Rethinking COVID-19: A Conversation with Dr. Nalini Chilkov – Rational Wellness Podcast 152
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Dr. Nalini Chilkov, a Chinese Medicine and Integrative Cancer expert provides a Unique Perspective on COVID-19 and what to do about it with Dr. Ben Weitz.
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3:25 Dr. Chilkov has been studying what has been happening in China and they have been using a lot of traditional Chinese herbal medicine, with over 90% of COVID-19 patients having received herbal medicine. In fact, there were two studies that demonstrated that there were front line clinicians in two different hospitals that did not get sick in the midst of treating patients because of the Chinese herbs they were taking. Simply giving our caregivers masks and protective equipment is not enough to take care of them. And we need to think about the arc of the journey that COVID-19 patients go through and how to address them at different phases of that journey, as is often done in Chinese medicine.
5:30 We need to think about how our most vulnerable citizens are protected and it is different in the US as compared to China. In China the most vulnerable are the elders and men, which is partly because men in China tend to smoke, while women generally do not, so their lungs are vulnerable. In the US, the age disparity is not as significant and we are seeing more patients in the 30-50 range who are being hospitalized. You are more vulnerable if you are over 80 and somewhat in the 60-80 range but in the US we have such an epidemic of obesity and diabetes and metabolic syndrome that most patients have some risk factors. Patients with obesity have the worst outcomes.
7:48 The biggest risk to death is not having the infection but when the virus gets into the lungs and stimulates an excessive immune response and creates a cytokine storm that tends to lead to death. Having diabetes leads to more inflammation, more oxidative stress, and more kidney damage and the kidneys are one of the organs targeted by this disease, along with the lungs and the heart. The complications of COVID-19 are lung fibrosis, myocardial damage, kidney nephron fibrosis, and disruption of the gastro-enterologic tract. Patients with autoimmune diseases are more vulnerable since they have upregulated immune systems, so they tend to have ratcheted up levels of inflammatory cytokines. And we have cancer patients who vulnerable because they either are immunosuppressed due to their chemotherapy treatments and we have leukemia patients who already have elevated levels of white blood cells. And COVID-19 patients who get hospitalized often have lung fibrosis, many have kidney damage, and possibly myocardial damage and damage to the neurons of the brain, so these recovered patients really can benefit from Functional Medicine to help repair them and restore their full function.
11:34 Fibrosis can result from patients going through a lot of oxidative stress and inflammation once they recover. One strategy to combat this fibrosis is by taking a nutritional supplement, Modified Citrus Pectin. Dr. Chilkov talked about certain Chinese herbs that can help with fibrosis, including Chinese red sage, dan shen, salvia miltiorrhiza, white peony, Bai Shao, and peony alba. N-AcetylCysteine can be helpful since it helps to produce glutathione to quench oxidative stress and NAC can thin mucous secretions in the respiratory tract and it can be nebulized.
13:43 Intravenous vitamin C is being used in hospitals in China and in some hospitals in New York City to quench the cytokine storm. Quercetin can also help in this way. Some of the Chinese herbs have large amounts of quercetin, as well as resveratrol, and berberine.
14:41 One herb that is being used a lot in China COVID-19 is scutellaria baicalensis, which is also used widely in cancer treatment. Scutellaria baicalensis has phytophenols, baicalin and baicalein, which are active in the viral replication, but also they’re in the category of bioflavonoids and so, like quercetin, they actually change the confirmation of the virus at the cell membrane and its ability to bind and enter into the cell and start taking over the machinery of the cell. Stinging Nettle Root (not Nettle Leaf) has antiviral activity against coronavirus and tends to inhibit the acute respiratory syndrome when COVID-19 becomes deadly, as Dr. D’Adamo explained in a recent webinar he participated in with Dr. Brady and Dr. LePine. Here is an article that Dr. D’Adamo wrote about Stinging Nettle Root: COVID-19: Stinging Nettle Lectin. There is a brilliant Chinese doctor, Michael McCulloch who put together a list of the herbs being used in China that are available in the US and a Chinese herb company, Health Concerns, has some formulas that we can use, including Clear Heat, which has most of the antiviral herbs being used in China, and Lily Bulb Formula, which for the lung for patients whose lungs have been burned by inflammation. There is also a formula of Chinese herbs that was put together by Dr. Misha Cohen for AIDS patients called Enhance that can also be used here. And probiotics are helpful, esp. for the GI symptoms that some patients get.
19:48 There are western herbs like andrographis, which is an herb traditionally used in Ayurveda and China, echinacea, and elderberry that are effective for coronavirus. Metagenics makes a product, Andrographis Plus that can be combined with Immucore, which contains Vitamins C, D, zinc, selenium, and medicinal mushrooms. Pure has a product, Innate Immune Support that contains andrographis, astragulus, and reishi mushroom extracts. A basic formula should include vitamin A, C, D, zinc, probiotics, and a Chinese mushroom product, like Clinical Synergy’s Mycoceutics Immune Max or Pure’s M/R/S Mushroom Formula.
21:02 The coronavirus may not flourish in warmer weather, though we do not really know yet. If you are immunosuppressed, you might want to avoid eating raw food like salads and cook all your food, which kills the virus.
25:40 We need to focus on what changes the cell membranes, what regulates inflammation, what changes immune response, and what changes epithelial barriers. So this means vitamins C, A, D, zinc probiotics and some immune enhancement, like quality Chinese mushrooms and astragalus, which is a great immune tonic and a lung tonic. This is for prevention. If a person has been diagnosed, we need to be careful about taking immune enhancing herbs, since we don’t want to increase the cytokine storm. Elderberry is fairly weak and not much to worry about, but herbs like andrographis, echinacea, and astragalus and Chinese mushrooms might make a cytokine storm worse, so these should be stopped once the patient is sick. At this point you should focus on using antiviral nutrients like Isatis, which is a Chinese herb that has antiviral properties, as does the yin chiao formula used for colds and flus, which contains honeysuckle, and chrysanthemum may have some antiviral properties as well. Herbs like feverfew and boswellia are anti-inflammatory that can be helpful in reducing the inflammation in the lungs that can occur with COVID-19. Also omega 3 fatty acids can make the cell membranes healthier and can help to dial down the inflammation. And it is not a good idea to take NSAIDs like ibuprofen since they seem to make things worse.
29:49 If the patient starts showing signs of breathing trouble and may be entering the acute respiratory distress syndrome, this is a medical emergency and the patient needs to be seen by a physician immediately, evaluated for oxygen, and taken to the Emergency Room. Their airway is being obstructed due to an inflammatory response with cytokines in their lungs. Curcumin makes sense at this point. The inflammation also leads to hypercoagulability and some of these patients end up with thrombi (blood clots). These patients can become dehydrated, so fluids and electrolytes can be helpful. They also need adequate protein so they can repair tissue and make antibodies, so protein or amino acid supplements make sense. Probiotics and glutamine can help heal the lining of the GI tract.
32:43 Fever is a normal part of the immune response and in naturopathic medicine we don’t try to decrease a fever unless it gets extremely high.
35:24 Melatonin. One of the reasons why older people do more poorly is because they tend to have lower levels of melatonin. Melatonin is a super antioxidant that can help quench some of the oxidative stress and it also modulates immunity and impacts T cell function. Dr. Chilkov has experience in using high dosages (20-40 mg) of melatonin for cancer patients. At a higher dosage, it may cause vivid dreams. But melatonin is not a sedative. At a low dosage, even at .5 mg it is a dark signal to the brain, but at higher, therapeutic dosages melatonin is a neuro-hormone and a neuro-antioxidant and a signal to the immune system.
37:50 Vitamin D is very beneficial for immune function in helping to protect against a virus. During the SARS epidemic Canada instructed their population to take vitamin D, since it has been shown to decrease vulnerability to viral respiratory infections. Therapeutically you could give 50,000 units for three or four days and then drop down to 20,000 and 10,000 a day after that but it’s really the blood level of 25-OH vitamin D being close to 75 nanograms per milliliter when you get this change in immune response. And keep the level below 100 ng/mL.
40:07 When COVID-19 patients are recovering they often have a lot of fatigue because their HPA axis has been on overdrive, so we should think about using adatogens, like rhodiola and ashwagandha. They need to have their microbiome tended to and we should have them get a cardiology check to see if their heart muscle was damaged.
Dr. Nalini Chilkov is a licensed Acupuncturist and Doctor of Oriental Medicine and is a respected expert in Collaborative Integrative Cancer Care. She has been a lecturer at the School of Medicine at UCLA and UC Irvine in California as well as many schools of Traditional Oriental and Naturopathic Medicine. Dr. Chilkov is in private practice in Santa Monica, California and can be reached at 310-453-5700 or through her website at NaliniChilkov.com. As the founder of the American Institute of Integrative Oncology, Dr. Chilkov offers a course for professionals called the Foundations of Integrative Oncology Professional Training Program that can be found at the American Institute of Integrative Oncology website.
Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111 or go to www.drweitz.com. Phone or video consulting with Dr. Weitz is available.
Dr. Weitz: Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting edge health information. Subscribe to the Rational Wellness Podcast for weekly updates and to learn more, check out my website, drweitz.com. Thanks for joining me and let’s jump into the podcast. Hello Rational Wellness Podcasters, thank you so much for joining me again today. For those of you who enjoy listening to the Rational Wellness Podcast, please give us a ratings and review on Apple Podcasts and if you’d like to see a video version of this interview, you can go onto my YouTube page. If you go to my drweitz.com website, you can see detailed show notes and a complete transcript.
Today, I’ll be speaking with one of the nation’s top integrative experts on cancer, to get her perspective on the current coronavirus pandemic, including how it impacts cancer patients. Dr. Nalini Chilkov is a doctor of oriental medicine and an acupuncturist with more than 30 years in private practice in Santa Monica, California. She’s lectured at both UCLA and UC Irvine Medical Schools as well as ed schools of naturopathic and oriental medicine. Dr. Chilkov is recognized as one of the go-to experts in integrative cancer care and immune enhancement and she runs the American Institute of Integrative Oncology. She offers an incredible Foundations of Integrative Oncology online course for clinicians to learn how to help manage the health of cancer patients while they are ongoing traditional care. Dr. Chilkov, thank you so much for joining me today.
Dr. Chilkov: Thank you for having me.
Dr. Weitz: So I know you have a little bit different perspective on this COVID-19 coronavirus pandemic, but before we get to that, since we’re in Los Angeles and we’re all on lockdown and stay at home orders, how are you managing to still see some patients, or how are you handling this situation?
Dr. Chilkov: Well, my practice is composed of patients from all over the world, and so I’ve been doing telemedicine for a long time and so I’m just doing it from home right now.
Dr. Weitz: Oh, okay. You just don’t get to see the in-person acupuncture patients.
Dr. Chilkov: Yeah, yeah. So the people who come to see me in Los Angeles are also consultation and cancer management patients, but many of them come in for acupuncture, so that’s the piece that isn’t happening. Those patients have a bit of resistance to doing a telemedicine visit because they’re accustomed to seeing me in person, but I’m just carrying on here.
Dr. Weitz: We’re all carrying on.
Dr. Chilkov: Right?
Dr. Weitz: You can see I have the mark of the mask from wearing an N95 mask all day, tends to rub the skin off across your nose. So tell me about your latest understanding of the coronavirus and what’s going on with this situation.
Dr. Chilkov: Well, I’ve invested a considerable amount of time trying to understand this, looking through a slightly different lens because there’s plenty of brilliant people who are teaching us about the physiology of this virus and the standard nutraceutical approach but I think we really need to think about it, about the arc of this experience that patients have, and how we address patients at different phases of that journey, but also, because of my interest in Chinese medicine and Chinese herbal medicine, I have been taking a deep dive into what has been going on in China and over 90% of COVID-19 patients have received Chinese herbal medicine concurrently with Western herbal medicine and this is not very publicized and also, there’s a couple of studies … They’re now publishing what they’ve been doing with these patients and there are some emerging patients of what makes sense and what’s working.
So I’d like that share that but I also want to share that there were two studies that came out of China demonstrating that the caregivers, the frontline, up close and personal caregivers in two hospital settings, were given Chinese herbs to keep them from getting the infection and there was a set of clinicians in two different hospitals that did not get sick in the midst of treating these patients. So I think we need to be thinking about how to care for the caregivers as well, because we have higher exposure, being intimately involved with our patients.
Dr. Weitz: That’s a good point, and simply giving them masks and protective equipment is really not enough, yeah.
Dr. Chilkov: It’s not sufficient, no. It’s not sufficient, the masks don’t protect you 100% and I think we also need to think about who are our more vulnerable patients. Now, the demographic of the patient population in China is different than in the United States, so we’re actually seeing different trends here. So although in China, the elders and the men are more vulnerable, our population is different. In China, most men smoke and most women don’t, so puts a disparity in lung vulnerability in that population. What we’re seeing in the United States is that it’s not so dramatic in terms of age. Once you get over 80 you’re highly more vulnerable in the United States and certainly between 60 and 80 is a slightly more vulnerable but we have a significant number of patients who are between 30 and 50 who are being hospitalized here as well. We also have more obesity.
Dr. Weitz: Do you think that’s because we do such a good job with getting chronic diseases, that we don’t wait till we’re older to get them. We end up with diabetes and heart disease much younger.
Dr. Chilkov: Yeah, that’s the problem, we have an epidemic of obesity and metabolic syndrome and diabetes that is driving high risk in all age groups. It turns out United States, the worst outcomes are in obese patients, if you take the age factor out.
Dr. Weitz: Not a shock.
Dr. Chilkov: Right, because of the high inflammation. If you have diabetics of any age, these people already have more inflammation, more oxidative stress and more kidney damage, so we know that one of the vulnerable organs in this syndrome are the kidneys, so if you lose kidney function. So the complications of this disease are lung fibrosis, myocardial damage, kidney nephron fibrosis, disruption of the gastro-enterologic tract because we know the virus is found in the gut. In fact, David Brady, his company Diagnostic Solutions, is developing a stool test to look at the virus in the stool.
Dr. Weitz: Yeah, it’s already available.
Dr. Chilkov: Right, and so we have this bigger picture to consider and there’s a sub-population of people who contract this, who develop this cytokine storm, this hyper up-regulation of the immune system, so patients who have autoimmune disease are more vulnerable, but also we have a lot of cancer patients who’ve had immunotherapies who have ratcheted up their inflammatory cytokine titers and who now have autoimmune disease on top of having cancer and these are highly vulnerable patients. We have cancer patients who are myelosuppressed due to their chemotherapy treatments and we have cancer patients who have leukemias who already have elevated levels of white cells. So we need to think a little bit differently about patients in terms of age demographics and risk factors in the United States versus the information we’ve gotten out of China. We’re a different population here.
Dr. Weitz: It’s still fairly predominant in men over women though, right?
Dr. Chilkov: It is, it’s interesting and women do have different immune patterns that start evolutionarily in order to carry a baby that has different DNA than you have, to be able to do that, your immune system has to be able to adjust, right?
Dr. Weitz: Right and isn’t it the case that estrogen leads to a stronger immune system and that during pregnancy, the estrogen drops so the mother doesn’t react and that’s why-
Dr. Chilkov: Exactly.
Dr. Weitz: … women have a higher risk of autoimmune disease?
Dr. Chilkov: Yes, yes. So we want to look at where a woman who’s diagnosed with the disease in her hormonal life cycle, if she’s on hormone replacement therapy and if she gets sick, do we want to withdraw some of her estrogen so that she doesn’t have a cytokine storm? I mean, these are questions.
Dr. Weitz: Or maybe the estrogen is immunoprotective.
Dr. Chilkov: It might be, it might be but the real risk that we’re learning is not from the virus itself but how it hijacks the immune system and in those patients whose immune system goes into overdrive, that’s where the damage and the mortality is being seen. These are the patients that get the most into trouble breathing. These are the patients who, if they don’t die from the syndrome, they come out of it with a high level of lung fibrosis, possibly myocardial damage, most of these patients have nephron damage too and so we’re looking at a population of survivors that need our help. They need functional medicine. They need what we do because we know how to repair people and restore function and I think we need to be really thinking about all this fibrosis that this disease causes as well. So we can have a big impact on the prevention and we can have an impact with the survivors and if we have patients that are staying at home with this illness, then we have a lot of antivirals in the [inaudible 00:11:14].
Dr. Weitz: Is the fibrosis mainly in the lungs, or is it in the other organs as well?
Dr. Chilkov: Well the fibrosis is being seen in the lungs and the nephron and the nature of the damage is to the myocardium, it’s not expressly fibrotic but whatever tissue dies, it gets more fibrotic.
Dr. Weitz: As soon as I think of fibrosis, I immediately think of modified citrus pectin and galectin-3 and Isaac.
Dr. Chilkov: Yes, I think we need to think about that. Where I actually think about is Chinese herbs have a lot of research on their impact on fibrosis and one of the herbs I use the most in cancer patients for fibrosis, which is very common in cancer patients, is Chinese red sage, dan shen, salvia miltiorrhiza. There are studies on that and lung fibrosis. I’ve seen studies on white peony, Bai Shao, peony alba and fibrosis. So there’s a number of botanicals which do have research in their impact on fibrosis and these are botanicals that change the amount of development of fibrotic tissue and activity of the fibroblasts-
Dr. Weitz: So these could be taken ahead of time to reduce the potential for fibrosis, or would they be taken afterwards?
Dr. Chilkov: No, I think of using them-
Dr. Weitz: After care.
Dr. Chilkov: … for the recovery period but if you have a patient who you can see is in a physiologic state where fibrosis is going to happen, I would think about using them then. Remember, the fibrosis is the sequelae of extraordinarily amounts of inflammation and oxidative stress. So those patients also need to take N-acetylcysteine because that, of course, is producing glutathione and quenching a large amount of the oxidative stress. But remember that N-acetylcysteine is also used in medicine to thin secretions in the respiratory tract and it can actually be nebulized. So we can think about putting people on nebulized-
Dr. Weitz: Yeah, they’re using IV vitamin C and that seems to be having some effect, so that may be one of the ways that vitamin C plays a role as well.
Dr. Chilkov: I knew vitamin C is being used in China in hospitals and we can certainly use that here, I think that-
Dr. Weitz: It is being used in some hospitals in New York.
Dr. Chilkov: Oh, is it?
Dr. Weitz: Yes.
Dr. Chilkov: Oh, that’s fabulous. So I think that that is intervening with the cytokine storm, I think that’s what that’s doing. And quercetin, quercetin also acts in that way. A lot of the formulas in China, the herbs that are in them, have high amounts of quercetin and high amounts of resveratrol and high amounts of berberine. So if you just look at the phytochemicals that are in a lot of the formulas that are the dominant formulas being used, that’s one thing I’m seeing. Then, the Chinese Materia Medica has a large number of antivirals, very large number. Another herb that you see in a lot of the formulas coming out of China is scutellaria baicalensis, which is used widely in cancer treatment but scutellaria baicalensis has phytophenols in it, baicalin and baicalein, which are active in the viral replication, but also they’re in the category of bioflavonoids and so, like quercetin, they actually change the confirmation of the virus at the cell membrane and its ability to bind and enter into the cell and start taking over the machinery of the cell. We also, David Brady and Peter D’Adamo talked recently about nettles. Now, there’s some confusion, I’ve had people ask me, nettle leaf and nettle root are two different medicinals.
Dr. Weitz: Yeah, they were talking about nettle root, which I use on some of the male patients who have high levels of binding protein, whatever it is, the one that binds testosterone.
Dr. Chilkov: Yeah, it’s an aromatase inhibitor basically. Yeah, so nettle root is used also in estrogen-dominant cancers, where there’s estrogen receptor positive. Again, you could do that in testosterone receptor positive syndromes also to deal with the aromatase enzyme, transforms androgens into estrogens in the tissue. So that’s helpful but nettle leaf is also used as an antihistamine and so some people, I think are confused about which is being used in COVID, I think that clarification needs to be made.
Dr. Weitz: Right, so it’s the nettle root that you want to use for COVID, right?
Dr. Chilkov: Yes, yes, yeah, because we’re not having high histamine, we’re having high cytokines.
Dr. Weitz: Right, right, okay.
Dr. Chilkov: We have this virus that specifically binds. So there is a very, very brilliant Chinese doctor named Michael McCulloch who practices in the Pine Street clinic up in San Anselmo in Northern California, who’s a long-term friend and colleague of mine and he is a PhD epidemiologist as well as a doctor of Chinese medicine and he speaks Chinese and he’s been tracking all this research. What he did is he took all the herbs that are currently being used in China and he looked at which ones can we get in the United States and then he looked at which ones are actually active with this virus and he made a list of those because a shortlist of things we can get here. So I looked at that list and there is a Chinese herb company that I like very much called Health Concerns that has some formulas that already exist that I think we can use. In my clinic, I do compound custom formulas so I can replicate the formulas that are used in China but just for the clinician who isn’t doing that, Health Concerns has a formula called Clear Heat, which has most of the antiviral herbs in it that are being used in China, not all of them, but most of them. There’s also a formulas that’s called Enhance, that was developed by Dr. Misha Cohen during the AIDS epidemic in San Francisco in the early days and it’s a combination of Chinese medicinal mushrooms, antivirals and also tonic herbs. What was found in China is that these patients need to have digestive tonics given to them. The patients who have digestive tonics given to them, and I’m using probiotics as well, do better. Isn’t that interesting? Their nutritional status is maintained, right?
Dr. Weitz: Yeah, a significant percentage of patients who are hospitalized have GI symptoms.
Dr. Chilkov: Yes, yes. There are Chinese traditional herbal formulas that support what we call digestive chi and so that’s in this Enhance formula. So that’s a really nice formula, I think for recovery also and it can be used for the person who also just doesn’t want to get sick with this, it’s a nice formula for that, whereas the Clear Heat is for if you have a viral infection. So those are two formulas that are available. There’s a traditional Chinese formula called Lily Bulb Formula that is available from Health Concerns and it’s available from a lot of companies that make Chinese herbs, granules and things. That is for the lung and that’s for the patient whose lungs have been burned by inflammation and that would be a really nice formula for people for recovery.
Dr. Weitz: What about some of the Western herbs you hear a lot of people talk about, like andrographis, echinacea and elderberry?
Dr. Chilkov: So andrographis is actually an herb traditionally used in Ayurveda and China, it’s actually of Asian origin and it has a lot of studies on it, Metagenics makes a formula called Andrographis Plus, which could absolutely be used. You could combine that with the Metagenics formula ImmuCore, you could put those two together, that’s a nice combination. That has Chinese mushrooms and the A and the C and then you could add some vitamin D and zinc. If someone wants to just put together a basic protocol, vitamin A, vitamin C, vitamin D, zinc, some probiotics and some kind of Chinese mushroom product, Clinic Synergy, Isaac’s formula, Isaac Eliaz’ formula. I like their Mycoceutics Immune Max, is a very nice formula. For these patients who are super inflamed as you mentioned, the PectaSol-C could also be used. I think that’s a thought.
Dr. Weitz: Yeah, there seems to be a fair amount of research showing it reduces fibrosis, so-
Dr. Chilkov: Yes, it does, it absolutely does. So when there’s traditional, old time naturopathic medicine where you do hot castor oil packs, hot castor oil fomentations over fibrotic areas. It does penetration all that deeply so I don’t think it’s going to get into the lungs or into the kidneys, however. So you can use it over pelvis certainly, but that’s not where we’re seeing fibrosis in these patients.
Dr. Weitz: It seems to be data that heat is beneficial in helping to reduce the ability of the virus to grow and to flourish?
Dr. Chilkov: Well that’s in Petri dish, so I don’t think we really know what … I just read a comment yesterday, there’s some people are hoping that this is going to behave like the influenza virus and decrease in the summer, but there’s evidence that that is not a factor, that this virus is very happy in warm weather also. So certainly in terms of our food safety, if we’re concerned about that, the virus is killed by cooking. You have to get your food heated. So people are particularly vulnerable and immunosuppressed, they might want to not eat raw food right now and cook all their food if they’re really, really concerned. That’s something any immunosuppressed person might think about, not having more exposure to bacterial pathogens in food and the lipopolysaccharide’s immune triggers, inflammatory triggers, that come with that. So it just depends where someone is on the spectrum and that’s why patients also need us because we really treat so individually.
Dr. Weitz: I’ve really been enjoying this discussion, but now, I’d like to pause to tell you about the sponsor for this episode of the Rational Wellness Podcast. This episode is sponsored by Pure Encapsulations, which is one of the few lines of professional nutritional supplements that I use in my office. Pure Encapsulations manufactures a complete line of hypoallergenic research-based dietary supplements. Pure products are meticulously formulated using pure scientifically-tested and validated ingredients. They are free from magnesium stearate, gluten, GMOs, hydrogenated fats, artificial colors, sweeteners and preservatives.
Among other things, one of the great things about Pure Encapsulations is not just the quality products but the fact that they often provide a range of different dosages and sizes, which makes it easy to find the right product for the right patient, especially since we do a lot of testing and we figure out exactly what the patients need. For example, with DHEA, they offer five, 10 and 25-milligram dosages in both 60 and 180 capsules per bottle size, which is extremely convenient.
Now, back to our discussion.
Dr. Weitz: Well, are there any natural products that work similar to the way hydroxychloroquine works? Which has been talked about as one of the preventative drugs that may have some benefit?
Dr. Chilkov: Well, I think this is all conjecture. I think this is all conjecture. Not to my knowledge. I mean, you can use quinine, but-
Dr. Weitz: Yeah, people are talking about artemesia.
Dr. Chilkov: … the problem with hydroxycloroquine is that it should be assessed patient by patient because it does have cardiac toxicity. It also seems that you have to give it with zinc to get a really good effect because of the entry into the cell. So I think we just don’t know enough and I think it’s really dangerous to be having intellectual exercises around this until we have more data too, because these patients are vulnerable and so we certainly don’t want to experiment on them. But for our, relatively well, population-
Dr. Weitz: But Donald Trump says it’s the game changer.
Dr. Chilkov: Donald Trump knows nothing about science. I am fairly conservative and was a cell biologist and I think we have to go with data. I think that this particular virus is an animal we don’t understand completely and of course will be mutating and changing and that we just need to go with what we know will be of benefit to our patients for sure. So what changes that cell membrane, what changes inflammation, what changes immune response, what changes epithelial barriers. These things, we know what to do. So again, then you can go back, vitamin C, vitamin A, vitamin D, zinc, probiotics and then some immune enhancement.
So if you want to think the immune enhancement part, I like the high quality Chinese mushrooms plus astragalus, which is a great immune tonic and a lung tonic. But a caveat here is, as soon as a person is diagnosed with it … So those go in the prevention box. As soon as a person is diagnosed with, or obviously has the viral exposure and infection, I withhold those because we don’t know which patients are going to have cytokine storms and patients who continue to use astragalus and Chinese mushrooms will have exaggerated cytokine storms. This is the elderberry question as well. Now, elderberry is very mild so I’m not so worried about it if people use it but echinacea falls into that category as well, that can increase and make worse a cytokine storm. So I always like to err on the side of safety, so I pull out those things which potentially will make the inflammatory response bigger. I take those out and then put in the antivirals in a much more aggressive way. So andrographis falls into that category. Another category is Isatis, is another Chinese herb which is a potent antiviral. The very well-known yin chiao formula used for colds and flus has honeysuckle in it and that has been shown to be active against this virus and that’s lonicera, you’ll see that in many formulas. Chrysanthemum has been shown to have some activity. I think about an herb like feverfew, tanacetum parthenium, which is super anti-inflammatory, so I think about putting that into these formulas.
Think about other herbs that we know act on inflammation in the lungs, like boswellia, boswellia is very powerful for inflammation in the lungs, it not only interacts with the Cox enzymes, but with the LOX-5 enzyme, which is more active in the lungs and with asthmatics, for example. So I’m using that, the boswellia’s also active in the gut. I’m thinking about using lots of Omega-3 fatty acids in these patients to make the cell membrane healthier and to dial down inflammation and these are very safe things that don’t have a lot of drug interactions. Also, we know that the over-the-counter NSAIDs, the non-steroidal anti-inflammatory drugs seem to make this worse and so, although people are having inflammation and might want to reach for those, it’s been advice that people not take Advil and Aleve, or even aspirin when they have this syndrome. So I think again, we’re just all really learning and we have to also learn on our American patient population, which is … The average patient’s taking 10 to 20 pharmaceuticals at the time they’re diagnosed also.
Dr. Weitz: What about when the patient’s … If they’re sick and they start having breathing problems? Is there anything you think about using then?
Dr. Chilkov: I think that anyone who is showing respiratory distress of any kind should be seen by a physician.
Dr. Weitz: Sure.
Dr. Chilkov: And be evaluated for oxygen. These people basically are having airway constriction due to constriction, so think what happens to an asthmatic lung, that the airway is obstructed due to an inflammatory response. In this case, it’s not eosinophils, it’s inflammatory cytokines like IL-6 and IL-8 and IL1B1, so we do know we have lots of botanicals that interact with those. Those happen to be the cytokines most ramped up in cancer as well, so curcumin is available and the other thing that’s happening with these patients, this extra inflammation leads to hyper-coagulation and so some of these patients are forming a lot of thrombi and so if you have a patient that’s having pain in their lower legs, or suddenly gets short of breath, they may have developed a dangerous thrombus. So these are medical emergencies and we should not be messing around. We should be getting them to urgent care, basically.
Dr. Weitz: Sure.
Dr. Chilkov: But what we can think about, do you have a patient who has a higher risk of thrombus formation, like a diabetic or an obese patient, a hypertensive patient, their blood vessels are too constricted. So these patients should stay hydrated also. Even a low grade fever can disrupt your electrolytes so making sure patients are not only replacing fluids but electrolytes and I’ve seen people become both sodium and potassium depleted going through this syndrome. So very important. Then how do we repair tissue and hold onto fluids and make antibodies? You need to have adequate protein repletion. So we have good functional foods that can assist people. I think about the digestive issues that are going on, so not only probiotics, but perhaps glutamine will help the epithelial lining of the GI tract. So I think about things like that. If patients really can’t eat, maybe we should be giving them full spectrum amino acids just so that they have the building blocks that they need, right?
Dr. Weitz: Right.
Dr. Chilkov: Nobody’s going to use that as their diet but therapeutically, patients can quickly become depleted in essential nutrients.
Dr. Weitz: Right and some of these patients do have a loss of appetite.
Dr. Chilkov: Yes, well fever does yeah, fever does that.
Dr. Weitz: Now, what’s your perspective on fever?
Dr. Chilkov: Well fever is a normal part of an immune response and so in naturopathic medicine we don’t try to decrease a fever, we know that a high fever’s really only dangerous to the young brain for seizure but typically, adults don’t have anything dangerous happen to them, and so it’s part of the body’s solution to make the environment inhospitable to the organism and so I don’t have a problem with a person having a fever but as soon as a person has a low grade fever, we should be moving them in our mind into the category of active infection and being concerned about cytokine storms. We should be concerned about that.
Dr. Weitz: Right, so one of the tricky things is, there’s a percentage of patients who don’t have any symptoms at all, they’re outside spreading the disease.
Dr. Chilkov: Well, probably a lot of kids are in that category, you know?
Dr. Weitz: Yes.
Dr. Chilkov: Probably a lot of kids are getting it and sharing it with other children and with their adult caretakers and-
Dr. Weitz: Now young kids are typically very vulnerable to the flu and don’t do that well. Why do you think young kids do well with this virus?
Dr. Chilkov: Everyone has that question right now, we actually don’t know the answer to it but it might teach us something about the immune system. Maybe it’s because they have an active thymus, I mean, who knows? Todd LePine posited to use peptides, thymic peptides in these patients, which we also do in cancer patients, to mobilize immunity. I just had a hip surgery and I took thymic peptides and I could see my blood cell counts change from doing that. I had much more robust immunity after using those but we don’t know enough. I really think it’s important not to experiment and conjecture because we don’t really know if that also might ramp up more inflammation. We don’t know that because elevating white blood cells has the potential to increase inflammation and clotting risk as well. So again, I’m just very conservative. I do not experiment unduly, even if it sounds like a good idea, because the border between low risk and high risk can change in a day in these patients and we should not experiment on them. That’s my comfort zone.
Dr. Weitz: There’s been some discussion about melatonin and one of the reasons why older people are not doing as well because they have lower levels of melatonin.
Dr. Chilkov: Well I think the studies on melatonin are pretty good and melatonin is widely used in cancer as well, at high doses. So, I think that melatonin has a couple of functions here. Of course it’s a super antioxidant, it can help quench some of the oxidative stress but it also modulates immunity and impacts T cell function and so because I have experience using melatonin in high doses, which most clinicians don’t unless they’re working with cancer patients, I am comfortable giving 20 to 40 milligrams of melatonin to patients. Some patients in the cancer setting get up to 180 milligrams of melatonin over a 24 hour period and patients who are particularly sensitive to melatonin, the early sign is you get really vivid dreams. Now, melatonin is not a sedative, people think it’s a sedative, it’s a dark signal to the brain at half a milligram. Once you start getting into these super doses, you’re not using it to modulate sleep cycle any more. You’re using it as a neuro-hormone and a neuro-antioxidant and a signal to the immune system. So that’s very different. So I think also clinicians need to remember there are nutritional doses of nutraceuticals and botanicals and phytochemicals and there are therapeutic doses and we have to really understand the difference. So some clinicians are suggesting for example, at early signs of viral exposure, that patients take up to 50 to 100,000 units of vitamin A for a few days. Although in all our educations, our textbooks tell us that that’s liver toxic, I have never seen that in clinical practice. Never once have I ever seen that.
Dr. Weitz: Yeah, you know the World Health Organization actually recommends for children to protect them from a vaccine, to take 300,000 units?
Dr. Chilkov: Yes, yes, yes. Yes, that’s done in developing countries when they give children multiple vaccines at once. During the SARS epidemic, that was a coronavirus, during the SARS epidemic, the entire country of Canada instructed their population to utilize vitamin D because we know vitamin D decreases vulnerability to viral respiratory infections. Again, a lot of physicians aren’t well educated in the therapeutic use of vitamin D, and so you can give 50,000 units for three or four days and then drop down to 20,000 and 10,000 a day after that but it’s really the blood level of 25-OH vitamin D being close to 75 nanograms per milliliter when you get this change in immune response. So you can measure your patients, vitamin D goes up very slowly, even if you give high oral doses. It’s only dangerous where it gets near 100 nanograms per milliliter and then you start to change the compartment where calcium is found, but up to that, it’s pretty safe. So I think that using … with the general public, I feel safe saying you can take 10,000 a day.
Dr. Weitz: Yeah, I’ve seen that as well, there’s the occasional patient, where you give them a modest dosage and it shoots up to a hundred but it seems like 80% of them, it’s really difficult to get that level up, especially if you’re trying to get to a therapeutic range of … you mentioned 75 but somewhere’s 50 to 70, 60. It’s really hard to get up to that range and keep it there.
Dr. Chilkov: Well, in patients where you’re having that experience, you’re giving them fairly aggressive oral dosaging and you see the OH-25 vitamin D doesn’t budge a lot-
Dr. Weitz: Oh, I check the 125 also,…
Dr. Chilkov: … you have to check the 125 because you want to see the rate of turnover. So we know that autoimmune patients and cancer patients utilize vitamin D at a much higher rate and so we don’t know that about these patients but we could measure, we could find out.
Dr. Weitz: Yeah, good. Okay, and let’s see. I think that’s about the thoughts that I had. Anything else you wanted to cover?
Dr. Chilkov: Well I think that we should all really be thinking about how we are going to help these patients recover. So let’s think about what happens for the patients who’ve had hospitalization or patients who’ve had aggressive bouts at home. I’m seeing patients being sick for two to three weeks beginning to end and then at that end, where the virus and the sequelae of the acute symptoms has dropped off, there are patients who are experiencing a lot of fatigue because their HPA axis has been on overdrive, so we need to help people with resilience and think about our adaptogens.
Dr. Weitz: Adrenal support.
Dr. Chilkov: Well not only adrenal support, but the category of adaptogens, things like rhodiola and ashwagandha also speak to the parasympathetic balance. These patients have faced death, a lot of them, so they’ve really been in extreme physiology. A lot of them have been alone and away from family and really sick and not having someone there to down-regulate them.
Dr. Weitz: And it makes it even worse when they’re in the intensive care and not only don’t they have their friends or family there, but the people caring for them are covered with masks so they don’t even get to see their faces.
Dr. Chilkov: Right, they’ll get that. Yeah, get that and if you’re intubated, you can’t speak for yourself either. So there are people who have some large or small version of PTSD and so that’s vagal nerve, parasympathetic balance, that’s very important. I think all these people need their microbiome and GI tracts tended to and then we have to look at what sub-population they were in. Did they go into this with cardiovascular disease, then are we concerned? Do we want them maybe to get an ejection fraction test when they come out to see if their heart muscle was damaged or not?
Dr. Weitz: Sure.
Dr. Chilkov: We want to monitor if their hypertension is still well managed, or now it’s not well controlled. The diabetic, what has happened to them as a result of this? I think we don’t know enough but since we are looking for health. We are looking for health, not marginalized good enough, which is the standard of care in medicine today. But if we really want to get these people back to robust health, that’s one category of things we need to do. Then we need to also think about repairing damage and so how do we make the heart muscle more efficient? How do we protect the kidneys and the lungs? So for example in cancer, these organs are also damaged by the inflammatory nature of cancer but also the pro-oxidative therapies they receive damage all these organs as well and so we use milk thistle a lot for these patients. So I don’t have all the answers yet because I don’t have enough experience with a large enough population of these survivors but these are the things I’m thinking about, certainly acupuncture is a restorative therapy that also helps you regulate, helps you regulate. So we need to think about hormesis and all of the self-regulating functions that are disrupted by trauma, really, by emotional and physical trauma that these patients have gone through and-
Dr. Weitz: And also the trauma that some of the healthcare workers are going through when they care for these very sick patients.
Dr. Chilkov: Yeah, I’m thinking about also putting together some ideas for caring for the caregivers, because we have a whole traumatized, highly stressed population of heroes and heroines on the front lines and I think there’s a fair amount of anxiety, whatever end you’re on, the patient end or the caregiver, or the, “Am I going to get it,” end. So we need to help our patients have better coping skills also.
Dr. Weitz: Right, great. Awesome. Well, thank you so much for spending some time with us, Dr. Chilkov.
Dr. Chilkov: You’re welcome.
Dr. Weitz: How can people get a hold of you and find out about your programs and seeing you if they want to?
Dr. Chilkov: My clinic website is just my name, NaliniChilkov.com, N-A-L-I-N-I C-H-I-L-K-O-V and my professional training for primary care frontline clinicians who want to care for the health of cancer patients and survivors is aiiore.com and if you opt in to my list on that site, you’ll get a series of videos, very short videos, in which I talk about how we can begin to make a difference in the lives of these patients in primary care settings.
Dr. Weitz: Awesome, thank you so much.
Dr. Chilkov: Thank you.
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