Many people have asked me to share the strategies I use to optimize my ability to handle infection(s) and the corresponding inflammatory response. It is the exaggerated inflammatory response that leads to complications of infection such as Acute Respiratory Distress Syndrome (ARDS). Therefore people with hypermobility disorders and coexisting conditions such as Mast Cells Activation Syndrome (MCAS) may be at higher risk of complications due to COVID-19 since there is a higher prevalence of chronic underlying inflammation and hyperactive mast cells.
Minimizing pre-existing excessive inflammation MAY therefore decrease one’s chances of needing ICU level care and/or ventilator support of lung function due to COVID-19 infection!
Please discuss this with your primary care provider before making any changes to your treatment protocol. There are drug-drug interactions as well as drug-food or drug-herbal interactions that can occur and can be very significant. Only your own healthcare provider(s) can help you weigh the risks and benefits of the various options presented here.
Additionally, these steps are of course in addition to staying current on the CDC recommendations including washing hands frequently, thoroughly wiping down surfaces, staying sheltered inside etc.
My top priority is quality sleep as the number of hours of restful sleep you get directly impacts your level of immunity. Now, I haven’t always been able to sleep well but since reintroducing melatonin, I am getting plenty of hours of restorative sleep. Melatonin can also have beneficial effects on immunity and is best taken a couple of hours before your desired bedtime. Melatonin prepares the brain for sleep but does not induce sleep. Being relaxed is a precursor to falling asleep so it can be helpful to read or do some other relaxing activity first (as opposed to looking at our phones which wakes our brains up….. yeah I am guilty sometimes too). Dosing of melatonin varies with some people responding to as low as 0.5mg and others taking 10mg. Sustained release formulations may work better for some people.
Working on my breathing has really helped me cope lately. Slowing down the breathing rate to (ideally) about 6 breaths per minute (one breath every 10 seconds) stimulates baroreceptors (stretch receptors) and activates the parasympathetic nervous system (PNS) which is the “rest, digest, and restore” part of the autonomic (or automatic) nervous system. The PNS helps to balance the overdrive of it’s counterpart, the sympathetic nervous system (“fight, flight or freeze”). The balance between these two plays a huge role in immunity and we want as much activation of the PNS as possible. This is one way in which the mind impacts the body physiologically! Practicing this during the day makes it easier to engage this strategy successfully at night when trying to sleep. Other strategies that can be helpful include meditation, guided imagery, music therapy and yoga. Anything that calms the nervous system will be helpful for the immune system!
Right now, I am trying to eat foods that are as nutritious as possible. I know my body needs colorful fruits and vegetables as well as healthy fats and quality protein. Probiotic foods can be helpful too as the microbiome plays a huge role in the immune system. Some foods I am eating include kiwi, oranges, frozen berries, greek yogurt, canned salmon, canned beans, almond butter and a piece of dark chocolate here and there. Although I prefer the taste of coffee, I have been drinking lots and lots of green tea. Green tea is rich in polyphenols and can help with immune function.
I have a confession to make.
I was a big fan of supplements long before COVID-19. Having a hypermobility disorder myself, I figured out years ago that some supplements could help me dramatically reduce pain and inflammation. Supplements can also be used to boost your body’s immune system and improve your ability to fight off infection. The dosing of some supplements can be guided by following laboratory measurements (usually in the blood), whereas others do not have any such markers.
NO supplement has proven effectiveness against COVID-19, however many have been studied in other infections in the past and have shown promise. Each works in a slightly different way and have different contraindications (reasons they should NOT be taken). Some are necessary nutrients for proper immune system functioning whereas others act by reducing the inflammatory response to infection. Some can also be used to reduce chronic inflammation (often a contributor to chronic pain and other chronic illness). Below are some of the ones I use most and often recommend to my patients. As always, do not make any changes to your healthcare regimen without discussing with your own primary care provider.
Vitamin D is actually a hormone and is vitally important to many bodily processes related to pain processing such as sleep quality and mood. Vitamin D also plays a pivotal role in the immune system with deficiency being associated with both increased infections and increased autoimmunity (misdirected immune response where the body attacks itself). Getting adequate sun exposure and eating Vitamin D fortified products is adequate for some, but other people require supplementation in order to attain an adequate blood level of Vitamin D. Dancers and other athletes who train indoors may be at particularly increased risk of Vitamin D deficiency.
Recommendations for Vitamin D supplementation vary and ideally long term dosing is based on laboratory values. There are different forms of Vitamin D with D3 being the preferred form. The data is mixed on what to do regarding Vitamin D ONCE a person gets sick. There is evidence that people who are more severely ill may have lower Vitamin D blood levels than those who are less sick, but once we get sick it is unclear what we should do. Some experts recommend taking an additional 10-15 thousand IU of Vitamin D daily for up to one week at the beginning of an infectious illness if you suspect your Vitamin D level was low to start with. Taking Vitamin D with fat helps to improve the absorption.
Quercetin is a highly bioactive flavonoid (plant pigment) important for mast cell stabilization and immune health. Quercetin is found in many foods such as onions, green tea, apples, and berries. In addition to anti-inflammatory activity, quercetin has been shown to have antiviral properties. I take 500mg twice daily. Many of my MCAS patients respond very favorably to supplementation with Quercetin.
N-acetyl-cysteine (NAC) is used both as a prescription drug and as a dietary supplement and converts in the body to a very powerful antioxidant, glutathione (see section below for more details). NAC has been studied rather extensively and can help clear mucous from the pulmonary system. It may be helpful for reducing the excessive inflammatory response that sometimes happens in the lungs with COVID-19. I take 900mg once or twice daily.
Palmitoylethanolamide (PEA) has been researched for over 50 years and has hundreds of publications relating to its pharmacologic profile. PEA has been used for mast cell stabilization, reducing inflammation and in flu and respiratory infections. It is also available in liposomal (liquid) form which is better absorbed but does need to be refrigerated. I take 2.5-5ml of the liquid when at home (which happens to be a lot more these days) and use the 400mg capsules when I am out and about. I love PEA and take it three to five times a day with meals/snacks
Vitamin C is probably one of the best known nutrients involved in immunity. Although high dose Vitamin C is dangerous over any prolonged period, I do sometimes increase the dose I take over the short term to help fight infection (up to 2000mg daily for 5-7 days). When possible, I take liposomal Vitamin C or timed release (since it is a water soluble vitamin).
Zinc plays a pivotal role in numerous different aspects of immunity and zinc-deficient people experience an increase risk of infection from many different organisms. Zinc is present in the following foods: oysters, red meat, poultry, beans, nuts, seafood, whole grains, fortified breakfast cereals and some dairy products. Phytates, a substance present mostly in grains and cereals, binds Zinc and can decrease blood levels. Zinc deficiency is more common in vegetarians, preganant and lactating women, and those with gastrointestinal disorders. Alcohol consumption affects immunity in a variety of ways – through lowering Zinc levels and disruption of the gut microbiome.
Zinc is available in many forms – capsules, lozenges, and topical applications. It is available as a stand alone supplement and is an ingredient in numerous combination supplements. Read labels carefully to know everything you are taking. I started taking a total of between 15 and 30mg of Zinc per day (usually on about 2-3 days per week) after COVID-19 became a pandemic. Zinc, especially when used directly on the nose, may lead to the loss of smell which may be permanent. Long term supplementation with Zinc is not recommended as it may lead to Copper deficiency.
Vitamin A is a fat soluble micronutrient crucial for growth and development, vision and protecting cellular linings in the body. It also has anti-inflammatory effects and is involved in the development of the immune system. Even though I am a pescatarian (many food sources are animal sourced), I do not current take a separate Vitamin A supplement. We are able to produce Vitamin A from carotenoids found in plants however a significant percentage of the population has a genetically impaired ability to do so. Some foods are also fortified with Vitamin A.
Curcumin is a component of turmeric, a spice found in curry powder. Curcumin has potent anti-inflammatory and immune boosting effects and has been reported to be beneficial in treating arthritis, allergy, asthma, atheroscleroisis, heart disease, Alzheimer’s disease, diabetes and cancer. I usually take 500mg twice daily (with black pepper) and also include turmeric in my diet as much as possible.
Last but definitely not least, glutathione – the most abundant antioxidant in the body and regulatory for immunity at many different levels. Glutathione is crucial for regulating oxidative stress and also inflammation. Many studies have shown protective effects on the lungs when glutathione levels have been replenished. Glutathione is believed to be more than just an inhibitor of inflammation but rather it may crucially direct the migration of inflammatory cells away from the lung (where they cause Acute Respiratory Distress Syndrome) and towards the site of infection!
Glutathione levels can be increased through dietary means and/or by supplementation. Green tea can significantly increase antioxidant abilities and glutathione levels. I am not normally an advocate of drinking fruit or vegetable juice due to the simple sugar content, however it would be reasonable to consider adding these to your diet especially if you currently have limited produce options. Some excellent choices are pomegranate, grape juice and kale juice.
Foods to support healthy glutathione levels include a number of green foods (asparagus, avocado, broccoli, brussel sprouts, collard greens, cucumber, green beans, kale, and spinach). It is preferred to eat these vegetables raw or mildly steamed. Other nutrients and foods that support healthy glutathione levels include Alpha lipoid acid, curcumin, omega-3 fatty acids, salmon, selenium, vitamin E, vitamin C, and whey protein. Other antioxidants shown to be protective in animal models include quercetin and NAC (a glutathione prescursor).
There are a variety of delivery systems for supplementing with glutathione – oral, sublingual (under the tongue), liposomal and intravenous with the last three likely being preferred due to the breakdown that can occur in digestion. I take liposomal glutathione 250mg per day most days of the week (depending on dietary sources as above).
These are stressful times! There are things we can do, however, to improve our odds of beating this scary infection called COVID-19 . And the good news is that any steps you are able to take now will likely benefit you in the future long after COVID-19 is said and done.
Taking all of these steps is not possible for many people due to limited resources and/or availability. One thing we all can do is work to slow our breathing and remember to be compassionate and loving towards ourselves and others during these challenging times!
Wishing you the best of health!
About Linda Bluestein
Board-certified anesthesiologist, integrative medicine physician and former ballet dancer, Linda Bluestein, M.D., specializes in treating dancers and other athletes at increased risk of hypermobility disorders and is the founder and host of the podcast, “Bendy Bodies with the Hypermobility MD”. Dr. Bluestein also founded and is a former co-host of the podcast “Hypermobility Happy Hour”, the first podcast to focus exclusively on issues related to hypermobility disorders and is a contributing author for the book, Disjointed – Navigating the Diagnosis and Management of Hypermobile Ehlers-Danlos Syndrome and Hypermobility Spectrum Disorders. Through her private practice, Hypermobility MD, Dr. Bluestein is helping people from all over the country live better lives.
Dr. Bluestein, a highly sought after international and invited speaker, is at the forefront of research on pain, hypermobility and dance medicine. She completed her anesthesiology residency at the Mayo Graduate School of Medicine after receiving her Medical Degree from the University of California, Los Angeles School of Medicine and is a member of the International Association for Dance Medicine and Science, the Performing Arts Medicine Association, and the Resources Committee for the Dance Healthy Alliance of Canada.
As a leading specialist in connective tissue disorders such as Ehlers-Danlos Syndromes (EDS), Dr. Bluestein helped to create the first online EDS CME (Continuing Medical Education) program. She also serves as an assistant professor at the Medical College of Wisconsin, Central Wisconsin where she is the course director for the RISHI Healer’s Art Program.