NOTE: First things first: this does not represent medical advice, and under no circumstances should anyone use the information that follows in place of medical advice and treatment from a qualified medical professional as it applies to the Covid-19 virus*. What follows may be highly useful as adjuvant or complementary approaches to treatment of complications of Covid-19 along with traditional therapies, be they in extremis medical situations due to complications from Covid-19, and or, due to ongoing chronic post covid syndromes.
As of the original posting of this article (March 2020), data and clinical experience from medical professionals employing some of these modalities has convinced me I had it right from the start on first posting of this article. As of this update (Feb 2021) additional data has further supported what follows.
Before we get to that, remember, vast majority of people who get Covid-19 will be fine and experience minimal to moderate flu-like symptoms. However, as one article stated “The virus matters, but the host response matters at least as much, and probably more, “…according University of Iowa virologist Stanley Perlman, which likely explains the wide range of effects this virus has on people. That is, those in good health with a healthy immune system appear to experience minimal effects from this virus, and those with compromised immunity, and other comorbidities such as obesity, hypertension, the elderly, those with pre-existing lung diseases, and so forth, can experience serious complications and even death. The life-threatening complications to Covid-19 for susceptible people “…sepsis was the most frequently observed complication, followed by respiratory failure, ARDS, heart failure, and septic shock” according to The Lancet (1) all of which have a high mortality rate.
Covid-19 specifically attacks the respiratory system – caused by the severe acute respiratory syndrome – and the respiratory system is especially sensitive to damage from oxidative stress. I believe that oxidative stress is a key aspect of the most dangerous outcomes of this virus and others and emerging science supports importance of oxidative stress and cytokine dysregulation due virulent viruses (2). Oxidative stress, what’s called a “cytokine storm,” or “cytokine release syndrome” * and sepsis, are interrelated phenomena with a simplified model of:
Formation of ROS -> Oxidative stress -> Cytokine storm -> Sepsis, Severe Acute Respiratory Syndrome, and related sequelae.
To repeat, that’s a generalized/simplified model, and the exact relationship between them, as well as the pathophysiology of the latter two, has not been fully elucidated. However, I’m confident that positively impacting any of the three has direct or indirect benefits to all three.
To break this down a bit, Covid-19 appears to interfere with heme iron metabolism, and that causes a major increase in oxidative stress via an increase in free iron ions “…the body will accumulate too many harmful iron ions, which will cause inflammation in the body and increase C-reactive protein and albumin. Cells react to stress due to inflammation, producing large amounts of serum ferritin to bind free iron ions to reduce damage.” (3). However, it’s been questioned whether the increase in oxidative stress is due specifically to the free iron, so that aspect of the cascade is unclear at this time. Regardless, oxidative stress via formation of ROS and their derivatives appears to be the key initiator of the hyper immune response seen in a small percent of people exposed to Covid. Focusing on the actual initiator of the cascade (formation of ROS) vs the downstream effect (hyper inflammation) is where all but a small group of medical professionals fail to focus. They attempt to block the inflammatory response vs going after what’s actually driving it, and that’s a lost opportunity that’s also less problematic and toxic to treat.
What causes cytokine storm syndrome/cytokine release syndrome (CST/CRS) ? The exact mechanisms are unclear, but oxidative stress is clearly a key component and “…Covid-19 triggers in some people something called a cytokine storm, where one’s own immune system goes berserk. This ‘virus-activated’ immune response can be deadly, causing severe respiratory distress and the subsequent shutdown of multiple organs. Indeed, how one’s immune system reacts appears to be central to Covid-19′s severity.” And excellent review discussing the role of oxidative stress in one of the most serious complications from Covid – Severe Acute Respiratory Syndrome – can be read HERE.
With cytokine storm, the immune system is unable modulate itself properly and pro inflammatory cytokines are over produced, the lungs are flooded by immune cells which attack lung tissue, and a cascade effects takes place and serious illness and death may follow. The use of the broadly immunosuppressive Corticosteroids are employed in such situations, and more targeted immune modulating drugs such a tocilizumab are being looked at now, as well as the anti-malaria drug chloroquine, and various anti-viral medications to develop a cocktail that can effectively combat this virus.
That brings us to sepsis, which is directly related to cytokine storm syndrome, but one does not always lead to the other and they’re not interchangeable syndromes. However, they share specific commonalities in how they play out via the excessive production of pro-inflammatory cytokines (such as IL-6, Il-8, IL-10, IL-18 and TNF-α)
which leads to multi organ failure if not quickly controlled. Sepsis results from the complicated interactions between the infecting bacteria or viruses and the host immune system which can “…trigger a cytokine storm, which is often detected in patients with sepsis.” (4)
Hence, the two, while technically/medically different, are directly interrelated.
I will link sources below for those who wish to see the how and why of the dots I’m attempting to connect, but make no mistake, 100% accurate or not as to the dots I’m connecting, there will be information supplied that could very likely save lives for those who experience those rare, but deadly, complications of this virus. While not fatal, damage to various organs and tissues via a less acute and robust immune response driven by ROS likely the cause of what’s now being called “post Covid syndromes.”
It’s time we went outside the box of traditional treatment on this, as the mortality rate for those who experience those complications is unacceptably high and the routes by which they can be drastically reduced easy to deploy, inexpensive, and non-toxic. Again, nothing that follows is recommended in place of traditional approaches via medical care, but adjuvant to it. Finally, if employed early enough with Covid infections, may alleviate or mitigate post covid syndromes.
While it’s probably prudent to keep ones anti-oxidant defenses up via the ingestion of key nutrients, it’s unclear what, if any benefits would be had via oral ingestion in terms of the course or severity of disease with Covid-19, but studies do indicate vitamin D status for example is strongly correlated to the severity of Covid. IV administration of several key compounds may prove to be highly valuable however in greatly reducing the damage caused by oxidative stress, cytokine storm, and sepsis and related pathology. Current recs based on available data would be an IV containing:
Vitamin C, Thiamine, N-acetyl cysteine (NAC), glutathione, zinc, plus Hydrocortisone (if indicated by a physician based on most recent data). The combination of vitamin C, thiamine, and Hydrocortisone, was found to be considerably more effective for treating sepsis than Hydrocortisone alone (5) as discussed in a Physicians Weekly:
“Dr. Marik and colleagues found a hospital mortality rate of 8.5% in the treatment group, compared with a rate of 40.4% in the control group. Among patients treated with the vitamin C protocol, the propensity adjusted odds of mortality was 0.13. Sepsis-Related Organ Failure Assessment scores decreased for all patients in the treatment group, and none developed progressive organ failure. While patients treated with the vitamin C protocol were weaned off vasopressors an average of 18.3 hours after starting treatment, those in the control group had an average length of vasopressor use of 54.9 hours.” – PWeekly | Sep 26, 2018.
For those who want details on the protocol etc, a review on that topic can be found HERE as well as citation #4 below. NAC is essential for elevating glutathione as glutathione is essential for immunity and combating viruses and a recent study with 10 patients – who were on hydroxychloroquine – found life saving benefits to the addition of NAC alone. That essential study on the potential benefits of NAC and Covid can be viewed HERE. One small study found benefits of NAC in ARDS. One excellent review paper discusses how NAC may prevent COVID-19-associated cytokine storm and acute respiratory distress syndrome is HERE. The importance Glutathione can’t be underestimated in here, and a recent paper posits that endogenous deficiency in GSH is the “…Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients” and just published a tour de force of a review paper on the potential benefits of NAC with Covid to read HERE. Finally, the must read paper that brings the above together: the importance of GSH, ROS formation, cytokine storm, NAC, and reducing the impact of covid via maintaining GSH is HERE.
Bottom line: the importance of sustaining GSH levels in the treatment of Covid and its complications – both acute and chronic – can’t be understated, and that also applies to virtually all viral infections.
Below – via Dr. Jimmy Gutman – a short discussion on the value of glutathione (GSH) as it applies viral infection and literature list supplied, as well as routes of increasing GSH, such as using whey protein, is worth a read, as whey may more effective for raising GSH than NAC. It should be noted that some studies did not find benefits from the Vitamin C, Thiamine, Hydrocortisone therapy v (6), but I strongly suspect synergism to exist with the addition of NAC and glutathione and another study found benefits of the Vitamin C, Thiamine, Hydrocortisone combination on another known complication of Covid-19, severe pneumonia (7). Finally, it should also be noted the Chinese government recommends the use of IV vitamin C for covid-19 infections, but has used much higher doses than the studies I have cited, “…from 50 to 200 milligrams per kilogram body weight per day to as much as 200 mg/kg/day” or 4,000 to 16,000 mg for an adult.
Oral Ingestion Of Key Supplements?
As mentioned previously, whether oral ingestion of those and other compounds will assist in reducing severity, and potential for complications, if one is exposed to Covid-19 is unclear, but supporting host immunity with key nutrients is warranted in my view. Whey protein (as glutathione and immune enhancer), and or NAC, vitamin C, and apo-lactoferrin, zinc, and vitamin D, may be of value as general immune enhancement specific to viral infections. IV route is essential however if it’s as serious as sepsis, cytokine, storm, and ARDS, and must be employed – concomitant with Corticosteroids and other medications (e.g. antibiotics, vasopressors, etc.) as directed by medical professional – as early as possible. As far as other drugs and nutrients to consider for oral ingestion as a preventive measure, the Life Extension protocol for Covid-19 is worth a read HERE.
GLUTATHIONE AGAINST VIRAL DISEASE – A SPECIAL MESSAGE – Dr. Jimmy Gutman
Over the past few weeks, I have received numerous questions about the coronavirus and whether raising glutathione can offer some protection. For the sake of time and efficiency I have written this message. My answer is that I believe there is an very important role for glutathione in this situation, but I do not have any direct studies to prove my point. Thus far, no clinical trials have been published looking directly at the role of glutathione in the treatment or prevention of coronavirus.
Why then do I support the idea of raising glutathione as an effective strategy. It is based on the hundreds of other studies where glutathione has been shown to positively effect the outcome in numerous other viral diseases and plays an important role in the development of these infections. Doing a bit of searching on www.pubmed.gov will reveal articles on glutathione from the common cold (rhinovirus), to the “Flu” (influenza), to AIDS/HIV, hepatitis A, B, and C, DNA viruses, RNA viruses, retroviruses and more.
To simplify, the majority of viruses studied thrive in an environment of low glutathione and high oxidative stress.I have listed a small sampling of these studies below for those that want to pursue this research below.
Dr. Jimmy Gutman author of The Comprehensive Guide to Glutathione
Glutathione as an antiviral – A sampling of the literature
Great page on all things NAC and Covid is HERE
(7) Combined vitamin C, hydrocortisone, and thiamine therapy for patients with severe pneumonia who were admitted to the intensive care unit: Propensity score-based analysis of a before-after cohort study
*= AKA coronavirus, Wuhan virus.
*= “cytokine storm,” or “cytokine release syndrome” may have differences, but in this article, they’re viewed/treated identically.
Will Brink is the owner of the Brinkzone Blog. Will has over 30 years experience as a respected author, columnist and consultant, to the supplement, fitness, bodybuilding, and weight loss industry and has been extensively published. Will graduated from Harvard University with a concentration in the natural sciences, and is a consultant to major supplement, dairy, and pharmaceutical companies.
His often ground breaking articles can be found in publications such as Lets Live, Muscle Media 2000, MuscleMag International, The Life Extension Magazine, Muscle n Fitness, Inside Karate, Exercise For Men Only, Body International, Power, Oxygen, Penthouse, Women’s World and The Townsend Letter For Doctors.
He’s also been published in peer reviewed journals.
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