Calming your Cytokine Storm

Updated: Sep 17


Seemingly, every news organization is devoting essentially all of their attention to a certain virus that is running free, while we stay locked up.


The better news is that the global medical community is also devoting much of their attention to figuring out how and why SARS-CoV-2 does what it does. The hope is that by unlocking the chain of symptoms and reactions, we can create treatments and ultimately, vaccines.


New information is coming out, basically every day, but one concept that is getting more and more attention is the natural physiological reaction called a cytokine storm. As with any storm, the cytokine variety can range in intensity from mildly discomforting to deadly.


While this term may be new to many of you, if you've ever worked with a Lyme Literate MD, chances are good that you've discussed a cytokine storm. You've just called it by a different name: a Herxheimer Reaction.


What is a Cytokine?


Put simply, a cytokine is a signaling molecule that is secreted by immune cells to stimulate some sort of action in the body. Any time our immune system is called into action, whether to fight infections or repair injuries, these cytokines help begin the process. There are many types of cytokines, capable of stimulating or stopping inflammation, as the body calls for. This makes cytokines vital to fighting and recovering from just about anything the world can throw at us.


The problem with these particular signaling molecules is that in some cases the inherent "shut off valve" in the body doesn't work. This means that what can start as a gentle shower of response can very rapidly increase 1000x into a sudden, severe storm (see what I did there?) This storm triggers a continuous reaction that overwhelms the body leading to severe disease and even death.


Two European doctors, Adolf Jarisch and Karl Herxheimer were among the first to formally observe this cytokine reaction occurring in the late 1890s. While treating patients for syphilis (a not-so-sly cousin of Lyme disease), they noted that several patients experienced worsening symptoms after treatments. The patients developed fevers, chills, headaches, muscle pain, and even rashes. The term Jarisch-Herxheimer Reaction was coined. Over time, doctors and scientists found that other infections caused the same reactions.


Today, many medical professionals are finding a similar cytokine rush in COVID-19 patients. Specifically, the SARS-CoV-2 virus triggers excess production of the inflammasomes NRLP3 and NF-kappa B. This leads to an increase in the cytokines IL-1b and IL-18 and IL-6. These signal the body to create inflammation. One of the side-effects of this reaction is an increased amount of fluid in the lungs (this is what causes the cough and shortness of breath associated with this infection). In many patients, the storm is controlled. In some, however, the infection multiplies so rapidly that the body releases far too much cytokine all at once. The resulting chain reaction fills the lungs with so much fluid that the patient essentially drowns.



Breaking the Chain


Because this whole process is a large chain reaction that feeds on itself, breaking any single link will stop the whole process in its tracks. Sadly, there isn't a medication that can instantly halt the reaction. But there are several things we do know about what drives the inflammation and the resulting cytokine reactions.


At our practice, we deal with cytokine storms daily. (For example: Lyme or Borrelia burgdorferi has been shown to increase the cytokines TNFa, IL-6, IL-8). Fortunately for those with chronic infections, the reaction rarely ever balloons and doesn't become fatal. We work with our patients to help them become adept at spotting a Herxheimer reaction that is starting, and taking steps to keep it "tolerable".


Below is some of what we've learned about reducing the storm:

Lifestyle:


We've known for decades that smoking and drinking in excess increase the risk for all sorts of diseases. We are just starting to understand the impact that other behavior choices have (such as sleep or meditation). However, studies have shown:

  • Sleep deprivation increases NRLP3

  • Excess stress (cortisol) activates NFKappaB while meditation and yoga can lower it

  • Smoking increases NFKb

  • Overeating / processed food increase NFKb

  • Excess alcohol increases NFKb


Diet:

There are several compounds found in foods that have been proven to reduce NRLP3 and NFKappaB activity (the initial inflammasome in the cytokine chain reaction).


Specifically:

  • Quercitin: found in apples and onions

  • Resveratrol: found in purple grapes and blueberries

  • Curcumin: found in turmeric

  • Allicin: found in garlic

  • Sulforaphane: found in cruciferous vegetables

  • Specialized Pro-Resolving Mediators: found in foods high in essential fatty acids like fish and roe


Additionally, there are a host of other foods that can lower NFKb, including:

  • Fats such as olive oil

  • Fruits: cherries, pomegranates

  • Vegetables: Soy, fennel

  • Herbs and Spices: Basil, rosemary, cloves, ginger, cinnamon, capsaicin, cayenne, anise

  • Seeds: Flax or sesame

  • Other items such as: chocolate (!), honey, or nutritional yeast

  • Tea: rooibos or green