By Dr. Lawrence Cheng, MD and Dr. Ashley Riskin, MD
Apart from supportive care, there are currently no effective therapies for COVID-19 infection. It is, therefore, more important than ever to shift our focus towards a sound prevention strategy.
While we are still learning about the pathophysiology of this novel virus, we do know that inflammation plays a key role in the disease process.
We have seen a hyper-immune, hyper-inflammatory response in severe cases that results in respiratory distress.
An integrative approach provides a potential strategy to reduce inflammation and maintain optimal immune system functioning.
Given the lack of any effective treatments or vaccines at this point, the best strategy is to reduce the number and the rate of people getting infections simultaneously. In other words, flatten the curve.
Follow the latest rules, social distancing advice and stay home orders from the Provincial Health Officer.
Our goal is to avoid everyone becoming ill at the same time and to avoid overwhelming the healthcare system.
Integrative prevention strategy
Maintaining a healthy immune system is our prime focus in warding off serious effects of being exposed to this virus.
A healthy immune system is the result of many factors including:
- adequate restorative sleep at least 7 hours nightly
- balanced nervous system that is not stuck in fight or flight (sympathetic) over-drive
- adequate key nutrients to maintain cellular function
- movement and exercise (daily over 30-minutes)
We talk a lot about supplements with our patients, but they’re secondary to the following pillars of reducing inflammation and optimizing immune function.
One major factor for a resilient immune system is a resilient nervous system and at present, most of us could do better in this area.
Chronic stress drives our autonomic nervous system to be in the fight or flight (sympathetic) mode. The stress response is necessary and adaptive when we truly need to respond to an acute threat, but chronic activation can lead to impaired immunity.
Practice meditation, mindfulness and yoga. There is no question that yoga and meditation help to decrease our stress response through multiple pathways. These practices help to calm and regulate our autonomic sympathetic stress response as well as balance our neuro-endocrine (hormonal) axis.
Some useful resources include guided meditation apps, biofeedback tools that use heart rate variability, and enlightened books such as Pema Chodron, Living beautifully with Uncertainty, and Jon Kabat-Zinn’s classic, Full Catastrophe Living.
Seek joy and laughter, play and connection. Social connection and support favour resilience pathways that decrease our risk for illness and infections. Even though we need to maintain physical distancing, that does not mean we should be isolating ourselves from connection. In fact, this is the opportunity to slow down, do less and connect more with those we love, our friends and with nature.
Eat a healthy, whole food, nutrient dense, and anti-inflammatory diet:
- vegetables and fruits contain various flavonoids that can have a direct impact on inflammatory signaling pathways; it’s important to get 5 to 7 servings of various vegetables per day; consider a greens powder if needed
- add garlic, onions, ginger and spices (turmeric, oregano, rosemary) for anti-inflammatory actions
- avoid sugars, refined flour products, and all processed foods
- stay hydrated with lots of fluids, especially warmer fluids such as soups and broths
- eat fermented foods (kimchi, sauerkraut, etc.) to help support a healthy microbiome
Get enough sleep. Optimal immune function is significantly dependent on restorative sleep. Aim for 7 to 9 hours every night. Shorter sleep duration is associated with increased risk of infectious illness. Furthermore, shortened sleep may increase certain inflammatory markers that may be implicated in viral disease severity. During sleep, the body repairs, consolidates memories and enhances cellular and immune function.
Movement and exercise
Get moving. Exercise clearly helps boost the immune system. There are many great on-line resources for exercise programs, including yoga, pilates and body-weight routines. Make space in your home to make it easy to get moving. Aim for 30 minutes minimum a day of moderate intensity exercise.
Given that severe COVID infections typically involve a immune-hyper response in the lungs, the common advice to take immune-boosting supplements likely isn’t prudent for COVID-19 patients.
In severe disease, it would seem boosting the immune system may be problematic. There is debate currently on some of the commonly used supplements for colds and flus. Information is changing and it’s important to note that no robust studies have yet been reported that review any supplements for their effects on COVID-19.
Our overall strategy is to boost the immune system early in order to prevent infection, but should infection develop, it’s important to stop certain supplements that may be problematic. Please consult your healthcare provider on what’s best for you.
Stay healthy, stay well. Practice physical distancing but increase your social connections. We are all in this together. Let’s continue to support each other and take this opportunity to come together as a community and to have more gratitude and appreciation for what we already have.
Finally, please note that there are currently no COVID-19 studies proving the clinical effectiveness of any integrative therapies as described above. This article is not intended as medical advice and any changes to your own care strategy should be discussed with your healthcare provider.
Dr. Lawrence Cheng, MD, CCFP(EM), MPH, is clinical co-director and co-founder of Connect Health Centre for Integrative and Functional medicine.
Dr. Ashley Riskin, MD, is co-founder and co-director of Connect Health Centre for Integrative and Functional medicine. connecthealthcare.ca