Description
COVID-19 kills some people and spares others. How do you ensure that you are on the right side of the statistics? There are just too many self-proclaimed medical experts recommending all kinds of treatments and supplements for COVID-19 out there.
How do you navigate through such scientific fog?
Best Supplements for CV-19
When it comes to science and evidence, most consumers are confused with the mixed messages out there.
The answer unfortunately is not so simple. There are many considerations. If there are many studies and the results are mixed (some positive and some negative results), the scientific community will normally do a process referred to as a ‘systematic review’. A systematic review refers to the entire process of selecting, evaluating, and synthesizing all available evidence and studies to come out with an aggregated conclusion.
There are more than 120 trials testing the various nutrients and dietary supplements including vitamin D, vitamin C, zinc and Quercetin. Vitamin D remains the most tested vitamin followed by vitamin C and Zinc for COVID-19.
Do take note that for optimal effectiveness, each supplement should not be considered as a single intervention as most of the supplements are given as part of a combination protocol.
Below are the handful of supplements under the most intense study for effectiveness against the coronavirus:
Vitamin D
Based on several publications and studies, vitamin D seems to be the “most promising” supplement for COVID-19 protection. However, the causal relation between the two is still unclear.
Two studies in France (C Annweiler, Nov 2020; G Annweiler, Nov 2020), one in India (A Rastogi, Nov 2020) and one in Spain (M Castillo, Oct 2020) showed that Vitamin D supplementation seems to decrease the mortality rate, the severity of the disease, and the inflammatory markers’ levels among the COVID-19 infected patients, leading to a better prognosis and increased survival.
The largest observational study to date, looked at data for 191,779 American patients who were tested for SARS-CoV-2 between March and June 2020 and had had their vitamin D tested sometime in the preceding 12 months.
Data from 14 observational studies — suggest that vitamin D blood levels are negatively correlated with the incidence and/or severity of COVID-19; meaning if your vitamin D level is high, your risk for COVID-19 is low and vice versa.
A study published in November 2020 from Singapore (CW Tan, Nutrition 2020), found that those who were started on a daily oral dose of vitamin D3 (1,000 IU), magnesium (150 mg) and vitamin B12 (500 mcg) within the first day of hospitalization and continued up to 14 days were significantly less likely to require oxygen therapy and further intensive care.
A study early this year of 20 European countries found a link between low levels of vitamin D and higher percentages of COVID-19 cases and mortality. Separately, more than 80% of 200 people hospitalized for COVID-19 in Spain were found to be deficient in vitamin D, according to a study published in October in the Journal of Clinical Endocrinology & Metabolism.
Association of American Physicians and Surgeons’ Home-based Guide
According to the Association of American Physicians and Surgeons’ home-based guide to treating COVID-19, vitamin D, C and zinc are necessary.
Co-Nutrients Reduce Your Vitamin D Requirement
You can minimize your vitamin D requirement by making sure you’re also getting enough magnesium. Magnesium is required for the conversion of vitamin D into its active form and research has confirmed higher magnesium intake helps reduce your risk of vitamin D deficiency by activating more of it.
Vitamin K2 is another important cofactor, and taking both magnesium and vitamin K2 can lower your vitamin D requirement.
Eggs (44 IU per egg) are an excellent source.
Do take note that you can also get good amounts of vitamins C and D, zinc and other essential vitamins and minerals from a basic multivitamin. If you are taking a multivitamin, your D-vitamin needs may be covered, but be careful not to let the total exceed 4,000 IU or 100 mcg.
To maintain healthy levels, only 400 to 800 IU (15 to 20 mcg) of vitamin D is required daily, but, to boost low levels, higher doses, such as 2,000 IU daily, are used and are generally safe.
Vitamin C
Interestingly, many of the risk factors for COVID-19 overlap with those for vitamin C deficiency. Certain sub-groups (male, African American, older, those suffering with co-morbidities of diabetes, hypertension, COPD), all at higher risk of severe COVID-19, have also been shown to have lower serum vitamin C levels . Average plasma vitamin C levels are generally lower in men than women, even with comparative intakes of vitamin C, which has been attributed to their higher body weight .
The largest registered trial is the Lessening Organ Dysfunction with Vitamin C-COVID (LOVIT-COVID) trial in Canada, which is recruiting 800 patients who are randomly assigned to vitamin C (intravenous, 50 mg/kg every 6 h) or a placebo for 96 h, i.e., equivalent to 15 g/day for a 75 kg person (NCT04401150).
This protocol has also been added as a vitamin C arm in the Randomized, Embedded, Multifactorial Adaptive Platform Trial for Community-Acquired Pneumonia (REMAP-CAP; NCT02735707). The study design provides further rationale for the use of vitamin C in COVID-19 patients .
There is also a high-dose (10 g/day) vitamin C intervention study in 500 adults is in progress in Palermo, Italy (NCT04323514).
At the Cleveland Clinic, researchers are enrolling people into a study to see if vitamin C or zinc — or a combination of the two — can reduce the duration of COVID-19 symptoms. Patients will be given the supplements after they have tested positive for COVID-19.
Word of Caution – The U.S. Recommended Dietary Allowance (RDA) for vitamin C is 75 to 120 milligrams per day. Taking large doses of vitamin C (ascorbic acid) on a regular basis lowers your level of copper, so if you are already deficient in copper and take high doses of vitamin C, you can compromise your immune system.
While generally considered safe even in high doses, way too much vitamin C — anything above 2,000 milligrams daily—can cause headaches, insomnia, gastric discomfort, diarrhea, heartburn, and other issues.
Temporarily taking megadoses of vitamin C supplements to combat a case of the cold or flu is likely not going to cause a problem.
Many vitamin C supplements that are above the US RDA are sold in the market. It’s important to seek a physician’s advice if you intend to take high dose vitamin C on a long term basis. High doses of vitamin C (over 500 mg per day) over the long-term may increase the risk of cataracts. High-dose vitamin C can also reduce the effectiveness of certain medications and interfere with certain blood tests.
To be on the safe side, you may also request for your kidney functions to be monitored.
For long-term, daily use, your best bet is to eat a diet that is full of high quality organic vegetables and fruits that are minimally processed. Not only will you get vitamin C, but you will get all the other accessory nutrients and micronutrients that are needed to optimize it.
That said, there are also several reasons to consider taking supplemental vitamin C. First, your body cannot make it. Second, most people do not get sufficient amounts from their diet and, third, your body’s requirement for vitamin C can increase 10-fold whenever your immune system is challenged by an infection, disease or physical trauma.
Zinc
Foods that are high in zinc include oysters, crab, lobster, mussels, red meat, and poultry. Cereals are often fortified with zinc. Most multivitamin and nutritional supplements contain zinc.
Zinc has been shown in a lab study to inhibit regular coronavirus (not the current SARS-CoV-2) in a 2010 publication.
As of December 2020, there are 40 studies that have been launched to investigate the benefits of Zinc against COVID-19. You can review the status of these trials on clinicaltrials.gov.
A study in Spain (Gonzalez, The Lancet preprint, Oct 2020) among people hospitalized with COVID-19 found that having very low blood levels of zinc was associated with more severe disease and higher mortality rates.
Taking zinc long term is typically safe for healthy adults, as long as the daily dose is under the set upper limit of 40 mg of elemental zinc (PubMed).
Be aware that typical daily doses of zinc provided by zinc lozenges generally exceed tolerable upper limits for zinc, and for this reason, they should not be used for longer than about a week.
Excessive doses may interfere with copper absorption, which could negatively affect your immune system as it can cause copper deficiencies, blood disorders, impair the absorption of antibiotics and potentially permanent nerve damage or loss of smell.
The ideal dose for prevention while the COVID-19 risk is high is 40-100 mg/d, a portion of which comes from zinc lozenges to spread the zinc through the tissues of the nose, mouth and throat. It should be accompanied by at least 1 mg copper from food and supplements for every 15 mg zinc.
Do take note that you should keep the dosage back to within 40 mg/d once the exposure risk is back to normal.
Zinc Sulphate is also part of Dr. Vladimir Zelenko anti-coronavirus experimental protocol. Please take note that the protocol is experimental and has not been 100% proven. Do discuss with your doctor before taking the medication as per the protocol. You can check out his publication in the International Journal of Antimicrobial Agents.
Note: Hydroxychloroquine is a zinc ionophore. If increased intracellular Zn ion concentration is required to disrupt viral replication, perhaps using multiple zinc ionophores would increase that concentration thus decreasing viral replication further. Other OTC (over the counter) zinc ionophores include quercetin (QCT) and epigallocatechin-gallate (EGCG – green tea extract).
Quercetin
Quercetin is a natural antihistamine and anti-inflammatory plant pigment that boosts your immune system and may work to control viral replication, according to some research. It allows zinc to exert its proven antiviral properties; in treating COVID-19, quercetin may also lower inflammation, help clear mucus, prevent ventilator-induced damage and support immunity.
According to the research, quercetin has been shown to help fight obesity, Type 2 diabetes, circulatory dysfunction, chronic inflammation and mood disorders. It has even been found to help lower blood pressure. Researchers have found that quercetin can trigger tumor regression and begin the process of apoptosis. This is programmed cell death, without which cells can grow uninterrupted and develop into cancerous growths.
Quercetin was initially found to provide broad-spectrum protection against SARS coronavirus in the aftermath of the SARS epidemic that broke out across 26 countries in 2003. Now, some doctors are advocating its use against SARS-CoV-2, in combination with vitamin C, noting that the two have synergistic effects.
Incidentally, ascorbic acid (vitamin C) and the bioflavonoid quercetin (originally labeled vitamin P) were both discovered by the same scientist — Nobel prize winner Albert Szent-Györgyi. Quercetin’s antiviral capacity has been attributed to five main mechanisms of action:
- Inhibiting the virus’ ability to infect cells by transporting zinc across cellular membranes
- Inhibiting replication of already infected cells
- Reducing infected cells’ resistance to treatment with antiviral medication
- Inhibiting platelet aggregation — and many COVID-19 patients suffer abnormal blood clotting
- Promoting SIRT2, thereby inhibiting the NLRP3 inflammasome assembly involved with COVID-19 infection
Similarly, vitamin C at extremely high doses also acts as an antiviral drug, effectively inactivating viruses.
A molecular docking and pharmacological study, published in Heliyon, March 2021; highlighted that flavonoids such as quercetin was demonstrated to efficiently block the human ACE-2 receptor whereas hesperidin, naringin, and ECGC were found to be efficient towards the viral spike protein.
There is evidence that vitamin C and quercetin co-administration exerts a synergistic antiviral action due to overlapping antiviral and immunomodulatory properties and the capacity of ascorbate to recycle quercetin, increasing its efficacy.
Front Line COVID-19 Critical Care Working Group (FLCCC) recommends (updated April 26, 2021):
- Vitamin D3: 1000–3000 IU/day. Note RDA (Recommended Daily Allowance) is 800–1000 IU/day. The safe upper-dose daily limit is likely < 4000 IU/day. Vitamin D deficiency has been associated with an increased risk of acquiring COVID-19 and from dying from the disease. Vitamin D supplementation may therefore prove to be an effective and cheap intervention to lessen the impact of this disease, particularly in vulnerable populations, i.e. the elderly and obese.
- Vitamin C: 500 – 1,000 mg BID (twice daily)
- Quercetin: 250 mg daily. It is likely that vitamin C and quercetin have synergistic prophylactic benefit. Quercetin should be used with caution in patients with hypothyroidism and TSH levels should be monitored.
- Melatonin: 6 mg before bedtime (causes drowsiness).
- Zinc: 30 – 40 mg/day (elemental zinc). Zinc lozenges are preferred.
- Ivermectin for
- prevention in high-risk individuals (> 60 years with co-morbidities, morbid obesity, long term care facilities, etc): 0.2 mg/kg per dose (take with or after meals) — one dose today, repeat after 48 hours, then one dose weekly. (also see ClinTrials.gov NCT04425850).
- Post COVID-19 exposure prevention: 0.2 mg/kg per dose (take with or after meals) — one dose today, repeat after 48 hours.
NB. Ivermectin has a number of potentially serious drug-drug interactions. Please check for potential drug interaction at Ivermectin Drug Interactions – Drugs.com. The most important drug interactions occur with cyclosporin, tacrolimus, anti-retroviral drugs, and certain anti-fungal drugs.
For early outpatient protocol (COVID-19 positive), the Front Line COVID-19 Critical Care Working Group, FLCCC recommends (updated Apr 26, 2021):
- Vitamin D3 — 4000 IU/day.
- Vitamin C: 500 – 1,000 mg BID (twice daily)
- Quercetin: 250 mg twice a day.
- Melatonin: 10 mg before bedtime (causes drowsiness).
- Zinc: 100 mg/day. Zinc lozenges are preferred.
- Ivermectin: 0.2–0.4 mg/kg per dose (take with or after meals) — one dose daily, take for 5 days or until recovered. (
- Fluvoxamine: 50 mg twice daily for 10–14 days. Add to ivermectin if: 1) minimal response after 2 days of ivermectin; 2) in regions with more aggressive variants; 3) treatment started on or after day 5 of symptoms or in pulmonary phase; or 4) numerous co-morbidities/risk factors. Avoid if patient is already on an SSRI (selective serotonin reuptake inhibitor).
- Nasopharyngeal Sanitation: Steamed essential oil inhalation 3 times a day (i.e. vapo-rub) and/or chlorhexidine/benzydamine mouthwash gargles and Betadine nasal spray 2–3 times a day.
- Aspirin: 325 m/day unless contraindicated.
- Pulse Oximeter: FLCCC also recommend monitoring your oxygen saturation with a pulse oximeter and to go to the hospital if you get below 94%.
The medical evidence to support each drug and nutrient can be found under “Medical Evidence” on the FLCCC’s website.
Note: Although ivermectin and hydroxychloroquine are relatively safe drugs, they are still synthetic chemicals that can have side effects. Vitamin D, C, Zinc and Quercetin are nutrients that your body require for optimal health. Nutrients are safer alternatives especially if your risk is low e.g. age below 50 and no other chronic illness. Discuss with your doctor on the benefit vs risk for each treatment.
Conclusion
Aside from supplements, there are other ways that may help improve immune response and to prevent you from catching the coronavirus.
- Wear protective face mask. This is to protect not only yourself but others.
- Abundant evidence suggests that eating whole in fruits, vegetables and whole grains—all rich in networks of naturally occurring antioxidants and their helper molecules—provides protection against free radicals.
- Getting Enough Sleep
- Avoid Sugar, red meat and processed foods.
- Don’t smoke.
- Take steps to avoid infection, such as washing your hands frequently
- Try to minimize stress.
- Drink enough water to keep your body hydrated.
- Avoid excess alcohol.
- Avoid enclosed crowded areas.
- Regular physical activity (outdoor activities may not be allowed in countries with ‘lock-down’).
- Consult your nearest local healthcare provider if you have any doubt.
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Disclaimer: Always see your doctor before taking these supplements. Be aware that most of the dosages are above the recommended dietary allowance (RDA) and therefore such dosages should not be maintained on a long term basis.
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