Written by Belinda Anderson, Ph.D., director of the Monmouth University Institute for Health and Wellness
Anderson is the associate editor of Explore: The Journal of Science and Healing published by Elsevier. Explore is a Medline-listed journal, which is an index of the biomedical journal literature produced by the National Library of Medicine. All research in Medline is peer reviewed. Explore expedited the publication of a paper that speaks to the issue of safety with regard to supplements and the COVID-19 pandemic. Anderson discusses this paper below, which can be accessed online.
Many people self-medicate with over-the-counter supplements. Especially now during the COVID-19 pandemic, people are taking supplements to boost their immune system in case they are exposed to the virus. But is this safe?
The paper, entitled “Integrative considerations during the COVID-19 pandemic,” was written by a team of experts at the University of Arizona. In the paper they repeatedly state that–“no integrative measures have been validated in human trials as effective specifically for COVID-19.” However, based on in-vitro evidence and an understanding of the virulence of the virus, they provide advice on which supplements could be beneficial to prevent or treat mild symptoms of COVID-19, and those that are potentially harmful to COVID-19 infected people.
The paper begins by discussing the virulence and pathogenicity of the COVID-19 virus, and the importance of inflammation as a causative factor in the worst pathological aspects of the infection. COVID-19 activates the NLRP3 inflammasome, which results in the activation of the host immune system and the release of various proinflammatory cytokines. This understanding leads to a rationale as to what lifestyle practices and supplements can help prevention, and help or hinder recovery from mild infection.
To support the immune system and protect against infection the authors advocate for the beneficial role of adequate sleep, stress management, consumption of fresh fruit and vegetables, and supplements such as Zinc, Vitamin C, Melatonin, Elderberry and Vitamin D.
For people who appear to be, or are known to be, infected, and whose symptoms are mild, some supplements can be beneficial, and some should be avoided because they can potentially make the infection worse. The difference lies in whether supplements increase inflammatory cytokines or not. Increasing inflammatory cytokines adds to the already elevated cytokine levels due to the viral infection. Thus, taking supplements that further elevate inflammatory cytokines can lead to a cytokine storm, which is thought to be part of the acute viral pathology.
The authors recommend that mildly infected individuals should avoid such supplements as elderberry, medicinal mushrooms, echinacea, and vitamin D. However, other immunostimulatory supplements like garlic, peppermint, green tea, zinc, and vitamin A are safe to take because they do not cause an increase in inflammatory cytokines.
This is an important article for healthcare providers that have supplement prescribing in their scope of practice, and for people self-medicating to help prevent or treat mild symptoms of COVID-19. Making supplement decisions based on an understanding of the pathogenesis of COVID-19 is the best evidence-based medicine approach that we currently have.
This research also reinforces that just because supplements are freely available, does not always mean they are safe, and it is always best to seek professional advice from a healthcare provider that has supplements in their scope of practice, such as naturopaths, acupuncturists, functional medicine physicians, and chiropractors.