Covid-19 Immune Strategies

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In this episode of Functional Medicine Research, I interview Dr. Joe Mather and Dr. Jeffrey Moss about Covid-19 immune strategies.  We had a great discussion about the immunology of Covid-19, diet, lifestyle, supplements, as well as Dr. Mather’s first-hand clinical experience with Covid-19.

Covid-19 Immune Strategies

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Below is a full transcript of the interview on Covid-19 immune strategies:

Dr. Hedberg: Well, welcome everyone to Functional Medicine Research. I’m Dr. Hedberg. Really excited today to have two very special guests. We’re gonna be talking about COVID-19.

And the first guest is Dr. Joe Mather. He’s a MD. He also has a Master’s in Public Health and Tropical Medicine. He’s a board-certified Family Practice Physician. He graduated from Tulane University School of Medicine and Tulane University School of Public Health and completed his Family Medicine Residency in 2014. And he did actually travel to Malaysia to do infectious disease research and became interested in the role of intestinal infections and their impact on health. He also worked in a rural New Zealand clinic and he was the Medical Director of an Urgent Care and working as a Concierge Physician at the Center for Longevity and Wellness. Dr. Mather strives to deliver evidence-based individualized medicine to his patients. He does have a functional medicine practice in Louisiana where he works with a variety of patients with a specific interest in complex chronic disease and helping patients to optimize their health and longevity.

Now, interestingly, I just learned that, in 2013, Dr. Mather worked on a medical mission, and this was in Nicaragua where he provided healthcare to the remote mountainous region of Nicaragua and helped 2,400 patients and 5 villages. And he also has additional experience in infectious disease, he actually conducted a research project on tuberculosis treatment among Burmese refugees in Malaysia. So that’s one of the reasons why I was really excited to have him on because of his deep infectious disease research and also because he’s the only one of the three of us who has direct experience with COVID- 19.

So, Dr. Mather, welcome to the show.

Dr. Mather: Thank you so much. Happy to be here.

Dr. Hedberg: Great.

And then our other guest is Dr. Jeffrey Moss. He’s the founder of Moss Nutrition. He graduated from the University of Michigan dental school where he employed clinical nutrition and his dental practice. He still has a small clinical nutrition practice today. He founded Moss Nutrition 27 years ago, providing high-quality research-based products and excellent education on how to use these products as well.

And so Dr. Moss has been involved in functional medicine for over 30 years, and he’s been writing monthly newsletters, providing commentary on controversial and cutting-edge topics.

Dr. Hedberg:  Dr. Moss also established a online course on organic acids and amino acids testing, and he’s a frequent speaker, teaching seminars across the country, and he’s been a featured guest on many radio shows.

So, welcome Dr. Moss to the show.

Dr. Moss: Thank you. Thank you for having me.

Dr. Hedberg: So, COVID-19 is a really interesting times and I put together just some basic immunology of what I’ve been reading about what’s going on with this virus. And I think the three of us, I know I’ve talked to Dr. Moss about this. The three of us were hesitant to put anything out about COVID-19 in the beginning, mainly because of a lack of experience with the actual virus, but also, it was more of a cautious and wait-and-see type approach and we wanted to make sure there was enough available data to start making some valid conclusions. And again, as I mentioned earlier, you know, I really wanted to have someone on with direct experience and that’s why we’re gonna be talking to Dr. Joe Mather because he has direct clinical experience with this virus.

So, this is just some information that I just came upon recently. Just a couple of bullet points here that I think is pretty interesting. It is an RNA virus with 28 proteins. Symptoms take about 2 to 11 days to begin. And this is really interesting. I just read about this over the weekend in a paper. So viral shedding, it’s about 20 days, but it can last up to 37 days. And some patients are being released at 14 days. So this was kind of a concerning point that I noted that you know, some people will be shedding for over a month, which means they’re still contagious.

And then the average age in China up to this point based on the Chinese research was actually 44. So, in the beginning, you know, some of the headlines were that this is mainly, you know, older people, senior citizens, those over the age of 60, people with various preexisting conditions. But it is affecting healthy people even in middle age and even young people are being hospitalized to this day.

And then swallowing the virus, it causes diarrhea. And the mechanism is TNF-alpha activation. That’s what triggers the diarrhea in a percentage of patients who get it in the gut. There’s been a lot of talk of the ACE-2 receptor. And the ACE-2 receptor is just not in the lung. It’s in other body tissues like the kidneys and also the GI tract.

So I’ve read through all of the immunopathology research on this virus. I just wanted to break down how the immune system is responding to this virus and tie in some strategies that individuals can use to make their immune systems more robust and potentially, have a better chance of dealing with this virus.

So, this is a naive T cell and it can usually go one of four ways. And the Th1 cells, these are the cells that are firstly involved in immunity against this virus. So Th1 cells are involved in intracellular microbes, so this would be viruses and bacteria inside the cell. And natural killer cells are also a big component of this immune defense against the virus.

So, a couple of key points. So, cortisol and norepinephrine, they actually induce apoptosis of Th1 cells and natural killer cells. So stress breaks down the initial response to any type of intracellular infection. Stress also increases the NLRP3 inflammasome. And a lot of the practitioners listening, I’m sure are familiar with this inflammasome. So stress is going to upregulate the inflammasome and dampen the Th1 response. Sleep enhances a Th1 response and lack of sleep or a decrease in sleep increases inflammation. So that’s another really key point.

And then, a couple of ways that you can increase or support a Th1 response. The first is glutathione. So this can be increased with an acetylcysteine or taking something like liposomal glutathione. That’s kind of a general supportive strategy for a Th1 immune response. There’s also quite a bit of literature on glutathione and its protective effects on mucosal membranes. So that would be the sinuses, the lungs, and the gut.

Another way to enhance a Th1 response is with compounds like Echinacea, Goldenseal, Berberine, vitamin A, vitamin E, and melatonin was also involved in a Th1 response.

And then natural killer cells. These are also involved and they can be enhanced with vitamin C, Astragalus, Andrographis, and mushrooms like Cordyceps. Now, vitamin D is commonly recommended in cases like this. And there’s one important point about vitamin D to understand why, and that’s because vitamin D is actually required for proper macrophage function. The macrophages have lysosomes that break down microbes. And vitamin D has to be there to have a good lysosomal function to fight off infections.

So that’s the Th1 component.

And then the Th2, there’s reciprocal inhibition. So when Th2 is upregulated, it dampens the Th1 response. And so Th2 is involved in parasites, allergies, asthma, eosinophils, things like that. And one of the things to understand is that a decrease in Th1 many times is going to be due to chronic or even acute elevations in a Th2 response. So I’m gonna get to some research on that here in a minute. So, you can dampen the Th2 response by, of course, dealing with, optimizing gut health, but also , Quercetin, astragalus, and even some local raw honey can help to dampen a Th2 response and prevent inhibition of Th1.

The third point that I wanted to make is that, and I just read this over the weekend because there’s been a number of papers that just came out in the last few days, looking at specifically at how the immune system is responding to this virus. So, it turns out COVID-19 causes T-cell depletions. So it suppresses CD4 and CD8 cells, B cells, and natural killer cells. And so this is known as pathogen evasion strategies where pathogens manipulate the immune system to allow it to proliferate and take hold.

And the other interesting thing is that the pattern that they’re seeing also is that higher neutrophils and lower lymphocytes equals a poor outcome in the patients. And that makes sense because when Th1, it gets out of control, that can drive Th17. So Th17 cells are involved in fungi and bacteria in the cavities of the body. So the sinuses, the lungs, and the gut, but theTh17 cells are most active in that area. And you can see here on the bottom right-hand corner, they’re highly involved in neutrophil activation. So there are cytokines that are elevated in these cases and it may drive towards the Th17, you get higher neutrophil activation and lymphocyte depletion. So that all makes sense immunologically.

And now, the fourth thing is there is some research coming out on nitric oxide as a potential therapeutic component for this virus.

And then the last point is on gut healing because that’s going to really help balance the Th1 and the Th2 response. So while you’re at home right now, you know, you have a lot of extra time, this might be the time to learn how to make things like sauerkraut or kimchi and start to add these to your diet to strengthen the immune system.

So, I want to now go to this paper, which was really interesting. Pollen exposure weakens innate defense against respiratory viruses. So, hundreds of plant species release their pollen into the air every year during early spring. During that period, pollen-allergic as well as non-allergic patients frequently present to doctors with severe respiratory tract infections. Our objective was therefore to assess whether pollen may interfere with antiviral immunity. So they found that pollen significantly diminish the interferon gamma and pro-inflammatory chemokine responses of the airway epithelial to rhinoviruses and viral mimics and decrease nuclear translocation of interferon regulatory factors.

So mice were infected with a syncytial virus and they were co-exposed the pollen, and that attenuated antiviral gene expression and increased lung viral titers. And then in nonallergic humans, nasal symptoms were positively correlated with airborne birch pollen abundance and nasal birch pollen challenge led to downregulation of type I and type III interferons in the nasal mucosa.

So a large patient cohort numbers of rhino viral positive cases were correlated with airborne birch pollen concentrations. So they concluded the ability of pollen to suppress innate antiviral immunity independent of allergy suggests that high-risk population groups should avoid extensive outdoor activities when pollen and respiratory virus seasons coincide.

So this paper was out of Sweden and this author up here, Dr. Doe that I underlined, he was very recently quoted on Swedish radios stating that in Sweden they’re finding that the highest mortality rate of their patients with COVID-19 are in the areas with the highest pollen count and the lowest mortality rate is in areas with the lowest pollen count. But he did say that there needs to be more research to validate that claim that he made, but it partially makes sense. And as I mentioned previously, Th2 dampens the Th1 response and pollen appears to drive Th2, thus suppressing the body’s ability to fight off viruses.

Now, this paper that I went over, it has nothing to do with COVID-19, so I don’t wanna make a very strong claim here because this was on rhinoviruses and syncytial viruses. But the immune mechanisms are very similar, especially regarding type I and type III interferons.

And that brings me to this paper that just came out over the weekend. It’s entitled Type 1 interferons as a potential treatment against COVID-19. And they basically state that these have broad antiviral activity and they are studying this as a potential against SARS-CoV-2, these type I interferons and the relevance of evaluating these molecules in clinical trials for COVID-19.

So that’s just kind of an immunology overview of what I’ve read in the research and a couple of strategies there that clinicians and patients can think about.

So, let’s go to, Dr. Mather. So, again, welcome to the show, Dr. Mather. Really appreciate you coming on.

Dr. Mather: No problem, Nick. Happy to be here.

Dr. Hedberg: Yeah. So you’ve been in the trenches with this. Can you give us some insights on what you’ve seen so far, as far as how the patients are presenting and some of the things that you’ve been doing to help them get well?

Dr. Mather: Yeah. of course. So unhappily, New Orleans is actually one of the hotspots, nationally. And it looks like, in retrospect, that this was probably due to Mardi Gras occurring late February, right when we were starting to get virus spread through the States, we had a million or a million and a half people standing shoulder to shoulder drinking beer and staying out and partying. So I think we inadvertently had our annual celebration just magnify and explode COVID here in the community. So we’ve had it here since, as far as I can tell, the first week of March, that’s when I look back in my notes and I have the first symptoms in patients that are consistent with what I’m seeing now in positive cases.

So I’ve been dealing with this for five weeks. And make the point that I have a small private practice. And so, you know, my practice is a cash-based functional medicine practice with mostly patients with chronic and complex disease. And so, I don’t think that it represents New Orleans in general, but I’ve treated, I think, 17, either suspected or confirmed cases at this point. And so I feel like I’ve got a pretty good history or idea on what the patient history and presentation looks like.

So, just broadly speaking, most people will be exposed to this virus and have no symptoms or minimal symptoms. They may have some sniffles or just mild fatigue and not really know what to make of it. But that’s gonna be the vast majority of people. The largest number of patients will have a mild illness. Okay? So this seems to be about 80%. And what I’m seeing is fatigue, cough, shortness of breath are the dominant three symptoms that are making me really worried about COVID. I’m not seeing a lot of fever, temperature greater than 100.4, almost every single patient is telling me something to the effect of, “You know, doc, I feel hot and warm but when I take my temperature it’s just you know, 99.5 or 99.6.” And so, fever to me, although some of the testing is being restricted to patients who only have fever, fever does not make me, you know, I don’t think you have to have fever to have the disease.

Most of the mild cases in my experience are getting well in a shortish time period. About three to five days. And I can talk about why I think that’s the case. But then there clearly are moderate and severe cases in the community. Moderate we think represent about 15% of the total disease burden. And those are gonna be patients with amplified symptoms of the mild. So they’re gonna have more intense fatigue, intense shortness of breath, intense cough. They often will have fever. So they may start with, you know, a low-grade temp, and then it may become out read fever later in the course of illness. We see diarrhea more often in severe cases. And those are the patients that I get a little bit more worried about that they would turn more severe later in the course of illness.

I’m seeing a few moderate cases in my community, but the severest cases are going right to the hospital. And thankfully, I haven’t had any of those cases. I had a few patients that I think were close to becoming severe, but we were able to get them turned around and well. And that’s maybe one of the big points that I wanna make in a moment how we should be approaching this disease.

The patients who have a mild or a moderate disease and then becomes severe, it seems to happen day five or seven of the illness. And it’s fairly distinct and dramatic. We think that there is a fairly dramatic change in immune system functioning that happens at the five or seven-day mark. And that usually seems to be correlated with a very rapid drop in oxygen levels in the blood and a strong upregulation of unharmful immune responses. And those are the patients who really need to be at a hospital very quickly because there are cases of patients being fine and then desaturating and dying in a number of hours. And so that should put into bite how severe this disease can be.

And you know, we’re seeing very high mortality rates here in New Orleans and unfortunately, I think that’s because of a high burden of conditions like hypertension, elevated blood sugar, metabolic disease, hyperinsulinemia, and smoking. I think those metabolic conditions, in particular, are what we’re seeing predisposed to a bad outcome and have a mild case turn severe or moderate case turn severe.

And so I think how we approach this disease has to kind of mirror what’s gonna make someone worse. Because we know that with lifestyle medicine we can make very quick changes in someone’s metabolism, blood sugar, insulin, blood pressure, you know, within days to weeks. So what I’ve been preaching to my patients lines up very well with the presentation you made just a few minutes ago, Nick, about sleep, stress, diet. The lifestyle changes that we make can really make a big difference in how our immune system is gonna be able to handle this virus. And the patients I’m seeing that are getting the virus, clearing it within three days, they’ve got a mild cough and fever and then they’re back feeling 100%, those are patients who have really taken their lifestyle seriously. They’re sleeping eight to nine hours a night. They’re mindful of their stress and working on ways to lower their stress. Most of my patients I have eating some variation of a paleo diet, so low sugar or low processed food with minimal amounts of dairy and gluten. And I really think that those have made a big difference.

But one more point is that, well, I did say that most patients will have a short course of disease, three to five days. I have noticed that in the patients who are not taking those lifestyle habits as seriously, there are patients who are getting courses of the disease that are two to three weeks. So more in line with the severe influenza that can take 14 days or more for someone to really feel back to normal. Those are the patients who aren’t doing a good job with their lifestyle. And I think their immune system just isn’t functioning quite as well as someone who is using those preventative lifestyle habits.

So, any other big points I wanna make? I don’t think you have to have fever to have the illness. And the last thing and then maybe we can talk about treatments or answer any questions, but I know a lot of practitioners listen to your show, Nick, and I’m one of them. It’s amazing. And the one thing I see that I worry about in the integrative and functional medicine landscape is I think we are, unfortunately, looking too far downstream on this disease and we’re focusing too much on the cytokine storm, the immune response on severe cases because the pathology is novel and interesting. But I see a lot of time being spent debating Elderberry and doses of Melatonin and you know, supplements A to Z that might interfere with the really severe cases where I think the majority of our time should be spent focusing on the lifestyle and basic supplements that can really improve the strength of the immune system quickly so that people don’t get a severe disease or we don’t even have to be worrying about, you know, cytokine storms.

From my perspective, I work in a community and I wanna keep my patients away from the hospital whenever possible. You know, hospitals are kind of scary places right now. It looks like here in New Orleans, we may have just passed the tipping point where we’re starting to see more discharges than admissions. And my hope is that we’ve kind of passed the surge here, but I’m still very worried about our hospital systems. I think we have a very fragile healthcare system and I’m very worried that if people aren’t taking their health seriously, that we’re gonna very easily be overwhelmed and people will die unnecessarily, not just from the disease, but from the hospitals being overwhelmed and the patients who are not getting routine medical care, you know, patients coming into the hospital with chest pain and just sitting in the emergency room for hours and hours. But we’re gonna have a lot of people die if our hospitals are overwhelmed.

So for all those reasons, I think that this is a very manageable disease for the vast majority of patients and especially so if people have taken their lifestyle and health seriously. I know we can talk more, all three of us, about the best ways to do that. That’s kind of my two cents on the whole matter.

Dr. Hedberg: Right, right. Excellent. Yeah, I’m glad you brought that up about the inflammasome and things like that. It’s one of the reasons why I didn’t really talk a lot about anti-inflammatories because as you said, when someone’s in that stage, we don’t want a lot of information out there about taking a number of, you know, so-called natural anti-inflammatories when someone should probably be in the hospital, you know, under medical care.

So, I mentioned cortisol and norepinephrine, which are, of course, stress compounds in the body inhibiting Th1 and natural killer cells actually causing apoptosis of them. What are some of your strategies for managing stress in patients both lifestyle modifications and things like that? And if there are any supplements or compounds you wanted to mention for stress physiology, that would be helpful as well.

Dr. Mather: Yeah, so three things. And the first is sleep. This to me, you know…I wrote some recommendations for Jeff for the Moss Nutrition Report to get out to practitioners. And my first recommendation was sleep because this is unpopular advice to all my patients, but I really think it’s one of the most powerful tools we have at our disposal is simply getting people to have eight to nine hours of sleep. Anything under the eight I really consider a sleep deficit and I see incredibly, you know, big changes in both sympathetic nervous system activation and vulnerability to infections in people who are underslept. We see higher stress hormones in those who are not sleeping well. We see immediate up-regulation of epinephrine and norepinephrine. We see glucose rising as a result of those glucocorticoids. I see blood pressure going up. And so you know, everyone’s at home. You’ve got the ability and the freedom. Just make sure you’re sleeping. That’s number one.

Number two, I think it’s pretty clear from the medical research and literature that meditation is gonna be the strongest way to down-regulate stress hormones. And it does not have to be a lot. Twenty minutes a day is pretty consistently finding benefit. And that’s what I’ve been telling a lot of my patients and that’s what I’ve been doing myself quite a bit. So meditation. And there are great courses in mindfulness-based stress reduction across the country that are now being offered online. And so, if you have a lot of free time, you may consider taking a course in meditation or apps like Calm or Headspace, Insight Timer that can really help people ease their way in with guided meditations.

So those two lifestyles I think are just gonna be the most important. From a supplement standpoint, I really am a believer in HPA Select. Jeff, I think you have a fantastic product there. It consistently works in a huge percent of my patients, both subjectively and I find it helping metabolically. I think this is just a great product. I use it a lot and I think it’s got a lot of role here in COVID, in particular. Most of the herbs that are adaptogens actually have the side benefit of being potent antiviral and having antiviral properties. So I’m relying on this quite a lot. And so, you know, I’ll leave it there.

Dr. Hedberg: And so the HPA Select, that’s Eleuthero, Ashwagandha, Rhodiola, Panax Ginseng, and a small amount of Licorice. Would you agree that if someone is not, because some people just don’t do well with some of the adaptogens, some of them can be too stimulating like the Eleuthero, the Panax, even the Rhodiola, I have read some research on Ashwagandha and it is supportive of Th1 and modulates Th2. For those who can’t take some of the more stimulating adaptogens, would you agree that just Ashwagandha on its own could also be used?

Dr. Mather: Absolutely. Particularly when we’re treating complex disease, a lot of us have patients with mass cell activation and tend to be very sensitive to blend. And so HPA is powerful, but it is a mix of several herbs and some patients just can’t tolerate formulas with multiple ingredients in it. So yeah, I think I would rely on just a single Ashwagandha if HPA was maybe not a good fit for a patient.

Dr. Mather: Absolutely Excellent. So we’ve talked about sleep, and stress management, and then diet. You mentioned the paleo diet, which of course, I think one of the real keys there is that number one, it has no sugar or processed carbs, and then it also eliminates some of the most common food sensitivities which will further imbalance the immune system. Did you have anything else you wanted to add to dietary recommendations and the paleo diet?

Dr. Mather: Well, I’ve already given you my, maybe first most unpopular advice, which is to sleep more. Then the second, particularly in New Orleans, would be to drink less. So from a diet standpoint, alcohol is just very destructive of quality of sleep. And it also does inhibit immune function as well. So people are stressed and I know people are drinking, but I think this is the time where it really should be minimized, wherever possible.

You know, the paleo diet, it also is very nutrient-dense. If you’re eating a vegetable for a paleo diet with a high-end plant content, you’re getting a lot of the nutrients that are bandied about and talked about in integrated medical circles as having benefit against the virus. So these are things that people, kind of, they know innately, they know, you know, when they’re just thinking about these things what is helpful or not for them. And so, yeah, absolutely paleo diet, very critical. We know that sugar in of itself will suppress immune function. So the more that we can get those things out in healthy foods then the better we’ll be.

Dr. Hedberg: Excellent. So, Dr. Moss, I know you have a nice presentation for us, so why don’t you share your screen and go ahead and begin your presentation.

Dr. Moss: All right.Okay. All right, let’s see here. And can you see the screen?

Dr. Hedberg: It looks great.

Dr. Moss: Great. All right. Well, where I wanna start out is with Dr. Mather. And Joe, what I wanna say first is, you know, you put together some truly brilliant interventions in terms of antiviral protocols, immunologic protocols, and as we know, many other people have been doing the same thing. Of course, you have been basically showing, well, I’m in the trenches. That’s just not theoretical. I’ve made it work. But one of the things I’ve really appreciated about what you have done, which is fairly unique among all the commentators and commentaries that we have heard is, as you said, your emphasis on lifestyle and well, we are kindred spirits when you say back to basics. And I’m a back-to-basics type of guy.

And with that in mind, I wanna talk about an aspect of back to basics, basic lifestyle, particularly diet, an aspect of the paleolithic diet that I don’t think is getting the attention that it deserves, and that is fluid and electrolyte balance. And specifically, focusing on magnesium and potassium. In particular, potassium because I think as I’ve talked about repeatedly, even in the functional medicine community, I don’t think it’s getting the emphasis that it deserves.

And so, by looking at this, I wanna look at things that we’ve tend to talk about from an antiviral immunologic aspect from a different perspective and look at how a lot of the things that we are seeing clinically can be brought together by looking at fluid and electrolyte balance. For example, as we know, we are seeing different types of responses all the way from a large population that has no symptoms. I think the latest information out of the CDC, maybe 20%, 30% are showing no symptoms whatsoever. And there are patients who have moderate outpatient situations.

And the most common symptoms that these patients are presenting is muscle pain. And of course, as we’ve learned, one of the basics of functional medicine and nutritional therapies over the years is when you have muscle pain and muscle cramps, we give magnesium, one of the old old therapies. And then, of course, the comorbidities, as we know, probably the most common comorbidities, as you mentioned, Joe, has been hypertension. So, can we look at fluid and electrolytes and tie all these things together with a different package other than looking at it from an immunologic antiviral standpoint, which of course, I don’t wanna minimize, but can we add to that to give a more complete picture and a more comprehensive treatment?

All right. With that in mind, I wanna start out with some perspective. And this is a fascinating paper that looked at the 1918, influenza epidemic. And this author short at or talked about how we can learn from that. And notice the paper was written in 2018. They were kind of predicting, we could see something similar, very interesting kind of Nostradamus like prediction here. But what they pointed out is that there was a big difference in mortality from country to country and within each country. It was not uniform. And in addition to viral factors, there were other factors that came into play such as host factors. And in particular, the host immune status.

And what they pointed out, they did find some literature on this, is that malnutrition played a major role in the ’19 epidemic that we tend to think was purely the virus and immunologic status. But in fact, these authors point out there’s substantial information that malnutrition played a role, particularly they noticed this in India where there was particularly a high mortality rate. And during that time, there was a famine. Some crops had failed. There was a widespread drought. And so they make a key point in this article that malnutrition can play a significant role in these epidemics.

Now, what I was talking about before, as we all know, it needs to be emphasized is that in terms of mortality, what we’re seeing with COVID-19 is that comorbidities, in terms of the mortality rate is probably the major factor. And this is interesting also. I’ve been watching all these commentaries on TV and it seems like they just do not wanna talk about host resistance and they do not wanna talk about the impact of lifestyle.

So, finally, somebody in the mass media has decided to talk about the 1000-pound gorilla in the room. And that is the fact that most of these comorbidities as we can see in this quote are diet-related conditions. And so to a great extent, to extrapolate what we are seeing now in terms of the mortality, even morbidity is largely related to dietary issues. It’s nice to see somebody in the media finally talk about like I said, which we think is obvious, the 1000-pound gorilla in the room. Nice to see.

All right, now I’m gonna talk next about outpatient scenarios in terms of electrolyte imbalances. And I wanna start out with an anecdotal report. I’m fascinated by, what’s on television, the mass media. I’m a regular watcher to see what’s going on in the mass media with the “Inside Edition.” And they had an interesting anecdotal report of a woman who had a fairly severe case of COVID, outpatient, but her biggest chief complaints was muscle pain. And she reported that she felt a lot better almost immediately when she ate some chicken soup. Now, of course, I think one of the commentators, one of the esteemed media doctors came on and said, “Oh, that immediate response must’ve been due to all the protein in the chicken soup.”

And as we all know, you don’t get an immediate response immunologically when you eat some protein. But what do we know, what’s also in chicken soup is an electrolytes, and we know that when you are dehydrated and you’re missing electrolytes, particularly magnesium and potassium, it’s kind of right now when it comes to muscle pain in particular. And it was interesting, it did mention that. So I thought that was fascinating. And of course, we know the old-time therapy, the alkaline broth, which is cutting up potatoes and carrots and celery, components of chicken soup. So, a good and interesting anecdotal report.

But let’s move on here. And looking at now the hypertension medication controversy, which has been looked at purely in terms of its impact on viral activity, and of course, it’s very controversial whether it actually has an impact. But if we look at it from another perspective, look at it also has a significant impact on electrolyte balance. I think it adds another facet to it. And what I’m gonna be suggesting here is that many of the medications and dietary practices have created a significant depletion, a significant hyperkalemia, significant depletion of magnesium. And then the impact of the COVID-19 is basically is I’ll show the straw that breaks the camel’s back. So there’s a preexisting electrolyte imbalance, which is exacerbated by the virus.

And this is, as you probably know, a fairly common combination. Thiazides, calcium channel blockers, the angiotensin inhibitors, and the beta blockers are fairly common combination in these patients with increased predilection towards COVID who have comorbidities. But notice here, within 90 days of treatment, increased hyperkalemia risk regardless of potassium supplementation. So this combination has a significant negative impact on potassium status. Now, also, one thing I wanna mention here, I’m gonna be talking about hyperkalemia. Can we extrapolate to magnesium from hyperkalemia? These authors point out that actually because serum magnesium is a fairly unreliable indicator of magnesium store, they point out that serum potassium, hyperkalemia itself is an excellent indicator of magnesium deficiency. We can extrapolate. As we know metabolically, the chemistry, they tend to go together. You need potassium to use magnesium. You need magnesium to use potassium. So we can extrapolate from potassium hypokalemia, can we assume there’s also going to be hypomagnesemia? According to these authors, yes, we can.

All right. Here’s a study now on the muscle cramps, muscle pain. And what do they tell us here? Magnesium deficiency should also be included in differential diagnosis with persistent and severe muscle pain. And so again, we can probably extrapolate both potassium and magnesium.

All right, now let’s get to the inpatient scenario. The patients who are in the hospital who are at risk, not just for morbidity, not feeling good, but increased mortality. And I wanna talk about another interesting anecdotal report. And this made us several media sources. And this was a 90-year-old woman in one of those nursing homes in Kirkland. And they basically said that she was on death story. It was over. Write your will. Get ready for the burial. And they asked her, “What would you like in your last hours?” She said, “I want two things. I want prayer and I want some potato soup.” Well, she came on and they gave her a potato soup and she says, “Man, I am just feeling so much better.” And after that, and you can say whatever you want, I realize it’s anecdotal, she was on the road to recovery. And as far as I know, she’s still alive. And of course, I go back to the alkaline broth, potatoes, carrots, and celery. An interesting anecdote or report.

All right. With that in mind, let’s talk about nutrition in the inpatient scenario.

Number one, this is a paper from China, that in the inpatient scenario, that nutritional management is routine, was routine in China and much of the success in China with these patients, nutrition was an integral component as pointed out by this paper.

All right, now let’s get into the relationship with serum potassium and adverse clinical incomes in general. Serum potassium levels both below and above the normal range were consistently associated with adverse clinical outcomes across the volume of studies identified and summarized in this review. The body of evidence is compelling and it’s confirmation of the association between serum potassium and clinical outcomes and emphasizes the importance of careful monitoring and management of serum potassium in patients receiving treatment with an ACE inhibitors and the ACE blockers, the antagonists, in order to reduce risks of mortality.

So, again, I’m looking at these two drugs which have received a lot of attention in terms of the virus from a different perspective. They have a significant adverse impact on potassium status.

Now, how low is too low? Let’s take a look at that. I think one of the reasons that potassium hasn’t received the attention it deserves is because many of the patients are above the generally accepted cutoff by both the allopathic community and the nutritional community of 3.5. In fact, as this paper points out that in hypertensive patients below 4.1 is significant risk of increased mortality. So I think we have to adjust our thinking. We think when the patient’s in the fours, Oh, we’re safe, or we’re in the upper fours and the fives, we’re safe. According to this paper. In hypertensive patients, the range is much more constricted. So I think we have to keep that in mind. With that, hypokalemia becomes a much more crucial issue.

Hyperkalemia is common in the emergency department. Many of these patients with all the illnesses, by time they get into an inpatient situation, hyperkalemia is very common. But again, I would suggest often underappreciated because it’s not below 3.5. In this particular paper, 49% of the patients were symptomatic with weakness and muscle pain being the most common symptoms. So, the extrapolation areas, we’re seeing patients with muscle pain, a very common symptom with the COVID-19 patients, we can safely assume that there is going to be a clinically significant hypokalemia and hypomagnesemia.

We found 30-day mortality rates with different magnesium levels. Here’s the magnesium specifically. Eighteen percent at hypomagnesemia, 50% were hypomagnesemia,14.8%, normal magnesemia. But the point here is that low magnesium is hypomagnesemia is also significantly correlated with mortality. Low magnesium report in approximately 50% of ICU patients. So, again, both a low potassium and magnesium are a very common finding in all illnesses by the time they get to inpatient ICU situations.

Should we supplement with magnesium in critically ill patients? This paper tells us yes. And look at the manifestations of of magnesium deficiency. As I talked about hypercalcemia. Well, look at this. Respiratory muscle weakness, intractable arrhythmias. And, of course, that’s what we’re seeing in terms of mortality with many of these patients, the COVID-19 patients when they get the inpatient environment.

Now, here’s a paper here. Very interesting. It was done in China. What exactly did they see in terms of various blood chemistries? And we have a fairly small patient population. It was 19 patients. but nevertheless, take look at the red arrow and take a look at the serum potassium. What they looked at is, number one, the first column is overall, you see a 3.65. The next two columns relate to how long did it take to become COVID-19 negative on testing? As you move over there you’ll see the ones who did it in less than15 days, they got better sooner, 3.79. But take a look at the group over 15 days, took longer to get better. Notice that the potassium was 3.36. And that, of course, even from a textbook standpoint is low. So a very common finding in COVID-19 patients.

Now, let’s tie it all together here with this really fascinating paper that really deserves more attention. I’m gonna give it here in my limited time. I’m gonna probably write about it in detail, really looking at hyperkalemia and treating it as part of the treatment regimen in COVID-19 patients. What they did. First of all, the treatment was the patients who were discharged and well, they gave about three grams of potassium a day. They didn’t say the form. And over the average time of treatment of 34 grams. So you can see they’re about 10, 11 days.

And here you see the rest of the therapy. The severity of hyperkalemia meant a higher prevalence of severe cases. And this necessitated more frequent use of antiviral drugs. And you can see the drugs that were used there. And you can see the bottom sentence there that they had a fairly good cure rate. At the time that paper was written, 62 of the patients, 35% were cured and discharged from the hospital. But some of the conclusions are particularly relevant. The severity of hypokalemia led to substantially, more days of hospital stay and more days needed, as I talked about before, to have a PCR-negative result. But this last quote here, particularly important, the information from this analysis related to hyperkalemia directly reflects the very basis of the pathogenesis of SARS-CoV-2, and might be a reliable, in time, and sensitive biomarker to reflect the progression of COVID-19.

Can we look at serum potassium a simple anolyte routinely done and use that to extrapolate potential morbidity and mortality according this author? Yes we can.

So where I wanna leave you is, well, other than hypertensive medication, why might there be so many people who are hyperkalemic? We might say, of course, they’re not eating enough. They’re not not doing their paleolithic diet as suggested by Dr. Mather. But I wanna give one other interesting reason that I think is grossly underappreciated. And that is the impact of caffeine. This was a fascinating study where they gave 400 milligrams of caffeine to the healthy population, the young population over a two- hour period. And what did they notice? That over that period, the serum potassium decreased from an optimal of 4.4 to a questionable and concerning level of 3.9 with 400 milligrams.

And I wanna show you this interesting chart. And we’ll leave it here. All of the sources of caffeine that would be in the typical patient’s diet that is, of course, being under-reported. And as you can see when you look at this, we can see how easy it would be to get to 400 milligrams a day. So, hopefully, I’ve given another way of looking at this besides the important immunologic and viral perspective that looking at diet generally as talked about by Dr. Mather, but more specifically, looking at it in terms of the green leafy vegetables in that paleo diet and more specifically, fluid and electrolytes, magnesium potassium and the need for magnesium and potassium supplementation.

Dr. Hedberg: Excellent. Thank you for that presentation, Jeff. I have a few questions and just a couple of observations for everyone. So, what I see is I see a lot of people losing their jobs or their incomes dropping, which is a major stressor. I see loneliness. And Jeff, you’ve written about this in the past. The effects of loneliness on the immune system and it’s a driver of inflammation. I see increased social isolation, potentially less exercise, getting out physical activity. And I see Americans already on a highly acidogenic diet and high consumption of things like coffee and things that can deplete electrolytes. And so you just think of an individual out there who is hit with the loneliness and the social isolation or continued poor diet, the loss of their job, all these things together just seems like a recipe for a very difficult case or a poor outcome. Anything you wanted to add there?

Dr. Moss: Yes, I couldn’t agree more. We tend to, as nutritionists focus on nutrition and supplements, but looking at it more from allostatic load perspective where we have to take a look at all environmental stressors, psychological stressors, worry. Dr. Mather mentioned, of course, the importance of sleep being probably one of the most important. So yeah, I think you’re absolutely right. We have to look at this from a wider perspective and the concept of allostatic load, where really, any illness is related to the total environmental stress load. We tend to look at it, the load of poor diet. And in this case, infective viral activity. But really the answer as you’ve pointed out is going to rely on looking at reducing as much as possible all environmental stressors.

Dr. Mather: I think people should actually look at it kind of positively though because we do have a lot of those stressors here, but well, people should just realize how much of this is under their own power and how much slight shifts in these arenas, because they’re so fundamental, makes such huge differences clinically. And so I would just recommend anyone who’s feeling depressed or lonely, think of this as just a really great opportunity to make some needed changes to your life. Everything is disrupted, right? So, take the time to really just look inside and look at your lifestyle. What can be changed? For the patients I look with, you know, I may have 10 things I want them to do, but man, there’s got to be two things that they really can easily do. You know, you know, I can go to bed an hour earlier. Yeah, I can cut out the sugar. I mean, some basics here can go a long, long way. So I would want people to be optimistic about that and to realize that it’s really under their power to change things.

And the second is, I actually want to just piggyback on Jeff’s comments on potassium. I think there’s emerging biochemical posibility specifically for COVID in that the virus seems to disrupt the renin-angiotensin-aldosterone system. And in the severe patients, we’re seeing hypernatremia, high sodium levels, and low potassium. And so I really do think there is a place for potassium supplementation and management in the outpatient and in the inpatient. So I think you’re onto something here.

Dr. Hedberg: Thank you.

And Joe, I looked over your protocol, and it’s obviously excellent of course. Was there a particular reason not including N-Acetyl Cysteine or glutosiome or was that just, you know, we don’t wanna overwhelm our patients with too many pills and we have to pick the ones that are gonna be the most effective. Was that ?

Dr. Mather: Yeah, you’re exactly correct. That was one of the first on my list. But unfortunately, I spoke to Jeff and I think he said that his supply was low. So, because I was writing a newsletter to Moss Nutrition practitioners, I wanted to include specifically the things I thought were gonna help the most patients. I didn’t want people to scramble around for NAC that they couldn’t get.

Dr. Moss: There is a nationwide shortage right now. It’s not just us.

Dr. Hedberg: Okay. That’s what I hear.

Dr. Mather: But no, I think there… Oh gee, I’m trying to remember. I’ve read so many papers lately. I believe that not only do we have good evidence on some of those immune function, but I believe that there are clinical outcome data for NAC supplementation reducing the prevalence of influenza. So we have, and I think that was a dose of either 1200 or 1400 milligrams of NAC a day. So not a huge dose. That was showing a reduction in cases. And when we’re using nutritional interventions, we always wanna come back to outcome data whenever possible. So the things I’ve put on my recommendations were those where I found more little nuggets like that where we were actually reducing the number of either severity or incidents of infections.

And we also know, I’ll say this. So, when people are trying to sort out how to make sense of all the recommendations, obviously, we don’t have a ton of data directly on SARS-CoV-2, but we do have a ton of information on influenza and I think it’s reasonable as these are both RNA viruses to assume that there’s gonna be some overlap in how patients are gonna respond. So I did look at influenza data wherever possible and there’s just a wealth of published information there.

Dr. Hedberg: All right. Well, this was excellent. Any final thoughts, Dr. Mather, first, before we go?

Dr. Mather: Yeah, I have two. I’ll try to be short. I know we’re coming to the end. The first is I want to just sound a note of caution on the PCR testing that’s being done, the nasal swabs. I don’t think they’re particularly accurate. And the problem I’m seeing is that I’m seeing people who have symptoms consistent with the disease testing negative. And I worry that if this is done writ large that we’re gonna be continuing to spread the disease. Study out of China of about 200 patients with confirmed disease, they took multiple specimens, saliva, samples from the lungs, stool samples, urine samples, and then PCR swabs of the nose. In those patients, the PCR, nose swabs, the nasal pharyngeal swabs were only 63% sensitive, which means that about 40% of those patients with confirmed disease were given negative samples. And these weren’t hospitalized patients.

So my worry as a doctor in the community is that that false negative rate is gonna be even higher than that. You know, 37%, 40%. I’m worried that we’re gonna be somewhere about 45%, maybe 50% by the time this is all done. I have just a number of cases where I’m sure that it’s COVID and they’re responding to the supplements and prescription medications I’m using and they come back negative. We know this virus has a really high affinity for the lungs. So I think we’re looking for it in the nose where it’s not there. The cases in which they took bronchoalveolar lavages when they’re doing biopsies in the hospital settings, those were positive 93% of the time. So, the PCR technology is probably fine, but it’s probably the fact that we are looking in the wrong place.

So that’s the first thing is that if you have symptoms consistent with the disease, talk to your doctor, get treated, and don’t assume that you’re not contagious because, Nick, that paper is brilliant. You know, it’s 20 days on average that patients that can spread the disease. And we had one case of up to 37 days. So, you know, if there are people being able to spread this disease for a month walking around thinking they’re negative, that’s a real shame.

Well, I have a soapbox. And talking about the importance of lifestyle, supplements have a very big role. Zinc, resveratrol, quercetin. The adaptogenic herbs I think are important. Echinacea. Some of those herbal compounds that can influence immune activity are all critical.

The last thing I’ll say is that I’m a functional medicine doctor and I use supplements and diet, but I do think prescription medications have a role, particularly in the mild or moderate disease patients who are treated early. And I’m talking about hydroxychloroquine, which is the name for Plaquinel, right? And Azithromycin, which is a antibiotic that actually has antiviral properties. And these two medications, there’s a lot of controversy, there’s politics, there’s back and forth on the quality of studies.

I’ll just leave everyone with my experience that they’re helpful used early and I think we should have very little concern over the side effect profile. I think they’re very safe. The patients I’ve given it to, a small number of patients, but the patients I’m giving it to it’s helping. Sometimes dramatically. People just having no symptoms in 24 hours. Most patients who I give this combination to feel better within 48 hours. And my suspicion is that it’s preventing people from progressing into a serious disease by inhibiting viral replication early in the course of disease. We wanna treat this aggressively early so we keep people out of the hospital. And there is evidence that we are reducing the amount of time that people are gonna shed virus with these medications.

A lot of this is still, we’re gonna find the consensus and where new studies are coming out every day, but that’s my clinical sense from treating patients and my sense from taking in all the papers is that they’re helpful and that they should be considered early. I don’t think they’re gonna be as effective once you have the cytokine storm, once you have, you know, pulse-ox gradings of 70, people in respiratory collapse. I think you’re missed the boat at that point and that’s why people are saying that they’re not working is because they’re looking at inpatient population first, where I’ve had the opportunity to give them early. I’ve seen dramatic benefits. So I wanna leave people with my clinical experience for whatever it’s worth in that regard.

Dr. Hedberg: Excellent. Dr. Moss, any final thoughts?

Dr. Moss: Yes, a couple of thoughts. First of all, I wanna thank you for putting together this forum and getting the word out to the people who need to hear it most. And second of all, I wanna give a big thank you to Dr. Mather. The reason is, as we’ve all seen, virtually, every vitamin company has somebody who’s basically decided to go on “PubMed,” the medical literature, and basically extrapolate from studies and herpes virus, influenza and come up with, curative protocols that even though the language is compelling when you look at the literature, you realize it is extrapolation.

And that’s where I really was very hesitant to basically do that even though I was reading a lot of this literature and found it very compelling. And it wasn’t until I really had a chance to talk to Dr. Mather in the trenches. And as we have heard, Joe, you’ve given this a very practical, insightful, and scientific and broad-range perspective in terms of what’s going on, how to address it and particularly, in the outpatient population, but also, how we can look at this things to minimize one of the really true epidemics now besides COVID is fear of COVID and basically talking from an in the trenches perspective.

And now, really, because of what you were saying and what you put out, this has been the source of my confidence to really go out there and advise our customers and the patients of our customers and give, I think, a very unique perspective that isn’t coming from a lot of the other vitamin companies. So, again, I thank you so much.

Dr. Mather: Well, it’s been my pleasure to help. And actually, let me throw one more final thing out there. And this is a thank you to Nick because I learned this from you. The Lauric Select, I’m finding to be helpful. In a few case reports I’ve actually used that as monotherapy. And I started treating some patients with, Lauric Select Monolaurin, Nick, after your excellent training program. And I found it helpful in my practice for herpes viruses and influenza in the past. And so, I’ve relied on it heavily with my patients with COVID. And I have confidence that it’s helpful. So thank you for that, Nick. I wouldn’t have known that without your work.

Dr. Hedberg: Excellent. Yeah, Monolaurin is a great antiviral, antibacterial immune product. So, well, this has been really excellent. I really appreciate both of you coming on. And so you can go to drmather.com to learn about how to work with Dr. Mather. He does work with people remotely through telemedicine. And then, of course, Dr. Moss’s website is mossnutrition.com. And there will be a full transcript of this posted at drhedberg.com/covid19. So thanks everyone for joining us.

This is Dr. Hedberg. Go to drhedberg.com and search for COVID-19 and you’ll have access to the audio, the video, and a full transcript. So take care, everyone, stay safe, and I will talk to you next time.

"Dr. Hedberg's passion and concern to help me heal made all the difference in the world.”

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