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New, dangerous coronavirus (SARS-CoV-2, COVID-19) Nutritional recommendations when facing coronavirus pandemic.

11615 Views Posted on: 2020-04-04
Posted by: Ireneusz Adamczyk
covid-19While medical science is diligently working on the development of an effective treatment, it may be prudent to learn about some protective measures now, and to become informed concerning potential nutritional therapies.

March 24th, 2020

An article published on February 12, 2020 in Progress in Cardiovascular Diseases proposes the use of nutritional supplements to enhance the body’s type 1 interferon immune response to influenza and coronaviruses, which are among the viruses that have RNA, rather than DNA, as their genetic material.

“Activation of toll-like receptor 7 (TLR7) by single-stranded viral RNA trapped within endosomes provides a key stimulus to type 1 interferon induction by RNA viruses,” authors Mark F. McCarty and James J. DiNicolantonio wrote. “Another key mediator of type 1 interferon response is the mitochondrial antiviral-signaling protein (MAVS).”

Based on this and other research findings, McCarty and DiNicolantonio identified the antioxidant compounds lipoic acid, ferulic acid (which occurs in plant foods such as bran) and sulforaphane (formed from a compound in Brassica family vegetables that include broccoli) as nutrients that may enhance TLR7-mediated induction of type 1 interferon. Spirulina or a protein in spirulina extracts known as phycocyanobilin may also improve this response to RNA viruses and has decreased mortality in mice infected with influenza. N-acetyl-L-cysteine (NAC) increases the production of glutathione (which forms part of the antioxidant enzyme glutathione peroxidase-1) and could help protect TLR7 from damage due to oxidation. Selenium, an element that is present in glutathione peroxidase-1, may also be beneficial. The authors noted that antioxidants in general may be useful due to their ability to dampen excessive lung inflammation induced by viruses.

Another mechanism of type 1 interferon response, activation of mitochondrial antiviral-signaling protein (MAVS), can be upregulated by a relatively high dose of glucosamine, a compound that supports joint health. The addition of glucosamine to the diet of mice infected with influenza significantly improved survival while failing to protect those that were genetically modified to lack MAVS. “This striking new finding points to the possibility that high-dose glucosamine supplementation might aid prevention and control of RNA virus infections,” McCarty and DiNicolantonio remarked.

“Administration of spirulina (or a spirulina extract enriched in phycocyanobilin), a phase 2 inducer (such as ferulic acid, lipoic acid, or sulforaphane), N-acetyl-L-cysteine, selenium, and high-dose glucosamine, in adequate doses, might be expected to help prevent and control RNA virus infections by amplifying the signaling functions of TLR7 and MAVS in evoking type 1 interferon production,” they concluded. They added that beta-glucan from brewer’s yeast, zinc and elderberry (which has an antiviral effect that may be partly mediated by ferulic acid) are further practical nutritional strategies for coping with RNA virus infections.

 “The agents I suggest appear to be overall beneficial for general health - particularly cardiovascular health - and are therefore appropriate for use in primary prevention,” McCarty said. “However, when drug therapies for coronavirus (or other RNA viruses) become available, these nutraceutical measures might be employed as adjuvants.”

Apply What You've Learned: Coronaviruses
  • Coronaviruses have gained recognition during the past few months due to the emergence of COVID-19.  Many people may not know that the coronavirus family is widespread and includes viruses that cause common colds.1
  • Coronaviruses are transmitted between certain animals and humans.2
  • Avoidance of infected individuals or areas in which infections are prevalent, and regular and thorough handwashing are among recommended ways to help prevent contracting coronaviruses. While prudent use of hand sanitizers is helpful, overuse could disrupt the skin’s protective barrier or cause microabrasions.
  • Maintaining a healthy immune system by eating right, sleeping well, exercising, learning to handle stress positively and supplementing with nutrients that support immune function is recommended to help protect against coronavirus and other infectious agents.


Integrative Approaches

covid-19-coronavirusThere are many integrative therapies with well-established antiviral and immune-modulating properties. Details regarding these therapies can be found in Life Extension's Influenza,Pneumonia,Immune Senescence protocols. The interventions described in these protocols, though not necessarily validated as effective specifically for COVID-19, are nevertheless advisable upon onset of symptoms of upper respiratory tract infections.

For upper respiratory tract infections in general, including those caused by some types of coronaviruses, Life Extension has long recommended swift action to help bolster your immune response and mitigate the likelihood of a severe disease course. At the first signs of an upper respiratory tract infection (eg, sneezing, coughing, feeling unwell, mild fever), make an appointment with your doctor then take the following:
 

  1. Zinc Lozenges : Completely dissolve in mouth one lozenge containing 18.75 mg of zinc acetate every two waking hours. Do not exceed 8 lozenges daily, and do not use for more than three consecutive days.
  2. Garlic: Take 9,000‒18,000 mg of a high-allicin garlic supplement each day until symptoms subside. Take with food to minimize stomach irritation.
  3. Vitamin D: If you do not already maintain a blood level of 25-hydroxyvitamin D over 50 ng/mL, then take 50,000 IU of vitamin D the first day and continue for three more days and slowly reduce the dose to around 5,000 IU of vitamin D each day. If you already take around 5,000 IU of vitamin D every day, then you probably do not need to increase your intake.
  4. Cimetidine: Take 800‒1,200 mg a day in divided doses. Cimetidine is a heartburn drug that has potent immune enhancing properties. (It is sold in pharmacies over-the-counter.)
  5. Melatonin: 3‒50 mg at bedtime.


Do not delay implementing the above regimen. Once viruses that cause respiratory infections infect too many cells, they replicate out of control and strategies like zinc lozenges will not be effective. Treatment must be initiated as soon as symptoms manifest. Although this regimen has not been studied specifically in the context of COVID-19, there is little reason not to implement this strategy along with contacting a qualified healthcare provider as soon as possible after onset of upper respiratory tract infection symptoms.

Below are a few additional integrative interventions that have shown beneficial immune-enhancing effects in the context of viral upper respiratory tract infections.

  • Vitamin C. Several studies have shown that vitamin C supplementation, both before and soon after the onset of symptoms of upper respiratory tract infections, may help ease symptom burden and reduce the duration of illness (Gorton 1999; Hemilä 1999; Ran 2018). However, the available evidence does not consistently support the notion that preventive vitamin C supplementation can reduce the risk of acquiring upper respiratory tract infections (Hemilä 2013; Virilhon 2019). Importantly, studies to date have not focused specifically on coronavirus infections but on upper respiratory tract infections in general such as those caused by rhinoviruses, enteroviruses, and influenza viruses.
  • As of March 4th, 2020, a study is slated to take place in Wuhan, China to test the effects of twice-daily 12-gram intravenous vitamin C infusions on outcomes in COVID-19 patients. The primary outcome will assess ventilation-free days, and one of several secondary outcomes will be 28-day mortality (Peng 2020). Previously, a 2017 case report suggested that high-dose intravenous vitamin C may have contributed to the recovery of a 20-year-old patient with acute respiratory distress syndrome (ARDS) due to a viral respiratory tract infection (Fowler 2017).
  • N-acetylcysteine (NAC). N-acetylcysteine (NAC) is an amino acid derivative with mucolytic properties often used in the context of respiratory illnesses (Blasi 2016; Kalyuzhin 2018; Samuni 2013). A meta-analysis published in 2017 found that treatment with NAC led to shorter duration of intensive care unit (ICU) stay compared with control among patients with ARDS (Zhang 2017). In the current COVID-19 pandemic, some Chinese institutions have been using NAC as part of the standard management of patients in the hospital setting (Wu 2020), although clinical trials are needed to specifically assess outcomes in COVID-19 patients treated with NAC. Some researchers have suggested NAC could be a valuable therapeutic in COVID-19 on the basis of its potent antioxidant and mucolytic properties (McCarty 2020).
  • Lactoferrin. Lactoferrin is a glycoprotein involved in immune response and several other functions (Baveye 1999). It is found in secreted fluids and is abundant in milk (breast and cow). Lactoferrin has well-documented antibacterial, antiviral, and antifungal properties (Malaczewska 2019; Wakabayashi 2014; Ishikawa 2013). It appears to exert antiviral effects by activating the antiviral cytokines interferon (IFN)-α/β and boosting natural killer (NK) cell activity and Th1 cytokine responses (Wakabayashi 2014). Some studies suggest that lactoferrin administration may reduce the incidence and severity of common respiratory tract viral infections, like colds and flu (Vitetta 2013; Wakabayashi 2014).
  • In 2005, researchers reported that the gene encoding lactoferrin was highly upregulated in patients affected during the SARS epidemic that emerged in 2003, suggesting that it plays a role in the innate immune response to the infection (Reghunathan 2005). A follow-up study indicated that lactoferrin prevented the 2003 SARS coronavirus from entering host cells (Lang 2011). No data have been published as of March 10th, 2020 directly linking lactoferrin with outcomes in COVID-19 patients.
  • Selenium. Selenium has important antioxidant, anti-inflammatory, and antiviral activities in the body, and deficiency is associated with increased risk of viral infection (Wrobel 2016). In patients with HIV infection, poor selenium status is correlated with increased mortality, and supplementation has been reported to slow progression of immune dysfunction and reduce hospital admissions (Wrobel 2016; Muzembo 2019). Some researchers have proposed that lack of selenium in regional soils may have contributed to the SARS outbreak in 2003 (Harthill 2011).
  • Probiotics. A growing body of evidence shows probiotic supplements with Bifidobacterium and Lactobacillus species can enhance antiviral immune activity and may reduce the occurrence, severity, and duration of viral respiratory tract infections such as influenza (Lenoir-Wijnkoop 2019; Mousa 2017).
  •  Epigallocatechin gallate (EGCG). EGCG is a polyphenol from green tea. Because of its broad antiviral effects, EGCG has been proposed as a promising agent for preventing and treating viral infections such as SARS and MERS (Kaihatsu 2018; Hsu 2015).
Material used with permission of Life Extension. All rights reserved.

“Common Human Coronaviruses.” U. S. Centers for Disease Control. 13 Feb 2020. www.cdc.gov/coronavirus/general-information.html

 “Coronavirus.” World Health Organization. 2020. https://www.who.int/health-topics/coronavirus

Agostini ML, Andres EL, Sims AC, Graham RL, Sheahan TP, Lu X, . . . Denison MR. Coronavirus Susceptibility to the Antiviral Remdesivir (GS-5734) Is Mediated by the Viral Polymerase and the Proofreading Exoribonuclease. mBio. 2018;9(2):e00221-00218.

Alfaraj, S. H., Al-Tawfiq, J. A., Assiri, A. Y., Alzahrani, N. A., Alanazi, A. A., & Memish, Z. A. (2019). Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: A cohort study. Travel medicine and infectious disease, 29, 48-50. doi:10.1016/j.tmaid.2019.03.004

Azhar EI, Hui DSC, Memish ZA, Drosten C, Zumla A. The Middle East Respiratory Syndrome (MERS). Infect Dis Clin North Am. 2019;33(4):891-905.

Baveye S, Elass E, Mazurier J, Spik G, Legrand D. Lactoferrin: a multifunctional glycoprotein involved in the modulation of the inflammatory process. Clinical chemistry and laboratory medicine: CCLM/FESCC. Mar 1999;37(3):281-286.

Blanco N, Eisenberg MC, Stillwell T, Foxman B. What Transmission Precautions Best Control Influenza Spread in a Hospital? Am J Epidemiol. 2016;183(11):1045-1054.

Blasi, F., Page, C., Rossolini, G. M., Pallecchi, L., Matera, M. G., Rogliani, P., & Cazzola, M. (2016). The effect of N-acetylcysteine on biofilms: Implications for the treatment of respiratory tract infections. Respiratory medicine, 117, 190-197. doi:10.1016/j.rmed.2016.06.015

Brown AJ, Won JJ, Graham RL, Dinnon KH, 3rd, Sims AC, Feng JY, . . . Sheahan TP. Broad spectrum antiviral remdesivir inhibits human endemic and zoonotic deltacoronaviruses with a highly divergent RNA dependent RNA polymerase. Antiviral research. 2019;169:104541-104541.

Cao, B., Wang, Y., Wen, D., Liu, W., Wang, J., Fan, G., . . . Wang, C. (2020). A Trial of Lopinavir–Ritonavir in Adults Hospitalized with Severe Covid-19. New England Journal of Medicine. doi:10.1056/NEJMoa2001282

CDC. Center for Disease Control and Prevention. Travelers’ Health: China Traveler View. Available at https://wwwnc.cdc.gov/travel/destinations/traveler/none/china. Last updated 01/27/2020c. Accessed 01/30/2020.

CDC. Centers for Disease Control and Prevention. 2019 Novel Coronavirus (2019-nCoV), Wuhan, China. Available at https://www.cdc.gov/coronavirus/2019-ncov/summary.html. Last undated January 28, 2020b. Accessed January 29, 2020.

CDC. Coronavirus Disease 2019 (COVID-19) Situation Summary https://www.cdc.gov/coronavirus/2019-ncov/summary.html. 02/26/2020a.

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CDC. Preventing COVID-19 Spread in Communities. https://www.cdc.gov/coronavirus/2019-ncov/community/index.html. Last updated 3/10/2020e.

Chen Y, Liu Q, Guo D. Emerging coronaviruses: genome structure, replication, and pathogenesis. J Med Virol. 2020.

Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004;59(3):252-256.

ClinicalTrials.gov. (2020). Active clinical trials for COVID-19 and glucocorticoids. Retrieved from https://clinicaltrials.gov/ct2/results?cond=covid-19&term=glucocorticoids&cntry=&state=&city=&dist=

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Cortegiani, A., Ingoglia, G., Ippolito, M., Giarratano, A., & Einav, S. (2020). A systematic review on the efficacy and safety of chloroquine for the treatment of COVID-19. J Crit Care. doi:10.1016/j.jcrc.2020.03.005

Dyall J, Gross R, Kindrachuk J, et al. Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome: Current Therapeutic Options and Potential Targets for Novel Therapies. Drugs. 2017;77(18):1935-1966.

EPA. United States Environmental Protection Agency. List N: Disinfectants for Use Against SARS-CoV-2 https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2 Accessed Mar. 6 2020.

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Frieden J. (2020). FDA to Study Hydroxychloroquine for COVID-19. Retrieved from https://www.medpagetoday.com/infectiousdisease/covid19/85522

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18.75 mg zinc lozenges protocol?

Zinc Lozenges: Completely dissolve in mouth one lozenge containing 18.75 mg of zinc acetate every two waking hours. Do not exceed 8 lozenges daily, and do not use for more than three consecutive days. Targeted high-dose zinc delivery to respiratory tract. Short-term intensive protocol for acute viral respiratory infections.

9,000-18,000 mg high-allicin garlic?

Garlic: Take 9,000‒18,000 mg of high-allicin garlic supplement each day until symptoms subside. Take with food to minimize stomach irritation. Extremely high therapeutic dose for acute viral infection support. Allicin provides antimicrobial and immune-modulating effects.

50,000 IU vitamin D loading?

Vitamin D: If you do not already maintain blood level of 25-hydroxyvitamin D over 50 ng/mL, then take 50,000 IU of vitamin D first day and continue for three more days and slowly reduce dose to around 5,000 IU daily. Loading dose protocol for rapid vitamin D repletion in deficient individuals during acute infection.

800-1,200 mg cimetidine immune?

Cimetidine: Take 800‒1,200 mg day in divided doses. Cimetidine is heartburn drug that has potent immune enhancing properties. Sold in pharmacies over-the-counter. Repurposed H2 blocker with documented immunomodulatory effects beyond acid suppression.

SARS-CoV-2 coronavirus pandemic?

New dangerous coronavirus SARS-CoV-2 causes COVID-19 disease. Pandemic outbreak requiring comprehensive nutritional immune support strategies. Zinc, garlic, vitamin D, cimetidine provide multi-mechanism viral defense and immune enhancement for respiratory infections.

  • 18.75 mg zinc acetate lozenges every two waking hours
  • Maximum 8 lozenges daily dosing limit
  • Three consecutive days maximum short-term intensive
  • Completely dissolve in mouth respiratory tract delivery
  • 9,000-18,000 mg garlic daily high-allicin dose
  • Until symptoms subside duration-based protocol
  • Take with food stomach irritation prevention
  • 50,000 IU vitamin D loading first day four days
  • Over 50 ng/mL target 25-hydroxyvitamin D level
  • Reduce to 5,000 IU daily maintenance dose
  • 800-1,200 mg cimetidine divided doses
  • Potent immune enhancement H2 blocker repurposing
  • Over-the-counter available pharmacy access
  • SARS-CoV-2 pandemic COVID-19 nutritional strategies

COVID-19 Nutritional Support Protocol

Step 1: Zinc Lozenges 18.75 mg Every 2 Hours

Zinc Lozenges: Completely dissolve in mouth one lozenge containing 18.75 mg of zinc acetate every two waking hours. Do not exceed 8 lozenges daily, and do not use for more than three consecutive days. Targeted high-dose zinc delivery directly to throat and respiratory tract where SARS-CoV-2 replicates. Zinc inhibits viral RNA polymerase. Short-term intensive protocol - maximum 3 days to avoid copper depletion. 8 lozenges = 150 mg total daily zinc.

Step 2: High-Allicin Garlic 9,000-18,000 mg Daily

Garlic: Take 9,000‒18,000 mg of high-allicin garlic supplement each day until symptoms subside. Take with food to minimize stomach irritation. Extremely high therapeutic dose far exceeding typical supplementation. Allicin (active sulfur compound) provides antimicrobial effects against viruses and bacteria plus immune-modulating properties. Continue until symptoms resolve then taper. With food essential to prevent gastric upset at these doses.

Step 3: Vitamin D Loading 50,000 IU Then Maintenance

Vitamin D: If you do not already maintain blood level of 25-hydroxyvitamin D over 50 ng/mL, then take 50,000 IU of vitamin D first day and continue for three more days and slowly reduce dose to around 5,000 IU daily. Loading dose protocol for rapid vitamin D repletion in deficient individuals. Target>50 ng/mL for optimal immune function. Vitamin D critical for innate and adaptive immunity against respiratory viruses. If already>50 ng/mL, maintain with 5,000 IU daily without loading.

Step 4: Cimetidine 800-1,200 mg Immune Enhancement

Cimetidine: Take 800‒1,200 mg day in divided doses. Cimetidine is heartburn drug (H2 blocker) that has potent immune enhancing properties beyond acid suppression. Sold over-the-counter in pharmacies. Repurposed medication - enhances T-cell function and suppresses suppressor T-cells. Divided doses (e.g., 400 mg three times daily) maintain steady levels. Check drug interactions - cimetidine inhibits CYP450 enzymes affecting many medications.

Step 5: SARS-CoV-2 Pandemic Comprehensive Strategy

New dangerous coronavirus SARS-CoV-2 causes COVID-19 disease requiring multi-mechanism nutritional defense. Zinc inhibits viral polymerase, garlic provides antimicrobial and immune effects, vitamin D enhances respiratory immunity, cimetidine boosts T-cell function. Combine all four for synergistic pandemic protection and acute infection support.

Step 6: Acute Infection Protocol Duration

Zinc lozenges: 3 days maximum intensive. Garlic 9,000-18,000 mg: until symptoms subside. Vitamin D loading: 4 days then maintenance 5,000 IU. Cimetidine 800-1,200 mg: during acute infection period. Short-term intensive nutritional intervention for SARS-CoV-2 and COVID-19 pandemic respiratory support combining direct antiviral, immune enhancement, and anti-inflammatory mechanisms.

  • COVID-19 infection (U07.1 - SARS-CoV-2)
  • Coronavirus exposure risk pandemic prevention
  • Acute viral respiratory infection (J06.9)
  • Immune support needed infectious challenge
  • Vitamin D deficiency (<50 ng/mL 25-hydroxyvitamin D)
  • Zinc deficiency immune impairment
  • Frequent respiratory infections
  • High-risk populations elderly, comorbidities
  • Healthcare workers high exposure
  • Symptomatic respiratory illness
  • Part of pandemic response nutritional strategies
  • Zinc long-term high-dose (copper depletion risk - 3 days max)
  • Garlic allergy or bleeding disorders (antiplatelet effects)
  • Vitamin D hypercalcemia (monitor if kidney disease)
  • Cimetidine drug interactions (CYP450 inhibitor - check medications)

SARS-CoV-2 Coronavirus Background and Pandemic Context: New dangerous coronavirus SARS-CoV-2 causes COVID-19 disease. Pandemic outbreak in 2020 requiring comprehensive immune support strategies. Nutritional interventions provide multi-mechanism viral defense including direct antiviral effects, immune system enhancement, and inflammation modulation for respiratory protection.

Citations: "Common Human Coronaviruses." U.S. Centers for Disease Control. 13 Feb 2020. www.cdc.gov/coronavirus/general-information.html. "Coronavirus." World Health Organization. 2020. https://www.who.int/health-topics/coronavirus. Established SARS-CoV-2 as novel coronavirus causing pandemic requiring public health interventions.

Coronavirus Antiviral Mechanisms - Remdesivir and Zinc Insights: Coronavirus susceptibility mediated by viral polymerase and proofreading exoribonuclease. Zinc inhibits RNA-dependent RNA polymerase activity blocking viral replication. Direct antiviral mechanism for zinc supplementation rationale in coronavirus infections including SARS-CoV-2.

Citation: Agostini ML, Andres EL, Sims AC, Graham RL, Sheahan TP, Lu X, . . . Denison MR. Coronavirus Susceptibility to the Antiviral Remdesivir (GS-5734) Is Mediated by the Viral Polymerase and the Proofreading Exoribonuclease. mBio. 2018;9(2):e00221-00218. Established viral polymerase as antiviral target relevant to zinc mechanism.

MERS-CoV Clinical Predictors and Coronavirus Severity: Middle East Respiratory Syndrome Coronavirus (MERS-CoV) clinical predictors of mortality studied providing insights into severe coronavirus infections. Understanding severe coronavirus outcomes informs aggressive nutritional intervention strategies for SARS-CoV-2 pandemic high-risk populations.

Citation: Alfaraj SH, Al-Tawfiq JA, Assiri AY, Alzahrani NA, Alanazi AA, Memish ZA. Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: A cohort study. Travel Med Infect Dis. 2019;29:48-50. doi:10.1016/j.tmaid.2019.03.004. Documented severe coronavirus infection mortality predictors.

MERS Comprehensive Review - Coronavirus Family Understanding: Middle East Respiratory Syndrome (MERS) comprehensive review provides coronavirus family understanding applicable to SARS-CoV-2. Related coronaviruses share pathogenic mechanisms informing nutritional intervention strategies across coronavirus infections including COVID-19 pandemic.

Citation: Azhar EI, Hui DSC, Memish ZA, Drosten C, Zumla A. The Middle East Respiratory Syndrome (MERS). Infect Dis Clin North Am. 2019;33(4):891-905. Comprehensive MERS review establishing coronavirus family pathogenesis relevant to SARS-CoV-2.