deficient in many people due to high-carbohydrate diets that are often low in vitamin and mineral-rich foods like berries, dark green vegetables, lentils, beans, eggs, and nuts. (18, 19).
Finally, there is quercetin. Quercetin is a polyphenolic compound known as a flavonoid. Flavonoids are plant pigments with special nutritional value. Data suggest that they affect cell-to-cell signaling, receptor sensitivity, and inflammatory activity. The main dietary sources of quercetin for humans are apples, berries, capers, onions, tomatoes, kale, broccoli, nuts, buckwheat and tea. (20) In several experimental models of inflammatory conditions (including infections), quercetin reduced the production of reactive oxygen species and inhibited the overexpression of different components of inflammation including cytokines, in animal studies (21, 22, 23). Quercetin has been shown to inhibit cells from being infected with influenza, Zika, and Ebola viruses by blocking the viral entry into cells and reducing viral replication. The evidence suggests that quercetin could have antiviral properties. (24, 25, 26).
Added note: during the COVID-19 crisis, stress tends to be higher. This has led to many of you experiencing sudden acute episodes of back and neck pain unprovoked by activity or injury. Many of you have noted that the pain came on while watching television or sitting at the computer. Among its many effects on health, the hormones released in response to chronic stress can disturb blood sugar regulation, blood pressure, memory, decision making, and the ability to get restful, restorative sleep. In addition to a healthy diet and regimen of supplements that may help keep inflammation down but mood and energy up, I recommend two things: brief, intense cardiovascular exercise and 4 minutes of Kore Power Trainer once per day. Keeping a strong core is extra hard when we are more sedentary. KPT is the solution to that problem.
Below is the list of supplements with links in case you are interested in purchasing any of them for yourselves. I recommend that you only buy pharmaceutical grade supplements that have been tested for purity and reliability. For those of you who would like to take an all-in-one immune enhancement supplement, Metagenics has a new product that puts several of these things together in one table, called Immune Active.
Our office uses mainly two pharmaceutical-grade manufacturers: Pure Encapsulations and Metagenics. Below you will find links to our portal for each. By ordering through our portals you will receive periodic discounts sent to your email.
Pure Encapsulations products with link to purchase:
Polyphenol nutrients (for B vitamins)
Metagenics products with link to purchase: Use code DRBERKOFFWELCOME For 15% off your first purchase on everything.
Immune Active (NAC, C, Zinc, Quercetin, plus EGCG found in green tea)
GlutaClear (NAC, Vitamin C)
Inflavonoid Intensive Care (Boswellia)
D3 10,000+ K (Vitamin D plus K)
Glycogenics (Vitamin B complex)