Dear Friends,
How We Share Information
Before discussing the topic of immune resilience, we would like to start with some thoughts on how and what we say on the internet, and specifically, one regulatory issue. The Federal Trade Commission (FTC) has rightfully said, it is “unlawful under the FTC Act, 15 U.S.C. § 41 et seq., to advertise that a product can prevent, treat, or cure human disease unless you possess competent and reliable scientific evidence, including, when appropriate, well-controlled human clinical studies, substantiating that the claims are true at the time they are made. For COVID-19, caused by the SARS-COV-2 virus, no such study is currently known to exist for the products identified above. Thus, any Coronavirus- related prevention or treatment claims regarding such products are not supported by competent and reliable scientific evidence.”
That position is clear enough. We too are concerned that there are treatment recommendations appearing on the internet that have no scientific rigor to back them up. We do not want patients to have false hope or inaccurate information. We support the Federal Trade Commission’s warning to all kinds of providers, trying to keep the public safe.
But, in fact, there is a sort of disconnect, or difficulty, in communicating important information. What we would like to try to do is describe the confusion. This is our understanding at this time. While we could discuss most anything we wish, in terms of findings of a trial, hypotheses, recommendations, etc., at a conference, or a meeting, in blogpost or article, where the FTC steps in is in the matter of ‘commercial speech.’ Writing something in a blog or a research paper is not regulated by the FTC, as that is considered free speech, but the same information coming from a health clinic advertising a service might very well be regulated. In other words, it may not be the actual product or suggestion that is an issue but rather if that product or recommendation is part of a commercial concern or not, and if it is, it may fall under FTC rules. And the FTC will want proof, which is often not a research article but rather FDA regulatory approval.
As a real example, one we do not offer in our clinic, have not offered, and will not offer, is that of IV treatments. It is not part of our office practice, so we choose this just as an example. There was a great deal of research in the use of IV Vitamin C in the actual treatment of SARS-COV-2 virus. First this was conducted in China then in a variety of centers around the world and several governments studied the results carefully assessing in terms of a treatment option. These studies are documented in conferences, and in very detailed papers, and many scientific, peer-reviewed journal articles. This is allowed to occur. However, if a clinician in the USA, be it an MD, DO, ND, on their office website makes any comment that they offer IV Vitamin C treatment for patients with SARS-COV-2, then they may well receive a warning letter from the FTC telling them to stop. Basically, because this treatment has not been proven to the satisfaction of FDA, through regulatory clinical trials. It is also possible, that even if the practice stopped offering this service, they may not be allowed to say anything about it on their office website, as basic information, as we have not included this information on our website. This seems unfortunate, as it stifles the clinician from being able to share information with their patients, even if they are not offering that service themselves.
In discussions with FTC, we have learned that the main issue hinges around the ‘commercial’ aspect of information offered. General speech is not regulated, commercial speech is. But while this sounds simple enough, currently, it seems unfairly applied. For example, we are aware of over 100 warning letters that went out to individual clinics, as they are seen as commercial. But the same information is posted on medical school and hospital websites, which are in fact commercial institutions, and this added treatment option clearly has a commercial component. Each institution is vying for patients and students, and grants etc. So ,what comes across, at this time, is a sort of confusing moment for us. It seems as though if you are large enough and commercial, you can say something, but if you are smaller, and say the same thing, you can not. And what is really confusing is that the large institutions are often quoting our work and past comments. If you picture it, the individual clinician makes a comment, puts it on their website, then the large institution follows suit, then the small individual clinician is sent an FTC warning letter. It is confusing.
In many ways, we hope that our communication with the FTC, which we found very helpful will lead others to additional and ongoing clarifying communication with the FTC. We urge national medical organizations to interact positively with FTC to develop a working plan, or working document that smaller clinics can implement to stay on the right side of these rules. We would like organizations to work to insure that vital information is not stifled. For the naturopathic physician national organization, please contact the AANP, at, https://naturopathic.org/. For the FTC, please contact https://www.ftc.gov/. I cannot see how it is possible for the same information coming from similar institutions, only differing in size can have different regulatory outcomes. We encourage FTC to interact with the AANP to help their constituents understand the issues better.
And we should say, that while there are many health claims on the internet related to COVID-19 we aim to present information here on general health and immune resiliency only. And to cite the research that supports that effort. At this time there are no known proven medicines, conventional or natural, for the prevention, treatment or curative action against SARS-COV-2 virus. If you seek further information about marketing in this area, please review the Federal Trade Commission health claim materials at this site: https://www.ftc.gov/tips-advice/business-center/advertising-and-marketing/health-claims.
We present information about immune function, as for example the role it plays with viruses such as the influenza virus. In order to avoid confusion, it is important to underscore that the influenza virus is not the same as the SARS-COV-2 virus. While we believe that the comments below are useful towards immune resilience, there is no proof they would be effective against SARS-COV-2 virus.
Thoughts on Immune Resilience
Here our thoughts for your review at this time:
We continue to hear from many of you wanting guidance at this time. The bottom line is that viruses are ubiquitous, so it’s ever important to try to prevent exposure as much as possible by observing physical distancing, keeping your children and teens close and following all public health directives. Wear a mask when in public. Wash your hands when you arrive home, and know that good old soap and water may be better for all of us in the long run.
It has become increasingly clear than many of us have become asymptomatic carriers and we may be inadvertently putting all sorts of people at risk without intending to. So! Please do not become paranoid, but put effort into being careful just as you would want others to do for you.
And we also know that when and if you fall ill, the better shape you are in beforehand, the better. Most people will have only a mild form of this illness, but working to build a resilient immune system now, will serve you well should you become exposed or do become sick.
In order to create the most resilient immune system possible, here are my recommendations for you and yours. Please know that for those with underlying or chronic disease, or who have compromised immunity (for whatever reason), or have an autoimmune disease, I would want to work with you individually as not all these recommendations apply.
Here we go, with regard to supporting immune resilience:
1. Drastically reduce the amount of refined sugar you consume, it directly depresses your immune function.
2. For adults, consider elongating your overnight fast to at least 13-14 hours. This gives all the cells of the body a chance to regroup, to self-correct and to do the jobs they are supposed to do. It also gives the immune system an opportunity to “tidy up” if you will, and to be more effective.
3. Stay well-hydrated, a mucous membrane that is NOT dried out will flush all manner of germs - bacteria or viruses, better than mucous membrane that is very dry. If this does not come easy to you, consider putting out on the counter x amount of water for the day, and try to actually drink it. Everyone economizes fluids differently, so work to keep your urine pale. Don’t over-drink, that’s not good either!
4. Use a humidifier in the bedrooms, helps with #3. I recommend an ionizing type to cut down on possibility of mold.
5. Eat a healthy diet with a reduced percent of processed foods. Lean into: veggies, fruit, nuts, seeds, fish, poultry, meat, olive oil, whole grains and legumes. Take the imperative to be home more to pull out the vegetable steamer, to grow some spouts or microgreens. Take your extra time to cut all those veggies for a stir-fry or salad. Do a baking project with the kids, learn how to make a new recipe.
6. Start or keep up with an exercise plan. It raises your threshold for feeling stress, dissipates the stress you have and helps your body to be better perfused (i.e., gets the blood is moving better so all the other good choices you are making are amplified!) Here are some resources for at-home workouts. And if you’d like to do a yoga class at home, you’ll have many choices.
7. We know that smokers have a worse outcome if they do contract COVID-19, so take this opportunity to cut back or quit. The same is true for those who vape. Check out some free support to help you quit. Of course, quitting has long term positive impacts on health.
8. Bring in stress reduction. If you don’t already meditate, think about starting. Even 5 minutes using the app Headspace or Calm or deep breathing or a guided imagery session, is worth it. There are endless resources available online, many are free. Psycho-neuro-immunology, the science where we understand how the mind impacts the nervous system and the nervous system impacts the immune system, underscores the essential nature of this activity to all of our lives. Get the children involved with this, most kids enjoy it and find it fun. And if meditation is not your jam, hobbies, making art or music, or zoning out organizing your spice drawer, all that counts for stress reduction, too. Bring in music, more upbeat podcasts, books, positive news outlets. I have been enjoying the weekly sports podcast Only A Game, and Modern Love (a collaboration between the New York Times and NPR), as well as the uber-upbeat Kind World. Consider putting a limit on the amount of screen time you have each day, as it continues to be associated with obesity, poor diet and depression.
9. Try to spend some time outdoors every day. The Vitamin D from the sunshine is good, but so too is fresh air, a change of scenery and time away from screens! The more it is studied the more we understand why time in nature has further positive impact on immune function.
10. Keep alcohol consumption in check—it negatively impacts the immune system via a number of pathways. This is true for both chronic excessive drinkers as well as those who binge drink. Maybe this is the time you commit to less alcohol consumption.
11. Consider napping. Join about a third of us who enjoy a daily nap. Shorter is better, and you can expect some improved memory, energy and focus. Some have suggested napping as a public health tool to counter the impact of chronic sleep debt! Adequate sleep in general, is essential for a well-functioning immune system.
12. If you can, use nasal Irrigation or a Neti Pot which can help remove nasal secretions along with viruses before they have time to set up shop. We understand that the virus will multiply in that area for a few days before heading toward the lungs, so you can wash away the virus to a point using these approaches.
13. Ensure adequate sleep. This is a big one and an area where many people already struggle. If this is an issue for you, come in & let’s work on your insomnia! We naturopathic doctors have many tools to help with sleep challenges, even for those who rely on benzodiazapines.
14. The supplements we suggest include the following list. Please know that no one can take all the supplements all the time. First of all, it is cost-prohibitive. Secondly, it’s not that much fun. Seek guidance from a licensed provider for children or if you are pregnant or nursing. Please note all the suggestions below are OTC products, all are used within generally recommended dosages, and all are used in the mode of administration that is common. We are limiting the lists to products that are easily found in most health food stores, larger pharmacies or online. We do not suggest any specific label or company, please use reputable review sites.
Here we go:
a. Elderberry, syrup is fine - a tsp /day for the kids a TBSP for adults. Elderberry can is used as an antioxidant, often used in syrup form, and has been shown to help prevent flu.
b. Zinc 15 mg/day and 1-2 Zinc or Zinc/elderberry or Zinc/Echinacea lozenge for kids and adults. Zinc supports immune function. (See information from the CDC below, #1.)
c. Mushroom complex, there are many on the market to help support optimal immune function.
d. Foods high in Vitamin C as well as supplements can be put to good use. Studies have shown that Vitamin C helps reduce symptoms of seasonal influenza infection by a number of biochemical actions.
e. Probiotic. We want the most robust & diverse microbiome possible to support a resilient immune system. Probiotics appear to offer protection against flu, as well as other germs. Also eat/drink fermented or cultured foods each day, fork/spoonfuls or sips is plenty.
f. Garlic has anti-microbial properties to help support immune function and that help break up mucus.
g. Thyme is another anti-microbial herb and immune stimulant to consider when working to support immune function.
h. Likewise, Echinacea, is an immune modulating herb that activates white blood cells.
i. Lemon balm is a well known herb that reduces the inflammatory process which causes both fatigue and anxiety, so for many, it’s the perfect herb right now. Take in capsule or as a tea, or in combination with others listed here. While it works to support immune function, it can also work to calm the nerves.
j. Melatonin, long understood as a supplement to help with sleep, plays many other roles, from reducing GERD, to being anti-cancer and to helping support effective immunity.
The above thoughts are meant to be general concepts, not a personalized treatment plan. Interestingly, the supplements listed above were shown to modify symptoms caused by other viruses. For instance, research on elderberry (Sambucus) shows its capacity to decrease symptoms associated with the flu. Likewise, echinacea has been studied and confirmed to inhibit the symptoms caused by influenza viruses and by modulating the immune response. If you have nausea, ginger or chamomile tea can offer relief. If there is significant coughing, honey in warm water has been shown to be effective. Herbal teas and tinctures made from ivy leaf, thyme and marshmallow root have all been examined and found to help reduce the symptom of cough associated with influenza.
There are many ways that social isolation has a negative impact on overall health and mortality. One area of study reveals that feeling lonely has a negative impact on immune response which I am worried about right now for many of the people we know and love.
The challenges of this time will be amplified for those who already feel socially isolated or who struggle with depression, anxiety and other chronic complaints. There are free resources available to all, including:
-- For those living with domestic violence: https://www.thehotline.org.
-- For those with suicidal thoughts: https://suicidepreventionlifeline.org.
-- For those struggling with mental health or substance abuse: https://www.samhsa.gov/find-help/national-helpline.
-- Mental health/crisis text line: https://www.crisistextline.org/texting-in.
-- For older people struggling and feeling isolated: https://www.ioaging.org/services/all-inclusive-health-care/friendship-line
Our aim is to help our patients stay calm, to offer accurate, non-alarmist, actionable information and to treat those in need with effective natural medicine and a big scoop of compassion.
Hopefully one silver lining with COVID-19 is that we will grow more compassionate and thoughtful for the people around us. We’ll check in with neighbors, especially the elderly or those living on their own. We know that true social isolation is not good for health. As we reckon with the impact of COVID-19, let’s also focus on the positive steps we can take toward healthy living, for ourselves, our families and our communities. Perhaps on the other side of this epidemic we will keep up the better health habits, for more vibrant and enduring and health.
Our writing is in step with many institutions and providers throughout the USA culling from medical experience, and pooling from the many research articles found on PubMed as of May 15, 2020.
As an addendum, due to FDA/FTC rules, it is difficult to communicate from a medical office, tactics and strategies being used by many our medical colleagues, as they may run afoul of trade commission rules. Generally, these rules are in place to protect the public which is a very good thing. But aside from the research cited above, of which there is a great deal more, we want to highlight what our medical colleagues are now doing in the larger medical centers and hospitals, through the USA, as described on their public websites, as it seems as though they are making very similar comments. In no particular order, here goes, starting with the CDC:
1. https://wwwnc.cdc.gov/travel/yellowbook/2020/preparing-international-travelers/complementary-and-integrative-health-approaches. Starting with the CDC, which comments on some similar suggestions, when dealing with viruses in general. As for example, that zinc may lessen the duration of viral infections.
2. The Harvard TH Chan School of Public Health shares similar information and recommendations with the public on their website: https://www.hsph.harvard.edu/nutritionsource/2020/04/01/ask-the-expert-the-role-of-diet-and-nutritional-supplements-during-covid-19/
3. Eastern Virginia Medical School seemed to have taken a page straight out of our comments. https://www.evms.edu/pulse/archive/vitamincocktailmayhelpprotectagainstcovid-19.php
4. https://www.drugs.com/medical-answers/zinc-protect-you-covid-19-boost-immune-system-3535446/ offers similar information on their website.
5. https://www.sermo.com/press-releases/sermo-reports-zinc-and-vitamins-c-and-d-recommended-by-global-physicians-to-treat-and-build-resistance-to-covid-19/ This article cites that around 25% of the physicians in NYC are suggesting similar options.
6. On the UCHealth website, similar recommendations. https://www.uchealth.org/today/zinc-could-help-diminish-extent-of-covid-19/
7. From a top tier journal Nature, which publishes the European Journal of Clinical Nutrition we find similar concepts: . https://www.nature.com/articles/s41430-020-0635-2
8. Even those professionals who work with patients on other issues such as psychology are publishing similar recommendations. Here one of the main journals in psychology. https://www.psychologytoday.com/us/blog/experience-engineering/202003/can-supplements-help-combat-covid-19
9. The next one is published as the protocol in a hospital in the USA as a protocol for treatment, employing similar concepts. https://www.evms.edu/media/evms_public/departments/internal_medicine/Marik-Covid-Protocol-Summary.pdf
10. Even the oldest medical clinics highlight some of the same points. Here, as an example, the Mayo Clinic. https://www.mayoclinic.org/drugs-supplements-zinc/art-20366112
To be clear again. None of these suggestions have been approved as standard treatments or protocols by FDA/FTC. None of these suggestions can be marketed in the USA as treatments for the COVID-19 pandemic. But there are actually a great many centers using these sorts of suggestions. It is just that we cannot comment on these here. Hopefully, in the near future, as more research substantiates the comments made starting in January, will likely become standard.