©202 2 Michelle Fauver, PhD michelle@consciousmed.org 1 COVID Protection with Supplements Michelle Fauver, PhD March 31 , 2022 COVID remains an ongoing threat to individual and public health. Vaccines are widely recommended as the most effective means of reducing risk of infection and symptom severity. Unfortunately, the vaccines are not fully protective, not everyone is ab le to g et the vaccines , and others have legitimate concerns about vaccine safety. This paper will not look at relative risks of vaccines vs contracting the virus and will instead focus on non - vaccine and non - pharmacological approaches to reducing risk and improvi ng treatment. These approaches can be helpful for both the vaccinated and nonvaccinated. I am a professor of integrative medicine with experience teaching and doing research in Stanford’s School of Medicine, where I was founding co - director of the Program for Integral Health. I have diligently tracked the best available evidence for broader prevention and treatment options during the course of this epidemic. The following materials represent my current understanding of what is helpful , which may change as new evidence comes available. The materials presented below include a summary of recommend ed supplements for prevention and treatment , a few additional supplements that may be effective , a brief description of the evidence (with links to original sources) supporting each of the recommended supplements, and cautions about a couple supplements that may be contraindicated. Disclaimer: I am not a medical doctor. None of the statements in this paper are intended to diagnose, treat, cure, or prevent any diseas e. This information is not meant as medical advice. If you have a medical concern, please consult with a healthcare professional. Table of Contents Summary of Recommendations p. 2 Possible Additional Supplements p. 3 Evidence for Recommended Supplements p. 4 Vitamin C p. 7 Vitamin D 3 p. 10 Zinc p. 13 Quercetin p. 15 Selenium p. 16 Melatonin p. 18 A Few Words of Caution p. 20 ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 2 Summary of Recommendations Prevention The following supplements have shown beneficial effects in reducing the risk of being infected with the COVID virus. • Vitamin C : 2 - 4 g (2,000 - 4,000 mg) per day, may increase to level of tolerance. Buffered forms reduce stomach upset but are only partially absorbed . Liposomal forms are more completely absorbed. Distribute administration during the day, for instance taking half the total daily dose in the morning and half at night. • Vitamin D 3 : 100 mcg (4 , 000 - 5,000 IU) per day. If you h ave not been taking D3 supplements, start with 10,000 IU/day for 3 weeks. • Zinc : 15 - 30 mg per day. use the higher dose if over 50 years old or have ongoing health concerns. • Quercetin : 350 - 500 mg per day. • Selenium : Total selenium intake of 200 - 3 00 mcg per d ay , including food sources. T wo to t hree Brazil nuts per day should suffice. Take at a different time from vitamin C. Do not take more than the recommended amount for an extended period of time. • Melatonin : 5 - 10 mg per day. One hour before usual bedtime. T reatment Immediate action is required in order for treatments to have the best effect. The earlier treatment begins, the better the outcomes Begin treatment level dosages as soon as you believe you were exposed to the virus or when you experience the first possible symptom and continue unt il the symptoms subside. Prepare in advance for a possible infection by having a sufficient supply of these supplements on hand, especially of liposomal vitamin C. Each of these supplements have been shown in clinical trials to provide benefit even when co mbined with conventional medical treatments. Consult with your doctor about possible interactions with medications. • Vitamin C : 8 - 1 2 g (8,000 - 1 2 ,000 mg) per day of liposomal vitamin C, taken in doses of 2 - 3 g four times per day. Increase to tolerance. Some cases required up to 50 grams per day for resolution (th r ough IV and under professional care). • Vitamin D 3 : 250 mcg/ 10,000 international units (IU) • Zinc : 4 0 - 150 mg per day, divided into two or more doses. Continue for 3 - 5 days after symptoms stop. • Quercetin : 500 - 1,000 mg. Do not exceed 1,000 mg daily. • Selenium : Total selenium intake of 3 00 - 6 00 mcg per day , including food sources. Three to six Brazil nuts per day should suffice. Take at a different time from vitamin C. Do not take this amount for lon ger than two weeks. • Melatonin : 20 - 30 mg (or less to tolerance) per day, one hour before usual bedtime, or distributed through the day. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 3 Possible Additional Supplements Sinus spray . The prima ry mechanism of COVID infection is through absorption and initial proliferation of the virus in the nasal membranes . There is a Phase 3 clinical trial scheduled to end soon testing the effectiveness of a nitric oxide (NO) nasal spray as a COVID treatment. This is based on an earlier trial showing the spray was able to reduce viral load by 95% within 24 hours and by 99% within 3 days. This shows a nasally - delivered antiviral can be effective in reducing risk of COVID infection . The NO spray is not yet commercially avai lable , but breathing exercises can increase sinus NO levels Slow, regular, full breaths in and out through the nose lead to increased production of NO in the sinuses. When you hum during the nasal exhale your sinuses collect 15 times as much NO compared to a silent nasal exha le. Even just 2 - 3 minutes can make a big difference, so breathe steadily and hum in the car while driving to any public place. Xlear brand nasal spray can be used before and after venturing out in public. Its two principal active ingredients are grapefruit seed extr act (GSE) and xylitol. Lab - based experiments ( here and here ) and human case studies suggest this combination ha s strong preventive and treatment effects. Lots of research shows GSE has anti - viral activ ity , and xylitol reduces the ability of viruses to attach and implant into the sinus membranes. Even a simple saline spray reduces infection risk and symptoms. Curcumin with pepper Curcumin is the medically - active ingredient in turmeric . Black pepper, which contains piperine, increases your body’s ability to absorb and use curcumin about 20 - fold Piperine has anti - infla mmatory properties of its own, increasing immune function, and has also been found to bind to the protein spikes on the COVID virus and the ACE2 receptors in the host cells, possibly blocking the ab ility of the virus to infect the host cells directly. Curcumin also acts as an anti - oxidant, anti - inflammatory, and anti - depressant, among many other positive effects. Oral curcumin with piperine has shown positive treatment effects against COVID in a randomized clinical trial. Curcumin’s ability to normalize the disruptive inflammatory process that le ads to extreme respiratory distress in COVID are well established I take this daily as a general tonic and would increase the dosage on exposure to the virus. Nigella sat iva . C ommonly known as black seeds and sometimes referred to as black cumin, nigella sativa ha s strong evidence showing multiple positive health effects, including as an anti - viral. Preliminary clinical trials show effectiveness in treating COVID when delivered as an oil or as raw seeds in combination with honey. This plant is safe even at extremely high doses Gut health The microbiota inside our digestive system are strongly tied to a healthy immune system. Two r ecent studies found an important connection between gut health and the risk of long COVID . Research - supported ways to improve gut heath include eating more fruits and vegetables, supplementing with probiotics and amino aci ds , eating fermented foods and yogurt, eating less sugar and other sweeteners, exercising, getting enough sleep, and reducing stress. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 4 Evidence for Recommended Supplements When looking at the evidence for or against any natural substances, we first have to acknowledge the general paucity of information available. There are many possible reasons for this. One that cannot be dismissed is the lack of funding available for natural treatments as the funders generally cannot patent and profit from natural prod ucts. Typically, research in botanical medicine seeks to isolate components from the plant that can then be modified and thus patented. This lack of fund ing dramatically reduces the number of scientists willing or able to accurately assess the effects of these substances. Another reason for the lack of public health support for supplementation is that research funded by profit - based medical organizations consistently yield biased positive re sults , biased policy, and biased treatment recommendations (see for example here , here , and here ). Current prevention and treatment guidelines from the US National Institutes of Health can be found here There is no known effective pharmacological treatment for the most deadly symptom of COVID, severe respiratory distress. The only supplements the y mention are vitamin C, vitamin, D, and zinc, concluding there is not enough evidence yet to recommend them. It is fair to ask what is considered evidence. The gold standard used to be a randomized clinical trial. Now the gold standard is a meta - analysis, which combines the results of multiple studies. The meta - analysis method of research is widely misused to create the results desired. A recent meta - analysis of studies looking at the possible effects of C, D, and zinc supplements on COVID found no evidence they reduced COVID deaths , though they did show vitamin D might lead to shorter hosp ital stays One of the authors said , “ If you don't medically need these supplements, don't take them thinking they're protective against COVID - 19 They're not going to prevent y ou from getting it and they're not going to prevent you from dying." I’ll share only two quick critiques of th e study above . First, the treatments typically began long after the development of symptoms and after the people were hospitalized. We know treatment is more effective wh en begun immediately upon exposure or after first symptom development. Second, the doses given were in most cases small or pathetically small. We have to wonder why. Research document s a clear dose response from many of these supplements. More works better. The studies showing the best results in this meta - analysis still used only half the doses recommended here. For example, one of the studies included in the meta - analysis above tr eated hospitalized patients with moderate to severe symptoms (mean 12 days after symptom onset) with 12 g of vitamin C the first day and 6 g each of the next 4 days. They reported 1 person of 46 in the treatment group died (2.2%) and 5 people of 30 in the control group died (16.7%). This is still far below the treatment dose and duration recommended here. That said, there has been substantial research on many natural medicines, but much less in relation to COVID. There are numerous clinical trials in which natural treatments are given to human participants and measured for effectiveness against COVID, but almost all of them are very small, meaning the results may be unreliab le, and/or they are not yet completed. This means we have strong evidence supporting general effects of these medicines, but less ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 5 information on how these effects play out against this particular disease. We will make do with the information that is curren tly available. Evidence for Combined Supplement s A high - level review of the research done on the value of nutritional supplements in preventing and treating COVID, the authors report, “ Micronutrients such as vitamin C, D, zinc, and selenium play roles in antioxidant, anti - inflammatory, antithrombotic, antiviral, and immuno - modulatory functions and are useful in both innate and adaptive immunity. ... Despite the diversity of studies and the lack of randomized clinical trials and prospective cohorts, there is evidence of the potential protective and therapeutic roles of vitamin C, D, zinc, and selenium in COVID - 19. ” Prevention. A review of systematic review studies shows consistent support for the preventative role of vitamins C and D, zinc, and melatonin in strengthen ing the immune system against Covid and in reducing the inflammatory processes of Covid once contracted. A recent small study looked at the effects of a supplementation proto col very similar to that outlined in this paper. Of the 113 participants, all with multiple exposures to people with COVID during the study period, 53 received supplements and 60 did not. Three people allocated to the treatment group did not follow the rec ommended protocol, so for analysis they were moved to the control group. At 20 weeks, 2 people in the supplement group ( 4.0 %) had developed flu - like symptoms that were tested and found to be non - COVID related. At the same point, 12 people ( 19.0 %) in the co ntrol group developed flu - like symptoms, of whom 9 tested positive for COVID. Let me say that again: 0 COVID infections out of 50 people taking supplements (0.0%) 9 COVID infections out of 63 people not taking supplements (14.3%) Here is the combination of supplements used in the study: • 25 mg zinc • 10 drops of Quina™ (on average; the quina - bark extract may be titrated, as tolerated by some subjects, starting at 1 drop then building up to 8 - 16 drops daily . The larger doses m ay be taken as two 4 - 8 drop h alf - doses twice daily) • 400 mg quercetin [improves zinc uptake] • 1000 mg vitamin C • 1000 IU (25 mg) vitamin D3 • 400 IU vitamin E • 500 mg l - lysine. My take on the study and results is that zinc plays a critical role in reducing COVID risk. I think the vitamin C dose is too low, and the authors don’t mention whether the C was in a liposomal coating, which dramatically improves absorption. Based on other studies I would also add moderate supplementation of selenium and melatonin. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 6 This is a small - scale s tudy and the participants self - selected to receive or not receive the treatments. Both factors reduce confidence in the results; but the dramatic difference in outcomes between the two groups increases confidence that these supplements do in fact reduce in fection risk. Treatment. Another small study looked at treatment safety and symptom progression in a group of 30 COVID patients with mild to moderate symptoms who followed a naturopathic protocol similar to the protocol recommended here. Of the 30 participants, only 1 needed to be hospitalized and none died. The one who needed to be hospitalized did not begin the treatment until after symptoms had been present for 2 8 days. The naturopathic treatments included bone broth, herbs, probiotics, magnesium chloride, and vitamins A and K in addition to the supplements recommended on page 2. The authors reported no side effects or adverse events. They found quicker treatment after the first symptoms was strongly correlated with shorter symptom duration. The benefits of early treatment have also been found in conventional COVID care, though this is still not standard practice. Usually people with a positive diagnosis, even with symptoms , are told to quarantine at home, given no care recommendations, and to ld to “wait and see if the symptoms get worse ” When early treatment was provided to more than 1000 COVID - positive patients using widely available natural and generic medications, t he authors of this paper wrote, “ To date, of those who followed this protocol, we are unaware of a single COVID - 19 - related death, or of a single patient who has required pressure ventilation in an intensive care unit. ” A summary of the treatment plan is availab le here Their treatment plan include s use of vitamins C and D along with zinc as 3 of the 5 first - line medications ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 7 Vitamin C According to the US National Institutes of Health , Vitamin C is a powerful antioxidant that contributes to overall heath, is required for many physiological processes, and helps maintain organismic homeostasis. It is crucial to multiple areas of immune system functioning. Vitamin C has been found to effectively prevent and or treat multiple diseases, including some respiratory infections , and has been found to block some of the chemical processes required for the Covid virus to replicate. Doctors working with COVID - 19 patients in China at the start of the outbreak observed many patient s had better medical outcomes when they used vitamin C supplements. These observations were so consistent they initiated a clinical trial to test the effectiveness of high dose IV vitamin C as a stand - alone treatment. Unfortunately , the trial did not enroll enough people and was stopped. Their study registration includes a body of literature showing vitamin C has positive treatment effects on a wide range of COVID - 19 related symptoms. Intrave nous vitamin C is now being used by doctors in a chain of 23 hospitals in New York for their most seriously ill COVID - 19 patients. Patients are g iven 1,500 mg four times per day. This is still less than the dosage used in China, but NY pulmonologist Dr. Weber said, “The patients who received vitamin C did significantly better than those who did not get vitamin C. It helps a tremendous amount, but i t is not highlighted because it’s not a sexy drug.” The COVID - 19 virus belongs to the same coronavirus family as cold and flu viruses, and produces similar symptoms once infected. Supplementation of vitamin C has been found to reduce the risk of cold infections by half when the person experienced significant physical stress. Keep in mind that psychological stress leads to physical stress. Vitamin C has also been fo und to reduce symptom severity and the duration of colds and flus , and to reduce the risk of flu infection Dr. Hemilä of the University of Helsinki performed the most recent complete analysis of the available research on Vitamin C. Her work shows there is a strong dose response relationship, that is, the higher the vitamin C dose, the stronger the beneficial effects. When discussing the results of her analysi s, Dr. Hemilä concludes that "given the consistent effect of vitamin C on the duration of colds, and its safety and low cost, it would be worthwhile for individual common cold patients to test whether therapeutic 8 g/day vitamin C is beneficial for them. S elf - dosing of vitamin C must be started as soon as possible after the onset of common cold symptoms to be most effective." Many people with severe COVID - 19 symptoms experience respiratory distress requiring admission to a hospital’s intensive care unit (I CU) and mechanical ventilation. A meta - analysis of 6 studies found oral administration of 1 - 3 grams of vitamin C reduced length of stays in the ICU by 8.6%. The combined results from three studies show that vitamin C administration reduced the duration of mechanical ventilation by 18.2%. Remember that per Dr. Hemilä ’s report, these results were found with very low, almost non - therapeutic doses. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 8 I ndividual reports by alternative health practitioners show high - dose vitamin C (up to 50 grams per day) administered through an IV can stop and reverse disease progression, even once the cytokine storm has begun in the lungs. Contrarily, a small clinical trial found no important differences in conventional treatment including hydroxychloroquine and adding 6 grams of IV vitamin C to that combination convent ional treatment. Dosage V itamin C is inexpensive and carries very little risk of harm, even at higher dosing levels. If you choose to supplement with vitamin C as a preventive, you might want to start with 2 grams a day administered orally, preferably us ing a buffered or liposomal form (see the Delivery Methods section below). That should be sufficient to strengthen your immune system. Take the supplements on first waking, 30 minutes before a meal, or more than 2 hours after a meal. If you choose to use a higher dose of regular vitamin C, pay attention to when you begin to develop gastric distress or diarrhea then reduce the dose until those symptoms disappear. To use vitamin C supplementation as a treatment for colds or flus (remember we still have the flu going around), the best results have been obtained by administering 8 - 12 g ( 8 ,000 - 12 ,000 mg) immediately upon appearance of the first symptoms, then continuing that dose daily until the symptoms subside. You may want to keep a supply of liposomal vitam in C on hand to allow you to deliver this high of a dose without unwanted side effects. Delivery The goal with most supplements is to have the nutrient delivered to all tissues throughout the body. This is accomplished primarily through the blood circul atory system. There are three ways of taking vitamin C: standard vitamin C orally, liposomal vitamin C orally, and liquid vitamin C intravenously. These three methods produce widely varying bioavailability of the vitamin, that is, how much of the vitamin t aken in actually gets used by the body. Standard vitamin C, orally – This is the method most people use and are familiar with. The vitamin is ingested and the digestive system is responsible for absorbing the vitamin and carrying it to the bloodstream. But there are problems. Many low - cost vitamin manufacturers pack th e vitamin in pills using binders that are not easily dissolved in the digestive system, so some or most of the pill itself passes through undigested and gets evacuated. Higher quality vitamins dissolve more completely, making more of the vitamin available. Powdered vitamins tend to dissolve even more completely , but the powdered products also tend to be loaded with sugar which is not something you want to add to your diet The second issue is absorption. Vitamin C requires specialized cells in the small i ntestine to carry it through the intestinal walls and into the bloodstream. There are only so many of these cells. Once they’ve carried about 200 mg of C into the bloodstream, the amount they transport drops off rapidly so they start transporting only abou t 50% of the rest of what’s available. This percentage continues to drop as more vitamin C is ingested. This leads to increasingly diminished absorption with increased consumption. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 9 Liposomal vitamin C, orally – Liposomal vitamin C is manufactured with a l ayer of fat around the vitamin molecules, which essentially mimics the action of the specialized transport cells. This allows almost all of the ingested vitamin to move across the intestinal walls into the bloodstream no matter the amount ingested. Because absorption is no longer limited by the availability of the transport cells, there are no diminishing returns with increased consumption. Liquid vitamin C, intravenously – Intravenous administration bypasses the gastrointestinal (GI) tract and delivers vitamin C directly to the bloodstream. The upper limit dosing of 2 g/day mentioned below is based on the potential development of diarrhea due to vitamin C sitting in the GI tract and not being absorbed. There is no safety limit yet identified for IV administration. IV administration of vitamin C can only be performed by healthcare professionals, and several clinical trials using this treatment have been completed. The FDA has not approved high - dose vitamin C for treatment in cancer or other conditions. Safety The Food and Nutrition Board of the US Institute of Medicine set the current recommended intake and safety levels for vitamin C in 2000. Their report says “the evidence of adverse effects due to intakes of vitamin C supple ments is at this time limited to osmotic diarrhea and gastrointestinal disturbances which are self - limiting.” They set the Tolerable Upper Intake Levels (ULs) for adults for vitamin C at 2,000 mg/day based on the adverse effect of osmotic diarrhea Both d iarrhea and gastric distress occur only with oral delivery of standard vitamin C. Diarrhea is caused by unabsorbed vitamin C attracting water to it in the intestines. This can be countered by tak ing a form of vitamin C that is absorbed more fully. Gastric distress, which can be felt as stomach pain, cramping, or nausea, is primarily caused by the high acidity of the vitamin (ascorbic acid). This can be countered by lowering the dose or by using a product that is buffered. Buffering means using a second compound to reduce the acidity of the vitamin C, usually in the form of calcium ascorbate or rose hips. The Food and Nutrition board also recommended that men with any form of kidney disease not take more than 2,000 mg/day to avoid risk of developing kidney stones. This risk has not been found in women (IOM report above ) Pregnant women should not take more than 2,000 mg/day to avoid even the remote possibility of fetal harm. Such harms have not been found in any clinical study, but there have been anecdotal and isolated reports of harm. Five years after the Institute o f Medicine report above was published, a complete review of vitamin C safety studies and clinical trials found “ dietary supplements of vitamins E and C are safe for the general population. ... Many clinical trials with these vitamins have involved subjects with various diseases, and no consistent pattern of adverse effects has occurred at any intake. ” ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 10 Vitamin D 3 Vitamin D 3 is both a nutrient present in some foods and a hormone produced by our bodies through exposure to sunlight. It plays a critical role in immune function. Vitamin D deficiency is widespread, especially among older adults , people with darker skin tones, and those living in areas of the world with less sunlight exposure Overall, about 40% of the US population is deficient, defined as having a blood level lower than 20 ng/mL Vitamin D serves many roles in the body and is necessary for healthy functioning of multiple systems. Partly due to its many actions, there are conflicting findings a s to its effectiveness in pre venting or treating the flu. These conflicting findings continue when researchers focus more on its effects on COVID. A 2022 review of published literature on vitamin D and COVID reports, “ Current evidence suggests that taking a vitamin D supplement to m aintain [normal, healthy levels] , can help reduce the risk of COVID - 19 and its severe outcomes, including mortality. ” Clinical and laboratory evidence indicate s vitamin D operates in two main ways against COVID. First , it increases immune system function in killing off viruses and clearing existing viruses from host cells; and second it reduces the inflamm atory processes produced by COVID infection and helps directly reduce the “ cytokine storm ” implicated in the severe acute respiratory distress that causes so many CO VID deaths. Prevention. An early summary of COVID research on vitamin D as a preventative and treatment concluded “Despite limitations and remaining uncertainties, accumulating evidence strongly supports widespread vitamin D supplementation, in particular of high - risk populations, as well as high - dose su pplementation of those infected.” A systematic review found a strong association between lower vitamin D levels and higher risk of infection. A large - scale study found low vitamin D levels associated with a 77% increase in risk of COVID infection. Later research by the same team found black people with normative healthy levels of vitamin D (target range 30 to 39.9 ng/mL ) were infected at rates more than 2.6x high er than those with D levels higher than the identified “healthy” levels. Increased D levels led to increased protection, but this pattern was found only among the study’s black participants. No additional protection was found among white participants beyon d those obtained by having normal healthy levels. Treatment. H aving healthy or high levels of vitamin D when first infected may influence the course of the disease. According to a study in Israel , p atients with deficient vitamin D levels were 14 times more likely to have a severe or critical case of COVID - 19. Those deficient in vitamin D showed a mortality rate of 25.6% , while those with healthy or higher levels had a mortality rate of only 2.3%. Not all research demonstrates protective effects for initially high vitamin D levels, and similar study designs sometimes yield conflicting results. A retrospective s tudy of 148 hospitalized COVID patients found no difference in fatality rates between those with high or low levels of a vitamin D metabolite (which indicates D levels). Another retrospective study of 287 hospitalized patients found higher vitamin D levels associated with decreased mortality among those over 65 years old and those under 65 who were not obese. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 11 A randomized control trial us ed a single injection of 100,000 IU of cholecalciferol ( one of the hormone forms of vitamin D 3 ) shortly after hospitalization for C OVID. They found no difference in length of hospitalization, admission to ICU, or mortality rate. They did find that people w ith healthy or high levels of vitamin D on admission had less respiratory distress, shorter stays, fewer ICU admissions, and fewer deaths. As a stand - alone treatment for symptomatic COVID, the picture becomes slightly more clear. Early in the pandemic, v i tamin D oral supplements were used in a randomized control clinical trial with hospitalized COVID patients. The authors report that “Of 50 patients treated with calcifediol [the body’s form of vitamin D ] , one required admission to the ICU (2%), while of 26 untreated patients, 13 required admission (50%)”. A very conservative systematic review was p erformed of all clinical trials using vitamin D as a treatment where the outcome measured was ICU admissions and/or deaths. The study found a trend toward improved clinical outcomes with supplementation, and the evidence was especially strong when the supplements were delivered after hospitalization. What this paper did not answer is what doses delivered with what frequency yield the best results. The dosages used in the 13 included studies varied widely. Less conservative but still rigorous systematic reviews , meaning they include more of the clinical trials that have been run and published in medical journals, found more than just a trend toward better outcomes . I n the 4 3 studies that tracked mortality , they report a 76% improvement in mortality rates w hen treatments began soon after symptom development When treatment beg an well after symptom onset, say with moderate to severe symptoms, supplementation with vitamin D led to a 4 8 % improvement in mortality rates. Dosage. Current dose recommendation for adults is to supplement 600 - 800 international units (IU) of vitamin D daily . This level is designed only to ensure proper movement of calcium in the body to maintain bone health. Current recommendations for healthy immune function range from 1,000 to 4,000 IU per day, depending on current blood serum levels. The Endocrine Society recommends doses of 50,000 IU of weekly vitamin D (equivalent to ~ 6,600 IU daily) for 8 weeks t o treat vitamin D deficiency If you have not been supplementing vitamin D 3 , we recommend starting with 10,000 IU/day for 3 weeks. Once you’ve reached immune - enhancing levels, then take 4,000 IU/day thereafter for protection. For treatment, take 10,000 IU per day. Blood levels of less than 20 nanograms per mL (ng/mL) of 25 - hydroxyvitamin D [25(OH)D] are considered deficient for bone health and this is still used as the benchmark. Because of that limited perspective, you will often find sources online recommending levels of 20 - 30 ng /mL as optimal. We have to also recognize these earlier recommendations are based on norms of white adult populations in the United States. As seen in some of the COVID trials, much higher ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 12 levels ar e needed for black populations. There are also differences based on age, sun exposure, diets, and how far away from the equator the person lives. Current best recommendations for whole person health , including immune function and reduced cancer risks, are in the 30 - 60 ng/mL range, with many recommending 50 - 66 ng/mL as ideal. Safety. Vitamin D is considered very safe. A healthy person would need to take very large doses for an extended period of time to reach vitamin D toxicity. Vitamin D supplement ation may lead to dry mouth or headaches. It can also increase blood calcium , which can cause anxiety, confusion, heart problems, ki dney problems, and muscle weakness. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 13 Zinc Zinc is essential for immune function Zinc deficiency is surprisingly common, increases with age , and increases the risk of viral infections. Besides it s protective immune - support role, zinc also acts as a direct antiviral through multiple chemical mechanisms. Zinc has been shown to protect lung tissue , prevent pathogen entry , an d rebalance dysregulated antiviral and inflammatory responses A 2010 study found that zinc combined with ionophores (see quercetin below) effectively shut down replication of the SARS - coronavirus, a close cousin o f the COVID coronavirus. Zinc has long been recommended to treat the common cold, which is also often caused by coronaviruses. A high quality meta - analysis found supplementing with z inc alone reduced symptom s and duration of colds from the usual 7 days down to only 4 days Because of these and other studies, it was recommended at the start of COVID to include zinc as part of an overall prevention and treatment plan. A clinical study of hospitalized COVID patients found a direct correlation between lower zinc levels and increased sympt om severity. Another group used zinc as a treatment for four hospitalized COVID patients. They reported “ All four patients experienced significant improvement in objective and symptomatic disease measures after one day of high dose therapy .” A third study found hospitalized COVID patients given supplemental zinc led to more people being discharged home, and reduced ICU ad missions, need for artificial ventilation, and overall COVID mortality. Dosage. The recommended daily allowance (RDA) for zinc in adults is 11 mg/day for men and 8 mg/day for women. This is for baseline metabolism, not for strengthening the immune system. There are also no separate recommendations for seniors, even though they are known to consistently have lower zinc levels in their bodies. The upper level of regular zinc supplementation not likely to produce negative effects on calcium and copper levels is 40 mg/day in healthy adults. Some treatments call for using up to 200 mg per day of zinc to assist with wound healing while monitoring calcium levels. For strengthening the immune system against COVID infection, a good range is to take 15 - 30 mg/day, d epending on age and health status. For treating COVID, you could increase your intake to 40 - 150 mg/day, perhaps best delivered through lozenges, depending on age and severity of symptoms. Continue for 3 - 5 days after symptoms stop. Delivery. Zinc is found in many foods and common vitamin/mineral supplements Zinc is also commonly available in lozenges, sometimes combined with other vitamins, minerals, or herbs, and marketed as a treatment for colds. This method of delivery can be handy for treating COVID The lozenges come in doses of 5 - 20 mg each. Look for supplements containing zinc picolinate or zinc gluconate. Zinc gluconate worked better in one study than zinc aceta te. Do not be misled by some labels reading zinc in the product name but then elsewhere say they are homeopathic. H omeopathic zinc does not contain zinc. Also avoid lozenges that contain elderberry in combination with zinc. See why the “Words of Caution” s ection at the end of this paper. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 14 Safety. Do not use zinc in nasal sprays as they may lead to loss of sense of smell There are no records of zinc toxicity occurring through eating foods containing z inc. Acute zinc toxicity can usually be induced by ingestion of more than 200 mg of zinc in a single day (in adults). Zinc toxicity may result in gastric distress, nausea, dizziness, and disorientation. Because of how the body processes zinc, high zinc lev els may lead to reduced levels of copper, iron, and magnesium. ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 15 Quercetin Quercetin is a plant pigment bioflavonoid found in many foods , especially in blueberries and red onions Quercetin acts as an anti - oxidant and anti - inflammatory , with immune - enhancing and anti - viral actions as well. Most relevant to this discussion however, is that i t serves as a zinc ionophore, meaning it helps transport the zinc molecule across cell membranes so the cell can make use of the zinc. This action dramatically increases the anti - viral activities of zinc. Quercetin in combination with vitamin C was recommended for COVID prevention and treatment near the start o f the epidemic. Q uercetin demonstrates a strong affinity for binding with the COVID proteins and receptor sites, indicating it may block virus binding and infection of host cells. Laboratory studies show multiple pathways by which quercetin itself reduces and modulates the inflammatory actions leading to severe respiratory distress. Parts of quercet in specifically block entry of the SARS coronavirus from entering host cells. It has strong evidence for effectiveness against related cold and flu viruses , along with quite a few other viruses . A preliminary study of fro nt line healthcare workers regularly exposed to patients with COVID found 1 person of 71 who took quercetin with vitamin C and bromelain tested positive for COVID during the 3 month study period , while 9 of 42 people who did not use the supplements tested positive. Dosage. The usual recommended dose of quercetin is 75 - 250 mg, taken once or twice per day A daily dose of 350 - 500mg provides better protective effects against infection . Do not exceed 500 mg per day . For treatment, increase the dose to 500 - 1, 000 mg/day. Delivery. Quercetin supplements may be purchased in capsule, pill, and powder form. They seem to be equally well absorbed by the body. It can also be delivered intravenously. Safety. While quercetin has produced negative effects in the lab at even moder ate doses, these effects have not been observed in animal or human studies with much higher doses. Three human trials using doses ranging from 3 to 1,000 mg per day for months at a time found no adverse effects (see p. 2194 of this paper fo r sources). There are some reports of temporary damage to kidney function at doses of more than 1 g per day. Generally, side effects are rare and mild, especially as quercetin is found naturally in many foods. These effects may include headaches, nausea, and tingling sensations. Pregnant women, breastfeeding women, and people with kidney disease should avoid high er dose supplements ©202 2 Michelle Fauver, PhD michelle@consciousmed.org 16 Selenium Selenium, like zinc, plays a role in immune function. Many studies show selenium deficiency lowers immune function and selenium supplem entation increases immune function Both population - based studies and clinical trials show it has anti - viral and anti - bacterial properties.