COVID-19

Hydroxychloroquine and chloroquine (antimalarial drugs): quinism and the risk of sudden and lasting neuropsychiatric effects

July 31, 2020 By Trudy Scott 80 Comments

The Quinism Foundation, a nonprofit charitable organization “promotes and supports education and research on quinism, the family of medical disorders caused by poisoning by mefloquine, tafenoquine, chloroquine, and related quinoline drugs.”

Executive Director of the foundation, Dr. Remington Nevin, MD, MPH, DrPH, is a Johns-Hopkins trained psychiatric epidemiologist and drug safety expert and former U.S. Army public health physician. He has published extensively on the subject.

The foundation share the symptoms of chronic quinoline encephalopathy, also known as neuropsychiatric quinism:

The term “quinism” may seem new, but the symptoms of poisoning by mefloquine (previously marketed as Lariam®), tafenoquine (marketed as Krintafel® and Arakoda™), chloroquine (marketed as Aralen®), and related quinoline drugs are all too familiar: Tinnitus. Dizziness. Vertigo. Paresthesias. Visual disturbances. Gastroesophageal and intestinal problems. Nightmares. Insomnia. Sleep apnea. Anxiety. Agoraphobia. Paranoia. Cognitive dysfunction. Depression. Personality change. Suicidal thoughts.

These symptoms are not “side effects,” they are symptoms of poisoning by a class of drug that is neurotoxic and that injures the brain and brainstem. This poisoning causes a disease, and this disease has a name: Chronic quinoline encephalopathy — also known as quinism.

In March they published this press release: The Quinism Foundation Warns of Dangers from Use of Antimalarial Quinolines Against COVID‑19. Here are some highlights:

A risk of sudden and lasting neuropsychiatric effects from the use of antimalarial quinolines against COVID‑19, the disease caused by the novel coronavirus
In susceptible individuals, these drugs act as idiosyncratic neurotoxicants, potentially causing irreversible brain and brainstem dysfunction, even when used at relatively low doses

What is concerning is lasting neuropsychiatric effects and the fact that even low doses can cause irreversible effects. The Foundation “has urged policy makers, physicians, and members of the public to be alert to such effects.”

Dr. Nevin states that “these are not safe drugs” and “While it may be tempting to attribute anxiety, depression, paranoia, or other mental health symptoms to the psychological effects of the COVID‑19 pandemic, these symptoms may be an early warning sign of idiosyncratic neurotoxicity, and must be taken seriously.”

You can read the entire March 2020 press release here. It contains a link to U.S. Food and Drug Administration’s MedWatch program for reporting adverse effects.

Another press release published late July also cautions the use of tafenoquine against COVID-19 which The Qunism Foundation states “is a neurotoxic quinoline antimalarial drug with a similar adverse effect profile to mefloquine.”

New COVID-19 research on chloroquine and hydroxychloroquine

It’s encouraging to see that new research published on COVID-19 and these medications also highlights the possibility of neuropsychiatric side effects (even through the authors state it’s considered uncommon): Psychiatric Aspects of Chloroquine and Hydroxychloroquine Treatment in the Wake of COVID-19: Psychopharmacological Interactions and Neuropsychiatric Sequelae

…neuropsychiatric side effects are very uncommon but possible, and include a potentially prolonged phenomenon of “psychosis following chloroquine.” Hydroxychloroquine has less information available about its neuropsychiatric side effects than chloroquine, with psychosis literature limited to several case reports

Case reports on psychiatric symptoms induced by hydroxychloroquine

Here is one of these case reports: Psychiatric symptoms induced by hydroxychloroquine. A 36-year-old woman was diagnosed with Systemic Lupus Erythematosus (SLE) and antiphospholipid syndrome, and was treated with prednisone 10 mg and hydroxychloroquine 200 mg every 24 hours. Her arthritis improved but

One month after initiation of treatment, the patient began with generalized anxiety, suicidal ideation and the appearance of auditory and kinaesthetic [tactile] hallucinations.

She had similar adverse effects 5 years later when hydroxychloroquine (without prednisone) was prescribed following an outbreak of cutaneous SLE

A week later, the patient was admitted to the Department of Psychiatry because of suicidal ideation, self-harm and kinaesthetic and auditory hallucinations, which improved after withdrawal of hydroxychloroquine and treatment in a psychiatric setting.

Since then, the patient has not been taking hydroxychloroquine and has had no further episodes of kinaesthetic [tactile] or auditory hallucinations.

Here are two other case reports: Hydroxychloroquine-induced acute psychosis in a systemic lupus erythematosus female and Hydroxychloraquine-induced acute psychotic disorder in a female patient with rheumatoid arthritis: a case report.

Risk factors for susceptibility

This review article from 2018, Neuropsychiatric clinical manifestations in elderly patients treated with hydroxychloroquine: A review article mentions that these adverse events can range from less severe nervousness to “actual psychosis and suicidal tendencies.”

It also lists possible risk factors that may make certain individuals more susceptible:

co-exposure to interacting drugs, alcohol intake, familial history of psychiatric diseases, female gender, and the concomitant use of low-dose glucocorticoids [such as prednisone].

Malaria drug causes brain damage that mimics PTSD

I first learned of this neuropsychiatric connection a number of years ago when I read about the “case of a service member diagnosed with post-traumatic stress disorder but found instead to have brain damage caused by a malaria drug.” You can read about this here – Malaria drug causes brain damage that mimics PTSD: case study.

A few years ago I also blogged about the anti-malaria medication mefloquine and how it was known to contribute to neuropsychiatric symptoms in susceptible individuals: PTSD from 3 tours in Afghanistan: Can GABA help with the anxiety?

My concerns about long-term prophylactic use and lack of awareness

My concerns are long-term prophylactic use. There are a number of clinical trials planned or in progress for long-term use in healthcare workers. If they are stressed, anxious, depressed and exhausted because of the COVID-19 work they have been doing, they may incorrectly attribute some of their symptoms to all that rather than the medication side-effects. And if they do get COVID-19, they may confuse the neurological and psychiatric effects of COVID-19 with those of chloroquine or hydroxychloroquine.

What also concerns me is the lack of awareness. None of the advocates of this class of medications mentions quinism, the possible neuropsychiatric side-effects and long-term risks, or who may be susceptible.

I would be very happy if chloroquine or hydroxychloroquine is found to be a solution (or part of a solution) for COVID-19 – alone or in combination with zinc – for certain individuals.

But I believe we do need to be very aware about side-effects as serious as these. I’d also like to see education for healthcare providers and the consumer, as well as informed consent for the consumer.

Similar concerns with other medications

In the past I’ve written about similar concerns with other medications such as benzodiazepines, SSRIs and fluoroquinolone antibiotics:

Your feedback and questions so we can all learn

I encourage you to keep all this in mind as you navigate what you hear in the news, read on social media and/or read in the research on hydroxychloroquine.

Keep all this in mind too if you have future plans to travel to a malaria area for a vacation in the future (wouldn’t we love that – a trip!?).

Have you used chloroquine or hydroxychloroquine for COVID-19 and experienced psychiatric side-effects? Or know someone who has?

Have you used antimalarial medications in the past and experienced psychiatric side-effects? Was this a short-course or long-term prophylactic use?

Have you used these medications for lupus or rheumatoid arthritis with success and without psychiatric side-effects? Or have you experienced adverse effects and had to stop?

If you have had adverse psychiatric effects please share which medication, dosage and frequency? Also do you have any of the predisposing risk factors: alcohol intake at the time, history of psychiatric diseases (you or family members), are female, and were also prescribed low-dose glucocorticoids such as prednisone, and/or other medications (and which ones)?

Feel free to post your questions here too.

Mercury & gadolinium toxicity, iron overload, COVID-19: NBMI research update and potential applications

July 10, 2020 By Trudy Scott 15 Comments

Professor Boyd Haley set out to find a safe and non-toxic heavy metal chelator that would cross the blood-brain barrier, get inside the cells and bind mercury. The compound was initially sold as an antioxidant called OSR and is now called NBMI. In 2018 I wrote a blog about this – Mercury detox: NBMI as a safe and non-toxic heavy metal chelator. At the time NBMI was in phase 2 clinical trials. The blog was a popular one then and still gets many comments and requests for updates. Today I’m sharing some updates on progress, new studies and proposed new applications. I still find NBMI intriguing and look forward to it being readily available once the studies are completed.

The recent newsletter from EmeraMed, reports that their projects are all running according to plan (despite coronavirus setbacks) and “producing the anticipated positive results necessary to bring our drug to market. When we complete the studies requested last year by the FDA, EmeraMed will file a new drug application (NDA), which then starts the FDA approval process.”

Studies on metal binding have shown that NBMI is strongly attracted to mercury, arsenic, lead, cadmium, uranium, gadolinium [used as a contrast agent in MRIs] and free iron and copper.

EmeraMed are expanding the clinical trials to look at other disorders that NBMI can potentially improve. These updates were shared in the newsletter:

The Colombian drug regulatory agency INVIMA approved a trial for mercury intoxication in May 2020:

…mercury intoxication and kidney disease are a serious life-threatening intractable condition and prominent in Colombia

…mercury from fish in the Santa Margareta river is one potential source for kidney injury leading to dialysis treatment. It will be a double-blind placebo controlled pivotal study, the participants health and results will be carefully monitored.

The treatment will be much longer than our earlier trials with gold miners and will look at numerous physiological parameters.

There are two pilot studies on iron overload in Europe:

Excess iron causes many devastating disorders, some lethal. Atypical Parkinson, an always fatal disease, is partially finished.

We expect to receive an interim report by July 2020 on a Thalassemia study that shows a highly significant benefit from NBMI. 8 out of 8 improved without any reported drug induce toxic side effects. “Impressive” in the words of one reviewer.

A potential use for COVID-19 based on NBMI increasing glutathione levels:

The mechanism of action is based on the ability of Emeramide to: 1; enter cells and cross the blood brain barrier, 2; scavenge and remove existing hydroxyl free radicals lowering oxidative stress and 3; chelate into non-reactive and non-toxic complexes several toxic metals and most importantly Fe2+ a redox metal that has been proposed to be displaced from hemoglobin by the COVID-19 infection.

We know NBMI would help because viruses need to release free iron to be able to reproduce. That iron causes oxidative stress possibly leading to a cytokine storm.

Another potential application is environmental clean-up of rivers, lakes and streams:

Arsenic (As) in drinking water is a well-recognized problem but since it is very difficult to remove, EPA maximum drinking water standard allows drinking water to have arsenic levels that cause significant amounts of bladder and lung cancers.

And one more potential application is the improved “treatment of waste-water sewer sludge to remove mercury or other toxic metals before it is spread on farms.”

Here is the mercury feasibility trial mentioned in the newsletter: Efficacy of N,N’bis-(2-mercaptoethyl) Isophthalamide on Mercury Intoxication: A Randomized Controlled Trial, where NBMI was given to 36 gold miners with high levels of mercury in their urine:

Although this study was designed with a small sample size to test for feasibility, the gained results with 300 mg NBMI already showed an effect on physical fatigue with statistical significance and there were indications to positive effects on other symptoms, like sleeping problems.

The newsletter link above has information about which countries are allowing early access. Please contact the company directly rather than ask me about how to obtain the product as I am simply sharing what they have shared with me. I also encourage you to sign up for EmeraMed’s newsletter so you can keep up to date with progress and access information.

I find it intriguing and look forward to it being readily available once the studies are completed.

Please share if you used the original OSR product with any success or if you have managed to obtain NBMI and trial it?

And feel free to post your questions for Professor Boyd Haley. I’m hoping to have him speak on Anxiety Summit 6: Toxins/Meds/Infections.

Coronavirus and vitamin C for immune support: new pain or more severe pain due to oxalate issues?

May 15, 2020 By Trudy Scott 113 Comments

I have concerns regarding the use of high doses of oral vitamin C for boosting immunity – for a subset of susceptible individuals who have dietary oxalate issues. This is directly related to the many recommendations that have been and are being made in relation to the coronavirus pandemic, but it applies beyond the pandemic for anyone who has dietary oxalate issues. My concerns relate to high doses of vitamin C making existing pain symptoms worse or even causing new pain symptoms in someone who is not aware they may have oxalate problems. This may include joint pain, vulvodynia, bladder pain, painful urination, eye pain, headaches, foot pain, stomach pain, general body pain, deep bone pain etc. All this can manifest as fatigue, irritability, anxiety, low mood and insomnia.

I’ve been promising to blog about this topic for over a month and have gathered enough information for a short book! I figured a good place to start is to share feedback I’ve received so far and ask for your feedback so we can learn and heal, educate and inform others going through this, as well as offer insights to researchers and doctors who are not aware of this issue (and sometimes say “based on biology it’s not possible”).

In the coming weeks, if there is enough interest, I’ll share additional information on mechanisms, what the research says and what the research says is not possible, labs, types of oxalate issues (there are many), the possible causes (there are also many) and long-term impacts beyond pain (for the thyroid, mitochondria, heart and more), the solutions, additional resources and feedback from experts (of which there are very few – as of now I’ve been reading everything published by Susan Owens, Julie Matthews, Great Plains Labs and research published by kidney specialists).

Until then I’m humbly asking for your feedback. If you have no idea what oxalates are or are taking vitamin C with no issues, then please don’t worry. Things will become clearer as you read this blog and read follow-on blogs. I feel it’s really important to get this initial blog out rather than waiting until I have everything written up perfectly.

I’ve also been hearing feedback from folks who have now recovered from coronavirus or are still recovering, with many reporting lingering pain and fatigue. I am concerned some of that pain may be related to high doses of oral vitamin C or IV (intravenous) vitamin C leading to oxalate issues they may not be aware of.

My request to you – please share your vitamin C oxalate story

This is what I posted on facebook and I’ll simply share it again here: I’m looking for oxalate vitamin C stories to share with folks who don’t believe or are not aware that high dose vitamin C causes issues for those with dietary oxalate issues.

1) What symptoms do you experience?

2) How quickly do you notice symptoms after taking vitamin C?

3) What form of C have you tried? (ascorbic acid or Ester C or whole food sources of C like camu camu/amla/goji berry/acerola cherry/rosehips/kakadu plum/acai berry/ maqui berry or liposomal or something else). Please also share the brand and source of vitamin C if you know

4) How much vitamin C do you use and is this more than you usually take or are you/were you taking this for the first time?

5) How long did it take to get back to normal/no pain/no symptoms once you stopped taking vitamin C?

NOTE – ONLY VITAMIN C: for questions 2) through 5) – in order to be sure the new symptoms are due to vitamin C and not something else – the addition of vitamin C must be the only change made and then stopping vitamin C must also be the only change made. I have clients keep a log too and repeat the “test” if they are not sure. This can be likened to a gluten elimination trial but in reverse. Repeating the “test”also depends on the symptom severity.

6) Does/did anything help to counter the adverse effects (like calcium citrate, vitamin B6, NAC, MSM, biotin, bile support, Epsom salts baths or anything else)?

7) How long have oxalates been an issue for you and are you eating low oxalate? Or is this all new to you?

8) Would you equate the effects of vitamin C to eating high oxalate foods like spinach, raspberries, nuts and seeds, kiwi fruit, figs, turmeric, chocolate, wheat, white potato, soy, beets etc (less severe/same symptoms/more severe)?

I’m also adding these new questions based on some of the research I’ve been doing:

9) Are you aware of any kidney issues and if you get regular blood work done do you track and take note of your estimated Glomerular Filtration Rate (eGFR)? What have you observed in terms of values? (In case eGFR is new to you it measures how well your kidneys filter the wastes from your blood and is the best overall measure of kidney function. It helps determine if you have any kidney damage.) Have you ever been told you have kidney issues and have other kidney lab markers out of range?

10) What are your results on the Great Plains Lab organic acids test (OAT) for the following: Oxalic acid, Glycolic acid (glycolate), Glyceric acid (glycerate), Arabinose (a yeast/candida marker) Ascorbic acid (ascorbate, vitamin C), Pyridoxic acid (marker of vitamin B6 status), Furandicarboxylic acid and hydroxy-methylfuroic acid (markers for fungi such as Aspergillus), and markers of bacterial imbalance?

11) Do you have pyroluria (based on a urine test) or have more than 15 symptoms from the the pyroluria questionnaire and/or are susceptible to low vitamin B6 (poor dream recall and/or nightmares) and low zinc (and therefore high copper)?

12) How do you score on symptoms of low serotonin, low GABA, low endorphins and low catecholamines? (here is that questionnaire). Is your anxiety, low mood, cravings or sleep worse when you are dealing with your other oxalate symptoms/pain?

13) Do you have any genetic markers that indicate a susceptibility for oxalate issues?

14) Do you have celiac disease, gluten sensitivity, leaky gut, liver issues, gall stones, no gallbladder, poor bile production, fat malabsorption, mold toxicity issues, low pancreatic enzymes, candida, high iron/ferritin?

15) What are your results on a mold toxicity test such as the Great Plains MycoTOX profile? and/or do you live in a moldy home/worked in a moldy environment or have in the recent past?

16) What are you results on a stool test (and which stool test)?

17) Do you have high mercury, high lead or high levels of other metals?

18) What is your vitamin D level (now if you happen to know it and/or typical levels in the past) and did you start to take extra vitamin D during this pandemic too? If you are taking extra vitamin D how much extra? And does your vitamin D supplement also contain vitamin K1 and vitamin K2?

19) Do you have any other out-of-range (functional levels) markers on blood work or other lab tests?

I will come back and add references and the rationale for posing these questions.

Also, feel free to comment with a nickname to keep your health information private.

Josefin’s story: painful “fat tissue” around elbows, knees and hips, and an irritated bladder

I share some of the Facebook feedback below, but first, here are Josefin’s comments on my coronavirus blog. Josefin thanked me for not ignoring the oxalate problems that might come with higher doses of vitamin C, saying she has “experienced them first-hand and it is not something to take lightly.”

I asked her to share what happens when she eats medium and high oxalate foods (like spinach, nuts, kiwi fruit, chocolate etc). She shared this:

I gradually decreased my oxalate content in food as recommended in the TLO-group. During that year I experienced periods with a lot of the typical dumping-signs like sandy stools, pain in body and especially in joints and muscles, sand in eyes, bladder pain, peeing a lot, cravings for oxalate foods and a temporary relief in the dumping symptoms when I ate some higher oxalate foods.

I also realized that the painful “fat tissue” that I had all over the body (but mainly around elbows, knees and hips) for 10 years was really deposited oxalates with mostly fluid around it, since I lost it more and more while I dumped and had more pain there also when I dumped. Now the deposits are all gone.

I did want to know if the adverse symptoms she experienced with vitamin C were the same as when eating foods high in oxalates, and she confirmed they were:

Many of the symptoms of dumping were the same as I had previously experienced a few days to weeks after trying to do bowel flushes with vitamin C.

Josefin has been on a low oxalate diet for 3 years and has found the most vitamin C she can tolerate is 200-250mg of vitamin C per day. More about that in her own words:

Now after being on a low oxalate diet for 3 years (carnivore the last year) I have tried taking vitamin C very many times and come to the conclusion that about 200-250 mg per day is what I can take. If I take more I will get a gradual increase of that painful fat-tissue that will start after a few days to weeks depending on how much vitamin C I take. I will also get more of a flu feeling and irritated bladder.

When I stop taking the vitamin C I will within a day or two get all my typical dumping symptoms and they will continue for days to weeks depending on how much I have taken. Symptoms severity also depends on how much I have been taking.

It turns out she gets similar reactions with various forms of vitamin C: “ascorbic acid, calcium ascorbate, multimineral buffered ascorbate and also liposomal vitamin C from Quicksilver Scientific”.

Syd’s story: cystitis, along with a crashed brain

Syd shared this on the Facebook post:

I get symptoms from taking high dose Vitamin C within about 45 minutes. It shows up as cystitis, mostly, along with a crashed brain.

She did confirm that when taking vitamin C (possibly the ascorbic acid form) the symptoms mimic her symptoms when eating high oxalate foods. She also wants to try liposomal vitamin C and camu camu to figure out if she gets the same reactions:

I have the very same response to high oxalate foods. I used to think it was a bladder infection, but I tested four times and every time the test was negative. I’m having a response at the moment. I (stupidly) started eating protein bars that have nuts in them and after eating about four of them across several days, I have the cystitis symptoms.

I’m staring at some liposomal Vit C in the fridge that I’ve been wanting to try at a low dose. Same with some camu camu. I need the cystitis symptoms to abate first.

Virginia, Cathi and Melissa and their pain stories

Virginia also offered feedback on Facebook on her experiences with vitamin C, and again they are similar to when she eats high oxalate foods:

I took a pack of Vit C 1000mg (ascorbic acid) at night last week, next morning I noticed oxalate dumping. Took calcium citrate and it was gone within a day and yes the reaction is similar to eating high oxalate foods

On another Facebook thread my question got Cathi wondering if vitamin C was a factor in her worsening arthritis:

Hmmmmmm this has me thinking. I started Vitamin C crystals 1000mg a day – small spoonful in water. It is sour and not awful. Then, a couple of months ago the arthritis deposits in my right hand fingers got much worse and my right wrist has given me so much grief I have had to reduce my yoga. And I got a weird cyst or something on the inside of my right wrist. I wonder…. Gonna stop it and see if it makes a difference!!! Thank you as I was totally stumped and I hope this is the answer!!!!

On this same thread, Melissa shared that noticed severe joint and muscle pain within 2 or 3 days of starting vitamin C:

When the COVID stuff started, I started taking vitamin C as a preventative measure to keep my immune system strong. Within two or three days, I had system joint and muscle pain everywhere. I could hardly move! I stopped the vitamin C and it cleared up in 3 or 4 days. I’ve never had kidney stones, but my brother has, so maybe it’s a genetic predisposition? I do have a history of on & off systemic joint pain since my early 20’s.

I never thought I had oxalate issues but now I’m wondering if it might be related to my random systemic joint pain.

I was taking between 1,000 to 3,000 mg per day. The label says Solaray timed release vitamin c (ascorbic acid), acerola cherry and rose hips.

Thanks to these folks, everyone who has already contributed on other blogs, all the Facebook feedback (and to you if you provide feedback today).

My hesitation – I don’t have all the answers and we are in the midst of a pandemic where vitamin C is so important

I planned to include this in part 2 but I’m adding this section now because a few hours after publication there are already so many comments and questions. I did hesitate about publishing this blog when I don’t have all the answers and because we’re in the midst of a pandemic where vitamin C has been shown to be very important.

There is plenty of research on the benefits of vitamin C and it’s widely used with much success during serious illness and for sepsis. This paper, An Update on Current Therapeutic Drugs Treating COVID-19, published just last month, discusses vitamin C (ascorbic acid) as a supporting agent, playing a role as a potent antioxidant, with benefits for immune health and as an antiviral against flu viruses.

It also discusses an IV vitamin C coronavirus trial and high dosages currently being used in various hospitals for this virus. The authors do also say “no major side effects” which is what we are typically told about vitamin C.

The Orthomolecular Medicine News Service have issued a number of valuable press releases on vitamin C specific to coronavirus but they are steadfast in their conviction that there are no issues with vitamin C, saying it doesn’t cause kidney stones.

For the majority (I think) there will be no major side-effects but for those with oxalate issues high doses of vitamin C are clearly problematic.

One caveat is that there may be a place for short-term high-dose use during a healing crisis, even for someone with dietary oxalate issues. Unfortunately I don’t have an answer for this aspect yet and I’m hoping a vitamin C expert will contribute to the discussion or I’ll discover some research about this.

And let’s not forget this study published in 1994, The clinical effects of vitamin C supplementation in elderly hospitalised patients with acute respiratory infections, where 200mg of supplemental vitamin C per day resulted in an 80% decrease in deaths among severely ill, hospitalized respiratory disease patients.

This topic is near and dear to my heart and folks have oxalate issues now so I decided to go ahead and publish this information. I’m looking for a solution for my community who are already aware they have oxalate issues (many of you have already reached out to me so thank you) and for myself too. I’ll share details of my oxalate story (my pain is in my feet and my eyes) and my vitamin C experiment in a future blog (I used food based vitamin C and 100-200mg/day and it didn’t go well).

As I mentioned above, I’m also concerned there are many people who don’t know they have oxalate issues and may end up with issues because of all the well-meaning vitamin C advice that is being shared during this pandemic.

I may have bitten off more than I can handle with this topic – I’m learning voraciously and it’s like drinking from a fire-hose! But I’m doing what I often do … I learn by teaching and asking for your feedback and questions, and I’m open about the fact that I’m not an expert and don’t have all the answers.

**** Some cautions *****
Please discuss your situation with your doctor and other health practitioners before stopping or reducing vitamin C based on what you’re reading here.

If you are completely new to the topic of oxalates, this is sound advice from Susan Owens on getting started: “work your way gradually into a completely low oxalate diet.” You can learn more on getting started here. Susan runs the Trying Low Oxalate Group (TLO) on facebook and they are extremely helpful. I will be sharing additional resources/studies/practitioner feedback etc. but this will get you started.

A reminder that pain can have many root causes other than dietary oxalate issues (or in addition to oxalate issues): gluten issues, nightshades, low GABA, low serotonin, low endorphins, Lyme disease (bartonella can cause foot pain), fibromyalgia, low B12, heavy metals, mold toxicity, autoimmune conditions etc.

******************

Feel free to comment below – share your feedback and ask your questions. And do let me know if you’re interested in learning more about this topic and additional blog posts.

If you’re a practitioner who works with individuals with dietary oxalate issues I’d love to hear from you too.

Read all posts in this series:

Coronavirus: new research on vitamin D supplementation possibly improving clinical outcomes

April 24, 2020 By Trudy Scott 57 Comments

It’s very encouraging to see research like this being published in the midst of the coronavirus pandemic: Vitamin D Supplementation Could Possibly Improve Clinical Outcomes of Patients Infected with Coronavirus-2019 (COVID-2019)

Serum 25(OH)D level was lowest in critical cases, but highest in mild cases. Serum 25(OH)D levels were statistically significant among clinical outcomes.

The results suggest that an increase in serum 25(OH)D level in the body could either improve clinical outcomes or mitigate worst (severe to critical) outcomes, while a decrease in serum 25(OH)D level in the body could worsen clinical outcomes of COVID-2019 patients.

In other words, lower levels of vitamin D were associated with more severe symptoms and higher levels were associated with less severe symptoms. The role of vitamin D in immunity has been long understood and is summarized in the paper as follows:

Vitamin D has been proven to reduce risk of getting a common cold. It also enhances cellular immunity, modulates adaptive immunity, and enhances expression of antioxidation-related genes.

There are a few aspects I’d like to highlight: it was not a peer-reviewed randomized controlled trial but rather a retrospective study (looking back on past events) submitted as a research letter; it was a small study of 212 cases and they were all confirmed to have SARS-CoV-2 infection. Vitamin D status was based on serum 25(OH)D levels of “(1) normal -25(OH)D of >30 ng/ml, (2) insufficient-25(OH)D of 21-29ng/ml, and (3) deficient-25(OH)D of < 20 ng/ml,” with tests done every 7 days.

What is astounding to me is that such a small difference in vitamin D levels could have such a dramatic impact on severity of symptoms i.e. from a median of 31.2 ng/ml to 17.1 ng/ml:

mild – mild clinical features without pneumonia diagnosis: serum 25(OH)D level was 31.2 ng/ml
ordinary – confirmed pneumonia with fever and other respiratory symptoms: serum 25(OH)D level was 27.4 ng/ml
severe – hypoxia (at most 93% oxygen saturation) and respiratory distress: serum 25(OH)D level was 21.2 ng/ml
critical – respiratory failure requiring intensive case monitoring: serum 25(OH)D level was 17.1 ng/ml.

The author concludes as follows, recommending randomized controlled trials and large population studies:

… this study provides substantial information to clinicians and health policy-makers. Vitamin D supplementation could possibly improve clinical outcomes of patients infected with COVID-2019. Further research should conduct randomized controlled trials and large population studies to evaluate this recommendation.

I would really like to acknowledge the author, Dr. Mark Apilio, for taking the time to gather this information and submit this research in the midst of the pandemic, so we can all learn and further our knowledge.

I reached out to him to find out more about his interest in vitamin D. I was also curious to find out if vitamin D levels are routinely checked in the Philippines and if vitamin D supplementation recommendations are common practice. I received this feedback:

I am a clinical professor with experience in handling patients with infection. In times like this, academicians in the Philippines are driven to finding therapeutic drugs for Covid-19 or palliative drugs, at least. Also with other experts’ advice, Vit D could be a good topic to research using clinical outcomes of the Covid-19 patients.

Vitamin D supplementation in the Philippines is uncommon since most of the Filipinos believe that they could get Vit D easily because of the sun (country near the equator). However, Vit D test is common for patients with severe respiratory infections for monitoring of status. Based on the table [in the review letter], mean ± SD was used to report serum 25(OH)D level of the cases. I am happy with the results of the study and the support of Vit D advocates like you. I do hope this shall serve as a call for health officials to at least focus on something like this which could impact clinical outcomes of Covid-19 patients.

Keep in mind that low vitamin D is also a factor when it comes to mental health and anxiety. You can read more about this aspect here – Vitamin D: anxiety, depression, sun exposure, supplements and optimal levels. This blog also has additional information about testing and optimal ranges from the Vitamin D Council.

I really like these two Designs for Health products: Vitamin D Synergy which provides Vitamin D3 2000 IU and vitamin K1; and Vitamin D Supreme which provides Vitamin D3 5000 IU and vitamin K1/K2. Both can be purchased via my online supplement store (details on setting up an account here).

Vitamin D is such a simple and yet powerful intervention for immune support and I look forward to randomized controlled trials for coronavirus. In the meantime, it’s one of the many immune-supportive nutrients I plan to continue using and recommending to my clients.

UPDATES 5/1/2020:

I’m sharing some updates to last week’s blog on vitamin D and coronavirus because there is a brand new study with astounding results and some other supporting vitamin D papers. There is also new research on vitamin K and coronavirus and I’ve added this one too. I did hear back from the author in the Philippines and added his feedback above.

This is the new paper with astounding results. It was a retrospective cohort study: Patterns of COVID-19 Mortality and Vitamin D: An Indonesian Study (and just posted April 26). It had 780 cases with laboratory-confirmed infection of SARS-CoV-2 in Indonesia:

Age, sex, co-morbidity, Vitamin D status, and disease outcome (mortality) were extracted from electronic medical records. The aim was to determine patterns of mortality and associated factors, with a special focus on Vitamin D status. Results revealed that the majority of the death cases were male and older and had pre-existing conditions and below normal Vitamin D serum level.

These are the astounding results:

Vitamin D deficient cases (serum 25(OH)D of < 20 ng/ml) were approximately 19.12 times more likely to die from the disease
Vitamin D insufficient cases (serum 25(OH)D of 21 – 29 ng/ml) were approximately 12.55 times more likely to die from the disease

This review paper, Evidence that Vitamin D Supplementation Could Reduce Risk of Influenza and COVID-19 Infections and Deaths published earlier in April makes these recommendations about dosages and vitamin D levels to aim for (pending additional research):

To reduce the risk of infection, it is recommended that people at risk of influenza and/or COVID-19 consider taking 10,000 IU/d of vitamin D₃ for a few weeks to rapidly raise 25(OH)D concentrations, followed by 5000 IU/d. The goal should be to raise 25(OH)D concentrations above 40-60 ng/mL (100-150 nmol/L). For treatment of people who become infected with COVID-19, higher vitamin D₃ doses might be useful. Randomized controlled trials and large population studies should be conducted to evaluate these recommendations.

In this paper (not yet peer-reviewed), Reduced Vitamin K Status as A Potentially Modifiable Prognostic Risk Factor in COVID19, the authors report that vitamin K status – according to Dp-ucMGP levels – was reduced in patients with COVID-19 and related to poor prognosis.”

They state this is due to the fact that “Coagulation is an intricate balance between clot promoting and dissolving processes in which vitamin K plays a well-known role.” They also propose an intervention trial with vitamin K for patients with COVID-19.

Do share if you routinely get your vitamin D levels checked and supplement regularly with vitamin D. And let us know if you’ve noticed an improved immune system when your vitamin D levels are optimal. If you did get the virus please also let us know how you’ve fared and recovered.

Coronavirus: my immune boosting and antiviral plans (and what to use if you’re anxious)

January 31, 2020 By Trudy Scott 107 Comments

3/27/20: Updated with a good blog post on elderberry (addressing cytokine storm concerns); an excellent video on “The Coronavirus Explained”; 3 new and promising coronavirus/COVID-19 studies on gut health and melatonin; an excellent hand-washing video I encourage you to watch with your families; a recap on using GABA, tryptophan, DPA, glutamine and tyrosine for emotional support

3/20/20: Updated with webinar information so you can post your questions.

3/12/20: Updated as a result of the situation in Italy and the WHO pandemic declaration – Italy overwhelmed with not enough ICU beds and ventilators; predictions the USA healthcare system (and other countries) will likely not be able to handle a similar situation; stay home and immune-boosting advice from Dr. David Brady; additional resources from Dr. Elisa Song; and more on hand-washing

1/31/20: Originally published – vitamin C and foundational nutrients; my other immune boosting nutrients and first aid kit; GABA or tryptophan if you are worried, overly anxious or fearful

UPDATES 3/27/20:

Coronavirus explained, gut health, elderberry, melatonin and more

So much is changing so quickly and there is so much to learn about the coronavirus. I am spending all my time pouring through the literature, learning from other practitioners, reaching out to researchers and trying to connect some of the dots for you. For this reason I’ve decided to do an update each week to this blog and add new findings and relevant information for you.

I’ve updated this blog again TODAY with a good blog post on elderberry, an excellent video on “The Coronavirus Explained” and 3 new and promising coronavirus/COVID-19 studies on gut health and melatonin. I will be taking a deeper dive into these studies, sharing my perspectives related to the anxiety nutrition work I do. I also share an excellent hand-washing video I encourage you to watch with your families! And a recap on using GABA, tryptophan, DPA, glutamine and tyrosine for emotional support.

Elderberry concerns about it triggering a cytokine storm – put to rest

There have been many questions about elderberry and concerns about it possibly triggering a cytokine storm. Suzy Cohen addresses all these concerns here: In Defense of Precious Elderberries

The misinformation you’re getting was based upon a research article that evaluated blood cells in test tubes. It was not a well-designed, placebo-controlled clinical trial. It was not even done on real live people (in vivo).

A number of my respected colleagues agree with her conclusions: “compounds from elderberries can directly inhibit the [flu] virus’s entry and replication in human cells, and can help strengthen a person’s immune response to the virus.” More here.

Understanding the Coronavirus

I found this video very helpful for understanding the coronavirus: The Coronavirus Explained & What You Should Do

New and promising coronavirus/COVID-19 studies on gut health

Here are two new coronavirus/COVID-19 gut health studies. I will be taking a deeper dive into these studies in a future blog post, sharing my perspectives related to the anxiety nutrition work I do. For now, here are the links. It’s very preliminary research but if you tuned in to the recent Anxiety Summit 5: Gut-Brain Axis, you know how promising this is:

2019 novel coronavirus infection and gastrointestinal tract

Although no specific antiviral treatment has been recommended to date, we speculate that probiotics may modulate the gut microbiota to alter the gastrointestinal symptoms favorably and may also protect the respiratory system

Management of Corona Virus disease-19 (COVID-19): The Zhejiang Experience

Nutritional and gastrointestinal function should be assessed for all patients. Nutritional support and application of prebiotics or probiotics were suggested to regulate the balance of intestinal microbiota and reduce the risk of secondary infection due to bacterial translocation.

Anxiety and fear were common in patients with COVID-19. Therefore, we established dynamic assessment and warning for psychological crisis.

I address anxiety in all the work I do an agree it needs to be at the forefront for everyone. I take a deeper dive into GABA and theanine and the anxiety/sleep/immunity connections in this recent blog: GABA and theanine for easing anxiety, improving sleep and supporting immunity.

Melatonin as a potential treatment: new research

This in press and pre-proof paper on melatonin is also very promising: COVID-19: Melatonin as a potential adjuvant treatment:

Melatonin, a well-known anti-inflammatory and anti-oxidative molecule, is protective against ALI/ARDS [acute lung injury/acute respiratory distress syndrome] caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. Notably, melatonin has a high safety profile.

I will also be taking a deeper dive into this study in a future blog post, sharing my perspectives on serotonin, melatonin, anxiety and sleep.

THE best hand-washing video!

This is THE best hand-washing video I’ve come across. It was even retweeted and acknowledged by WHO Director General, Dr Tedros Adhanom Ghebreyesus.

I’m pretty sure I may have been missing my thumbs! What about you?

I don’t know how to share a video from twitter other than share the twitter link so I hope you can watch it.

We’re using soap at home and have one designated person in our household of four adults going out to pick up food items. This is the time we use hand-sanitizer (and gloves). Here is another blog on How to Make Your Own Hand Sanitizer in case you’re in a similar situation to us and can’t find ingredients to make more. Suzy mentions vinegar and colloidal silver in this one and shares a number of practical recipes.

IV vitamin C, oxalates, anti-malarial drugs and losss of smell and taste

It’s so encouraging that New York hospitals are treating coronavirus patients with vitamin C. There are, however, concerns for folks who have dietary oxalate issues (with both oral and IV vitamin C). I’ve been gathering feedback and research on this topic and will hopefully have more to share next week.

I also have some major concerns about the anti-malarial drugs chloroquine and hydroxychloroquine and will share those, together with my perspectives on the loss of smell and taste as a possible marker of infection.

Until then, here is another little “bouquet of hope” from our garden to you … My darling mom-in-law brought this lovely little arrangement to me in my home office earlier this week! Aren’t I a lucky girl!?

Amino acids for emotional support, good sleep and to prevent comfort-eating

Finally, don’t forget about the amino acids for added emotional and nutritional support (our needs are higher at a time like this):

GABA for physical tension and anxiety (more here)
tryptophan for excessive worrying and feeling fearful (more here)
glutamine if you’re not eating well and getting blood sugar crashes, and for gut healing (more here)
tyrosine if you just can’t focus and want to curl up in bed (more here)
and DPA if you’re feeling overly emotional and weepy, comfort-eating is your support right now (more here)

This blog, The Antianxiety Food Solution Amino Acid and Pyroluria Supplements, lists the products that I use with my individual clients and those in my group programs.

Please feel free to comment on any of the above new developments and share what you are learning too. And do let me know if this format is helpful for you.

Keeping you in my thoughts! And keeping you informed and empowered so anxiety is less of an issue.

UPDATES 3/20/2020:

I’m planning a series of webinars to get your coronavirus questions answered:

I’m planning to interview a health coach/colleague living in Italy/Germany right now and have her share her experiences about living in lock-down and more about the situation in Europe
I’m planning to interview Dr. David Brady to share his patient protocols for immunity, testing and much more
I’ll be doing one with me talking about best how to deal with the anxiety, worry and laying awake until 3am fearful. Anxiety and lack of sleep adversely impact immunity so we have to sort that out. I’ll also cover the many nutrients for anxiety that also support immunity
I’m looking for an expert to talk about vitamin C and the risks for those with dietary oxalate issues, and other viable and safe options instead of vitamin C
I’ll be interviewing a doctor on the role of melatonin in counteracting severe inflammatory responses such as pro-inflammatory cytokines. It’s being theorized that older individuals are being more impacted because of low melatonin levels and it’s because children have higher levels of melatonin they are less impacted.

I hope these will be helpful for you? What questions do you have for each webinar (please list the webinar # and the question/s when you comment below. Please don’t send your questions via email – as you can imagine we are receiving a large number of emails!) Let me know what other information you are looking for.

UPDATES 3/12/2020:

The situation in Italy has me concerned

At the time of initial publication of this blog at the end of January, I was in agreement with what the Orthomolecular Medicine News Service were suggesting – we were reading a lot of media hype.

I am not one for fear-mongering, but after reading this very sobering account by two Italian doctors 2 days ago, I am now much more concerned about the coronavirus for the folks who will be most severely impacted – the elderly and the immune-compromised.

In Italy they do not have enough ventilators or ICU beds. Dr. Jason Van Schoor shared warnings from a colleague working in Northern Italy:

I feel the pressure to give you a quick personal update about what is happening in Italy, and also give some quick direct advice about what you should do.

First, Lombardy is the most developed region in Italy and it has a extraordinary good healthcare, I have worked in Italy, UK and Aus and don’t make the mistake to think that what is happening is happening in a 3rd world country.

The current situation is difficult to imagine and numbers do not explain things at all. Our hospitals are overwhelmed by Covid-19, they are running 200% capacity

We’ve stopped all routine, all ORs have been converted to ITUs and they are now diverting or not treating all other emergencies like trauma or strokes. There are hundreds of pts with severe resp failure and many of them do not have access to anything above a reservoir mask.

Patients above 65 or younger with comorbidities are not even assessed by ITU, I am not saying not tubed, I’m saying not assessed and no ITU staff attends when they arrest.

We have seen the same pattern in different areas a week apart, and there is no reason that in a few weeks it won’t be the same everywhere

You can read the entire thread on Twitter here. At first glance there is skepticism and disbelief this could be happening but a trusted colleague in San Francisco has heard similar accounts from doctors she knows in Italy. It’s thanks to her that I started digging deeper into the situation in Italy and had my mind changed.

And this article in the New York Times was also just published confirming much of this: Italy’s Health Care System Groans Under Coronavirus — a Warning to the World. They they do mention doctors being muzzled which is very concerning. We need transparency if we are to learn.

Predictions the USA healthcare system (and other countries) will likely not be able to handle a similar situation

This article supports what is happening in Italy, with serious predictions for the USA (and presumably other countries too) – What does the coronavirus mean for the U.S. healthcare system? Some simple math offers alarming answers

What does an avalanche of uncharacteristically severe respiratory viral illness cases mean for our health care system? How much excess capacity currently exists, and how quickly could Covid-19 cases saturate and overwhelm the number of available hospital beds, face masks, and other resources …

….like in Italy where this is happening right now!

This is why I am now fully behind social distancing and staying home

I’m still of the opinion I need to focus on healthy living/eating and boosting my immunity (and it’s what me and my family are currently doing) but I am now fully behind social distancing, staying home, not attending big events and not traveling – so this virus can be contained as much as possible. Knowing what I now know about Italy makes this an easy decision which is why I’m sharing it here today – even if it is frightening.

Dr. David Brady, ND, author of The Fibro Fix, provides some basic advice on staying as healthy as possible in this recent video posted on Facebook. His is the calm voice of reason, sharing precautions to take during the COVID-19 pandemic and also fully supporting the social isolation and stay home message. He does mention andrographis for antiviral support, garlic, elderberry, vitamin C, lauric acid (monolaurin), vitamin D, preformed vitamin A (as opposed to beta-carotene), zinc and echinacea as all good nutrients to consider for his patients and family.

Unfortunately, many of my colleagues are still saying it’s media hype, out of control fear-mongering, is not as bad as the flu and there is no way this could happen in a country like the USA, Australia, UK and elsewhere. I know they’ll get on board with all this once they have this information too.

I sincerely hope I am wrong about this and things don’t get as bad as Italy. For now I’m playing it safe.

My hand-washing research

I got called out for not mentioning hand-washing when I first published this blog. My focus was to share my first-aid kit i.e. nutraceuticals I use but KT was is absolutely right

Hand hygiene is the single most important intervention for reducing healthcare associated infections and preventing the spread of antimicrobial resistance.

My assumption was that this is common knowledge but based on this statement in the same paper, perhaps this isn’t the case?

while tremendous progress has certainly been made in this field, a significant amount of work is yet to be done in both strengthening the evidence regarding the impact of hand hygiene and maximizing its implementation

With regard to what to use: antibacterial soap showed little added benefit compared with regular soap

Interestingly this paper also states “Hand hygiene is clearly effective against gastrointestinal and, to a lesser extent, respiratory infections. Studies examining hygiene practices during respiratory illness and interventions targeting aerosol transmission are needed.” I’m not sure of the implications of this for the coronavirus. For now I’m following the guidelines outlined in Dr. Song’s blog (below).

This 2017 Time article, Washing Hands In Cold Water Works As Well As Hot Against Germs, clears up what they say is often conflicting data and has some good guidelines from a study published the same year (it was looking at E. coli bacteria and not viruses): wash hands in cold water, at least 10 secs of lathering and use regular soap. Hand lotion afterwards seems to help too.

Additional resources

I’ve also got some blogs from colleagues to share with you so you have additional resources:

My friend and colleague Dr. Elisa Song MD shares this very comprehensive blog – Coronavirus (COVID-19): What a Pediatrician Wants You to Know (published late Feb so a little out of date with some of the stats). I’m so pleased to see Dr. Song write about IV Vitamin C and look forward to the outcome of the clinical trial she refers to: Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia.

It’s an approach the physicians of the Orthomolecular Medicine News Service are recommending and it’s gives me a higher level of comfort in these days ahead.

As I mentioned above I do have some questions and concerns about this vitamin C IV approach (and high doses of oral vitamin C) for folks with oxalate issues (myself included) and for folks with G6PD deficiencies and hemochromatosis. I’ll share more as I learn more.

And this one from Dr. Song too – Handwashing and Coronavirus: Are you doing it the right way? I encourage you to watch the hand-washing demo videos she links to and show them to your children! This fact is astounding: “If 60% rather than 20% of air travelers maintained clean hands, it could slow down the spread of infections by almost 70%“

Dr. Song also shares How to Make a 60% Alcohol-Based Hand Sanitizer. “Washing hands with soap and water is the #1 recommended way to prevent the spread of Coronavirus. But if you don’t have access to soap and water, what can you do? The CDC recommends using a hand sanitizer with at least 60% alcohol.“

A blog from Paleohacks: Thieves Oil What It Is, Benefits & How to Make It. Use Thieves oil as a natural disinfectant around your home. “It’s great for wiping down counters, cleaning toys, disinfecting cutting boards, removing stale odors, freshening trash cans and gym bags, and even cleaning veggies.”

Originally published 1/31/20:

How are you handling all the coronavirus news? Worried? Anxious? Fearful? Or are calmly watching and listening and making sure your immune system is in good shape and you have natural antivirals on hand if necessary? (and updated 3/12/20 – are you taking the stay at home message seriously? much more on that below)

There are still many unknowns but I’ve been gathering some articles and resources for my own personal use. I’m not an expert in infections but since folks in my community are asking I promised to share my first-aid kit and rationale in a blog post.

I can help with the anxiety and fear aspect if all this doesn’t put your mind at ease. I cover how I use individual amino acids with my clients at the end of this blog post.

Vitamin C and other foundational nutrients

This newly published blog by Andrew Saul PhD, Vitamin C Protects Against Coronavirus, offers sage foundational advice that resonates with what I already know:

The physicians of the Orthomolecular Medicine News Service and the International Society for Orthomolecular Medicine urge a nutrient-based method to prevent or minimize symptoms for future viral infection. The following inexpensive supplemental levels are recommended for adults; for children reduce these in proportion to body weight:

Vitamin C: 3,000 milligrams (or more) daily, in divided doses.

Vitamin D3: 2,000 International Units daily. (Start with 5,000 IU/day for two weeks, then reduce to 2,000)

Magnesium: 400 mg daily (in citrate, malate, chelate, or chloride form)

Zinc: 20 mg daily

Selenium: 100 mcg (micrograms) daily

Vitamin C, Vitamin D, magnesium, zinc, and selenium have been shown to strengthen the immune system against viruses.

Additional rationale for vitamin C

In another blog by Andrew Saul PhD, Nutritional Treatment of Coronavirus, offers additional rationale for vitamin C: “Abundant clinical evidence confirms vitamin C’s powerful antiviral effect when used in sufficient quantity” and states that the “physicians on the Orthomolecular Medicine News Service review board specifically recommend at least 3,000 milligrams (or more) of vitamin C daily, in divided doses. Vitamin C empowers the immune system and can directly denature many viruses.”

It’s very encouraging to read that just 200mg a day“given to the elderly resulted in improvement in respiratory symptoms in the most severely ill, hospitalized patients.”

~~This statement from the above blog puts much of what is considered to be media hype and fear-mongering into perspective:~~ (see below why I no longer feel this is media hype)

“The common cold is a coronavirus, and SARS is a coronavirus, so they are the same viral type” ~ David Jenkins, MD, Professor of Medicine and Nutritional Science, University of Toronto.

I do have some questions and concerns about using high doses of oral vitamin C and vitamin C IV for folks with oxalate issues (myself included). I’m actively seeking answers.

Vitamin D, olive leaf extract, oregano oil, elderberry, NAC and diet

Here are some additional links that I have found or were shared with me (thank you if you shared one of these with me!):

Vitamin D and the anti-viral state “These results support the hypothesis that vitamin D … may play a major role in the inhibition of viruses.” I’m very aware of the immune-boosting properties of vitamin D.
Olive leaf extract “decreased the duration of upper respiratory illness in high school athletes.” We always have this on hand and it appears to work well for me and my family so I’ll make sure to keep this in mind.
Oregano oil – per this article on Holistic Primary care “A number of preliminary in vitro or animal studies have shown that compounds in oregano oil are virustatic and virucidal against several viral pathogens.” I always have oregano oil on hand (and especially when flying) and it always works well for me at the first sign of any bug. I was pleased to come across this research even though we don’t yet have a human study.
Black elderberry liquid extract “displays an inhibitory effect on the propagation of human pathogenic influenza viruses” and has antimicrobial effects against bacteria responsible for infections of the upper respiratory tract. This is also a firm favorite in our household in the winter months and I seldom need more than one or two doses at the first sign of the sniffles.
N-acetyl-L-cysteine (NAC) “antioxidants like NAC represent a potential additional treatment option that could be considered in the case of an influenza A virus pandemic.” I’ll be giving NAC more consideration.
Here are some well-balanced perspectives from Peter D’Adamo on Facebook mentions drinking plenty of water, stocks, garlic (freshly crushed), onions, leeks, elderberry and Andrographis paniculata. He does say “Keep in mind these are just my opinions and observations over a thin veneer of facts.”

Consider lomatium?

Lomatium is not my first choice but I’m listing it here out of interest. Lomatium by Barlow Herbals “During the flu pandemic of 1917-1918, the root came into extensive use by the two Washoe Indian tribes near Carson City, Nevada.” I have yet to try this one but have heard Jane from Barlow Herbals talk about lomatium on a number of summits and I’m intrigued.

My first-aid kit

In summary, here is my first-aid kit: Vitamin C, zinc, extra selenium, vitamin D, magnesium, oil of oregano, olive leaf extract, black elderberry and Biocidin Throat Spray and Xlear Nasal Spray (the latter two are always on hand and I always also travel with them).

I also always have essential oils on hand: tea tree oil, eucalyptus, peppermint, rosemary, lavender and others. I’ll be adding sage per Dr. Elisa Song’s blog (see below).

This is pretty much what I always use other than adding in extra selenium, so it was very affirming to gather all this research.

trudy first aid kit — Here are just a few products from my first-aid kit.

GABA or tryptophan: if worried or overly anxious or fearful

If you’re feeling worried or overly anxious or fearful, the best way is to be informed and prepared. Interestingly, some of the very same nutrients mentioned above also help ease anxiety – vitamin C, zinc, vitamin D, magnesium and selenium and B vitamins – because they are co-factors for making neurotransmitters like serotonin, GABA and dopamine.

If all this information and being prepared isn’t enough to calm you down, then don’t forget the individual amino acids for quick relief. I use GABA for clients who are feeling physically tense and tryptophan or 5-HTP for worry-type of anxiety and if they are imagining the worst and can’t switch off their busy mind off.

We use the trial method to find the ideal amount for each person, starting low and titrating up based on symptoms and then down if not added benefits are seen.

You can find my most popular amino acid products on the supplements blog here (and with details for how to set up an account for my online store). You can find everything else I write about in the store too. Just be sure to work with your practitioner.

My thoughts are with you and all of those currently ill and those who will get ill. We will get through this together.

My hope is that you are less anxious and fearful as you become more informed.

Please share your immune-boosting remedies and your thoughts and plans.

As I mentioned above, these are resources and information I’ve gathered for my own personal use, and are in no way intended to be recommendations.

Increased sociability improves vagus nerve function: the role of social anxiety, pyroluria and low zinc

December 13, 2019 By Trudy Scott 43 Comments

With the objective of taking a deeper dive into some of the favorite topics of the recent Anxiety Summit: Gut-Brain Axis, today’s blog is about the vagus nerve since Dr. Navaz Habib’s interview, Vagus Nerve Activation to Reduce Anxiety, was voted one of the favorites. I’m focusing on one tool that improves vagus nerve function that we didn’t have time to get into in great detail – and that is how increased sociability helps. It’s all good and well to recommend getting out and hanging out with more people but if you have the social anxiety condition called pyroluria it’s really challenging, hard work and very stressful. Added stress makes pyroluria worse so it becomes a vicious cycle.

Let’s start with the research that supports the connection between the vagus nerve and increased anxiety and mood problems. In the interview with Dr Navaz, we discussed this paper: Vagus Nerve as Modulator of the Brain–Gut Axis in Psychiatric and Inflammatory Disorders which states that “vagus nerve stimulation is a promising add-on treatment for treatment-refractory depression, posttraumatic stress disorder, and inflammatory bowel disease” and how stimulation of vagal fibers that go from the gut to the brain (afferent fibers) influences neurotransmitter production and “play crucial roles in major psychiatric conditions, such as mood and anxiety disorders.” The gut bacteria play a major role too, “partly by affecting the activity of the vagus nerve.”

In our interview we end with very practical ways to activate your vagus nerve

Deep breathing exercises (mentioned in the above paper, together with yoga and meditation) and cold showers (which makes you breathe harder)
Gargling and using the gag reflex
Humming, chanting and singing (I used these approaches for my vagus nerve issue after my terrifying plane ride. GABA also helped with the voice/throat spasms I experienced – more here on that)
Auricular acupuncture (which is also very effective for addictions)
And finally, social interaction or increased sociability, which I want to cover today

The research on the vagus nerve and being more social

Let’s look at the research on the vagus nerve or vagal tone and being more social. This paper, Upward spirals of the heart: autonomic flexibility, as indexed by vagal tone, reciprocally and prospectively predicts positive emotions and social connectedness, reports that that vagal tone and connectedness or being more social is a two-way street i.e. it’s reciprocal

“…increases in connectedness and positive emotions predicted increases in vagal tone” and
“Adults who possessed higher initial levels of vagal tone increased in connectedness and positive emotions more rapidly than others”

In summary, the more social and happy you are, the healthier your vagus nerve is and a healthier vagus nerve leads to feeling more connected and happy.

This study was done with adults in a community-dwelling setting over 9 weeks: “adults were asked to monitor and report their positive emotions and the degree to which they felt socially connected each day.”

Address pyroluria in those who have social anxiety

Pyroluria, the social anxiety condition, was not part of the study because it’s under-recognized as a factor in anxiety. I’d like to propose that we address pyroluria in those who have social anxiety in order to further improve social connectedness and their vagus nerve function.

Many folks with pyroluria put on a brave face in social settings and even “extrovert” which is extremely stressful. The added stress makes pyroluria worse (zinc and vitamin B6 are dumped in much higher amounts) so it becomes a vicious cycle.

Others, who are not willing to even show up because of their severe social anxiety, are not getting that social interaction and connectedness that is so crucial for improved vagus nerve function and better overall health.

Here is the pyroluria questionnaire and the pyroluria/introvert connection.

Connecting the dots further we have

research that reports that vagus nerve stimulation has potential in autism treatment and we know pyroluria and social issues are common in autism
one of the key nutrients for pyroluria, zinc, plays a role in vagus nerve function
another key nutrient in pyroluria is vitamin B6 and it plays a role in reducing inflammation
according to the vagus nerve study above, the vagus nerve “plays important roles in the relationship between the gut, the brain, and inflammation”
both zinc and vitamin B6 are needed for neurotransmitter production, so increasing both GABA and serotonin will further improve mood and reduce anxiety
and finally, the more social and happy you are, the healthier your vagus nerve is and a healthier vagus nerve leads to feeling more connected and happy

By addressing the social anxiety called pyroluria with a foundation of zinc and vitamin B6, we can increase sociability and thereby improve vagus nerve function.

UPDATE 5/7/2020:

Social isolation during the coronavirus pandemic – other vagus nerve exercises

This blog is very applicable now during the coronavirus pandemic. I’ve made an update because I feel we need to start thinking about the longer-term adverse impacts of social isolation and work on other ways to improve vagus nerve function during isolation or quarantine.

This can include any or all of the ways mentioned above: deep breathing exercises, yoga, meditation, cold showers, gargling/gag reflex, humming/chanting/singing and/or auricular acupuncture.

Do you find you have better vagus nerve function when you are more sociable? What of these vagus nerve exercises have you been doing and found helpful during isolation? Do you have any other favorite approaches like using essential oils or anything else?

Vagus nerve stimulation to treat respiratory symptoms associated with COVID-19

This paper reports benefits in 2 patients with coronavirus – Use of non-invasive vagus nerve stimulation to treat respiratory symptoms associated with COVID-19: A theoretical hypothesis and early clinical experience

Both patients reported clinically meaningful benefits from nVNS therapy [non-invasive vagus nerve stimulation].
In Case 1, the patient used nVNS to expedite symptomatic recovery at home after hospital discharge and was able to discontinue use of opioid and cough suppressant medications.
In Case 2, the patient experienced immediate and consistent relief from symptoms of chest tightness and shortness of breath, as well as an improved ability to clear his lungs.

The authors also share that “vagus nerve stimulation has been demonstrated to block production of cytokines in sepsis and other medical conditions.”

With this virus being novel and with everyone learning we are still appreciative of small case reports like this and hope to see bigger studies done. Until then there is other evidence of the overall importance of the vagus nerve in helping to regulate lung infection and immunity.

The nVNS therapy mentioned in the COVID-19 paper is an external device that delivers “a proprietary signal through the skin to either the right or the left branches of the vagus nerve in the neck.” It’s not something I’ve used personally or had clients use so please share if you’ve had success with this device or a similar device.

Loving social isolation and thriving during coronavirus

On the flip side we also need to consider that there are some individuals who are loving social isolation and thriving emotionally. I share some feedback from folks in my community:

Elissa: “As an introvert, my mental health has never been better ☺️. Loving isolation life.”
Drew: “Loving it in many ways. Dreading the hedonism starting up again…”
Tiffany: “My anxiety levels have decreased and I have decreased my anxiety meds! I think it’s because the demand to produce has decreased. I can actually move at my own speed in this world. I’m fortunate, though. My heart goes out to those people in medical fields. I really miss some things, like time with my dad, but we have made some adjustments, like driveway picnics.”
Katie: “I was praying for relief from the busyness. Definitely didn’t have this in mind and my heart hurts for those who are impacted. It has been a beautiful time of rest and restoration for my body and soul.”
Wendy: “My life is usually slow paced and introverted. Now it’s more so and I’m finding the less I do in a day, the better I sleep. I’m actually dreading getting back to “normal” with all the pressures put on us by extroverts. Yes I have sympathy for people suffering mentally by isolation, but for the first time I feel like my type of lifestyle is socially acceptable. I’m tired of life expectations being dictated by the extrovert half of the population.”

I appreciate these folks for sharing their valuable perspectives about thriving in these times. It reinforces how unique we all are.

If you’re struggling with social isolation…

How are you feeling and what are you most looking forward to doing once social isolation recommendations are relaxed?
I’m guessing you don’t have pyroluria but please share if you do?

If you are thriving in social isolation…

Would you consider yourself an introvert /a contented introvert?
Have you got pyroluria and has addressing it nutritionally in the past allowed you to be more sociable or at least less anxious when you are in crowds?
How are you feeling during social isolation and what do you love the most right now?
What are you not looking forward to once social isolation recommendations are relaxed?
And how do you plan to go back to the old “normal” or don’t you?

Please comment below and let us know where you are with social isolation during this pandemic – struggling or thriving? And what vagus nerve exercises are you using right now? Have you used an external device with success?