Recommendations to Optimize Immune Function in the era of Covid-19


Anthony Lowham MD



  1. SARS-CoV-2 stands for “Severe Acute Respiratory Syndrome Coronavirus 2.” It is the virus that causes the disease.
  2. COVID-19 is an acronym for CoronaVirus Disease 2019. This refers to the viral illness.
  3. Severe COVID-19 results in pulmonary inflammation and the activation of a “cytokine storm”. This process results in the production of free radicals and ‘reactive oxygen species’ (ROS). When more free radicals and ROS exist than antioxidants, oxidative cell damage occurs. Antioxidants act as scavengers of free radicals and ROS.

Disclaimer: This article is for informational purposes only. Please contact your Health Care Provider before initiating any significant dietary change, exercise program or utilization of supplements/nutraceuticals.

Guidelines are provided to assist in maximizing our immune system function through exercise, diet and targeted supplements (nutraceuticals). In addition, a review of oral and nasal rinse protocols is provided to help reduce the risk of viral transmission and deplete viral load.

Age, obesity, and the presence of chronic medical conditions including heart disease, hypertension, diabetes, obesity, and kidney disease are individual risks factors for poor outcomes associated with Covid-19 infection.  Modification of risk includes maximizing an approach to healthy nutrition, exercise, and appropriate early treatment and supplementation. In this article, I will not be discussing Covid-19 vaccination. I will also not include any specific recommendations regarding the potential benefits of Hydroxychloroquine or Ivermectin in the treatment of Covid-19.  (1)

If you develop signs or symptoms of Covid-19, contact your Health Care Provider early.   Obtain a PCR test for confirmation and become aware of the available therapeutics.  Consider early Immunoglobulin therapy if available. Other therapeutics are becoming available and should be discussed with your Health Care Provider.

The clinical manifestations of Covid-19 range from asymptomatic infection, mild flu or cold-like symptoms, to severe pulmonary and extrapulmonary manifestations characterized by extreme inflammation and “cytokine storm”.  Communication among the cells of the immune system is primarily from a diverse group of small proteins called Cytokines.  Examples of inflammatory mediators involved in the cytokine storm include Interleukin-1, Interleukin-6, and Tumor Necrosis Factor (TNF).  A “cytokine storm” and severe inflammation are the hallmarks of severe Covid-19 infection.

Immune System

The Immune System has the ability to recognize and resist invasion from foreign (non-self) pathogens including viruses and bacteria.

Through contact exposure, inhalation and ingestion, our bodies are exposed to millions of pathogens daily.  We have an Innate and Adaptive immune response to deal with these invaders.

The Innate immune response is non-specific and is the first line of defense.  It includes the epithelial surfaces of the skin, lung, gut, blood cells (neutrophils and phagocytes), and the activation of an inflammatory response. (2)

In contrast, the Adaptive immune response is highly specific to the particular pathogen that induced it. The ability to distinguish what is foreign from what is “self” is a fundamental feature of the Adaptive immune system.

The Adaptive immune response is mediated primarily by Lymphocytes.  T lymphocytes are involved in the targeted destruction of diseased cells and B-lymphocytes produce antibodies that act to specifically neutralize a foreign invader.

The Adaptive Immune response also provides long-lasting protection. Receiving a vaccination leads to activation of Adaptive immunity towards a specific antigen.  In the case of Covid-19 mRNA vaccination, this is Immunity developed toward the Spike protein.  Adaptive Immunity also occurs after contracting and recovering from Covid-19.  In each case, specific cells (memory B-cells) remain on standby to quickly activate antibody production on re-exposure to a specific antigen and (memory-T-cells) become activated to kill virus-infected cells. (3)

Natural Adaptive Immunity following COVID-19 recovery, and Vaccine mediated Adaptive Immunity both provide significant protection against infection or re-infection from Covid-19.

In some cases, the immune system fails to make the distinction between ‘foreign’ and ‘self’ and acts against the body’s own cells.  This is called autoimmune disease.  Autoimmune disorders like Inflammatory bowel disease, Hashimoto’s thyroiditis, lupus, rheumatoid arthritis, and type 1 diabetes result from dysfunction of the Immune response.

Immunosuppression can occur as a result of diseases including leukemia or multiple myeloma.  Medications including steroids (Prednisone) and chemotherapy drugs to treat cancer, may also cause immunosuppression.  In these cases, the body’s defenses are compromised and the person may be more susceptible to infection from viruses or bacteria.


All parts of the body, if used in moderation and exercised in labors to which each is accustomed, become thereby healthy and well developed and age slowly; but if they are unused and left idle, they become liable to disease, defective in growth and age quickly.” -Hippocrates, 5th century BC

A consistent and focused exercise program is necessary to maintain a healthy and strong body, especially as we age. Before initiating an exercise program, contact your Health Care Provider for guidance.  Make use of Personal trainers or Fitness coaches to help you develop a program and utilize proper technique.

A study in the British Journal of Sports medicine indicated that patients participating in regular exercise had a lower rate of hospitalization, requirement for ICU care, and death following Covid-19 infection compared to inactive patients. (4)

The National Institutes of Health states,  “The practice of physical activities strengthens the immune system, suggesting a benefit in the response to viral communicable diseases. Thus, regular practice of moderate intensity exercise is suggested as an auxiliary tool in strengthening and preparing the immune system for Covid-19.” (5)

Aerobic activities, resistance training, and flexibility movements are necessary and valuable strategies to strengthen our immune system and help us to remain vibrant and healthy as we age. Exercise of any intensity on a daily basis results in improvement in overall physical and mental health.

Aerobic exercise improves how our bodies utilize oxygen.  Average or moderate intensity exercise for at least 20 minutes provides aerobic benefits including improved cardiopulmonary function, increased life expectancy, and less risk of diabetes, stroke, and heart disease. For more information see here.

Anaerobic exercise is used to increase power, strength, and muscle mass.   It is usually short duration (<2 minutes) and high intensity.  Examples include weight lifting, sprinting, and HIIT (High Intensity Interval Training).  Age-related decreases in muscle size, strength, and function is termed Sarcopenia.  Resistance training (weight lifting) is the most effective method at any age to reverse sarcopenia.  For more information see here.

Resistance exercise is effective at maintaining muscle health with increasing age, and also has significant effects on cardiovascular disease risk factors, type 2 diabetes, cancer, and mortality. Resistance exercise is the most effective exercise strategy for improving overall health in older adults. (6)

Agility training improves a person’s ability to stay balanced and maintain control with body movement.  Sports such as tennis, pickleball, volleyball, and soccer improve agility.  Stretching and flexibility can be improved with Yoga which also affects muscle conditioning and balance. For more information go here.

Elderly Walking
This link provides more detailed information: US Physical Activity Guidelines


Proper Nutrition allows us to provide our body with the building blocks for healthier living and the support our Immune system requires to function appropriately.  Just as important, maintaining a healthy weight allows a person to remain more active.

There is a substantial relationship between diet and nutrients and immune function. This includes the role of macronutrients, micronutrients, and the gut microbiome in mediating the health of our immune system. Nutritional modulation of the immune system has applications within the clinical setting of Covid-19, but can also have a role in healthy populations. (7)

The US obesity rate currently stands above 40%.  In comparison, no US state had an obesity rate above 25% in the year 2000.  In addition, childhood obesity rates are also rapidly increasing.  Obesity has serious health consequences including increased risk for type 2 diabetes, high blood pressure, stroke, and many types of cancers.

Obese patients have a substantially higher risk of developing Covid-19 infection and twice the risk of requiring hospitalization.  In addition, the requirement for ICU admission and the need for assisted mechanical ventilation increases significantly. Obesity is also a risk factor in young adults and children who do not have other comorbid conditions. Prior health conditions including impaired cardiorespiratory health, poor nutritional status, and reduced muscular function (sarcopenia), also contribute to a worse evolution of Covid-19. (8)

The Covid-19 virus may preferentially infect fat cells (adipocytes). Adipocytes are a major source of inflammatory mediators such as Interleukin-6 (IL-6) which play a role in the development of Covid-19 and the associated “cytokine storm”. (9)

Guidelines for Proper Nutrition

Before making any significant changes to your diet, make sure you contact your Health Care Provider.

We call it Nutrition, not Diet.  It is the healthy way we eat over time.  What works for us, as an individual, day to day.  No approach is the best.  But, there are some steps and guidelines that are beneficial to almost everyone.

  • Eat food with a single ingredient -beef, eggs, fish, avocado, broccoli, berries
  • Reduce carbohydrates, especially simple carbohydrates and added sugar (HFCS, sucrose).
  • Understand the Glycemic Index (GI)*
  • Increase healthy fats (Avocado oil, olive oil, butter, tallow, ghee, Coconut oil)
  • Avoid seed oils (Canola oil, corn oil, cottonseed, soy oil, sunflower oil)
  • Avoid sugar and fat combinations
  • Increase protein intake**
  • Consider Intermittent fasting (IF) and/or Time Restricted Eating (TRE)***

*The Glycemic Index (GI)

The GI is a rating system where foods are ranked on a scale of 1 to 100 based on how much they raise blood sugar. Processed foods such as candy, breads, cake, and cookies have a high GI, while whole foods such as unrefined grains, non-starchy vegetables, and fruits tend to have a lower GI.

For more information go here .

**Increase Protein Intake

To increase your daily protein intake, consider a Whey protein supplement popular with Bodybuilders such as Optimum Nutrition Gold Standard Whey or Signature Whey Protein.

These allow an increase in protein intake and are a better option than most protein “nutritional” supplements that are highly marketed including Boost and Ensure.  The main ingredient of Boost High Protein (20g protein) is “glucose syrup”. The main ingredient in Ensure Complete (30g protein) is “corn syrup”.  In simple terms, the main ingredient is sugar.

There are some concerns that a high quantity of animal-based protein may be detrimental to patients with poorly functioning kidneys.  Aim for 1gram/kg of protein daily.   If you have a history of kidney disease, contact your Health Care Provider.

*** Intermittent fasting (IF), Time Restricted Eating (TRE) 

Both strategies, alone or in combination allow for the introduction of structure and schedule.  They have been shown to have beneficial effects in regards to fat loss and improvement in cardiometabolic health. (10)

Intermittent fasting entails only eating during defined time periods.   During the fasting periods, the hormone Insulin is reduced, which allows the body easier access to fat for energy (lipolysis). The most common IF schedule is 8PM until Noon the following day.  This gives our bodies a 16 hour period of fasting.  Water, coffee, tea and other non caloric beverages are allowed during the fasting period.

Time Restricted Eating (TRE). With TRE, all calories are consumed during scheduled eating periods.  This may mean three meals a day (breakfast 6-7 AM, Lunch 12-1 PM, Dinner 6-7 PM) or two meals a day combined with IF.

For more information, go herehere and here

Healthy Food


Disclaimer: Currently, there are no specific CDC guidelines in place for the use of vitamins or supplements for the prevention or treatment of Covid-19.


The NIH (National Institutes of Health) has a website for health professionals entitled, “Dietary Supplements in the Time of Covid-19” available here:

The FLCCC (Front Line COVID-19 Critical Care Alliance) has prevention and early treatment protocols (I-MASK) in place for review here:

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.  Consideration of utilizing supplements should always be combined with a healthy lifestyle including exercise and a whole food based diet.

A. Vitamin D3

Optimization of Vitamin D3 to levels above 50ng/ml is recommended. Patients are encouraged to check their D3 level to help guide optimization strategies.

There is a  strong correlation between the death rate resulting from Covid-19 and the vitamin D3 blood level.  With a level above 30 ng/mL, mortality decreases considerably. (11)

Vitamin D3 has a central role in the function of the immune system and vitamin D3 deficiency may contribute to a worse prognosis following a diagnosis of Covid-19.  Vitamin D3 may be associated with an increased likelihood of contracting SARS-CoV-2, developing Covid-19, the seriousness of the illness, and mortality.

Maintaining appropriate levels of Vitamin D3 through natural sun exposure and proper supplementation is recommended to the public to assist in the pandemic. (12,13)

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.

Vitamin D3 (cholecalciferol) is recommended over vitamin D2 (ergocalciferol).  In my opinion, any vitamin D3 supplement should contain vitamin K2 or Menaquinone.  Vitamin D3 assists in Calcium absorption, vitamin K2 may be necessary to ensure Calcium deposition in bone.

A comprehensive and frequently updated site that provides details on studies regarding Vitamin D3 and Covid-19 is available here.

Recommendation: Vitamin D3 with K2, 5,000iu /daily.  Reduce in Spring/Summer/Fall as sun exposure increases. To best guide recommendations for supplementation, obtain a blood test to determine your vitamin D3 level. Vitamin D3 deficient  (<20ng/ml), utilize 10,000iu/daily for 1-2 months and then switch to 5,000iu/daily. Vitamin D3 insufficient (20-30ng/ml), 10,000iu/daily for 1 month, then 5,000iu/daily.

B. Vitamin C

Vitamin C or ascorbic acid is an antioxidant acting to reduce oxidative stress.  It may augment our innate immunity in strengthening the skin barrier and our Adaptive immunity by promoting the formation and function of infection fighting blood cells including lymphocytes and phagocytes.

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. (14)

Due to the excellent safety profile, low cost, and potential for rapid upscaling of production, administration of vitamin C to patients with severe respiratory infections such as Covid-19, appears warranted. Vitamin C benefits multiple physiological functions, many of which are relevant to Covid-19. These include its antioxidant, anti-inflammatory, and immuno-modulatory functions. (15)

Prior to the Covid-19 epidemic, 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%.(16)

Early reviews in the Covid-19 pandemic suggested that intravenous vitamin C in hospitalized patients and oral vitamin C in the outpatient setting may provide benefit.  It was postulated vitamin C intervention may improve oxygenation parameters, reduce inflammatory markers, decrease days in the hospital, and reduce mortality in severely ill patients. High doses of oral vitamin C supplementation may also improve the rate of recovery in less severe cases. No adverse events have resulted from Vitamin C administration in published clinical trials in Covid-19 patients. (17)

Despite its known benefits, more recent meta-analyses of randomized controlled trials studies evaluating Vitamin C and Covid-19 outcome in hospitalized patients does not show a clear benefit in regards to mortality, ICU admission, hospital stay, or mechanical ventilation. (18)

Recommendation:  *Liposomal or *Bioperine containing Vitamin C, 500mg once or twice daily. If taking higher daily doses (2,000mg), it may be beneficial to take 500mg at intervals during the day. * “Liposomal” drug delivery systems utilize a biocompatible layer of fats, known as phospholipids, to deliver nutrients. * “Bioperine” is a patented extract of black pepper that has also been shown to facilitate nutrient absorption.

C: Zinc

Zinc supplementation improves the mucociliary clearance of inhaled particulates, strengthens the integrity of the epithelium, acts to decrease viral replication, supports anti-oxidative effects, reduces lung damage, and minimizes secondary infections.  Zinc deficiency can be added to the factors predisposing individuals to infection and detrimental progression of Covid-19. Due to its direct antiviral properties, it can be assumed that Zinc administration is beneficial for most of the population, especially those with suboptimal Zinc status.(19)

In cell culture, Zinc may slow down coronavirus replication through inhibition of enzyme RNA polymerase. (20)

In a prospective study comparing Zinc levels in 47 patients infected with COVID-19 with a control group, a significant number of Covid-19 patients were zinc deficient. These zinc deficient patients developed more complications, and the deficiency was associated with a prolonged hospital stay and increased mortality. (21)

In a review of 28 randomized controlled trials in adult populations unlikely to be Zinc deficient, there was some evidence suggesting Zinc supplementation might prevent respiratory tract illness symptoms and shorten the duration.  Indirect evidence suggests Zinc may potentially reduce the risk, duration, and severity of Covid-19 infections, particularly for populations at risk of Zinc deficiency including people with chronic disease,  co-morbidities, and older adults. (22,23)

Recommendation: Zinc gluconate, Zinc picolinate, or Zinc glycinate 20-30mg once daily on an empty stomach Zinc lozenge (Cold Eeze) prior to anticipated close contact.

D: Quercetin

Quercetin is the most abundant flavonoid in vegetables and fruits and has been the most studied. As an anti-inflammatory and antioxidant, it may be a potential treatment for severe inflammation, one of the main life-threatening conditions in patients with Covid-19. (24)

Quercetin is a Zinc ionophore.  It acts to facilitate the passage of Zinc through the cell membrane where it can perform anti-viral functions. In addition to Quercetin, ECGC and clioquinol (hydroxyquinoline) also act as Zinc ionophores. (25)  Once intracellular, Zinc may slow down coronavirus replication through inhibition of enzyme RNA polymerase. (20)

Additionally, Quercetin has been shown to be a potent inhibitor of coronaviruses by inhibiting cellular viral entry as well as regulating inflammatory cytokines.

Quercetin displays a broad range of antiviral properties which can interfere at multiple steps of pathogen virulence  including virus entry, virus replication, and viral protein assembly. These therapeutic effects can be augmented by the co-administration of vitamin C. It is recommended that combined administration of these two compounds be utilized for both the prophylaxis and the early treatment of respiratory tract infections, including Covid-19 patients. (26)

In a study of healthcare workers, the combination of Vitamin C and Quercetin provided protection against Covid-19 infection compared to a control group.  Specifically, 1.4% (1/71) of healthcare workers using Quercetin and Vitamin C combination were infected with Covid-19 vs. 21.4% (9 /42) of healthcare workers in the control group who were infected with Covid-19. (27)

Quercetin statistically shortens the timing of molecular test conversion (PCR test) from positive to negative, reducing at the same time symptoms severity and negative predictors of Covid-19.  (28)

A comprehensive and frequently updated site providing details on studies regarding Quercetin and Covid-19 is found here.

Recommendation: Quercetin 250-500 mg/daily

E. Melatonin

It is well-known that melatonin is an anti-oxidative and anti-inflammatory agent that counters acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) induced by viral and bacterial infections. Melatonin can be beneficial in critically ill patients by reducing vessel permeability, inducing sedation, decreasing agitation, and increasing sleep quality. These beneficial properties of melatonin highlight the hypothesis that melatonin may exert improved clinical outcomes for Covid-19 patients. (29)

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. Melatonin usage in the current Covid-19 outbreak is suggested to be beneficial. (30)

Melatonin acts to reduce reactive oxygen species(ROS)–mediated damage and cytokine-induced inflammation in viral diseases similar to Covid-19. (31)

Melatonin is a natural antioxidant and its levels decrease with age. Viral infection and the release of inflammatory cytokines result in the formation of reactive oxygen species (ROS). Lung damage from this severe inflammation can be inhibited with melatonin. In addition, immunity is impaired by anxiety and sleep deprivation. Melatonin improves sleep habits, reduces anxiety, and stimulates immunity. By using the safe over-the-counter drug melatonin, we may be immediately able to prevent the development of severe disease symptoms in coronavirus patients. (32)

In a single-center, prospective study, hospitalized patients receiving Melatonin 10mg daily, showed reduced thrombosis, sepsis, and mortality compared to a control group. (33)

A recent systematic review of the literature concludes. (1) melatonin has anti-inflammatory, antioxidant, and immuno-modulatory effects.  (2) It has been shown to have a wide margin of safety. (3) The contributions reviewed make it an effective therapeutic alternative in the treatment of Covid-19 infection. (34)

Recommendation:  Melatonin 3-10mg each evening

F: Glutathione/NAC

Glutathione is a tripeptide composed of the amino acids glutamate, cysteine, and glycine.

N-acetyl cysteine (NAC) is a precursor to Glutathione.

Glutathione (GSH) is the “master antioxidant”. It acts to neutralize free radicals and reactive oxygen species (ROS). The ability of glutathione to relieve oxidative stress may be important in the prevention of cell mutation (cancer), degenerative diseases such as Alzheimer’s and Parkinson’s as well as typical signs of aging.  Oxidative stress is now thought to be a significant contributor to all of these inflammatory diseases.  Adequate availability of Glutathione is critical for maintaining health, protecting the body from toxins, and promoting longevity. (35)

Covid-19 infection results in Glutathione deficiency and the development of oxidative damage.   The oxidant damage increases with age.  Restoration of effective antioxidant properties with Glutathione replacement should be considered. (36)

Unfortunately, many oral formulations of Glutathione cannot bypass the acidic environment of the stomach and are destroyed.  To combat this, Glutathione can be given as an IV formulation, as a sublingual (SL) tablet, or in a ‘liposomal’ formulation.   Liposomes encapsulate the Glutathione in a lipid layer and have been demonstrated to elevate Glutathione levels in the bloodstream with subsequent improvement in immune function markers. (37)

There is a higher rate of serious illness and death from Covid-19 infection among older people and those with co-morbidities. The inability to effectively deal with oxidative stress may account  for increased individual susceptibility to Covid-19 infection and Glutathione deficiency may be the most plausible explanation for serious complications and death in Covid-19 patients. (38)

N-acetyl L-cysteine (NAC) is a precursor of glutathione.  It is more absorbable in oral form and  helps to replenish intracellular Glutathione.

N-acetylcysteine (NAC) has been FDA approved for many years and is used for acetaminophen overdosage and the treatment of COPD.  Potential therapeutic benefits of NAC include replenishing intracellular Glutathione, scavenging ROS with suppression of “cytokine storm”, thus reducing inflammation and tissue injury.  NAC administration in combination with other antiviral agents may dramatically reduce hospital admission rate, mechanical ventilation, and mortality. (39)

In a prospective Brazilian study, 82 consecutive patients admitted with moderate or severe Covid-19 were evaluated. Patients receiving NAC 600mg twice daily, had significantly reduced progression to severe respiratory failure, decreased need for mechanical ventilation, and reduced mortality. (40)

In contrast, a study of 92 patients utilizing a three day course of intravenous NAC in patients with mild/moderate Covid-19 showed no improvement in clinical outcome when evaluating  28 day mortality, length of ICU stay, requirement for ventilation, or organ failure. (41)

In another study of severely compromised Covid-19 patients, including 9/10 patients requiring ECMO, NAC elicited clinical improvement and markedly reduced C-reactive protein (CRP) in all patients and ferritin in 9/10 patients. CRP and ferritin are markers of inflammation.  NAC mechanism of action may involve the blockade of viral infection and the ensuing “cytokine storm”. (42)

Recommendation:   Liposomal Glutathione or NAC 900mg once or twice daily

G. Magnesium

Magnesium is a cofactor in more than 300 enzyme systems that regulate diverse biochemical reactions in the body, including protein synthesis, muscle and nerve function, blood glucose control, and blood pressure regulation. It contributes to the structural development of bone and is required for the synthesis of DNA, RNA, and the antioxidant Glutathione. Magnesium also plays a role in the active transport of calcium and potassium ions across cell membranes, a process that is important to nerve impulse conduction, muscle contraction, and normal heart rhythm. (43)

Magnesium is also necessary for the activity of the Innate and Adaptive immune response. An appropriate nutritional regimen or supplementation might contribute to protecting against Covid-19 infection, reduce the severity of Covid-19 symptoms, and facilitate recovery after the acute phase. (44)

Food processing reduces Magnesium availability in the soil and food chain and has resulted in lower dietary Magnesium intake.  In addition, long-term prescribed drugs such as proton pump inhibitors might precipitate subclinical Magnesium deficiency. The Magnesium content in fruits and vegetables has dropped 80% in the last fifty years. (45)

Magnesium deficiency is common and generates chronic inflammation.  Inflammation is the common denominator of a wide range of mental and physical health problems including metabolic diseases, cognitive impairment, osteopenia, sarcopenia, and depression. (45)

In a single-center study, hospitalized patients over the age of 50, not requiring oxygen therapy, were administered a vitamin D / Magnesium / vitamin B12 combination.  Treated patients demonstrated a significant reduction in clinical deterioration requiring oxygen support, intensive care support, or both. (46)

Although no specific studies have examined Magnesium supplementation for Covid-19, based on its importance in cellular function, and a high rate of dietary deficiency, supplementation may be beneficial.

Recommendation: Magnesium glycinate or biglycinate 200-400mg daily

H. EGCG (Epigallocatechin gallate)

Epigallocatechin gallate (EGCG) is a catechin (type of flavonoid), and well known antioxidant. It is found in high concentrations in green tea.

Early population studies, evaluating the consumption of high quantities of green tea, suggested that higher consumption may reduce the overall risk of Covid-19 infection. (47)

Coronaviruses encode proteins that are cleaved by 3CL protease (the main protease) for maturation. Therefore, 3CL protease is a main target when developing antivirals against coronaviruses. Several studies have reported that EGCG inhibits the enzymatic activity of the coronavirus 3CL protease. (48)

In vitro cell culture studies demonstrated that EGCG exposure decreased the levels of coronavirus RNA and protein in infected cell media. These results indicate that EGCG inhibits coronavirus replication. (49)

EGCG also acts as a Zinc ionophore. It assists in the passage of Zinc through the cell membrane and into the cell. (25)

Besides direct antiviral actions, the major EGCG benefits lie in its ability to simultaneously downregulate the expression and signaling of many inflammatory mediators (ROS). EGCG can be considered a potentially safe, natural supplement to counteract inflammation associated with Covid-19. (50)

Recommendation:  EGCG (green tea extract) 200-400mg daily

A single cup (8 ounces ) of brewed green tea typically contains 50–100 mg of EGCG.

I. Omega 3 Fish Oil (polyunsaturated fatty acids, DHA/EPA)

For more information, see here

Fatty fish have the highest concentration of Omega-3 fatty acids (DHA/EPA).  Omega-3 oils are important for brain development and function.  Studies have shown people with the highest fish intake have less dementia and Alzheimer’s.  Omega-3 supplementation at higher doses (2,000mg/day) may also lower triglycerides.

Many scientists consider Omega-3 fatty acids ‘anti-inflammatory’  and Omega 6  fatty acids ‘inflammatory’.  The Omega 6:3 ratio in the American diet may be unhealthy (18:1).  A lower ratio of omega-6/omega-3 fatty acids may be more desirable in reducing the risk of many of the chronic diseases of high prevalence in Western societies.

Omega-3s play important roles as components of the phospholipids that form the structures of cell membranes. Omega-3s also form signaling molecules known as eicosanoids.  These signaling molecules affect the body’s cardiovascular, pulmonary, immune, and endocrine systems. Omega-6 fatty acids, also form eicosanoids. Omega-6 eicosanoids are generally more potent mediators of inflammation, vasoconstriction, and platelet aggregation than those made from omega-3s. Thus, higher concentrations of omega-3s than of omega-6s tip the eicosanoid balance toward less inflammatory activity. (51)

Higher intakes and blood levels of EPA and DHA are associated with lower levels of inflammatory cytokines. Omega-3s might also affect immune function by upregulating the activity of macrophages, neutrophils, T cells, B cells, natural killer cells, and other immune cells. (51)

There are currently studies ongoing to see if Omega 3 supplementation may be beneficial in preventing Covid-19 infection. (52)

Recommendations:  Omega 3 (DHA/EPA) 1,000mg daily with food.

J. Oronasal rinses

In vitro studies (cell culture) have demonstrated that cetylpyridinium chloride (CPC), a component of common mouthwash formulas, reduces SARS-CoV-2 infectivity.  CPC disrupts the viral envelope, interfering with viral fusion to the target cell.  CPC-containing mouth rinses decreased more than a thousand times the infectivity of SARS-CoV-2 in vitro. (53)

Based on in vitro effectiveness, CPC-containing mouthwashes could be a cost-effective measure to reduce SARS-CoV-2 infectivity in saliva, aiding to reduce viral transmission from infected individuals. Performing oral washes for 1 to 2 min should be enough to effectively decrease the infectivity of viruses in the saliva, especially during the first 2 weeks after infection, when higher viral levels are detected and individuals are more contagious. (53)

A randomized, controlled study has demonstrated the effectiveness, particularly of cetylpyridinium chloride (CPC) containing mouthwashes, and dilute Povidone-Iodine solutions to reduce viral load in Covid-19 patients. (54)

Based on its effectiveness, protocols for the use of Povidone-Iodine formulas in nasal spray have been recommended for the general population to reduce the transmission of SARS-CoV-2.  In addition, health care workers with high risk contact to Covid-19 patients should benefit from Povidone-Iodine nasal irrigation.  It is recommended that Povidone-Iodine oro-nasal spray should be used as an adjunct to PPE, mask, or vaccine. It is considered to be safe, cheap, easily available, and effective. (55)


  1. Gargle with CPC containing mouthwash twice daily for 1-2 minutes and after any situation where there is prolonged close contact with other individuals.
  2. Utilize Povidone-Iodine nasopharyngeal irrigation utilizing a nasal spray device or Neti pot Dilution recommendation is 0.5% to 1%. How to make a 1% nasal solution of Iodine from a 10% Iodine solution-here
  3. For Covid-19 infected individuals it may be reasonable to perform CPC gargle and Povidone-Iodine nasal irrigation every 3-4 hours to reduce viral load and decrease viral transmission.

If you have any questions, please email me at or call Benessere Clinic (332-6222)

Anthony Lowham MD



  1. Bryant A, Lawrie TA, Dowswell T, et al. Ivermectin for Prevention and Treatment of COVID-19 Infection: A Systematic Review, Meta-analysis, and Trial Sequential Analysis to Inform Clinical Guidelines. Am J Ther. 2021;28(4):e434-e460. Published 2021 Jun 21.


  2. Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Innate Immunity.
  3. Alberts B, Johnson A, Lewis J, et al. Molecular Biology of the Cell. 4th edition. New York: Garland Science; 2002. Chapter 24, The Adaptive Immune System.
  4. Sallis R, Young DR, Tartof SY, Sallis JF, Sall J, Li Q, Smith GN, Cohen DA. Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. Br J Sports Med. 2021 Oct;55(19):1099-1105
  5. a Silveira MP, da Silva Fagundes KK, Bizuti MR, Starck É, Rossi RC, de Resende E Silva DT. Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature. Clin Exp Med. 2021;21(1):15-28
  6. Tavoian D, Russ DW, Consitt LA, Clark BC. Perspective: Pragmatic Exercise Recommendations for Older Adults: The Case for Emphasizing Resistance Training. Front Physiol. 2020 Jul 3;11:799.
  7. Childs CE, Calder PC, Miles EA. Diet and Immune Function. Nutrients. 2019;11(8):1933. Published 2019 Aug 16.
  8. Popkin B.M., Du S., Green W.D., Beck M.A., Algaith T., Herbst C.H., et al. Individuals with obesity and COVID‐19: a global perspective on the epidemiology and biological relationships. Obes Rev. 2020;21:1–17.
  9. Giovanny J.Martínez-Colón, Kalani Ratnasiri, Heping Chen,Sizun Jiang, Elizabeth Zanley, Arjun Rustagi, Renu Verma, Han Chen, Jason R. Andrews, Kirsten D. Mertz, Alexandar Tzankov, Dan Azagury, Jack Boyd, Garry P. Nolan, Christian M. Schürch, Matthias S. Matter, Catherine A. Blish, Tracey L. McLaughlin
    bioRxiv 2021.10.24
  10. Patikorn C, Roubal K, Veettil SK, Chandran V, Pham T, Lee YY, Giovannucci EL, Varady KA, Chaiyakunapruk N. Intermittent Fasting and Obesity-Related Health Outcomes: An Umbrella Review of Meta-analyses of Randomized Clinical Trials. JAMA Netw Open. 2021 Dec 1;4(12)
  11. Borsche L, Glauner B, von Mendel J. COVID-19 Mortality Risk Correlates Inversely with Vitamin D3 Status, and a Mortality Rate Close to Zero Could Theoretically Be Achieved at 50 ng/mL 25(OH)D3: Results of a Systematic Review and Meta-Analysis. Nutrients. 2021 Oct 14;13(10):3596.
  12. Ghelani D, Alesi S, Mousa A. Vitamin D and COVID-19: An Overview of Recent Evidence. Int J Mol Sci. 2021;22(19):10559. Published 2021 Sep 29. doi:10.3390/ijms221910559
  13. Yisak H, Ewunetei A, Kefale B, Mamuye M, Teshome F, Ambaw B, Yideg Yitbarek G. Effects of Vitamin D on COVID-19 Infection and Prognosis: A Systematic Review. Risk Manag Healthc Policy. 2021 Jan 7;14:31-38.
  14. Simonson W. Vitamin C and coronavirus.Geriatr Nurs. 2020;41(3):331-332. doi:10.1016/j.gerinurse.2020.05.002
  15. Carr AC, Rowe S. The Emerging Role of Vitamin C in the Prevention and Treatment of COVID-19. Nutrients. 2020 Oct 27;12(11):3286.
  16. Hemilä H, Chalker E. Vitamin C Can Shorten the Length of Stay in the ICU: A Meta-Analysis. Nutrients. 2019;11(4):708. Published 2019 Mar 27. doi:10.3390/nu11040708
  17. Holford P, Carr AC, Zawari M, Vizcaychipi MP. Vitamin C Intervention for Critical COVID-19: A Pragmatic Review of the Current Level of Evidence. Life. 2021; 11(11):1166.
  18. Rawat D, Roy A, Maitra S, Gulati A, Khanna P, Baidya DK. Vitamin C and COVID-19 treatment: A systematic review and meta-analysis of randomized controlled trials. Diabetes Metab Syndr. 2021;15(6):
  19. Wessels I, Rolles B, Rink L. The Potential Impact of Zinc Supplementation on COVID-19 Pathogenesis. Front Immunol. 2020 Jul 10;11:1712.
  20. te Velthuis AJ, van den Worm SH, Sims AC, Baric RS, Snijder EJ, van Hemert MJ. Zn(2+) inhibits coronavirus and arterivirus RNA polymerase activity in vitro and zinc ionophores block the replication of these viruses in cell culture. PLoS Pathog. 2010;6(11):e1001176. Published 2010 Nov 4. doi:10.1371/journal.ppat.1001176
  21. 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.
  22. Hunter J, Arentz S, Goldenberg J, Yang G, Beardsley J, Myers SP, Mertz D, Leeder S. Zinc for the prevention or treatment of acute viral respiratory tract infections in adults: a rapid systematic review and meta-analysis of randomised controlled trials. BMJ Open. 2021 Nov 2;11(11)
  23. Arentz S, Hunter J, Yang G, Goldenberg J, Beardsley J, Myers SP, Mertz D, Leeder S. Zinc for the prevention and treatment of SARS-CoV-2 and other acute viral respiratory infections: a rapid review. Adv Integr Med. 2020 Dec;7(4):252-260.
  24. Saeedi-Boroujeni A, Mahmoudian-Sani MR. Anti-inflammatory potential of Quercetin in COVID-19 treatment. J Inflamm (Lond). 2021 Jan 28;18(1):3.
  25. Dabbagh-Bazarbachi H, Clergeaud G, Quesada IM, Ortiz M, O’Sullivan CK, Fernández-Larrea JB. Zinc ionophore activity of quercetin and epigallocatechin-gallate: from Hepa 1-6 cells to a liposome model. J Agric Food Chem. 2014 Aug 13;62(32):8085-93.
  26. Colunga Biancatelli RML, Berrill M, Catravas JD, Marik PE. Quercetin and Vitamin C: An Experimental, Synergistic Therapy for the Prevention and Treatment of SARS-CoV-2 Related Disease (COVID-19). Front Immunol. 2020;11:1451. Published 2020 Jun 19. doi:10.3389/fimmu.2020.01451
  27. Arslan B, Ergun NU, Topuz S, et al. Synergistic Effect of Quercetin and Vitamin C Against COVID-19: Is a Possible Guard for Front Liners. SSRN; 2020.
  28. Di Pierro F, Iqtadar S, Khan A, et al. Potential Clinical Benefits of Quercetin in the Early Stage of COVID-19: Results of a Second, Pilot, Randomized, Controlled and Open-Label Clinical Trial. Int J Gen Med. 2021;14:2807-2816. Published 2021 Jun 24. doi:10.2147/IJGM.S318949
  29. 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
  30. 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
  31. Cross KM, Landis DM, Sehgal L, et al. Melatonin for the early treatment of COVID-19: A narritive review of current evidence and possible efficacy. Endocr Pract. 2021;27(8):850-855. doi:10.1016/j.eprac.2021.06.001.
  32. Shneider A, Kudriavtsev A, Vakhrusheva A. Can melatonin reduce the severity of COVID-19 pandemic? Int Rev Immunol. 2020;39(4):153-162.
  33. Hasan ZT, Atrakji DMQYMAA, Mehuaiden DAK. The Effect of Melatonin on Thrombosis, Sepsis and Mortality Rate in COVID-19 Patients. Int J Infect Dis. 2021 Oct 12;114:79-84.
  34. Molina-Carballo A, Palacios-López R, Jerez-Calero A, Augustín-Morales MC, Agil A, Muñoz-Hoyos A, Muñoz-Gallego A. Protective Effect of Melatonin Administration against SARS-CoV-2 Infection: A Systematic Review. Current Issues in Molecular Biology. 2022; 44(1):31-45.
  35. Pizzorno J. Glutathione!.Integr Med (Encinitas). 2014;13(1):8-12.
  36. Kumar P, Osahon O, Vides DB, Hanania N, Minard CG, Sekhar RV. Severe Glutathione Deficiency, Oxidative Stress and Oxidant Damage in Adults Hospitalized with COVID-19: Implications for GlyNAC (Glycine and N-Acetylcysteine) Supplementation. Antioxidants. 2022; 11(1):50.
  37. Sinha R, Sinha I, Calcagnotto A, Trushin N, Haley JS, Schell TD, Richie JP Jr. Oral supplementation with liposomal glutathione elevates body stores of glutathione and markers of immune function. Eur J Clin Nutr. 2018 Jan;72(1):105-111.
  38. Polonikov A. Endogenous Deficiency of Glutathione as the Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients. ACS Infect Dis. 2020 Jul 10;6(7):1558-1562.
  39. Shi Z, Puyo CA. N-Acetylcysteine to Combat COVID-19: An Evidence Review. Ther Clin Risk Manag. 2020;16:1047-1055. Published 2020 Nov 2. doi:10.2147/TCRM.S273700
  40. Assimakopoulos SF, Aretha D, Komninos D, Dimitropoulou D, Lagadinou M, Leonidou L, Oikonomou I, Mouzaki A, Marangos M. N-acetyl-cysteine reduces the risk for mechanical ventilation and mortality in patients with COVID-19 pneumonia: a two-center retrospective cohort study. Infect Dis (Lond). 2021 Nov;53(11):847-854.
  41. Taher A, Lashgari M, Sedighi L, Rahimi-Bashar F, Poorolajal J, Mehrpooya M. A pilot study on intravenous N-Acetylcysteine treatment in patients with mild-to-moderate COVID19-associated acute respiratory distress syndrome. Pharmacol Rep. 2021;73(6):1650-1659.
  42. Ibrahim H, Perl A, Smith D, Lewis T, Kon Z, Goldenberg R, Yarta K, Staniloae C, Williams M. Therapeutic blockade of inflammation in severe COVID-19 infection with intravenous N-acetylcysteine. Clin Immunol. 2020 Oct;219
  43. Rude RK. Magnesium. In: Ross AC, Caballero B, Cousins RJ, Tucker KL, Ziegler TR, eds. Modern Nutrition in Health and Disease. 11th ed. Baltimore, Mass: Lippincott Williams & Wilkins; 2012:159-75.
  44. Trapani V, Rosanoff A, Baniasadi S, et al. The relevance of magnesium homeostasis in COVID-19 [published online ahead of print, 2021 Oct 23]. Eur J Nutr. 2021;1-12. doi:10.1007/s00394-021-02704-y
  45. Cazzola R, Della Porta M, Manoni M, Iotti S, Pinotti L, Maier JA. Going to the roots of reduced magnesium dietary intake: A tradeoff between climate changes and sources. Heliyon. 2020;6(11):e05390. Published 2020 Nov 3. doi:10.1016/j.heliyon.2020.e05390
  46. Tan CW, Ho LP, Kalimuddin S, et al. Cohort study to evaluate the effect of vitamin D, magnesium, and vitamin B12in combination on progression to severe outcomes in older patients with coronavirus (COVID-19). Nutrition. 2020;79-80:111017. doi:10.1016/j.nut.2020.111017
  47. MaksimStorozhuk
    medRxiv 2020.10.23.20218479;
  48. Park J, Park R, Jang M, Park YI. Therapeutic Potential of EGCG, a Green Tea Polyphenol, for Treatment of Coronavirus Diseases. Life (Basel). 2021;11(3):197. Published 2021 Mar 4. doi:10.3390/life11030197
  49. Jang M, Park R, Park YI, Cha YE, Yamamoto A, Lee JI, Park J. EGCG, a green tea polyphenol, inhibits human coronavirus replication in vitro. Biochem Biophys Res Commun. 2021 Apr 2;547:23-28.
  50. Menegazzi M, Campagnari R, Bertoldi M, Crupi R, Di Paola R, Cuzzocrea S. Protective Effect of Epigallocatechin-3-Gallate (EGCG) in Diseases with Uncontrolled Immune Activation: Could Such a Scenario Be Helpful to Counteract COVID-19? Int J Mol Sci. 2020 Jul 21;21(14):5171
  51. Danielle Swanson, Robert Block, Shaker A. Mousa, Omega-3 Fatty Acids EPA and DHA: Health Benefits Throughout Life, Advances in Nutrition, Volume 3, Issue 1, January 2012, Pages 1–7,
  53. Muñoz-Basagoiti J, Perez-Zsolt D, León R, et al. Mouthwashes with CPC Reduce the Infectivity of SARS-CoV-2 Variants In Vitro. Journal of Dental Research. 2021;100(11):1265-1272.
  54. Seneviratne, C.J., Balan, P., Ko, K.K.K. et al. Efficacy of commercial mouth-rinses on SARS-CoV-2 viral load in saliva: randomized control trial in Singapore. Infection 49, 305–311 (2021).
  55. Arefin MK. Povidone Iodine (PVP-I) Oro-Nasal Spray: An Effective Shield for COVID-19 Protection for Health Care Worker (HCW), for all [published online ahead of print, 2021 Apr 8]. Indian J Otolaryngol Head Neck Surg. 2021;1-6. doi:10.1007/s12070-021-02525-9