Covid19 and the cytokine storm

We know that the majority of the mortality from Covid19 is sadly from respiratory or multi-organ failure resulting from a phenomenon called the cytokine storm.

Cytokine storm is essentially an inflammatory response gone out of hand. In essence, cytokines are chemical messengers our body uses communicate between cells. When a virus attacks us, our cells sound the alarm by activating proteins like the NLRP3 inflammasone, which lead to the release of inflammatory cytokines to open up blood vessels and recruit more white blood cells to kill the virus. This is acute inflammation and is a good thing. It helps us deal with foreign invaders and is supposed to happen.

However, for reasons we don't fully understand yet, this acute inflammation snow balls in about 20% of the people infected the virus during the latter part of the covid-illness (data currently suggests between day 7-10 after initial onset), and starts to cause infiltration in the lungs, causing breathing difficulties and in extreme situations, ARDS (Acute Respiratory Distress Syndrome) - so the main reason we are practicing social distancing now is to avoid overwhelming our medical systems with the need for ventilators.

I cannot tell you what can prevent or mitigate the cytokine storm right now as the science is still being unravelled. However, what I can do is share my opinion based on the observations I've made.

If we take a look at the high risk groups - those over 65, those with either obesity, diabetes, heart disease, hypertension, chronic lung and liver disease... one of the common denominators is chronic inflammation.

Could it be that if you have a higher level of background, chronic inflammation, this sets you up to be at higher risk of developing the cytokine storm? We don't fully know, but it makes sense on a mechanistic level.

Remember, acute inflammation is necessary but what I'm talking about here is the 'unnecessary' inflammation triggered by our lifestyle that do not serve a purpose to protect us e.g. chronic inflammation may result from a poor diet, lack of sleep or environmental toxins.

Now, I cannot tell you that reducing inflammation can mitigate the chances of developing cytokine storm. This has not been proven. But, reducing chronic inflammation can bring other myriad health benefits so there is NO HARM in adopting lifestyle measures to reducing chronic inflammation whilst you practice social distancing and handwashing to reduce your chances of catching the virus.

How am I doing this?

- Optimize sleep - sleep deprivation is associated with reduced immune cell function, blood sugar dysregulation and inflammation. There is also some evidence that melatonin, a sleep hormone released during deep sleep, can be protective against inflammation, with many practitioners proposing that this may be one reason the elderly is at high risk. More data is needed, but i am using this time to really optimize my sleep by practicing good sleep hygiene. 

- Reduce foods that cause inflammation - refined sugar, fried foods, processed foods, omega6 dominant oils like sunflower, foods which I am intolerant to like dairy and gluten. 

- Stress management - this is a highly stressful time for everyone. There is a lot of fear that stems from uncertainty, the lack of security and safety. We may not have control over external events, but we 100% have control over our thoughts. And our thoughts translate to our feelings. Our body cannot tell what is real from what may just be projections from our minds. Sometimes we project stories about our future that trigger off the flight or fight response in our body EVEN though nothing has happened yet. And so at this time, it is especially important to moderate the internal stories we are feeding ourselves. Make sure we minimize our exposure to negative media, and really check in with our thoughts and feelings. I know it is really hard right now. But trying to look for the small items of good in your everyday life and practice gratitude - to infuse our mind with optimism and calm an overactive nervous system down. 

- Load up your plate with plants and nutrient-dense foods. There is some evidence that zinc may play a role in blocking viral replication of the SARS-CoV (a different coronavirus) inside the cells. However, zinc HAS to be inside of cells for this effect to take place. And that's why flavanoids like quercetin and catechins have also been shown to help reduce viral replications of other coronaviruses - these compounds HELP ZINC to get inside of the cells, they are called 'iontophores'. Whilst we do not have the data yet to show this translates to covid19, eating foods rich in flavanoids can bring about other health benefits like cardiovasular health support, cognitive function support and healthy blood sugar regulation.

So I am getting at least 20 different vegetables in per day (this includes herbs and spices), focusing on vitamin C rich and flavanoid rich fruits and vegetables like berries, grapes, onions, apples, spinach, bell peppers, drinking lots of match/tea and quality cacao/chocolate. I am also adding in lots of anti-inflammatory and anti-microbial herbs like rosemary, thyme, oregano, garlic, turmeric to my food on a daily basis.

You know how much I love using food - so I'm loving ginger tea which I boil at home on the stove, and I've been adding in some rosemary and orange peel to that and consume one cup a day.

Now how about supplements? Well, I can't advise on supplements for you - you need to discuss these with your healthcare provider and get their recommendations on dosages. However, here's what I am taking:

- zinc

- vitamin D

- mushroom extract, either in my matcha or food

- elderberry with astragulas (if I get sick I plan to stop it, as there was one study that showed elderberry could increase IL-6 production. Although I do not personally think this translates to cytokine storm, I will err on the side of caution and stop it if I do get sick). I also advise you to check with your practitioner, especially if you have autoimmune conditions - I make my own at home but if you don't want to make it, check out http://www.tasharoseremedies.com/

- algae based omega 3

I am not supplementing with vitamin C right now, because my diet is rich in vitamin C. However, if your diet is not particular rich in Vitamin C or you are in the high risk group you may wish to discuss supplementation with your doctor. It is generally a safe supplement at 500-1000mg a day, the main side effect from large doses being diarrhoea, kidney stones and haemolysis if you have inherited genetic conditions like G6PD mutations. I do have some vitamin C supplements at home which I will take at the onset of symptoms. Currently there are trials going on with IV vitamin C in covid19 due to some preliminary data from China and studies previously showing that it may help in sepsis.