Tips for People with Immune System Disorders

Tips for people with immune system disorders

Here is the important question that I asked this renowned pharmacist:

Do you have self-help tips to protect the immune system with this pandemic going on, especially for people with autoimmune diseases?

Written by Suzy Cohen, RPh

The rapid global spread of COVID19 has been extraordinarily disruptive to our lives, businesses, and even health status. While the disease appears to be self-limiting for the vast majority, those with immune system disorders might be at higher risk. We already know that pulmonary disease, as well as endocrine disorders and obesity are contributing co-morbid factors. Take control of your ability to fight off an infection. You can improve your odds by supporting your immune system properly with antioxidants and immune loving herbs and vitamins. 

Get More Sunshine for Vitamin D.

The compound was first discovered in the late 1920’s. Vitamin D is great for bones and teeth, but it’s also the part of our immune system that “remembers” specific attackers so it can mount a faster defense next time these attackers are present. This is called the adaptive immune system. Vitamin D helps modulate the adaptive immune system by boosting our T cells, a type of white blood cell that patrols our bodies like soldiers, ready to destroy any dangerous cells they come across. Without adequate vitamin D, our T helper cells are listless and don’t respond as they should to threats. You can convert UV light into Vitamin D by being out in the sun 20 minutes a day, or you can supplement which will give you a higher amount. Ask your doctor to test your Vitamin D level to determine whether or not you are deficient and have regular testing to monitor levels while supplementing to avoid Vitamin D toxicity. Not surprisingly, clinical trials are taking place to investigate the use of Vitamin D for COVID-19.[1-3]

Get More Vitamin C.

Vitamin C is not something humans can make. We can eat citrus fruits and vegetables to obtain it, and that’s a good idea because this nutrient boosts production of T helper cells, which is a white blood cell that helps fight for us. Vitamin C was studied by Linus Pauling for it’s ability to shorten the duration of a cold. It’s also a very strong water-soluble antioxidant that can suppress inflammatory chemicals. Vitamin C deficiency will lead to impaired immunity, thus higher susceptibility to infections. Furthermore, when there is added stress on the body, it will run out of C faster due to  enhanced inflammation and metabolic requirements. Research shows that supplementation with vitamin C appears to support respiratory infections [7-9] and clinical trials are underway to investigate the use of Vitamin C in patients with COVID-19.[4-6] They give it in high doses for COVID-19 in other countries, via injections. 

Think Zinc.

While there’s no magic bullet for any viral infection, the use of zinc has been substantiated by many anecdotal reports as well as some scientific evidence.[10] Those people who swear by zinc as a cold remedy, will tell you to take it early on and that it will help shorten the duration of misery. This could be especially beneficial if you have a sore throat. That’s why you see zinc in many lozenge forms. People commonly take it for cold and flu! If it can prevent viral replication, then it might be able to reduce the amount of days of suffering. In a Cleveland Clinic study in the late 90’s people who took zinc lozenges every few hours had 3 days shortened off their cold symptoms. 

Zinc works by blocking the replication of the virus, so fewer clones are made. This is true according to several scientific reports, however we should be clear, it is not a guarantee against being infected by the corona virus, or any other type of virus. We know that zinc warrants more study, as it may be beneficial in lessening symptomatology, and cytokine release. We’ve seen medical doctors referring to using zinc along with other prescription medications, such as hydroxychloroquine, lopinavir/ritonavir, azithromycin, and intravenous immunoglobulin (IVIG).[11]

According to a May 2020 article published in Medical Hypothesis, zinc “possesses a variety of direct and indirect antiviral properties” and “may also act in a synergistic manner when co-administered with the standard antiviral therapy, as was demonstrated in patients with hepatitis C, HIV, and SARS-CoV-1.”  The article goes on to describe how zinc may work, and why it might be beneficial: “Zinc may inhibit viral replication by alteration of the proteolytic processing of replicase polyproteins and RNA-dependent RNA polymerase (RdRp) in rhinoviruses, HCV, and influenza virus, and diminish the RNA-synthesizing activity of nidoviruses, for which SARS-CoV-2 belongs. Therefore, it may be hypothesized that Zinc supplementation may be of potential benefit for prophylaxis and treatment of COVID-19.”[12]

Zinc is depleted by acid reducing medications, meaning that reflux drugs reduce your body’s stores of this important mineral. So if you’re supported on those types of medications, I feel you may be at higher risk for zinc deficiency. You can talk to your doctor about restoring the nutrient, which is very easy to do. If you are interested in zinc supplementation, there are many formulas sold online and at health food stores. The lozenges, liquid zinc supplements and oral forms are widely available. Dosages vary according to the salt/type of zinc you purchase. Be sure to supplement for a short period (not forever!) and do not overdo it. Signs and symptoms of excessive zinc include nausea, vomiting, reduced appetite, abdominal pain, diarrhea and sometimes frequent headache. When zinc is taken chronically, it causes an imbalance with copper. Zinc and copper sit on a see-saw, and should remain balanced in the body (homeostasis). If you take too much zinc, it can cause a relative deficiency of copper. This will ironically lower immunity! Balance with minerals is important.

Autoimmune Special Precautions.

During the pandemic, I’ve been asked if people with AI disorders have a higher risk. We do not know the answer to that because there isn’t any data on it. But if your immune system is over-reactive, it might mean that you can mount a faster attack. The opposite argument could be made as well. If you’re hyper-sensitive to things in your body and you’re self-attacking, then any pathogen that finds its way into your tissues could cause your body to ‘look over there’ and go attack. This is mere conjecture on my part, so please don’t take anything here as gospel. 

Should I continue to take my medications?

If you are taking thyroid medications, it is best to stay on those medications. They do not impair immune function. They simply replenish thyroid hormones that may be lost due to a thyroidectomy, impaired thyroid production or slow activation of T4 to T3. Many studies have shown that adequate levels of thyroid hormone lead to proper immune function, so definitely stay on your thyroid medication as prescribed.

The plot thickens when it comes to medications for autoimmune conditions that seek to suppress your immune function. The idea of these types of medication that suppress immune function is that they slow down the self-attack in autoimmune disease. If your immune cells are slowed and less active from the medicine you take each day, you are at greater risk for the virus. Here’s a perfect situation where staying home saves lives! If you are able to stay at home – and I realize that not everyone can do that – or at least protect yourself very well when you do go to work, then you will have the best chance of avoiding infection in the first place. That should be your goal. 

The short answer to the original question about staying on your medicine (or not) is that it’s better to stay on your medications to control your autoimmune condition, and NOT go off them just because we are still dealing with the pandemic. Please discuss this with your physician.

The imbalance or moreover, the overactive immune attack that is caused by an immune system condition such as Hashimoto’s, Rheumatoid arthritis, psoriasis, MS and Lupus can be difficult to navigate during this time. The reason is that the very nature of your medication is to slightly suppress your immune system so that it attacks your own tissue with less vigor. This is how medications such as Enbrel, methotrexate and oral (systemic) steroids work. Nasal, rectal or topically applied steroids won’t hinder immunity too much, so don’t worry about those. My discussion is about medications like the biologicals and oral steroids, which by the way should NEVER be stopped suddenly. 

These categories of medications suppress an overactive immune system. They help slow down the speed and vigor of the self attack. An autoimmune disorder leads to higher levels of pro-inflammatory cytokines and the immune system might be viewed as overactive, not ‘deficient.’

Everything I say about “autoimmune disorders” could be useful to someone who is on chemotherapy, or has recently gone through it. For example, if you’ve just been treated for prostate cancer, or multiple myeloma, or something similar, then you are greatly more susceptible to complications of the coronavirus. This is because many chemotherapies suppress the immune system, and the higher risk for infection may persist for years. This is termed immunodeficiency. The immune system is weaker than normal and thus, may not be able to mount a fight should a pathogen be encountered. 

There are two categories of people that need to be careful: 
1. Those who are immunodeficient.
2. Those who have high levels of cytokines, due to autoimmune disorders

Because of chemotherapy, or treatment with immunosuppressive agents for autoimmune conditions, you are more susceptible to contracting an infection as compared to others in your age group. Perhaps, in the past, you have dealt with more colds, UTIs, skin infections/wounds, gut infections or other infections that you didn’t get prior to your pharmaceuticals. With COVID-19, that is yet another pathogen to be worried about. 

*Never stop any medication without guidance from your doctor.

But is there a connection?

The scientific literature has to catch up with what I’m telling you. 

No, there is not a clear, definitive connection between people with autoimmune disorders and COVID-19, not as of yet anyway. But this is because we are still compiling data. Everything is happening so fast as you are aware, and it seems like every day the numbers, drug recommendations and opinions change. It’s very hard to navigate through all of this, even as a healthcare professional with 30 years experience! 

But I can tell you that there is no debate on one thing. The condition of having COVID-19 causes an uptick in pro-inflammatory cytokines in the human body. It is the release of these cytokines that does the multi-organ damage. Those who succumb to COVID-19 do so from the uncontrollable spike in cytokines that attacks various parts of the body.

There is also no debate on the fact that people with autoimmune disorders live with a general increase in cytokines, due to the disease itself. If your AI disease is uncontrolled, the cytokine levels may be even higher. 

That’s why the use of certain medications is important to you. They reduce the cytokine levels, one key example is hydroxychloroquinine. That’s exactly what it does, and many others. But in doing so, it is also an immunosuppressive drug! So there’s a good side and a dark side to it, just like every medication. A risk and a benefit. It reduces cytokines, but it also suppresses immunity. This is why the data on hydroxychloroquinine is not clear and definitive.  

I think your risk is probably higher for complications if you have an AI disease because the cytokines will go even higher in the presence of the coronavirus.

Discuss 3 Options with Your Doctor.

Please discuss with a qualified physician. I am not one so I cannot advise.

1. Should I stay on the full dose of my immune-suppressing medicine so that my AI condition does not progress?

2. Should I discontinue my immune-suppressing medicine so that my immune system is stronger, in case I come into contact with COVID-19?

3. Should I take a lower dose of the same medication I’m on, just as a compromise.

4. Are there any herbs, vitamins and supplements that I should be taking?

Final Thoughts and Tips.

1. Shelter in place as much as possible.

2. Don’t invite guests to your home since that raises your risk. 

3. If you go out, wear a mask (or face covering) and latex gloves.

4. Wash your hands often and thoroughly with soap and water.

5. Don’t touch your face.

6. When you get back to your car, remove your latex gloves and sanitize your hands. 

7. When you arrive back home, take off your clothes and shower. 

8. Be sure to leave your shoes out in the garage or utility room, don’t take them into the bedroom.

9. If you have packages, try to open them outdoors using latex gloves. Bring the item inside your home and wash it if possible. 

10. Quickly wash/rinse your food from the grocery store if possible. 

11. If you are truly at high risk, don’t take chances. If possible, have a relative or friend run an errand and bake them a pie to say thanks.

12. Postpone large gatherings and avoid large crowds. This might be prudent during this time

While this may sound extreme, this is a time when taking precautions matters, especially if you have an immune system disorder.

About Suzy Cohen, RPh

Registered pharmacist Suzy Cohen has been a health writer for over 15 years. Her syndicated column, Dear Pharmacist, reaches millions of readers each week and you may have also seen her blogs on The Huffington Post. She has spoken on programs such as Good Morning America Health, The Dr. Oz Show, The 700 Club, The View and The Doctors.

References:

  1. Vitamin D Testing and Treatment for COVID 19. Clinical Trial 2020. Retrieved: https://clinicaltrials.gov/ct2/show/NCT04407286?cond=COVID+vitamin+D&draw=2&rank=1
  2. Investigating the Role of Vitamin D in the Morbidity of COVID-19 Patients. Clinical Trial 2020. Retrieved: https://clinicaltrials.gov/ct2/show/NCT04386044?cond=COVID+vitamin+D&draw=2&rank=2
  3. Increased Risk of Severe Coronavirus Disease 2019 in Patients With Vitamin D Deficiency. Clinical Trial 2020. Retrieved:
  4. Vitamin C Infusion for the Treatment of Severe 2019-nCoV Infected Pneumonia. Clinical Trial 2020. Retrieved: https://clinicaltrials.gov/ct2/show/NCT04403932?cond=COVID+vitamin+D&draw=2https://clinicaltrials.gov/ct2/show/NCT04264533
  5. Early Infusion of Vitamin C for Treatment of Novel COVID-19 Acute Lung Injury (EVICT-CORONA-ALI). Clinical Trial 2020. Retrieved: https://clinicaltrials.gov/ct2/show/NCT04344184
  6. Use of Ascorbic Acid in Patients with COVID 19. Clinical Trial 2020. Retrieved: https://clinicaltrials.gov/ct2/show/NCT04323514?cond=COVID+and+vitamin+c&draw=2&rank=3
  7. Kyaw Myint, P., et al. Plasma vitamin C concentrations and risk of incident respiratory diseases and mortality in the European Prospective Investigation into Cancer-Norfolk population-based cohort study. European Journal of Clinical Nutrition. 2019 Jan;73:1492-1500.
  8. Hemila, H. Vitamin C Supplementation and Respiratory Infections: a Systematic Review. Military Medicine, 2004;11(169):920.
  9. Hemila, H., Louhiala, P. Vitamin C may affect lung infection. Journal of the Royal Society of Medicine. 2007 Nov;100(11):495-498.
  10. Horowitz, R., Freeman, P.R., Three Novel Prevention, Diagnostic, and Treatment Options for COVID-19 Urgently Necessitating Controlled Randomized Trials. 2020 May 22;143:109851.
  11. Eun Kang, J., Jeong Rhie, S. Practice Considerations on the Use of Investigational anti-COVID-19 Medications: Dosage, Administration and Monitoring. Journal of Clinical Pharmacy and Therpaeutics. 2020;00:1-7.
  12. Kumar, A., et al. Potential Role of Zinc Supplementation in Prophylaxis and Treatment of COVID-19. Med Hypotheses. 2020 May 25;144:109848.

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About Dana Trentini

Dana Trentini founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.

Comments

  1. 1992: Detection of coronavirus RNA and antigen in multiple sclerosis brain
    Epidemiological studies of patients with multiple sclerosis (MS) and animal model data support the hypothesis that viruses initiate the immunopathogenic events leading to demyelination in MS. There have been no reports, however, of consistent detection of viruses in MS central nervous system tissue. We probed MS and control brain with cDNA probes specific for human, murine, porcine, and bovine coronaviruses. We report the in situ hybridization detection of coronavirus RNA in 12 of 22 MS brain samples using cloned coronavirus cDNA probes. In addition, tissue was screened for coronavirus antigen by immunohistochemical methods; antigen was detected in two patients with rapidly progressive MS. Significant amounts of coronavirus antigen and RNA were observed in active demyelinating plaques from these two patients. These findings show that coronaviruses can infect the human central nervous system and raise the possibility that these viruses may contribute to the pathogenesis of MS in some patients.
    https://onlinelibrary.wiley.com/doi/abs/10.1002/ana.410310511

  2. Jan Trahan says

    Please do not encourage people to wear latex gloves out in public. If they use them in their own home that’s fine. I am extremely allergic to latex. I can’t even smell it. I have had to find new doctors because of this allergy. I can not be around latex balloons!! I even had to mis my grandson’s birthday party because another group brought in latex balloons. Please be aware there are people out there that have allergies you can’t see.

  3. https://www.btf-thyroid.org/news/thyroid-disease-and-coronavirus-covid-19

    This was published by the BTF a couple of months ago – it’s so hard not knowing what to follow. As a teacher I’m in a really difficult position…

  4. Karen Hooks says

    Do you need to continue taking Synthroid along with this? I’ve taken it for years and have never felt better. I can’t find a doctor who will prescribe anything else for me!

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