A Functional Medicine Approach to COVID-19

As a Functional Medicine physician, I spend a lot of time thinking about the causes of illness. I have seen case after case where symptoms resolved once the cause of a disease was addressed. I am constantly looking to fix the “upsteam” cause of a problem rather than chasing the “downstream” effects that result.

Unfortunately, I observe many Functional and Integrative Practitioners forgetting this lesson. Instead of advising their patents on the tried and tested foundational tools to build health and immune function, I see too much speculation on the use of supplements to treat the cytokine storm that is seen in late stage disease COVID-19. These patients need ICU care and a ventilator, not melatonin.

I’ll share what I find to be the most practical and effective tools in my patients at preventing and addressing viral illness. .

A Functional Medicine Approach to COVID-19

My approach is to address overall health so that we can lessen the impact of COVID-19 on the body. To do this, most patients need a “back to basics” approach. First and foremost, take a close look at what lifestyle changes you can make.

These simple changes will make the most impact on your personal health and lower your vulnerability to COVID-19.

Then, if you are looking for extra support, take a look at those supplements that have the most evidence behind their use. Remember, “supplements are supplemental!” They can’t replace the benefits that will come from living a healthy lifestyle. All that being said, I am convinced that the supplements listed below have made a difference in my patients. The patients that are adding targeted supplements to a healthy lifestyle are getting over this virus fairly quickly and without trouble.

Our goal is to prevent as many of these green arrows from turning red as possible.

Our goal is to prevent as many of these green arrows from turning red as possible.

How can I improve the health of my immune system right now?

Let’s start with the most critical and steps that you can take right now to lower your chance of getting COVID-19: optimizing your lifestyle.

PRIORITIZE SLEEP FIRST

Sleep has a profound impact on immune health and directly helps improve resistance to respiratory infections (1,2,3,4,5). This is listed first because it is the single most important lifestyle component that you have control over. During my years of working in an Urgent Care sleep deficits were the leading cause of patients not responding to treatment. Nearly without fail those patients whose uncomplicated colds worsened into pneumonia were not sleeping enough.

I recommend a minimum of 8 hours a night. If you have OSA, it is critical that you wear your CPAP. Sleep in a dark, cool environment.

Get at least 30 minutes of sunshine during the day, and make sure that you are not exposing yourself to bright light before sleep. This means that you should turn all electronics off an hour before bed.

OPTIMIZE YOUR DIET

A healthy diet is a critical component of health. We know that sugar consumption directly lowers the functioning of immune cells (6).

I typically recommend a paleo diet as I feel it is the easiest for most patients to follow. I emphasize minimizing intake of wheat/gluten, dairy, sugar and processed foods while maximizing a variety of vegetables, protein sources, fruit, nuts and seeds, seafood, and healthy fats such as olive oil. If you are eating a low protein vegetarian diet, then it is very important to increase protein intake during periods of stress.

LOWER YOUR STRESS LEVELS

The published literature supports what I see in my clinic - higher stress levels directly lead to poor immune functioning (7,8). Turn off TV and twitter. Get fresh air and sunshine.

Use the time of social distancing to pick up a new hobby or health habit that you’ve been meaning to do. This is a very good time to learn to meditate if you do not already do so (7).

What Supplements Are The Most Helpful?

We do not yet have published data on which supplements are most likely to be helpful combating COVID-19. Of the supplements listed below I am observing that many physicians are recommending quercetin and zinc based on some of the preliminary data and mechanism studies.

These are some of the supplements that I’ve been routinely using in my clinic for years to prevent viral infections. The supplements below are those that I think have the best published evidence behind their use in preventing addressing a viral respiratory illness. Most of the studies supporting these recommendations are based on clinical outcome data against influenza.

Probiotics

Look for a blend of lactobacilus and bifidobactera. There is a wealth of information showing that probiotic supplementation in a variety of doses and strains are helpful at preventing upper respiratory infections (9,10,11,12).

Zinc

Not only does zinc have a great track record at lowering the impact of common colds and viral illnesses (13) but there is emerging data suggesting that it might inhibit the viral replication of the SARS-CoV-2 virus. Take this with meals to prevent nausea.

Vitamin C

Again, there are a number of studies showing that vitamin C supplementation can lower the frequency and intensity of the common cold and some reports suggest that vitamin C supplementation may decrease the incidence of pneumonia (14,15,16,17). Be careful with vitamin C, as many patients don’t know that this acts as a laxative at higher doses. Don’t say I didn’t warn you!

Resveratrol and Quercetin

I frequently use these two compounds side by side. Clinically there are a lot of uses for these supplements as they are anti-oxidants, have anti-inflammatory properties, and can stabilize mast cells. Early evidence is emerging supporting anti-viral properties of Quercetin, and similar to zinc, may inhibit replication of SARS-CoV-2 (18,19,20).

Adaptogenic Herbs

These herbs help modulate the body’s stress response, and happen to have a variety of anti-viral effects. I find them very powerful and helpful in a variety of clinical settings. The product I use the most is a blend of several of these herbs including Ashwagandha, Rhodiola, Eleuthero, Ginsing and Licorice Root (18, 21,22,23,24,25).

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References:

  1. Cohen S, Doyle WJ, Alper CM, Janicki-Deverts D, Turner RB. Sleep habits and susceptibility to the common cold. Arch Intern Med. 2009;169(1):62–67. doi:10.1001/archinternmed.2008.505

  2. Godbout JP, Glaser R. Stress-induced immune dysregulation: implications for wound healing, infectious disease and cancer. J Neuroimmune Pharmacol. 2006;1(4):421–427. doi:10.1007/s11481-006-9036-0

  3. Patel SR, Malhotra A, Gao X, Hu FB, Neuman MI, Fawzi WW. A prospective study of sleep duration and pneumonia risk in women. Sleep. 2012;35(1):97–101. Published 2012 Jan 1. doi:10.5665/sleep.1594

  4. Prather AA, Leung CW. Association of Insufficient Sleep With Respiratory Infection Among Adults in the United States. JAMA Intern Med. 2016;176(6):850–852. doi:10.1001/jamainternmed.2016.0787

  5. Prather AA, Janicki-Deverts D, Hall MH, Cohen S. Behaviorally Assessed Sleep and Susceptibility to the Common Cold. Sleep. 2015;38(9):1353–1359. Published 2015 Sep 1. doi:10.5665/sleep.4968

  6.  Sanchez A, Reeser JL, Lau HS, et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr. 1973;26(11):1180–1184. doi:10.1093/ajcn/26.11.1180

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  8. Stress-induced Immune Dysregulation Implications for Wound Healing, Infectious Disease and Cancer

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  10. King S, Glanville J, Sanders ME, Fitzgerald A, Varley D. Effectiveness of probiotics on the duration of illness in healthy children and adults who develop common acute respiratory infectious conditions: a systematic review and meta-analysis. Br J Nutr. 2014;112(1):41–54. doi:10.1017/S0007114514000075

  11. Yeh TL, Shih PC, Liu SJ, et al. The influence of prebiotic or probiotic supplementation on antibody titers after influenza vaccination: a systematic review and meta-analysis of randomized controlled trials. Drug Des Devel Ther. 2018;12:217–230. Published 2018 Jan 25. doi:10.2147/DDDT.S155110

  12. Langkamp-Henken B, Rowe CC, Ford AL, et al. Bifidobacterium bifidum R0071 results in a greater proportion of healthy days and a lower percentage of academically stressed students reporting a day of cold/flu: a randomised, double-blind, placebo-controlled study. Br J Nutr. 2015;113(3):426–434. doi:10.1017/S0007114514003997

  13. Mousa HA. Prevention and Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies. J Evid Based Complementary Altern Med. 2017;22(1):166–174. doi:10.1177/2156587216641831

  14. Hemilä H, Douglas RM. Vitamin C and acute respiratory infections. Int J Tuberc Lung Dis. 1999;3(9):756–761.

  15. Hemilä H. Vitamin C and SARS coronavirus. J Antimicrob Chemother. 2003;52(6):1049–1050. doi:10.1093/jac/dkh002

  16. te Velthuis AJ, van den Worm SH, Sims AC, Baric RS, Snijder EJ, van Hemert MJ. Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathog. 2010;6(11):e1001176. Published 2010 Nov 4. doi:10.1371/journal.ppat.1001176

  17. Phillips JM, Gallagher T, Weiss SR. Neurovirulent Murine Coronavirus JHM.SD Uses Cellular Zinc Metalloproteases for Virus Entry and Cell-Cell Fusion. J Virol. 2017;91(8):e01564-16. Published 2017 Mar 29. doi:10.1128/JVI.01564-16

  18. Wu, C.-Y., Jan, J.-T., Ma, S.-H., Kuo, C.-J., Juan, H.-F., Cheng, Y.S.E., Hsu, H.-H., Huang, H.-C., Wu, D., Brik, A., Liang, F.-S., Liu, R.-S., Fang, J.-M., Chen, S.-T., Liang, P.-H., Wong, C.-H., 2004. Small molecules targeting severe acute respiratory syndrome human coronavirus. PNAS 101, 10012–10017.

  19. Wu W, Li R, Li X, et al. Quercetin as an Antiviral Agent Inhibits Influenza A Virus (IAV) Entry. Viruses. 2015;8(1):6. Published 2015 Dec 25. doi:10.3390/v8010006

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