COVID-19 and Autoimmune Disease

NOTE:  When it comes to COVID-19 and Autoimmune disease, the research is ongoing regarding this new virus and things are changing at a rapid pace.  I will continue to update this post as time allows.  Please, do your research, speak to your doctor if you are confused or have questions. And remember, the very best things you can do for your health do not involve fancy herbs or supplements. They are:

• Eat a varied diet.  Whole foods are the best. Avoid sugar and processed foods.
• Move. Get some physical activity – not too much. Walking and yoga are great.
• Drink water.  Our bodies need to be hydrated to function optimally.
• Protect your sleep.  Above all else, figure out what you need to do to sleep 8-9 hours a night. Avoid caffeine, avoid computers and TV screens at night, avoid the news if you have to.  Do what you have to do.  Sleep is SO crucial to our overall health and well-being.

***

Time to talk about what to do to – and what NOT to do – to boost your immune system during flu season.  Or COVID-19 season, as the case may be.  And a reminder:  I am NOT a doctor or medical professional.  The information below is pulled from various sources online, please read the linked articles carefully and speak with your doctor about any concerns.

I have an autoimmune disease.  Should I be worried?

Most of us are NOT “immune-compromised”, so we do NOT fall into that risk category that everyone is talking about.

Blurb from Dr. Datis Kharrazian’s article “Autoimmunity and immune resilience to viruses such as coronavirus, or COVID-19” below:

“Having an autoimmune disease does not necessarily weaken immune resilience. Instead, what matters is the state of your immune function in relation to your autoimmunity. In other words, different people can have the same autoimmune disease but have different states of immune function.

“For instance, some people with Hashimoto’s will have high white blood cell counts, while others will have low white blood cell counts. Some will have different degrees of natural killer cell activity, B-cell activity, T-cell regulation, and so on.  Autoimmunity can either heighten or depress immune resilience.

“This variability in immune function means that some people with autoimmunity can have a very heightened immune state and thus a high degree of immune resilience. It’s common in my practice for some autoimmune patients to say they have not had a cold or flu in five to 10 years, even though their heightened immune activity may exacerbate autoimmune attacks against tissue.

“On the other hand, others have low white blood cell counts, impaired function of natural killer cells (which fight pathogens), and depressed immunity. For these patients, their autoimmune disease causes them to constantly catch every cold and flu that comes around.”  See link above for full article.

This is from Beyond Celiac (specifically for those with celiac, but, an excellent description):

“The immune system of someone with celiac disease activates in response to gluten when it shouldn’t. The immune system is over-active rather than suppressed. In contrast, the immune system of someone who is immunocompromised doesn’t react when it should. It is less effective at fighting off germs like those causing the flu and the coronavirus. Treatments such as chemotherapy, certain drugs for autoimmune conditions, steroids and some conditions (like AIDS), suppress the immune system’s response. Therefore, people with those conditions or taking those treatments are more at risk.”

HOWEVER:

“If you are taking corticosteroids and other immunosuppressant medications, you are at increased risk for coronavirus. While not typically used for celiac disease, these medications are often used to treat other autoimmune diseases, such as rheumatoid arthritis and lupus, which those with celiac disease are at higher risk of also having.” See link above from Beyond Celiac for the full article.

Updates to my original post regarding COVID-19 and Autoimmune disease follow as pertinent information becomes available;  scroll down to “Other Things To Consider” for the rest of the original post.

UPDATE 9/5/20:  Vitamin D may reduce severity of COVID

This clinical trial demonstrated that “administration of a high dose of Calcifediol or 25-hydroxyvitamin D, a main metabolite of vitamin D endocrine system, significantly reduced the need for ICU treatment of patients requiring hospitalization due to proven COVID-19. Calcifediol seems to be able to reduce severity of the disease, but larger trials with groups properly matched will be required to show a definitive answer.”

UPDATE 7/13/20: Fermented foods shown to possibly lower COVID-19 mortality

This study has not been peer-reviewed as of yet, and correlation does not equal causation;  “…the European Food Safety Authority (EFSA) Comprehensive European Food Consumption Database to assess the consumption of different fermented foods by country… COVID-19 mortality rates were calculated using information from the Johns Hopkins Coronavirus Resource Center, and EuroStat was used to obtain data on confounders by country, including gross domestic product, population density, the proportion aged over 64 years, unemployment rate and obesity prevalence.

The researchers report that of all the variables considered, only fermented vegetables had a significant impact on the mortality rate by country.

For each gram per day increase in the average national consumption of fermented vegetables, the risk for COVID-19 mortality fell by 35.4%.”

UPDATE 5/26/20:  Lingering symptoms and cross-reactivity of proteins when it comes to COVID-19 and Autoimmune Disease:

A new study about COVID and autoimmune disease from Dr Datis Kharrazian et al. They have discovered that there is potential for the coronavirus infection to produce antibodies that may cross-react with the brain, thyroid, and the gut. Does this mean we should expect a spike in autoimmune-related disease in the future?

“Vaccine-induced autoimmunity from autoimmune cross-reactivity is associated with narcolepsy, Guillain-Barré syndrome, multiple sclerosis, demyelinating neuropathies, systemic lupus erythematosus, and postural orthostatic tachycardia syndrome…Due to the significant red flags for the potential cross-reactive interactions with the current COVID-19 pandemic, we studied the relationships between spike and nuclear proteins of SARS-CoV-2 and autoimmune target proteins.

UPDATE 3/21/20: Gut distress as a symptom of COVID-19, dangers of high amount of Vitamins A, C, and D

Gut distress: A small study from China suggests that COVID-19 may present digestive symptoms (diarrhea, vomiting, abdominal pain, etc) in patients before the more well-known respiratory issues.  From the study:  “We found that digestive symptoms are common in patients with COVID-19. Moreover, these patients have a longer time from onset to admission and their prognosis is worse than patients without digestive symptoms. Clinicians should recognize that digestive symptoms, such as diarrhea, may be a presenting feature of COVID-19, and that the index of suspicion may need to be raised earlier in at-risk patients presenting with digestive symptoms rather than waiting for respiratory symptoms to emerge. However, further large sample studies are needed to confirm these findings.”

For those of us who may already have gut issues, be extra mindful and keep those food-mood journals going to help track any symptoms (virus related or otherwise!).

Vitamins A and D in high amounts – from Chris Kresser:  This was in an email blast from Chris:  “On the webinar I did last weekend, I offered several ideas for boosting immune function during the COVID-19 outbreak. Among them were propolis and high-dose vitamin A and D. I have since come across research suggesting that propolis and megadoses of A and D may not be a good idea because, at least in theory, they could increase the expression of angiotensin-converting enzyme (ACE2) receptors.

“In many cases, botanicals, plant medicines, and nutrients like propolis and vitamins A and D have a modulatory effect—i.e., they upregulate or downregulate a function based on what is needed. That may be true here.

“However, since coronavirus gets into our cells by hijacking ACE2 receptors, I think it’s probably wise to avoid anything that might upregulate those receptors. For this reason, I now suggest avoiding propolis and high doses of vitamins A and D during the COVID-19 pandemic. You can (and should) still eat adequate amounts of A and D in food, and can supplement with lower doses of vitamin D (e.g., 1,000 IU) if you live in a place where you’re getting minimal sun exposure, or your 25-D levels are below 40 mg/dL. ”

It is not clear what the research is that he came across to suggest the above.  However, this is a good reminder to always test before supplementing and that the best way to get vitamins and minerals is through your diet. Another great reason to eat your liver, as your mom would say!

Vitamins C and D in high amounts – Chris Masterjohn has this to say in this post: “… I am not using high-dose vitamin C. While I support the study of high-dose oral or intravenous vitamin C in critical care, and will follow any findings that emerge, I am concerned that vitamin C could increase interferon, which in SARS is a trigger for the “cytokine storm” that causes inflammatory damage in the lungs. As a result, I am staying away from high-dose vitamin C as a preventative.

“I’m avoiding Umcka and bee propolis right now for the same reasons.

“Although I’m continuing to get an average of 3,000 IU of vitamin A per day from food and continuing to get normal sunshine and eat foods that naturally contain vitamin D, I am avoiding any supplementation with A and D. I’m worried that they could increase ACE2, the protein that the virus uses to enter cells.”

UPDATE 3/18/20:  Elderberry

There is much discussion around elderberry when it comes to COVID-19 and Autoimmune disease,.  This is from herbalist Stephan Buhner from his Facebook page:

“a) I don’t like elderberry and i am not recommending it in this protocol, i am recommending elder LEAF or stem. b) elder leaf, stem, and berry are not the same things, they do not contain the same constituents, they do not act identically in the body. c) elder leaf is a th1/th2 modulator, that is it MODULATES cytokines, raising them if low, lowering them if high. d) HOWEVER, with elderberry there is some evidence that it raises TNF-a and TH1 cytokines, THERE IS SOME PROBLEM WITH THIS AS A BLANKET STATEMENT. I note in Herbal Antivirals that IN MICE who were infected with malaria, the use of sambucol, an elderberry extract, TNF-a increased, making the condition worse. Then i note that elderberry POSSIBLY stimulates TH1 cytokines. Another study found that in 12 healthy human volunteers sambucol did in fact increase TH1 cytokines, esp TNF-a. This could indeed be a problem . . . or it could not. e) In those studies elderberry was given to both mice and men AS A SINGLE HERB. It was not surrounded by other herbs in a complex protocol, and many of the other herbs are in fact potent cytokine normalizers. f) Again, the elder component is only 1/9 of the core protocol, see mathematical calculation on that above. It is tiny in comparison. f) I DO NOT LIKE ELDERBERRY as an herbal medicine and I NEVER recommend it; the protocol calls for elder leaf, a very different herb. g) and FINALLY, I would not under any circumstances suggest elderberry as a single use herb for treating the corona virus, as it could, WHEN USED BY ITSELF IN LARGE DOSES, increase TH1 which is not something to do with this organism. (And, please, do not take this last comment out of context, if you are going to send these comments around, please include all of it, not just this last comment devoid of context.)”

UPDATE 3/15/20: Chris Kresser, Ibuprofin, Melatonin

Chris Kresser hosted an excellent webinar discussing Covid-19; you can view it here. He stresses the importance of social distancing and hand washing, stating that:  “This is a marathon, not a sprint. So we’re talking about months, not weeks. It’s pretty unrealistic to assume that this will intensify for a week or two and then peter out after that; there’s no evidence that’s what’s going to happen… we’re going to be dealing with this for a while. What it looks like over the next weeks and months will largely on how aggressive our early response is. The more aggressively and effectively we respond now, the less of an impact it will have later and the less serious the consequences.”

Chris Kress also has an informative podcast on COVID-19, transcript and audio file here. Not all of it pertains to COVID-19 and Autoimmune disease, but it’s good info nonetheless.

IBUPROFEN:  From this article: “French authorities have warned that widely used over-the-counter anti-inflammatory drugs may worsen the coronavirus.

“The country’s health minister, Olivier Véran, who is a qualified doctor and neurologist, tweeted on Saturday: “The taking of anti-inflammatories [ibuprofen, cortisone … ] could be a factor in aggravating the infection. In case of fever, take paracetamol [which is known in the US by the generic name acetaminophen and commonly by the brand name Tylenol]. If you are already taking anti-inflammatory drugs, ask your doctor’s advice.”

“Health officials point out that anti-inflammatory drugs are known to be a risk for those with infectious illnesses because they tend to diminish the response of the body’s immune system.”

NOTE that the above is debatable, as shown by this article, translated from Finnish here: ”

“According to Olli Vapalahti , professor at the University of Helsinki, there is no evidence that paracetamol [acetominophen] is a better drug for coronavirus than ibuprofen, writes Iltalehti .

“Vapalahti says there is no evidence that anti-inflammatory drugs would dampen the body’s immune system and thus pose a risk to patients with infectious diseases.”

HOWEVER:  For those of you following the AutoImmune Protocol, the reason we avoid NSAIDS like ibuprofen when on the protocol is that they can be inflammatory.  And we want to avoid excessive inflammation.

Bottom line: Speak to your doctor to see what is best for you.

MELATONIN and SELENIUM:  This is a BIG article.  See the cited studies in the article, which can be found here.  A blurb:

“Melatonin has recently been shown to reduce IL-1β secretion and attenuate inflammasome-associated vascular disorders by improving endothelial leakage and suppressing NLRP3 inflammasomes [99].  Patients with underlying CVD conditions may greatly benefit from the use of melatonin in the treatment of COVID-19.

“Selenium is a strong scavenger of free radicals. Selenium is believed to be effective against viruses such as Ebola, HIV and influenza A virus [47, 48].  However, selenium is also a powerful inhibitor of angiotensin-converting enzyme (ACE) [49]. Patients suffering from cardiovascular diseases, hypertension and diabetes are often prescribed drugs that inhibit ACE.

“The use of selenium during COVID-19 infections therefore, can be problematic.  ACE inhibitors actually INCREASE expression of ACE2, and SARS-CoV-2 infects host cells through binding with ACE2 receptors [50]. ACE2 receptors are found on lung epithelial cells, intestines, kidneys and blood vessels. Thus using ACE inhibitors either through medication or supplements risk elevating COVID-19 infection and developing severe or even fatal disease complications [51]. ”

Again, speak with your doctor before supplementing.

UPDATE 3/14/20:  Cytokine Storm Syndrome, Risk factors when it comes to COVID-19 and Autoimmune disease:

From this study:

“In conclusion, predictors of a fatal outcome in COVID-19 cases included age, the presence of underlying diseases, the presence of secondary infection and elevated inflammatory indicators in the blood. The results obtained from this study also suggest that COVID-19 mortality might be due to virus-activated “cytokine storm syndrome” or fulminant myocarditis.”

Cytokine storms happen when the body starts producing too many immune cells.  The result is inflamed tissue – much more than necessary. If we as autoimmune patients do not already have inflammation under control, this may be a concern.  As always, healing the gut is the first step towards reducing inflammation, and eliminating gluten is the first step to heal the gut.

While there is much to be learned about cytokines storms and how/why they happen and how they can be avoided, it is of utmost importance to know about the potential dangers – especially if you have autoimmune conditions.  Let your medical team know about cytokine storms and that there is a test available (see below) to predict if this will happen.  Many doctors, ER’s, and hospitals may not be aware this is even an issue.

There is a cheap, simple test that will help diagnose cytokine storm syndrome.  From this article, which also offers a great explanation of what cytokines are, what a storm is, etc:

“A cheap, simple test, widely available at most hospitals in the United States and worldwide, can help diagnose cytokine storm syndrome, Cron said. “A protein called serum ferritin tends to get very high in this disorder,” he said. “If you are sick enough to be in a hospital and you have a fever, you should get a serum ferritin. It typically comes back in less than 24 hours and almost every hospital can do it, and if it’s high you can work them up for cytokine storm syndrome.”

Certain herbs can help or hurt cytokine issues.

From this article as well as this article, here are some herbs to take to DECREASE or SUPPRESS the risk of a cytokine storm (may not be a complete list, use caution and do your research). When it comes to COVID-19 and Autoimmune disease, this is quite important:

• Turmeric
• Yarrow
• Cayenne
• Garlic
• Ginger
• Horseradish
• Milk Thistle
• Red Raspberry
• Resveratrol (Grape Leaf)
• Quercetin
• Skullcap
• St. Johns Wort
• Tea Tree Oil
• Vitamin C

And here are herbs to STOP TAKING if you are sick (they may only make things worse and promote cytokine production). Again, may not be a complete list, use caution and do your research:

• Elderberry (see below for more info)
• Echinacea
• Honey (any sugar of any kind makes it worse)
• Chocolate
• Ginseng
• Colloidal Silver
• Kimchee

More complete list of herbs at the bottom of this article here.

Risk factors for different AI disorders

This article from Aviva Romm, MD, suggests that Type1 (and Type 2) Diabetes are at greatest risk for complications from Covid-19, while Rheumatoid Arthritis, Lupus, and Multiple Sclerosis also carry greater risk.  The article also goes into detail about recommendations for specific autoimmune conditions.  As always, speak to your doctor if you have any questions or concerns.

Other things to consider with COVID-19 and Autoimmune Disease.

For those of us with autoimmune issues, there is an imbalance in Th1 and Th2 helper cells.  Th cells are types of white blood cells that help balance our immune system. In a “normal” person, a good balance of these cells creates a smooth-running machine.

When someone has an autoimmune condition, this balance is thrown off.  So many of us end up as what is called “Th1 dominant” or “Th2 dominant”.

A bit more about these helper cells.

Th1 cells help fight infections, viruses, and some types of bacteria. They are pro-inflammatory (remember, inflammation is a good thing when it comes to the body’s natural process of dealing with viruses and healing!)

Th2 cells deal with toxins, allergens, and other types of bacteria.  They are not inflammatory.

When it comes to COVID-19 and Autoimmune disease, consider this:  Some AI disorders are T1 dominant: Hashimoto’s Thyroiditis, Type 1 Diabetes, Multiple Sclerosis, Crohn’s, Celiac, or Rheumatoid Arthritis – most of us with these conditions have a Th1 dominance. So we may better fight off colds, the flu, and other viruses. HOWEVER:  See above if you are taking corticosteroids and other immunosuppressant medications as these can make you more vulnerable to viruses.

If you have Lupus, IBD, Ulcerative Colitis, Scleroderma, you may be Type 2 dominant.

***If you are Th2 dominant, it may be a good time to start supporting your Th1 side. *** See posts below from Dr. Kharrazian and Self-hacked for more information on how to do this.

There are always exceptions, some may have myriad health conditions that must be considered, and some may flip-flop between Th1 and Th2 dominance. Medications that one is taking must be taken into consideration as they can affect immunity.  Please call your doctor if you have any questions or concerns about your health when it comes to autoimmune disease.

For more on Th1 and Th2, how to determine which you are, and how to balance these helper cells, read this from Dr. Datis Kharrazian and this post from Self-hacked.

What does immune-compromised or immuno-deficient mean?

From this article regarding the difference between autoimmune disease and immune deficiency:

“Autoimmune diseases are caused by overactive immune system leading to damage of self-tissues and organs in the absence of a harmful stimulus.  Immune deficiency is a disease where the immune system is not capable of mounting an immune response against foreign material, organisms due to a single or multiple defects in the immune system.”

From the CDC (Center for Disease Control):

“Examples of persons with weakened immune systems include those with HIV/AIDS; cancer and transplant patients who are taking certain immunosuppressive drugs; and those with inherited diseases that affect the immune system (e.g., congenital agammaglobulinemia, congenital IgA deficiency). The risk of developing severe disease may differ depending on each person’s degree of immune suppression.”

From the Immune Deficiency Foundation:

“Primary immunodeficiency diseases (PI) are a group of more than 400 rare, chronic disorders in which part of the body’s immune system is missing or functions improperly. While not contagious, these diseases are caused by hereditary or genetic defects, and, although some disorders present at birth or in early childhood, the disorders can affect anyone, regardless of age or gender. Some affect a single part of the immune system; others may affect one or more components of the system. And while the diseases may differ, they all share one common feature: each results from a defect in one of the functions of the body’s normal immune system.”

What can I take to help boost my immune system when it comes to COVID-19 and Autoimmune disease?

• First off, please check with your doctor before supplementing, always “test don’t guess” to make sure you actually *need* a certain vitamin or mineral.
• Don’t go looking for a magic pill that will make you Superhuman.  Sorry, but that doesn’t exist.  What you can do is eat/exercise/sleep well (see below), wipe down surfaces (counters, tables, doorknobs, faucets, fridge handles etc) with a 1/10 bleach/water solution daily, practice good handwashing habits, social distancing, and stop touching your face.  Here’s a great audio clip from Science Friday about how handwashing is the best thing you can do to help stop the spread of disease.
• Your diet.  If you are eating a diet rich in fruits and vegetables of all colors of the rainbow, you are doing great.  Getting our vitamins, minerals, and other nutrients from whole food sources is always best.  Avoid processed foods and sugar if you can.
• Exercise.  Don’t go overboard, but move. Every day.
• Sleep.  Do not underestimate the healing power of sleep. If we are tired and run-down, our bodies will be more susceptible to infections. Aim for 7-9 hours per night.
• Additional vitamins.  Some may find that additional supplementing with Vitamins A, C, D, E, as well as glutathione, magnesium, and zinc may help boost the immune system. Chloroquine phosphate may help after infected.
• Melatonin may help avoid a cytokine storm, see articles above for more on this.
• Supplements that support your Th1 side if you are Th2 dominant. See posts above from Dr. Kharrazian and Self-hacked for more info on how to do this.

NOTE:  Don’t buy crap supplements off the shelves. Do your research, get properly made supplements that do not contain gluten, soy, corn, or other potentially inflammatory fillers.  I like Thorne, Jarrow, and KAL brands personally.  More on supplements on this page.

Some things to avoid with COVID-19 when it comes to Autoimmune Disease – especially when infected:

• Elderberry.  Taking elderberry before you contract a virus may be helpful, but be mindful if you are already sick. Those who are getting really ill (or dying) from COVID-19 experience excessive cytokine production.  From this study:  “We conclude from this study that, in addition to its antiviral properties, Sambucol Elderberry Extract and its formulations activate the healthy immune system by increasing inflammatory cytokine production.”  Especially important if you are Th1 dominant (see above).
• Going to state the obvious here, but avoiding sugar, caffeine, and alcohol when sick will only help your body fight off whatever is going on.
• Don’t get a flu shot thinking it will help with this new virus. It actually may make you more susceptible. A COVID-19 vaccine may be a year away, and by then the virus may have mutated so that vaccine will not work. This article shows how viruses can mutate.
• Being around people if you are not feeling well, even if you’re not “down for the count”.  Don’t be a hero and pretend like you’re ok.  You may run the risk of infecting hundreds of others, which is how this thing spreads and THEY will then be down for the count because of YOU.  Stay at home if you can.

To summarize:

Use common sense, don’t be in a group or large event if you don’t have to be.  Don’t stockpile things you don’t need like masks, sanitizer, etc – think of your fellow humans and also medical professionals on the “front lines” who need equipment like masks much more than you do.

Understand your condition and speak with your doctor about any concerns.

Eat well. Wash your hands. Stop touching your face.  Go for walks. Meditate.  All of these things can help boost your immune system.

Yes, for some of us we need to be extra careful with this new virus. Yes, we have a lot to learn moving forward, as these viruses and pandemics will be commonplace in the future.

One other thing: for god’s sake, stop watching the news.  It’s one thing to be informed, but another to be so terrified of what’s going on due to media hype.  They feed off of our fear.  Don’t feed them. If you do choose to watch/listen to the news, get the whole picture and make choices based on facts, not on fear.  Dig for the facts, get informed, use common sense.

Will update this post as needed.

Be well, everyone.

As always, a reminder that I am not a doctor or licensed medical professional.  This article is provided for informational purposes only.  Please contact your doctor if you ever have any questions about your health.  If you are looking for a doctor who understands autoimmune conditions, please see this post.

My offer to you.

In light of all that’s been going on in this world, I would like to offer you, dear reader, some coaching.

I will listen deeply, offer empathy, and help you make sense of what’s going on in the world right now. It does not have to be about nutrition or autoimmune issues. We can talk about anything that’s on your mind.

We can talk about anything that’s on your mind:

• creating new habits in this “new normal” – or maintaining current habits
• work challenges – either working from home or being out of work
• figuring out how to best spend your time with your now at-home children (and still retain your sanity)
• how to cope if you have too much free time, or if you are finding it hard to strike a work-time vs. free-time balance in light of recent changes
• how best to manage stress
• guilty feelings about not having to go work or the gym or maybe cheating on your diet
• feeling ok doing absolutely nothing for a while
• helping you create structure in your life and a plan moving forward – whatever that may mean to you
• help you regain control if you are feeling out of control
• if you are a health care worker, I can offer empathy and support for what you are facing right now.

To book your Complimentary “Meet & Greet” Session and Assessment, click here.

Be well, everyone, and I look forward to meeting you.

Sandy

Sandy Swanson is a Certified Functional Health Coach who received her training from Chris Kresser’s ADAPT Health Coach training course (A-CFHC) and is also a National Board Certified Health and Wellness Coach (NBC-HWC).  You can learn more about her here and more about what coaching is here.