Functional Herbal Therapy in the Time of COVID-19 Transforming global health
2 Disclaimer • This session with Simon Mills and Kerry Bone provides information exclusively to healthcare practitioners and offers the opportunity to hear the views, recommendations and experiences of other practitioners. Research discussed on COVID-19 and the application of herbs and other health-related information is not a substitute for individual medical advice and standard of care treatment. • Simon Mills and Kerry Bone make no warranty, expressed or implied, with respect to the information provided. As respected educators in the field, they are acting in their independent capacity as herbal clinicians to share their knowledge and experience with colleagues in a closed forum. The information discussed should not be construed as making claims for, or endorsing, specific herbal products. Transforming global health
3 Topics Covered • COVID-19, what it is, what it does, who is harmed by it • Functional Herbal Therapy (FHT) • FHT and COVID-19 • Some clinically relevant herbs • Immune herbs and cytokine storm risk Transforming global health
The structure of a coronavirus. Image credit: Scientificanimations.com / CC BY-SA 4.0 Transforming global health
Transforming global health
Transforming global health
Verity R, Okell LC, Dorigatti I et al. Estimates of the severity of coronavirus disease 2019: a model- based analysis. Lancet Infect Dis. 2020 Mar 30. pii: S1473-3099(20)30243-7. doi: 10.1016/S1473- 3099(20)30243-7. PubMed PMID: 32240634 Transforming global health
Myers LC, Parodi SM, Escobar GJ, Liu VX. Characteristics of Hospitalized Adults With COVID-19 in an Integrated Health Care System in California. JAMA.2020 Apr 24. doi: 10.1001/jama.2020.7202. [Epub ahead of print] PubMed PMID: 32329797 COPS2, Co-morbidity Point Score version 2; IQR, interquartile range Transforming global health
Richardson S, Hirsch JS, Narasimhan M et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. 2020 Apr 22. doi: 10.1001/jama.2020.6775. [Epub ahead of print] PubMed PMID: 32320003 Transforming global health
Du RH, Liang LR, Yang CQ et al. Predictors of Mortality for Patients with COVID-19 Pneumonia Caused by SARS-CoV-2: A Prospective Cohort Study. Eur Respir J. 2020 Apr 8. pii: 2000524. doi: 10.1183/13993003.00524-2020. [Epub ahead of print] PMID: 32269088 Transforming global health
The most common co-infections were rhinovirus/enterovirus (6.9%), respiratory syncytial virus (5.2%), and non–SARS-CoV-2 Coronaviridae (4.3%) Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of Co-infection Between SARS-CoV-2 and Other Respiratory Pathogens. JAMA. 2020 Apr 15. doi:10.1001/jama.2020.6266. [Epub ahead of print] PubMed PMID: 32293646 Transforming global health
12 The Elderly • The elderly are at increased risk of dying from RTI • Why? • Higher incidence of comorbidities and risk factors • Prior and concurrent viral infections • Reduced immunity (immunosenescence) • Chronic low grade inflammation (inflammageing) Transforming global health
13 Immunosenescence Transforming global health Grizzi F. DiCaro G et al. Immun Ageing 2013, 10 :9. doi: 10.1186/1742-4933-10-9. PMID: 23496863
14 Transforming global health Madjid M, Safavi-Naeini P et al. JAMA Cardiol 2020 Mar 27 . doi: 10.1001/jamacardio.2020.1286. PMID: 32219363. [Epub ahead of print]
15 Functional Herbal Therapy • Functional herbal therapy (FHT): a system of modern prescribing for western herbal clinicians • Incorporates the defining characteristics of functional medicine • Applies these to the unique properties of medicinal plants • Embraces that contemporary western herbal therapeutics should draw heavily on its empirical roots Transforming global health
16 Functional Herbal Therapy Defining attributes 1 Understanding diseases as disordered processes of normal physiology 2 Embracing the complexity of mosaic diseases, where the individual story counts most 3 Matching treatment energetics with the patient’s condition 4 Complex interventions (network pharmacology) for multifactorial disorders (mosaic diseases) 5 Therapy based on twelve core strategic targets 6 Modular treatments and pulsed dosing used as key strategies where appropriate 7 The key overriding consideration is to support the affected tissues Transforming global health
17 FHT Core Strategies and COVID-19 • Support HPA axis • Reduce pathogens (viral focus) • Enhance mitochondrial function and biogenesis • Boost macrocirculatory, microcirculatory and endothelial health; improve blood quality • Optimise immune function • Resolve inflammation • Enhance natural barriers • Address metabolic imbalances • Support the affected tissues Transforming global health
Key Immune Herbs Major immune herbs • Echinacea • Andrographis • Medicinal mushrooms Other immune herbs • Holy Basil • Pelargonium • Commiphora • Adaptogenic/tonic herbs but especially Astragalus, Eleuthero and Tinospora Transforming global health
Quotes from Ellingwood • “In pleuritis , in bronchitis , in peritonitis, especially pelvic peritonitis from sepsis ; in hepatitis and nephritis and cystitis always at the beginning of the acute stage before much structural change has occurred, it may be given, and will retard and often throw off the attack.” • “It is perfectly safe to give echinacea in massive doses—from two drams to half an ounce every two or three hours—for a time at least…” • “In septic peritonitis it (Bryonia) may be given alternately with aconite , or aconite and echinacea , the latter remedy directly controlling the sepsis .” 19 Transforming global health
Mushrooms and Immunity • Research suggests branched chain beta-glucan polymers found in the fruiting bodies of various mushrooms are particularly adapted to heightening immune vigilance against potential pathogens 1 • Innate immune cell responses are augmented by binding of beta- glucans to dectin-1 expressed by macrophages or dendritic cells • Interaction of mushroom beta-glucans with the dectin-1 receptor may even be able to “train” the innate immune response (as per BCG vaccine) via epigenetic changes 2 1: Taylor PR, Tsoni SV, Willment JA et al. Dectin-1 is required for beta-glucan recognition and control of fungal infection. Nat Immunol. 2007 Jan; 8(1):31-38. PMID: 17159984 2: van der Meer JW, Joosten LA et al. Trained immunity: A smart way to enhance innate immune defence. Mol Immunol. 2015 Nov; 68(1): 40-44. doi: 10.1016/j.molimm.2015.06.019. PMID: 26597205 Transforming global health
Two-stage Model for Immune Activity Wasser SP. Medicinal Mushrooms in Human Clinical Studies. Part I. Anticancer, Oncoimmunological, and Immunomodulatory Activities: A Review. Int J Med Mushrooms. 2017; 19 (4): 279-317. doi: 10.1615/IntJMedMushrooms.v19.i4.10. PMID: 28605319 21 Transforming global health
22 Diaphoretic Herbs • Diaphoretic herbs: often overlooked when discussing herbs for managing acute viral infections • Their appropriate use could be critical in managing acute phase and preventing CS • Include Mentha x piperita (peppermint), Achillea (yarrow), Sambucus (elderflower), Matricaria (chamomile), Tilia (lime flowers) and Asclepias tuberosa (pleurisy root) • Were central to the Eclectic strategy during the Spanish Flu pandemic Transforming global health
23 Clinically Relevant Antiviral Activity • Activity in vitro , preferably broad-based AND • Identified active phytochemicals (or metabolites) with known bioavailability (or can be enhanced) AND • In vivo activity demonstrating reduced viral loads AND • Clinical trial activity demonstrating reduced viral loads and improved clinical outcomes; BUT EVEN THEN • Should ALWAYS be combined with immune herbs Transforming global health
24 Microcirculation Diet Diet Individual Components Microcirculation Hypertension 1 Berries 85 to 115g per day 2 Cocoa (90% chocolate, 20g/day) 3 Garlic as 1-2 fresh, crushed raw cloves per day 4 Beets as juice or supplement plus sunlight 5 Green tea – several cups per day 6 OR Green tea and hibiscus tea – several cups per day of each 7 Introduce the key elements of the DASH guidelines: High in fruit, vegetables, whole grains, low-fat dairy products, fish, chicken and lean meats 8 Fibre, especially 30g/day of freshly milled/ground flaxseeds 9 Reduce salt to 3g/day (approx. ½ teaspoon) and increase potassium If hypertension is present points 6,7,8 and 9 are added Transforming global health
Immune Herbs and Cytokine Storm Risk Transforming global health
Immune Herbs and Cytokine Storm • Echinacea , medicinal mushrooms and elder berry should be avoided because they increase the risk of an inflammatory response by elevating cytokines • Andrew Weil website and Center for Integrative medicine • Herbs have been identified as having a counter-productive effect on the body’s natural defenses against the coronavirus including willow bark and other herbal anti-inflammatories , such Echinacea , turmeric and Boswellia and Commiphora • ANSES (French Agency for Food, Environmental and Occupational Health & Safety) Transforming global health
Acknowledgement • Many thanks to my colleague Berris Burgoyne for assistance with some of these slides Transforming global health
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