Integrative perspectives on coronavirus

Photo Cred: CDC/Unsplash

By Katherine Shagoury

Americans should prepare for a “significant disruption” from the coronavirus, according to representatives from the U.S. Centers for Disease Control and Prevention (CDC) in a telephone briefing earlier this week.

According to the CDC at press time, there are currently 14 confirmed cases in the United States, 12 travel-related and two person-to-person spread. There have been more than 82,000 confirmed cases worldwide, the majority of which are in mainland China. The WHO said the global risk is high.

The good news, experts say, is that symptoms are typically mild—fever, cough, shortness of breath—and some cases may not exhibit any symptoms at all. Severe symptoms and death have, thus far, been limited to at-risk patients, such as elderly and those with a preexisting condition.

But as fears and anxiety surrounding the coronavirus outbreak intensify, practitioners should prepare for inevitable questions about prevention and treatment. While the CDC offers its own comprehensive recommendations, we spoke with four integrative practitioners on what they recommend for helping patients find empowerment, boost immunity, and protect from respiratory illnesses like coronavirus.  

Much of the immune system resides in the gastrointestinal tract and nutrition is one important consideration when it comes to boosting immunity, according to Kellie Blake, RDN, LD, IFNCP, psychiatric dietitian at River Park Hospital in Huntington, West Virginia.

“There is no one magic food or nutrient, but rather the combination of nutrients and phytonutrients contained within the diet that helps to maintain a healthy immune response,” Blake said. “By educating patients on the importance of gut health, integrative practitioners can assist patients in maintaining a healthy immune response against the bacteria and viruses that cause illness.”

The gut microbiome is as unique as a fingerprint, Blake said, but there are some universal suggestions for maintaining gut microbiome balance. Removing foods and substances that are known to damage the gut lining and harm the commensal bacteria like gluten, refined grains, additives, ultra-processed foods, artificial sweeteners, added sugars, processed meats, inflammatory oils, excessive alcohol, and known food intolerances can help prevent dysbiosis and maintain healthy gut barrier function, she said.

In addition, increasing foods that fuel the commensal bacteria will also help to maintain the health of the gut microbiome and optimize immune system function.  

“Encourage patients to adopt a plant-centric meal plan that includes a wide variety of vegetables to maximize nutrient intake, specifically vitamin C,” said Blake. “Furthermore, adding daily fermented foods like sauerkraut, kimchi, apple cider vinegar, and yogurt can provide valuable probiotics. And daily consumption of prebiotic foods like garlic, onions, chicory root, bananas, and legumes will help fuel the commensal bacteria.”

The best offense is a good defense, according to Bill Reddy, L.Ac., Dipl.Ac., licensed acupuncturist at Inova Well in Fairfax, Virginia.

“Unless a person in your clinic is immunocompromised in some way, undergoing cancer treatment, HIV positive, or on anti-rejection drugs, then prevention is the best medicine,” he said.

Reddy suggests limiting refined sugar intake for any level of health promotion and disease prevention strategy, but it is especially important during flu season. A 1973 study suggests that the sugar contained in one liter of soda can reduce white blood cell function by 40 percent.

Maintaining quality sleep hygiene is also paramount to reducing chances of contracting a virus, he said.  Sleep deprivation has detrimental effects on immune-cell number, function, and cytokine production. Eight to nine hours of sleep is optimal for most people, although sleep needs vary with age, he said.

“Climbing in bed a half hour early will earn dividends in the fight against any virus,” Reddy said.

Although the evidence-base for vitamin C and immune function isn’t overwhelming, it certainly can’t hurt to take 1,000 to 3,000 milligrams of buffered vitamin C per day, Reddy said. Chinese herbs such as reishi mushroom (Ganoderma Lucidus), schizandra berry (Fructus Schizandrae), cordyceps mushroom (Cordyceps) and astragalus root (Radix Astragalus) can support immune function and would be useful to take during flu season. 

Stress is another major factor in immunity, so practicing any mindfulness meditation, tai chi, qigong, or yoga could be the extra defense that is needed to ward off infection.  Finally, universal infection precautions such as washing hands regularly, especially in crowded areas, can offer extra peace of mind and an added level of protection against any virus, Reddy said.

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Traditional Chinese Medicine (TCM) has a long history of managing and treating viral infections, according to Melissa Carr, B.Sc., Dr.TCM, registered doctor of TCM at Active TCM in Vancouver, British Columbia. In fact, one of the most ancient texts pertaining to health, the Huang Di Nei Jing (Inner Canon of the Yellow Emperor), written sometime around 300 B.C., recorded information about an upper respiratory plague that was transmitted via human-to-human contact.

During the severe acute respiratory syndrome (SARS) outbreak in 2003, 40 to 60 percent of infected patients received Chinese herbal medicine in addition to standard modern medical treatment, and consensus from the studies showed that the addition of TCM treatment resulted in better control of fever, improved oxygen saturation in critically ill patients, alleviation of symptoms like dyspnea, faster clearance of chest infection, and lower consumption of steroids.

The remedies chosen were mostly based on each individual’s differentiated TCM pattern of diagnosis, but herbs like yu xing cao (herba houttuyniae), jin yin hua (flos lonicerae), huang qin (radix scutellariae), and ban lan gen (radix isatis) have been shown to have antiviral and antibacterial properties, so they are often included. Other herbs commonly chosen for viral infections include ones from the TCM herbal materia medica classifications of “Clear Heat and Purge Fire” and “Release Exterior Wind Heat.”

For prevention, because every individual is different and patterns of imbalance vary, it’s important to strengthen the person by addressing that person’s digestive issues, stress management, pain challenges, sleep dysfunctions, and other areas that can draw away the body’s ability to deal with an infection, according to Carr.

“When patients ask how they can avoid the coronavirus, I work on foundational health,” she said.

For those who tend to have weak immune systems and struggle with fatigue and recurrent colds, the TCM formula Yu Ping Feng San may be suitable, Carr said. This formula has been shown to have anti-inflammatory effects for the respiratory system, stimulate phagocytic activity, and improve immune response. It is composed of huang qi (radix astralagi), bai zhu (rhizome atractylodis macrocephalae), and fang feng (radix saposhnikoviae). Many western herbalists are now familiar with the chief herb in this formula, astragalus, as an immunosupportive herb, she said.

Carolina Brooks, ND, BA, IFMCP, a functional medicine practitioner, said she believes we do not fully understand the severity and transmissibility of this disease yet, but it’s clear that the elderly and the immunocompromised are most at-risk. She said she believes in a more practical approach, individuals working on their own terrain and considering compounds that will support their unique immune response against aggressive pathogens.

As someone who travels frequently, she offers several practical recommendations. She sprays colloidal silver on scarves and covers her face, but does not wear a mask, for example.

A 2013 paper in Science looked at the link between immune function, circadian rhythm, with jetlag increasing risk of inflammatory disease and increasing Th17 cell differentiation. Brooks does her best to mitigate jetlag when traveling by exposing herself to light at the correct times and using melatonin to make sure she gets enough sleep. She fasts for most days for twelve to sixteen hours a day, and takes a regular cocktail of ginger, cayenne, and turmeric shots with a litre of green juice daily, even when she’s on the road.  

“When people tell me they can’t follow a regime when they travel,” Brooks said, “I advise them it’s possible, you just need to be prepared to venture out to a supermarket or ask restaurants to tweak things for you.”

Brooks said she does not carry all my supplements with her when she travels, but always takes one gram of glutathione daily, large doses of vitamin D with K, and drinks echinacea tea throughout the day.

She also always takes a bespoke herb tincture blend, usually full of adaptogens, immune, and gut support. Recently, she has been more focused on addressing acute and chronic coronavirus exposure. She chooses herbs in her prescriptions based on the following objectives:

1. The affinity of the plants to the systems the virus affects, in this case the respiratory, digestive, and nervous systems
2. The herbs should have strong anti-viral activity
3. The herbs should be effective against resistant infection
4. The herbs should have anti-inflammatory and immunomodulating properties
5. The herbs should contain useful compounds such as emodin, a compound which a 2007 paper in Antiviral Research recognized as a significant therapeutic agent in the treatment of a coronavirus protein
6. Some of the herbs should be adaptogenic to support resilience and circadian shifts when travelling

This list of herbs I have used which synergistically work together to combine these properties and achieve my prescription objectives includes Japanese knotweed, Turkey rhubarb, Dan Shen, Cordyceps, Chinese goldenthread, Baikal skullcap, liquorice, cinnamon, Isatis, Siberian ginseng, and elder.

“I’m taking this tincture blend at a dose of 10 millilitres three or four times a day when I travel, and twice a day when I am on the ground,” she said.

References

Cui, H., Li, Y., Guo, L. (2020). Traditional Chinese medicine for treatment of coronavirus disease 2019: a review. TMR Journals. Retrieved from: https://www.tmrjournals.com/tmr/EN/10.12032/TMR20200222165?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Traditional_Medicine_Research_TrendMD_1

Du, C., Choi, R., Zheng, K.(2013). Yu Ping Feng San, an ancient Chinese herbal decoction containing Astragali Radix, Atractylodis Macrocephalae Rhizoma and Saposhnikoviae Radix, regulates the release of cytokines in murine macrophages. PloS one, 8(11), e78622. Retrieved from: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0078622  

Huang, J. Su, D., Feng, Y. (2014). Antiviral herbs—present and future. Infect Disord Drug Targets. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/25159303

Ho T, Wu S, Chen J, Li C, Hsiang C. 2007) Emodin blocks the SARS coronavirus spike protein and angiotensin-converting enzyme 2 interaction. Antiviral Research. Volume 74, Issue 2, May 2007, Pages 92-101. Retrieved from: https://www.sciencedirect.com/science/article/pii/S0166354206001215?via%3Dihub

Leung, PC. (2007). The efficacy of Chinese medicine for SARS: a review of Chinese publications after the crisis. Am J Chin Med. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/17708624

Liang X., Huang Y., Pan, X. (2019). Erucic acid from Isatis indigotica Fort. Suppresses influenza A virus replication and inflammation in vitro and in vivo through modulation of NF-κB and p38 MAPK pathway. Journal of Pharmaceutical Analysis. Retrieved from: https://www.sciencedirect.com/science/article/pii/S2095177919301583?utm_source=TrendMD&utm_medium=cpc&utm_campaign=Journal_of_Pharmaceutical_Analysis_TrendMD_1

Qin, Q., Niu, J., Wang, Z. (2012). Astragalus embranaceus extract activates immune response in macrophages via heparanase. Molecules. Retrieved from: https://www.ncbi.nlm.nih.gov/pubmed/22695229

Yang, Z., Yan, J., Han, N.(2016). Anti-inflammatory effect of Yu-Ping-Feng-San via TGF-β1 signaling suppression in rat model of COPD. Iranian journal of basic medical sciences. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5080430/

Yu X, Rollins D, Ruhn KA, Stubblefield JJ, Green CB, Kashiwada M, Rothman PB, Takahashi JS, Hooper LV (2013) Th17 cell differentiation is regulated by the circadian clock. Science. 8 Nov 2013, Vol. 342, Issue 6159 p. 727-730. Retrieved from: https://science.sciencemag.org/content/342/6159/727.