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Acute Covid-19 Infection- A Functional Medicine Approach



One of my followers is unfortunately infected with the SARS-COV-2 virus again. Their first infection was in November 2020 and they are still suffering with Long Covid.

They saw their non UK based doctor after a positive PCR test and were recommended the following:


  • albuterol - a short acting bronchodilator used for chest tightness and wheeze

  • azithromycin 250 mg - an anti-inflammatory drug proposed to reduce the cytokine storm

  • dexamethasone 6 mg - an immune suppressant

  • zinc 50 mg - protects the body from the virus entering, directly inhibits viral replication, balances the immune response


I was slightly alarmed by this! Not the zinc or the inhaler. Just the azithromycin and dexamethasone.

And the fact that NONE of the supplements that that are also known to help with an acute Covid infection are listed - the likes of Vitamin C, Vitamin D, Quercetin, NAC etc...

If you have been following me for a while you will know I am all about the EBM - evidenced based medicine.

Just look at these quotes from research studies printed in excellent medical journals:


In the Lancet - "In patients with mild-to-moderate COVID-19 managed without hospital admission, adding azithromycin to standard care treatment did not reduce the risk of subsequent hospital admission or death. Our findings do not support the use of azithromycin in patients with mild-to-moderate COVID-19".



In the New England Journal of Medicine - "The RECOVERY trial provides evidence that treatment with dexamethasone at a dose of 6 mg once daily for up to 10 days reduces 28-day mortality in patients with Covid-19 who are receiving respiratory support. We found no benefit (and the possibility of harm) among patients who did not require oxygen".


I have recently watched a podcast on The Doctor's Farmacy featuring Dr Patrick Hanaway. Here he w referenced the Institute of Functional Medicine who have provided a " Functional Medicine Approach to Covid-19 : Virus-Specific Nutraceutical and Botanical Agents ".

In this they have made recommendations for the treatment of confirmed COVID-19 illness (as per conventional standards and practice) so that they:


  • May reduce the severity and duration of acute symptoms and complications.

  • May support recovery and reduce long-term morbidity and sequelae.


The MOST IMPORTANT thing to note is that these recommendations are relatively inexpensive, are widely available, have EVIDENCE and have zero to very low risks associated with them. They do have a disclaimer though _

"This resource is only intended to identify nutraceutical and botanical agents that may boost your immune system. It is not meant to recommend any treatments, nor have any of these been proven effective against COVID-19. None of these practices are intended to be used in lieu of other recommended treatments. Always consult your physician or healthcare provider prior to initiation. For up-to-date information on COVID-19, please consult the Centers for Disease Control and Prevention at www.cdc.gov."


Their Recommended Interventions


ZINC Zinc contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. There is also evidence that it suppresses viral attachment and replication. Zinc deficiency is common, especially in those populations most at risk for severe COVID-19 infections, and is challenging to accurately diagnosis with laboratory measures. Supplementation with zinc is supported by evidence that it both prevents viral infections and reduces their severity and duration. Moreover, it has been shown to reduce the risk of lower respiratory infection, which may be of particular significance in the context of COVID-19.



ELDERBERRY

Elderberry (Sambucus nigra) is seen in many medicinal preparations and has widespread historical use as an anti-viral herb.15 Based on animal research, elderberry is likely most effective in the prevention of and early infection with respiratory viruses.16 One in-vitro study reported an increase in TNF-alpha levels related to a specific commercial preparation of elderberry,17 leading some to caution that its use could initiate a “cytokine storm.” However, these data were not confirmed when the same group performed similar studies, which were published in 2002.18 Therefore, these data suggest it is highly implausible that consumption of properly prepared elderberry products (from berries or flowers) would contribute to an adverse outcome related to overproduction of cytokines or lead to an adverse response in someone infected with COVID-19.


PO- means orally, qd means once a day


VITAMIN D

Activated vitamin D,1,25(OH) D, a steroid hormone, is an immune system modulator that reduces the expression of inflammatory cytokines and increases macrophage function. Vitamin D also stimulates the expression of potent antimicrobial peptides (AMPs), which exist in neutrophils, monocytes, natural killer cells, and epithelial cells of the respiratory tract. Vitamin D increases anti-pathogen peptides through defensins and has a dual effect due to suppressing superinfection. Evidence suggests vitamin D supplementation may prevent upper respiratory infections.



However, there is some controversy as to whether it should be used and the laboratory value that should be achieved. Research suggests that concerns about vitamin D (increased IL-1beta in cell culture) are not seen clinically. The guidance we suggest is that a laboratory range of >50 and < 80ng/mL serum 25-hydroxy vitamin D may help to mitigate morbidity from COVID-19 infection.



VITAMIN A

Vitamin A is a micronutrient that is crucial for maintaining vision, promoting growth and development, and protecting epithelium and mucus integrity in the body. Vitamin A is known as an anti-inflammation vitamin because of its critical role in enhancing immune function. Vitamin A is involved in the development of the immune system and plays regulatory roles in cellular immune responses and humoral immune processes through the modulation of T helper cells, sIgA, and cytokine production. Vitamin A has demonstrated a therapeutic effect in the treatment of various infectious diseases.



VITAMIN C

Vitamin C contributes to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Vitamin C accumulates in phagocytic cells, such as neutrophils, and can enhance chemotaxis, phagocytosis, generation of reactive oxygen species, and ultimately microbial killing. Supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections.78 Vitamin C has been used in hospital ICUs to treat COVID-19 infection.



N-ACETYLCYSTEINE (NAC)

N-acetylcysteine promotes glutathione production, which has been shown to be protective in rodents infected with influenza. In a little-noticed six-month controlled clinical study enrolling primarily elderly subjects, those receiving 600 mg NAC twice daily, as opposed to those receiving placebo, experienced significantly fewer influenza-like episodes and days of bed confinement.


bid means twice a day


QUERCETIN

Quercetin has been shown to have antiviral effects against both RNA (e.g., influenza and coronavirus) and DNA viruses (e.g., herpesvirus). Quercetin has a pleiotropic role as an antioxidant and anti-inflammatory, modulating signaling pathways that are associated with post-transcriptional modulators affecting post-viral healing.


bid means twice a day


EPIGALLOCATECHIN GALLATE (EGCG)

Green tea, in addition to modulating the NLRP3 inflammasome and, based on a preprint, potentially targeting the SARS-CoV-2 main protease (Mpro) to reduce viral replication, has also been shown to prevent influenza in healthcare workers.


CURCUMIN

Curcumin has been shown to modulate the NLRP3 inflammasome,101 and a preprint suggests that curcumin can target the SARS-CoV-2 main protease to reduce viral replication.


MELATONIN

Melatonin has been shown to have an inhibitory effect on the NLRP3 inflammasome. This has not gone unnoticed by the COVID-19 research community, with two recent published papers proposing the use of melatonin as a therapeutic agent in the treatment of patients with COVID-19.

(high doses may worsen brain fog and cause drowsiness - I would recommend higher doses only for acute infection)


RESVERATROL

Resveratrol, a naturally occurring polyphenol, shows many beneficial health effects. It has been shown to modulate the NLRP3 inflammasome. In addition, resveratrol was shown to have in vitro activity against MERS-CoV in an animal study.





I would be interested to know what you would do in this situation/ Would you take all the mainstream medications, or ignore them and choose the functional approach, or would you do both?


References

Azithromycin "Should azithromycin be used to treat COVID-19? A rapid review" https://bjgpopen.org/content/4/2/bjgpopen20X101094

Dexamethasone "Dexamethasone in Hospitalized Patients with Covid-19" https://www.nejm.org/doi/full/10.1056/NEJMoa2021436

The Functional Medicine Approach to COVID-19: Virus-Specific Nutraceutical and Botanical Agents

https://www.ifm.org/news-insights/the-functional-medicine-approach-to-covid-19-virus-specific-nutraceutical-and-botanical-agents/

The Doctor's Farmacy https://drhyman.com/blog/2020/12/23/podcast-ep150/

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