Russell Setright Naturopath

Complementary Medicines role may help in the prevention and treatment of acute respiratory infections and enhanced immune function.

Russell Setright

Including; Pelargonium sidoides, Vitamin D3, Vitamin C, Echinacea, Curcumin, Ginseng, Zinc

 

No supplement, diet, or lifestyle modification — aside from social distancing and practising proper hygiene ⁠— can help guarantee protection from developing COVID-19.

                             

                                                                                                         ******************************

ABSTRACT

With the COVID-19 pandemic upon us and the threat of flu this winter, many people are concerned about what to do and how to help support their immune system and reduce their chances of becoming infected.

In the United States the 2019-2020 flu season, Influenza (Flu) has caused an estimated 36 million illnesses, 370,000 hospitalizations and 22,000 deaths, according to the Centres for Disease Control and Prevention. (27)

In 2017 there were 1,255 deaths due to influenza in Australia which was one of our worst in recent years An individual dying from influenza in 2017 was most likely to be female, aged over 75 years, have multiple co-morbidities and living in the eastern states of Australia (28)

Although these figures are devastating, they are expected, as we know when the season will start and end every year. We also have vaccinations and treatments that although not completely effective allow us to have some control over the infection.

The new coronavirus pandemic resulting in COVID-19 infections  is something of an unknown as we don’t know how far it will spread or when it will stop and how many deaths it will cause.

Because of the unknowns about the new coronavirus we all must do everything we can to prevent its spreading and to look after our own and family’s health. Not just Governments but everyone has a role to play.

This review of the data supports of the most commonly used nutrients and complementary medicines that may have benefits for the prevention and treatment of some viral infections. These data should only be used for educational purposes and not replace the good advice currently being given by our Government and Health Authorities.

Although these complementary medicines are not a replacement for medical management, they are worth discussing with your healthcare professional.

                                                                                                ******************************

Methods

The literature up to April 2020/ was searched without language restriction using the following databases: PubMed, ISI Web of Science (Science Citation Index Expanded), EMBASE, and the Cochrane Library.

 

INTRODUCTION

Most people at one time or another will catch a common cold or flu and many different types of viruses cause these infections. It is these viruses that infect the nose, throat and upper and lower respiratory tract causing pain, congestion, difficult breathing and fever and for some this can be serious and potentially fatal infections.

As we move into the colder months in Australia, common sense tells us that keeping warm and avoiding sudden temperature changes, such as, leaving a warm home or office for the cold outdoors will reduce the chances of catching a cold, flu or other viral infection.

Studies have found that exposure to cold temperatures suppresses the immune system and cold air rushing into the nasal passages makes infections more probable by diminishing the local immune response. (23)

Modifying this by reducing the effect of sudden changes in temperature along with good nutrition and some lifestyle changes will help improve your immune system.

1.      Eat a diet high in fruits and vegetables.

2.      Get adequate sleep.

3.      Exercise regularly.

4.      Maintain a healthy weight

5.      If you drink alcohol, drink only in moderation

6.      Try to minimise stress.

7.      Practice good hygiene and wash your hands regularly.

In addition, this article covers some of the studies that support the benefits of nutrients and herbs and their possible effect on enhancing immune function.

​

The importance of good hygiene can’t be over emphasised.

Wash your hands with soap and water for 20 seconds and use hand sanitisers, practice social distancing and self-isolation if you have any symptoms of a cold, flu or other respiratory tract infection, don’t soldier on, if you have an infection that could be transmitted to others.  

It is vital to practise social distance and good hygiene practise to help slow the progression of any viral disease in particular COVID-19. Keep 1.5 metres in-between people and don’t leave home unless you must.

As the coronavirus can survive up to four hours on copper, a day on cardboard and up to three days on plastic and stainless steel It is best to wear gloves when opening doors from rest rooms, touching handrails , shopping trollies and lift and terminal buttons.

When deposing of gloves turn inside out and don’t touch the outside of the glove and wash hands for 20 seconds or use sanitiser.

Bottom line is if you don’t come into contact with the virus you won’t contract it or pass it on.

​

A good night’s sleep is a must.

Sleep affects your immune system and not enough or poor-quality sleep has an adverse effect.

 A good night’s sleep is very important it can boost the effectiveness of certain specialized immune cells called T cells that reduce the likelihood of getting sick after being exposed to a virus. A lack of sleep can also affect how fast you recover if you do get sick. (19)

Unfortunately, many people just continue doing work and play without rest and sleep is vital for a good functioning immune system.

Is our diet is lacking in important immune supporting nutrients?

For many Australians the answer to this question is yes.

​

A balanced diet is needed to supply of required energy and nutrients for adequate tissue maintenance, repair and growth.

Our diet supplies the proteins, carbohydrates, fats, vitamins and minerals required to maintain the human body in good health are met by eating a wide variety of nutritious foods.

Unfortunately, in Australia the majority of people don’t have a balanced diet and may be lacking in some of the vital nutrients that are required to help us maintain a healthy immune system, fight infection and maintain good health.

An example of deficiencies in the intake of fruit and vegetables is found at FIG 1.

​

​

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

​

Figure 1: Prevalence of inadequate fruit and vegetable intake for persons aged 18 and over, 2014–15

Australian Government, Institute of Health and Welfare

                                                                                                                  *************************

​

COMPLEMENTARY MEDICINES AND NUTRITIONAL SUPPORT

​

Vitamin D, Vitamin C, Zinc and Echinacea

Vitamin D, vitamin C, zinc, & Echinacea have been found to improve 3 main immunoreactive clusters of innate & adaptive immunity in terms of shortening the duration and/or lessening the severity of symptoms of viral infectious disease of the upper respiratory tract. (30)

These complementary medicines are covered separately in the following.

​

Vitamin D

There are two forms of vitamin D that are important in humans: ergocalciferol (vitamin D2) and cholecalciferol (vitamin D3). Vitamin D2 is synthesized by plants and obtained by humans through diet. Vitamin D3 is made in the skin when 7-dehydrocholesterol reacts with ultraviolet-B (UVB) rays from sunlight at wavelengths between 270–300 nm and stored in the blood as calcidiol (25-hydroxy-vitamin D). Both D2 and D3 precursors are hydroxylated in the kidneys and liver to form 25- hydroxyvitamin D (25(OH)vit.D), the non-active 'storage' form, and 1,25-dihydroxyvitamin D. 1,25 (OH)2D, the biologically active (hormone) form that is tightly controlled by the body.

One of the functions of vitamin D is to maintain normal blood levels of calcium and phosphorus which helps form and maintain strong bones.

However, research also suggests that increased blood levels of 25(OH)VitD may provide protection from CVD, diabetes, osteoporosis, hypertension, certain cancers, and several autoimmune diseases and viral and bacterial infections (49).

​

Vitamin D3

A review of published studies found that a significant number of Australians and New Zealanders have less than optimal serum vitamin D levels, with mild to moderate deficiency ranging from 33 to 84% depending on age, skin colour and/or those in residential care.

There are large interpersonal variations as to how much vitamin D will be made for a given dose of UVB. Some of the contributing factors include skin type, and age, about 50% less vitamin D will be synthesised by an 80-year-old compared with a 20-year-old (46), also obesity (as vitamin D is stored in fat tissue contributes to a reduction (47)

These studies have also reported a significant relationship between low vitamin D status and an increase in the prevalence of diseases including diabetes, CVD, metabolic syndrome, osteoporosis, hypertension, certain cancers, several autoimmune diseases the Flu and all-cause mortality. The data also suggest that normalising blood 25(OH)VitD levels by supplementation with vitamin D3 may have a positive effect in disease prevention.

​

Vitamin D insufficiency affects almost 50% of the population worldwide. An estimated 1 billion people worldwide, across all ethnicities and age groups, have a vitamin D deficiency. This pandemic of hypovitaminosis D (low vitamin D) can mainly be attributed to lifestyle. (24)

Vitamin D can modulate the innate and adaptive immune responses. Deficiency in vitamin D is associated with increased (autoimmunity) the immune responses of an organism against its own healthy cells and tissues as well as an increased susceptibility to infection (25)

​

Low vitamin D status is associated with higher rate of respiratory infections

A large study of 18,883 people reported strong association between low blood levels of vitamin D (25OHVitD) and increased respiratory infections. Those with the lowest blood vitamin D levels reported having significantly more recent colds or flu and the risks were even higher for those with chronic respiratory disorders, including asthma and COPD. Those with low vitamin D levels were nearly 40 per cent more likely to have had a respiratory infection than those with adequate vitamin D levels (2).

​

Other findings support the concept of vitamin D possessing important pleiotropic actions outside of calcium homeostasis and bone metabolism. In children, an association of nutritional rickets with respiratory compromise has long been recognized. Epidemiologic studies clearly demonstrate the link between vitamin D deficiency and the increased incidence of respiratory infections (3)

Vitamin D3 supplements found to reduce the incidence of influenza in School children

​

A recent randomised double-blind, placebo-controlled trial among School Children in Japan was conducted. The Children were randomly divided into two groups: One group received daily supplements of 1200iu daily of vitamin D3, while the other group received a placebo. The children were then assessed for the incidence of influenza over the 2008 to 2009 winter period.

​

The study found that the incidence of influenza was 10.8 per cent in the vitamin D3 supplemented group, compared with 18.6 per cent in the placebo group; this reduction was even greater for those who had low vitamin D (25OHVitD), with a 74 per cent reduction in the incidence of influenza.

Also, asthma attacks were significantly reduced in asthmatic children in the vitamin D3 supplemented group (4)

​

Vitamin D and COPD

A study of people with chronic obstructive pulmonary disease COPD reduced symptoms by taking regular doses Vitamin D boosts immune responses to respiratory viruses that may trigger COPD attacks & reduced harmful inflammatory responses,

​

Vitamin C

Vitamin C reduces the symptoms and duration of respiratory infections

Correct nutrition is a necessity, we should always endeavour to include plenty of fresh fruit and vegetables in the daily diet as these are a good source of vitamin C.

Vitamin C is an essential nutrient that cannot be synthesised and plays an important role in the body's immune‐modulating system. Vitamin C donates electrons that protect the body from oxidant damage generated through exposure to toxins and pollutants (39)

Vitamin C has anti-viral activity & is an essential factor in the production of the anti-viral immune response during the early phase of viral infection. (33)

​

Vitamin C found to be deficient in hospitalised patients.

As we have a good variety of vitamin C rich foods in Australia, there should not be a deficiency and given the importance of vitamin C in immune function we would expect that people in hospital had adequate vitamin C. However, it appears that this is not the case.

One study found that Vitamin C deficiency is common in Australian adults attending a surgical practice within south western Sydney. (34)

In another study among hospitalised patients it was found 76.5% had low vitamin C levels.

These Patients were older and had higher C‐reactive protein (CRP) levels and they had fourfold higher odds of staying in hospital for more than 5 days than those with normal vitamin C levels. (35)

​

People who are ill require higher doses of vitamin C

Vitamin C deficiency results in impaired immunity and higher susceptibility to infections. In turn, infections significantly impact on vitamin C levels due to enhanced inflammation and metabolic requirements.

The treatment of established infections requires significantly higher (gram) doses of vitamin C to compensate for the increased inflammatory response and metabolic demand.

​

EXPERIMENTAL CARE Coronavirus doctors treating patients with Vitamin C claim they’re doing ‘significantly better.

Seriously sick coronavirus patients in New York state’s largest hospital system are being given massive doses of vitamin C based on promising reports that it’s helped people in hard-hit China,

In an interview with Dr. Andrew G. Weber, a pulmonologist and critical-care specialist affiliated with two Northwell Health facilities on Long Island, said his intensive-care patients with the coronavirus immediately receive 1,500 milligrams of intravenous vitamin C.

The patients who received vitamin C did significantly better than those who did not get vitamin C,

​

More studies on Vitamin C

Studies and clinical trials have shown that supplementing with vitamin C and vitamin E can help strengthen the immune system reducing the incidence and symptoms of colds and flu (5)

Vitamin C supplementation can start with bottle fed babies. Blackcurrant and rose hip formulas high in vitamin C are readily available. These fruit juice formulas should be included in baby’s daily feeding routine. Children over two years of age can either have a crushed Children's Chewable Vitamin C tablet added to their food or chew one tablet twice daily and adults should take between 1,000 mg and 2,000mg daily. In six trials with participants exposed to short periods of extreme physical or cold stress or both (including marathon runners and skiers) vitamin C reduced the common cold risk by half. (6)

​

In thirty-one comparisons studies that examined the effect of regular vitamin C supplementation on common cold duration (9745 episodes). In adults the duration of colds was reduced by up to 12% and in children up to 21% In children, 1 to 2 g/day

Vitamin C shortened colds by 18%. The severity of colds was also reduced by regular vitamin C administration (7)

Dr. Harri Hemilä from the University of Helsinki, Finland, analysed the findings of two randomized trials each of which investigated the effects of two vitamin C doses on the duration of the common cold. The first trial administered 3 g/day vitamin C to two study groups, 6 g/day to a third group, and the fourth group was administered a placebo. Compared with the placebo group the 6 g/day dose shortened colds by 17%.

Self-dosing of vitamin C must be started as soon as possible after the onset of common cold symptoms to be most effective." Dr Hemilä also states that further therapeutic trials should be carried out to investigate the dose-response relation in the region of over 8 g/day of vitamin C. (29)

Vitamin C and Pneumonia

In and older randomized, double-blind placebo-controlled trial with elderly people in the UK (mean age 81 years), who were hospitalized because of acute bronchitis or pneumonia.

Vitamin C reduced the respiratory symptom score in the more ill patients but not in their less ill counterparts. There were also six deaths during the study, all among the more ill participants: five in the placebo group, but only one in the vitamin C group. (37)

​

Echinacea

Echinacea found to reduce the incidence  and the duration of respiratory infections

Echinacea is one of the most commonly used herbal products, but controversy exists about its benefit in the prevention and treatment of the common cold. However, when excluding verities of echinacea that had minimal effect and examining those that did the results were very positive.

The two types were echinacea purpura and echinacea angustifolia

 A meta-analysis evaluating the effect of echinacea on the incidence and duration of the common cold was undertaken. The meta-analysis included 14 studies were where Incidence of the common cold was reported (30)

The results found that Echinacea decreased the odds of developing the common cold by 58% and the duration of a cold by 1·4 days. The authors concluded that published evidence supports echinacea's benefit in decreasing the incidence and duration of the common cold. (8)

A study examining Echinacea as source of potent antivirals for respiratory virus infections reported that all strains of human and avian influenza viruses tested, and these included respiratory syncytial virus, and rhinoviruses were very sensitive to a standardized Echinacea purpurea preparation (21)

Another randomised, double-blind, placebo-controlled study over four months confirms that Echinacea purpurea supports the immune resistance and acts directly against a series of viruses. Also, it is efficacious and safe in respiratory tract infections for long-term and short-term prevention as well as for acute treatment. (22)

​

Lactoferrin

Lactoferrin found to reduce the incidence of the common cold

Lactoferrin is a compound that is naturally produced in the body by immune cells and it is particularly prevalent in secretions of the upper airways, eyes and stomach. 

Bovine lactoferrin supplementation has been shown to boost the activity of certain immune cells. One study found that the total number of cold-associated symptoms reported by participants that received a Lactoferrin/whey compound (Lf/IgF) was significantly less than those in the placebo group.

Also, total days sick with a cold and cold severity were reduced over the clinical trial period for Lf/IgF over placebo, but the trend was not significant (9)

​

Ginseng Panax quinquefolium

Extracts of the root of North American ginseng (Panax quinquefolium) have been found to have the potential to modulate both innate and acquired immune responses.

A study that included 323 adults who were randomly assigned to take either the ginseng capsules or placebo capsules filled with rice powder every day for 4 months. During that time, participants kept daily logs of any cold symptoms including runny nose, congestion, sore throat and headache.

In general, adults in both groups had a similar likelihood of developing one cold during the study period. But less than half as many in the ginseng group had a repeat cold 10 percent, versus almost 23 percent in the placebo group (10)

Administration of red ginseng and vitamin C was found to enhance the activation of immune cells like T and NK cells, and repressed the progress of viral lytic cycle. It also reduced lung inflammation caused by viral infection, which consequently increased the survival rate. (36)

​

Pelargonium sidoides and Viral respiratory infections

For centuries, the herb Pelargonium sidoides has been traditionally used in South Africa for the treatment of respiratory diseases. The common name for this herb is umckaloabo which is derived from the Zulu language and means “heavy cough”. Today specialised farms using ecological cultivation methods produce Pelargonium sidoides.

Evidence suggests that Pelargonium sidoides may assist in acute bronchitis and acute sinusitis by preventing the reproduction of various respiratory viruses and inhibiting the adhesion of certain bacteria to respiratory cells. Kaloba® also helps to clear excess mucus from the respiratory system during acute sinusitis or acute bronchitis. (11)(12)

Bronchial epithelial cells are the first target cell for rhinovirus infection. The course of viral infections in patients with acute bronchitis, asthma and COPD can be improved by oral application of Pelargonium sidoides extract (17)

In numerous randomized controlled trials (RCTs) and systematic reviews such as those published by the Cochrane Collaboration, Pelargonium sidoides extract EPs® 7630 (Kaloba) was shown to be effective in acute respiratory tract infections (ARTI) in all investigated age-groups.

Activate the Immune response.

Pelargonium sidoides improves immune response by activating human monocytes that drives the Innate Immune defence cells Th17 and Th22. These cells are key mediators linking adaptive and innate immune responses. (18)

Pelargonium sidoides In Children

Eight RCTs investigating the application of EPs 7630 in acute bronchitis, acute tonsillopharyngitis, and ARTI in the context of chronic preconditions were identified. Results showed a statistically significant improvement of ARTI symptom severity for EPs 7630 as compared to controls. The investigation of EPs 7630 in asthmatic children and adolescents with ARTI demonstrated a significant symptom-alleviating effect and a possibly associated reduction of asthma attacks. In immunocompromised children with acute upper RTI, an alleviating effect of EPs 7630 was shown. All RCTs reviewed reported good safety and tolerability of EPs 7630. (15)

Pelargonium sidoides- In Adults

Treatment of acute bronchitis in adults. For each of the five individual symptoms, rates of complete recovery were considerably higher in the EPs 7630 (Kaloba) group. Within the first four days, onset of treatment effect was recognized in 68.8% of patients in the EPs 7630 group compared with 33.3% of patients in the placebo group. Health-related quality of life improved more in patients treated with EPs 7630 (Kaloba) compared with placebo-treated patients.

Pelargonium sidoides been clinically proven to help provide relief of acute bronchitis symptoms after 7 days (45% of the patients taking Kaloba® experienced recovery after 7 days compared to 6.4% taking a placebo), it can help speed up recovery too (43) (44)

This herb is now available in the product Kaloba® which is an Aust Reg product in Australia.

​

Hedera helix (Ivy)

Ivy extracts are part of many current cough medicines and studies have found Ivy helps liquify and clear mucus from the airways and relax and calm convulsive coughing.

 In the past, the leaves and berries were taken orally as an expectorant to treat cough and bronchitis and Professor Weiss MD in his book Herbal Medicine, mentions Ivy extract as a treatment for whooping cough symptoms.

A study of 9657 patients (5181 children) with bronchitis (acute or chronic bronchial inflammatory disease) were treated with a syrup containing dried ivy leaf extract. After 7 days of therapy, 95% of the patients showed improvement or healing of their symptoms. The authors of the study concluded that the dried ivy leaf extract is effective and well tolerated in patients with bronchitis (13)

Another study investigated the anti-inflammatory effects on induced acute lung inflammation in vitro and to elucidate its anti-inflammatory mechanisms

The authors of the study concluded that extract of ivy plant Hederacoside-C (HDC) could inhibit the S. aureus induced acute lung inflammation and it may be a potential therapeutic drug against acute lung inflammation (48).

​

Curcumin

Curcumin is a bright yellow chemical produced by Curcuma longa plants. It is the principal curcuminoid of turmeric (Curcuma longa), a member of the ginger family.

Many studies have found that Curcumin is associated with a great variety of pharmacological activities, including anti-influenza activity.

One study found that, curcumin could regulate immune response following influenza A virus infection through inhibiting production of local inflammatory cytokines.

Curcumin was found to inhibit (NF-κB) a family of highly conserved transcription factors that regulate many important cellular behaviours, in particular, inflammatory responses, cellular growth and cell death signalling in macrophages. Macrophages are a type of white blood cell of the immune system that engulf and digest cellular debris, foreign substances, microbes, cancer cells, and anything else that does not have the type of proteins specific to healthy body cells.

Curcumin also supported production of immune substances that respond to influenza A virus infection.

 The potential of curcumin as a promising treatment against IAV infection, whose effect may be mediated by regulating immune response to prevent injury to the lung tissue (41)(42)

​

Zinc

Zinc is necessary for a healthy immune system and low zinc levels can increase the susceptibility to disease, illness & increased blood pressure.

Zinc as does vitamin D and C, influences the innate immunity which the first line of defense against infections. Unlike acquired immune response, the innate immune system does not have a memory.

Studies reveal that zinc supplementation and optimal intake of zinc may restore impaired immune response and decrease infection incidence. Also, zinc supplementation results in increased numbers of T and NK immune cells (50).

Zinc deficiency

Unfortunately, we have major deficiency problems in Australia, particularly in our older population.

In Australia based on the EAR 37% of men & 9% of women have inadequate zinc intakes and males 71 years and over 66% had inadequate zinc intakes and females had 12.1 % inadequate zinc intakes FIG2.

Importantly If we look at the recommended dietary allowance which is higher than the EAR then these deficiency percentages are higher. (32)

FIG 2

                                                

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Zinc deficiencies in Australia by Age

 

According to a meta-analysis of three randomized controlled trials zinc acetate lozenges may increase the rate of recovery from the common cold three-fold. On the fifth day, 70% of the zinc lozenge patients had recovered compared with 27% of the placebo patients. (14)

Another meta-analysis shows that zinc supplementation can reduce the duration and severity of a cold, if it’s started early on.

 Also, convincing evidence from 13 randomized placebo-controlled trials that taking zinc soon after the onset of symptoms of the common cold significantly reduces both the duration and severity of symptoms. Zinc supplements are widely available over the counter, it was recommended that patients take zinc the next time they develop a cold. (20)

Zinc and coronavirus.

A 2010 study examined how zinc could inhibit a cousin of SARS-CoV-2: SARS-CoV (COVID-19. The team reported that zinc inhibits replication of the virus by interrupting the RNA-synthesis (45)

Although zinc can be helpful in reducing the symptoms of some illnesses and the common cold rhinoviruses. This may not mean that zinc is effective against COVID-19. Further studies are underway in Australia to see if zinc can be used as an effective treatment for coronavirus infection. Let’s hope there is some good news from these studies.

However, it may also be important to have correct dietary intake of zinc prior to infection and not just as a treatment.

It is interesting to note that an age dependent death graph for COVID-19  is very similar to an age dependent zinc deficiency graph from Australian Government Department of Health April 2020 FIG 3. However, although this may just be coincidence it deserves further investigation.

FIG 3

                        

 

 

 

 

 

 

 

 

 

 

 

 

 

   Age related Deaths from COVID-19 in Australia

 

Analgesics do they help?

The use of analgesics and other cold formula to just “push on through” may ease the aches and pains associated with respiratory infections, but they don’t reduce your spreading the virus to others and in fact may worsen the symptoms and increase time needed till recovery.

In some cases, we just may need something to get through an important event, taking analgesics may help, but prevention and a reduction of the duration and symptoms of a respiratory infection is the best way and complementary medicine may just have an answer.

Ibuprofen should not be used for managing symptoms CORVID-19

Scientists and senior doctors have backed claims by France’s health minister that people showing symptoms of covid-19 should use paracetamol (acetaminophen) rather than ibuprofen, a drug they said might exacerbate the condition. (26)

Taking ibuprofen or paracetamol will not cure a viral infection.

Complementary Medicine is better than Ibuprofen or Paracetamol in the prevention, and treatment of respiratory infections (common cold and Flu) is these analgesic medicines may adversely affect the immune systems function by lowering temperature when it is not at a dangerous level and by doing so may lower resistance to infection. Whereas complementary medicine is focused on prevention and a reduction in severity of the illness.

​

Paracetamol and or Ibuprofen could prolong the symptoms of respiratory infections

One study found patients were more likely to come back within a month with worsening symptoms or new symptoms if they were prescribed ibuprofen or ibuprofen with paracetamol for the symptoms of the common cold. Between 50 per cent and 70 per cent of participants in this study who were prescribed ibuprofen or ibuprofen with paracetamol had elongation and worsening of the symptoms that required returning to their doctor. (1)

Health Department Warning

Call the Poisons Information Centre on 13 11 26 (Australia) if a child, young person or adult has taken more paracetamol or ibuprofen than is recommended. Paracetamol is often taken by people who intend to harm themselves (suicide attempts). Paracetamol in large doses can cause severe liver damage

Use in the elderly

Ibuprofen should not be taken by adults over the age of 65 without careful consideration of co-morbidities and co-medications because of an increased risk of adverse effects, in particular heart failure, gastro-intestinal ulceration and renal impairment.

Use in pregnancy

Category C: Ibuprofen inhibits prostaglandin synthesis and, when given during the latter part of pregnancy, may cause closure of the foetal ductus arteriosus, foetal renal impairment, inhibition of platelet aggregation and may delay labour and birth. Use of ibuprofen is thus contraindicated during the third trimester of pregnancy, including the last few days before expected birth.

Get medical advice before taking analgesic medications for the treatment of viral infections

There are many herbs, vitamins and minerals that may have a positive effect in reducing the incidence, duration and symptoms of respiratory infection are available.

These data that are following are also fluid and is not to replace good medical advice.

 Following is information on the most used complementary medications that have goog scientific evidence supporting their use.

Hopefully ongoing research will develop a treatment or immunisation for COVID-19 soon, but we must slow down the progression of any virus with the above and any forthcoming health department recommendations.

If you have symptoms of respiratory tract infections, talk to your doctor and always follow your health care practitioners and Health Authorities advice.

​

Discussion

Interventional and observational epidemiological studies provide evidence that vitamin D, Vitamin C and Zinc deficiency may confer increased risk of influenza and respiratory tract infection

The data are consistent in the findings that our older population are at a higher risk of these deviancies and at the same time at increased risk of death from viral infections.

 It is therefore important that given these nutrients have a positive role is immune function and possible anti-viral effects we urgently need to improve dietary advice  to correct these deficiencies, and in some cases there may be a need for supplementation if these deficiencies cannot be corrected by dietary advice.

Additional studies are necessary to fully elucidate the efficacy, effective therapeutic dose  and mechanism of these nutrients.

Conflict of Interest Statement

The author declares that he consults to both professional associations and industry and states the information in this article is not influenced by any association or company and is published independently. He is member of the Australasian Medical Writers Association Inc.

 

References.

1. P. Little, M. Moore, et al. Ibuprofen, paracetamol, and steam for patients with respiratory tract infections in primary care: pragmatic randomised factorial trial. BMJ, 2013; 347 (oct25 2)

2. Adit A. Ginde, MD, MPH; Jonathan M. et al. Association Between Serum 25-Hydroxyvitamin D Level and Upper Respiratory Tract Infection in the Third National Health and Nutrition Examination Survey. Arch. Intern. Med. 2009;169(4):384-390

3. Walker VP, Modlin RL. The vitamin D connection to pediatric infections and immune function. Pediatr Res. 2009 May;65(5 Pt 2):106R-113R.

4.  Urashima U, et al. “Randomized trial of vitamin D supplementation to prevent seasonal influenza A in schoolchildren” American Journal of Clinical Nutrition, March 10, 2010.

5. Hemila, H. “Vitamin C and the Common Cold” Br. J. Nutrition” 67(1);316, January, 1992

6. Hemilä H, et al. Vitamin C for preventing and treating the common cold. Cochrane Database of Systematic Reviews 2007

7. Harri Hemilä1, et al. Vitamin C for preventing and treating the common cold Editorial Group: Cochrane Acute Respiratory Infections Group, Published Online: 31 JAN 2013

8. Sachin A Shah PharmD a c, Stephen Sander PharmD et al. Evaluation of echinacea for the prevention and treatment of the common cold: a meta-analysis The Lancet Infectious Diseases, Volume 7, Issue 7, Pages 473 - 480, July 2007

9.  Luis Vitettaemail, Samantha Coulson et al, The clinical efficacy of a bovine lactoferrin/whey protein Ig-rich fraction (Lf/IgF) for the common cold: A double blind randomized study, Complementary Therapies in Medicine Volume 21, Issue 3 , Pages 164-171, June 2013

10. Gerald N, et al. Efficacy of an extract of North American ginseng containing poly-furanosyl-pyranosyl-saccharides for preventing upper respiratory tract infections: a randomized controlled trial. CMAJ October 25, 2005 vol. 173 no. 9 doi: 10.1503/cmaj.1041470

11. Heinrich Matthys, et al. Efficacy and safety of an extract of Pelargonium sidoides (EPs 7630) in adults with acute bronchitis: A randomised, double-blind, placebo-controlled trial Phytomedicine Volume 10, Supplement 4, 2003, Pages 7-17

12. Taofikat B. Agbabiaka, et al. Pelargonium sidoides for acute bronchitis: A systematic review and meta-analysis, Phytomedicine Volume 15, Issue 5, 15 May 2008, Pages 378–385

13. S. Fazio et al, Tolerance, safety and efficacy of Hedera helix 1 extract in inflammatory bronchial diseases under clinical practice conditions: A prospective, open, multicentre post marketing study in 9657 patients Phytomedicine Volume 16, Issue 1, January 2009, Pages 17–24

14. Harri Hemilä, James T. Fitzgerald, Edward J. Petrus, Ananda Prasad. Zinc Acetate Lozenges May Improve the Recovery Rate of Common Cold Patients: An Individual Patient Data Meta-Analysis. Open Forum Infectious Diseases, 2017; 4 (2) DOI: 10.1093/ofid/ofx059

15.  Domenico Careddu and Andrea Pettenazzo, Pelargonium sidoides extract EPs 7630: a review of its clinical efficacy and safety for treating acute respiratory tract infections in children International Journal of General Medicine 2018:11 91–98

16. G. Chuchalin MD. Berman MD, et al, Treatment of Acute Bronchitis in Adults With a Pelargonium Sidoides Preparation (EPs® 7630): A Randomized, Double-Blind, Placebo-Controlled Trial, Elsevier Volume 1, Issue 6 Pages A1-A10, 415-496 (November 2005)

17. Michael Roth, Lei Fang, et al, Pelargonium sidoides radix extract EPs 7630 reduces rhinovirus infection through modulation of viral binding proteins on human bronchial epithelial cells,  PLoS One. 2019; 14(2): e0210702.

18. Katrin Witte, Egon Koch, et al. The Pelargonium sidoides Extract EPs 7630 Drives the Innate Immune Defense by Activating Selected MAP Kinase Pathways in Human Monocytes, PLoS One. 2015; 10(9): e0138075.

19. Stoyan Dimitrov, Tanja Lange, et al. Gαs-coupled receptor signaling and sleep regulate integrin activation of human antigen-specific T cells  J Exp Med (2019) 216 (3): 517–526.

20. Goutham Rao, MD, Kate Rowland, MD. Zinc for the common cold—not if, but when, J Fam Pract. 2011 Nov; 60(11): 669–671

21. James Hudson, Selvarani Vimalanathan. Echinacea—A Source of Potent Antivirals for Respiratory Virus Infections, Pharmaceuticals (Basel). 2011 Jul; 4(7): 1019–1031.

22. Schapowal A. Efficacy and safety of Echinaforce® in respiratory tract infections Wien Med Wochenschr. 2013 Feb;163(3-4):102-5

23. Harvard Health Letter Out in the cold Published: January 2010

24. Rathish Nair, Arun Maseeh. Vitamin D: The “sunshine” vitamin J Pharmacol Pharmacother. 2012 Apr-Jun; 3(2): 118–126.

25. Cynthia Aranow. Vitamin D and the Immune System, J Investig Med. 2011 Aug;59(6):881-6

26.   Michael Day. Covid-19: ibuprofen should not be used for managing symptoms, say doctors and scientists, BMJ 2020;368:m1086 Published 17 March 2020

27.   2019-2020 U.S. Flu Season: Preliminary Burden Estimates, Centers for Disease Control and Prevention

28.   Australian Bureau of Statistics Causes of Death, Australia, 2017

29.   Harri Hemila. Vitamin C and Infections Nutrients, 2017;9 (4): 339

30.   Mariangela Rondanelli, Alessandra Miccono, et al. Self-Care for Common Colds: The Pivotal Role of Vitamin D, Vitamin C, Zinc, and Echinacea in Three Main Immune Interactive Clusters (Physical Barriers, Innate and Adaptive Immunity) Involved during an Episode of Common Colds—Practical Advice on Dosages and on the Time to Take These Nutrients/Botanicals in order to Prevent or Treat Common Colds Evid Based Complement Alternat Med. 2018; 2018: 5813095.

31.   David A Jolliffe1 Lauren Greenberg et al.  Vitamin D to prevent exacerbations of COPD: systematic review and meta-analysis of individual participant data from randomised controlled trials, BMJ thorax jnl-2018-212092, Volume 74, Issue 4

32.   Australian Bureau of Statistics, 2015

33.   Yejin Kim , Hyemin Kim, et al. Vitamin C Is an Essential Factor on the Anti-viral Immune Responses Through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection Immune Netw, 13 (2), 70-4 Apr 2013

34.   Praveen Ravindran, Stephanie Wiltshire, et al. Vitamin C deficiency in an Australian cohort of metropolitan surgical patients, Pathology, Volume 50, Issue 7, December 2018, Pages 793

35.   Yogesh Sharma, Michelle Miller, et al.  Vitamin C deficiency in Australian hospitalised patients: an observational study Journal of Internal Medicine Volume 49, Issue2 February 2019 Pages 189-196

36.   Hyemin Kim, Mirim Jang, et al.  Red Ginseng and Vitamin C Increase Immune Cell Activity and Decrease Lung Inflammation Induced by Influenza A virus/H1N1 Infection, J Pharm Pharmacol, 68 (3), 406-20 Mar 2016

37.   Hunt C., Chakravorty N.K., Annan G., et al.The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections. Int. J. Vitam. Nutr. Res. 1994;64:212–219

38.   Nathens AB, Neff MJ, Jurkovich GJ, et al., prospective trial of antioxidant supplementation in critically ill surgical patients. Ann Surg 2002;236:814–822.

39.   Figueroa‐Méndez R, Rivas‐Arancibia S. Vitamin C in health and disease: its role in the metabolism of cells and redox state in the brain. Frontiers in Physiology 2015;6:397.

40.   Anitra C. Carr, Silvia Maggini. Vitamin C and Immune Function, Nutrients 2017, 9(11), 1211

41.   Han S, Xu J, et al. Curcumin ameliorates severe influenza pneumonia via attenuating lung injury and regulating macrophage cytokines production. lin Exp Pharmacol Physiol. 2018 Jan;45(1):84-93

42.   Da-Yuan Chena, Jui-Hung Shien et al. Curcumin inhibits influenza virus infection and haemagglutination activity, Food Chemistry Volume 119, Issue 4, 15 April 2010, Pages 1346-1351

43.   Matthys H et al.Planta Medica 2008;74:686-92. Research supported by ISO-Arzneimittel,Ettlingen,Germany.

44.   Matthys H et al.Curr Med res Opin 2007;23:323-31.Research supported by ISO-Arzneimittel,Ettlingen,Germany.

45.   Zn Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture, PLoS Pathogens 6(11):e1001176 · November 2010

46.   MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce vitamin D3. J Clin Invest 1985 Oct;76(4):1536-8

47.   Blum M, Dolnikowski G, Seyoum E, Harris SS, Booth SL, Peterson J, et al. Vitamin D(3) in fat tissue. Endocrine 2008 Feb;33(1):90-4

48.   Muhammad A, khtar A, et al. t Anti-inflammatory effects of Hederacoside-C on Staphylococcus aureus induced inflammation via TLRs and their downstream signal pathway in vivo and in vitro,  Microbial Pathogenesis Volume 137, December 2019, 103767

49.   Setright, R. Vitamin D3, The Super Nutrient: An Independent Review of Complementary Medicine Evidence, Journal of the Australian Traditional-Medicine Society 17(2):26-34 · June 2011

50.   Chandra, R. K. (1992) Effects of vitamin and trace-element supplementation on immune responses and infections in the elderly. Lancet 340: 1124–1137.

 

An important note

No supplement, diet, or lifestyle modification — aside from social distancing and practicing proper hygiene ⁠— can protect you from developing COVID-19.

The strategies outlined above may boost your immune health, but they don’t protect specifically against COVID-19

1. Anitra C. Carr, Silvia Maggini. Vitamin C and Immune Function, Nutrients 2017, 9(11), 1211

 

The information in this article is for information purposes only always see your healthcare practitioner for advice and treatment for accident and illness and discuss any information in this article with them.