Current Research on Herbs and Nutrients Holds Promise Against COVID-19

I’ve grown frustrated and concerned over the degree to which the news surrounding COVID-19 focuses on fear and the promise of a ‘super hero’ vaccine that will eventually save us.

Every week, I come across research that supports the use of herbal and nutritional compounds, diet, and lifestyle that have been shown to be of potential benefit in bolstering our immune defense against the virus. It’s unfortunate that these studies are not being more widely reported and implemented in our approach to this disease.

What We Know About COVID-19

The risks of COVID-19 have been widely publicized. We know that the elderly are more likely to be hospitalized and die from the disease. We’ve heard that people with pre-existing conditions such as diabetes, cardiovascular disease, and immune related diseases are more likely to suffer complications from the virus. And we’ve been told that certain ethnic groups are more likely to become severely ill and die from the disease. Forty-two percent of COVID-19 related deaths have been in nursing homes, affecting people over the age of 85. What else do we know for certain?

The truth is that there are no significant differences in mortality based on ethnicity, insurance status, or individual medical comorbidities, although a negative trend exists for diabetes. There is, however a clear trend toward increased overall mortality in Class 3 obesity, which is more prevalent in certain ethnic and social economic groups.[1] Instead of hoping for a vaccine to save us, we need to focus on improving health through eating better, getting more physical activity, and addressing specific nutritional deficiencies that are key players in immune health.

Propolis May Be Effective Against COVID-19

If I had to choose a favorite natural medicine, it would be propolis. In my clinical practice, I’ve witnessed the beneficial effects of propolis for a wide variety of health conditions. Recently, propolis has emerged as potentially useful against COVID-19.

A resinous material produced by honeybees from plant exudates, propolis is valued worldwide in traditional herbal medicine for its immune modulating and anti-microbial effects.

According to a recent study, propolis components have inhibitory effects on the ACE2, TMPRSS2 and PAK1 signaling pathways. In addition, antiviral activity has been proven in vitro and in vivo. In pre-clinical studies, propolis was shown to promote immunoregulation of pro-inflammatory cytokines, including reduction in IL-6, IL-1 beta and TNF-α. This immunoregulation involves monocytes and macrophages, as well as Jak2/STAT3, NF-kB, and inflammasome pathways, reducing the risk of cytokine storm syndrome, a major mortality factor in advanced COVID-19 disease.

Major pathways through which propolis can interfere with SARS-CoV-2 attachment to the host cell, viral replication, and pathophysiological consequences. SARS-CoV-2 entry into target cells requires spike protein binding to ACE2 and activation by TMPRSS2.

The researchers concluded that propolis has also shown promise as an aid in the treatment of the comorbidities that are particularly dangerous in COVID-19 patients, including respiratory diseases, hypertension, diabetes, and cancer.[2]

Echinacea for the Prevention or Treatment of Respiratory Infections

Echinacea is perhaps the best-known herb for the enhancement of immune function. It promotes T-cell activation, interferon production, natural killer cell activity, antibody binding, lymphatic function and macrophage phagocytosis.[3]^,[4],[5]

Echinacea was traditionally used by American Indians of the western plains and was the herb most widely used by Eclectic physicians.  It was used primarily as a blood purifier to treat various conditions such as abscesses, boils, gangrenous wounds, poison ivy, scarlet fever and influenza.[6]^,[7] 

Current evidence suggests that Echinacea supplementation may decrease the duration and severity of acute respiratory tract infections (ARI); however, no studies using Echinacea in the prevention or treatment of conditions similar to COVID-19 have been identified.

Previous studies have reported that Echinacea may decrease the severity and/or duration of ARI when taken at the onset of symptoms. The studies reporting benefit used E. purpurea or a combination of E. purpurea and E. angustifolia containing standardized amounts of active constituents. Few adverse events from the use of Echinacea were reported, suggesting that this herbal therapy is reasonably safe.

No human trials could be located reporting evidence of cytokine storm when Echinacea was used for up to 4 months.

When assessing all human trials which reported changes in cytokine levels in response to Echinacea supplementation, the results were largely consistent with a decrease in the pro-inflammatory cytokines that play a role in the progression of cytokine storm and Acute Respiratory Distress Syndrome, factors that play a significant role in the death of COVID-19 patients.[8]  

The WHO recognizes that medicinal plants such as Aretmisia annua are being considered as possible treatment for COVID-19.[9] In addition, four Iranian companies have launched studies to make herbal medicine for the treatment of COVID-19.[10]

Traditional Medical Approaches Have Much To Offer

Traditional Chinese medicine (TCM) and Ayurvedic medicine utilize a number of herbs for viral diseases. In India, researchers are studying the effects of medicinal plants on the coronavirus.[11] Although the mechanism of action of herbal extracts includes inhibition of viral replication, studies demonstrate that traditional herbal extracts may also interact with key viral proteins that are associated with virus virulence.[12]

Traditional Chinese Medicine and COVID-19: What the Research is Saying

After the outbreak of COVID-19 in China, TCM herbal protocols were employed to prevent, treat, and improve recovery from COVID-19. The first case of COVID -19 cured and discharged from the hospital by prescription of TCM was reported on January 24^th, 2020 in Beijing.

According to the evaluation of patients with COVD-19 who were treated by TCM, the disappearance of clinical symptoms and hospital stays decreased by 2, 1.7, and 2.2 days, respectively. Herbal components used in these studies included honeysuckle, mint and licorice to reduce fever and improve lung function, boost lymphocytes, and improve recovery.[13]

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Positive Benefits in a Clinical Trial Combining TCM Herbal Formula and Conventional Drug Therapy

A recent clinical research study demonstrated the unequivocal benefits of adding a traditional Chinese herbal formula to a treatment program for COVID-19. In a randomized trial, forty-two patients with COVID-19 were randomly assigned to receive a decoction (XBD) (1 bag/time 200 ml, 2 times/day) plus conventional medicine (n = 22) and conventional medicine alone (n = 20). Both groups were treated for 1 week. The primary endpoint was the disappearance rate of main symptoms (fever, cough, and fatigue).

The results of this study found that compared with the group receiving only conventional medicine, clinical symptoms such as fever, cough, fatigue and loss of appetite in the experimental group were significantly reduced. The number of lymphocytes in the experimental group increased significantly, which all returned to normal parameters. Meanwhile, the C-reactive protein and erythrocyte sedimentation rate (markers of inflammation) in the experimental group were significantly reduced as well.[14]

According to a 2020 study published in The American Journal of Chinese Medicine, researchers stated: “We reviewed the latest national and provincial clinical guidelines, retrospective cohort studies, and case series regarding the treatment of COVID-19 by add-on Chinese medicine. We have also reviewed the clinical evidence generated from SARS and H1N1 management with hypothesized mechanisms and latest in silico findings to identify candidate Chinese medicines for the consideration of possible trials and management. Given the paucity of strongly evidence-based regimens, the available data suggest that Chinese medicine could be considered as an adjunctive therapeutic option in the management of COVID-19.”[15]

Vitamin D Status and COVID-19

Vitamin D treatment has been found to decrease the incidence of viral respiratory tract infection, especially in patients with vitamin D deficiency.

A recent retrospective cohort study involving 489 patients at an urban academic medical center included patients with a 25-hydroxycholecalciferol or 1,25-dihydroxycholecalciferol level measured within 1 year before being tested for COVID-19 from March 3 to April 10, 2020.

In this study, deficient vitamin D status was associated with increased COVID-19 risk, a finding that suggests that randomized trials may be needed to determine whether vitamin D affects COVID-19 risk.[16] For more information on Vitamin D see my blog post entitled, “There’s No Substitute for Sunlight: The Essential Influence of Nature’s Sunshine Vitamin on Health.” https://www.donnieyance.com/theres-no-substitute-for-sunlight-the-essential-influence-of-natures-sunshine-vitamin-on-health/

Zinc and Respiratory Health

Many studies have proven the critical role that zinc plays in respiratory and immune health.  Zinc preserves natural barriers such as the respiratory epithelium to prevent pathogen entry, for a healthy function of the immune system and the redox system. As such, zinc deficiency can probably be added to the factors predisposing individuals to infection and detrimental progression of COVID-19.[17] Finally, due to its direct antiviral properties, zinc is likely beneficial for most of the population, especially those with suboptimal zinc status. [18]

Zinc supplementation improves mucociliary clearance, strengthens the integrity of the epithelium, decreases viral replication, preserves antiviral immunity, attenuates the risk of hyper-inflammation, supports anti-oxidative effects and thus reduces lung damage and minimizes secondary infections. Older subjects, patients with chronic diseases and most of the remaining COVID-19 risk groups would most likely benefit from zinc supplementation.[19]^,[20] For example, 57.5% elderly and nursing home residents in the U.S., for which high incidence of respiratory tract infections is described, have significantly decreased zinc intake levels and are considered subjects with high risk regarding COVID-19.[21]

Viral mechanism of COVID-19 and how they might be opposed by zinc data. There is an impressive intersection of known risk factors for zinc deficiency (blue circle) and the predisposition for a severe COVID-19 infection (red circle).⁶

For more information on zinc, see my blog post entitled, “Zinc: The Most Important Nutrient for Immunity”https://www.donnieyance.com/zinc-the-most-important-nutrient-for-immunity/, as well as an earlier blog entitled, “Why Zinc Is So Important (And Why You Might Be Deficient)” https://www.donnieyance.com/why-zinc-is-so-important-and-why-you-might-be-deficient/

Quercetin and Immunity

In decades of research, quercetin has demonstrated potential benefit and safety for a wide range of health issues. Preclinical studies show that quercetin has both immunomodulatory and antimicrobial effects, and quercetin supplementation has shown beneficial effects on the incidence and duration of respiratory tract infections.[22] For more information on quercetin see my blog post entitled: “Quercetin’s Remarkable Health Benefits.”

Closing Thoughts

As the media continues to promote fear of COVID-19, it also seems to promote fear around the use of herbs. For example, the NIH states: “There is no scientific evidence that any of these alternative remedies can prevent or cure COVID-19. In fact, some of them may not be safe to consume. Some of these purported remedies include herbal therapies, teas, essential oils, and tinctures.”[23]

The herbs and natural remedies I’ve used in my clinical practice for the past four decades have a long history of safety and effectiveness. Meanwhile, the government promises a vaccine at sometime in the future that ‘might’ protect us from this latest public health threat. For many months we’ve been left to wait in a state of fear and helplessness, with no guidance except to wear masks, to isolate ourselves, and to avoid contact with one another. This is simply not the answer.

I am mystified as to why herbs and herbal medicine, the oldest tradition of medicine, is referred to as “alternative” while modern drug therapies are considered normal and mainstream. We have many herbal allies that have been proven to bolster our resistance and to aid our recovery from illness. We need to focus on improving our health and strengthening our immunity, and the healing plants have a great deal to offer to us. I will continue to stand up for the plants and praise them as humble gifts for our healing.

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[1] Capone S, Abramyan S, Ross B, et al. Characterization of Critically Ill COVID-19 Patients at a Brooklyn Safety-Net Hospital. Cureus. 2020;12(8):e9809. Published 2020 Aug 17. doi:10.7759/cureus.9809

[2] Berretta AA, Silveira MAD, Cóndor Capcha JM, De Jong D. Propolis and its potential against SARS-CoV-2 infection mechanisms and COVID-19 disease: Running title: Propolis against SARS-CoV-2 infection and COVID-19 [published online ahead of print, 2020 Aug 17]. Biomed Pharmacother. 2020;131:110622. doi:10.1016/j.biopha.2020.110622

[3] Orinda, D., etal, 1973.  Antiviral activity of components of echinacea purpurea.  Arzneimittelforschung 23 (8) : 1119-1120.

[4] Fonseca FN, Papanicolaou G, Lin H, Lau CB, Kennelly EJ, Cassileth BR, Cunningham-Rundles S. Echinacea purpurea (L.) Moench modulates human T-cell cytokine response. Int Immunopharmacol. 2014 Mar;19(1):94-102. doi: 10.1016/j.intimp.2013.12.019.

[5] Currier NL, Miller SC. Echinacea purpurea and melatonin augment natural-killer cells in leukemic mice and prolong life span. J Altern Complement Med. 2001 Jun;7(3):241-51.

[6] Ellingwood, F. American Materia Medica, Therapeutics and Pharmacognosy.  Vol. 2.(Portland: Eclectic Medical Publications; 1983), pp. 358-376.

[7] Felter, H. W. and  Lloyd, J.U. King’s American Dispensatory, 18^th Edition, Volume 1.(Portland:  Eclectic Medical Publications, 1983), pp.671-677

[8] Aucoin M, Cooley K, Saunders PR, et al. The effect of Echinacea spp. on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review [published online ahead of print, 2020 Aug 1]. Adv Integr Med. 2020;10.1016/j.aimed.2020.07.004. doi:10.1016/j.aimed.2020.07.004

[9] S. Koch, W. Pong, First up for COVID-19: Nearly 30 Clinical Readouts before End of April, vol. 20, BioCentury Inc. (2020)

[10] Clinical trial number NCT04317040 for “CD24Fc as a non-antiviral immunomodulator in COVID-19 treatment (SAC-COVID)” (at ClinicalTrials.gov).

[11] S. Vimalanathan, S. Ignacimuthu, J. HudsonMedicinal plants of Tamil Nadu (Southern India) are a rich source of antiviral activities, Pharmaceut. Biol., 47 (5) (2009), pp. 422-429

[12] Mirzaie A, Halaji M, Dehkordi FS, Ranjbar R, Noorbazargan H. A narrative literature review on traditional medicine options for treatment of corona virus disease 2019 (COVID-19). Complement Ther Clin Pract. 2020;40:101214. doi:10.1016/j.ctcp.2020.101214

[13] Y. Li, X. Liu, L. Guo, J. Li, D. Zhong, Y. Zhang, M. Clarke, R. JinTraditional Chinese herbal medicine for treating novel coronavirus (COVID-19) pneumonia: protocol for a systematic review and meta-analysis Syst. Rev., 9 (2020), pp. 1-6

[14] Xiong WZ, Wang G, Du J, Ai W. Efficacy of herbal medicine (Xuanfei Baidu decoction) combined with conventional drug in treating COVID-19:A pilot randomized clinical trial. Integr Med Res. 2020;9(3):100489. doi:10.1016/j.imr.2020.100489

[15] Chan KW, Wong VT, Tang SCW. COVID-19: An Update on the Epidemiological, Clinical, Preventive and Therapeutic Evidence and Guidelines of Integrative Chinese-Western Medicine for the Management of 2019 Novel Coronavirus Disease. Am J Chin Med. 2020;48(3):737-762.

[16] Meltzer DO, Best TJ, Zhang H, Vokes T, Arora V, Solway J. Association of Vitamin D Status and Other Clinical Characteristics With COVID-19 Test Results. JAMA Netw Open. 2020;3(9):e2019722. Published 2020 Sep 1. doi:10.1001/jamanetworkopen.2020.19722

[17] Ackland ML, Michalczyk A. Zinc deficiency and its inherited disorders -a review. Genes Nutr. (2006) 1:41–9. doi: 10.1007/BF02829935

[18] Wessels I, Rolles B, Rink L. The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis. Front Immunol. 2020;11:1712. Published 2020 Jul 10. doi:10.3389/fimmu.2020.01712

[19] Petrilli CM, Jones SA, Yang J, Rajagopalan H, O’Donnell LF, Chernyak Y, et al. Factors associated with hospitalization and critical illness among 4,103 patients with COVID-19 disease in New York city. medRxiv [Preprint]. (2020). doi: 10.1101/2020.04.08.20057794. [Epub ahead of print].

[20] Vishnevetsky A, Levy M. Rethinking high-risk groups in COVID-19. Mult Scler Relat Disord. (2020) 42:102139. doi: 10.1016/j.msard.2020.102139

[21] Briefel RR, Bialostosky K, Kennedy-Stephenson J, McDowell MA, Ervin RB, Wright JD. Zinc intake of the U.S. population: findings from the third National Health and Nutrition Examination Survey, 1988-1994. J Nutr. (2000) 130:1367S−73S. doi: 10.1093/jn/130.5.1367S

[22] Aucoin M, Cooley K, Saunders PR, et al. The effect of quercetin on the prevention or treatment of COVID-19 and other respiratory tract infections in humans: A rapid review [published online ahead of print, 2020 Jul 30]. Adv Integr Med. 2020;10.1016/j.aimed.2020.07.007.

[23] https://www.nccih.nih.gov/health/in-the-news-coronavirus-and-alternative-treatments, retrieved September 6, 2020.