COVID – Update November 2021

COVID – Update November 2021

COVID – Update November 2021
As the pandemic has unfolded, we have provided periodic updates to a blog
on COVID-19 diagnosis and prevention/severity reduction.  This update
provides information relating to current topics of concern.

Testing

Most people are now familiar with the three types of COVID testing. Rapid
and PCR testing based on nasal swabs are used to test for current infection.
Antibody testing is used to assess for prior infection. Patients often ask if
antibody testing can be used to determine if they are immune from
infection, and whether a vaccine or booster would be appropriate.
Unfortunately, current testing methods do not enable a determination of
immunity to be made. As a consequence, antibody testing is generally not
of value at this time.

Preventing and Reducing Disease Severity

The currently accepted methods for preventing COVID-19 are immunization,
wearing a mask, and social distancing.  Most patients are knowledgeable
and do not have questions regarding the latter two methods.
We are often asked for our advice on whether to vaccinate.  In our view, this
is an individual decision based on assessment of benefits and risks. For
most adult patients, benefits of immunizing are reduction in likelihood of
severe illness, hospitalization, death, and post-illness complications. Risks
are generally low and related to adverse effects that are self-limited; we
assess them on an individual basis based on prior and current history.
Alongside of this, it may be helpful to take steps to minimize biological risk
and the severity of infection.  Maintaining or achieving a healthy body
weight and optimizing blood sugar, nutrition, and physical fitness are the
cornerstone of this approach.  Additionally, it is known that COVID-19
involves an initial period of a few days of generally low symptoms, which in
some individuals then gives rise to an immune response that has the
potential for life-threatening illness and post-illness long-term
complications (fatigue, cognitive and mood issues, respiratory or
cardiovascular deficits).  In other words, like some other infections such as
Lyme (which we see a lot of in our practice) the “host response” (individual
biological health) is important in determining the course of the illness.
Although evidence is evolving regarding interventions that may have the
potential for ameliorating COVID-19 severity, among integrative and other
practices an approach that includes the following has been used:

  • Antioxidants such as Vitamin C 1000 mg twice daily prior to
    illness, and 2000-3000 mg three times daily early in the course of
    illness
  •  Vitamin D3 5000 units daily prior to illness to reach 25 OHD levels
    of 50 or above and 5,000-10,000 units twice daily early in the
    course of illness
  •  Zinc 30 mg daily prior to illness and four times daily early in the
    course of illness
  • Quercetin 250 mg daily prior to illness and four times daily early in
    the course of illness
  • Avmacol, which includes sulforaphane (an active immune-
    enhancing ingredient in broccoli sprouts) and increases the
    availability of glutathione, a powerful antioxidant, daily prior to
    illness, and three times daily early in the course of illness
  • Melatonin 3-5 mg once daily prior to illness and two to three times daily early in the course of illness
  • Inhalation of nebulized hydrogen peroxide 3% solution several times daily prior to illness, or hourly early in the course of illness; a video demonstrating this technique is at https://archive.earthclinic.com/remedies/hydrogen_peroxide_inhalation.html
  • Avoidance of electromagnetic fields (EMFs), such as are generated by wi-fi, cell phones, and other devices as much as possible prior to illness and more aggressive early in the course of illness
  • Caution in taking folates or ACE inhibitors
  • Use of hydrogen water, such as Quicksilver H2 Elite, once daily prior to illness and three times daily early in the course of illness
  • Use of ozone water or other methods of administration of it; this involves purchase of an ozone generator (see, e.g. https://www.simplyo3.com/collections/generators/products/stratus?_ga=2.87899931.2018403127.1586138178-2043708408.1586138178); a liter of ozone water daily prior to illness and three times daily early in the course of illness
  • Use of a broad spectrum herbal treatment approach, including one by Stephen Buhner whom many know as a prolific American herbalist with perhaps the broadest experience with use of herbs in treating Lyme disease; summary of Buhner’s recommendations can be found at https://highgardentea.com/herbal-treatment-for-coronavirus/

Increasingly, monoclonal antibody treatments have also become available
in Maryland. Should you develop symptoms, we recommend that you
consider the information in this post and communicate with your IHP
physician or PA on your specific situation.

Osteoporosis and Low Bone Density

Bone is a dynamic structure, constantly being remodeled by cells that remove it (osteoclasts) and renew it (osteoblasts).  Once adulthood is reached, these two processes should stay in relative balance, but as hormonal status changes over time, the removal process predominates.  For some people, hormonal-mediated bone removal may be predated or augmented by other conditions.

Predominance of bone removal results in low bone density (sometimes referred to as osteopenia).  When bone density declines, the structure of bone is altered and it loses some of its strength and flexibility.  Severe bone loss is referred to as osteoporosis; osteoporotic bone has thinner outer cortex and trabecular supporting structure.

Low bone density and osteoporosis are associated with increased risk of fracture.  Other factors, however, are also important in predicting fracture risk:  age, smoking status, body size, alcohol use, etc.  The FORE Fracture Risk Calculator (https://americanbonehealth.org/bone-health/introducing-the-fore-fracture-risk-calculator/) can be used to calculate fracture risk.  Importantly, the radiographic assessment of bone density by DXA scanning, which is the most widely used method of predicting fracture risk, does not take into account all of the factors that are relevant to this prediction.  The quality of bone (how it is structured and what its mineral composition is), as well as its density, is also important.  Bone quality is not generally assessable through non-invasive testing.

It is common for patients to undergo DXA scanning, be told that their bone density is low, or that it is declining rapidly based on serial scans, and that as a result prescription medications are recommended to reverse the process of bone loss.  Although for some patients this may be appropriate – particularly when the risk of fracture is very high – for others it may not be for several reasons:

  • DXA scanning is subject to error, particularly if the patient is not properly positioned during the scan
  • Factors that are causing the imbalance of bone resorption and bone renewal have not been identified and addressed
  • Risks resulting from the use of the medications may be significant, particularly with bisphosphonates, which are associated with osteonecrosis of the jaw, and with spontaneous fractures owing to their effect on bone, which is to block the removal process such that bone formation predominates, which increases bone density but alters its quality (making it structurally more brittle).

When a DXA scan shows low bone density, it is appropriate to do lab testing to assess for conditions that are associated with bone loss (imbalance between removal and renewal).  Testing includes the general assessment that we use for most patients in integrative care (for hormonal status, nutrients, gut health/celiac status, and inflammation), as well as assessment of factors that are more specific to bone, including PTH, serum calcium, Vitamin D levels, 24 hour urine calcium, C Telopeptide (CTX) and osteocalcinin.  The latter three factors assess balance between bone removal and renewal, and are used in initial assessment of causes of low bone density and to monitor impact of treatment over the short run, with biannual DXA scanning and fracture risk prediction over the long run.

There are multiple causes of low bone density from imbalance between resorption and formation of bone:

  • Nutrient deficiency, either dietary or due to poor absorption from the gut
  • Hormonal imbalance: hypothyroidism or its overtreatment, hyperthyroidism, hyperparathyroidism, insufficient or excess insulin/diabetes, low growth hormone/IGF-1
  • Chronic inflammation and oxidative stress: infection or leaky gut-based
  • Heavy metal toxicity: cadmium, lead, mercury, aluminum, iron

The approach to treatment is as follows:

  • Healthy diet and weight-bearing exercise
  • Nutrient supplementation with magnesium, calcium, Vitamin K2, Vitamin D3, strontium, and trace minerals
  • Address issues identified through history and diagnostic testing: nutrient deficiencies, hormonal gut health, inflammation/oxidative stress, heavy metal toxicity

Helpful resources are:

 

IV Nutrient Infusions

Nutrients given by intravenous infusion have been used by many alternative and integrative medicine practitioners for decades.  The rationale for their use is that the blood levels of such nutrients when given orally is limited by the ability of the gut to absorb them, whereas with IV nutrients blood levels can be substantially increased.  This has been confirmed by clinical studies.

In considering use of IV nutrients, two questions must be asked:  are they effective in achieving their intended therapeutic purpose, and are they safe.  Ideally, the answers to these questions would be based on clinical research, but unfortunately the amount of such research is limited.

Four types of IV nutrients are in common use:  Vitamin C infusions, glutathione infusions, multinutrient (Meyers’) infusions, and phosphatidylcholine infusions.

Vitamin C infusions are the best studied.  Vitamin C has many effects:  it is an antioxidant that protects against damage caused by free radicals, boosts the immune system’s effect on wound healing and infections, and is toxic to some types of cancer cells.  There is some evidence that such infusions are beneficial in cancer patients in improving quality of life, and possibly that there are effects on tumors that reduce size and increase time to relapse.  It may also have benefit in patients with infection, shingles, and with chronic fatigue.  Used in patients without contraindicated medical conditions, IV Vitamin C is safe.

Like Vitamin C, glutathione is an antioxidant.  Most literature on its use is not based on clinical research, but instead based on case reports.  It may be effective in increasing the effectiveness of manual therapies in patients with musculoskeletal conditions, in reducing symptoms of parkinsonism, and in improving symptoms associated with autoimmune or other inflammatory response.  It appears to be safe.

Multinutrient infusions were popularized decades ago under the name Myers infusions, based on the work of a Baltimore physician named John Myers, and a modified version of this infusion has been used with thousands of patients across the country.  The infusion includes Vitamins C, B complex, B12, B5, B6, calcium, and magnesium.  It has been shown to have some benefit for patients with fibromyalgia, and based on case reports may result in improvement in fatigue, pain, and depression in patients with such issues.  Multinutrient infusions are safe.

Phospholipids are a key component of the membranes that surround all of our cells.  When such membranes are disrupted by toxicity or injury, particularly in nerve cells, illness results.  IV phospholipids are widely used in Europe, and based on experience, may be of benefit to patients with brain injury and inflammatory/degenerative conditions.  They are safe.