• Yousef Zarbalian, MD

Coronavirus Pandemic, part 2 : how to support your immune system

Updated: Apr 25, 2020

Given widespread concern for the growing coronavirus pandemic, I want to share my medical advice as a physician who treats medical conditions that affect the immune system. As a rheumatologist who has seen conditions characterized by an immune system that is out of control, I am well aware of the kind of critical illness and lung inflammation that the coronavirus may unleash (also called ARDS = Acute Respiratory Distress Syndrome). To date, there is very limited research regarding interventions to prevent the immune system from having an auto-inflammatory response to the virus and therefore prevention is more important than anything else we do (see my previous blog post here). However, given many readers of this article have already stocked up on supplements and are now wondering what do with them and how much to take safely, I have posted some of my insights below.

Recommendations to support your immune system:

1) Eat a diet rich in fruits and vegetables

A number of research articles have established that the phytonutrients and flavonoids which are present in every fruit and vegetable have unique antiviral and antibacterial properties. Eating a wide variety of high-quality fruits, vegetables, and grains is arguably more important than any number of supplements out there.

As a single example, cited in this article luteolin was found to have antiviral activity against the previous coronavirus which caused SARS:

Xu et al. [142] tested 400 highly purified natural compounds for inhibition of EV71 and coxsackievirus A16 infections and found that luteolin exhibited the most potent inhibition through disruption of viral RNA replication. Besides these antiviral activities, luteolin or luteolin-rich fractions showed antiviral effects against severe acute respiratory syndrome coronavirus (SARS-CoV), rhesus rotavirus, CHIKV and Japanese encephalitis virus (JEV)

Dietary sources of luteolin include celery, broccoli, green pepper, parsley, thyme, dandelion, perilla, chamomile tea, carrots, olive oil, peppermint, rosemary, navel oranges, and oregano.

2) Get exercise

Within reason and while maintaining appropriate physical distance, get exercise (outdoors if your location is not on lock-down). In multiple studies going back decades, moderate physical exercise has been linked to a lower risk of respiratory viral infection, likely due to its positive impact on immune surveillance and immune regulation.

3) Rest

It is well-established that sleep is important for multiple systems in the body including immune health and infection prevention. Try your best to get 8 hours of sleep per night as there is an association with increased likelihood of respiratory viral infection with 5 or less hours of sleep per night.

4) Stay in touch with friends and family:

One study shows that maintaining social ties is protective of respiratory viral illness

and that loneliness and social isolation predict self-reported symptoms after a viral challenge.

5) Can supplements help?

One of my physician colleagues shared with me the International Society for Orthomolecular Medicine's supplement recommendations which have been circulating for the prevention of Coronavirus infection. Given that I disagree with their dosing of vitamin C based on possible harm, I have listed a few widely used supplements with my caveats below.

Vitamin C

Vitamin D3


Selenium: 100 mcg (micrograms) daily

  • Similar to zinc, it is important to avoid selenium deficiency (excerpt from article below) but mega-doses are unnecessary in people who have a well-balanced diet.

Selenium promotes proliferation and favors differentiation of naive CD4-positive T lymphocytes toward T helper 1 cells, thus supporting the acute cellular immune response.

In summary, I want to emphasize the link between healthy diet/lifestyle and immune health. We should favor prevention with the pillars of long-term human health, as opposed to a "quick fix" approach and supplements.

Dr. Yousef Zarbalian is a rheumatologist, internist, and acupuncturist at East-West Rheumatology which he founded in 2019.

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