Supplements In The Time of Covid

The COVID-19 virus emerged in 2019 and as of December 2022  has infected over 600 million people across the globe.  With the onset of the colder months, we are again seeing an uptick in COVID -19 cases. The initial signs of infection include headache fever, muscle aches, pain, diarrhea and fatigue.  Some people experience severe illness, which typically starts a week after becoming infected with the virus. The virus continues to wreak havoc on the human body, with progressive respiratory failure, multi organ failure, life threatening pneumonia and eventually death. The newer variants however appear to have a milder disease course. This may however be related to more widespread immunity to the disease.

In addition to regular COVID-19 symptoms , possibly 10% to 75%, experience what has been termed long COVID-19. The symptoms of long COVID-19 include cognitive dysfunction, muscle weakness, sleep difficulties and fatigue. Persons experiencing long COVID-19 will have the symptoms for several months after the initial illness has passed.  

With COVID-19’s havoc on the global population, dietary supplements are marketed for improving immune health.  Data suggests that certain supplements may provide some protection from the COVID virus. There is also some data to suggest that for those who did develop a COVID-19 infection, supplements could help to reduce the severity of symptoms associated with the disease. 

Role of the Immune System 

The main purpose of the immune system is to defend our bodies against infection that causes diseases. The immune system includes any responses which are the body's first line of defense, as well as adaptive responses which are those that are engaged during later stages of an infection.

The immune system has two broad functional parts (Innate and adaptive). The innate immune system is made up of physical barriers, which include the gut epithelium and the skin.  These prevent the entry of pathogens. Also included are leukocytes, which are white blood cells. These consist of neutrophils  and macrophages that release cytokines and natural killer cells that work to fight off foreign pathogens. These components of the immune system are however nonspecific, which means they do not respond or recognize specific pathogens. 

For identification and response to specific pathogens, the body calls upon the adaptive immune system. This consists of the B lymphocytes and the T lymphocytes. The B lymphocytes secrete antibodies into our blood and tissues, while the T lymphocytes provide cell mediated immunity.  Both of these are pathogens specific.

The adaptive response does not start working for at least several days or weeks. It initially takes this time to develop and generate immunological memory.  Subsequent exposure to a pathogen will result in a rapid and vigorous immune response. It is the adaptive immune system that is targeted by vaccinations to help protect the body from future versions of the pathogen included in the vaccine. It is the body's immune response that causes the symptoms such as pain and swelling, which initiates the healing process. 

Supplements and The Immune System

Does the immune systems require vitamins such as Vitamin C, vitamin D and minerals, such as zinc, to maintain proper function?

Clinical deficiencies of any of these nutrients can make us more susceptible to infections. Botanicals and probiotics are not felt to be essential, but may affect immune function positively when supplemented.  

Because of the complexity of the immune system, it is difficult to measure the impact of  these vitamins, minerals and other supplement ingredients as there is no straightforward, single measure used for assessing the function of the immune system disease resistance.

Dietary supplements have the ability to enhance immune function by reducing inflammation; this can help to manage the signs and symptoms of infections like COVID-19.  But the truth is that many of these ingredients have not been studied in relation to COVID-19. There is research that suggests people might be able to improve their immune function and prevent or reduce symptoms that are cold or flu like.  Just as supplementation may help other respiratory tract infections, some scientists believe that they hold some promise for the COVID-19 virus as well. 

Here are some vitamins, minerals and ingredients and how they are believed to affect the immune system and body on a whole. Much of the information is garnered from individual case reports, as well as animal studies. 

Vitamin C 

This essential nutrient can be found in a wide array of vegetables and fruits. The recommended daily allowance is between 75mg and 120mg for non-smoking adults. Smokers will need an additional 35 mg daily. 

Vitamin C has roles in both adaptive and innate immunity thanks to its antiviral, antimicrobial and antioxidant effects. Some research suggests that supplementing with Vitamin C has the ability to enhance immune function, depending on an individual’s vitamin C status. 

Note that vitamin C supplementation may affect some medications, such as chemotherapy and radiation therapy. 

Vitamin D

This essential vitamin is only present in very few foods, including  seafood like Tuna and Salmon naturally. In the United States, where Vitamin D deficiency is rampant, it is found in a number of vitamin D fortified foods. The body can make some of  its own Vitamin D when you expose yourself to the sun. 

Vitamin D’s role in immunity is believed to help lower the replication rates of pathogens like viruses. It increases immune cells and suppresses inflammation. Some evidence suggests that supplementation with vitamin D can help prevent infections of the respiratory system. 

Vitamin E

This is an essential nutrient that is available in a number of foods. It is an antioxidant that helps to maintain cell membrane integrity. It also enhances antibody production, natural killer cell activity, and lymphocyte proliferation. 

Studies show mixed results on the effects of Vitamin E supplementation for respiratory tract infections. Because of its effect on the immune system, it has been recommended for use by some experts in managing patients with COVID-19 infection. 

Echinacea

This is also known as purple coneflower and is an herb that is grown in North America and Europe. Supplements found in the American Market contain extracts from multiple plant parts and species.  It is believed that the herb contains antibacterial and antioxidant properties that stimulate the natural killer cells and monocytes, while also inhibiting viruses so they do not bind to host cells.

Numerous studies suggest that echinacea offers benefits for preventing the common cold, and it is suggested that it may have similar effects on COVID-19.  One clinical study found the alleviation of muscle pains, shortness of breath and coughing in 91% to 98% of the individuals receiving echinacea, ginger and hydroxychloroquine. 

The use of Echinacea appears to be safe, as there have been only a few reported adverse side effects. The most commonly reported side effects are skin rashes and gastrointestinal upset. 

Elderberry

This is the fruit of the Sambucus nigra tree.  The tree can be found in North America, parts of Africa, Asia and Europe.  It contains flavonols, anthocynanins and phenolic acid.  It is known for its anti-inflammatory, antiviral, antioxidants, and antimicrobial effects. It is also known to be a stimulant for the immune system.  Studies on this ingredient have been done using elderberry extract and have not used the actual berries.

Elderberry supplement cells doubled at the beginning of the COVID-19 pandemic in the United States. Some researchers have recommended the use of Elderberry in treating COVID-19 symptoms.  This is due to preliminary laboratory findings that suggest it has the ability to prevent upper respiratory tract infections, as it prevents the virus from binding to its host cells.  Results of small clinical trials on its effects on the common cold and flu are promising.

Both Elderberry flowers and their ripe fruit appear to be safe for consumption. People are recommended against consuming the unripe fruit, the bark of the plant, the seeds or the leaves as they are potentially toxic and can cause diarrhea, vomiting, nausea, and dehydration. When cooked, the heat destroys the toxin, so the cooked berry and commercial products that are properly processed do not have the safety concerns.

Ginseng

Ginseng is found mainly in Korea and China, but can also be found in the United States and Canada.  Ginseng contains ginsenosides that stimulate B lymphocyte proliferation and increase production of interferon-gamma and interleukins, both of which affect regulation and activation of the immune system. 

Ginseng is also reported to have anti-inflammatory activity and impair virus replication.  It is however not clear how Ginseng works to provide positive effects on the immune system.  There are a number of trials that have attempted to examine if ginseng helps to prevent infection, such as be cold and flu, but the results have been mixed.

Ginseng is safe, with minor side effects including headache, gastrointestinal symptoms, and difficulty sleeping. Ginseng is known for its ability to interfere with anti-diabetes medications and immunosuppressants. 

Magnesium

This essential mineral can be found in a number of foods, including nuts, whole grains, seeds, and green leafy vegetables. Magnesium plays a role in both innate and adaptive immunity, as it is the cofactor for more than 600 enzymatic reactions. Magnesium supplementation is understood to be good for people suffering from asthma and pneumonia. While most people, don’t generally develop magnesium deficiency, a lot of people are not consuming the recommended amounts daily.

Low magnesium levels are associated with decreased immune cell activity, increased inflammation, increased oxidative stress, and increased levels of some inflammatory cytokines.  Low magnesium is also associated with type 2 diabetes, obesity, cardiovascular disease, hypertension and impaired lung function.  Since all of these conditions are associated with poor COVID-19 outcomes, supplementing magnesium can help improve COVID-19 effects on the body.

Magnesium intake from food is safe, and from supplements it is safe up to 350 mg per day for children and adults.  Taking too much magnesium can cause magnesium toxicity, which  presents  with symptoms such as lethargy, ileus, vomiting, nausea, facial flushing, urine retention, muscle weakness. 

Melatonin

This is a hormone that is produced in the brain's pineal gland at night. It serve’s the purpose of regulating the Circadian rhythm.  As we age, our melatonin levels decrease. Laboratory studies indicate that melatonin can enhance immune response.  It also has an antioxidant effect and an anti-inflammatory effect.  Supplementation with melatonin appears to improve some oxidative stress markers in persons at risk for heart disease and type 2 diabetes.

There is still no evidence to show that melatonin prevents or enhances our treatment of COVID-19, but some researchers recommend it because of it’s anti-inflammatory, antioxidant, and immune enhancing capabilities.

Omega-3 Fatty Acids 

These polyunsaturated fatty acids are found in food such as fatty fish, flaxseed, and also in fish oil supplements. These compounds affect immune function by increasing the activity of neutrophils, B cells, T cells, macrophages, natural killer cells and the other cells of the immune system.

Self-reported use of Omega-3 supplements in the United Kingdom, the United States and Sweden showed a 12% lower risk of COVID-19 infection. Studies are currently underway to investigate if the supplements reduce the risk of COVID-19 and lower inflammation levels.

It is unlikely that omega-3 fatty acid supplementation will cause adverse side effects. But some side effects include unpleasant taste, odoriferous sweat, headache and gastrointestinal discomfort. 

Selenium

This essential mineral can be found in a number of foods, including eggs, seafood, Brazil nuts, dairy products and meat to name a few. This mineral supports the immune system on both the innate and adaptive functions. It reduces infection risk and is an antioxidant, so it reduces systemic inflammatory responses. 

Data is insufficient to recommend for or against the use of selenium to help treat or prevent COVID-19 symptoms. Safe supplementation with Selenium is between 45 and 400 mcg per day. Higher intakes can lead to symptoms such as metallic taste in the mouth, garlic breath, nail loss or hair loss among other symptoms. 

Zinc

This is another essential nutrient that can be found in a wide variety of foods. Zinc plays roles in the innate and adaptive processes. Zinc is also necessary for taste and smell. When someone is suffering from zinc deficiency, the formation, activation and maturation of their lymphocytes is affected. 

Studies have shown an association with low zinc status and viral infections. People with a zinc deficiency are also at high risk of diarrhea. 

Zinc may interact with some antibiotics, such as penicillamine, which is a drug that is used in the treatment of rheumatoid arthritis. The absorption of zinc can be reduced by some medications as well, such as some antibiotics and thiazide diuretics. 

 

Supplementing won't help you to prevent the COVID-19 infection, but it can make it easier for you to ride the waves of an infection without having to be admitted to a hospital.

 

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