Dr. Anthony Lowham
Currently, there are no specific CDC guidelines in place for the use of vitamins or supplements for the prevention or treatment of COVID-19. In addition, Vitamins/Supplements/Nutraceuticals are not regulated by the FDA. It is important to obtain products from a reputable company and in a form that is well tolerated and well absorbed. In my opinion, these are simple, safe measures that may ensure an individuals immune system is optimal if they contract COVID-19. Consideration of utilizing supplements should always be combined with a healthy lifestyle including exercise and a whole food based diet.
Recommended Immune Support Protocol
- Vitamin D3 with K2, 5,000iu/daily
*Consider checking your Vitamin D3 level. If <30ng/ml consider 10,000iu/daily for the first two months.
- Zinc picolinate
*Consider Zinc lozenge (Cold Eeze, Zinc Gluconate) 1-3x daily prior to anticipated public exposure.
30mg once or twice daily
- Vitamin C, 1,000mg once or twice daily
- Melatonin 3-5mg daily
Severe acute respiratory syndrome coronavirus-2 (SARS-COV-2, COVID-19) has quickly became a global pandemic and has been responsible for over 200,000 deaths in the United States. Specific risk factors associated with a poor outcome after SARS-COV-2 infection include increased age, obesity, diabetes and underlying cardiorespiratory illness. Although mortality of infected individuals has steadily decreased, there is no current curative treatment and no vaccine is currently available. In many cases, morbidity and mortality are related to the development of an acute inflammatory immune response manifested as a “cytokine” storm, with resulting progressive respiratory compromise and development of Acute Respiratory Distress Syndrome (ARDS). Researchers have realized the importance of reducing the cytokine storm experienced by patients with this potentially life-threatening virus. Members of the medical community are beginning to evaluate the potential role of vitamins and supplements as potential treatment options or as additions to other treatments. (1)
A. Vitamin D3
The first step in the formation of vitamin D occurs in the skin as UVB rays convert 7-dehydrocholesterol to cholecalciferol. Modification occurs first in the liver, producing 25-hydroxyvitamin D3 or Calcidiol. Calcidiol then enters our circulation and is converted by the kidney and other tissues into the active form-1,25 dihydroxyvitamin D3 or Calcitriol. One of the main functions of vitamin D3 is to increase intestinal Calcium, Phosphorous and Magnesium absorption from our food. It acts to regulate proper bone mineralization and prevent osteoporosis. A severe deficiency of vitamin D, resulting in weak and soft bones, is known as “Rickets”.
But vitamin D3 has broad effects beyond its role in bone health. Calcitriol is also formed in other tissues including the brain and respiratory system. Calcitriol produced in those tissues has localized effects, including immune system support. Vitamin D3 has receptors in every cell of our bodies. The effects of Vitamin D3 are most similar to the effects of a hormone. Like other hormones, it has receptors within our cells and is able to bind to DNA and affect gene expression. In this manner it effects the regulation of about 900 different genes.(2)
An analysis of multiple studies evolving vitamin D and respiratory infection demonstrated vitamin D supplementation was safe and protected against respiratory infection, especially in individuals who were the most vitamin D deficient. (3,4)
Vitamin D3 has the ability to reduce inflammation by modulating the cytokine storm from TNF-α (tumor necrosis factor-alpha) and IFN-β (interferon-beta) associated with Influenzae A (H1N1)(5).
A review of current literature related to Vitamin D3 clearly suggests adequate Vitamin D3 levels are protective against severe COVID-19, especially in susceptible populations. It appears a correlation exists between Vitamin D3 levels and COVID-19 susceptibility. Vitamin D3 supplementation could prove to be an essential element in the fight against COVID-19.(6)
Two studies in the initial phase of the COVID-19 pandemic demonstrated that patients with COVID-19 infection have worse outcomes if their vitamin D levels are low.(7,8)
A retrospective study from the Philippines looked at 212 patients infected with COVID-19. The overwhelming majority of patients with severe and critical COVID infection had vitamin D levels <30ng/ml (insufficient) or <20ng/ml (deficient). The study author concluded that Vitamin D supplementation could possibly improve clinical outcomes of patients infected with COVID-19. (7)
A second retrospective study, this one from Indonesia, examined the outcomes in 780 patients infected with COVID 19. In this study, after correcting for age, sex and comorbid conditions, patients with insufficient (21-29ng/ml) Vitamin D levels had a mortality rate 7.6 times higher. In patients with Vitamin D deficiency (<20ng/ml), the mortality rate was 10 times higher. (8)
Although these are retrospective studies, there appears to be a strong correlation between deficient and insufficient vitamin D levels and increased mortality from COVID 19 infection. But, correlation does not necessarily mean causation. Elderly, frail, immunocompromised and metabolically unhealthy individuals tend to be less physically active and spend less time outdoors. As a result, they have lower levels of Vitamin D3.
Increasing vitamin D levels, especially in susceptible populations requires simple, effective measures. According to a 2011 study, over 40% of adults in the US are deficient in Vitamin D (<20ng/ml). This is even higher in populations with increased skin pigmentation including Native Americans, Hispanics and African-Americans. (9)
Recently, a Pilot study looked at the effects of Vitamin D3 supplementation on 76 patients admitted to the Hospital with COVID-19 diagnosis and respiratory symptoms. Fifty(50) patients received high dose vitamin D3 supplementation. Only 1/50 patients (2%) required admission to the Intensive Care Unit. Of the 26 remaining patients who did not receive Vitamin D3, 13/26 (50%) required admission to the Intensive Care Unit.(10)
Researchers have also noted patients with deficient Vitamin D3 status are almost twice as likely to test positive for COVID-19.(11)
How to Raise Vitamin D
- Regular sun exposure is the most natural way to raise vitamin D levels. Aim for 10–30 minutes of midday sunlight, several times per week, without sunscreen. People with pigmented skin may need a little more than this. Your exposure time should depend on how sensitive your skin is to sunlight. Eat whole, nutrient dense foods and avoid processed food. Remember, Vitamin D3 is primarily supplied by sunlight, not food. But our physiological state, including obesity and metabolic syndrome, is related to low Vitamin D3 levels.
- Vitamin D supplementation. To best guide recommendations for supplementation, it may be reasonable to obtain a blood test to determine your vitamin D3 level. Typically, in vitamin D3 deficient patients, I utilize 10,000iu/daily for 1-3 months and then switch to 5,000iu/daily.
Vitamin D3 (cholecalciferol) is recommended over vitamin D2 (ergocalciferol). In my opinion, any vitamin D3 supplement should contain vitamin K2 or Menaquinone. As discussed, vitamin D3 assists in Calcium absorption, vitamin K2 may be necessary to ensure Calcium deposition in bone.
Recommendation: Vitamin D3 with K2, 5,000iu-10,000iu/daily
B. Vitamin C
Overall, regular use of vitamin C supplements shortens the duration of the common cold, but taking vitamin C supplements once cold symptoms have already begun, has no proven benefits. In addition, Vitamin C does not reduce the risk of contracting a cold, except in persons undergoing heavy physical stress (e.g. marathon runners, skiers, or soldiers) where the incidence of colds is cut in half. It is likely that this antiviral effect is why vitamin C has attracted interest as a possible treatment of COVID-19. (12)
A meta-analysis of twelve trials looked at the length of ICU stay and requirement for mechanical ventilation in patients receiving Vitamin C supplementation. Patients receiving Vitamin C supplementation required 8% less time in the ICU. In three trials in which patients needed mechanical ventilation for over 24 hours, vitamin C shortened the duration of mechanical ventilation by 18.2%.(13)
Recommendation: *Liposomal or *Bioperine containing Vitamin C 1,000mg once or twice daily
“Liposomal” drug delivery systems utilize a biocompatible layer of fats, known as phospholipids, to deliver nutrients. They utilize the same phospholipids that are contained in our cell membranes.
“Bioperine” is a patented extract of black pepper that has also been shown to facilitate nutrient absorption.
Zinc supplementation improves the mucociliary clearance of inhaled particulates, strengthens the integrity of the epithelium, decreases viral replication, preserves antiviral immunity, attenuates the risk of hyper-inflammation, supports anti-oxidative effects, reduces lung damage and minimizes secondary infections.(14)
A study comparing Zinc levels in 47 patients infected with COVID-19 with a control group, showed that a significant number of COVID-19 patients were zinc deficient. These Zinc deficient patients experienced more complications including a longer hospital stay and increased mortality. Although it is not clear whether zinc supplementation after admission to hospital with a diagnosis of COVID-19 helps to reduce the severity of disease, a recommendation is made for more research to examine the role of Zinc supplementation as a cost-effective therapy for COVID-19. (15)
Recommendation: Zinc picolinate or Zinc glycinate 30mg once or twice daily
Zinc lozenge (Cold Eeze) prior to anticipated close contact.
It is well-known that melatonin is an anti-oxidative and anti-inflammatory agent that counters acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) induced by viral and bacterial infections. Melatonin can be beneficial in critically ill patients via reducing vessel permeability, inducing sedation, decreasing agitation and increasing sleep quality. These beneficial properties of melatonin may highlight this hypothesis that melatonin may exert further clinical outcomes for COVID-19 patients (16)
Although the direct protective action of melatonin against COVID-19 is unknown, its extensive application in animal studies and human clinical trials has repeatedly verified its efficacy and safety in a broad range of disorders. Therefore, melatonin practical usage in the current COVID-19 outbreak is suggested to be beneficial.(17)
Recommendation: Melatonin 3-5mg daily
If you have any questions, please email me at email@example.com or call Benessere Clinic (332-6222)
Anthony Lowham MD
- Michienzi SM, Badowski ME. Can vitamins and/or supplements provide hope against coronavirus?. Drugs Context. 2020;9:2020-5-7. Published 2020 Jun 22. doi:10.7573/dic.2020-5
- Bivona G, Agnello L, Ciaccio M. The immunological implication of the new vitamin D metabolism.Cent Eur J Immunol. 2018;43(3):331‐ doi:10.5114/ceji.2018.80053
- Martineau AR, Jolliffe DA, Hooper RL, et al. Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis of individual participant data. 2017 Feb 15;356:i6583.
- “Vitamin D Fact Sheet for Health Professionals”. National Institutes of Health (NIH). February 11, 2016
- Khare D, Godbole NM, Pawar SD, Mohan V, Pandey G, Gupta S, Kumar D, Dhole TN, Godbole MM. Calcitriol [1, 25[OH]2 D3] pre- and post-treatment suppresses inflammatory response to influenza A (H1N1) infection in human lung A549 epithelial cells. Eur J Nutr. 2013 Jun;52(4):1405-15. doi: 10.1007/s00394-012-0449-7. Epub 2012 Sep 27. PMID: 23015061.
- Razdan K, Singh K, Singh D. Vitamin D Levels and COVID-19 Susceptibility: Is there any Correlation?.Med Drug Discov. 2020;7:100051. doi:10.1016/j.medidd.2020.100051
- Alipio, Mark, Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-19) (April
9, 2020). Available at SSRN: https://ssrn.com/abstract=3571484 or http://dx.doi.org/10.2139/ssrn.3571484
- Raharusun, Prabowo and Priambada, Sadiah and Budiarti, Cahni and Agung, Erdie and Budi, Cipta, Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (April 26, 2020). Available at SSRN: https://ssrn.com/abstract=3585561 or http://dx.doi.org/10.2139/ssrn.3585561
- Forrest KY1, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults.Nutr Res.2011 Jan;31(1):48-54. doi: 10.1016/j.nutres.2010.12.001.
- “Effect of calcifediol treatment and best available therapy versus best available therapy on intensive care unit admission and mortality among patients hospitalized for COVID-19: A pilot randomized clinical study”
Marta Entrenas Castillo, Luis Manuel Entrenas Costa, José Manuel Vaquero Barrios, Juan Francisco Alcalá Díaz, José López Miranda, Roger Bouillon, José Manuel Quesada Gomez
J Steroid Biochem Mol Biol. 2020 Oct; 203: 105751. Published online 2020 Aug 29. doi: 10.1016/j.jsbmb.2020.105751
- 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. doi:10.1001/jamanetworkopen.2020.19722
- Simonson W. Vitamin C and coronavirus.Geriatr Nurs. 2020;41(3):331-332. doi:10.1016/j.gerinurse.2020.05.002
- Hemila H, Chalker E. Vitamin C can shorten the length of stay in the ICU: a meta-analysis. Nutrients. 2019;11:1–30. doi: 10.3390/nu11040708. [PMC free article] [PubMed] [CrossRef] [Google Scholar]
- 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
- Jothimani D, Kailasam E, Danielraj S, et al. COVID-19: Poor outcomes in patients with zinc deficiency [published online ahead of print, 2020 Sep 10]. Int J Infect Dis. 2020;100:343-349. doi:10.1016/j.ijid.2020.09.014
- Zhang R., Wang X., Ni L., Di X., Ma B., Niu S., Liu C., Reiter R.J. COVID-19: melatonin as a potential adjuvant treatment.Life Sci.2020 doi: 10.1016/j.lfs.2020.117583. [PMC free article] [PubMed] [CrossRef] [Google Scholar] [Ref list]
- Bahrampour Juybari K, Pourhanifeh MH, Hosseinzadeh A, Hemati K, Mehrzadi S. Melatonin potentials against viral infections including COVID-19: Current evidence and new findings. Virus Res. 2020;287:198108. doi:10.1016/j.virusres.2020.198108