SURVIVING THE PANDEMIC:
A SUMMARY of RESEARCH on SUPPLEMENTS which MAY REDUCE COVID 19 SEVERITY, by Margaret Kluthe, M.D.
Tired of being told to take ‘this vitamin’ or ‘this supplement’ to ‘boost your immune system’, but no-one can say if there’s any science to it? Then this article is for you — a slightly ‘wonky’ summary of over-the-counter medications and supplements which may, or may not, decrease Coronavirus severity; it also includes the ‘wonky’ references to readable reports on the research.
This paper summarizes common supplements, including those given to President Trump for Covid-19 (he also received prescription and experimental medications). It is for educational purposes and does not recommend for or against any supplements; individuals should consult their primary care provider prior to taking them.
The most critical measures for surviving this pandemic are to stay home and, when/if you have to go out, practice ‘social distancing’, wear a mask at all times, avoid establishments without universal mask-wearing mandates and wash your hands often. Only these, and vaccination, can blunt the spread of coronavirus!
SUPPLEMENT SUMMARY: A complete multivitamin is beneficial and contains sufficient vitamins to supplement a good diet, although extra vitamin D is often needed. However, additional supplements could have value during the COVID-19 pandemic, but data is preliminary and not conclusive. The two doctors below have different approaches, and both of them take vitamin D.
Dr. Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, takes Vitamin D and C to support his immune system. He stated that, in addition to vitamin D, “If people want to take a gram or so of vitamin C, that would be fine, but the other supplements are useless.” <https://bgr.com/2020/09/28/coronavirus-treatment-vitamin-d-anthony-fauci-recommendation/>
Dr. Paul Marik, MD, Chief of Eastern Virginia Medical School’s Pulmonary and Critical Care Medicine division, takes a different approach and shared the supplements that he was taking in a May 2020 article. They are:
· Vitamin D 1,000 IU (OTC Vitamin D3)
· Vitamin C 500 mg
· Zinc 75 mg
· Melatonin 1–2 mg
· Famotidine (Pepcid AC) 10 milligrams.
“Vitamins to help fight COVID — and some might surprise you!” Kurt Williams, Posted at 8:03 PM, May 27, 2020. <https://www.wtkr.com/news/coronavirus/vitamins-to-help-fight-covid-and-some-might-surprise-you>.
RESEARCH: In most studies of OTC products, patients were asked what supplements they were taking at the time of diagnosis or hospitalization with Covid-19, then differences in the severity of their illness were compared to patients not on supplements. This type of study identifies substances ASSOCIATED with better or worse outcomes, but does not prove the product itself caused the difference. For example, in colonial New England, communities building more churches saw more taverns springing up ten years later. This association of churches and taverns was not causative; both reflected increased population growth. Likewise, an association between a supplement and improved outcome does not prove that it was the supplement that made the difference.
Vitamin deficiencies versus over-supplementation: Vitamin deficiencies may place people at risk for more serious disease, but supplements may not help individuals who are not deficient, and excessive amounts can be harmful. For example, children with low vitamin A levels are more likely to die of measles and supplements increase their chance of survival, but extra vitamin A does not decrease illness severity in children with normal vitamin A levels.
Nutritional references and recommended daily allowances (RDA’s) and upper limits (UL’s) were obtained from the Harvard T.H. Chan School of Public Health website. <https://www.hsph.harvard.edu/nutritionsource/vitamin-c/>
VITAMIN D RECOMMENDATIONS for OTC VITAMIN D3: Recommended Intake:
1. Age 19–69 years: 600 units/day. Age over 70: 800 units/day.
2. Upper limit for OTC Vitamin: 4,000 units/day (Vitamin D3).
3. Many specialists suggest 1,000 to 2,000 units/day during winter. Some doctors suggest temporary, higher doses for people at risk for low Vitamin D and COVID-19.
4. Excessive Vitamin D levels, although rare, can be harmful.
5. Individuals whose physician recommended other doses, or who are taking prescription vitamin D2 (ergocalciferol, which is dosed differently), should continue as instructed.
LOW Vitamin D levels are common in Northern climates. Vitamin D is a hormone produced when sunlight acts on the cholesterol in the skin to synthesize it. “Unless you live in a (warm) sunny country or eat a very large amount of oily fish, you are quite likely to need supplements to maintain a normal level,” per Professor Jon Rhodes. Vitamin D helps control infection, reduces inflammation and may decrease autoimmune disease. https://www.bbc.com/news/health-52371688.
Previous studies have shown that Vitamin D deficiency is linked to increased risk of respiratory infections. A randomized, controlled trial found that Influenza A rates in the vitamin D supplemented group were about 40% lower than in the placebo group”. Harvard School of Pub Health. <https://www.hsph.harvard.edu/nutritionsource/vitamin-d/>.
Low vitamin D levels are associated with increased risk of COVID-19 infection, severe disease and death. Early on, it was noted that populations with lower vitamin D levels (i.e. people in Italy, people of color living in northern climates and people living in nursing homes) had higher Covid-19 hospitalization and death rates.
Vitamin D deficiency is present in 25 to 40% of the population and may increase susceptibility to Covid-19. A study of Covid-19 rates found that individuals with documented low vitamin D levels (from earlier testing) were nearly twice as likely to be positive for Covid-19: “Among 489 people, those with low vitamin D levels were 77% more likely to test positive.” ‘Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results’, David O. Meltzer, MD, PhD1; Thomas J. Best, PhD2; Hui Zhang, PhD2; JAMA open network, 9–3–2020. <https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770157>. <https://news.uchicago.edu/story/vitamin-d-deficiency-may-raise-risk-getting-covid-19-study-finds>
Higher COVID-19 death rates have been found in patients with low vitamin D levels. Among hospitalized patients over age 40, patients with good vitamin D levels had half the death rate (9.7%) compared to the 20% death rate in patients with low levels (less than 30 ng/ml.). “In addition, blood markers of inflammation were lower and disease-fighting lymphocytes higher in patients with (good) Vitamin D levels.” ‘Vitamin D sufficiency, a serum 25-hydroxyvitamin D at least 30 ng/mL reduced risk for adverse clinical outcomes in patients with COVID-19 infection’. Zhila Maghbooli, et al. Published: September 25, 2020, <https://doi.org/10.1371/journal.pone.0239799> <https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239799>
ZINC Dosing range 15–40 mg/day, UL is 40 mg/day
The RDA for adults is 11 mg/day for men and 8–12 mg/day for women
Adequate Zinc intake is important for healthy immune cell functioning. Even mild Zinc deficiency causes slower activity of our disease-fighting white cells which protect against viruses and bacteria. Harvard TH Chan School of Pub Health. https://www.hsph.harvard.edu/nutritionsource/zinc/
COVID-19 patients with low Zinc levels had more serious illness and higher death rates. Among 249 hospitalized COVID-19 patients in Spain, there was greater inflammation and more ICU admissions in those with low zinc levels. The average zinc level of patients who died was 43 mcg/dL, compared to 63 mcg/dl in those who survived. Roberto Guerri-Fernandez et al, Hospital Del Mar, Barcelona, presented during a conference on Covid-19. <https://www.webmd.com/lung/news/20200923/could-zinc-help-fight-covid-19>
ASPIRIN, (acetylsalicylic acid or ASA), 80 mg once a day. Aspirin should be taken with food and can cause gastric irritation, bleeding ulcers and worsen kidney disease. Individuals should consult their doctor before starting it.
Blood clots in the lungs, strokes and heart attacks have occurred with COVID-19, sometimes early in the illness, and small clots have also been found in many organs during COVID-19 autopsies. Aspirin appeared to reduce Covid-related blood clots in a few studies.
“A daily dose of aspirin may help reduce the risk of serious complications from COVID-19”, per researchers from the University of Maryland School of Medicine. Doctors found that “COVID patients had fewer complications when they took aspirin.” Among 412 patients, 98 of them received aspirin a week before hospital
admission, or within 24 hours of admission. “The patients given aspirin were 43% less likely to be admitted to the intensive care unit (ICU), 44% less likely to be placed on mechanical ventilation, and 47% less likely to die in the hospital”, said Jonathan Chow, M.D. https://www.webmd.com/lung/news/20201105/researchers-say-aspirin-may-help-covid-patients
FAMOTIDINE (PEPCID) is an anti-acid medication.
A Wuhan study reported that Famotidine (Pepcid) might reduce Covid-19 severity. In the early days of the pandemic, it was observed that patients taking it had half the death rate of their peers.
A U.S. study found fewer complications, intubations and deaths among patients on famotidine. In a high-risk group, intubations were 32% fewer for patients on famotidine, and deaths were 44% lower, with 14.5% of patients on famotidine dying compared to 26% not taking it, reported Jeffery F. Mather. Mather JF, et al, American Journal of Gastroenterology, 8/2020. <https://www.cleveland.com/coronavirus/2020/08/new-research-reinforces-theory-that-pepcid-heartburn-medication-might-help-your-body-battle-coronavirus.html>
MELATONIN is produced by the brain to induce sleepiness, and may reduce Covid-19 susceptibility and could benefit patients in the ICU.
A small observational study found that melatonin use was linked to a reduced likelihood of being positive for COVID-19. Research by Feixiong Cheng found that “People taking it had significantly lower odds of developing COVID-19, (or) dying of it,” possibly due to its ability to modulate immune over-reaction. ‘Melatonin Could Potentially Treat COVID-19’, Carolyn Crist, Web MD, 11–12–2020, <https://www.webmd.com/lung/news/20201111/melatonin-could-potentially-treat-covid-19> and < https://www.theatlantic.com/health/archive/2020/12/covid-19-sleep-pandemic-zzzz/617454/?fbclid=IwAR1xrL32Tz26ko72De7lEn12dyGc5_V_GVWvpfm4fM8ToLrhBCkVERgX8hA>
For severely ill patients, melatonin may have additional benefits. “Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation need, and improving sleep quality, which might also be beneficial for better clinical outcomes for COVID-19 patients.” <pubmed.ncbi.nlm.nih.gov/32217117>
VITAMIN C: The RDA for Vitamin C is about 100 mg/day.
The Upper Limit, or highest safe dose, is 2,000 mg/day. High doses of vitamin C can cause gastric irritation and diarrhea.
Vitamin C is important for healthy immune system and, because it is a good antioxidant, it also decreases inflammation. https://bgr.com/2020/09/28/coronavirus-treatment-vitamin-d-anthony-fauci-recommendation/
Vitamin C helps the immune system fight infections, but there are no studies regarding its effectiveness against the coronavirus. Vitamin C is found in oranges, red peppers, kiwi fruit, strawberries, broccoli and many fruits and a healthy diet should include these foods. A moderate supplemental dose may give additional immune system support. ‘Vitamins to help fight COVID — and some might surprise you’ Kurt Williams, May 27, 2020. <https://www.wtkr.com/news/coronavirus/vitamins-to-help-fight-covid-and-some-might-surprise-you>
IN CLOSING, some supplements and OTC medications may mitigate the severity of COVID-19 for many people. Unfortunately, research to date is not definitive and most studies were retrospective. Protecting yourself and family from contracting COVID-19 is critical. This review is for informational purposes to assist discussion with your medical provider and the author does not recommend for or against them.
Margaret Kluthe, M.D., is a retired pediatrician in Ogden, Utah. References available on request. margaretkluthe@outlook.com
