Please note that this information is not a substitute for the continually updated official information from appropriate health authorities including the Centers for Disease Control and Prevention and the World Health Organization, nor for your primary care provider.
I know you’ve been waiting to hear from me on how to prevent and treat COVID-19 naturally, particularly the herbs and supplements I recommend, what I think about elderberry and cytokine storm, and more. In this article I’ll be discussing these, and in a subsequent article, coming in the next couple of days, I’ll talk about natural therapies for COVID-19 symptoms, whether they work, what’s appropriate to try, and when to get medical care.
While herbs are an important part of my life and work this is really a time to be cautious about who you listen to and conservative about what you try. In this article I share important prevention strategies and which herbs and supplements are safe and have enough evidence to support immunity that they seem worth a try.
But before I jump into natural therapies for immunity, I want to address what’s happening in the natural medicine community.
COVID-19: Health Click Bait That's Good for the Wellness Industry (But Maybe Not Good for You and Me)
I feel I’m in a bit of a déjà vu when it comes to COVID-19. As soon as SARS hit in the early 2000s, and then again when H1N1 hit, there was no shortage of information from ‘experts’ on what natural medicines you can take (and buy) for prevention and cure of what, each time, was an entirely new infection with no research on the infection, let alone the herbs or supplements, and no precedent for traditional use – as the infections were entirely new!
At that time, I was the president of the leading professional organization for herbalists in the US and one of the largest in the world. Seeing the glut of articles, advertisements, and products being hawked, I, along with the leaders of two other natural medicine organizations published a press release stating that this was a real medical condition, not a hoax as some proposed, that the situation was still emerging and we really didn’t know the extent of the threat, and begging people to please not forego commonsense approaches to prevention and appropriate conventional medical testing and care should you think you have the disease, or should you appear to have a severe case or complications.
The differences now are that:
- The Internet has become massive, and there’s no shortage of influencers and experts, many of whom are not experts at all,
- Integrative and functional medicine then fringe, have now become mainstream, and access to ‘alternative testing’ and supplements is nearly ubiquitous,
- And there are players, big and small in the natural medicine arena, more than willing to profit (substantially!!!) off of half-truths, hyperbole, and your fear by selling you tests and treatments they swear work.
We live in a world in which an outbreak of this magnitude is click-bait. It’s an opportunity for health-influencers of all sorts to position themselves as leaders and experts even when they have no training in public health, infectious disease, or natural therapies, and have no clinical experience (I actually have an extensive amount of all four), and it’s an opportunity for supplement companies to cash in – and they are. Of course, within that there are many well-meaning people, including those who may even be personally loading up on the supplements and treatments they are selling.
But over the past ten days especially, as COVID-19 has spread rapidly across the planet and landed solidly on US shores, I’ve seen quite a lot of content on the internet from the integrative, herbal, and functional medicine worlds that has really disturbed me.
Here are just a few examples:
- The founder of a well-known medical start-up, promoting itself as the medicine of the future, provided what on the surface appeared to be a reasonable and important analysis of the fact that chronic illness now rampant in the US makes people more vulnerable to infections and complications from them, and rightly attributes this to a broken health care system. So, where’s the problem? The big take-home of the article (and accompanying series of Instagram posts) is that you might want to get lab testing for chronic diseases – and while you’re reading the article, you get a pop-up offering you that very testing if you join that practice. We do know that having a chronic health condition like diabetes does increase one’s risk of complications not just from this new novel virus, but from flu and most other infections. There are no lab tests that can tell you if you are high risk for contracting COVID-19.
- A well-known herbalist touting that he has personally cracked the code on what causes this novel coronavirus and makes humans physiologically susceptible – and not only that – he’s selling the herbs to boost your immune system and protect you against the disease. I can guarantee you he is not being nominated for the Nobel Prize in Medicine this year, and that he has not cracked a code that scientists world-wide – good people like you and me with families they also want to protect – have not yet cracked. Even companies that stand to make billions on vaccinations and treatments, with research teams on this 24/7 right now to be first to market, haven’t figured it out.
- One of the largest natural “medicine” websites alleges (falsely) that the use of high dose (intravenous!) Vitamin C is a cure for COVID-19, and is being used in other countries as an effective cure. then links to a company that sells IV Vitamin C therapies.
I’ve also seen a lot of emotional and spiritual platitudes, I’m sure meant to be well-meaning reassurance and inspiration, but which I find, at best, fall flat as disingenuous, and at worst, frankly disrespectful. For example, a well-known health celebrity posted, and another shared that COVID-19 is forcing us all to slow down, make time to be more present in our lives, and recognize our powerful connection to nature. Really? How’s that working for the people who have lost their jobs in the service industry because the café, restaurant, or retail shop they work at closed? The single mom who can’t stay home and do crafts and play cards with her kids, whose schools have closed, and she’s scrambling to find child-care and not lose her job? The doctors, teachers, and others working overtime, and also facing exposure to SARS-COV-2, the virus responsible for COVID-19 infection? Or the people of entire countries such as Italy that are essentially locked down, with those sick facing severe shortages on life-saving medical equipment, and whose death rate from COVID-19 has now surpassed China's?
And sadly, I’ve seen what I consider completely inappropriate humor such as an Instagram tile with a ‘joke’ about how “something was going to kill us all eventually anyway, so it may as well be this, we should therefore all just spit in each other’s mouths and die, and let the animals take over the planet.” While we all need levity in dark times, as I read that I was horrified at the trivialization of a condition that public health officials and physicians around the world are working hard to keep tabs on for our protection, that has caused thousands of people to have to bury a family member, and as one of my online follower's brother-in-law was struggling for his life, one of the first COVID-19 cases in his state, and my best friend was stressed and exhausted about what to do if his practice had to close – or he got sick – in the wake of their first COVID-19 positive test result from a patient this week. COVID-19 is not a drill – and it’s not funny, so I’ve taken to privately writing to integrative practitioners posting jokes on their social media – asking them to have some respect for the families, health care providers, schoolteachers, service workers, and others.
I’m sorry to sound snarky. It’s just really pisses me off because I know you’re concerned and looking to people you can trust. On the one hand the medical establishment is saying all natural approaches are ridiculous, but on the other, there are many incredulous claims and I don’t want you to get duped, sold, or worse, harmed – for example, by taking excessive doses of supplements or jumping onto the IV Vitamin C bandwagon. In these times, I feel obligated to call BS when I see it. Maybe I shouldn't be apologizing at all.
Staying Safe With a Natural Approach
There are 4 big risks when following a natural approach to not only COVID-19 prevention, but any potentially serious illness:
- Foregoing practices that are known to be preventative, like those on the CDC website – including wearing a face covering (i.e. mask) – that we should all be diligently observing.
- Not getting necessary medical treatment.
- Taking harmful substances, or taking possibly harmful doses of otherwise generally safe substances.
- Ignoring side-effects of supplements or contraindications that might be unique to your situation.
Following the tips in the remainder of the article should help you to prevent these risks.
First Things First, Follow These 4 Steps
While it may seem like overly simplistic guidance, the best way to prevent illness is to avoid being exposed to the virus. And if you are exposed, to avoid getting infected by it. The basics of preventing infection spread are the most important place to start for this and any infection – including the flu which is currently still much more prevalent and likely to affect you personally than COVID-19. These are also steps you can take even if the supplement aisle shelves are empty at your local stores!
1. Wash Your Hands…Properly
Dance like no one is watching. Wash your hands like the entire world is watching.
One of the most practical, commonsense steps to prevent infection is washing hands. Coronaviruses, like this year's version that has so far caused at least 250,000 infections worldwide, are encased in a lipid (fatty) envelope. Just like soap cuts grease and fat on your hands and dishes, soap can break that fat apart and make the virus less able to infect you.
So wash your hands often with soap and water for at least 20 seconds, especially after blowing your nose, coughing, or sneezing, going to the bathroom, and before eating or preparing food. Sounds simple? It is – but you'd be surprised by how many people don't follow these basic guidelines.
How to Wash Your Hands
A 2013 study found that of more than 3,700 people observed by trained observers, only about 5% of them washed their hands properly for disease prevention. One in four people use the “splash and dash” method – wetting their hands but not using soap, only 5% spent more than 15 seconds washing, rubbing, and rinsing their hands, and only 1 in 10 washed after using the restroom. In general, most people wash their hands for only about 6 seconds. So how do you wash hands properly? Turn on the water (hot and cold work equally well) lather up, and sing the happy birthday song TWICE while thoroughly rubbing soap all over your hands, then rinse and dry your hands. Of note, liquid soap cleans germs off of hands; foam soap not so much. If you're in a public bathroom, and there's no soap, just rubbing your hands together under the water does do some good.
- If soap and water are not readily available, use an alcohol-based hand sanitizer with at least 62% alcohol, covering all surfaces of your hands and rubbing them together for at least 20 seconds, or until they feel dry. Chances are right now, though, soap is more available than hand-sanitizer!
- Touching high contact surfaces in public, for example, handrails on stairs and escalators) whenever possible. When possible, use just your elbow or knuckle to touch light switches. buttons on elevators etc., use your hip to open doors, and wash hands after pumping gas.
- Handshakes – this is a great time to simply smile and say hello, or try an elbow bump. Folks will get it.
- Sharing drinks, food, utensils and other personal items, particularly with those outside of your intimate family members.
And some basic quirky practical steps I learned in medical school when I was exposed to environments rife with bacteria and viruses include:
- Regularly cleaning your own high-touch surfaces, for example, the touchscreen on your phone and your computer keyboard.
- Wipe down shared computer surfaces before using, and wash hands after touching such surfaces.
2. Avoid Touching Your Mouth, Nose, and Eyes
Avoid touching your eyes, nose, and mouth with unwashed hands as much as possible. This is no small feat considering that we do it on average a few hundred times daily. When you're out, keep your hands in your pockets – it really makes you more conscious of the urge to touch your face. If there are triggers that usually lead to touch your face (i.e., wiping mascara from the corner of your eyes), learn to recognize and avoid doing it – most of these are quirky little habits we don't even realize we have.
Should I Wear a Face Mask?
Wear cloth face coverings in public settings when around people outside of your household, and especially when other social distancing measures are difficult to maintain. If you have symptoms and you live with others, a mask is appropriate at home to prevent spread of infection to them.
3. Avoid Exposure As Much As Possible
Social distancing is very important. DISTANCING is defined as staying at home when you're not out for essential activities or a walk, avoid contact with those with likely COVID-19 symptoms, exposure, or positive test results, keep 6 feet distance from others outside your home. But social distancing is different than social isolation, which none of us should have to endure. Learn how to practice social distancing while staying connected here.
4. Seek Appropriate Medical Care When Needed
When is medical care necessary? Seek prompt (or emergency!) medical care if you have any of the following symptoms:
- Difficulty breathing or shortness of breath
- Persistent pain or pressure in the chest
- New confusion or inability to arouse
- Bluish lips or face
- Your illness is worsening
- Any other serious or unusual symptoms
Bridging Commonsense and Natural Medicine
Natural medicine isn't all about the supplements; a healthy lifestyle is actually the foundation for immune health. In my own steps to prevent infection with SARS-COV-2, I'm following the above precautions and am solely doing the two following things: eating well and getting enough rest. You heard that right; other than the multivitamin I take most days, I'm not taking any special supplements. However, as you'll see, my diet naturally provides me with a host of herbs and nutrients.
Eat a nutritionally rich diet: A healthy diet is one of the keys to a healthy, robust immune response when you do get exposed to viruses and bacteria. Keep your diet simple, light, and eat healthy foods only. An optimally healthy diet is a basic Mediterranean-style diet that includes 6 to 8 servings of fresh veggies and fruits daily, nuts, seeds, whole grains, legumes, fish, and eggs.
Get Enough: Sleep quantity and quality play a role in immune health, and lack of adequate sleep can make us more susceptible to colds, the flu, and can impair immune response more generally, while creating a generally heightened inflammatory state. How much sleep do most of us need for optimal health? No less than 7 and no more than 9 hours per night of good rest. Having sleep troubles? The tips I share here might help.
Again, these are things you can do if you're unable to access supplements when shelves are empty or you don't have stores in your community.
Natural Approaches that are Reasonable, Might Be Immune Supportive, and “Can't Hurt” If You Want to Try Them
So, the big question you have for me is: Are there any natural preventative strategies that could be helpful, aren’t harmful, and might be worth trying or worth the expense if a supplement or herbal purchase is required? Let’s look at these together.
The bottom line is that there are no supplements or herbs that are, at this time, known to prevent or treat COVID-19, and there’s no evidence whatsoever that boosting your immune system will prevent COVID-19, or mitigate the severity of your illness should you get sick. As one of my colleagues stated so well, most of us have healthy functioning immune systems – it’s not like our immune systems are a flat tire waiting to be pumped up.
That said, many of us are running around exhausted and depleted a lot of the time, are low in some nutrients that might help prevent viral infection generally, and when there’s no harm in gentle supplementation, several of these are probably worth trying, as it’s nice to feel you’re doing something extra for yourself (and those in your care) during trying and uncertain times.
Based on 35 years of extensive research and clinical practice, I do strongly feel that nutritional supplements and botanical medicines have a strong role to play in immune support. There are also many herbs with a history of traditional use for improving immunity and resilience. While some nutrients and herbs do have anywhere from a small amount of weak trials to more robust supportive evidence for the prevention of cold and flu, keep in mind, COVID-19 is not the common cold – nor is it the flu – and we have no idea how that evidence applies to either of the current strains of coronavirus causing COVID-19. Further, even when nutrients or herbs may be effective, there is tremendous variation in potency and quality of individual products.
That said, the following supplements have moderate evidence for prevention of cold or flu and I consider them generally safe for most individuals to take. Exceptions for specific groups or those with specific conditions are noted.
Zinc plays an important role in immunity, helping the body to fight invading bacteria and viruses, and may help the lining of the respiratory passages prevent against viral replication and inflammation. The best form for preventing respiratory infection is zinc lozenges, preferably zinc acetate, which may also help to reduce the severity of upper respiratory symptoms associated with colds. I don't recommend nasal sprays which can alter sense of smell, or zinc tablets or pills, as they aren't as well absorbed. A dose of 5 to 10 mg/day is typically enough, but you can take up to 45 mg/day for up to a few weeks. I recommend the lower doses for pregnant women and breastfeeding women (make sure to also see how much is in your prenatal vitamin). As I learned the hard way from two vomiting young children on a cross-country car trip about 3o years ago, zinc supplementation can cause nausea and vomiting, so preferably take your zinc supplement with a meal, though many combination lozenges that contain other herbs and honey, for example, are less nauseating.
Zinc supplements can interfere with the absorption of certain medications including quinolone or tetracycline antibiotics. If antibiotics are required for the treatment of COVID-19 complications or another infection, discontinue supplementing with extra zinc. It may also interfere with diuretics and medication used to treat Rheumatoid Arthritis – so check with your doctor if you're taking either before supplementing with zinc.
Vitamin D is a fat soluble vitamin that has an important effect not only on bone health, but on immune function and ability to fight infections. According the a 2017 meta-analysis in the British Medical Journal, vitamin D supplementation was safe and it protected against acute respiratory tract infection overall. Individuals who were very vitamin D deficient experienced the most benefit from taking it. A study published in Thorax found that Vitamin D deficiency is common in people who develop Acute Respiratory Distress Syndrome (ARDS), one of the feared complications of COVID-19, and per this report, appears to contribute to the development of the condition.
The best form of vitamin D for maximal absorption is Vitamin D3, and supplementing between 1000- 2000 IU/day is a safe and ample dose for most people, and is safe during pregnancy and breastfeeding. Per the Office of Dietary Supplements, up to 4,000 IU/day for children 9 years and older, adults, and pregnant and lactating women is considered quite safe. Children's doses are typically 400 to 800 iu daily.
For best absorption, try taking it with a meal that also contains healthy fats, like salmon or avocado, though it can be taken any time. Food sources of Vitamin D include fatty fish such as salmon, tuna, and mackerel, and cheese, while egg yolks provide small amounts.
Vitamin C is probably the most commonly recommended nutrient for cold and flu prevention, and there’s a reason for it. Not only does it help immune cells function properly, nearly 150 studies demonstrate that it can help fight different pathogens and supports the health of the respiratory passages. But those are all animal studies. Can if help prevent colds and flu in people? Here’s what a 2013 Cochrane Database Meta-analysis, based on 29 trial comparisons involving 11,306 participants, had to say:
- Vitamin C appears to lead to a 50% reduction in the likelihood of catching a cold in athletes who “perform regular or acute bouts of intense exercise” compared to athletes who don’t take Vitamin C.
- Cold duration may be reduced by about 8% in adults who take vitamin C regularly, and colds may also be less severe.
Given the low cost and relative safety of vitamin C supplementation, and its possible benefits preventing respiratory infections, it seems worth including it in an overall daily cold and flu prevention plan and isn’t contraindicated in a COVID-19 prevention plan. A typical dose is up to 2000 mg daily. This dose is also safe for pregnant and breastfeeding people. Children’s dosing is substantially lower. Can't find vitamin C because everyone else has bought it up? Oranges and grapefruits are important sources of Vitamin C, as are red and green peppers, kiwifruit, broccoli, strawberries, cantaloupe, and baked potatoes, so eat a wide variety daily.
What about Probiotics? Probiotics are attributed with myriad benefits and numerous mechanisms by which they support immunity – and indeed, a healthy microbiome is mission critical for an overall healthy immune response. But what about taking probiotics for prevention of colds, flu, and other respiratory infections? A 2015 Cochrane Database review found no evidence that probiotics prevent respiratory infection; a subsequent review, though perhaps a less reliable one, found some possible benefits for children. athletes, and the elderly. Nonetheless, a typical probiotic product containing an array of Lactobacillus and Bifidobacterium species is considered safe for most people (if you have IBD or are immunodeficient speak with your health care provider before supplementing), and is safe during pregnancy and breastfeeding. Have some unexpected time on your hands right now and want to learn more about your microbiome and probiotics? They're fascinating – and my guest here on Natural MD Radio is one of the world's leading microbiome researchers!
Echinacea is an herb traditionally – and still commonly – recommended for the prevention and treatment of the common cold. Numerous studies, including a Cochrane Database Review, found that echinacea provides consistently positive results, but not necessarily at clinically significant levels. Herbalists contend that inconsistent or underwhelming study results are due to the use of lower quality products, inadequate dosing, or both. Because echinacea is safe for most people, and does show some benefit for upper respiratory infection prevention, and prevention of recurrent infection, I consider it a reasonable part of a prevention program for colds. While there is no evidence yet for any herbs or supplements treating COVID-19, it appears safe and reasonable to include for supporting the immune system, should you choose to try it. Echinacea has been shown to be generally safe use during pregnancy and breastfeeding. A typical dose is 300 to 500 mg of dried herb in capsule or tablet, three times daily, or 2.5 to 5 mL of tincture (liquid extract) up to 3 times daily.
Who should avoid it or speak with their doctor before taking echinacea? Those with active, chronic systemic autoimmune conditions such as lupus, those with autoimmune conditions who have previously tried it and experienced a symptom flare, and those on immunosuppressive medications.
Astragalus: This lesser known herb in the west is one of the most important herbs in Traditional Chinese Medicine, I consider it analogous to echinacea, and it may have slightly stronger immune enhancing effects. Traditionally, it was used in have been used in medicinal strength teas and soups as part of an overall lifestyle that includes herbs in the diet. I generally recommend it in tincture form for prevention in my patients who tend to get a yearly cold that turns into bronchitis kind of thing, but I also teach them how to make a traditional immune tonic soup – a bit of a spin on the classic chicken soup. You can find my recipe here; it's healthful with or without the added herbs – which admittedly, are an acquired taste. Where can you get these herbs? Mountain Rose Herbs, online, right here. Traditionally astragalus is not used when you have a fever.
What about Elderberry? There's an enormous amount of information and misinformation circulating on the internet about elderberry, COVID-19, and a phenomenon called ‘cytokine storm.' The bottom line is that most of the evidence for elderberry is for the treatment of flu when taken during the first 72 hours of symptoms, not for the prevention of either colds or flu, though one study showed a reduced duration and severity of colds (upper respiratory infection) in air travelers compared to those who didn't use it.
Cytokine Release Syndrome (CRS), or in its extreme, cytokine storm is an immunologic phenomenon that occurs in advanced states of infection, for example, in ARDS, as mentioned above, a potentially severe advanced COVID-19 complication, sepsis, also a possible severe COVID-19 complication, or with certain specific immunologic medications (i.e., monoclonal antibodies). It was considered a major cause of death in the Spanish Flu, SARS, and H1N1. Interleukin-6 is a term often dropped in these conversations because it is an immune mediator that acts as both a pro-inflammatory cytokine but, simultaneously it also acts as an ant-inflammatory. The association with elderberry and cytokine storm is implausible; elderberry is not able to cause cytokine storm whether used for prevention or infection, or during infection. Were one to be experiencing cytokine storm, one would be far too sick for herbal therapies; this is an ICU/life support level crisis. Bottom line: elderberry is unlikely, based on what we know at this time, particularly relevant for COVID-19 prevention or even treatment of mild-to moderate symptoms and if you're concerned about cytokine release syndrome or cytokine storm as a result of this herb, don't use it.
What about Garlic? While garlic is one of the most classic herbs used to prevent and treat respiratory infection, and historical evidence even suggests it may have prevented some sub-populations in Europe from the Plague, it is more specific to bacterial infections than viral infections. Nonetheless, it is one of my personal go-to dietary strategies for overall health and immune health. I include garlic as well as ginger, also an antimicrobial herb, in my cooking and ginger in my tea almost daily, which I highly encourage for general health if you tolerate either or both of these healthful herbs.
Green Tea: Speaking of tea, several studies over the past few years have found that drinking hot green tea can reduce the likelihood of upper respiratory infections. It's unclear whether this is due to the warm vapor or the aromatic oils we inhale when sipping tea, but if you enjoy green tea, a couple of cups a day can be a pleasant ritual and nourishing way to possibly support upper respiratory health.
Further Herbs You Might Consider: Adaptogens, including ashwagandha and holy basil and medicinal mushrooms, particularly reishi (Ganoderma ludicum), are widely used by herbalists to optimize immune health and resilience. Studies looking at reishi have found that it is able to regulate the immune system, calming an overstimulated immune response, while enhancing reduced immune function. Adaptogens and reishi mushroom have also been shown to improve a sense of well-being and reduce anxiety, which most of us can use in these times. While not recommended during pregnancy, and those who are on immunosuppressive medications should speak with their doctor before using, these herbs are generally otherwise safe for most people, including those who are breastfeeding. Doses vary per adaptogen or medicinal mushroom and products used.
Also, Gargle. I know this is such a weird recommendation, but I had to include it because not only do a small number of studies, including one published in the American Journal of Preventative Medicine, suggest that this practice has some benefit for preventing upper respiratory tract infections, but it's one that's been passed from my herbalist great grandmother, to my grandma, to my mom, to me, it's totally free, and heck, it can't hurt. While salt-water gargles are what they recommended, there's no evidence that they're more effective than plain water. How often and for how long should you gargle? Aim for 2 to 3 times daily for 15 to 30 seconds each time.
Empty Shelves: Where to Obtain Reliable Nutritional and Herbal Supplements
I was just in my local food co-op yesterday and took a stroll down the natural supplements aisle to see what was happening. The shelves that usually house the immune support supplements were almost entirely empty. I want to emphasize that if you're unable to obtain herbs locally, please don't freak out. Remember that it's the prevention basics (i.e., hand-washing, hands aways from eyes-nose-mouth, and minimizing exposure) that are proven to help and that are free. Additionally, eating well, sleeping enough, and doing everything you can to stay relaxed and connected to loved ones (even if by phone, FaceTime, or Skype), are all important for immune health.
I make it a policy not to directly sell herbs or supplements. I always want you to know that the information I'm sharing is for your benefit, and I never want you to ever have to worry that there's an ulterior motive. Because so many of you ask me where to get supplements that you can trust, I know it's getting really hard to get products locally, and products at Amazon aren't always reliable, here's access to the company that I use for my personal use and that my patients use here. This access will be available to you indefinitely, with a continual discount, and you can read about the donation of income from supplements sales on that page. But please, don't blow your paycheck on supplements. Focus on the other stuff, especially if your budget is tight right now – or like so many, you're facing a layoff, cut-backs on your work hours, etc.
Also, please stay tuned to the posts on my Instagram or Facebook pages where I'm engaging in conversations, comments, and offering live events for conversation, and just time to connect to break up the ‘social distancing' that could be one of the worst things for our immune system, along with the stress of it all. My heart is with you in these trying times, and I am listening to your concerns and questions so I can continue to provide and expand on the information and support that you need – and trust.