I thought I would put together a summary of the best suggestions to support our immune health based on some of the information and concerns that have come to light during the pandemic. I consider some of the research that has been done over the last year and highlight some of the studies on both general immunity and also reference some more COVID specific support supplements.
Over the past year, government advice has primarily been around simply avoiding the virus by preventing contact and behavioural recommendations around hand washing, sanitisers, keeping surfaces clean etc. However none of these address the issue of building our innate immune defence should we fall prey to the virus. In addition although the mainstream media has talked about high risk groups as the elderly, those with other co-morbidities and the immunosuppressed, it hasn't given much more detail than that or looked at this from a much bigger lens so that is what I am going to do today. Another cause of confusion and fear is that there have sadly been deaths among younger people and those who on the surface don't have any health challenges. However, we don’t know what is going on underneath. If we see health as merely the absence of ‘disease’ we will be confused by this. What we need to know is how robust that person's health was which means understanding their nutrition, nutrient deficiencies, stress levels, sleep, weight, metabolic challenges. All of these can compromise immunity and all of these can be present as significant risk factors in the absence of diagnosed conditions. In addition one of the problems with ignoring these risk factors is that as soon as life goes back to normal if we don't examine our health now and correct any risk factors or deficits nutritionally we are going to remain in the high risk group not just for this virus but for anything else that comes along. Now is the time to build resilience, so that if we do become infected our immune systems will kick into action and we will make a good recovery. We live as part of a virome. Viruses have always been present and always will be and therefore the only intelligent strategy to build resilience is to support the host environment, in other words you and me! We can not always control for the existence of viruses but we can learn to live with them and for that we need to support our immune health.
First up, stress! We know that stress suppresses our immunity and right now we have a very strange and unpredictable world and 24/7 coverage of all things COVID along with changes in family and working life, loss of jobs and income. While some are enjoying the lifestyle changes and time with children and are talking about time for reflection, others are feeling trapped, hopeless and completely overwhelmed. Wherever we are, there are always stresses in life and we can only do our best to manage these. The trick is to acknowledge this and to set aside time as part of our daily routine to actively do stress relieving activities such as walking, breathing techniques, meditation, drawing, relaxation music ( I use this a lot!) We can’t always change the stress but we can change how we respond to it. Interestingly, adaptogen herbs can not only help modulate the stress response and build resilience but also have immune modulating effects. Panax ginseng ‘as a dietary supplement modulates the immune system and comprises a complex network of different cells and proteins that protects the body from infections.’
Interestingly, an Ayurvedic herb called Ashwagandha may have promise as a prophylactic for covid. The Narendra Modi government is leading a study to consider whether ashwagandha could be offered as an alternative to hydroxychloroquine as a potential covid preventive.
This has a massive effect on immune function. Whatever you do, do not compromise on sleep. Simple strategies include removing caffeine, turning off screens as the blue light effect can stay with us for 2 hours! Using special blue light blocking glasses can help and putting flux.com to your computer to dim the light. Ensure a cool bedroom, use blackout blinds, eye masks, and avoid all light emitted in the room including plugs etc to support melatonin. We can boost our melatonin by walking in daylight which raises serotonin and this converts to melatonin when it is dark to prepare us for sleep. Melatonin levels also influence our immune function so we really need to get this one right. There are supplements you can take to help this along if required.
‘During sleep, your immune system releases proteins called cytokines, some of which help promote sleep. Certain cytokines need to increase when you have an infection or inflammation, or when you're under stress. Sleep deprivation may decrease production of these protective cytokines. In addition, infection-fighting antibodies and cells are reduced during periods when you don't get enough sleep.’
For more tips on how to support sleep head over to our youtube video …. and also have a listen to this great podcast….. But whatever you do don't take short cuts with sleep!
Moderate exercise has been shown to raise white blood cells and antibodies to fight infection. Exercise also helps increase circulation and decreases stress hormones so it is an all round win win. Seated and adapted movement can also be helpful so don't feel left out. Studies have shown that just 20 mins of moderate exercise per day can improve immune function.
Getting just enough exercise is also important, finding that sweet spot between not too much and not too little as too much exercise can compromise immunity as much as too little.
We know that good nutrition is essential for supporting immunity, but how many of us are eating optimally? Recent evidence has shown that certain nutrient deficiencies have led to increased risk of covid, with zinc, vitamin C and vitamin D being widely reported. It has also been reported that those with increased risk of dying from Covid are those with metabolic health challenges eg diabetics and those overweight. Even more interesting is that high blood sugar is also a risk factor for poor prognosis even in non diabetics! A study of 11,000 C-19 patients in Spain found that even among those who were not critically ill when they got to hospital. having elevated blood sugar because a risk for death.
Obesity and metabolic risk
We have major health challenges in the UK now as processed foods represents over 50% of the diet. More and more research is pointing to metabolic disease as representing many of the high risk groups.
This highlights where we should be focussing our efforts in supporting people with obesity and metabolic challenges.
“According to a recent study led by University of North Carolina nutrition professor Barry Popkin, obese COVID-19 patients were more than twice as likely to require hospitalization than non-obese patients, about 1.75 times more likely to require a stay in an intensive-care unit, and 1.5 times more likely to die. But why? “Fat cells are active,” Popkin explains—they generate low-grade chronic inflammation that compromises the immune system. Obesity often brings with it breathing troubles like reduced lung capacity and sleep apnea, as well as a propensity for blood clotting.
“We’ve known that processed food is dangerous, but we’ve always assumed it was for chronic diseases,” says Dr. Robert Lustig, professor emeritus of pediatrics at the University of California, San Francisco. “What we didn’t know, until this pandemic, is that chronic disease also sets you up for morbidity and mortality from acute diseases” like COVID-19.”
Practical tips for respiratory care
Good old fashioned salt water gargles help loosen mucous and are antibacterial. Raw honey in hot water is soothing and healing. chamomile and peppermint teas are soothing for sore throats and mint tea in particular can be helpful for mucous reduction. Ensure plenty of hot drinks for mucous breakdown.
For respiratory congestion and sinus problems, try neti pots as these can be helpful for nasal irrigation. Vaporisers and diffusers can be very helpful with essential oils such as eucalyptus, peppermint, menthol or frankincense. Repeated sinus infections can be exacerbated when there are food intolerances or allergies. In addition, yeast overgrowth can also contribute so if you do have repeated infections this is something to look into to prevent the need for endless round of antibiotics which add to the vicious circle.
NAC or N-Acetyl cysteine
For problems with mucous production, again allergies and food intolerances need to be identified. However an excellent supplement for breaking up stubborn mucous can be NAC or N-acetyl cysteine. One of our go to supplements for clinging and stubborn mucous in a range of conditions is NAC or N-Acetylcysteine.
NAC actually has a fascinating history and has been well researched for health challenges other than mucous.
“NAC, which appears to work by reducing the thickness of mucus, has been shown to be a safe and effective treatment for chronic bronchitis.
A review of 39 clinical trials of NAC (N-acetyl cysteine) found that 400 to 600 mg per day was a safe and effective treatment for chronic bronchitis. NAC supplementation was found to reduce the number of aggravations of the illness in almost 50% of people taking the supplement, compared with only 31% of those taking placebo. Smokers have also been found to benefit from taking NAC. In addition to helping break up mucus, NAC may reduce the elevated bacterial counts that are often seen in the lungs of smokers with chronic bronchitis. In another double-blind study, people with chronic bronchitis who took NAC showed an improved ability to expectorate and a reduction in cough severity. These benefits may result from NAC's capacity to reduce the viscosity (thickness) of sputum. “
Other studies have shown benefits in COPD and also bronchiectasis
“Treatment with N-acetylcysteine, a mucus-dissolving and anti-inflammatory agent, reduces the frequency of acute worsening episodes and improves the quality of life of patients with bronchiectasis, results from a randomized trial in China show.”
There are a number of botanicals and supplements which have been shown to boost immunity, give symptomatic relief and shorten illness. Some of these have been researched with reference to Covid-19
It has been highlighted that Covid can be deadly due to its ability to attack part of the immune system called the inflammasome leading to a release of cytokines and a cytokine storm. This can cause severe and sometimes irreversible damage. The SARS-CoV-2 has been shown to activate something called the NLRP3 inflammasome. A 2016 review article which looked at natural compounds which can regulate this showed that supplements such as quercetin, curcumin, resveratrol and green tea can modulate this.
This has been regarded as an important tool in prevention and management of covid and this study gives a helpful overview to understand why that might be. “Interestingly, most of the risk groups described for COVID-19 are at the same time groups that were associated with zinc deficiency. As zinc is essential to preserve natural tissue barriers such as the respiratory epithelium, preventing pathogen entry, for a balanced function of the immune system and the redox system, zinc deficiency can probably be added to the factors predisposing individuals to infection and detrimental progression of COVID-19. Finally, due to its direct antiviral properties, it can be assumed that zinc administration is beneficial for most of the population, especially those with suboptimal zinc status.”
You can test your zinc with this simple taste test and all the family can do this for a bit of fun at home.
Vitamin C of course is well known for supporting immune health. This paper examines the link between deficiency and risk of reparatory infection and Covid and also its efficacy as a part of the toolbox for treatments. “This literature review focuses on vitamin C deficiency in respiratory infections including COVID-19; the mechanism of action in infectious disease and adrenal function supporting the anti-inflammatory actions of glucocorticosteroids: its role in preventing and treating colds and pneumonia and its role in treating sepsis and COVID-19. The evidence to date indicates that oral vitamin C (2-8g/d) may reduce incidence and duration of respiratory infections and intravenous vitamin C (2-24g/d) has been shown to reduce mortality, Intensive Care Unit and hospital stays, time on mechanical ventilation in severe respiratory infections.”
Vitamin A is an important micronutrient for regulating cellular immune response, modulation of T helper cells, secretory IgA and cytokine production. Studies have shown a reduction of symptom duration in viral infection. Early supplementation with vitamin A was associated with reduced mortality in patients with Ebola.
In children vitamin A has been shown to be particularly helpful when combined with zinc and this study of 826 preschool children concluded that when combined together significantly reduced the duration of Upper respiratory tract infection.
To order a good child’s immune supplement which includes both vitamin A plus vitamin D, vitamin C and probiotic have a look at this one for toddlers and this one for older children.
As most of you know, 70-80% of our immune system is in our gut, therefore it is unsurprising that that the gut plays a central role in optimising immunity. We can enhance our good bacteria by avoiding sugars and sweeteners and by increasing the diversity of colour and fibre in our diet. This large meta analysis of 23 trials and 6269 children indicated that children supplemented with probiotics has fewer days off school and reduced duration of illness.
Combined with vitamin C, D, Zinc and A as per previous studies and recommendations would therefore seem a sensible option across the winter to decrease incidence of Upper respiratory tract infections in children. Some great options here for different ages.
As we are talking about the importance of gut health you may have seen recent reports on research from South Korea and Hong Kong on the influence of gut bacteria on Covid severity. “Each person has a unique assortment of bacteria in their gut which play a variety of roles, including in modulating the immune response.
Research from the Chinese University of Hong Kong found people suffering with Covid-19 had a 'significantly altered' microbiome composition.
Separate research from South Korea found people with a poorly functioning gut are more likely to develop severe Covid-19 because the lack of healthy microbes makes it easier for the virus to infect cells in the digestive tract”
This was actually reported months ago by Dr Christine Bishara MD and her team. Last summer I has the great privilege of interviewing Christine about her research into this very subject and her research team highlighted the protective role of probiotics in the gut in prevention and management of Covid. They also considered why children didn't seem to be at risk of covid in quite the same way as adults. To find out why and to understand more on this fascinating and pivotal research, you can listen to our podcast here.
If you’ve been following us a while you’ll know of the research being done by the NHS in conjunction with Southamptom University into this impressive ayurvedic herb as a treatment which could be used for URTI. Even more exciting it was recently reported that Thailand’s health ministry has approved the use of Andrographis to treat early stages of Covid as a pilot programme. It's something we always have in our medicine cabinet!
Well known as an antiviral it has been good to see this herb being studied in UK hospitals! From vitamin D to vitamin C, zinc, andrographis and now elderberry the list of nutraceuticals and botanicals being used and researched in conventional medicine settings is growing to support the current virus. So encouraging to see more and more UK hospitals using a bigger lens and realising the much bigger medicine cabinet they have available to them.
‘Ms Jessica Evans, director of research and innovation at the East Kent Hospitals Trust, said: “We are all very excited to have been given approval to start this trial, which could have huge implications for the treatment of coronavirus.”
“A previous study with flu patients showed people who took the extract had significant improvements in their symptoms within two days, compared to six days for those who did not.” Order here
Last but not least, everyone's favourite when it comes to the immune system and that is our good old sunshine vitamin! As a clinic we test vitamin D every day and it is deficient in over 50% of our clients. As we only get around 10% from food, more on this in our blog, we really need some unprotected sunshine to convert into vitamin D which is an essential in our immune function. Vitamin D has always been well documented for immune protection and in particular for upper respiratory conditions. If the government had recommended essential supplementation a year ago the evidence from many studies over the last 12 months suggests we would have prevented significant illness and mortality from the Covid virus. To not supplement is simply a no brainier in my view and that of countless scientists across the world. Below are just some of the studies into vitamin D that have come to light over the past 12 months.
When the endocrinology and respiratory units at Newcastle upon Tyne Hospitals NHS foundation trust made an informal recommendation to its clinicians to prescribe vitamin D, the decision was considered unusual. “Our view was that this treatment is so safe and the crisis is so enormous that we don’t have time to debate,” said Dr Richard Quinton, a consultant endocrinologist at the Royal Victoria Infirmary in Newcastle.”
“In the Newcastle hospitals, patients found to be vitamin D-deficient were given extremely high oral doses of the nutrient. Of the first 134 coronavirus patients given vitamin D, 94 had been discharged, 24 were still receiving inpatient care, and 16 had died. The clinicians hadn’t clearly associated vitamin D levels with overall death rates, but only three patients with high levels of the nutrient died, and all of them were frail and in their 90s.”
A 2020 study from the Division of clinical epidemiology and ageing research in Heidelberg Germany has suggested that vitamin D insufficiency may account for almost 9 our of 10 covid-19 deaths. “Evidence from observational studies is accumulating, suggesting that the majority of deaths due to SARS-CoV-2 infections are statistically attributable to vitamin D insufficiency and could potentially be prevented by vitamin D supplementation. Given the dynamics of the COVID-19 pandemic, rational vitamin D supplementation whose safety has been proven in an extensive body of research should be promoted and initiated to limit the toll of the pandemic even before the final proof of efficacy in preventing COVID-19 deaths by randomized trials.”
Boston University found that vitamin D sufficiency reduces infection and impact of covid-19. “Patients with sufficient levels of vitamin D are less likely to experience complications and die from COVID-19, according to a new study in the US, while another has found it also reduces infection rates.
Vitamin D sufficiency was linked with a significantly decreased level of inflammatory markets, and higher blood levels of immune cells, in new research from Boston University's school of medicine.”
I would also like to share a very encouraging study which is the first randomised controlled trial of vitamin D in C-19. Expressed as relative risk vit D reduced the risk of ICU admission 25 fold. So it eliminated 96% of the risk of ICU admission. More analysis on this study on this interesting article
Hope you have enjoyed this summary of some of the available evidence which is considerable and growing. We are especially delighted to see more of these nutraceuticals and botanicals being used and researched in a range of settings. Perhaps what we really need is for those of us with an interest in natural medicine to get together and raise funds for further independent study in this vital work.
Disclaimer: This blog is provided for educational purposes only. If you are taking any medication or have a medical condition please check with a registered Nutritional Therapist or your healthcare provider before taking any supplements.
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