COVID-19—Balancing the Benefit and the Evidence
Guidance for Cancer Patients—and the Rest of Us
This webpage is for all of us who are at risk of COVID-19.
There is a great deal we don’t know yet about the COVID-19 virus. We don’t know if getting it confers immunity. We don’t know if it will become another (more dangerous than most) seasonal contagious respiratory infection. We don’t know where containment strategies will work and where they won’t.
What is remarkable is the absence of widespread awareness of the possible benefits of health promotion and the potential value of integrative medicine.
CDC's Prevention Recommendations
CDC does good work promoting hygiene measures. What is remarkable is the absence of widespread awareness of the possible benefits of health promotion and the potential value of integrative medicine.
COVID-19 and Cancer
Cancer tends to thrive in an inflamed body. Strategies that minimize inflammation to reduce cancer risk may also reduce risks of severe COVID-19.1
We have assembled websites and resources that we respect, shown at right. We also offer some notes that will continue to evolve as our understanding of the virus evolves.
We list what is known about supplements and natural products. Some herbal and nutritional supplements and other integrative practices may also be of benefit. Equally important, some herbal and nutritional supplements may increase your risk. But first we tell you about 7 Healing Practices to get healthier—and some of which you may have overlooked.
Donald Abrams, MD, has famously said about integrative medicine: “The lower the risk, the lower the burden of proof.” If something is unlikely to hurt you and may well benefit you, it may be worth your consideration. While the therapies offered on this page have not been tested on the COVID-19 virus, most are unlikely to hurt you and show indications of possible benefit.
Based on research in MERS, another coronavirus, early detection and treatment are key to increase your chances of recovery.3 Report symptoms as soon as possible, get tested and follow monitoring and treatment protocols.
But even before you show symptoms, you can bolster your immune response, alleviate stress and inflammation, and promote wellness.
The 7 Healing Practices Build the Foundation
The healthier you are at any age, the more likely you are to mitigate the severity of and improve chances of recovery. Our 7 Healing Practices promote health and wellness. Each of these seven practices has strong research support for making you a healthier and more resilient person at any age.
Zinc and Respiratory Infections
Zinc deficiency, which reduces immunity, is common in the elderly, strict vegetarians and people taking medications including ACE Inhibitors and those that reduce stomach acid (such as omeprazole or esomeprazole).
Shellfish, legumes, dark chocolate and pumpkin seeds are good sources of zinc. Other foods are listed by HealthLine.
Supplementing zinc in people who are deficient may reduce the chance of getting a respiratory infection.4 According to integrative oncologist and BCCT advisor Keith Block, MD, zinc supplements are not needed as a preventive by most people and could have adverse effects if taken for too long.
- Eating well, especially 5-7 servings of vegetables and 2-3 servings of fruits a day, especially naturally colorful fruits and vegetables high in flavonoids, such as tomatoes, apples, onions, oranges, nuts, parsley, celery and berries. Also consider eating foods high in zinc, especially if you have a deficiency (see the box at right). Avoid foods that disrupt the immune system or promote inflammation, such as sweets, sugar, and processed foods with chemical additives. If you have food allergies or sensitivities, such as with gluten and dairy, avoiding those foods can lessen inflammation.
- Moving more is beneficial, especially outdoors in nature. Based on studies of other respiratory viral infections (pre-Covid-19) moderate intensity exercise may improve immune function and lower the risk and severity of infection. Prolonged, intense exercise can compromise the immune system.5
- Managing stress: Fear causes stress, and stress disrupts the immune system, increasing pro-inflammatory cytokines that can lead to more severe disease.6 Moving from fearful to careful can make a difference. Dr. Martin Rossman's website offers Free Audio and Video Resources to Help with Your Stress and Self-Care, which can help you let go of stress.
- Sleeping well: Many integrative physicians say this is the most important thing you can do. Sleep allows the immune system to reset.
- Creating a healing environment: See Is COVID-19 making you stay at home or "shelter-in-place"? Turn your home into a healing space! from the Andrew Weil Center for Integrative Medicine.
- Sharing love and support may reduce susceptibility to respiratory infection.7 Free counseling and 100 online support groups are available through CancerCare. Also see our Healing Circles: Share Your Experience page.
- Exploring what matters now: A diagnosis of cancer creates much uncertainty in your personal world. The COVID-19 pandemic makes for uncertain times for the entire world. Many more of us are looking carefully at what really matters. What we learn from that exploration may change our lives in profound ways.
Other notes about health-promoting behaviors:
- Traditional Chinese medicine practitioners believe you should stay warm so your body temperature doesn't drop and burden your immune system.
- If you smoke, consider seeking support to quit. Quitting can make a difference quickly.8
Natural Products and Viruses
Some herbal and nutritional supplements and other integrative practices may also be of benefit.
In general, supplements and products that regulate a healthy immune response are beneficial before infection. But no human trials have been completed with natural products and COVID-19. Balance the potential benefits with costs and potential harm from supplements. See our list at right of some trusted websites for recommendations from credible practitioners. Note that these recommendations vary.
Recognize that supplements that boost immune function may be beneficial before infection but afterward might contribute to an inflammatory cascade. At that point, recommendations often shift.
Supplements to Avoid
Some remedies are not backed by evidence and/or may be unsafe. ConsumerLab details particular danger with the Miracle Mineral Solution (sodium chlorite), chlorine dioxide kits and colloidal silver (although some sources recommend gargling with colloidal silver mouthwash, making sure not to swallow).
If you have an active infection or you think you might have the infection, don’t take or immediately stop taking these immunostimulatory agents which increase inflammatory cytokines:9
- Polysaccharide extracts from medicinal mushrooms
- Echinacea angustifolia and E. purpurea
- Larch arabinogalactan
- Vitamin D
Elderberry (Sambucus nigra) is somewhat controversial. It is widely considered beneficial as a possible preventive. However, with an active viral infection some practitioners recommend discontinuing it, while others do not believe it will be harmful. See the Commentary below.
Supplements Recommended by Knowledgeable Integrative Health Practitioners
The Debate over Effectiveness
The question of whether vitamin C, either oral or high dose intravenous (IV), is actually beneficial is debated. In fact the debate over vitamin C mirrors the debate over many other supplements and natural products mentioned here.
These supplements are recommended to reduce risk of COVID-19 infection and/or to lessen symptoms or severity of infection. Please refer to the respected websites and resources listed above to get guidance on when, how much and how to take supplements:
- Astragalus (Astragalus membranaceus)
- Elderberry (Sambucus nigra) (controversial during an active infection)
- Garlic (Allium sativum)
- Licorice root (Glycyrrhiza glabra)
- Medicinal mushrooms (full mycelium mushroom extracts, but not polysaccharide extracts)
- Turmeric / curcumin
- Vitamin C
- Vitamin D (some advise against use during an active infection)
- Zinc pills or lozenges for about a week or so when symptoms of COVID-19 begin (even if you don't have a zinc deficiency). Some caution against nose sprays or swabs that contain zinc, as these have been linked to loss of smell.
No one is claiming these supplements cure COVID-19, but they may lessen the risk or the severity of disease. Dosing recommendations are available from the Andrew Weil Center for Integrative Medicine and ConsumerLab.
Other Therapies and Approaches
During a 2003 SARS outbreak, inhaled nitric oxide improved lung function, reduced time spent on a ventilator and showed antiviral activity. Several device companies have recently received FDA's blessing for emergency expanded access to offer inhaled nitric oxide gas for treating COVID-19.11 SJ. Nitric oxide, BCG, and COVID-19's weakness. MedPage Today. May 10, 2020. Viewed May 18, 2020.
Complementary Medical System Approaches
Advance Care Planning
Those of you who are at greater risk for more serious COVID-19 illness may be thinking about how you’d like to be cared for should you become critically ill. Could a ventilator help me? If I’m nearing the end of my life, are there effective ways my pain and distress can be controlled at home or in a palliative/hospice care unit? These are important questions and there are people who can help you sort through this and make your wishes known: Advance care planning facilitators such as oncology social workers and hospice and palliative care teams are some examples. If you’d like to discuss your wishes, start with your doctor. You may also want to make an appointment to talk to an advance care planning facilitator. For more information on Advance Care Planning:
Naturopathic medicine, functional medicine, traditional Chinese medicine, Ayurveda and other systems each have approaches to wellness, to immune support, and to fighting viral infections. Following a specific approach may help you avoid overloading your body by using a shotgun approach—taking everything that anyone recommends, irrespective of possible interactions or side effects, or of its potential benefit for your situation.
Naturopathic oncologist and BCCT advisor Heather Wright, April 6, 2020: There was an active debate about elderberry within our organization. I believe elderberry is okay and will be supportive, as do others in our community. I will say I have had two patients over the years with confirmed elderberry allergy, though, so this is not unheard of. I do not think elderberry will contribute to the inflammatory cascade in COVID. I also don’t think people can or will take enough of it to do harm. Elderberry syrup on all bottles recommends very low doses. I don’t see my patients going beyond conservative dosing on labels and at those doses I believe they will be safe and that it will be supportive.
Written by Laura Pole, RN, MSN, OCNS, and reviewed by Nancy Hepp, MS; most recent update on May 27, 2020.
General COVID-19 Resources
- Centers for Disease Control Coronavirus information: Coronavirus (COVID-19)
- World Health Organization:
- National Cancer Institute: Coronavirus: What People with Cancer Should Know
- American Institute for Cancer Research:
- Fred Hutchinson Cancer Research Center: Coronavirus: what cancer patients need to know
- Memorial Sloan Kettering Cancer Center: The 2019 Novel Coronavirus (COVID-19): Key Facts and What It Means for People with Cancer
- Fox Chase Cancer Center: What Every Cancer Patient Should Be Asking About Coronavirus
- Moss Reports: Cancer and Coronavirus
- CancerNet: Coronavirus 2019: What People with Cancer Need to Know
- Anticancer Lifestyle Program:
- Center for Mind-Body Medicine: Meeting the Coronavirus Challenge: Tools to Heal Mind, Body, Spirit, and Community
- The Atlantic:
- I thought stage IV cancer was bad enough, then came a pandemic during the presidency of Donald Trump
- The Big Story: Battling Cancer During a Pandemic (webinar video; the first 7:30 minutes is relevant to COVID-19)
Treatments and Prevention
- US Food and Drug Administration: FDA advises patients on use of non-steroidal anti-inflammatory drugs (NSAIDs) for COVID-19
- ConsumerLab.com: Natural Remedies and Supplements for Coronavirus (COVID-19)
- The Andrew Weil Center for Integrative Medicine:
- The Institute for Functional Medicine:
- Helpsy Health: Partnership Proposal: Supportive Tool for COVID-19
- Cynthia Li, MD: How to Shield Yourself against COVID-19: Science-Based, Integrative Medicine Strategies for a Once-in-a-Century Pandemic
- Podcast: Five to Thrive Live. Critical Covid-19 Update.
- Natura Institute: Resilience and Covid-19 Integrative Medicine Recommendations
- Society for Integrative Oncology: TCM and Integrative Oncology Practice in China During COVID-19 Outbreak
- Heather Wright, ND: A note from Dr. Wright on COVID-19
- Because Health: A Complete Guide to Non-Toxic Cleaning and Disinfecting During the Coronavirus Pandemic
- MedPage Today: Malaria drugs in COVID-19: hope or hype?
- Adams C. Can herbal medicines fight the COVID-19 coronavirus? Journal of Plant Medicines
- Amory B. Lovins and Eric Rasmussen: Don’t just avoid the virus — defeat it by strengthening your immunity
- Medium, Richard Hobday: Coronavirus and the Sun: a Lesson from the 1918 Influenza Pandemic
- Panda S. There's one overlooked factor to consider in fighting COVID-19. Inverse
- John Weeks: The Path to a Virginia Medical Center’s COVID-19 Integrative Protocol Using Multiple Natural Agents: Interview with Paul Marik, MD
- StudyFinds: Study: Patients low in vitamin D twice as likely to develop severe COVID-19 symptoms
- BMJ Opinion: Paul Garner: Covid-19 and fatigue—a game of snakes and ladders
- Myalgic Encephalomyelitis Action Network: Researchers expect COVID-19 will cause surge of chronic illness, including ME
- Science: Not wearing masks to protect against coronavirus is a ‘big mistake,’ top Chinese scientist says
- Harvard Business Review: Your employee tested positive for Covid-19. What do you do?
- WebMD: Life after COVID-19: the road to recovery
For Healthcare Professionals
- National Comprehensive Cancer Network Continuing Education: Talking to Patients about Cancer Treatment, Risk Factors, and Treatment Cessation during the COVID-19 Pandemic
- Lise Alschuler: COVID-19 Guidelines for Integrative Medicine Professionals: Integrative Considerations during the COVID-19 Pandemic
- Journal of the National Comprehensive Care Network: Managing cancer care during the covid-19 pandemic: agility and collaboration toward a common goal
- National Comprehensive Cancer Network: Self-Care and Stress Management during the COVID-19 Crisis:Toolkit for Oncology Healthcare Professionals
- Social Work Hospice and Palliative Care Network: Resources for Hospice and Palliative Care Social Work Professionals during the COVID-19 Crisis
- COVID-ready communication skills: a playbook of VitalTalk Tips
- Coalition to Transform Advanced Care: Getting Ahead of Covid-19 Issues: Dying from Respiratory Failure Out of the Hospital
- Respecting Choices: Resources to help you have conversations about treatment preferences before a medical crisis
- POLST: POLST and COVID-19
- Helfgott Research Institute: Traditional, Complementary and Integrative Health and Medicine COVID-19 Support Registry
- American Association of Naturopathic Physicians' COVID-19 Task Force: antibody testing guidelines
- Yanuck SF, Pizzorno J, Messier H, Fitzgerald KN. Evidence supporting a phased immuno-physiological approach to COVID-19 from prevention through recovery. Integrative Medicine.
- Oncology Association of Naturopathic Physicians: Integrative Immunotherapy for COVID-19: 4-video series and slides
- Integrative Oncology Talk