COVID-19: WHAT YOU NEED TO KNOW

I’ve received numerous messages from patients concerned about COVID-19. Here are some facts about the virus, tips to avoid transmission and optimize immune function, and treatment ideas if you have symptoms. Please remember to PREPARE, DON’T PANIC.

.

Q: How serious is the virus?

A: The World Health Organization’s official name for the virus is SARS-CoV-2, which causes COVID-19 illness. There are now 547 cases in 34 states and 21 deaths. Most people (approximately 80-85%) have mild illness. The mortality rate may be “considerably less than 1%” instead of the 2% reported by some groups, according to Anthony Fauci, MD, director of the National Institute of Allergy and Infections Diseases. See the editorial published February 28 in the New England Journal of Medicine. This editorial accompanies a report of 1100 Chinese patients with confirmed COVID-19 which documented a 1.4% mortality rate for those admitted to the hospital.

Q: How does it spread and what’s the best way to avoid transmission?

A: The virus spreads through respiratory droplets from an infected person coughing or sneezing. People are thought to be most contagious when they have symptoms (fever, cough, difficulty breathing).

You’ve likely heard from public health officials to avoid contact with symptomatic people, wash your hands, and don’t touch your face. Viruses can linger on surfaces and find their way into your body from rubbing your eyes or touching your nose or mouth. Here’s a good article about how to avoid touching your face.

Q: How contagious is the virus and is there anything I can do to avoid getting it?

A: At the root of this question is the “pathogen vs terrain” cause of illness. Ideally, integrative medicine acknowledges both. The specific virus that causes COVID-19 appears to spread easily so avoiding transmission is fundamental. Most people have mild symptoms. If you are in a high-risk group (older adults especially with heart, lung, or kidney disease or diabetes), you may be more likely to develop severe symptoms. The most important thing you can do to minimize viral illness is to maintain a robust immune system. There are 5 pillars for optimal immune function—diet, sleep, exercise, stress management, and supplements.

It’s crucial to optimize your immune function

Ideal Diet

You must create an overall diet which, as public health and nutrition expert David Katz observes, is a noun not a verb. In other words, rather than continually dieting, develop a health-affirming eating pattern: Diet is “the single leading predictor in modern nations of life and death, longevity and vitality, and the risk of all major chronic diseases.” Your best diet is likely a whole-food, plant-centered Mediterranean approach. For more information on implementing a Mediterranean diet with resources, recipes, and shopping ideas, see the non-profit organization Oldways.

How many of these aspects of an immune-enhancing diet do you follow?

• Meeting daily nutritional requirements: a minimum of 7-9 servings of vegetables (especially leafy greens and cruciferous) and low-glycemic fruit (such as berries and pomegranate seeds), good quality protein, healthy fats, and whole grains or high fiber food.

• Avoiding simple or refined carbohydrates such as sugar and processed grains. This includes not drinking sugar in soft drinks, fruit juices, or added to coffee. Whole grains (wild rice, quinoa, steel cut oats), beans and legumes are fine for people without high blood sugar who digest them well. Dairy, especially soft cheeses and milk, can contribute to inflammation for many people.

• Not consuming sugar. I’m repeating this because it’s so important. You must read labels (recently, Daniel bought what he thought was pure organic almond butter and didn’t notice the added sugar listed on the label).

Practicing time-restricted eating by consuming all calories within a 6 to 10-hour window. Eating early vs later may be more effective to improve blood sugar and insulin response. Also, allow 3 hours between your last meal and bedtime.

Sleep

We spend 1/3 of our lives sleeping. With average US life expectancy of 78 years, 25 years are spent asleep yet many people don’t prioritize sleep or understand how critical it is to longevity and survival. It may seem like you enter a passive state when you sleep but your brain and body perform many complex activities during this time. Sleep allows time and energy to repair damage from daily metabolism, stress, UV radiation, and toxin exposure. Cortisol and adrenaline drop during sleep and the recovery hormones growth hormone and melatonin are released. Growth hormone, mostly secreted during deep sleep, enables muscles to grow and strengthen and injuries and tissues to repair. Growth hormone and melatonin, combined with downregulation of cortisol and adrenaline, enhance immune defense. If you don’t get enough quality sleep, you can get sick more easily when exposed to viruses and bacteria. Research has shown that adequate sleep the night following vaccinations is needed for immunological memory.

Exercise

Unfortunately, the percentage of Americans who don’t exercise is alarming: according to the CDC, nearly 50% of American adults don’t meet physical activity guidelines for aerobic exercise—2 hours and 30 minutes of moderately-intense (continuous effort at 55-70% of maximum heart rate) or 1 hour and 15 minutes of vigorously-intense (70-85% of maximum heart rate) aerobic activity throughout the week. For additional health benefits, adults should increase moderate activity to 5 hours weekly or perform vigorous activity for 2 hours and 20 minutes per week.

Exercise boosts cardiorespiratory fitness, meaning it enhances heart and lung function. Frequent physical activity increases the number and activity of T-cells needed to kill virus-infected cells, and minimizes the decline in immune function (called “immunosenescence”) seen with aging. Epidemiological evidence indicates that regular exercise reduces the risk of contracting viral and bacterial communicable diseases and mitigates symptoms of upper respiratory tract infections.

Don’t use time demands or stress as an excuse not to exercise—if your stress level is high, it’s even more important to engage in physical activity to prevent respiratory infections.

Begin where you are. If you’re completely sedentary, your goal may be to go for a 10-minute walk after meals (which, by the way, will lower your blood sugar better than walking 30 minutes once a day) or shoot for 10,000 steps per day. If you want to get the most benefit from exercise, consider the results of a study comparing moderate continuous exercise with high intensity interval training (HIIT). Interval training was superior in enhancing endothelial function (dilation of arteries, decreased clotting, and lower plaque formation and rupture), insulin sensitivity, muscle mass, and reducing blood sugar. Overall, studies suggest HIIT is the most effective form of exercise to improve blood sugar regulation and insulin resistance. HIIT also reduces body fat better than moderate-intensity training and requires less time.

Interval training involves a series of low-to-high-intensity exercise periods interspersed with rest or recovery periods. One option is to walk, run, or bike at a low-intensity pace for 5 minutes, then increase the incline, speed, or resistance to high-intensity (84-92% of max HR) for 30 to 60 seconds, followed by lower intensity for 90 seconds. Repeat this pattern for a total of 8 times (if you're out of shape, best to start with 4 cycles and work up).

Your heart rate should be 65-75% of maximum during warmup and between interval bursts. Heart rate should be 84-92% of maximum during higher-intensity interval bursts. To determine your target heart rates, fill in these blanks:

Maximum heart rate (HR) = 208 – (0.7 x age): _____

Multiply max HR by 0.65 = _____

Multiply max HR by 0.75= _____

Multiply max HR by 0.84= _____

Multiply max HR by 0.92= _____

If you’re telling yourself the story, “I’m just not motivated to exercise,” consider this—motivation is a myth. The desire to improve doesn’t come from outside of yourself; it’s cultivated within by “just doing it.” I’ve been an exerciser for more than 25 years completing many marathons and half marathons and it’s still difficult to get up early to work out or go for a run in the rain after a long day of patients. To keep myself accountable, I sign up for races in advance, track my running miles on an app, use a Pelton bike, and sign up for classes at Orange Theory Fitness.®

Stress

In an interview with Oprah Winfrey, I once heard Brené Brown make a statement that summarized what I’ve noticed over the past 19 years working with patients: “The body notices, keeps score, and never lies.”

The American Institute of Stress, a non-profit founded in 1978 by prominent researchers such as Drs. Hans Selye and Linus Pauling, is a treasure of information on stress-related topics—from research to self-assessment tools to stress management help. The Institute estimates that 75-90% of all visits to physicians are for stress related problems.

The feelings and symptoms of stress are due to a sequence of biochemical events in your body. Technically, stress is not an actual event or circumstance—it’s your body’s reaction to an event or circumstance. This means that stress is not what happens to you—it’s how you respond to what happens to you. You have the ability to control how you respond to events and circumstances in your life and to diminish the impact stress has on your body.

Significant, prolonged stress can over-activate the immune system, tipping the balance toward inflammation. Frequent infections and illnesses are also common with chronic stress in part due to the suppression of natural killer cell function. Natural killer cells are part of your body's surveillance system—their job is to circulate and destroy cancerous and viral-infected cells. A meta-analysis reviewing more than 300 studies regarding stress and the immune system concluded that chronic stress suppresses all aspects of immunity, increasing the risk for frequent infections and cancer.

Since breathing controls your autonomic nervous system, one simple way to neutralize stress is to focus on your breathing. Your heartbeat speeds up with every inhalation and slows down with every exhalation. When you feel stressed, focus on lengthening your exhalation. This shifts your autonomic nervous system form sympathetic (fight or flight) to parasympathetic (rest and digest) activity. You may want to count to yourself—4 counts for each breath in, 6 counts for each breath out. After only 3 breath cycles requiring less than 1 minute, you will minimize the impact of stress.

Perhaps the best stress-reducing tool is to learn mindfulness. Mindfulness improves the brain’s ability to process emotions under stress. With regular mindfulness meditation practice, you will train your mind to focus on the present moment and lower cortisol. Originally taught as a standardized program by Jon Kabat-Zinn, mindfulness training can help you find the “pause” button in your brain. If you feel easily triggered or irritated by life experiences, mindfulness will enable you to respond rather than react. If you often rush through the day or feel like life is overwhelming or out of your control, mindfulness will empower you, and help you shift your focus from worrying about the past or future to being here, now.

Perhaps you think meditation is a “chore,” another thing on your to do list, or you’re intimidated by the idea of “sitting and doing nothing.” This perception is common and may come up over and over (in fact, this resistance may get in the way of eating a healthy diet, exercising, or adopting other health-affirming habits). Developing mindfulness takes no effort—it simply involves observing what is. When you learn mindfulness, you can allow grumbling or complaining thoughts to surface and let them pass—in other words, you can learn to become “a master of your own life.” Check out Jack Kornfield’s free 40-Day Mindfulness Training Program.

Supplements

The most important nutrients for immune function are zinc, selenium, N-acetyl cysteine (NAC), and vitamins A, C, & D. If you’re taking PhytoSynergy Multi – 2 tablets per day, you should add extra vitamin C – 1000 mg once or twice per day and NAC 1000 to 1800 mg per day. Your Vitamin D3 dosage should be based on lab results (ideal is 40-70 ng/ml). If you feel like your immune system is week, you can take 2 capsules of Chronic Immune from Mountain Peak Nutritionals once per day.

What if you feel like you’re getting sick?

1. Recognize symptoms (especially cough, fever, or chills) and stay home to avoid exposing others. 

2. Eat as much raw garlic as possible. Try mashing 2 to 4 cloves in an avocado to mask the intense taste. This will provide 6,000 to 12,000 mcg of allicin (the most anti-viral, immune supportive component of garlic). You can also take SuperGarlic 6000 made by Metagenics. Each tablet contains 6,000 mcg of allicin, enterically coated so they dissolve in the intestine and don’t cause stomach upset or bad breath. Don’t take deodorized garlic—it won’t work.

3. Take 1000 mg of vitamin C every hour to bowel tolerance (until loose stools develop) and 2 capsules of Acute Immune (from Mountain Peak Nutritonals) every two hours.

4. Heat up your body and sleep as much as possible. To generate a fever, use an infrared sauna or take a hot bath and drink 1-2 cups of strong ginger tea. You can make ginger tea by boiling grated or blended ginger root in water for several minutes before straining. After soaking in the bath, be careful not to become chilled. Go to bed, pile on the blankets and sweat. Congratulate yourself if you develop a fever—this is a sign that your immune system is engaged to fight the virus. Also, sleep as much as possible and avoid coffee, alcohol, all sugar, and dairy products.

5. If you are immunocompromised or have lung disease and you get sick, please call your primary care provider. If you have severe chest pain or trouble breathing, go to an urgent care or emergency room. If you believe you have been exposed to COVID-19 (recent travel from an infected area or exposure to someone with known infection) please call before going to your primary care provider or seeking care to prevent infecting others.