Stuart Richer, OD, PhD, FAAO, is director of ocular preventive medicine at James Lovell Federal Health Care Facility in Chicago. He is also associate professor of family and preventative medicine at Chicago Medical School and assistant clinical professor
Have a plan to combat immune senescence in your senior patients at risk for the disease
At the Ocular Wellness and Nutrition Society,1 we teach our members how to build a firewall of immune protection for patients, eyecare providers, and their families.
Humans have lived and survived severe acute respiratory syndrome (SARS, 2004), avian flu (2008), swine flu (2010), Middle East respiratory syndrome (MERS, 2012), Ebola (2014), Zika (2016), and Ebola part deux (2018). Now COVID-19 is the new challenge.
Each flu season, tens of thousands die, especially those with pre-existing health challenges (smoking, obesity, diabetes, cancer, and more.) Yet as of this writing, we have seen only 302 U.S. coronavirus deaths.
For the United States, there remains an “unknown denominator” because reliable testing kits were largely unavailable during the first 4 months of the COVID-19 outbreak. That is, a small percentage Americans, thus far, have been tested for the pathogen.2 Regardless of the potential for increased virulence, resistance and proliferation of this virus, following government recommendations for social distancing and hygiene will of course buy us time and “flatten the curve.” However, optimizing the immune system by reducing fear and stress, and improving lifestyle while optimizing nutrition is more important than ever.
Immune processes and adjustment behaviors powerfully regulate each other.3 Thus, it is plausible that healthy food, quality sleep, sunshine, exercise, music, meditation, pets, and supplementation result in improved immune performance. Conversely, stress has been shown to lower immune competence in patients with cancer.4
Meta-analytic reviews have summarized results from the large number of studies using the “stress/non-stress” paradigm, revealing consistent immune changes in the presence of psychological stressors.5-8 Overly stressed individuals exhibit poorer sleep, exercise less, and have poor dietary habits, as well as habitual drug and alcohol use, all of which depress immune competence.5-8
Central activation of the sympathetic nervous system, even via non-adrenomedullary pathways such as sleep deprivation, has been shown to have a pivotal role in the regulation of inflammation and innate immunity in astronauts in hyper-stressed environments.9 We know that the brain controls immune responses. Stress also increases the need for vitamin C from the diet or supplements.10
Related: Can azithromycin treat COVID-19?
Build natural immunity
Even in the polluted Chinese city of Wuhan and surrounding environment, it is reported that 81 percent of individuals who were infected had only mild disease: non-pneumonia and mild pneumonia.11 The good news is that Americans are likely already developing antibodies on their own without the aid of a vaccine.12 Functional foods and dietary supplements may enhance this natural immunity to overcome immune senescence.
Improve immunity by reducing simple sugars from the diet, from soda, fruit juices, candy, and cake. Choose nutrient-dense plant food, vegetables and vegetable juices and vitamin C/bioflavonoid-containing fruits. Sugar feeds bacteria that grow, like strep, so avoid secondary infections.
Sunlight and vitamin D3
The potential for co-infection is always present. The over-arching governor is the Earth in winter solstice tilting away from the sun with our immune system crashing. It is then that infectious disease erupts. Mass vitamin D nourishment is preferred, from vitamin D rich foods such as cold-water fish (like sardines or salmon) and mushrooms. However, fish alone in the absence of sunlight might not significantly raise vitamin D blood levels. Therefore, evaluate and optimize patients’ 25 OH vitamin D liver reserve status with a blood draw or finger blood spot test.
Protective effects of vitamin D are strongest in individuals with profound vitamin D deficiency at baseline, although those with higher baseline 25(OH)D concentrations also experience benefit according to meta-analysis studies.13
House-bound elderly patients of color, those living in northern latitudes or not exposed to natural sunlight, and at-risk patient such as smokers, the obese, and patients with pre-existing conditions such as diabetes and heart disease are the patients to be concerned about.13
Zinc lozenges for sore throat
The hallmark sign of an infection is a cough, probably bronchial. The immune system will not kick in to produce T cells until about the sixth or seventh day of a bout with flu or cold. Zinc combats microbial infection by invigorating the thymus gland to produce naÃ¯ve T white blood cells that will become competent memory T-cells that produce antibodies against incoming microbes.14
Taking a zinc acetate lozenge at the first sign of a cold or cough may shorten a bout of the common cold by three days and longer.14 These lozenges should not be taken daily, only during illness.
Deep breathing the mist of a hot shower or from a nebulizer are helpful. Sore throats are addressed by gargling with saltwater (alkaline) to battle streptococcus (acid forming bacteria), using anesthetics for comfort (such as Chloraseptic spray). Stress increases the need for vitamin C, while common medications such as steroids, aspirin, and diuretics deplete vitamin C.15
Related: Optometry during COVID-19 pandemic
Elderberry syrup, an option for children, may shorten a bout with a cold by one to one and a half days. Echinacea dosing is 10 g and is mildly helpful. Beta glucan is superior to elderberry syrup. Licorice root may quell SARS-type viruses, but it is not for daily use due to blood pressure raising effects.16
Related: COVID-19 and contact lens wear: What ODs and patients need to knowDaily nutrition and supplementation
As a general principles, in addition to minimizing junk food and promoting nutrient dense food, ODs may prescribe a high-potency, broad spectrum daily multivitamin. Optimal immunity requires A, C, D, E, B2, B6, folic acid, iron, selenium and zinc.17 But it also requires prebiotics, probiotics and symbiotics for an optimal microbiome, as the gut lining represents 70 to 80 percent of the immune system.18
Zinc is the gate keeper of immune function and Zn mono-methionine optimizes T-cell immunity.19 The body will not produce adequate T-cells for long-term immunity without zinc; 10 mg for children; 30 mg for adults.19 Advise patients not to take more or the body will excessively bind up zinc.20
Polyphenols such as quercetin and resveratrol have robust anti-viral properties.21-23
Choose foods or supplements that build the master intracellular antioxidant in all living cells: glutathione (GSH). This can be accomplished with a half a cup daily of avocado, pinto beans or asparagus, or prescribing 500 mg of reduced glutathione (Figure 1). Note that vitamin C is a master GSH booster. It is suggested that at-risk groups take 500 mg of vitamin C q4 to 6 hours.
For elderly individuals or those with pre-existing medical conditions, who are at high risk, evidence confirms vitamin C’s effectiveness when used in excess of recommended allowances.21-23
Patients with acute viral infections show a depletion of vitamin C and increasing free radicals and cellular dysfunction.21-23 The immune system of such patients should be treated with vitamin C, oral or intravenous (IV), for neutralizing free radicals throughout the body and inside cells, maintaining physiological functions, and enhancing natural healing.
An international team of physicians affiliated with the institute have organized three ongoing clinical trials in China and published the intravenous protocols of the Japanese College of Intravenous Therapy (IVC) 12.5 g to 25 g (12,500 mg to 25,000 mg) for acute viral infections. 23-25 IVC is usually administered once or twice a day for two to five continuous days, at a dose of 12 grams to 24 grams per day, with or without general antiviral treatments.
ODs should use this information to begin further research on modulating immunity and form their opinions based on existing and unfolding knowledge24,25 not fear.16
More by Dr. Richer: Consider the underrated significance of vitamin K2 in eye care
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