Preventative Cocktail and Associated Risks for Hygiene
A Look at Various Vitamins and Supplements
Michelle Strange: A Tale of Two Hygienists presents this week’s TIPisode: Quick and easy tips to keep you up to date and presented by the experts in the profession. Now, get ready for your unofficial TIPisode.
Tom Viola: Hey, everybody. This is Tom Viola from Pharmacology Decalcified and tomviola.com. It’s my pleasure as always to present this TIPisode for you at A Tale of Two Hygienists with my dear friends Michelle and Andrew.
Today’s TIPisode is regarding a topic on which I speak often, patient self-medication, and this discussion has never been more important than during this COVID-19 pandemic. We all know that evidence continues to support that certain behaviors — like maintaining a physical distance of six feet, wearing a mask, washing hands frequently — are the most effective methods of preventing COVID-19 infection, but there remains much information and misinformation regarding the use of vitamins and dietary supplements to do the same. This is where patient self-medication becomes important for us in hygiene because we have to know everything a patient’s taking, not just their prescription drugs but also the over the counter drugs, dietary supplements, everything.
Recently, the Eastern Virginia Medical School published Critical Care Management Protocol for COVID-19, and even though they acknowledged that there’s very limited data — and actually nothing specific for COVID-19 — they also indicated that this cocktail may have a role in the prevention and mitigation of COVID-19 disease.
Okay. So you must be wondering what’s in this cocktail. Well, for prophylaxis, meaning to prevent COVID-19 infection, their protocol recommends the following: vitamin C, quercetin, zinc, vitamin D3, melatonin, and even Pepcid (famotidine) as an option.
These vitamins and supplements that I’m talking about are available without prescription. The doses that this protocol is recommending aren’t excessively high. I think the vitamin C dose was around 500 milligrams, the quercetin somewhere between 250 and 500 milligrams twice a day, the zinc 75 to 100 milligrams once a day, the vitamin D3 between 1,000 and 4,000 international units once a day, and the melatonin was somewhere between 0.3 milligrams and 2 milligrams once a day. The Pepcid dose was a standard dose you’d see for the use of treating heartburn, you know, once a day. So it wasn’t that it was excessive.
The thing is, patients may read this and think, “Well, if that’s the dose they recommend, then if I’m at higher risk for COVID, maybe since these are available over the counter and they’re really just vitamins and supplements, maybe I can take more than the recommended dose, and that would give me even more or extra protection.” Okay. That’s possible, and that’s of concern to us in dental hygiene because the concomitant use of these vitamins and supplements in higher doses may result in adverse effects with implications for hygiene.
So, for example, the use of vitamin C to reduce the risk of contracting the common cold as well as to reduce the symptoms of a common cold, well established. It’s been around for, you know, as long as I can remember. Vitamin C is an antioxidant, and it’s necessary for the proper function of our immune system. So that sounds good.
Quercetin, which is a plant flavonoid, well that gained notoriety when researchers in China found that quercetin and other small molecules can bind to the spike protein of SARS-CoV-1 coronavirus — not the one that we’re currently dealing with — and therefore was able to interfere with that virus’s ability to infect the host cells. All right.
And zinc. Well, we all know about zinc. It’s thought to be essential for immune cell development, and lots of people use it to reduce the risk of contracting respiratory infections and, again, to reduce the severity of their symptoms.
So what’s the problem? When taken together and taken in higher doses, they act synergistically. That sounds good because it may boost their antiviral activity, but it can also result in nausea, vomiting, and kidney damage. Ironically, high doses of zinc can also cause nausea and vomiting and kidney damage.
Okay. What about the vitamin D3? Man, I’ve heard so much about vitamin D3 over the last couple of years. You know, everything from treating depression to all sorts of maladies. Well, we all know deficiency of vitamin D3 has been implicated in lots of respiratory disorders. Studies conducted early in the COVID-19 pandemic found that countries with a high prevalence of hypovitaminosis D — you know, they don’t get a lot of vitamin D in their diet — were more likely to have serious outbreaks and higher mortality rates. Okay. So I guess that makes the case for vitamin D supplementation. However, high doses of vitamin D might overstimulate the immune system, and that’s problematic in COVID-19. And, again, too much vitamin D may cause kidney damage.
All right. Well, what about melatonin? Well, melatonin is most often used to improve sleep, and that could be beneficial for immunity. But melatonin is also thought to reduce inflammation and fibrosis in the lungs, which we all know are common complications for patients with COVID-19, again making the case for melatonin. However, in high doses, melatonin can increase the risk of CNS depression, especially when taken concomitantly with drugs that we often use in dentistry like benzodiazepines and opioid analgesics.
So all I can say at this point, my friends, is I am definitely in favor of trying anything that’s going to work to help prevent or treat COVID-19 infection. And I’m not your typical allopath. Hey, I am a big believer in alternative therapies. If they work and they’re not harmful, let’s try them. But, at least according to a recent review published in the Annals of Pharmacotherapy, their statement says it all. There’s an overall lack of evidence supporting the use of dietary supplements for the prevention or treatment of COVID-19. Or, in other words, my friends, we just don’t know enough yet.
One thing that struck me is the statement they made at the end of their study, which was “patients and providers should not rely on dietary supplements to prevent or cure COVID-19.”
We’ll see, my friends, how things break over the course of the next couple of months. But we know one thing for sure: this year, the new normal is all about uncertainty. And, when I find out more information and I know more, I will be certain to share it with all of you, my good friends.
In the meantime, thank you so much for your time today. As always, it is indeed a pleasure to be able to present these TIPisodes. Michelle and Andrew, you know I love you guys, and I’d do anything for you. So, by all means, looking forward to working with you again.
For all of you folks out there, come visit me, tomviola.com. You can find lots of good information about what’s new in the world of dental pharmacology, local anesthesia, and I’ve got plenty of courses you can take for CE credit, so come on over.
If you don’t want to take courses or read my blog, that’s fine. How about visiting me on Facebook and Instagram? I got lots of good information for you there. Quick bites so that you can stay current on what’s new in the world of pharmacology.
Hope to see y’all soon. Thanks so much. Take care.
Michelle Strange: We hope you enjoyed this week’s TIPisode. Be sure to reach out to our guest experts and let them know how helpful their tips were. Follow A Tale of Two Hygienists on Facebook, Instagram, and head over to ataleoftwohygienists.com and subscribe to our newsletter. You can also email us at firstname.lastname@example.org, and keep listening for more awesome content from your unofficial dental hygiene podcast.