Glutathione and COVID-19: Very Preliminary Evidence

The New York Post reported this Saturday on the case of a second year medical student at Sophie Davis/CUNY School of Medicine who apparently cured his mom's COVID-19-related respiratory distress with 2,000 milligrams of glutathione.

Josephine Bruzzese, 48, developed symptoms of COVID-19 on March 22. “She was so short of breath she couldn't speak,” the article quotes her 23-year-old son, the med student, as saying. Her family rushed her to New York University's Langone Hospital in Brooklyn. She was diagnosed with pneumonia suspected to be COVID-19, but no tests were available at the time.

She was put on hydroxychloroquine, and some of her symptoms improved, but she still couldn't breathe. The family tried various remedies for her breathing, none of which worked. James contacted Dr. Richard Horowitz, a Hudson Valley Lyme disease specialist, who recommended glutathione.

“After one 2,000-milligram dose, the family witnessed a miracle,” the Post reports. Within an hour, her breathing dramatically improved. She continued the glutathione for five days, and never had a relapse of her breathing problems.

Bruzzese, Horowitz, and Phyllis Freeman of the Hudson Valley Healing Arts Center wrote up the story in a combined report of two cases, along with another patient that Horowitz had treated, and published it in Respiratory Medicine Case Reports in April.

Case reports are anecdotal. While they don't demonstrate cause-and-effect with any certainty, they do point to possibilities, and improvement of COVID-19 respiratory symptoms after taking glutathione can now be said to have evidence for it as a possibility.

I also find it extremely plausible that glutathione would help with respiratory distress. Glutathione is primarily intracellular, except in the lung, where its concentrations in extracellular fluid are extremely high. There, it is responsible not only for neutralizing reactive oxygen species from the broad array of toxic substances we take in with each breath, but also for keeping mucous fluid by preventing or breaking disulfide bonds that would otherwise cause the mucous to clump together, and by combining with nitric oxide to make nitrosoglutathione, our endogenous bronchodilator. Glutathione and nitrosoglutathione levels are known to be lower in people with asthma, and in a severe asthma attack nitrosoglutathione levels can drop to zero.

I used to get asthmatic symptoms in response to certain foods and, when I was living in a moldy apartment, would sometimes have these symptoms provoked by laughing too much. In every instance 1000 milligrams of reduced glutathione would clear it up, usually within minutes.

Intravenous N-acetyl-cysteine, a precursor to glutathione, has been used to treat acute respiratory distress syndrome (ARDS) with some success, and has been used in at least one case to improve pneumonia resulting from the H1N1 “swine” flu.

Additionally, glutathione might have antiviral effects toward SARS-CoV-2, the coronavirus that causes COVID-19. Glutathione is known to have antiviral effects towards HIV, herpes simplex virus type 1, influenza A, murine leukemia virus (which infects mice), dengue virus serotype 2, and hepatitis C virus. A recent preprint* used computer modeling to predict that the binding of the SARS-CoV-2 spike protein to ACE2, the human protein it uses to attach to the cell it is infecting, depends on disulfide bond formation. Since one of the principle roles of glutathione in the extracellular fluid of the lung is to break disulfide bonds, glutathione may be able to slow the rate at which the virus gets into our cells, thereby slowing the rate at which it replicates and reducing the peak viral load.

The authors of the case report focus on glutathione's role as an antioxidant, in which case it would be expected to protect against the high level of reactive oxygen species produced by neutrophils that invade the lung during COVID-19, and on its ability to restrain the activity of nuclear factor kappa-B (NFkB), which plays a role in the inflammation of ARDS. As pointed out in the review I linked to in the previous paragraph, glutathione's reduction of NFkB activity appears to protect against the replication of dengue virus as well, may do the same for HIV, and perhaps is broadly antiviral in general.

In addition to the intrinsically anecdotal nature of case reports, these case reports are also difficult to interpret because of the multifactorial nature of the treatments.

Bruzzese was at first treated with hydroxychloroquine, amoxicillin, and clavulanate. In response to her continued respiratory distress, she was given 50 mg zinc, one gram of vitamin C four times a day, 2000 mg L-glutathione with 2 Alka Seltzer Gold, 600 mg alpha lipoic acid, and 1200 mg N-acetyl-cysteine.

The second patient covered in the report had an even more multifactorial treatment. He was given hydroxychloroquine, Zithromax, and nitazoxanide as antimicrobials. His nutritional support included probiotics, zinc, vitamin C, beta-glucan, curcumin, sulforaphane, alpha-lipoic acid, and glutathione. He was instructed to “alkalinize his body” with baking soda, lemons, or limes. He was given intravenous glutathione with electrolytes, and his improvement in response to it was described as getting a little better each day, as opposed to the immediate miracle experienced by Bruzzese. His shortness of breath resolved completely, while his body aches and headaches “significantly improved,” his cough became “mild” and “lingering,” and his night sweats and “air hunger” returned occasionally. The patient described what remained after the treatment as more suggestive of a relapse of his chronic Lyme than a continuation of his COVID-19.

While it is difficult to parse out the exact role of glutathione in any of this, the quick response of Bruzzese's breathing problems to oral glutathione reminds me of my own response when I've had asthmatic symptoms (which no longer are a problem for me), and the importance of glutathione to proper lung function is beyond any shadow of a doubt, from a mechanistic perspective.

I think it is too early to say whether glutathione helps with COVID-19, but it might act as an antiviral, and I find it very unlikely that it has no role to play in improving breathing function if suffering from respiratory distress. It should certainly be studied further, and for most people it is harmless to try as an adjunct to appropriate medical treatment (though if you are receiving medical treatment please clear any adjunctive treatments with your doctor).

Stay safe,
Chris

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I am not a medical doctor and this is not medical advice. I have a PhD in Nutritional Sciences and my expertise is in conducting and interpreting research related to my field. Please consult your physician before doing anything for prevention or treatment of COVID-19, and please seek the help of a physician immediately if you believe you may have COVID-19.

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*Footnotes

*  The term “preprint” is often used in these updates. Preprints are studies destined for peer-reviewed journals that have yet to be peer-reviewed. Because COVID-19 is such a rapidly evolving disease and peer-review takes so long, most of the information circulating about the disease comes from preprints.