The Terrain Health Supplement Primer

Get Healthy and Stay Healthy.

By Dr. Robin Rose

The gut is the gateway to good health. It’s the master guardian of your body protecting you from the manifestation of disease and illness. The right micro ecological balance in your gut can prevent disease and maintain your health. That matters now more than ever.

Early data indicates COVID-19 invades the gastrointestinal (GI) tract. Digestive symptoms (diarrhea, vomiting, abdominal pain) appear to correlate with worse outcomes and the propensity to develop more advanced disease. COVID-19 can be detected in the stool before respiratory or other symptoms ensue, and even after patients have recovered from the illness and the virus is no longer found in the respiratory tract. There are strong concerns that the virus can spread and persist through the fecal-oral route (another method of disease spread). Studies have already shown that COVID-19 can persist in the stool for up to 30 days or more. WASH YOUR HANDS REALLY WELL AFTER USING THE FACILITIES AND BEFORE EATING! MAKE YOUR KIDS DO THE SAME THING!

In China, early reports indicate that the microbiome balance is impaired among many COVID-19 victims. These patients have a significant reduction in certain “good” bacteria such as lactobacillus and bifidobacterium. Gut flora imbalance may lead to bacterial translocation (the bacteria leaking out of your gut and invading your bloodstream). The gut is your first and most important line of defense. We must maintain the proper balance of gut microbiota with nutritional support and supplements.

The immune system and the microbiome are intimately related and their functions are interwoven through complex biochemical pathways. Both are crucial to our health and longevity. At Terrain Health, we will frequently explore the science behind how certain foods and supplements support the gut microbiome and the immune system to help prevent and treat infections and chronic diseases.

We should all be taking specific supplements on a daily basis, year-round as we do not get enough of these essential elements or micronutrients from our food. During the past half-century, over-farming has led to widespread topsoil erosion depleting our fruits and vegetables of their nutritional value. As a consequence of repeated plowing, fertilizing, and spraying, the top few feet of farmland soil has been leached of its original minerals and stripped of the biological life that facilitates nutrient uptake in plants. That means you don’t get as much zinc, iron, and numerous other minerals vital to maintaining a healthy microbiome. Now let’s hone in on the products that can be used for the COVID-19 epidemic.

Coronaviruses (CoVs) are enveloped RNA viruses causing respiratory and enteric diseases. The CoVs are widely distributed in nature and their zoonotic transmissions into human populations can cause epidemic disease. After entering into respiratory or gastrointestinal tracts, these viruses establish themselves by entering and infecting lumenal macrophages and epithelial cells. In the end, inhibiting human CoVs may require a multi-target approach.

I would suggest that during the cold and flu season, and now amid the COVID-19 pandemic, we should arm ourselves with certain supplements that will support our immune system to avoid and fight off an infection. There is an interaction between natural substances, where each agent is working on a particular pathway that is independent of the other, but all part of the same equation resulting in synergistic treatment combinations. Simply put, these supplements work in concert.

The Supplements

Probiotics: These are critical form optimal gut and immune support. Our large intestines are colonized with trillions of bacteria, both friendly and unfriendly weighing in at about 3 lbs! The human microbiome plays a crucial role in helping us maintain homeostasis (balance) and influences almost every organ in our body. Unfortunately, the vast majority of us live in a state of dysbiosis (meaning we have more unfriendly than friendly bacteria) which can have several health implications stemming from “leaky gut.” Leaky gut can be highly problematic, playing a role in the manifestation of several diseases including obesity, inflammatory bowel disease, diabetes, depression, asthma, allergic disorders (atopic dermatitis, rhinitis) and even cancer. Studies show that not only does having a healthy microbiome stimulate stem cell proliferation, but also that dysbiosis or compositional changes in gut microbiota is linked to the ageing of stem cells. Furthermore, Natural Killer (NK) cell activity and functionality are enhanced during the incorporation of probiotic strains in diet. For all these reasons (and more) it is imperative to have a healthy, well-balanced microbiome to maintain health and support your immune system. It is important to use a multi-strained, pharmaceutical-grade probiotic that is shelf-stable and does not require refrigeration. And remember to eat a diet high in phytonutrients and phytochemicals incorporating all the colors of the rainbow in fruits and vegetables into your diet to support the gut microbiota and ensure that the probiotics you are giving yourself will thrive.

Terrain Health recommends Perque’s Digesta Guard Forte:

Recommended dose: Adults: 2-4 caps daily; Children: 1-2 caps daily.

Vitamin D: Having adequate Vitamin D levels is crucial for optimal immune function. It CANNOT be achieved without supplementation during the winter months. Studies show that people with Vitamin D deficiency are 11 times more likely to contract a cold or the flu. Supplementing with Vitamin D can reduce colds and flu by 42%. The interactions between viral infections and Vitamin D appear to be more complex as more and more research continues to elucidate this phenomena. Vitamin D appears to induce a transient antiviral state through its regulation of the immune system. Studies demonstrate that Vitamin D has direct antiviral effects particularly against enveloped viruses (i.e influenza). Many adults need 5,000 IU (international units) or more of Vitamin D3 (the form best absorbed) daily during the winter months. It is best to get your levels of 25-OH Vitamin D checked for accurate dosing. Many need 5,000 IU or more of vitamin D3 a day in the winter. Without prior blood testing, we recommend starting with 2,000 IU for adults, 1,000 IU for children. In order for this intervention to be effective, it is important that you have been taking this supplement continually before the respiratory tract infection ensues. 

A few more caveats: First you may see that some Vitamin D supplements are also made with Vitamin K1/K2. This is because when it comes to calcium metabolism, Vitamins D and K work synergistically, and both have important roles. Vitamin D enhances the absorption of calcium from the food we eat. When calcium intake is low, Vitamin D maintains its blood levels by drawing on the body’s main calcium supply- your bones. So what does Vitamin K do? Since Vitamin D does not fully control where the calcium in your body goes, Vitamin K steps in and regulates calcium in two ways: by promoting bone calcification so that it properly accumulates in your bones and teeth, and by preventing calcium from accumulating in your soft tissues, such as the kidneys and blood vessels.

Secondly, having an inadequate Vitamin D receptor (VDR) restricts it from getting into the cells. Approximately 30% of the population has a poor VDR. Other natural ways to increase VDR activation include the intake of resveratrol, Omega-3’s, magnesium, zinc, quercetin, curcumin, ginger, and regular exercise.

Here are 2 more studies showing the powerful effects of Vitamin D.

Terrain Health recommends Vitamin D3 2,000 IU daily from Vital Nutrients for adults.

Terrain Health recommends Vitamin D3 1,000 IU from Orthomolecular for children.

*You may want to test your levels every 3-6 months to ensure you are getting adequate amounts.

 *Terrain Health recommends Vitamin D3 5,000 IU daily from Designs for Health for adults if you have recently had blood work done showing that your Vitamin D level is lower than 30ng/ml.

Also, it is important to note that certain people with pre-existing medical conditions including sarcoidosis, kidney disease, liver disease, and hyperparathyroidism, need to use caution when using high doses of Vitamin D as they may be at risk for developing kidney stones or worsening renal function.

Vitamin C (Ascorbic Acid): This vital vitamin helps support the immune system by promoting normal antibody responses, white blood cell function, and activity as well as maintaining normal levels of interferons. Ascorbic acid is one of the most potent antioxidants and provides nutritional support to all functions of the body, including iron absorption from the gastrointestinal tract. It is also an important component of collagen synthesis.

When we are fighting off an infection, our body utilizes Vitamin C at a much higher rate and we are therefore able to tolerate higher doses without side effects. Studies show that high doses of oral and IV Vitamin C are well tolerated and effective at fighting off the common cold and Influenza.

In the past, Vitamin C deficiency was associated with pneumonia. There have been countless studies that have indicated that Vitamin C may alleviate or prevent infections caused by viruses and bacteria. Two controlled trials found a statistically significant dose-response, for the duration of common cold symptoms, with up to 6–8 g/day of vitamin C. Thus, the negative findings of some therapeutic common cold studies might be explained by the low doses of 3–4 g/day of vitamin C. Three controlled trials found that vitamin C prevented pneumonia. Two controlled trials found a treatment benefit of vitamin C for pneumonia patients. One controlled trial reported treatment benefits for tetanus patients. Read the full study here.

It is important to note that some people (particularly those with a history of kidney stones) taking high doses of Vitamin C (2,000 mg or more daily) can be at increased risk for forming calcium oxalate stones. Also, use caution with high doses in patients with hemochromatosis and other conditions leading to iron overload. Furthermore, Intravenous (IV) Vitamin C therapy has become very trendy in the past few years. Many people seek out Vitamin C therapy to prevent or combat infection. Although, it appears that IV administration does not increase your risk of kidney stones, it can increase your risk of hemolytic anemia if you have Glucose-6-phosphate dehydrogenase deficiency (G6PD). Therefore, before proceeding with high dose IV Vitamin C therapy, it is recommended to check your G6PD level.

Vitamin C may emerge as a critical weapon in the fight against Coronaviruses generally as it did with SARS.

Since the COVID-19 epidemic has reared its ugly head, Vitamin C has gotten a lot of press in treating COVI0-19 patients across the globe. China is in phase 2 trials using high dose Vitamin C 24 gm IV daily for patients with SARI (Severe Acute Respiratory Injury) associated with the novel coronavirus.  The rationale stems from the notion that Vitamin C is an antioxidant that may prevent cytokine-induced damage to the lungs. Cytokines are small proteins released by cells, which trigger inflammation and respond to infections. This type of inflammation can be deadly.

Terrain Health recommends Vital nutrients 1,000 mg (ascorbic acid) daily for adults.

Terrain Health recommends now Vitamin C 500 mg chewable tablets daily for children.

It is important to note that some people (particularly those with a history of kidney stones) taking high doses of Vitamin C (2,000 mg or more daily) can be at increased risk for forming calcium oxalate stones. Also, use caution with high doses in patients with hemochromatosis and other conditions leading to iron overload.

Quercetin: It has been called “king of the flavonoids” because of its powerful antioxidant properties and its ability to support a healthy inflammatory response in the body. Furthermore, it has been shown to have anti-viral and even anti-mutagens and anti-cancer causing properties. Quercetin helps regulate histamine (the compound responsible for some of the unpleasant symptoms associated with occasional and seasonal upper respiratory symptoms).

Quercetin has also been a major player in treating leaky gut as it helps with tight junction formation in the intestines.  It is found in many foods that are recognized for their health benefits, such as red onions, apples, olive oil, dark berries and grapes, capers, salad greens, and culinary herbs such as dill, cilantro, watercress, and radicchio.  Quercetin is the most researched bioflavonoid. Several published studies about Quercetin’s antiviral properties have created a groundswell of interest in the medical community among researchers exploring treatments for COVID-19.

Clinical trials to test Quercetin’s effectiveness are scheduled to start in China within the next few weeks.The rationale for the use of Quercetin as an effective antiviral and even more so in the fight against COVID-19 is its shape and structure. This powerful antioxidant’s shape enables it to sit on the cell wall surface, disrupting the virus’s ability to penetrate the cell wall.

Terrain Health recommends Vital Nutrients Quercetin 250 mg 1-2 caps two- three times/day for adults (or it can be taken in combination with stinging nettle as below)

Quick overview on Flavenoids:

They are a class of polyphenolic plants and fungus secondary metabolites widely found in fruits and vegetables. They are the largest group of phytonutrients with more than 6,000 types .  They have miscellaneous reciprocal biochemical and antioxidant effects associated with various diseases such as cancer, Alzheimer’s disease and atherosclerosis. It is due to antioxidants, anti-inflammatory, anti-mutagens and anti-cancer-causing properties combined with the ability to control major cell enzyme functions. What is even more fascinating is that some flavonoids also have antiviral activity including apigenin, luteolin, quercetin, amentoflavone.  Among other polyphenols, quercetin has been shown to inhibit the proteolytic activity of SARS-CoV 3CLpro./

Stinging nettle (Urtica dioica):

The nettle plant has been used throughout the ages and throughout the world for a wide variety of medicinal purposes. Use of this herb dates back to ancient Egypt, ancient Greece, and among native peoples in North America and has been consumed directly, or made into soup, tea, and even brewed into beer. Stinging nettle’s immune-supporting effects are owed to its high content of Vitamin C and Iron. It  appears to play a critical role in the anti-inflammatory response by reducing inflammatory cytokine release and reducing inflammatory biomarkers such as TNF-a, IL-1, IL-6, and hs-CRP. Thus, supporting its use over the years in supporting respiratory health. It has also been used to treat pain and support joint health as it interferes with the way the body sends pain signals, therefore, decreasing the sensation of pain. Like quercetin, nettle is also a natural antihistamine. However, unlike many over-the-counter treatments that regulate histamine, nettle does not cross the blood-brain-barrier, which means it is unlikely to cause the drowsiness that has been associated with common OTC products that promote upper respiratory health.

Why this has activity against Coronavirus: Urtica dioica Agglutinin (UDA) was isolated from stinging nettle. It’s Antiviral activity has been reported for HIV-1 and 2, cytomegalovirus (CMV), respiratory syncytial virus (RSV), Influenza A, and SARS-CoV.

Studies show that UDA likely inhibits SARS-CoV infection by targeting early stages of the replication cycle, namely, adsorption or penetration. In addition, it has been demonstrated that UDA neutralizes the virus infectivity, presumably by binding to the SARS-CoV spike (S) glycoprotein.

Terrain Health recommends Designs for Health Quercetin and Nettles 1 cap three times/day for adults

Zinc: It is an essential mineral needed for many aspects of cellular metabolism. It has been shown to play an important role in supporting immune function, testosterone metabolism, and numerous other functions in the body. Zinc is involved in more than 200 enzymatic reactions and plays a critical role in genetic expression, cell division, and growth. Zinc has been shown to promote healthy neurological and reproductive function as well as eye health. Zinc also plays an important role in protein synthesis, normal tissue formation, and wound healing, making zinc supplements a popular choice for supporting skin health.  Research suggests zinc supplements may reduce oxidative stress and support a healthy immune response during seasonal challenges.

As we age, Zinc deficiency can negatively impact our immune system and the chronic inflammatory response.

Terrain Health recommends Thorne Zinc Picolinate 30 mg daily for adults

Terrain Health recommends Thorne Zinc Picolinate 15 mg daily for children 9-12 y/o

The case for melatonin:

Melatonin:  Melatonin is a versatile molecule, synthesized not only by the pineal gland but also in small amounts by many other organs like the retina, gastrointestinal tract, thymus, bone marrow, lymphocytes, etc. It plays an important role in various functions of the body such as sleep and circadian rhythm regulation, immunoregulatory mechanism, free radical scavenger, antioxidant functions, oncostatin actions, control of reproductive functions, regulation of mood, etc. Melatonin has also been found to be effective in combating various bacterial and viral infections. Melatonin’s protective action against sepsis is suggested to be due to its antioxidant, immunomodulating and inhibitory actions against the production and activation of pro-inflammatory mediators. Use of melatonin has been beneficial in treating premature infants suffering from severe respiratory distress syndrome and septic shock.

Melatonin has also been found to be effective in fighting viral infections in a variety of experimental animals and in vitro studies. These data suggest a possible therapeutic potential for melatonin in human virus-induced disorders.

Based on clinical features, pathology, the pathogenesis of acute respiratory disorder induced by either highly homogenous coronaviruses or other pathogens, the evidence suggests that excessive inflammation, oxidation, and an exaggerated immune response very likely contribute to COVID-19 pathology. This leads to a cytokine storm and subsequent progression to acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) and often death. Melatonin, a well-known anti-inflammatory, and anti-oxidative molecule is protective against ALI/ARDS caused by viral and other pathogens. Melatonin is effective in critical care patients by reducing vessel permeability, anxiety, sedation use, and improving sleeping quality, which might also be beneficial for better clinical outcomes for COVID-19 patients. To read more see the full article.

Melatonin may be the reason why children under the age of 9 seldom exhibit severe symptoms. In fact, children tend to exhibit mild or even no symptoms at all, even though they have been infected by COVID-19.

The fatality rate from COVID-19 increases with age. It is shown to be 0.2% for age groupings ranging from 10 y/o through 39 y/o, then doubles to 0.4% for 40-49 y/o, and then starts to exponentially increase from 50 y/o and older (see chart in the article).  The highest rate of fatality is seen in patients 80 years old and above. What is even more fascinating is that the mortality trend from COVID-19 mirrors this graph in reverse.

Exogenous intake during COVID-19 is being recommended only because normal endogenous production for adults may not be adequate for protection against COVID-19.  Children under nine years of age are protected from COVID-19 because they have up to TEN TIMES the ‘normal’ amount of adults. Additionally, our environments lend themselves to constant light pollution at night including the blue light from our phones, televisions and computers, LED lighting in our homes, etc…all contributing to vastly diminishing the normally low level of melatonin in adults. Supplementing with a minimum physiological dose during the COVID-19 pandemic can provide additional protection against infections.

The reason for melatonin playing such a major role in fighting infection and perhaps even more so during this pandemic is because the NLRP3 inflammasome is now recognized as a target for melatonin!  What is this, you ask?

The activation of this inflammasome is key to the induction of the cytokine storm. The fact that melatonin can inhibit the NLRP3 inflammasome elevates this powerful molecule to a truly unique position in the fight against COVID-19.  As a result, if a patient, regardless of age, has adequate melatonin, it is likely the infectiousness of COVID-19 will be greatly reduced, thereby significantly diminishing the chances of developing ARDS/ALI significantly diminished.

Healthy adults should take no more than the recommended physiological dosage range (closer to the lower end), where the higher end applies to people who are older or that may have underlying health conditions.

It is recommended to take melatonin at night, about 1 to 2 hours before sleep and 2 to 3 hours AFTER your last meal. You should ideally finish eating before it is dark.  It is beneficial to lower your ambient lighting at night, as the lowest amount of light will disrupt melatonin production. Melatonin is produced in all cells, including mitochondria.

Terrain Health Recommends  Pure encapsulations Melatonin 0.5 mg one hour prior to bedtime for adults

N-Acetyl Cysteine (NAC): NAC is a cellular antioxidant and amino acid that is the precursor to glutathione, the body’s most powerful antioxidant.  NAC specifically promotes healthy lung tissue, but also helps support liver function and detoxification, and muscle recovery.

In the lungs, NAC breaks up sulfide bonds that are responsible for thickening mucus. By supporting healthy mucus viscosity, NAC helps maintain normal breathing patterns and promotes healthy lung function. In fact, NAC has been studied and used in the treatment of pneumonia and other lung diseases such as COPD and emphysema.

Glutathione is manufactured by the liver, and is a key compound used by the liver to help protect our bodies from that daily exposure to harmful substances, such as chemicals, pollutants and heavy metals. It is essential to have adequate glutathione levels because when this antioxidant is low the liver is vulnerable to damage from these toxins. Therefore, NAC assists the body in maintaining proper levels of glutathione in order to aid in the natural detoxification process.  NAC is a key player in muscle recovery after workouts and periods of muscle exertion. After a strenuous workout, damaging free radicals propagate as a natural result of vigorous muscle contractions. While the master antioxidant, glutathione, efficiently works to scavenge the excess free radicals, NAC quickly boosts the body’s glutathione supply.

Terrain health recommends Vital Nutrients NAC 600 mg twice daily for adults

Glutathione (Liposomal): This is the body’s “master” antioxidant and powerful detoxifier. It can support healthy immune function and neutralize a broad spectrum of free radicals. More than 100,000 studies have been published related to the physiologic effects of glutathione and broadly, these studies have found glutathione to protect against oxidative stress, detoxify chemicals and toxins, boost immune function, and support healthy aging.

Liposomal Glutathione offers a much more rapid and complete uptake than the non-liposomal alternative. To further clarify, the application of liposomes to assist drug delivery has been shown to be beneficial for stabilizing therapeutic compounds, overcoming obstacles to cellular and tissue uptake, and improving the overall bioavailability of the compound.

Terrain health recommends Quick Silver Liposomal Glutathione Spray

Omega 3’s: To maintain optimal health, our bodies require a variety of different fats including essential fatty acids. Two of these—omega-6 and omega-3 fatty acids—are essential. Unfortunately, the American diet is very high in omega-6, but low in omega-3 due to industrialized farming practices and modern food processing technology. It is beneficial to our health for several reasons to correct this imbalance through foods and supplements.  Omega-3 fatty acids have many powerful health benefits for your body and brain. In fact, few nutrients have been studied as thoroughly as omega-3 fatty acids.

There are 3 types of omega-3 fatty acids: ALA, EPA and DHA. Each plays a particular role in the health of our body. ALA, the most common omega-3 fat, is not biologically active until it’s converted into EPA or DHA, which are essential for your body. It is also important to have the right balance of EPA and DHA in your diet or supplement. While both DHA and EPA can reduce inflammation, a 2:1 EPA:DHA ratio seems to be more effective in addressing inflammatory risk factors. Omega 3’s are crucial for anything from supporting brain health to preventing cardiovascular disease to fighting autoimmune disease to helping prevent cancer and dampening the inflammatory response. To see the health benefits of Omega3’s read full article.

The best sources of omega-3 fats are cold water fish such as salmon, sardines, and mackerel. The best sourced Omega 3’s are from marine animals. Marine animals are different from the plant forms (which are found in foods such as walnuts and flaxseed). Many people cannot effectively convert the plant form to the animal forms, which are the more potent and biologically active ones the human body requires. Supplementation is suggested to maintain a healthy balance of fatty acids, since many people do not consume cold water fish regularly.

Terrain Health recommends OmegaAvail TG1000 by Designs for Health 2 caps daily for adults.