HOW TO AVOID COVID-19 & SOME OTHER VIRAL INFECTIONS

HOW TO AVOID COVID-19 & SOME OTHER VIRAL INFECTIONS

[DR AMIR FARID ISAHAK]

[This article was written during the lockdown due to the COVID-19 pandemic, April 2020].

Viruses are inanimate matter than gain “life” once they enter cells. A virus is made of genetic material (DNA or RNA) that carry the instructions on how to replicate itself once it invades or infects a cell. Viruses invade the cells of the smallest to the largest organisms – bacteria, plants, animals and humans.

Viruses have caused many epidemics and pandemics throughout history. The Spanish Flu (influenza) pandemic of 1918-1919 infected 500 million (1/3 of the global population then) and killed an estimated 50 million people. More recently coronaviruses caused the SARS (2003) and MERS (2012) epidemics. Now in 2020 we are in the midst of another coronavirus pandemic (COVID-19).

For COVID-19, the number infected exceeded 1 million in early April 2020, with over 50,000 deaths. The numbers are expected to continue to rise rapidly. Millions are expected to die unless effective treatments and vaccines are discovered soon.

Until these are available, we have to depend on measures to prevent infection, and if we still get infected, we have to depend on our own immune system to fight the virus.

Statistics from China showed that 15% of those infected may not have symptoms at all and 65% have mild symptoms which may not require hospitalization. The other 20% have severe symptoms that definitely require hospitalization, with a quarter of this (5%) requiring ventilator support, and 60% of those on ventilator will die, giving an overall fatality rate of about 3%. But these rates vary between countries.

Unfortunately, even those who are asymptomatic are infectious and can spread to their unsuspecting families and friends, and also contaminate the surfaces wherever they go. This is why this infection spreads so fast and so easily.

The severity of symptoms and the fatality rate also varies between the young and the old. The risk of severe symptoms and death increases with age, especially for those with co-morbidities (chronic diseases like hypertension, heart disease, lung disease, diabetes, cancer, etc).

ACTIONS TO PREVENT INFECTION & TO FIGHT COVID-19 DISEASE

The virus itself is called SARS-nCoV-2 and the disease it causes is called COVID-19, but we shall refer to it simply as the COVID-19 virus.

SARS was caused by the SARS-CoV virus. They are similar and are from the family of coronaviruses which are common in both humans, and more so in animals. Both had originated in bats and somehow mutated and crossed over to humans (zoonosis), possibly through other animals as intermediate hosts.

Here are the steps required to prevent getting infected by the virus, and to fight the disease should you get infected.

HOW TO PREVENT ACQUIRING OR TRANSMITTING THE VIRUS BY DIRECT CONTACT, AIRBORNE DROPLETS OR CONTAMINATED SURFACES

The first strategy should be preventing the virus from ever getting near us. That means avoiding infected and potentially infected people. Unfortunately, the virus spreads even after the infected persons have left an area, because viral-infested droplets left by them (through their coughs and sneezes if they didn’t wear masks) would contaminate the surfaces in that area. Surfaces they touched could also be contaminated if they didn’t wash or sanitize their hands.

1)      SOCIAL DISTANCING & QUARANTINE

Infected people may not have symptoms at all, or have mild symptoms mimicking the usual coughs, colds and fevers (or even seasonal influenza).

So in a pandemic, everyone is a suspect, especially those with some symptoms, no matter how mild.

Because of that, social distancing and other more stringent measures become necessary.

Healthy people should stay home as much as possible, and leave home only for essential errands, and only the head of the family should be going outside for these errands. While outside, and upon returning, all necessary precautions to wash or sanitize should be taken.

Masks should be compulsory even for the healthy people when going outside the home (with people in the vicinity). Social distancing should be practiced. A 1 meter gap is currently advised, but 2 meters is safer. Body contact, especially handshakes, should be avoided at all cost.

Confirmed cases should be treated in hospital or quarantined in designated places.

All suspected people (persons under investigation, PUI) should be under self-quarantine at home until their tests results are known. Precautions not to put housemates at risk must be strictly in place.

All those with a history of contact with a PUI should self-quarantine at home too, and must get tested if the PUI is confirmed positive.

2)      WEAR MASKS

The experts disagree whether healthy people should wear masks during this pandemic, but the countries that enforced masks for all have shown better control of the spread of the disease. The WHO recommended masks for all only after more than 1 million are infected worldwide.

Those with symptoms certainly have to wear masks. Front-line healthcare workers have to wear masks and more (PPE, personal protection equipment), depending on their nature of duty.

Masks for those with symptoms are to prevent infecting others, while masks for the healthy are to prevent them getting infected, and to prevent infecting others if they are in fact infected but asymptomatic.

Masks can also prevent the uninfected wearer from touching the mouth and nose (ie. the infection routes) should the hands be contaminated by the virus.

Surgical masks (3-ply) are sufficient for the public, while frontline healthcare workers in certain areas should wear N95 masks and face-shields.

3)      BRING FACIAL TISSUES, DISINFECTION WIPES & SANITIZERS WHEREVER YOU GO

The best and cheapest way to minimize contaminating others and the area around you when you cough or sneeze is to do so onto a tissue, and then throw it into a covered waste-bin. If you don’t have a tissue, then do so onto your sleeve (hopefully you are not wearing a sleeveless shirt). But your shirt will become contaminated.

Remember – in a pandemic, everyone is potentially infected and infectious (can spread the infection to others) even while not having symptoms.

Tissues can be used to handle things which are highly likely of being contaminated (door handles and knobs, supermarket baskets and trolleys, petrol pump nozzles, etc). The tissues can just be thrown away once they are used.

It is even better to disinfect the surfaces that you are going to touch or hold. So you have to bring disinfection wipes or sanitizers with you.

4)      AVOID CONTAMINATED SURFACES

The COVID-19 virus has been shown to survive on certain surfaces for many days, so anyone touching these surfaces will become contaminated and possibly infected.

If he then touches his eyes, nose or mouth, the virus will gain access into his body.

If he touches other people or other surfaces, these will then become contaminated.

Because the risk of getting contaminated this way is very high, frequent hand-washing or hand-sanitizing is very crucial to avoid getting infected.

We can reduce the risk by wearing gloves (certainly for frontline healthcare workers); by using facial tissues, disinfection wipes and sanitizers (see above); by using the non-dominant hand to touch doors, handles and knobs and most other things; and to push doors using our buttocks instead of using our hands.

The reason for using the non-dominant hand is that we usually use the dominant hand to touch our faces (and adjust our masks, which should be avoided).

Since every family has to get provisions from the grocers or supermarkets, these places continue to be “meeting places” where the virus can spread. The shopping baskets and trolleys, which are repeatedly re-used, are mostly contaminated unless frequently sanitized by the shop-owners. For our own safety, we should disinfect or sanitize the parts we are going to hold before doing so.

Extra effort should be made to avoid contact at the cashiers’ when paying for purchases. Unfortunately, the transfer of notes, coins and cards between buyers and cashiers could be one of the ways the virus spread easily in the community. Cashiers should wear gloves. And so should the buyers! The best is to use contactless payment methods.

Some banks in China even sanitize the currency notes regularly.

Finally, we should also regularly disinfect our mobile phones (tablets, laptops too) as we touch them many times in a day.

5)      WASH HANDS WITH SOAP OR USE SANITIZER

The virus is easily deactivated by soap-water because soap dissolves the fat in its covering. Regular and thorough washing (at least 20 seconds) of the hands will keep the hands virus-free after being contaminated.

If soap-water is not available, hand-sanitizers with at least 60% alcohol (or other known virucidal chemicals) can be used instead. But hand-washing is the best.

HOW TO PREVENT DISEASE IN CASE YOU GET INFECTED

If the virus gets onto your body, you are contaminated, but not yet infected. Infection occurs only when it gets inside your body. The COVID-19 virus gains access through the eyes (then into the nose through the tear ducts); or into the nose or mouth directly. It then infects the cells on the surface (mucous membrane) of the naso- and oropharynx which explains the early symptoms of blocked nose, dry coughs and sore throat. It then gets to its final target – the cells lining the alveoli of the lungs, where it causes most damage, resulting in pneumonia, severe acute respiratory distress, and even death.

However, you may get infected but do not develop symptoms at all, and you will still spread the virus to others. You are most likely to recover fully and become immune, although there are reports of people becoming re-infected.

1) STAY HEALTHY – Home, Lifestyle, Diet, Exercise, Stress & Sleep

Those who are healthy have a better chance of preventing the development of symptoms, and recovering from these. So you must take all the necessary actions to promote and maintain optimum health.

Even under lockdown or quarantine, efforts should be made to create a healthy home environment by ensuring sufficient flow of fresh air and sunlight whenever possible.

If there is any contact with a positive case, then the house must be thoroughly disinfected. It is also good to do so frequently as it is really difficult to avoid contamination once you venture outside, and you will certainly contaminate your home.

If you are a smoker, you should take this opportunity to stop smoking, because smokers fare worse if they get infected. The COVID-19 virus targets the lungs.

And if you still smoke, do not smoke indoors and make it worse for your family members.

2) EXERCISE

I expect a surge in the problems of obesity, hypertension, heart disease and stroke after this lockdown is over because of unhealthy food, over-eating and lack of exercise.

Many people don’t exercise, but in the normal situation, they would at least be walking and climbing stairs in the course of their daily routines. The lockdown stops all this and many will become couch-potatoes locked on their smartphones, laptops and TVs.

Being confined at home makes exercise difficult for those used to going outdoors or to the gym. Those who have in-house gyms are luckier. But we must do some daily exercises nevertheless.

The most basic exercise is deep breathing. This has many benefits, especially keeping the lungs themselves well-aerated. Everyone should do this daily.

These are some basic exercises that we all can do anywhere – stretching, running on the spot, step-ups, push-ups, sit-ups, reverse crunch and squats.

If you are familiar, you can also do Tai Chi, Qigong, Yoga or whatever you have learned. You can also do active dancing like Zumba or the Shuffle!

The more savvy ones can follow exercise programs on YouTube or online.

If permitted, you should also exercise outdoors, even within your own compound if such space is available. You need the fresh air and sunshine for good health.

Remember that we should exercise ½ hour daily 5 times a week or more.

Of course if you are infected and develop symptoms, you may become fatigued and need to rest instead.

3) MANAGE STRESS

This situation is stressful for many reasons. The fear of getting infected is in everyone’s mind. Then there are financial concerns for many, because jobs and businesses are all threatened.

Everybody being at home creates a lot of stress in some families. Reports of domestic violence increased as soon as the lockdown began, and Wuhan (the epicenter of COVID-19 in China) reported a rise in divorce cases after their lockdown was lifted.

This is a good time to reflect, reform and reboot many aspects of our lives, including improving our relationships with our loved ones.

Those who are religious or spiritual are more likely to withstand the financial concerns because their trust in God or a Higher Power will help calm them and have peace of mind. If you are one of them, meditate, supplicate and pray more for divine protection and assistance.

4) HAVE ENOUGH SLEEP

Sleep is required for the body to rest, repair and recharge. Sleep experts now advise that we need 7-9 hours of good sleep daily (at night plus daytime nap if necessary) to maintain good health. It used to be 6-8 hours.

Chronic sleep deprivation is associated with many chronic diseases. For example, those who only sleep 4 hours a night are at least 2x more prone to heart disease, stroke and diabetes.

Our concern here is the role of adequate sleep in maintaining and enhancing our immune system. The immune system is revitalized during sleep, and those with insufficient sleep will have a weakened immune defence.

SLEEP & GROWTH HORMONE

Our Human Growth Hormone (HGH) is released mainly during deep sleep. It is needed for the activation of certain immune cells (T-helper cells, Killer cells and B cells) which are important in the defence against viruses. This factor is very important because we cannot depend on drugs to save us. Until now there is no sure cure for COVID-19. Our own immune system is the first line of defence.

 

To ensure good HGH secretion, we must sleep before midnight. Earlier is even better.

HGH secretion declines rapidly with age such that by age 60 we are 40-60% down and by age 80, 60-90% down from the level at age 20. This has serious implications on our immune health and ability to fight viral infections.

Regular intense exercise and a high-protein diet can help improve HGH secretion. There are also amino-acid supplements that can help.

5) DIET & NATURAL REMEDIES

This is probably the most important component in our defence against viruses as there are many food items that can kill some viruses directly, or by enhancing our immune system.

----------------------------------------- DISCLAIMER -----------------------------------------

While some food items are mentioned or recommended here as possible ways to help our defence against viruses, these have not been specifically researched against the COVID-19 virus, although some items have been tested against other viruses, including other coronaviruses like SARS-CoV.

Therefore the recommendations are to be taken only as general advice, and not as proven prevention or treatment for COVID-19.

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A healthy plant-based diet, with plenty of fruits, veggies, roots and shoots (preferably organic) is known to promote good health, and good immunity.

We should avoid processed meats and canned foods, and cook fresh ingredients to maintain our health, more so in this period when our health needs to remain tip-top.

There are many proposed natural remedies to fight viruses, but unfortunately very few have been vigorously tested to prove the claims. Here are some of them:

ANTI-VIRAL HERBS & SPICES

Many herbs and spices have been proven by scientific studies to have some anti-viral properties. These include onions, garlic, elderberry, echinacea, calendula, cat’s claw, ginger, oregano, astragalus root, olive leaf and many more. Taken in small amounts frequently, they may help keep the immune system primed, but there is insufficient clinical research to make therapeutic claims.

Many naturopaths and alternative healers are recommending onions and garlic as possible remedies against COVID-19, but there is little scientific evidence to support this.

BLACK LICORICE 

Back licorice (active ingredient: glycyrrhizin) is widely utilized for its anti-inflammatory, immune-stimulating, and antiviral properties. In China, it is already being used as an adjunct to antiviral therapy for hepatitis and HIV.

Studies have shown that it inhibits SARS and other coronaviruses. But no study has been done on COVID-19 virus yet.

Black licorice can be easily obtained from supermarkets and Chinese medicine stores.

CREAT/GREEN CHIRETA (Andrographis paniculata)

Green chireta is used in Ayurveda for its immune-modulating properties. Recent research showed that some of its extracts inhibit key enzymes of the coronavirus. It is hoped that further research is done on COVID-19 virus itself.

COCONUT WATER & COCONUT OIL

Coconut water is touted as being antiviral, but no studies have proven this.

Coconut oil has some evidence of improving immunity, and scientists in the Philippines are doing research on its effectiveness against COVID-19.

VITAMIN C

Much interest has focused on vitamin C with the recent reports that very high doses (up to 24,000 per day by IV infusion) helped some severely ill COVID-19 patients recover.

However, this cannot be simply extrapolated to mean lower oral doses are effective in preventing or treating early infection.

Nevertheless, taking adequate vitamin C is important to ensure a healthy functioning immune system. Unfortunately, to this day, experts still disagree on how much vitamin C we should take. Those who promote vitamin C as prevention against COVID-19 suggest taking anywhere from 1,000 – 10,000 mg daily, which would require taking supplements.

Vitamin C can be easily obtained from citrus fruits, guava, kiwifruit, mango, papaya, pineapple, and many vegetables. The official daily allowance is only 75mg for women and 90mg for men!

VITAMIN D

Vitamin D boosts immunity and may help reduce the risk and severity of respiratory infections. Conversely, vitamin D deficiency is associated with severe acute respiratory syndrome. Vitamin D has many other health-enhancing benefits.

There is worry that staying indoors during the lockdown will cause many people to become deficient in vitamin D due to the lack of sun exposure.

In the tropics, we need only 10-15 minutes of sun exposure daily to achieve healthy levels of vitamin D. Those who have dark skin and those who live further away from the equator will need longer exposure.

Food sources of vitamin D include fatty fish (eg. tuna, mackerel, salmon), beef liver, egg yolk, cheese and fortified foods (some dairy products, orange juice, soy milk, and cereal).

As a precaution during this pandemic, some experts recommend supplementing with high doses (10,000 IU daily) for a few weeks to boost vitamin D levels, and then reduce to 5000 IU daily, especially for those who are confined indoors.

ZINC

Zinc is vital for many cellular functions, including for the immune cells. Studies show that zinc inhibits corona viral replication by blocking a key viral enzyme utilized for replication in host cells.

The anti-viral properties have been known for some time, and zinc lozenges have been a remedy for the common cold for decades.

Among the current “hot” drug candidates against COVID-19 are quinone and hydroxyquinone. These drugs stop the viral infection by at least 2 mechanisms: (1) by altering the ACE2 receptors that the virus latches on to gain access into the cells, and (2), by helping to bring zinc into the cells (see below).

Studies on COVID-19 coronavirus infection and replication are being done in earnest. The physiology of its replication is almost identical to that of SARS-CoV, and can be blocked by zinc.

Zinc-rich foods include meats, shellfish (oysters, crabs, lobster, prawns, etc.), legumes and beans.

A daily intake of 10g is recommended, but for better prevention, up to 50mg can be taken especially during this pandemic.

Improving free cellular zinc not only stops viral replication, but can also kill cancer cells and improve many other health conditions.

But the zinc needs to be transported from outside into the cell cytoplasm, and this requires special transporters called “ionophores’.

The two best natural zinc ionophores are quercetin and EGCG, which therefore make them also anti-viral agents. The drugs quinone and hydroxyquinone also act as zinc ionophores, which partly explain their effectiveness against COVID-19 in some preliminary studies reported thus far.

QUERCETIN

Quercetin is a plant pigment (flavonoid). It is found in many plants and foods, such as red wine, onions, green tea, apples, berries, Ginkgo biloba, St. John's wort and others.

Apart from its anti-viral action, there is some evidence that it may help in diseases of the heart and blood vessels and prevent cancer. It is also used for arthritis, bladder infections, and diabetes.

EGCG

Epigallocatechin gallate (EGCG) is a plant catechin polyphenol found as the main health-enhancing component of green tea.

It is also found in lesser amounts in other teas; fruits (cranberries, strawberries, blackberries, kiwis, cherries, pears, peaches, apples, and avocados); and nuts (pecans, pistachios, and hazelnuts).

There is some evidence that it reduces inflammation and prevents certain chronic conditions, including heart disease, brain disease, diabetes, and some cancers. Our interest here is its anti-viral properties.

GLUTATHIONE (GSH)

Glutathione is the most important intra-cellular antioxidant. It also has powerful anti-inflammatory, immuno-modulatory and detoxifying actions.

It is critical for the proper functioning of our immune cells, including fighting viral infections. Studies have shown that it empowers both the Killer cells (which kill virus-infected cells) and the B-cells (which produce antibodies that disable the virus). It can stop viral multiplication.

Glutathione is produced by the body. Unfortunately, as part of our programmed ageing, its production declines as we age. GSH production declines by 10-15% per decade after age 20. After age 60, the deficit is significant (at least 40% deficit). At 80, the deficit is 60-90%. The same is true for HGH (Human Growth Hormone – SEE ABOVE).

If you look at the graph of THE RISK OF DYING FROM COVID-19 (see below), you will find the elderly are most susceptible, and the young rarely die from it.

While there are many factors contributing to this, understanding how our immune cells function against viruses makes us realize that the decline in both HGH (Human Growth Hormone) and GSH (Glutathione) are major contributing factors to the poor immune defence.

There are several ways to boost GSH. Unfortunately, although GSH is found in food (plants and animals that we eat also produce GSH for their own protection), it is poorly absorbed and gets digested instead. The same applies for most glutathione supplements.

Scientists have discovered that it is possible to boost glutathione production even in older people by providing our cells with the amino-acid cysteine, which is the component of GSH least available from the diet. It is scarce in foods compared to other amino-acids, and it is fragile. It gets denatured easily when the food is cooked.

So you can get some cysteine if you consume raw cysteine-rich foods like meats, eggs, fish and poultry; cruciferous veggies like broccoli, Brussel sprouts, kale and cauliflower; and allium veggies like garlic and onions.

A convenient way to boost glutathione long-term is by taking supplements containing the stabilized forms of natural cysteine (ie. not denatured, well-absorbed, and made available for the cells) as the precursor for the manufacture of glutathione, instead of taking glutathione supplements (because these are poorly absorbed).

6)      AYURVEDA & TRADITIONAL CHINESE MEDICINE

There are reports claiming that Ayurvedic treatments and TCM are helpful in treating COVID-19 infections. Indeed TCM is being used in China together with mainstream medicine, with some success in fighting COVID-19.

7)      POVIDONE-IODINE GARGLE

Finally a simple tip to help prevent viral (and bacterial) throat infections, or provide rapid relief once infected. If we are lucky, it may also prevent downward spread of the virus into the trachea, bronchi and lungs.

Povidone-iodine solution is an excellent sterilizer, and is used in concentrated form as pre-operative sterilizing prep for surgeries.

A study showed that gargling a 0.23% solution for just 15 seconds rapidly inactivated SARS-CoV, MERS-CoV, influenza virus A (H1N1) and rotavirus. It also had bactericidal activity against Klebsiella pneumoniae and Streptococcus pneumoniae.

Povidine-iodine 1% solution is widely available as a gargle/mouth wash, and frequent use has been found to be effective against throat infections. Although no study has been done on COVID-19 virus, it makes good sense to use it as a precaution since it is effective against SARS-CoV. COVID-19 virus (SARS-CoV-2) is very similar to SARS-CoV.

REFERENCES:

Vitamin D could have key role in COVID-19 respose (http://www.irishhealth.com/article.html?id=27110)

Can Supplements Help Combat COVID-19? (https://www.psychologytoday.com/us/blog/experience-engineering/202003/can-supplements-help-combat-covid-19)

In Vitro Bactericidal and Virucidal Efficacy of Povidone-Iodine Gargle/Mouthwash Against Respiratory and Oral Tract Pathogens. Maren Eggers et al. Infect Dis Ther, 7 (2), 249-259 Jun 2018.

GLUTATHIONE & GROWTH HORMONE ARE CENTRAL FOR OUR IMMUNE DEFENCE AGAINST VIRUSES

GLUTATHIONE (GSH) & HUMAN GROWTH HORMONE (HGH)

ARE CENTRAL FOR OUR IMMUNE DEFENCE AGAINST VIRUSES.

(Please see diagram below for better understanding. Diagram adapted from MedCram by Roger Seheult, MD).

#1. GSH is required for the proper functioning of APCs - Antigen Presenting Cells which engulf viral-infected cells, and then process the viral antigens for presentation and correct identification by T-helper cells and Killer (cytotoxic) cells.

#2. GSH is required for the activation of CD4+ cells (by APCs) to become T-helper cells, which then initiate both the cellular (ie. by cytotoxic killer cells) and humoral (ie. by antibodies) defence against viruses.

#3. GSH is required for the activation of CD8+ cells (by T-helper cells) to become Killer cells, which then kill the cells infected by viruses.

#4. GSH is required for the activation of B-cells (also by T-helper cells) to produce antibodies against the virus.

GSH drastically reduces viral multiplication.

GSH reduces inflammation caused by the viral infection, without causing the same adverse reactions like ibuprofen does (Ibuprofen is an anti-inflammatory drug partly blamed for the high COVID-19 death rate in Italy).

GSH reduces oxidative stress, which would otherwise increase the virulence (aggressiveness) of the virus.

Our body produces Glutathione to maintain good health and fight infections. Glutathione has many important functions for the body, the most important of which are listed below.

It is:

1) the most important intra-cellular antioxidant

2) a very strong anti-inflammatory agent

3) a very strong detoxification agent

4) a very powerful immune booster & modulator (ie. it also calms down an overactive immune system, and helps auto-immunity return to normal)

5) a versatile Redox signalling molecule.

It has hundreds of other functions to keep us healthy.

Unfortunately, as part of our programmed ageing, its production declines as we age.

GSH production declines by 10-15% per decade after age 20.

After age 60, the deficit is significant (at least 40% deficit).

GSH-deficiency is associated with over 100 diseases and health problems, while high level of GSH is associated with good health and longevity.

All the organs, especially the liver, kidneys, eyes, brain, heart, lungs, intestines, etc. need the protection of GSH.

Because of the decline in production, the balance of Glutathione as you age is:

The range is between the healthy and unhealthy in each age group. Among the healthiest, the decline is slow and they have higher levels of GSH despite their age.

In comparison, there is no such predictable difference in vitamin C levels with age because we do not produce vitamin C, and any difference is due to dietary intake and factors that cause the body to utilize it. An old person who consumes a lot of vitamin C will have more than a young person who does not.

If you look at the graph of THE RISK OF DYING FROM COVID-19 (see below), you will find the elderly (especially those with co-morbidities or chronic diseases) are most susceptible, and the young rarely die from it.

While there are many factors contributing to this, understanding how our immune cells function against viruses makes us realize that the decline in GSH is one major reason.

The older people have much less Glutathione, and those with co-morbidities have the least.

But we may be able to beat the statistics by boosting our Glutathione.

There are several ways to boost GSH. Unfortunately, although GSH is found in food (plants and animals that we eat also produce GSH for protection), it is poorly absorbed and gets digested instead. The same applies for most Glutathione supplements.

Scientists have discovered that it is possible to boost Glutathione production even in older people by providing our cells with the amino-acid cysteine, which is the component of GSH least available from the diet. It is scarce in foods compared to other amino-acids, and it is fragile. It gets denatured easily when the food is cooked. So you can get some cysteine if you consume raw cysteine-rich foods like meats, eggs, fish and poultry; cruciferous veggies like broccoli, Brussel sprouts, kale and cauliflower; and allium veggies like garlic and onions.

A convenient way to boost Glutathione long-term is by taking supplements containing the stabilized forms of cysteine (ie. not denatured, well-absorbed, and made available for the cells) as the precursor for the cellular manufacture of Glutathione, instead of taking Glutathione supplements (because these are poorly absorbed).

In fact, exogenous Glutathione (from outside - ingested or injected) has to be broken down to its component amino-acids; these are then assimilated into the cells and Glutathione is re-synthesized inside the cells where it is most needed. The cells are equipped to make and "export" Glutathione but not to "import" it.

REFERENCES:

Alessandra Fraternale, Serena Brundu, Mauro Magnani. Glutathione and Glutathione Derivatives in Immunotherapy. Biol Chem 398 (2), 261-275. 2017 Feb 1. https://pubmed.ncbi.nlm.nih.gov/27514076/

H Gmünder, W Drög. Cell Immunol 138 (1), 229-37 Nov 1991. Differential Effects of Glutathione Depletion on T Cell Subsets. https://pubmed.ncbi.nlm.nih.gov/1913838/

Roberts JC, Nagasawa HT, Zera RT, Fricke RF, Goon DJW. Prodrugs of L-Cysteine as Protective Agents against Acetaminophen-Induced Hepatotoxicity. 2- (Polyhydroxyalkyl)- and 2-(Polyacetoxyalkyl) thiazolidine-4(R)-carboxylic Acids. Journal of Medicinal Chemistry. 1987, 30:1891-1896].

HUMAN GROWTH HORMONE (HGH) IS EQUALLY IMPORTANT

Another major factor, in tandem with GSH, is the decline in HGH (Human Growth Hormone) as we age past 20.

It is present at high levels in growing children, and declines at the same rate as GSH after we stop growing at about age 20, to very low levels in old age.

And just like GSH, HGH is also required for the optimum functioning of our immune cells - APCs, T-helper cells, B-cells and Killer cells as explained above.

The simplest way to boost HGH is to ensure you get sufficient, good sleep, as HGH is mostly secreted during sleep, following our biorhythm. You need to sleep early (definitely before midnight) to achieve that. However, as you age past 40, even this may not be enough to maintain HGH levels sufficient for optimum immunity.

To boost HGH higher, you need to see anti-ageing doctors, as HGH is also the most important anti-ageing hormone!

DR AMIR FARID ISAHAK.

ARE STATINS NECESSARY?

[This article was submitted for publication in my column Art of Healing in Oct 2013, but was rejected]

IS STATIN THERAPY TO REDUCE CHOLESTEROL NECESSARY?

In the previous article, I reported some studies which showed that the prevailing understanding about cholesterol and health needs to be re-assessed. In particular, while the link between high cholesterol and heart disease in men is established, high cholesterol may be protective against other causes of death such that high cholesterol does not correlate with higher overall deaths. Secondly, high cholesterol is in fact beneficial for women and therefore doctors should not prescribe anything to lower their cholesterol level (except perhaps a few exceptional cases).

Today I shall discuss some studies on statins which confirm the above conclusions.

STATINS DO NOT BENEFIT IN PRIMARY PREVENTION - STATIN THERAPY TO LOWER CHOLESTEROL LOWERS HEART DEATHS BUT INCREASES OTHER CAUSES OF DEATH

With the realization that some of the scientific studies were biased towards justifying the use of cholesterol-lowering drugs, researchers re-studied the data for the use of statins in patients who never had angina, heart attack or stroke (ie. statins were used as primary prevention) after excluding the doubtful and obviously biased studies (eg. the JUPITER trial, see below). They discovered that statins indeed reduced cholesterol levels and heart attacks, but did not reduce the overall death rates. Observational studies had already shown that lower cholesterol did not equate to lower overall deaths. Also, the heart benefits of statins were completely negated by the side-effects. Their conclusion – “Statins do not have a net health benefit in primary prevention populations and thus when used in that setting do not represent good use of scarce healthcare resources” (see Do Statins Have a Role in Primary Prevention? An Update. Therapeutics Letter, March-April 2010).

That statins only lower deaths from heart disease but not overall death rates is a very important fact that cannot be ignored. It means the net benefit is zero, because of increased deaths from other causes as a result of statin therapy. The doctors were impressed by the reduced cardiac deaths to justify prescribing statins, when in fact the evidence says that statins increase other causes of death, otherwise the death rates will not remain the same. It is a grave mistake to ignore this fact.

STATINS SHOULD NOT BE USED IN WOMEN & ELDERLY MEN FOR PRIMARY PREVENTION

In 2007 researchers at Harvard Medical School discovered that the treatment guidelines issued by the US National Cholesterol Education Program (NCEP) did not follow the available evidence. They discovered that according to the evidence, statins should not be given for primary prevention to women of any age, and to men above 69 years old (see Abramson J, et al. Are Lipid-lowering Guidelines Evidence-based? The Lancet 2007, 369:168-169).

Since 2001, the NCEP had advised all men and women with high cholesterol to take statins as primary prevention, in addition to diet and lifestyle modification despite these studies that show there is no benefit whatsoever for women to go on statins. Some of the studies were done on men, and generalized to women. Some of the studies were done on both sexes, but the results were lumped together. Most studies that evaluated the men and women separately found that women don’t need statins at all.

I had referred to the Norwegian HUNT 2 Study (J Eval Clin Prac 2012 Feb) which followed 52,087 Norwegians aged 20-74 who were free of cardiovascular disease (CVD) for 10 years, then assessed the relationship of total cholesterol with total mortality, CVD mortality, and heart disease mortality. It concluded that the cholesterol-risk profiles for men and women were totally different. Women in fact benefited from having higher cholesterol levels!

OVERALL BENEFIT OF STATINS IS LOW

The same Harvard study also showed that even for the younger men in whom there was some net benefit from statin therapy, the benefit was very small: 67 people have to take statin drugs for 5 years for 1 person to avoid getting a “cardiovascular event” (eg. angina, heart attack). Even the biased JUPITER trial (statin for primary prevention, see below) showed that 95 people need to take the statin for 2 years (extrapolated to 25 people for 5 years) to prevent 1 cardiovascular event. In other words, the statin drug reduced the absolute risk for heart attacks, stroke or death by only 0.2-0.6% in one year. How cost-effective is that? And what about the side-effects?

VERY LOW CHOLESTEROL IS DANGEROUS

The normal total cholesterol (Total-C) level is generally taken to be up to 5.2 mmol/L (with some variations between guidelines issued by expert committees). Many studies have shown that Total-C of about 4.0-5.0 gives the lowest mortality. Levels below 4.0 and above 5.2 correlate with higher mortality rates. See graph of MRFIT study below (N Engl Jnl Med 1989 Apr 6;320(14):904-10). This study showed that high cholesterol does correlate with higher overall deaths.

 

      [Note: 200mg/dL = 5.2 mmol/L]

However, many physicians and cardiologists advise their patients who are at very high risk of heart attacks to reduce the LDL-C level to below 1.8, which means the Total-C can be 3 or even lower if the HDL-C is also low. This can only be achieved with statins. Even if the very low cholesterol level reduces cardiac deaths, the studies show it increases other causes of death such that there is no net benefit.

A study showed that Total-C levels below 4 also tend to cause cognitive impairment, aggressiveness and suicidal tendencies. This underscores the importance of cholesterol for overall health, and reminds us that less is not always better (see Neurologia 9 Oct 2012). In October 2012, the US FDA conceded that statins can cause memory loss and cognitive decline, and required this warning to be included in the drug safety information.

INSUFFICIENT EVIDENCE TO SUPPORT MAXIMAL LOWERING OF LDL-CHOLESTEROL

The Cholesterol Treatment Trialists (CTT) is a UK-based collaboration of doctors and researchers who are largely responsible for promoting “evidence-based” aggressive cholesterol-lowering treatment using intensive statin therapy which has been adopted by doctors worldwide. It is the UK equivalent of the US NCEP (see above). Recently, researchers in Canada re-examined the studies used by CTT to justify their stance and discovered flaws in some of the studies used by CTT. After correcting for these flaws, they found that doubling the dose of atorvastatin (one of the most popular statins used) from 40mg to 80mg to achieve target levels improved outcomes only by 2% (ie. less angina, heart attacks), while increasing significantly the side-effects of fatigue, muscle pain, liver damage and kidney damage (the doubling of financial cost to the patient was not even considered, as rarely is consumer cost a factor in all these drug studies). They concluded that definitive evidence supporting maximal lowering of LDL-cholesterol or maximal dosing of statins is still lacking (see Sinderman A, et al. Is Lower and Lower Better and Better? A Re-evaluation of the Evidence from the Cholesterol Treatment Trialists’ Collaboration Meta-analysis for Low-density Lipoprotein Cholesterol. J Clin Lipidol 2012; 6(4):303-9).

Incidentally, in November 2012 the UK’s Medicines and Healthcare Products Regulatory Agency (MHRA) reduced the recommended maximum dose of statins from 80mg to 40mg because of safety concerns.

STATINS BENEFIT MEN ONLY IN VERY HIGH RISK PRIMARY PREVENTION

The most convincing study that supports the use of statins is ASCOT-LLA (Lancet 2003 Apr 5;361(9364):1149-58). The study was on 19,342 very high risk patients aged 40-79 years with hypertension plus at least three other cardiovascular risk factors. The study ended early for ethical reasons because the statin drug proved convincingly beneficial against the placebo and it was unethical to continue. The drug reduced cardiac deaths.  But somehow everyone seems to ignore the glaring fact that the results showed the risk of dying was higher for women who took statins than those who took placebo! This is another clear evidence that women should not be prescribed statins as primary prevention, even in high risk cases (see chart below).

While this study did not separate the older men (60-69 years) from the elderly men (70 years and above), note that other studies showed that the benefits of statins were confined only to men 69 years and below (see Harvard study above).

 

 Effect of atorvastatin vs. placebo on risk of death from heart disease in very high-risk subjects. Note that for women, the placebo was better than the drug!

BIASED STUDIES HAVE CORRUPTED EVIDENCE-BASED MEDICINE

A meta-analysis has great significance because it combines the results of several or many studies. However, most doctors, after being convinced by the experts brought in by the drug companies, are unlikely to be aware of some contrary aspect of the “evidence-based” data, as studies and conclusions negating the prevailing claims in support of the drugs are never highlighted to the doctors. The studies with “favourable results” are trumpeted to the doctors by the drug promoters, but reviews which negate the earlier findings are never brought to our attention. Those who have interest in the subject have to discover this through their own research.

A case in point is the JUPITER trial (reported in 2008 in NEJM 359 (21):2195-207) which showed that people with normal cholesterol and no heart disease, but were at higher risk of heart disease (as determined by elevated hsCRP levels) benefited from statin therapy (rosuvastatin was the drug used) by having less heart attacks and strokes. The trial was funded by the drug manufacturer, and their sales boomed after the results were published. Doctors were feted to “continuing medical education” talks and seminars to update them on this new finding. Soon many doctors started prescribing statins to patients even with normal cholesterol levels (as primary prevention).

But look what happened 2 years later. An independent research group reviewed the trial’s data and published this conclusion in the Archives of Internal Medicine (2010): “The trial was flawed. It was discontinued (according to pre-specified rules) after fewer than 2 years of follow-up, with no differences between the 2 groups on the most objective criteria….The results of the trial do not support the use of statin treatment for primary prevention of cardiovascular diseases and raise troubling questions concerning the role of commercial sponsors.”

Again we see the role of the drug company influencing the outcome of what is supposed to be an unbiased, objective scientific study.

How many doctors are aware of this damning refutation of the original claims made from the flawed trial conclusions? Since the drug companies do not publicize later findings which refute their claims, most doctors don’t know and continue to prescribe statins as primary prevention, costing the patients unnecessary expenses and side-effects, but benefiting themselves and the drug companies. Until now, most Malaysian doctors still prescribe statins for high cholesterol as primary prevention.

The CTT also based their conclusions on meta-analysis of many studies, but some of their conclusions are questionable when re-examined by other researchers. At least the CTT is honest in admitting that most of the studies were funded by the drug companies, and that its work was “observed” by representatives of these drug companies. Now I ask, how objective and independent can such researchers be?

SO IS STATIN THERAPY TO REDUCE HIGH CHOLESTEROL NECESSARY?

For now, there is enough evidence to state that women (even those at high risk with multiple risk factors) do NOT benefit from statin therapy to lower cholesterol, which may in fact cause more harm than good.

There is insufficient evidence to prescribe statins for elderly men (70 and above) with no history of heart disease or stroke (as primary prevention). 

For men below 70, primary prevention with statins reduces deaths from heart disease but increases other causes of death. For those with low risk, the evidence does not seem to justify statin therapy. The patients must be adequately informed of the potential risks and side-effects if statins are to be prescribed.

For very high-risk men below 70 with hypercholesterolemia and multiple risk factors for heart disease, primary prevention with statin therapy definitely reduces the risk of dying from heart disease to justify its use, but may increase the risk of dying from other causes such that the net effect is that there is no reduction in overall risk of dying. 

If you are one of them, you can choose what to die of - If you don’t want to die of heart disease, take statins, but your risk of dying from other causes increases, and your overall chance of dying (from heart and other causes) is unchanged by taking statins! But before you die (from whatever cause) you may suffer from memory loss, dementia, muscle cramps, and other side-effects.

While the benefit of statins for men with known heart disease (secondary prevention) is more convincing,  there is insufficient evidence that those who have heart disease will benefit overall from aggressive therapy to lower cholesterol to extremely low levels because of the side-effects on the brain and the increase in other causes of death. In such cases, the treatment must be individualized, and the patient should be informed of all the potential adverse effects. 


With the above scenario, we should consider reducing cholesterol (in men) by non-statin methods. These measures may include improving the metabolism by optimizing hormones and doing sufficient exercise, and herbal/nutritional therapies (eg. bergamot extract, oat beta-glucan, phytosterols, etc.). Hopefully more studies will be done on these safer alternatives so that they can be more "evidence-based" and more widely adopted.

DR AMIR FARID ISAHAK