美國衛生研究院(NIH) 指出,輔助治療COVID-19的15種營養素

The National Institutes of Health (NIH) identified 15 essential nutrients for adjunctive treatment of COVID-19.

COVID-19, which emerged in 2019, is a respiratory disease caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Common initial symptoms include cough, fever, fatigue, headache, muscle pain, and diarrhea. In some cases, COVID-19 patients may develop severe conditions, leading to respiratory failure, pneumonia, multiple organ failure, and death. [2]. Additionally, some individuals infected with COVID-19 experience “long COVID” symptoms in the months following the acute phase, including fatigue, muscle weakness, sleep difficulties, and cognitive impairments. [3] [4].

COVID-19 vaccines have been shown to be safe and effective in reducing the risk of the disease, including its severity. [5] [6]. Currently, there are supportive treatments for COVID-19, but there is no cure. People require various vitamins and minerals to maintain a healthy immune function. After the emergence of COVID-19, sales of nutritional supplements aimed at immune health have increased. Healthy individuals hope that such products can prevent SARS-CoV-2 infection, while COVID-19 patients hope they can help reduce the severity of the disease. [7] [8] [9] [10] Here are 15 nutrients related to COVID-19, summarized by the Office of Dietary Supplements of the National Institutes of Health (NIH). While the mechanisms are not yet clear, they can serve as references for clinical assistance in the case of SARS-CoV-2 infection. [11].

 

Andrographis

Efficacy

Andrographis, used in traditional medicine, can alleviate symptoms of common cold, flu, and other respiratory infections [12]. Andrographolide and its derivatives are believed to be its active components, having antiviral, anti-inflammatory, and immunomodulatory effects. Andrographis supplements can reduce the severity of respiratory infections[13] [14].

 

Research

Cell studies have found that andrographolide can bind to the main protease of SARS-CoV-2, thereby inhibiting its replication, transcription, and host cell recognition [15]. Research indicates that the symptoms in mild to moderate COVID-19 patients improved, especially cough, after taking andrographis (60 mg) for several days, with all patients recovering within 3 weeks [16] [17].

 

Safety

The safety of andrographis has not been fully studied, but no safety issues have been reported with short-term daily use of 340-1,200 mg. Research suggests that andrographis may have adverse effects on fertility; therefore, experts recommend that pregnant women and men and women trying to conceive avoid using it [18].

 

Echinacea

Efficacy

Echinacea supplements in the U.S. market contain extracts from various species and plant parts, volatile terpenes, polysaccharides, polyacetylenes, alkamides, phenolic compounds, caffeic acid esters, and glycoproteins [19]. Echinacea may have antioxidant and antimicrobial activity, stimulate monocytes and natural killer cells, inhibit the binding of viruses to host cells, and mitigate inflammation by suppressing cell inflammatory factors [20].

 

Research

Most research on echinacea focuses on its benefits for preventing and treating common colds, other upper respiratory tract infections, and wound healing in traditional medicine [21]. Echinacea is believed to have potential positive effects on COVID-19 [22]. Studies found that suspected COVID-19 patients with clinical symptoms who received combined treatment with echinacea, ginger, and hydroxychloroquine experienced relief from cough, muscle pain, and shortness of breath, although it did not reduce the severity of fever or throat pain and the hospitalization rate for COVID-19 [23].

 

Safety

The use of echinacea is generally safe, with few reports of adverse effects, most commonly gastrointestinal discomfort and rash [24]. The safety of echinacea for pregnant women is unclear, so pregnant women are advised to avoid echinacea supplements[25].

 

Elderberry

Efficacy

Elderberry contains various compounds, including anthocyanins, flavonols, and phenolic acids, which are believed to contribute to its antioxidant, anti-inflammatory, and immunomodulatory properties [26]. It is traditionally used to alleviate cold and flu symptoms and has been shown to have antiviral activity [27][28].

 

Research

Research on elderberry’s effects on COVID-19 is limited, and it is primarily marketed for its potential to prevent and alleviate common cold and flu symptoms [29]. A study on COVID-19 patients found that a combination of elderberry, echinacea, and propolis alleviated symptoms and improved recovery time [30].

 

Safety

Elderberry is generally considered safe when used as directed. Side effects may include gastrointestinal discomfort and allergic reactions, but they are rare. Pregnant and breastfeeding women, as well as individuals with autoimmune diseases, should consult a healthcare provider before using elderberry supplements [31].

 

Elderflower

Efficacy

Elderflower has been traditionally used for various medicinal purposes, including respiratory and immune support, and its flowers contain various compounds, including flavonoids, phenolic acids, and essential oils, which may contribute to its potential benefits [32][33].

 

Research

There is limited research specifically related to elderflower and COVID-19. However, its traditional uses suggest potential immune support benefits, and it is often used in combination with other herbs for respiratory health[34].

 

Safety

Elderflower is generally safe when used in moderation and for short durations. Side effects are rare and may include gastrointestinal discomfort. Pregnant and breastfeeding women should consult a healthcare provider before using elderflower supplements [35].

 

Garlic

Efficacy

Garlic contains various bioactive compounds, including allicin, which is known for its antimicrobial and immune-supporting properties. It has been traditionally used for its potential health benefits, including its immune-supporting properties [36].

 

Research

Garlic has been studied for its potential antiviral properties and immune-boosting effects [37]. While research specific to COVID-19 is limited, garlic’s general immune-supporting properties may be beneficial in overall health [38].

 

Safety

Garlic is considered safe when used in normal amounts as a food ingredient. When used as a supplement, side effects may include gastrointestinal discomfort and allergic reactions. Pregnant and breastfeeding women, as well as individuals with bleeding disorders, should consult a healthcare provider before using garlic supplements [39].

 

Ginger

Efficacy

Ginger contains various bioactive compounds, such as gingerol, which have antioxidant and anti-inflammatory properties. It has been traditionally used for its potential health benefits, including its ability to support the immune system [40].

 

Research

Ginger has been studied for its potential antiviral properties and immune-supporting effects [41]. A study found that a combination of ginger, echinacea, and hydroxychloroquine relieved cough, muscle pain, and shortness of breath in suspected COVID-19 patients, although it did not reduce the severity of fever or throat pain or the hospitalization rate for COVID-19 [42].

 

Safety

Ginger is generally safe when used as a food ingredient or supplement. Side effects are rare but may include gastrointestinal discomfort. Pregnant and breastfeeding women, as well as individuals with bleeding disorders, should consult a healthcare provider before using ginger supplements[43].

 

Licorice

Efficacy

Licorice contains various bioactive compounds, including glycyrrhizin, which is known for its anti-inflammatory and immune-supporting properties. It has been traditionally used for its potential health benefits, including its ability to soothe respiratory and digestive issues [44] [45].

 

Research

Licorice has been studied for its potential antiviral properties and immune-supporting effects [45]. While research specific to COVID-19 is limited, licorice’s general immune-supporting properties may be beneficial for overall health [46].

Safety

Licorice is generally safe when used in moderation and for short durations. Side effects are rare but may include high blood pressure, low potassium levels, and hormonal changes. Pregnant and breastfeeding women and individuals with certain medical conditions should consult a healthcare provider before using licorice supplements [47].

 

Oregano

Efficacy

Oregano contains various bioactive compounds, including carvacrol and thymol, which have antimicrobial and antioxidant properties. It has been traditionally used for its potential health benefits, including its ability to support the immune system [48].

 

Research

Oregano has been studied for its potential antiviral properties and immune-supporting effects [49]. While research specific to COVID-19 is limited, oregano’s general immune-supporting properties may be beneficial for overall health [50].

 

Safety

Oregano is generally safe when used as a spice or seasoning in food. When used as a supplement, side effects may include gastrointestinal discomfort. Pregnant and breastfeeding women and individuals with certain medical conditions should consult a healthcare provider before using oregano supplements [51].

 

Propolis

Efficacy

Propolis is a resinous substance produced by bees and contains various bioactive compounds, such as flavonoids and phenolic acids, which are believed to have antioxidant and antimicrobial properties. It has been traditionally used for its potential health benefits, including its ability to support the immune system [52]

 

Safety

According to the European Food Safety Authority (EFSA), it is safe for adults to supplement with EPA and DHA at a daily dose of 5 grams in the long term. This dosage has not been found to cause bleeding issues or affect immune function, glucose homeostasis, or lipid peroxidation[54]. The FDA’s recommendations in the United States align with those of EFSA[55].

 

Melatonin

Efficacy

Melatonin is a hormone produced by the pineal gland in the brain, primarily secreted at night, aiding in regulating circadian rhythms. Most studies on melatonin focus on its ability to regulate sleep and wake cycles, promote sleep, and reduce jet lag[55].

Some studies suggest that melatonin, by regulating natural killer cells, T lymphocytes, B lymphocytes, granulocytes, and monocytes, enhances the immune response. It may also have anti-inflammatory and antioxidant effects. Therefore, some research suggests melatonin may have a positive impact on COVID-19[56].

 

Research

Research suggests that melatonin may help regulate the cytokine storm that could occur in COVID-19 patients[57]. Clinical studies found that in COVID-19 pneumonia patients, the lipid peroxidation index significantly decreased, and the concentration of the inflammation marker C-reactive protein (CRP) was reduced when melatonin and theobromine were used together as treatment[58]. Currently, several studies related to melatonin’s potential to improve COVID-19 patients are ongoing[59].

 

Safety

The general recommended dosage for melatonin is 1-10 mg per day, and short-term use appears to be safe. Side effects are typically mild and may include dizziness, headaches, nausea, gastrointestinal discomfort, rashes, and drowsiness. However, some experts advise pregnant or breastfeeding women to avoid melatonin supplementation[60].

 

Probiotics

Efficacy

Probiotics are living microorganisms that, when provided in sufficient amounts, offer health benefits to the host. Examples include Lactobacillus, Bifidobacterium, and L. reuteri. Probiotics are naturally present in some fermented foods and can be used as nutritional supplements when added to foods[61]. Probiotics primarily act in the gastrointestinal tract and may help improve immune function in various ways, such as enhancing gut barrier function, increasing immunoglobulin production, inhibiting viral replication, and boosting white blood cell activity[62].

 

Research

Pre-COVID-19 research indicated that probiotics were beneficial in preventing or treating respiratory infections in children and adults, improving post-respiratory syncytial virus pneumonia and infection outcomes[63]. After the emergence of COVID-19, many researchers believe that probiotics may assist in COVID-19 treatment. Studies found that probiotics with specific strains could help alleviate COVID-19 symptoms (diarrhea, fever, weakness, headache, muscle pain, and breathing difficulty) and reduce the risk of death, ICU transfer, and respiratory failure[64].

Furthermore, various studies, including one in Canada, are ongoing to evaluate the use of probiotics to improve COVID-19 patient symptoms[65].

 

Safety

Probiotics have a long history of use in food and are naturally present in the gut microbiota. Probiotic supplements are generally safe for most people[70].

 

Quercetin

Efficacy

Quercetin is a flavonol found in many fruits, vegetables, spices, and beverages. Research suggests that quercetin may have antioxidant, antiviral, anti-inflammatory, and immune-regulating effects, as well as inhibiting platelet aggregation[71].

 

Research

Due to quercetin’s molecular structure and pharmacological properties, it is believed to have the potential to inhibit the SARS-CoV-2 virus and may be beneficial for COVID-19 patients[72]. Quercetin can reduce inflammation and organ damage in severe COVID-19 patients[73]. Studies have found that COVID-19 patients taking quercetin supplements, particularly those with mild to moderate cases not requiring hospitalization, had a reduced likelihood of hospitalization and shorter hospital stays, with decreased oxygen therapy needs for hospitalized patients[74].

 

Safety

According to the U.S. FDA, a daily dose of 500 mg of quercetin is considered safe (Generally Recognized as Safe, GRAS)[75].

 

Magnesium

Efficacy

Magnesium is an essential cofactor for over 600 enzymatic reactions in the body, and it plays a role in innate and adaptive immunity, blood pressure and heart rhythm regulation, antiplatelet action, bronchodilation, and vitamin D modulation. Therefore, magnesium deficiency is associated with reduced immune cell activity, increased oxidative reactions, and enhanced inflammation[76].

 

Research

Research has found that people with COVID-19 may experience magnesium abnormalities, either low or high levels in the blood; a French study found that 48% of COVID-19 patients had abnormally low magnesium levels[77]. However, hypomagnesemia is common in critically ill patients, regardless of their COVID-19 status[78].

An observational study in Singapore found that COVID-19 patients who supplemented with 150 mg of magnesium daily from the first day of hospitalization required less oxygen therapy, less support in the Intensive Care Unit (ICU), and had a shorter length of hospital stay[79]. Currently, numerous studies are evaluating the use of magnesium in COVID-19 patients to reduce complications[80].

 

Safety

Magnesium intake from food sources is considered safe at any level. Generally, taking magnesium from supplements or magnesium-containing medications is safe, with children’s maximum intake ranging from 65 to 350 mg/day and adults up to 350 mg/day. Intake above these limits may lead to diarrhea, nausea, and abdominal cramps[76].

 

Selenium

Efficacy

Selenium is an essential mineral found in many foods. The recommended dietary intake for selenium is 15 to 70 mcg for infants and children and 55 to 70 mcg for adults [77]. Selenium can help regulate the activity of T cells and natural killer cells, supporting both innate and adaptive immune systems. Its antioxidant capabilities may also help reduce systemic inflammation associated with acute respiratory distress syndrome and organ failure[78].

 

Research

Selenium deficiency may increase the risk of mortality from COVID-19[79]. Studies have found that the average selenium concentration in the blood of COVID-19 patients is lower than that of healthy individuals, and surviving COVID-19 patients have higher blood selenium levels than those who did not survive[80]. Clinical trials related to selenium for COVID-19 patients are ongoing[81].

 

Safety

Intake of selenium at doses ranging from 45 to 400 mcg per day is safe for infants and children, and up to 400 mcg per day for adults. Higher intake may result in garlic odor on the breath, metallic taste in the mouth, and hair and nail loss or brittleness[77].

 

Zinc

Efficacy

The recommended dietary intake (RDA) for zinc is 2-13 mg for infants and children and 8-12 mg for adults. Zinc is involved in numerous cellular metabolic processes, catalyzing about 100 enzyme reactions and helping regulate both innate and adaptive immune systems[82]. Additionally, zinc has antiviral and anti-inflammatory properties, aiding in maintaining the integrity of tissue barriers such as respiratory epithelial cells; zinc deficiency is associated with increased pro-inflammatory cytokine concentrations and lymphocyte dysregulation, which can affect immune function related to lung infections[83].

 

Research

Current data are insufficient to support or oppose the use of zinc for the prevention or treatment of COVID-19. However, given zinc’s role in immune function, its supplementation may help reduce the risk and severity of COVID-19[84]. Studies have found that COVID-19 patients with low blood zinc levels below 50 mcg/dL take longer to recover and have a higher mortality rate[85]. Another study suggests that COVID-19 patients with blood zinc levels below 80 mcg/dL are more likely to develop complications[86].

 

Safety

Intake of 4-34 mg/day of zinc is safe for infants and children, and up to 40 mg/day for adults. Higher intake may lead to nausea, vomiting, anorexia, abdominal cramps, diarrhea, and headaches[82].

 

Vitamin C

Efficacy

Vitamin C plays a crucial role in both innate and adaptive immunity due to its antioxidant, antibacterial, antiviral, and immune-regulating properties. Vitamin C helps maintain epithelial integrity, regulates B and T cells, enhances phagocytosis, helps normalize cytokines, reduces histamine, and may inhibit viral replication[87].

 

Research

Current data are insufficient to support or oppose the use of vitamin C for the prevention or treatment of COVID-19. However, some studies suggest that vitamin C may serve as an adjunctive therapy for COVID-19, potentially helping to reduce inflammation and vascular damage[88]. High-dose intravenous vitamin C was found to improve oxygenation index in moderate to severe COVID-19 patients, with all patients eventually recovering[89]. The COVID-19 Treatment Guidelines of the National Institutes of Health (NIH) state that the data are insufficient to support or oppose the use of vitamin C in the treatment of COVID-19, although some research suggests that intravenous vitamin C may improve severe cases[90]. Ongoing research related to vitamin C is also underway[91].

 

Safety

Daily intake of vitamin C at doses as high as 400 to 1,800 mg is safe for children, and up to 2,000 mg for adults[92].

 

Vitamin D

Efficacy

Vitamin D, in addition to its importance for calcium absorption and bone health, plays a role in immunity. Vitamin D may help reduce viral replication, suppress inflammation, and regulate immune cell activity, potentially modulating both innate and adaptive immune responses[93].

 

Research

Previous research suggested that vitamin D deficiency may make individuals more susceptible to infections such as influenza, hepatitis C, human immunodeficiency virus (HIV), and other viral diseases[94]. Current data are insufficient to support or oppose the use of vitamin D for the prevention or treatment of COVID-19. However, research indicates that vitamin D supplementation may help prevent respiratory infections[95]. Studies found a relationship between more severe COVID-19 cases and severe vitamin D deficiency[96]. Another study suggested a linear inverse relationship between vitamin D levels and the mortality rate in severe COVID-19 patients[97]. Supplementing COVID-19 patients with high doses of vitamin D was associated with a shorter duration of cough and loss of taste[98].

 

Safety

Daily intake of 25-100 mcg (1000-4000 IU) of vitamin D is safe for infants and children, and up to 100 mcg (4000 IU) for adults[99]. High-dose vitamin D intake may lead to nausea, vomiting, muscle weakness, confusion, pain, anorexia, dehydration, increased urination and thirst, and kidney stones[100].

 

Vitamin E

Efficacy

Vitamin E is an antioxidant that helps maintain cell membrane integrity and enhances antibody production, lymphocyte proliferation, and natural killer cell activity, playing a significant role in immune function. Vitamin E is also believed to limit inflammatory responses by inhibiting the production of pro-inflammatory cytokines[101].

 

Research

A study indicated that long-term supplementation of vitamin E in individuals aged 65 or above reduced the risk of upper respiratory tract infections, particularly the common cold, by 16%[102]. However, current data are insufficient to support or oppose the use of vitamin E supplements for the prevention or treatment of COVID-19. Nevertheless, due to its role in immune function, there is ongoing research on the potential benefits of vitamin E in improving COVID-19 outcomes[103].

 

Safety

Due to the anticoagulant effects of vitamin E, high-dose vitamin E intake may increase the risk of bleeding and lead to hemorrhagic stroke. It is recommended to be monitored and evaluated by a healthcare professional[76].

 

Summary

According to the information summarized by the National Institutes of Health (NIH) Office of Dietary Supplements, nutrients that may be associated with a reduced risk of contracting COVID-19 include selenium, Omega-3 fatty acids, and probiotics. Nutrients that may help prevent the worsening of COVID-19 symptoms or improve severity include magnesium, selenium, vitamin C, vitamin D, vitamin E, zinc, hawthorn, N-acetylcysteine, Omega-3 fatty acids, probiotics, and quercetin.

It’s important to note that these conclusions are based on clinical research reports, animal and cell studies, and related theoretical inferences. Further experiments and investigations are required to confirm their specific clinical applications and mechanisms. In the current urgent times of the pandemic, it is recommended to strengthen one’s immune system, in addition to vaccination and maintaining good hygiene, and nutrient supplementation can be a convenient and effective approach.

 

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