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There is no clear evidence that anything other than avoiding exposure can reliably prevent contraction of SARS-CoV-2 (the virus that causes COVID-19).

There is, however, evidence that a number of nutrients can either reduce your chance of contracting coronavirus or reduce the severity and length of illness if you do contract the virus. I don’t make this claim lightly, and the following content supports that statement with summaries and links to articles published in respected journals. Please take the time to follow some or all of the links.

This article will focus on nutraceutical supplements, not traditional herbal approaches, which I will cover in a later article. And, although it could go without saying, I’ll say it anyway. Adequate sleep, reducing stress, eating a healthy diet, and moderate, regular exercise are all important and effective ways to regulate your immune system and keep inflammatory responses in check. Immune system support can potentially reduce your chance of infection, and maybe even more importantly, inflammatory response regulation can reduce the likelihood that an infection will lead to more severe illness.

I have found evidence that maintaining adequate levels of vitamin D, vitamin C, quercetin and zinc through daily supplementation is warranted, especially in older patients or patients with other health issues that put them at higher risk. I studied the data (or lack of it) for many other products, including CBD oil, colloidal silver, a number of essential oils, garlic and melatonin, and did not find sufficient evidence for daily supplementation.

For those not wanting to delve into the details, please feel free to go directly to the “EBANM COVID-19 Prophylaxis” I’m recommending for all of my patients. If you’re interested in the details, let’s begin with vitamin D.

Vitamin D

A 2017 BMJ systematic review and meta-analysis found that vitamin D supplementation significantly decreased the risk of acute respiratory infections, especially in those receiving daily vitamin D (versus less frequent large doses). “Our study reports a major new indication for vitamin D supplementation: the prevention of acute respiratory tract infection.” ”Vitamin D supplementation to prevent acute respiratory tract infections: systematic review and meta-analysis.” BMJ. Martineau, et al, 2017.

Another review published recently (May, 2020), suggests that people at increased risk for influenza or COVID-19 consider taking vitamin D, with the goal of raising vitamin D concentrations to 40–60 ng/mL. Furthermore, they state: “Through several mechanisms, vitamin D can reduce risk of infections. Those mechanisms include inducing cathelicidins and defensins that can lower viral replication rates and reducing concentrations of pro-inflammatory cytokines that produce the inflammation that injures the lining of the lungs, leading to pneumonia.” “Evidence that Vitamin D supplementation could reduce the risk of influenza and COVID-19 infections and deaths.” Nutrients. Grant, et al, 2020.

A more general review states that low vitamin D levels are associated with an increased risk of viral and bacterial respiratory infections, along with other respiratory diseases, including tuberculosis, asthma, and chronic obstructive pulmonary disease. “All the reviewed articles state that Vitamin D deficiency is very common among patients with respiratory diseases.” “A review of Vitamin D effects on common respiratory diseases.” J Res Pharm Pract. Hejazi, et al, 2016.

And a less compelling, but still interesting, recent “preprint” article details how vitamin D, quercetin and estradiol alter the expression of genes encoding the protein targets of SARS-CoV-2. “Vitamin D and Quercetin have been identified as putative COVID mitigation agents.” Interestingly, the article also posits an explanation for the higher male mortality rates associated with COVID-19. “Vitamin D, quercetin and estradiol… mitigation of COVID-19.” Chem Rxiv. Glinskii, et al, 2020.

Vitamin C & Quercetin

Vitamin C is a potent antioxidant that contributes to immune defenses in a number of different ways. It also has anti-inflammatory effects that can limit the progression of disease. This article gives the details, and states that: “supplementation with vitamin C appears to be able to both prevent and treat respiratory and systemic infections. Prophylactic prevention of infection requires dietary daily vitamin C intake…”. “Vitamin C and Immune Function”. Nutrients. Carr, et al, 2017.

The following studies evaluated the antiviral effect of vitamin C in vivo and its related mechanism against the influenza virus. They explain that the antiviral benefits of vitamin C are likely due to its immunomodulatory properties, predominantly by increasing the production of interferon-α/β and downregulating pro-inflammatory cytokines, rather than a direct antiviral effect. We know that COVID-19 mortality is associated with the “cytokine storm,” so this may explain why vitamin C can reduce the severity of the illness. “The antiviral properties of vitamin C.” Expert Review of Anti-Infective Therapy. Biancatelli, et al, 2020. “Vitamin C is an essential factor on the antiviral immune responses…”. Immune Network. Kim et al, 2013.

Quercetin is an antioxidant that also has broad antiviral properties. It has been shown to reduce viral replication in human cell culture lines for a wide variety of viruses – including the coronaviruses that cause the common cold. This study shows immunomodulatory and antiviral activity against rhinovirus respiratory infections. More importantly, the paper details how quercetin inhibits cytokine expression, which can reduce the “cytokine storm” that is frequently the cause of death in many COVID-19 patients. “Quercetin inhibits rhinovirus replication in vitro and in vivo.” Antiviral Research. Ganesan, et al, 2012.

Zinc

Zinc can modulate antiviral and antibacterial activity. “In vitro experiments demonstrate that Zinc possesses antiviral activity through inhibition of SARS‑CoV RNA polymerase.” Zinc also regulates inflammatory responses that may reduce the severity of illness. “Zinc possesses anti‑inflammatory activity by inhibiting NF‑κB signaling and modulation of regulatory T‑cell functions that may limit the cytokine storm in COVID‑19”. “Zinc and respiratory tract infections: Perspectives for COVID-19 (Review).” Intl Journal of Molecular Med. Skalny, et al, 2020.

Zinc is an essential mineral that the immune system relies upon for an effective antiviral response. This paper explores how its antiviral properties generate both innate and acquired immune responses. “The Role of Zinc in Antiviral Immunity.” Advances in Nutrition. Read, et al, 2019.

A number of papers have studied the effects of zinc supplementation on both the prevention of acute lower respiratory infections (ALRIs) as well as the length of illness due to respiratory infection with zinc supplementation. “Zinc supplementation has been shown to have a preventive effect against respiratory infection. The study found that ALRI cessation was faster in children who received zinc supplementation and that their hospital stay was shorter”. “A Randomized Controlled Trial of Zinc Supplementation.” Pediatric Rep. Rerksuppaphol, et al, 2019. “Zinc: Role in Immunity, Oxidative Stress and Inflammation.” Clinical Nutrition Metabolic Care. Prasad, et al, 2009.

Finally, though SARS-Cov-2 acts very differently than the various viruses that cause the common cold, there are also some similarities in regard to how the immune system responds. This Cochrane review confirms Zinc’s ability to reduce the duration and severity of cold symptoms, and “when supplemented for at least 5 months, it reduces cold incidence.” Cochrane reviews have a reputation for being extremely rigorous. Though direct evidence that Zinc can prevent infection of SARS-CoV-2 is lacking, this is strong evidence that it can prevent other acute viral infections. “Zinc for the common cold.” Cochrane Database Syst Rev. Singh, et al, 2011.

For details on the specific products we recommend, as well as dose and frequency information, please see our “EBANM COVID-19 Prophylaxis” article.

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By Sean Michael Hall, L.Ac.

I do not recommend that people overdo supplements.

In fact, in my own practice, I often help patients reduce their supplement regimens, rather than add to them. That said, there are two supplements that I recommend across the board to just about everyone. One is a basic, whole-food based multi-vitamin. The second is a high-quality fish oil. Why? Because a multitude of reliable studies suggest that unless you are supplementing your diet with fish oil, it is very likely that you are deficient in omega-3 fatty acids.

At East Bay Acupuncture and Natural Medicine I recommend that everyone take 1 of 6 different varieties of fish oil. I’ve spent years finding the highest quality fish oils on the market, and I’m very proud of the brands and types that I carry. This article will serve as an overview of the benefits of fish oil, address safety concerns, and provide some information about the different varieties I routinely recommend in my practice.

Benefits of Omega-3 Fatty Acids

Cardiovascular Benefits:

Regular consumption of high-quality fish oil can lower triglycerides and increase good cholesterol, or HDL. High levels of triglycerides have been linked to increased risk of heart disease and stroke. These effects, combined with fish oil╒s ability to slightly thin the blood, reduce risk of heart attack. Fish oil can also help prevent strokes and certain incidences of sudden cardiac death in those who already have heart disease. Finally, it has been shown to aid in slowing hardening of the arteries and decreasing blood pressure.

Anti-Inflammatory Benefits:

Omega-3 fatty acids found in fish oil reduce inflammation by preventing the body’s production of pro-inflammatory molecules. Because inflammation is associated with many serious health problems, including cancer, autoimmune diseases, psoriasis, Alzheimer’s, and heart disease this is one of the most significant benefits of fish oil.

Additional Alzheimer’s Protection:

In addition to preventing Alzheimer’s by reducing the body’s inflammatory capacity, omega-3 fatty acids also protect against Alzheimer’s another way: by increasing the body’s production of a protein called LR11, which helps prevent the accumulation of toxic plaques.

Mental Health Benefits:

Omega-3 fatty acids also help to regulate the brain╒s dopamine and serotonin signaling systems, offering potential aid to those affected by depression, bipolar disorder, and other mental health concerns.

Prenatal Benefits:

Fish oil taken before and during pregnancy can be of great help to both mother and child. For the mother, omega-3 fatty acids have been shown to reduce risk of post-natal depression and premature birth. For the child, fish oil has been shown to aid fetal development, and healthy levels of omega-3 fatty acids in utero are associated with benefits including higher cognitive function and improved eyesight.

Benefits to Hair, Skin and Nails:

Maintaining healthy levels of omega-3 fatty acids provides readily visible benefits: those who consume enough of these essential fatty acids enjoy faster-growing hair and nails, and may notice that their hair looks more lustrous and their nails are harder and less likely to break.

The Problem with Eating Lots of Fish

Before I delve into the safety and potency concerns of fish oils, I’ll begin by explaining the problems associated with another source of omega-3 fatty acids: fish. Though our first instinct might lead us to believe it would be best to seek this helpful substance directly from the source, this is not the case. In fact, eating lots of fish in pursuit of omega-3s can be quite harmful due to the heavy metal contamination that is becoming more and more common.

Dangerously high levels of heavy metals such as mercury accumulate primarily in the tissue of the fish (including flesh and skin). It’s been shown that there are far fewer heavy metals in the oil of the fish. Studies have shown that the amount of heavy metals in fish oils are consistently within a minimal, safe range, that is generally lower than actually eating the fish. And, unlike the fish on your plate, which may have come from a variety of sources, some more reliably safe than others, the high-quality fish oils I recommend are always rigorously tested for purity.

I still recommend eating fish 2 to 3 times a week, but please be mindful when choosing the fish you eat.

I specifically recommend finding fish that is:

Not farm-raised
Lower on the food chain
From cold-water
Smaller
Fatty

Keeping these qualities in mind will help you choose a safer fish to eat. Good varieties of fish include:

Wild Alaskan Salmon
Herring
Sardines
Mackerel (not King Mackerel)
Anchovies

Fish Oil Quality and Safety Concerns

It’s clear that fish oil has a lot to offer, but I would warn against purchasing just any fish oil. Although most high-quality fish oils will not have contaminants, there may be other potency or quality issues. Heavy metal and other contaminants are not a big issue with most fish oils. Even lower quality fish oil is effectively tested for heavy metals, and since these contaminants tend to not be stored in the fat of the fish there is even less to worry about. A bigger concern, and one that is found in many supposedly high-quality fish oils, is the issue of rancidity.

Rancidity is a serious problem. 2009 tests yielded some disturbing information: many fish oil capsules on the market contained oxidative by-products an indicator that the fish oil was going rancid. Not only does rancid fish oil not offer the benefits of undamaged fish oil, it is actually quite harmful. Rancid fish oil does the opposite of fish oil: it promotes heart disease and other chronic illnesses through its inflammatory effects. Fish oil rancidity commonly begins at the source, with a less than ideal manufacturing process.

The problem with some brands extraction and bottling process is that fish oil begins to oxidize the moment it is extracted from the fish, and can then go rancid within days. If anti-oxidants are added immediately, the oxidation process that leads to rancidity will be avoided. Unfortunately, many manufacturers receive the oil in large tubs weeks after the oil has been extracted, and they wait until then to add the anti-oxidants, directly before encapsulating. At that point, the oxidation process has often already begun. Additionally, many fish oil capsules are labeled with expiration dates up to 4 years from the date of manufacture this is not best practice.

The brands that I recommend guard against fish oil rancidity by fortifying the fish oil with anti-oxidants, directly at the source, immediately after extraction from the fish. Additionally, they use the most effective form of vitamin E as the anti-oxidant (gamma and delta vitamin E), rather than the less effective, and less expensive (alpha-tocopherol) variety that many other companies use.

Once you’ve purchased a fish oil it is essential that it be stored in a cool, dark place before opening. Although not mentioned on most fish oil bottles, I recommend refrigerating after opening, and using within 3 months. If you purchase fish oil from a company that is aware of these issues, store the capsules properly, and use within a decent amount of time, you’ll have nothing to worry about.

Can’t I Just Eat Lots of Flax and Walnuts?

It is true that a number of other foods contain this important omega-3 fatty acids, including flax seeds, walnuts and grass-fed beef. However, the form of omega-3 in flax and walnut is alpha linoleic acid (ALA). While this is also a very healthy omega-3, the most important benefits of omega-3s come from eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) forms specifically.

The body is capable of breaking down the ALA in flax seeds or walnuts to EPA and DHA, but it requires an enzyme that many people stop producing as they age, and there are many others that lack the enzyme altogether. Additionally, the final amount of EPA and DHA is usually minimal. Fish oils contain all three forms: ALA, EPA, and DHA. When choosing a fish oil, I recommend finding one that contains a combined amount EPA/DHA that is equal to at least half the total volume of each capsule. If you look on the shelves, you’ll find that even most high-quality fish oils have less than this amount.

The Fish Oils I Recommend

I routinely recommend one of six different types of fish oils to my patients. After years of practice and research I’ve found that Designs for Health (DFH) and Green Pasture’s make the best quality fish oils on the market. The varieties I recommend are:

DFH OmegAvail Ultra

A high EPA/DHA potency fish oil.

DFH OmegAvail Ultra plus Vitamins D, K1, K2

The same high EPA/DHA potency fish oil, with the addition of some of the fat-soluble vitamins many people are deficient in.

DFH OmegAvail Hi-Po

A good choice for anyone that has a hard time digesting standard fish oils. Again, a high EPA/DHA potency fish oil, but with the addition of digestive enzymes and an enteric coating.

DFH OmegAvail Synergy

High EPA/DHA potency fish oil, with the addition of GLA. GLA is an omega-6 fatty acid that has a strong anti-inflammatory effect, making it especially useful for dermatologic and arthritic conditions.

Green Pasture’s Blue Ice Fermented Cod Liver Oil

This cod liver oil is the only one on the market that I recommend. Every other brand I’ve come across is extracted with a method that degrades the natural, fat-soluble vitamins in the oil, and contains synthetic vitamin additives instead. Cod Liver Oil is not as high in EPA/DHA, but it is one of the best dietary sources of Vitamins A and D, along with all of the natural metabolites of those vitamins.

DFH XanthOmega Krill Oil

A good choice for those who experience PMS and uterine cramps. Its efficacy in treating these conditions has been well documented, and I often recommend it for use in these cases. It’s also naturally high in an anti-oxidant called astaxanthin, making it the most stable fish oil.

I recommend each of these varieties for various conditions and constitutional differences. My personal regimen includes 4 capsules of OmegAvail Ultra w/ D, K1 and K2, plus 4 capsules of Cod Liver Oil daily. Please contact me if you would like my help in choosing the most appropriate fish oil for you and your family.