Treatments vs ‘a cure’ – flashback to 2020

Vitamin C and Intravenous Vitamin C/Thiamine therapy for cytokine storm are treatments that have a long history of safe and effective use. In early 2020 even vitamin C was getting discredited by the media and FDA as helpful and allowed treatments for Covid19. The post Treatments vs ‘a cure’ was a response to online bickering about there being no ‘cure’ for Covid19 – the implication being it is wrong to talk about how vitamin C can help then.

Vitamin C is an essential nutrient for vascular health and most everything else in a functioning body, indirectly if not directly.

Treatment is about providing all of the care a person needs when their health function is over stressed and possibly dysfunctional in some ways due to inflammation or infection effects. Treatment is well rounded to support various needs and reduce various symptoms.

Looking for a single ‘cure’ is a medical model viewpoint, based on the success of antibiotics, but also the success in early research days when finding and providing vitamin C was a fairly quick “cure” for scurvy – a deadly disease that was found to be “Vitamin C deficiency“. In that case the treatment was the cure. Vitamin D for rickets was also an early wonder cure that helped children grow up with straight and strong leg bones. Vitamin D fortification of milk and infant formula helped reverse that trend. Sadly scurvy is still occurring occasionally and medical professionals miss the diagnosis and simple cure – provide vitamin C.

Scurvy – severe vitamin C deficiency: “The modern doctor must keep this ancient disease in mind, as it presents insidiously with debilitating repercussions, particularly in older people who are at a higher risk. It is easily treatable once detected.” (1)

In the post Treatments vs ‘a cure’, I took a close look at a molecular docking study (3) that had grouped potential inhibitors for SARS-CoV-2 infection or replication into seven categories. I found that my selfcare treatments covered six of the seven categories, and citrus peel alone was potentially helping my infection selfcare in five of the seven ways. In total though I was using many items included in six of the seven categories. (3) SARS-CoV-2 can enter cells in many ways and spreads by exosomes – making many strategies necessary to block it or stop infected cells from remaining a latent infection.

The seven categories:

  1. PLpro inhibitors: “hesperidin and neohesperidin…might be the potential 3CLpro inhibitors and could probably be used for treating SARS-CoV-2.” (3) Citrus peel is a source of hesperidin and neohesperidin and vitamin C – L(+)-Ascorbic acid, quercetinoids, and other bioflavonoids like rutin. (13); Riboflavin-vitamin B2; Silybin – Milk Thistle; “epigallocatechin gallate, [EGCG]…exhibited high binding affinity to PLpro protein, suggesting the potential utility of these compounds in the treatment of SARS-CoV-2.” (3) EGCG – pomegranate peel and/or green tea. EGCG also acts as a zinc ionophore when zinc is available. (11); (–)- Rosmarinic acid – rosemary.
  2. 3C-like main protease (3CLpro) inhibitors: metabolite of riboflavin, Flavin mononucleotide, which a high dose vitamin B2 supplement might provide as the metabolite; Lutein – kale and other vegetables; and also hesperidin, neohesperidin, and rosmarinic acid.
  3. RNA-dependent RNA polymerase (RdRp) inhibitors: silybin – Milk Thistle.
  4. Helicase (Nsp13) inhibitors: hesperidin, neohesperidin and other flavonoids. “The natural products, such as many flavanoids from different sources (α-glucosyl hesperidin, hesperidin, rutin, quercetagetin 6-O-β-D-glucopyranoside and homovitexin), …showed high binding affinity to this target.” (3) Rutin is found in green and black tea and a few other foods. Quercetagetin… seems to be a form of quercetin, which also can act as a zinc ionophore, (11) and is in citrus and pomegranate peel and many plants. Homovitexin is also called isovitexin and is found in cannabis and flaxseed and in a few other foods. (4)
  5. Targets inhibiting virus structural proteins: hesperidin, and “licoflavonol from Glycyrrhiza uralensis” -non DGL licorice root. “By superimposing the ACE2–RBD complex to the hesperidin–RBD complex, a distinct overlap of hesperidin with the interface of ACE2 could be observed (Fig. 6C), suggesting hesperidin may disrupt the interaction of ACE2 with RBD [the RBD section of the SPIKE protein]. ” (3)
  6. Targets inhibiting virulence factor: did not include any that I was taking.
  7. Targets blocking host specific receptor or enzymesneohesperidin and hesperidin from Citrus aurantium again, the two phytonutrients are also in the peel of other citrus species. (5) “The natural products, such as phyllaemblicin G7 from Phyllanthus emblica, xanthones from the plants of Swertiagenus, neohesperidin and hesperidin from Citrus aurantium, exhibited potentially high binding affinity to ACE2 protein. ” (3

Hesperidin is in five of the seven categories; neohesperidin in four; and riboflavin, silybin and rosmarinic acid might help in two ways. Pomegranate peel phytonutrients likely also can help in numerous ways.

Treatments are needed for multifactorial problems, and SARS-CoV-2 or chimeric spike effects include multiple routes of possible harm. To ‘cure’ this – we need many treatments.

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Callus CA, Vella S, Ferry P. Scurvy is Back. Nutr Metab Insights. 2018 Nov 21;11:1178638818809097. doi: 10.1177/1178638818809097. PMID: 30479485; PMCID: PMC6249652. https://pubmed.ncbi.nlm.nih.gov/30479485/
  2. J Depew, Treatments vs ‘a cure’, April 3, 2020, transcendingsquare.com, https://transcendingsquare.com/2020/04/03/treatments-vs-a-cure/
  3. Canrong Wu, Yang Liu, Yueying Yang, et al., Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. Acta Pharmaceutica Sinica B, 27 February 2020, https://doi.org/10.1016/j.apsb.2020.02.008 https://www.sciencedirect.com/science/article/pii/S2211383520302999 * the genetic structure of the SARS-CoV(2) virus more closely matches the first, 2003, SARS-CoV virus in the way it can enter at ACE2 Receptors than it resembles the genetic structure of the coronavirus from bats native to China. There has also not been research support of the theory that the bat virus can infect humans as the shape does not fit the human ACE2 receptor: “…4 among the 5 most important amino acids (L465, L495, Y502, D510, and H514) that bind to ACE2 12 in Bat-CoV RaTG13 differ from SARS-CoV-2 (Fig. 3C). And there is no related research literature about whether Bat-CoV RaTG13 can infect human yet.”
  4. The other numbered references are on the original post. See 2 above. https://transcendingsquare.com/2020/04/03/treatments-vs-a-cure/

Pomegranate Peel/extract may help increase NAD+

Niacin supplementation may help when NAD+ is low during inflammatory conditions, which might include a viral infection or recovery. This topic was introduced in the recent post Kale & Carrots – super good right? maybe not for everyone. NAD+ levels also tend to be reduced with aging and may be a factor in chronic illness associated with aging. Promoting better NAD+ levels may help protect against aging and chronic illness associated with aging. “NAD+ levels decline during ageing, and alterations in NAD+ homeostasis can be found in virtually all age-related diseases, including neurodegeneration, diabetes and cancer. ” (3)

Providing niacin (6) and niacinamide would be helpful to promote more NAD+ as niacin can be made into the chemical. Preventing breakdown is another way to promote more NAD+. (3) EGCG was mentioned within the reference list of the Kale & Carrots post in some excerpts. EGCG may be able to promote more NAD+ within cells, and a few other flavonoid phytonutrients that may help reduce breakdown of NAD+ by inhibiting the enzymes involved in its metabolism. (7)

  • EGCG: “NMNATs are also attractive targets for raising NAD+ in cells because they have dual substrate specificity for NMN and nicotinic acid mononucleotide (NaMN), and they contribute to both de novo and salvage pathways (Zhou et al., 2002). The green tea compound epigallocatechin gallate [EGCG] has been reported to activate NMNAT2 by more than 100% and NMNAT3 by 42% at 50 mM, although this needs to be confirmed, as no data were presented in the paper (Berger et al., 2005).” (7)

Pomegranate peel/extract is also a source of EGCG. Pomegranate preparation tips and more information about health benefits is able on page effectivecare.info/G13. Pomegranate. It may have anti-inflammatory activity through down regulation of Fox03a (4) which is a protein that can increase oxidative stress damage in mitochondria (5) where the NAD+ chemical reactions are taking place.

  • Other phytonutrients may also be helpful to promote NAD+ by decreasing breakdown of it: “An alternative approach to raising NAD+ is to inhibit its degradation either by inhibiting PARPs or NADases, also known as glycohydrolases. The major NADase in mammals, CD38, is inhibited in vitro at low micromolar concentrations by flavonoids including luteolinidin, kuromanin, luteolin, quercetin, and apigenin (IC50 < 10 mM) .” (7)

Luteolinidin is an plant extract (a deoxyanthocyanidin) that is still in research phases for use as a CD38 inhibitor. (1) Kuromanin is also a plant extract, an anthocyanin, available for sale (expensive), under investigation as a CD38 inhibitor (preventing breakdown of NAD+) and neuro protectant. (2)

  • Luteolin is a flavonoid “found in celery, thyme, green peppers, and chamomile tea,” (18) and “chrysanthemum flowers, sweet bell [green/red/orange] peppers, carrots, onion leaves, broccoli, and parsley [78]. (21)
  • Quercetin – is in onions, garlic, green leafy veg, citrus peel, figs, and is a focus of several recent posts: Citrus Fig jam: (14), Hesperidin & quercetin content in citrus peel: (15), Decongestant properties of hesperidin/citrus peel: (16).
  • Apigenin is a flavonoid found in “grapefruit, plant-derived beverages and vegetables such as parsley, onions, oranges, tea, chamomile, wheat sprouts and in some seasonings.” (19) (Intake of more dietary flavonoids on average was associated with a reduced cancer risk. (19))
  • For references (14, 15,16, 18, 19, 21) see post: Phytonutrients that may help against SARS-CoV-2.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Luteolinidin chloride, medchemexpress.com, https://www.medchemexpress.com/luteolinidin-chloride.html
  2. Kuromanin chloride, goldbio.com, https://www.goldbio.com/product/4730/kuromani-chloride
  3. Katsyuba, E., Romani, M., Hofer, D. et al. NAD+ homeostasis in health and disease. Nat Metab 2, 9–31 (2020). https://doi.org/10.1038/s42255-019-0161-5 https://www.nature.com/articles/s42255-019-0161-5?proof=t
  4. Liu S, Zhang X, Sun M, Xu T and Wang A: FoxO3a plays a key role in the protective effects of pomegranate peel extract against amikacin-induced ototoxicity. Int J Mol Med 40: 175-181, 2017 https://www.spandidos-publications.com/10.3892/ijmm.2017.3003
  5. Tseng AH, Shieh SS, Wang DL. SIRT3 deacetylates FOXO3 to protect mitochondria against oxidative damage. Free Radic Biol Med. 2013 Oct;63:222-34. doi: 10.1016/j.freeradbiomed.2013.05.002. Epub 2013 May 7. PMID: 23665396. https://pubmed.ncbi.nlm.nih.gov/23665396/
  6. Pirinen E, Auranen M, Khan NA, Brilhante V, Urho N, Pessia A, Hakkarainen A, Kuula J, Heinonen U, Schmidt MS, Haimilahti K, Piirilä P, Lundbom N, Taskinen MR, Brenner C, Velagapudi V, Pietiläinen KH, Suomalainen A. Niacin Cures Systemic NAD+ Deficiency and Improves Muscle Performance in Adult-Onset Mitochondrial Myopathy. Cell Metab. 2020 Jun 2;31(6):1078-1090.e5. doi: 10.1016/j.cmet.2020.04.008. Epub 2020 May 7. Erratum in: Cell Metab. 2020 Jul 7;32(1):144. PMID: 32386566. https://pubmed.ncbi.nlm.nih.gov/32386566/

Treatments vs ‘a cure’

The question of what is a treatment versus what is a cure has been an issue online, while writing and communicating about dietary foods, supplements, or medications that might help treat patients with SARS-CoV(2) – Coranovirus Disease 2019, or COVID-19. The definition of the words suggest that a treatment is anything that helps with management of symptoms of a chronic or acute/short term illness, while a cure – to be cured – is something that resolves an illness.

Addition: It is being recommended to the FDA to fast track approval for preventive, early treatment with zinc and an anti-malarial and an antibiotic that are fairly available and have a long history of use, so risks and dosing have been studied. “It’s important to note that HCQ, zinc, and azithromycin are very well understood drugs with clear safety profiles; they are widely available, generic, inexpensive, and can be scaled rapidly, including to the developing world, which would be expedited by US leadership in recommendations.” More is included in the second half of this post about the zinc and anti-malarial medication. See this document for the recommendation to the FDA: (Immediate Treatment for Early Stage SARS-CoV-2 Infections).

Many treatments might be used to help a person become cured of a curable illness – so every single person that has recovered from being ill with the viral COVID-19 infection can be said to have been cured – with whatever treatments they used at home or were provided in a health care setting. I was sick with an untested illness that included symptoms matching the description and time-frame of the current pandemic infection. Once blood serology tests for antibodies becomes more widely available I may be able to have confirmation that the illness I had was due to the SARS-CoV(2) virus, (2/20 suspected exposure, 2/28 symptoms began, recovery took weeks).

Symptoms for me, and many people, started with a couple days of headache, exhaustion, nausea, vomiting, hot and cold feverish chills, and diarrhea. I coped by not eating, even water was nauseating. I stayed hydrated by sipping small amounts of water with a tablespoon or two of lime juice in it. Lemon juice or apple cider vinegar would also have provided similar acidity to stomach acid – if even water is nauseated then there is a problem with stomach acidity.

Along with the diarrhea there was intestinal pain with eating. The only foods that were very soothing were oranges with the white pith part of the peel left on and bean soup or sweet potato made with hydrolyzable tannins from pomegranate peel or walnuts. See the post ACE2, Diarrhea, COVID19, – It gets complicated.

The nausea and vomiting for me only lasted a couple days, the diarrhea lasted longer, a week or so, and as that was improving my cough, sore throat and difficulty breathing worsened. The cough became non-productive which translated from medical jargon equals – sticky thick mucus that just couldn’t be coughed out. There was an urge to cough and it would get bad enough to become oxygen deprived and see ‘stars’ – those little sparkly specks of whatever your brain/eyes are doing when you get too low in oxygen or with a severe headache.

The oranges with white part of the peel left on were soothing to the digestive system and helped thin the sticky mucus, can’t cough anything out problem. Hot steamy soup also helped thin the too-thick mucus problem so I was able to cough and feel better instead of worse. I was also using chewable vitamin C tablets, 100 milligram, which I had on hand and typically take one a day. I was using an extra one or two a day during the worst of the coughing.

Self-care strategies using nutrients/phytonutrients in moderate doses are considered First Aid rather than a medical treatment. Vitamin C Infusion given intravenously in high doses provided by a medical professional would be considered a medical treatment while my use of a chewable Vitamin C tablet in a 100 milligram dose for a sore throat would be considered First Aid, based on a definition within an employment policy about Workman’s Compensation. (wisconsin.edu/Medical Treatment Beyond First Aid).

Vitamin C has a recommended daily minimum intake of 60 milligrams for non-pregnant adults and 100 milligrams is only slightly more. High dose intravenous treatments may provide 15 grams over the course of the day. Adverse reactions are rare and the treatment has been successful for improving survival rate in the case of sepsis shock which can involve an excess of cytokines.

Many herbal nutrients can help the body have an immune reaction that is enough to cope with an infection without becoming an overactive response that results in an excessive amount of cytokines to be produced. I may have been lucky in my recovery or it may have been aided by the variety of nutrients and phytonutrients that I take as supplements or within my diet in the form of nutrient dense foods – or citrus peel and pomegranate peel – not typically considered food but very edible when the outer layer is removed and the white inner part is eaten, or the outer layer is prepared so only small amounts are used.

Traditional Chinese Medicinals (TCM) are used in combinations and are thought to be more effective than the herbs would be used singly. Individualized care by a trained practitioner is recommended as with any other medical care. The herbs have also been studied for potential use as anti-inflammatory medications if an active phytonutrient can be identified. Corylin from Psoralea corylifolia L. (Fabaceae) an herb used in both TCM and Ayurveda traditional healing has been found to have immunomodulatory effects which means it can help the body have enough of an immune response but not an overactive sepsis response. (2)

A computer modeling of the genetic structure of the SARS-CoV(2) virus was compared to a database of western medicines and a database of Traditional Chinese Medicinal herbs for potential treatments. Different areas of viral replication or cell entry were identified as possible targets for therapeutic agents and the potential treatments identified from the databases were grouped by the mechanism of action. (3)

Going through the list suggested that my routine use of multiple herbs, nutrient supplements, and nutrient dense foods may have helped my recovery as I use several of the potential therapeutic agents including some with different mechanisms of action.

  • In the first section PLpro inhibitors, I used citrus peel daily which includes hesperidin and neohesperidin and L(+)-Ascorbic acid – vitamin C, (13): “hesperidin and neohesperidin…might be the potential 3CLpro inhibitors and could probably be used for treating SARS-CoV-2.” (3)
  • The section also includes Riboflavin-vitamin B2 which I take a high dose of as it is water soluble and not available singly in RDA doses;
  • Silybin- which I would have in my Milk Thistle supplement;
  • and “…epigallocatechin gallate, [EGCG]…exhibited high binding affinity to PLpro protein, suggesting the potential utility of these compounds in the treatment of SARS-CoV-2.” (3) I use EGCG daily within pomegranate peel and/or green tea. It can also act as a zinc ionophore when zinc is available. (11)
  • (–)- Rosmarinic acid – is found in rosemary, an anti-inflammatory herb that I use generously in cooking because of the pain relieving/anti-inflammatory properties.
  • In the second section, 3C-like main protease (3CLpro) inhibitors: I would have a metabolite of riboflavin, Flavin mononucleotide, from my high dose vitamin B2 supplement, and Lutein which is found in cooked kale and other produce. The citrus peel phytonutrients hesperidin and neohesperidin also have this mechanism of action and rosmarinic acid from rosemary.
  • In the third section, RNA-dependent RNA polymerase (RdRp) inhibitors: silybin, in Milk Thistle is included again.
  • In the fourth section, Helicase (Nsp13) inhibitors, the citrus peel phytonutrients hesperidin and neohespiridin are mentioned along with other plant flavanoids: “The natural products, such as many flavanoids from different sources (α-glucosyl hesperidin, hesperidin, rutin, quercetagetin 6-O-β-D-glucopyranoside and homovitexin), …showed high binding affinity to this target.” (3) Rutin is found in green and black tea and a few other foods. Quercetagetin… seems to be a form of quercetin, which also can act as a zinc ionophore, (11) and is in citrus peel. Homovitexin is also called isovitexin and is found in cannabis and flaxseed and in a few other foods. (4)
  • In the fifth section, Targets inhibiting virus structural proteins, flavonoids are included again, with hesperidin and neohesperidin from citrus peel in my diet and “licoflavonol from Glycyrrhiza uralensis” in my supplement of licorice root. “By superimposing the ACE2–RBD complex to the hesperidin–RBD complex, a distinct overlap of hesperidin with the interface of ACE2 could be observed (Fig. 6C), suggesting hesperidin may disrupt the interaction of ACE2 with RBD [the RBD section of the SPIKE protein]. ” (3)
  • The sixth section Targets inhibiting virulence factor did not include any herbals that I take or eat regularly.
  • The seventh section Targets blocking host specific receptor or enzymes included neohesperidin and hesperidin from Citrus aurantium again, the two phytonutrients are also in the peel of other citrus species. (5) “The natural products, such as phyllaemblicin G7 from Phyllanthus emblica, xanthones from the plants of Swertiagenus, neohesperidin and hesperidin from Citrus aurantium, exhibited potentially high binding affinity to ACE2 protein. ” (3)

Six out of seven sections – and multiple possible phytonutrients or nutrients within the different potential areas targeting the virus mode of entry into the human cell at the ACE2 receptor or the viral replication process – I am recovered, and my use of the white part of the orange peel may have helped in five of the seven targets of action. Is it a cure? I am cured, recovered, not on a ventilator. I did have to stop smoking medical marijuana because I could tell I was heading for needing an asthma inhaler but I continued to use edible sources of cannabis as it helps a variety of health issues for me. I also use a high dose of zinc and the quercetin in citrus peel and onions, and EGCG in pomegranate peel and green tea, are both zinc ionophores – meaning they act as transport carriers to get zinc into an infected cell where the zinc can disrupt viral replication.

To use a sports metaphor – I like to cover all my bases, and shortstop, and center field, left and right field too. The wonder of nutrients and phytonutrients is they tend to be very low risk, some may have risk of overdose but not typically.

Treatments, multiple treatments might help provide a ‘cure‘, which refers to a recovery from illness. The idea that one medication is all you need to be ‘cured‘ became more of an expectation after antibiotics were discovered – however microbes mutate and become resistant when one drug is used consistently – and then the drug is no longer a cure. Using multiple treatments, that target different aspects of a pathogen’s mode of infection and replication needs, may help prevent mutations that make a single ‘cure‘ obsolete due to the pathogen developing resistance to the drug.

Many treatments might be needed for the various stages and range of symptoms that can occur with the COVID19, SARS-CoV(2) virus. It is new, waiting for clinical trials isn’t very helpful for people who are already sick. Citrus peel is readily available in fresh fruit or in Middle Eastern groceries as whole dried limes or powdered dried lemon or lime, and in the Traditional Chinese Medicinal Chen Pi. The whole peel includes the more bitter and potent outer part of the peel. One to two teaspoons is a more typical dose of the TCM Chen Pi and it would be used with a few others. The TCM guidance for COVID19 included licorice and astragalus which I also use daily as a supplement.

The inner white part of the peel is milder in flavor, I have been using an entire orange daily, half in the morning and half in the evening. This is my story, which I’m sharing as an example. Food is a personal choice, and fairly safe compared to many medications.

An orange peeled so the white pith remains.
The orange zest layer of the orange peel can be trimmed to leave the white pith with the sweet orange wedges. It is a rich source of quercetin, hesperidin, neohespidin and vitamin C..

Best of health, and best of appetite to all. – Severe lack of appetite, and also loss of sense of smell and taste, can all be symptoms of zinc deficiency. The infection process can use up nutrients faster than during normal health. Providing extra nutrients may be needed to promote healing – is that just expensive urine or an inexpensive ‘cure‘. If the person recovers from an illness – then they are cured. Waiting for clinical trials when nontoxic inexpensive solutions might be sitting on the grocery shelf seems like a mistake that can cost unnecessary lives.

Zinc with the aid of Zinc Ionophores also disrupt Viral Replication.

Zinc also has antiviral properties. Once it is carried into a cell by a zinc ionophore, whether nontoxic quercetin, EGCG, (11, 12) or potentially toxic Chloroquine or Hydroxychloroquine, (10), then it disrupts viral replication (6) by the mechanism of action in the third section – RNA-dependent RNA polymerase (RdRp) (3) of the computer modeling article.

Chloroquine and Hydroxychloroquine preferentially collect in the lungs which helps increase potency with smaller doses, part of risk is due to the medications also collecting more in cells with melanin which include skin and eye cells – damage to the eyes can be a risk with large doses or extended us for years as a malaria or autoimmune disease treatment. People with cardiac problems may also be more at risk of adverse cardiac reactions. (7)

Low magnesium (hypmagnesemia) or low potassium (hypokalemia) blood levels can be an indicator of cardiac risk with the use of Chloroquine or Hydroxychloroquine. (7) Dietary consult (me) would include in a hospital chart note the reminder that low magnesium levels can cause a suppression of potassium levels and therefore correcting the low magnesium might improve the potassium level too, and help protect against the risk of adverse cardiac events. (8)

With poor intestinal absorption low magnesium can become an acute risk – sudden, short term, or it can be a problem with chronic intestinal malabsorption of magnesium. Topical sources of magnesium can be absorbed through hair follicle pores. Magnesium chloride in lotions or liquid can be applied to the skin, or a foot soak or a bath with Epsom Salt, magnesium sulfate, can also be a beneficial source of bioactive sulfate. Foot soak, approximately 40 minutes for me, 1 cup Epsom Salt in a large wastepaper basket size container where the lower legs will also be covered by the magnesium rich water. Bath, approximately 20 minutes for me, research based also, with 1-2 cups of Epsom salt in a half-full bathtub. (9)

Just because a treatment is low cost, readily available, low toxicity risk, and effective, does not mean it is bad, it may just be bad for someone’s profit margin. Quercetin is readily available in many foods, raw red onion it the best source, although citrus peel may not have been included as a typical ‘food’ source. (14, 17) EGCG supplements are available derived from green tea, pomegranate peel is also a very good source and pomegranate season may be just near the end of availability for southern hemisphere consumers. Powdered pomegranate peel may be available in limited amounts. Citrus peel is readily available as fresh or dried products. Epsom salt is available in drugstores and the pharmacy section of department stores.

There has been some controversy in the US regarding use of chloroquine or hydroxychloroquine for treatment of patients with COVID19 infections. Supply issues can be resolved with increased production. The medication is also used for autoimmune patients (18) (who might be able to use artemisinin instead (15) or pomegranate peel (16), but ideally provide the pomegranate peel with zinc also, (11, 12) ) and there has been some trouble with filling their prescriptions due to an increase in demand due to the COVID19 epidemic. Production can be increased, the cardiac risk might be able to be reduced if topical sources of magnesium are provided to patients.

Whether the dose used is enough for effective control of viral replication is the theme of pdf presentation. Too low a dose may have been used in clinical trials that didn’t show efficacy for COVID19 treatment. Tere is a narrow range before toxicity is reached. Having a larger loading dose followed by smaller daily doses broken up into several small doses may be safer, while providing enough to be effective against the viral infection. (7) My big question would be – how much zinc was provided to patients in those trials? The pdf (7) never mentions zinc at all — while the chloroquines may also have some other antiviral capability, they have been shown to be effective against malaria when zinc is present in almost an equal weight to the chloroquine dose. (19)

Returning to my own health story – I do take a high dose zinc supplement for suspected pyroluria symptoms (might be genetic condition affecting an enzyme that would preserve the body supply of zinc and vitamin B6) and I did have more severe muscle cramps as part of my symptoms which is fairly normal for me and Epsom salt baths or footsoaks every 5-7 days helps to prevent or resolve the muscle cramps. Some individuals or conditions may cause long term problems with absorption of magnesium from the diet, or due to increased urinary loss of magnesium. Illness can increase need for magnesium as well as possibly decreasing absorption and increasing loss in sweating more, due to a high fever, or in urinary losses.

The heart is a muscle and all types of muscle use calcium to contract and magnesium to relax. Magnesium is given intravenously as a treatment for the long QT interval/Torsades de Pointes tachycardia that can be a cardiac adverse reaction with chloroquine treatment. (20) Why not give magnesium in a footsoak, before having a dangerous cardiac reaction?

Quercetin plus zinc has FDA approval for use in treatment of COVID19, Canadian research team.

  • CBC News Interview with “Dr. Michel Chrétien’s team at the Clinical Research Institute of Montreal” : Canadian team invited to do clinical trials in China for antiviral drug. *Quercetin deriviative plus zinc given 3-4 times per day, I hven’t found any results online yet. Feb 28, 2020, (youtube).

Disclaimer: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

Reference List

  1. Medical Treatment Beyond First Aid, wisconsin.edu,
  2. Hung, Y., Fang, S., Wang, S. et al. Corylin protects LPS-induced sepsis and attenuates LPS-induced inflammatory response. Sci Rep7, 46299 (2017). https://doi.org/10.1038/srep46299 https://www.nature.com/articles/srep46299
  3. Canrong Wu, Yang Liu, Yueying Yang, et al., Analysis of therapeutic targets for SARS-CoV-2 and discovery of potential drugs by computational methods. Acta Pharmaceutica Sinica B, 27 February 2020, https://doi.org/10.1016/j.apsb.2020.02.008 https://www.sciencedirect.com/science/article/pii/S2211383520302999 * the genetic structure of the SARS-CoV(2) virus more closely matches the first, 2003, SARS-CoV virus in the way it can enter at ACE2 Receptors than it resembles the genetic structure of the coronavirus from bats native to China. There has also not been research support of the theory that the bat virus can infect humans as the shape does not fit the human ACE2 receptor: “…4 among the 5 most important amino acids (L465, L495, Y502, D510, and H514) that bind to ACE2 12 in Bat-CoV RaTG13 differ from SARS-CoV-2 (Fig. 3C). And there is no related research literature about whether Bat-CoV RaTG13 can infect human yet.”
  4. Showing Compound Isovitexin (FDB000614), Foodb.ca, https://foodb.ca/compounds/FDB000614
  5. Rhyu, Meera & Kim, Eun-Young & Bae, In Young & Park, Yong-Kon. (2002). Contents of Naringin, Hesperidin and Neohesperidin in Premature Korean Citrus Fruits. Korean Journal of Food Science and Technology. 34. https://www.researchgate.net/publication/263398834_Contents_of_Naringin_Hesperidin_and_Neohesperidin_in_Premature_Korean_Citrus_Fruits
  6. Aartjan J. W. te Velthuis, Sjoerd H. E. van den Worm, Amy C. Sims, et al., Zn2+ Inhibits Coronavirus and Arterivirus RNA Polymerase Activity In Vitro and Zinc Ionophores Block the Replication of These Viruses in Cell Culture. PLOS Pathogens, Nov. 4, 2010, https://doi.org/10.1371/journal.ppat.1001176 https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1001176
  7. Umer, PDF about dosing and safety risks of the medications chloroquine and hydroxychloroquine.  Hypokalemia and hypomagnesemia can increase risks of cardiac side effects – Epsom salt foot soaks might be helpful, hypokalemia can be due to low magnesium availability in addition to low potassium intake or other metabolic imbalance due to hormones.  https://drive.google.com/file/d/19T-QIaE6FT-PzfWcnbTr5g6ZnV34WcL2/view?usp=drivesdk 
  8. Hypomagnesemia, MedicalNewsToday.com, https://www.medicalnewstoday.com/articles/321735
  9. J. Depew, Epsom salt footsoaks, Feb. 19, 2019, transcendingsquare.com, https://transcendingsquare.com/2019/02/19/epsom-salt-footsoaks/
  10. Xue J, Moyer A, Peng B, Wu J, Hannafon BN, Ding W-Q (2014) Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. https://doi.org/10.1371/journal.pone.0109180 https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0109180
  11. Dabbagh-Bazarbachi H, Clergeaud G, Quesada IM, et al., Zinc ionophore activity of quercetin and epigallocatechin-gallate: from Hepa 1-6 cells to a liposome model. J Agric Food Chem. 2014 Aug 13;62(32):8085-93. doi: 10.1021/jf5014633. Epub 2014 Jul 31. https://www.ncbi.nlm.nih.gov/pubmed/25050823
  12. Houston DMJ, Bugert JJ, Denyer SP, Heard CM. Potentiated virucidal activity of pomegranate rind extract (PRE) and punicalagin against Herpes simplex virus (HSV) when co-administered with zinc (II) ions, and antiviral activity of PRE against HSV and aciclovir-resistant HSV [published correction appears in PLoS One. 2017 Nov 20;12 (11):e0188609]. PLoS One. 2017;12(6):e0179291. Published 2017 Jun 30. doi:10.1371/journal.pone.0179291 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493292/
  13. Shafiya Rafiqa, Rajkumari Kaula, S.A. Sofia, et al., Citrus peel as a source of functional ingredient: A review. J of the Saudi Society of Ag Sci, 17;4, Oct. 2018, pp 351-358 https://www.sciencedirect.com/science/article/pii/S1658077X16300960
  14. Quercetin, Pharmacology, Toxicology and Pharmaceutical Science/Quercetin, ScienceDirect.com, https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/quercetin
  15. Hou L, Huang H. Immune suppressive properties of artemisinin family drugs. Pharmacol Ther. 2016;166:123–127. doi:10.1016/j.pharmthera.2016.07.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035609/
  16. Wang T1, Men R1, Hu M, et al., Protective effects of Punica granatum (pomegranate) peel extract on concanavalin A-induced autoimmune hepatitis in mice. Biomed Pharmacother. 2018 Apr;100:213-220. doi: 10.1016/j.biopha.2017.12.110. Epub 2018 Feb 9. https://www.ncbi.nlm.nih.gov/pubmed/29428670
  17. Gorinstein S, Leontowicz H, Leontowicz M, et al., Comparison of the main bioactive compounds and antioxidant activities in garlic and white and red onions after treatment protocols. J Agric Food Chem. 2008 Jun 25;56(12):4418-26. doi: 10.1021/jf800038h. Epub 2008 May 22. https://www.ncbi.nlm.nih.gov/pubmed/18494496
  18. Eva Schrezenmeier, Thomas Dörner, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 16, 155–166 (2020). https://doi.org/10.1038/s41584-020-0372-x https://www.nature.com/articles/s41584-020-0372-x
  19. Derek Lowe, Chloroquine, Past and Present, In the Pipeline, March 20, 2020, Science Translational Medicine, blogs.sciencemag.org, https://blogs.sciencemag.org/pipeline/archives/2020/03/20/chloroquine-past-and-present
  20. L. Brent Mitchell, Long QT Syndrome and Torsades de Pointes Ventricular Tachycardia. Last full review/revision Jul 2019, Merck Manual, Professional Edition, https://www.merckmanuals.com/professional/cardiovascular-disorders/arrhythmias-and-conduction-disorders/long-qt-syndrome-and-torsades-de-pointes-ventricular-tachycardia
  1. Vitamin C Is an Essential Factor on the Anti-viral Immune Responses through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659258/
  2. Sy Mukherjee, China’s high smoking rate may be exacerbating the coronavirus outbreak,  Feb. 19, 2020, Forbes.com, https://www.google.com/amp/s/fortune.com/2020/02/19/coronavirus-china-smoking-rate-men/amp/

Eat Food – Antivirals are found in common foods.

Chloroquine medications are dangerous, many medications are dangerous especially if taken in too large a dose. Chloroquines are typically used to treat malaria, a condition caused by a parasite. The mechanism of action is that the chemical can hold onto the mineral zinc and carry it into an infected cell where the zinc disrupts the replication of proteins, causing less virus replication. (6) It has been mentioned as a medication that potentially may be helpful for treating patients with the novel coronavirus that is currently causing a pandemic.

The chloroquine medications are also used by autoimmune patients and supplies of the drug are limited. Increasing production is a goal but will likely take some time. (7) There are other safer alternatives available in foods or phytonutrient extracts (1, 8, 9) that have an immune modulating effect – promoting removal of infected or damaged cells while also inhibiting an overactive immune response.

People with a heart condition may also be at more risk of dangerous side effects if taking chloroquines. The medication also needs to be given with zinc to be as effective as possible. The food or phytonutrient alternatives would also need to be used with zinc in the diet or added as a supplement. (1, 8, 9)

***** ONLY TAKE PRESCRIPTION MEDICATIONS THAT ARE PRESCRIBED FOR YOU BY YOUR OWN MEDICAL PROFESSIONAL *****

***** ONLY EAT FOOD *****

Someone is dead because they consumed a household product containing chloroquine because they thought it might protect them from coronavirus infection, (10), – dead is not infectable by a virus, but dead is also dead.

Quercetin plus zinc is also an antiviral that works as a zinc ionophore, (1), however it is readily available in some common foods or as a supplement and is nontoxic to cells. (1, 2) The zinc is disrupting protein replication within the infected cell so the virus can not be replicated to spread to other cells, for more replication, more infecting other cells, more replication, etcetera.

Onions are the richest source of quercetin (4) and citrus peel is also a very rich source. (3) Pumpkin seeds are the richest source of zinc in a vegetarian diet and is commonly available in meats in a non-vegetarian diet.

Pomegranate peel extract or the inner white membrane of a pomegranate is also a source of quercetin and another phytonutrient that acts as a zinc ionophore (epigallichatechin-gallate). (1) It also would be nontoxic to healthy cells and low risk compared to the chloroquine medications. (2) However it can have some side effects, acting as a diuretic and has COX2 inhibition activity. (recent post, older post) A tablespoon or two of the liquid extract or inner white membrane can be enough to provide some health benefits for an adult. (G13: Preparation & Benefits of Pomegranate)

Onions, citrus peel, pomegranate peel – we have choices, safe choices, to help our body’s own defense system stop the coronavirus. Chloroquines do not kill coronavirus – it helps our own defense system do its job – but with more risk to healthy cells, and normal function than onions, citrus peel or pomegranate peel or quercetin supplements. Zinc is a trace mineral which we need in small amounts, a larger dose taken for a week or two would be unlikely to build up to toxic amounts but please be aware that in large doses a zinc supplement could become toxic.

Eat food – that is what our body is designed for. If the GI tract is inflamed and the idea of eating food is no longer appealing due to pain or constant diarrhea than please see the recent post: ACE2, Diarrhea, & COVID19 – it gets complicated. and try to eat small servings of something that might help heal and stop the inflammatory reaction in the intestinal tract.

If nausea and vomiting are also symptoms, hold off on the food and just sip water that has a dash of lemon or lime juice or apple cider vinegar. Those all have a type of acid that is similar to stomach acid. In cases of severe nausea even plain water can be unsettling and larger amounts of anything can be a problem. Start gradually with small sips of the lemon water, or a lime or lemon popsicle may be soothing and not cause more vomiting.

Once feeling better some of the mucilaginous or hydrolyzable tannin foods mentioned in the recent post (ACE2, Diarrhea…) can help replace the mucous lining that coats the intestinal tract during times of health. It also serves as a defense system, helping to prevent entry of virus or other pathogens into the body between intestinal cells. And white blood cells patrol the area and actively defend against pathogens.

Pomegranate peel also provides hydrolyzable tannins if the white membrane is used in prepared foods like a bean soup (G8: Cookies & Bean Soup/recipes) or sweet potato dish. Pomegranate peel and citrus peel and onions (less so) are also sources of vitamin C which also helps our body’s natural anti-viral defenses. (5)

Addition: Table of drugs and phytonutrients that are being investigated for use as a COVID19 treatment, (@rubbersoul23,Eric/table) based on A SARS-CoV-2-Human Protein-Protein Interaction Map Reveals Drug Targets and Potential Drug-Repurposing, March 23, 2020, (biorxiv.org)

Disclaimer: This information is provided for educational purposes within the guidelines of Fair Use. It is not intended to provide individual guidance. Please seek a health care provider for individualized health care guidance.

Reference List

  1. Husam Dabbagh-Bazarbachi , Gael Clergeaud, Isabel M Quesada, et al., Zinc Ionophore Activity of Quercetin and Epigallocatechin-Gallate: From Hepa 1-6 Cells to a Liposome Model. J Agric Food Chem, 62 (32), 8085-93 2014 Aug 13. https://pubmed.ncbi.nlm.nih.gov/25050823/
  2. Houston DMJ, Bugert JJ, Denyer SP, Heard CM. Potentiated virucidal activity of pomegranate rind extract (PRE) and punicalagin against Herpes simplex virus (HSV) when co-administered with zinc (II) ions, and antiviral activity of PRE against HSV and aciclovir-resistant HSV [published correction appears in PLoS One. 2017 Nov 20;12 (11):e0188609]. PLoS One. 2017;12(6):e0179291. Published 2017 Jun 30. doi:10.1371/journal.pone.0179291 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5493292/
  3. Shafiya Rafiqa, Rajkumari Kaula, S.A. Sofia, et al., Citrus peel as a source of functional ingredient: A review. J of the Saudi Society of Ag Sci, 17;4, Oct. 2018, pp 351-358 https://www.sciencedirect.com/science/article/pii/S1658077X16300960
  4. Quercetin, Pharmacology, Toxicology and Pharmaceutical Science/Quercetin, ScienceDirect.com, https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/quercetin
  5. Kim Y, Kim H, Bae S, et al. Vitamin C Is an Essential Factor on the Anti-viral Immune Responses through the Production of Interferon-α/β at the Initial Stage of Influenza A Virus (H3N2) Infection. Immune Netw. 2013;13(2):70–74. doi:10.4110/in.2013.13.2.70 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3659258/
  6. Xue J, Moyer A, Peng B, Wu J, Hannafon BN, Ding W-Q (2014) Chloroquine Is a Zinc Ionophore. PLoS ONE 9(10): e109180. https://doi.org/10.1371/journal.pone.0109180 https://journals.plos.org/plosone/articleid=10.1371/journal.pone.0109180
  7. Eva Schrezenmeier, Thomas Dörner, Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol 16, 155–166 (2020). https://doi.org/10.1038/s41584-020-0372-x https://www.nature.com/articles/s41584-020-0372-x
  8. Wang T1, Men R1, Hu M, et al., Protective effects of Punica granatum (pomegranate) peel extract on concanavalin A-induced autoimmune hepatitis in mice. Biomed Pharmacother. 2018 Apr;100:213-220. doi: 10.1016/j.biopha.2017.12.110. Epub 2018 Feb 9. https://www.ncbi.nlm.nih.gov/pubmed/29428670
  9. Hou L, Huang H. Immune suppressive properties of artemisinin family drugs. Pharmacol Ther. 2016;166:123–127. doi:10.1016/j.pharmthera.2016.07.002 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5035609/
  10. Anne Flaherty, Sophie Tatum, Man dies after ingesting aquarium product containing chloroquine: Hospital network. March 23, 2020, abcnews.go.com, https://abcnews.go.com/Politics/man-dies-ingesting-chloroquine-prevent-coronavirus-banner-health/story?id=69759570