Tuesday, April 7, 2020

COVID-19 Thoughts and Recommendations: April 1, 2020

Dear family, friends, patients and colleagues,

We continue to hear from many of you wanting guidance at this time. Paul is publishing his ongoing work tracking the pandemic and sharing his public health and science thoughts. If you want to receive those as written, you can sign up here.

The bottom line is: the virus is ubiquitous, so it’s ever important to try to prevent exposure as much as possible by observing physical distancing, keeping your children and teens close and following all public health directives. Wear a mask and gloves when in a public. Wash your hands when you arrive home, and know that good old soap and water may be better for all of us in the long run.

It has become increasingly clear than many of us have become asymptomatic carriers and we may be inadvertently putting all sorts of people at risk without intending to. So! Please do not become paranoid, but put effort into being careful just as you would want others to do for you.

And we also know that when and if you fall ill, the better shape you are in beforehand, the better. Most people will have only a mild form of this illness, but working to build a resilient immune system now, will serve you well should you become exposed or do become sick.

In order to create the most resilient immune system possible, here are my recommendations for you and yours. Please know that for those with underlying or chronic disease, or who have compromised immunity (for whatever reason), or have an autoimmune disease, I would want to work with you individually as not all these recommendations apply. If you’re not sure, please schedule a time to “come in.” We are seeing patients via telemedicine and have had the chance to work with people from all over the globe. Linda, at our “front desk,” can help you schedule (860.763.1225).

Here we go, with regard to prevention:

1. Drastically reduce the amount of refined sugar you consume, it directly depresses your immune function.

2. For adults, consider elongating your overnight fast to at least 13-14 hours. This gives all the cells of the body a chance to regroup, to self-correct and to do the jobs they are supposed to do. It also gives the immune system an opportunity to “tidy up” if you will, and to be more effective.

3. Stay well-hydrated, a mucous membrane that is NOT dried out will flush all manner of germs - bacteria or viruses, better than mucous membrane that is very dry. If this does not come easy to you, consider putting out on the counter x amount of water for the day, and try to actually drink it. Everyone economizes fluids differently, so work to keep your urine pale. Don’t over-drink, that’s not good either!

4. Use a humidifier in the bedrooms, helps with #3. I recommend an ionizing type to cut down on possibility of mold.

5. Eat a healthy diet with a reduced percent of processed foods. Lean into: veggies, fruit, nuts, seeds, fish, poultry, meat, olive oil, whole grains and legumes. Take the imperative to be home more to pull out the vegetable steamer, to grow some spouts or microgreens. Take your extra time to cut all those veggies for a stir-fry or salad. Do a baking project with the kids, learn how to make sushi!

6. Start or keep up with an exercise plan. It raises your threshold for feeling stress, dissipates the stress you have and helps your body to be better perfused (i.e., gets the blood is moving better so all the other good choices you are making are amplified!) Here are some resources for at-home workouts. And if you’d like to do a yoga class at home, you’ll have many choices.

7. We know that smokers have a worse outcome if they do contract COVID-19, so take this opportunity to cut back or quit. The same is true for those who vape. Check out some free support to help you quit. Of course, quitting has long term positive impacts on health.

8. Bring in stress reduction. If you don’t already meditate, think about starting. Even 5 minutes using the app Headspace or Calm or deep breathing or a guided imagery session, is worth it. There are endless resources available online, many are free. Psycho-neuro-immunology, the science where we understand how the mind impacts the nervous system and the nervous system impacts the immune system, underscores the essential nature of this activity to all of our lives. Get the children involved with this, most kids enjoy it and find it fun. And if meditation is not your jam, hobbies, making art or music, or zoning out organizing your spice drawer, all that counts for stress reduction, too. Bring in music, more upbeat podcasts, books, positive news outlets. I have been enjoying the weekly sports podcast Only A Game, and Modern Love (a collaboration between the New York Times and NPR), as well as the uber-upbeat Kind World. Consider putting a limit on the amount of screen time you have each day, as it continues to be associated with obesity, poor diet and depression.

9. Try to spend some time outdoors every day. The Vitamin D from the sunshine is good, but so too is fresh air, a change of scenery and, time away from screens! The more it is studied the more we understand why time in nature has further positive impact on immune function.

10. Keep alcohol consumption in check—it negatively impacts the immune system via a number of pathways. This is true for both chronic excessive drinkers as well as those who binge drink. Maybe this is the time you commit to less alcohol consumption.

11. Consider napping.  Join about a third of us who enjoy a daily nap. Shorter is better, and you can expect some improved memory, energy and focus. Some have suggested napping as a public health tool to counter the impact of chronic sleep debt! Adequate sleep in general, is essential for a well-functioning immune system.

12. If you can, use nasal Irrigation or a Neti Pot which can help remove nasal secretions along with viruses before they have time to set up shop. We understand that the virus will multiply in that area for a few days before heading toward the lungs, so you can wash away the virus to a point using these approaches.

13. Ensure adequate sleep. This is a big one and an area where many people already struggle. If this is an issue for you, come in & let’s work on your insomnia! We naturopathic doctors have many tools to help with sleep challenges, even for those who rely on benzodiazapines.

14. The supplements we use now with our patients to enhance a resilient immune system include the following list. Please know that no one can take all the supplements all the time. First of all, it is cost-prohibitive. Secondly, it’s not that much fun. If you need help choosing and confirming dosage or for recommendations on brands or what is safe for children or if you are pregnant or nursing, please set up an appointment and we can tailor a plan just for you. 
Here we go:
            a. Elderberry, syrup is fine - a tsp /day for the kids a TBSP for adults. Elderberry can is used as an anti-inflammatory, anti-viral and antioxidant, often used in syrup form, has been shown to help prevent flu.
            b. Zinc 15 mg/day and 1-2 Zinc or Zinc/elderberry or Zinc/Echinacea lozenge for kids and adults. Zinc raises immune function through your blood but also kills on contact. This coronavirus, like the one that causes regular colds, starts out in the nose & the naso-pharynx. But for those who become quite ill, it drops to the chest. By “killing” in the nasopharynx you can help prevent that worsening. Listerine gargle does the same (20 seconds).
            c. Mushroom complex, there are many on the market to help support optimal immune function.
            d. Vitamin C helps reduce influenza infection by a number of biochemical actions. Foods high in Vitamin C as well as supplements can be put to good use.
            e. Probiotic. We want the most robust & diverse microbiome possible to support a resilient immune system. Probiotics are known to specifically offer protection against flu. Also eat/drink fermented or cultured foods each day, fork/spoonfuls or sips is plenty.
            f. Garlic has anti-microbial properties to help support immune function and that help break up mucus.
            g. Thyme is another anti-microbial herb and immune stimulant to consider when working to prevent the flu.
            h. Likewise, Echinacea, an anti-inflammatory, immune modulating herb activates white blood cells to fight infection and may also be used for prevention.
            i. Lemon balm is a beautiful herb that reduces the inflammatory process that cause both fatigue and anxiety, so for many, it’s the perfect herb right now. Take in capsule or as a tea, or in combination with others listed here. While it works to support immune function, it can also work to calm the nerves.
            j. Melatonin, long understood as a supplement to help with sleep, plays many other roles, from reducing GERD, to being anti-cancer and to helping support effective immunity.
There are MANY other things I would prescribe as preventive— both with regard to diet, supplements, botanicals and homeopathy, which would be individualized to the patient, depending on their personal health history and any relevant risk factors. Paul and I have treated or consulted on 140 patients with COVID-19 at this point - all people with mild disease (i.e., not hospitalized) and none have gone on to severe disease.

Any and all of the supplements listed above under "prevention" are also helpful for the treatment of flu. For instance, research on elderberry (Sambucus) shows its capacity to decrease flu symptoms. Likewise, echinacea has been studied and confirmed to inhibit the influenza viruses and by modulating the immune response. If you have nausea, add ginger or chamomile tea as desired. If there is significant coughing, honey in warm water can help.  Herbal teas and tinctures made from ivy leaf, thyme and marshmallow root have all been examined and found to help reduce cough associated with influenza.

Many of you have asked, what’s the best homeopathic remedy to take to prevent getting COVID-19 or what remedy to take if you fall ill.  The thing about homeopathy is that it is individualized to the person, it is the original personalized precision medicine. What works for one person may not work for another. We often treat people constitutionally, giving a remedy for the whole person to optimize health, mood and energy.

We recommend working with a trained homeopath and request a dose of your constitutional remedy at this time. Paul has created an algorithm for homeopaths which is in beta-testing at this time, to help streamline the case-taking and analysis, because the way many patients with COVID-19 present, there are symptoms of many homeopathic remedies. If you are interested in this topic, sign up to receive our Epidemic Updates.

We are also starting to see patients for whom the stress of COVID-19, the worries about family and money, the job insecurity, the 24-hour (bad!) news cycle, etc., is taking its toll. Anxiety, depression, and irritability are running deep. We are using Lithia Basic with many of our patients to help with both anxiety and depression. There is tremendous amount of research on low dose lithium’s impact on mood, memory, and more. We have put it together with lemon balm for anxiety and bacopa for cognition. Check it out here.

There are many ways that social isolation has a negative impact on overall health and mortality. One area of study reveals that feeling lonely has a negative impact on immune response which I am worried about right now for many of the people we know and love.

The challenges of this time will be amplified for those who already feel socially isolated or who struggle with depression, anxiety and other chronic complaints. There are free resources available to all, including:
            -- For those living with domestic violence: https://www.thehotline.org.
            -- For those with suicidal thoughts:  https://suicidepreventionlifeline.org.
            -- For those struggling with mental health or substance abuse: https://www.samhsa.gov/find-help/national-helpline.
            -- Mental health/crisis text line: https://www.crisistextline.org/texting-in.
            -- For older people struggling and feeling isolated: https://www.ioaging.org/services/all-inclusive-health-care/friendship-line

If you or anyone you know needs additional support or just a pep talk and to review what they are doing and how they are managing, they can schedule time with one of us through our front office at 860.763.1225. Our aim is to help our patients stay calm, to offer accurate, non-alarmist, actionable information and to treat those in need with effective natural medicine and a big scoop of compassion.

In my piece, Silver Linings of COVID-19 Health and Public Health Recommendations, I write, “Hopefully another silver lining with COVID-19 is that we will grow more compassionate and thoughtful for the people around us. We’ll check in with neighbors, especially the elderly or those living on their own. We know that true social isolation is not good for health. As we reckon with the impact of COVID-19, let’s also focus on the positive steps we can take toward healthy living, for ourselves, our families and our communities. Perhaps on the other side of this epidemic we will keep up the better health habits, for more vibrant and enduring and health.”

May you & yours be safe and healthy, welcome this year’s coming spring with particular joy and stay in touch with those you love, and us!

All the best,
Amy Rothenberg ND & Paul Herscu ND, MPH

A few weeks back we did a Brown Bag Lunch on COVID-19. As this is an evolving story this is not all current, but if you’d like to view, you can find the two sections at these links:
Part #1: https://www.youtube.com/watch?v=9vk8d1WoUFQ& 
Part #2: https://www.youtube.com/watch?v=gZNiVAv2ec0

Click here for other COVID-19 related links.