6. Melatonin and COVID-19
The potential utility of melatonin in treating COVID patients has not gone unnoticed, with a PubMed search combining melatonin and COVID producing more than 50 citations.
You may know about melatonin as a supplement that can support your healthy sleep cycle. Melatonin is released by the brain's pineal gland in response to nighttime darkness and is a key regulator of circadian synchrony.
Assisting sleep and rest is already an immune system-supporting benefit, but melatonin has more to offer. It is a powerful antioxidant that supports your immune health, brain, eyes, digestion, and more. It may even be helpful when it comes to COVID-19.
Melatonin is a hormone synthesized in your pineal gland and many other organs. While it is most well-known as a natural sleep regulator, it also has many other important functions. For example, melatonin is a potent antioxidant (Antioxidants, 2020) with the rare ability to enter your mitochondria, where it helps "prevent mitochondrial impairment, energy failure and apoptosis of mitochondria damaged by oxidation." It also helps recharge glutathione and glutathione deficiency has been linked to COVID-19 severity.
As discussed in a review (Cardinali et al. 2020 ), melatonin might counteract the consequences of COVID-19 via salutary effects on the sleep/wake cycle and more generally on chronobiology, as well as through its antioxidant and anti-inflammatory effects.
Based on melatonin's therapeutic potential and well-established safety profile, it has been suggested those at higher risk for severe illness and complications from viral respiratory infection, including the elderly and those with chronic medical conditions, may benefit most from regular use of 3–10 mg melatonin at bedtime (Ref).
Fluvoxamine (Selective Serotonin Reuptake Inhibitor) might also exert beneficial effects in COVID patients through its well-characterized ability to substantially increase (~ 2–3-fold) nighttime plasma levels of melatonin. This increase appears to result from fluvoxamine's inhibition of the melatonin-metabolizing liver enzymes (von Bahr et al.2000).
An Iranian randomised controlled trial (Arch Med Res 2021), studied 74 mild to moderate hospitalized patients. The study showed that adjuvant use of melatonin has a potential to improve clinical symptoms of COVID-19 patients and contribute to a faster return of patients to baseline health.
Data from Cleveland Clinic supports the use of melatonin. Here, the researchers analyzed patient data from the Cleveland Clinic's COVID-19 registry using an artificial intelligence platform designed to identify drugs that may be repurposed.
"Patients who used melatonin as a supplement had, on average, a 28% lower risk of testing positive for SARS-CoV-2. Blacks who used melatonin were 52% less likely to test positive for the virus."
Some researchers have suggested high doses of melatonin, ranging from 50 to 200 mg twice daily, might help treat patients hospitalized for severe acute respiratory illness (Ref).
In a small Philippine case series study of 10 hospitalised COVID-19 patients, high dose melatonin (hdM) was given in addition (adjuvant) to standard therapy. According to the authors:
"High dose melatonin may have a beneficial role in patients treated for COVID19 pneumonia, in terms of shorter time to clinical improvement, less need for MV, shorter hospital stay, and possibly lower mortality."
Production of melatonin diminishes with age, contributing to immune dysfunction and increasing oxidative stress, inflammation, and infection susceptibility (Ref). In addition, infectious viruses can suppress melatonin production, disrupting circadian controls and impairing immune function (Ref).
Melatonin supplementation may reduce the risk of acute viral respiratory infections, help mitigate some chronic health problems that increase infection vulnerability, and protect against neurological and cardiovascular complications of viral respiratory infections (Reiter et al. 2020).
In an observational study that followed 11,672 individuals, melatonin use was associated with a reduced risk of testing positive for a common, highly infectious respiratory virus (Ref).
Another study looked at data from 791 patients intubated for respiratory support during an outbreak of a severe acute viral respiratory illness and 2,981 patients needing the same level of respiratory support for other reasons. The use of melatonin, most often for sleep issues, during the intubation period was associated with significantly improved outcomes in both groups and increased the likelihood of survival in virus-infected patients who required mechanical ventilation (Ref).
As of September 2021, there are 7 published studies on melatonin against COVID-19. For the list of studies, check out c19melatonin.com.
More than 8 studies are currently underway to investigate the benefits of melatonin against COVID-19. Ultimately, the results of the above trials will offer more definitive evidence.
If you take a melatonin supplement, be careful: Too much can cause daytime sleepiness . There is no federal RDA nor any formal advice on supplement dose ranges. Based on an on-going Spanish study, a 2 mg daily dose protocol is being investigated for prevention of COVID-19. Do take note that the dosage for 'prevention' and 'treatment' is different, For prevention or maintenance, a lower dosage is normally recommended whereas a 'treatment' or 'therapeutic' dosage is normally higher.
Related: Nature's Bounty Melatonin 5 mg > One tablet before bedtime (Amazon)
7. Nigella Sativa (Black Seed Oil) and Cytokine Storm
Nigella sativa (N. sativa) is a small flowering plant that grows in Southwest Asia, the Middle East, and Southern Europe (Source). This shrub produces fruit with tiny black seeds. Commonly referred to as black seed, N. sativa seeds go by many other names, such as black cumin, black caraway, nigella, fennel flower, and Roman coriander (Source).
Black seed oil is extracted from N. sativa seeds and has been used in traditional medicine for over 2,000 years due to its many therapeutic benefits.
Thymoquinone which is the active ingredient in N. sativa seeds has demonstrated effects in significantly reducing the cytokine storm chances and consequent mortalities (Source).
Summary results of the 3 Randomized Controlled Trials (RCTs) of Nigella Sativa (n=915) are available on this dedicated webpage: c19ns.com. The 3 RCTs provide evidence that Nigella Sativa was associated with an average improvement of 84% in decreasing the likelihood of death and hospitalisation.
A review of the action of Thymoquinone, the likely active ingredient in nigella sativa (black seed/black cumin), in the lung was published in the International Journal of Nanomedicine (July 2021).
8. Glutathione, NAC and COVID-19
N-acetylcysteine (NAC) is a precursor to glutathione.
According to this paper (2021), SARS-CoV2 infection impairs the metabolism and redox function of cellular glutathione. According to the authors, NAC can prevent this damage and the role of NAC in COVID-19 therapy is worth investigating.
Studies published in ACS Infectious Disease (ACS Infect Dis. 2020) and Antioxidants proposed that glutathione plays a crucial role in the body's fight against the severe inflammatory response triggered by the SARS-CoV-2 virus. The research group in the ACS Infectious Disease study called it the "most likely cause of serious manifestations and deaths in COVID-19 patients."
NAC inhibits cellular entry and replication of some respiratory viruses, assists in clearing thickened mucous from the airways, suppresses inflammatory signalling, and may help mitigate viral infection-induced cytokine storm (Ref).NAC may also protect against coagulation problems associated with COVID-19, as it has both anticoagulant (source) and thrombolytic effects (source), meaning it may both prevent clots and break up clots that have already formed.
In a paper on NAC for COVID-19, published in the October 2020 issue of Clinical Immunology titled "Therapeutic Blockade of Inflammation in Severe COVID-19 Infection With Intravenous N-acetylcysteine", which is a case series report of 10 patients (including one with G6PD deficiency) given intravenous NAC. NAC elicited clinical improvement and markedly reduced inflammatory marker, CRP in all patients. NAC mechanism of action may involve the blockade of viral infection and the ensuing cytokine storm.
Another study, "Endogenous Deficiency of Glutathione as the Most Likely Cause of Serious Manifestations and Death in COVID-19 Patients" was led by Dr Alexey Polonikov from Russia (ACS Infect Dis. 2020).
What he found was that the reactive-oxygen-species-to-glutathione ratio was able to predict the severity of COVID-19 and the patient's outcome. When the patient had a low ROS-to-glutathione ratio, the patient had a very mild case. The fever disappeared on the fourth day without any treatment whatsoever.
When the ROS-to-glutathione ratio was high, the patient developed air hunger on the fourth day, experienced significant fever, hoarseness, myalgia and fatigue persisting for 13 days. A patient with even higher ROS and lower reduced glutathione had critical disease requiring hospitalisation for COVID-19-related pneumonia.
In another publication on Respiratory Medicine Case Reports:
Two patients living in New York City (NYC) with a history of Lyme and tick-borne co-infections experienced a cough and dyspnea and demonstrated radiological findings consistent with novel coronavirus pneumonia (NCP). A trial of 2 g of PO or IV glutathione was used in both patients and improved their dyspnea within 1 h of use. Repeated use of both 2000 mg of PO and IV glutathione was effective in further relieving respiratory symptoms.
Foods that have a positive impact on glutathione production include whey protein and cruciferous vegetables such as broccoli, green tea, curcumin, rosemary and milk thistle. Getting quality sleep may also help.
Different types of exercise can influence your levels as well. In one study, researchers enrolled 80 healthy but sedentary volunteers to measure the type of exercise that may have the greatest effect. They found that aerobic training in combination with circuit weight training showed the greatest benefit.
As of September 2021, more than 10 clinical trials are underway to assess the efficacy of NAC in the context of highly infectious respiratory viral infections.
What Is the Primary Cause of Severe COVID-19 Illness: Glutathione or Vitamin D Deficiency?
The hypothesis that vitamin D (VD) deficiency is responsible for severe manifestations and death in COVID-19 patients has been proposed and is actively being discussed by the scientific community.
Several studies reported that glutathione levels positively correlate with active vitamin D. (PubMed, PubMed)
Interestingly, a recent experimental study (PubMed) showed that Glutathione deficiency and the associated increased oxidative stress epigenetically alters vitamin D regulatory genes and, as a result, the suppressed gene expression decreases Vitamin D production, ultimately leading to a secondary deficiency of vitamin D. This study provides important information that glutathione is essential for the control of endogenous vitamin D production and demonstrates potential benefits of Glutathione treatment in reducing the deficiency of vitamin D. Taken together, these findings suggest that glutathione deficiency rather than vitamin D deficiency is a primary cause underlying biochemical abnormalities, including the decreased biosynthesis of vitamin D, and is responsible for serious manifestations and death in COVID-19 patients.
NAC (N-Acetyl Cysteine)
N-acetyl L-cysteine (NAC), as a precursor of glutathione, helps to replenish intracellular glutathione, a vital cellular antioxidant. NAC has a low molecular weight and is well absorbed via oral administration as compared to glutathione.
NAC may protect against coagulation problems associated with COVID-19, as it counteracts hypercoagulation and breaks down blood clots.
However, NAC has low bioavailability as an oral supplement, meaning that it's not well absorbed.
Glutathione and Zinc
To improve your glutathione, you need zinc, and zinc in combination with hydroxychloroquine (a zinc ionophore or zinc transporter) has been shown effective in the treatment of COVID-19.
Glutathione and Molecular Hydrogen
One of the best ways to increase glutathione, though, is molecular hydrogen. Molecular hydrogen does so selectively and will not increase glutathione unnecessarily if you don't need it. You can view Tyler LeBaron's lecture on the details of how it does this in "How Molecular Hydrogen Can Help Your Immune System."
Glutathione and Selenium
Selenium is also important, as some of the enzymes involved in glutathione production are selenium-dependent.
Glutathione and Blood Clot
Glutathione is also one of thenatural blood thinners as it is known to reverse the build-up of plaque and lessen the tendency of abnormal blood clots.
9. Green Tea (EGCG)
Epigallocatechin-gallate (EGCG) 200mg (prevention) or 400 mg (early treatment) 1 time a day(J. Agric. Food Chem. 2014) is part of the Zelenko protocol for prevention and early treatment of COVID-19. EGCG acts as a zinc ionophore and therefore needs to be combined with zinc.
Quercetin and EGCG act as zinc ionophores (J. Agric. Food Chem. 2014), the same mechanism of action that hydroxychloroquine has via helping zinc pass the cell wall where it might halt viral replication.
The strong oxidative stress-reducing and anti-inflammatory effects of green tea catechins, including epigallocatechin gallate (EGCG), have been well established. A solution of green tea catechins was found to inactivate COVID-19 virus in the laboratory (Ref).
Other laboratory and computer models suggest tea catechins may inhibit viral infectivity and growth (Ref). It has been proposed that EGCG, due to its immune-modulating effect, could have a role in suppressing hyper-inflammation and preventing lung fibrosis in patients with severe acute viral respiratory illness (Ref).
EGCG (Green Tea Extract), Quercetin, Zinc, Vitamin C and D - Zelenko Prevention Protocol
Dr Zelenko's prevention protocolrecommends the following for COVID-19 prevention for Low and Moderate Risk Patients:
2.1. Quercetin(Amazon) 500mg 1 time a day until a safe and efficacious vaccine becomes available. If Quercetin is unavailable, then use
3. Vitamin D3 5000 iu 1 time a day (Amazon)
4. Vitamin C 1000mg 1 time a day (PubMed)(Amazon)
EGCG (Green Tea Extract), Quercetin, Zinc, Vitamin C and D - Zelenko Treatment Protocol
Dr Zelenko's outpatient (over the counter options) 'treatment' protocol recommends the following for COVID-19 treatment for Low Risk Patients:
1. Elemental Zinc 50mg 1 time a day for 7 days (PubMed)
2.1. Quercetin (Amazon) 500mg 2 times a day for 7 days ( PubMed ) OR
2.2. Epigallocatechin-gallate (EGCG) 400mg 1 time a day for 7 days (J. Agric. Food Chem. 2014)
3. Vitamin D3 5000iu 1 time a day for 7 days (Amazon)
4. Vitamin C 1000mg 1 time a day for 7 days
10. Fish Oil (Omega-3 Fatty Acids) and Omega-6
Omega-3 Fatty Acids are part of the I-Recover treatment protocol for Long Haul or Post-COVID syndrome, launched on June 16, 2021 by the FLCCC (Front Line COVID-19 Critical Care Alliance).
A pilot study (Jan 2021) suggests that patients with the most omega-3s in their system were 75% less likely to die from COVID-19. The pilot study was conducted using blood drawn from 100 patients treated for COVID-19 at the Cedars Sinai Medical Center in Los Angeles. The postulated mechanism of action is the well known anti inflammatory role of higher omega-3 levels, which may helped quell the so-called 'cytokine storm' observed in some severe and/or fatal COVID-19 cases.
This protection may have come from the effect EPA and DHA have on the body. An opinion paper published in June 2020 in the journal Frontiers in Physiology expounded on how "EPA and DHA supplementation can alter many biological pathways which may have a direct influence in the outcome of COVID-19."(Front. Physiol., 19 June 2020) The writers listed the many nutrients that play a key role in managing a cytokine storm and continued:
"Among these micronutrients, LC-PUFAs (long-chain polyunsaturated fatty acids) such as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) are noteworthy because of their direct influence in the immunological response to viral infections.
Among these complex immunomodulatory effects, interleukin-6 (IL-6) and interleukin-1ß (IL-1β)—because of the suspected central regulatory role in the "cytokine storm"—should be highlighted."
The omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) modulate inflammatory processes in the body through a variety of mechanisms (Ref, Ref). Severe acute viral respiratory infections can sometimes trigger cytokine storm, in which excessive production of inflammatory cytokines leads to uncontrolled systemic inflammation and life-threatening tissue and organ damage. Another phenomenon, called eicosanoid storm, has also been proposed to contribute to widespread inflammation, tissue damage, and organ failure. Eicosanoid storm is characterized by excessive production of pro-inflammatory and procoagulant eicosanoids made from arachidonic acid, an omega-6 fatty acid synthesized in the body and obtained from dietary animal fat (Ref, Ref). By competing with arachidonic acid for metabolic enzymes, EPA and DHA decrease the production of pro-inflammatory and procoagulant eicosanoids and increase production of specialized inflammation-resolving compounds (Ref, Ref).
Accumulating evidence shows omega-3 fatty acids, administered orally or intravenously, may help control inflammation and improve outcomes in critically ill patients, including those with ARDS.489 A meta-analysis of 12 randomized controlled trials with a total of 1,280 critically ill patients with ARDS found supplementation with omega-3 fatty acids, in combination with gamma-linolenic acid (a less-inflammatory omega-6 fatty acid) and antioxidants, improved markers of lung function; however, only hourly administration, rather than large bolus intravenous dosing, was associated with reduced mortality. Although reductions in mechanical ventilation and length of stay in intensive care were seen, these effects did not reach statistical significance (Ref).
An observational study in 100 patients hospitalized with a severe acute viral respiratory illness found higher levels of EPA plus DHA were associated with lower mortality, though the effect was not statistically significant, possibly due to the small number of participants (Ref). During an outbreak of a severe viral respiratory infection, another study found countries with the highest intake of omega-3 fatty acids from marine sources had lower mortality rates than other regions of the world (Ref). The same research group used computer modeling to show how omega-3 fatty acids might bind to the highly infectious virus and interfere with its ability to enter cells (Ref).
That are more than a dozen studies on-going that examine the effect of EPA and/or DHA on the prevention of or lessening of symptoms of COVID-19.
Evidence suggests the omega-3 fats EPA and DHA affect biological pathways that may have direct influence in the outcome of COVID-19.
EPA and DHA have a direct influence in the immunological response to viral infections and can modulate immune response and function.
Animal-based omega-3 fats, especially DHA, also help prevent thrombosis (a blood clot within a blood vessel) by decreasing platelet aggregation. Hypercoagulation is another complication of severe COVID-19 infection that can have lethal consequences.
Omega-3 also lowers your risk of lung dysfunction, protects against lung damage and secondary bacterial infections, and improves mitochondrial function.
Research shows that by lowering triglycerides, the risk of developing a cytokine storm is diminished. Omega-3 supplementation is known to lower triglycerides, but krill oil does so more effectively than fish oil.
The British Rhinological Society's Guidelines for the Management of New Onset Loss of Sense of Smell During the COVID-19 Pandemic advises that that fish oil supplementation (2,000 mg of omega-3 fatty acids/day) may be beneficial when used in addition to standard treatment (olfactory training, oral steroids and steroid rinses) (Hopkins, Clin Otolaryngol 2020). This position is not based on a clinical trial of fish oil in COVID-19 patients but on limited animal and human research suggesting that omega-3 fatty acids may be beneficial for loss of smell due to olfactory nerve damage.
An interesting development published in Science, Nov 2020 revealed that linoleic acid (omega-6) binds with the 'spike protein' of the COVID-19 virus and interferes with the entrance of the virus into a human cell via the ACE-2 receptors. The study also revealed that in human cells, Linoleic Acid supplementation synergizes with the COVID-19 drug remdesivir in suppressing SARS-CoV-2 replication.
11. B Vitamins and COVID-19
Thiamine (vitamin B1), a water-soluble B-complex vitamin, is rapidly depleted during times of metabolic stress, including severe illness. Thiamine deficiency is common in hospitalized patients, especially those with critical illness (Ref). Thiamine is needed for cellular energy production and helps regulate reduction-oxidation balance, immune function, nervous system function, and vascular function (Ref).
Thiamine, at 200 mg twice daily, reduced mortality in patients with septic shock and thiamine deficiency, and laboratory research suggests it may inhibit the hyper-inflammatory immune response that accompanies cytokine storm (Ref). It is a key therapeutic in the MATH+ protocol (methylprednisolone, ascorbic acid [vitamin C], thiamine, and heparin, plus other supportive nutrients and medications), a treatment strategy proposed for managing advanced stages of severe acute viral respiratory illness (Ref). Although high-quality clinical evidence is lacking, two US hospitals implementing the MATH+ protocol in patients with a severe acute viral respiratory illness reported mortality rates that were approximately one-quarter of those reported from other US hospitals using standard care (Ref).
In a study in Saudi Arabia (Al Sulaiman et al. Crit Care 2021), 738 critically ill COVID-19 patients from two centers were included in the study. The in-hospital death rate and 30-day death rate were significantly lower in the group that received thiamine as an adjunctive treatment (a therapy given in addition to standard therapy). In addition, the thiamine group also were less likely to have blood clot during ICU stay.
Another study of COVID-19 patients with severe symptoms found 26.3% among diabetics with COVID-19 were vitamin B1 deficient.
A study published in November 2020 from Singapore (CW Tan, Nutrition 2020), found that those who were started on a daily oral dose of vitamin D3 (1,000 IU), magnesium (150 mg) and vitamin B12 (500 mcg) within the first day of hospitalisation and continued up to 14 days were significantly less likely to require oxygen therapy and further intensive care.
A case series (published in September 2020) of 9 elderly COVID-19 patients treated with a combination of NMN, zinc, betaine and sodium chloride resulted in rapid improvement.
The topic 'B vitamins' is a complicated subject and that's probably why they are called 'B Complex'.
B vitamins may constitute a long list, but each one is important for different reasons. B vitamins are especially effective in boosting your immunity when you combine the foods containing them so they can all work together for maximum effect. These include vitamin B1 (thiamin), B2 (riboflavin), B3 (niacin), B5 (pantothenic acid) and B7 (biotin).
B12, also known as cobalamin, is a powerful cold- and flu-fighting nutrient in your system, as is vitamin B6, another important, germ-combating vitamin that naturally benefits and strengthens your immune system and even protects against the damaging effects of air pollution.
Vitamin B9 and folic acid help repair tissues and aid in cell metabolism and immune support. They're found in dark leafy greens, wild-caught, cold water fish like herring, mackerel, sardines, anchovies and wild-caught Alaskan salmon, and pastured, organic chicken.
Niacin or vitamin B3 is a precursor to nicotinamide adenine dinucleotide (NAD+). There are three main forms of niacin, which are dietary precursors to nicotinamide adenine dinucleotide (NAD). These are nicotinamide riboside, nicotinic acid and nicotinamide.
Nicotinamide adenine dinucleotide (NAD+) is an essential cofactor in all living cells that is involved in fundamental biological processes. NMN (Nicotinamide MonoNucleotide), is also another precursor to NAD.
Adequate amounts of folate, vitamin B6 and vitamin B12 are also needed for your body to make the amino acid cysteine. N-acetyl cysteine (NAC) is a supplement form of cysteine. Consuming adequate cysteine and NAC is important for a variety of health reasons — including replenishing the most powerful antioxidant in your body, glutathione.
Related: Niacin and COVID-19 - Is Niacin a Missing Piece of the COVID Puzzle?
12. Molecular Hydrogen
There have been a plethora of studies on hydrogen's effects on inflammation, in particular in regulating/controlling inflammatory cytokines. For example:
- A group of scientists in China suggested that hydrogen-rich solution therapy may be a safe, reliable, and effective treatment for Multiple Organ Dysfunction Syndrome (MODS) induced by influenza and other viral infectious diseases ( SOJ Microbiol Infect Dis. 2017).
- In a 2017 lab study published in the World Journal of Gastroenterology, "HRW (hydrogen rich water) treatment significantly reduced EtOH-induced increases in serum alanine amino transferase, aspartate aminotransferase, triglycerol and total cholesterol levels, hepatic lipid accumulation and inflammatory cytokines, including tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-6."
- Another study in 2013 stated "The serum levels of cytokines such as IL-10, TNF-α, IL-12p70, and GM-CSF of mice administered with HW (hydrogen water) was significantly reduced as compared to PW (placebo water) group."
There are at least 30 other high-impact scientific studies that mention hydrogen's observed balancing and lowering effect on inflammatory cytokines.
Beyond the existing scientific studies that show a reason for excitement, hydrogen gas is also now being recommended in China as a therapy for individuals suffering from COVID-19, and there are very positive recorded anecdotal reports from patients.
- The epidemiologist who discovered the SARS Coronavirus back in 2003, Dr. Zhong Nanshan, is now recommending H2 therapy for COVID-19 — you can watch the video where he does so here .
- Other individuals in the scientific community are talking about hydrogen as a possible treatment for COVID-19.
The first preliminary report on COVID-19 patients (n=90) from China has been published demonstrating that Hydrogen/Oxygen mixed gas inhalation has superior effects compared to Oxygen alone (Journal of Thoracic Disease. 2020).
The science behind the virus and potential treatment is, of course, far more complex than this, and we do not intend to simplify the situation whatsoever. Nonetheless, the potential here is interesting — especially when you factor in the safety factor of molecular hydrogen. We will have to see what happens as the science develops and the clinical trials are conducted, and we will update this article with more information as it becomes available.
13. Selenium
Selenium plays a role in immune cell function and activation through its incorporation into enzymes and other proteins. It also reduces infectivity, replication, and virulence of several respiratory viruses (Ref). Sodium selenite, a form often used in supplements, has been found to block an infectious respiratory virus from entering cells by interacting with its spike protein in the laboratory (Ref).
Selenium works closely with vitamin E and cysteine to regulate oxidation and reduction balance and neutralize free radicals, and can help reduce inflammatory signaling by controlling oxidative stress (Ref). Poor selenium status may also increase the likelihood of induction of excess inflammation due to cytokine storm (Ref).
The soil concentration of selenium varies geographically around the world, affecting selenium status and resulting in endemic insufficiency and deficiency (Ref). A study comparing COVID-19 survival to regional selenium status during a major outbreak in China found survival was more likely in high-selenium regions (Ref). A study done during an outbreak in Germany found higher selenium and selenium-containing protein levels in COVID-19 infection survivors versus non-survivors (Ref).
Blood selenium levels have been noted to diminish in patients with critical illness, and lower levels are correlated with more severe illness and lower chance of survival (Ref). A meta-analysis of 19 randomized controlled trials found intravenous selenium supplementation in critically ill patients reduced total mortality (but not 28-day mortality) and shortened the length of hospital (but not intensive care unit) stay (Ref).
In a randomized controlled trial in 40 patients with ARDS, those who received sodium selenite intravenously for 10 days had increased glutathione levels, decreased inflammatory cytokine levels, and improved lung function compared with those who received saline (placebo). However, there were no differences in survival or intensive care unit stay (Ref).
Probiotics are living non-pathogenic microorganisms that, when administered in adequate amounts, can have a positive impact on health. Bacteria in theLactobacillus and Bifidobacterium genera, as well as Streptococcus thermophiles and Saccharomyces boulardii, are examples of common probiotics (Ref).
