COVID-19: Breaking down what we know about the virus, how if affects the immune system, and the importance of healthy terrain
Three weeks into physical distancing, much of my time at home has been filled by drinking in as much information as possible about COVID-19 from trusted sources such as Paul Anderson, ND and Heather Zwickey, PhD. Every podcast and webinar has served to further my understanding of how this virus works. One thing that has become abundantly clear to me is that this situation is finally shedding light on the hard truth that as a whole, our society is living in a state of imbalance and inflammation. I sincerely hope that out of this tragedy we will start making changes both on an individual level and a larger global level to shift our health back towards a state of balance. In order to understand why this is important, one must first understand how the immune system works and why this virus is having such a devastating effect.
What is a virus?
Viruses are one of the most abundant life forms on earth. Outside of a living host cell, a virus cannot survive. Unlike bacteria which contain the necessary machinery to replicate on their own, a virus does not have the capacity to do so. It must enter a host cell and take over the reproductive machinery of that cell in order to replicate itself. In other words, when a human is infected with a virus, the virus enters the body and uses the human’s own cells to reproduce itself and spread. Every virus has unique features, or virulence factors, which give them various types of advantages. These virulence factors determine how a virus attaches to and penetrates a cell, what types of cells and tissues the virus might target, what kind of immune response it triggers within the body.
How does the immune system work?
There are two main branches of the human immune system - the innate immune system which we are born with and is our first line of defense, and the adaptive immune system which we develop as we grow and is considered our second line of defense. Anything that causes an immune response is called an antigen - from grass pollen to gluten to bacteria and viruses. The innate immune system is constantly surveying the body for antigens, and when detected, initiates the early immune response with nonspecific defense mechanisms such as stimulating a fever or producing mucus to help kill or remove harmful antigens. The adaptive immune system then becomes active, creating antigen-specific antibodies which bind to and immobilize the foreign antigen. This part of the immune system has a memory. When you are re-exposed to an antigen that you have previously made antibodies for, your immune system quickly recognizes the antigen and is able to respond with rapid production of those specific antibodies to neutralize the infection. You may have heard that gut health plays an important role in immune system regulation. In fact, the largest concentration of the cells which produce antibodies is found in Peyer’s patches - small masses of lymphatic tissue that are found in the small intestine.1 Essentially, the small intestine is like a factory for creating defense cells! We also know that the microbiome, the population of beneficial bacteria that live in the gut, plays an essential role in regulating the immune response within the small intestine.
What makes COVID-19 unique and how does it affect the immune system?
SARS-CoV-19, or COVID-19, is in the coronavirus family of viruses, which includes the virus that causes the common cold, as well as MERS and SARS — both of which have had major outbreaks in the past. While we have seen other types of coronaviruses in the past, COVID-19 has several distinguishing features which are new to us and make it more dangerous.
COVID-19 binds to the membrane of cells on what is called an ACE-2 receptor. This receptor type is found on cells throughout the body, and is abundant in the lungs, heart, kidneys, gastrointestinal tract, and the central nervous system. This is why, in addition to the upper respiratory symptoms of cough and shortness of breath, many people are presenting with gastrointestinal symptoms such as diarrhea, and neurological symptoms such as confusion or loss of smell. Our bodies produce more ACE-2 receptors when chronically inflamed, meaning that those with chronic diseases such as hypertension and cardiovascular disease are at a greater risk when it comes to COVID-19.1
The reason we are seeing such severe illness in many people who have become infected with COVID-19 is not because of the virus itself, but because of the response it triggers within the immune system. Once inside the human cell, COVID-19 stimulates a specific inflammazone, a group of inflammatory proteins, which can cause uncontrolled inflammation, particularly in the lungs.2 Inflammation is an essential part of a healthy immune response. A small amount of inflammation is necessary to signal to the immune system and trigger an appropriate response. This process involves cytokines, which are cell signaling molecules that travel throughout the body, essentially to convey messages about what is going on in the immune system, and to trigger the production of various types of immune cells. While we need these inflammatory cytokines in the early stages of an immune response, it is important to be able to shut down or turn off cytokines a few days into the infection.2 This is normally achieved with the production of another type of immune cell called T regulatory cells, which are abundant in the gut and help to regulate and calm the immune response.1 It seems that COVID-19 has a particular virulence factor which prevents the body from shutting down the cytokine response, leading to what is known as a cytokine storm and causing a severe inflammatory reaction.2
The specific cytokines which are elevated in response to COVID-19 are called IL-1, which causes fever and fatigue, IL-6 which increases inflammation and anxiety, and TNF-alpha which is also highly inflammatory.2 What is more, people with existing underlying inflammation already have increased levels of IL-1, IL-6 and TNF-alpha rendering them more susceptible to this type of uncontrolled immune response.2
Bringing it all back home: why the situation is different in the United States
Most of the initial demographic data on COVID-19 from China and Europe indicated that those who are at high risk are adults over 60 years of age with existing health problems. As the virus has spread across the United States however, we have seen a shift in the data. More than half the cases in the US are in the 18-49 age bracket, with 26% of the severe and hospitalized cases in the younger demographic.1 Why is this?
It seems that inflammation may be the key. We know that COVID-19 binds to ACE-2 receptors which are increased in the presence of inflammation, and 40% of Americans among all age brackets have at least one chronic disease.1 Both young and older members of our population have increased inflammation and tissue damage due to high prevalence of asthma, autoimmunity, hypertension, obesity, diabetes, leaky gut and other digestive issues. In fact, up to 80% of Americans have been shown to have gut microbiome imbalances and leaky gut, including young, otherwise healthy individuals.1 When the gut is “leaky,” an endotoxin called lipopolysaccharide (LPS), which is produced by gut bacteria, leaks through the intestinal lining and into circulation where it causes inflammation and tissue damage. These changes in the gut lining and the inflammation they cause have been shown to be a driving factor in a variety of diseases including depression, diabetes and heart disease, and acid reflux.1
Where naturopathic medicine comes in and what you can do to take charge of your health
If you are reading this post, you are likely interested in naturopathic medicine, and therefore may already be on the right track. So much of what naturopathic doctors do in our work with patients is based on optimizing foundational health, decreasing inflammation, and of course - supporting and healing the gut. That being said, it is more important now than ever to take care of yourself! Medications, herbs, supplements and other natural therapies are excellent tools for healing, but if you don’t have solid foundational health you are putting those things into a system with holes in it. Another way to look at it is like tossing seeds into a garden that is overgrown with weeds. You must weed the garden first if you expect the seeds to grow! Here are some basic steps you can take today to strengthen your immune system in the face of this virus and the next virus to come, to improve your overall health & terrain, and to help prevent chronic disease.
Hydration
Did you know that 70% of Americans are chronically dehydrated? Being dehydrated causes a pH imbalance which makes the body more prone to infection. Hydration is essential for the healthy function of every system in the body and in the case of the immune system, adequate hydration is necessary to flush out toxins. A good rule of thumb is to drink half your body weight in ounces of water daily. For example a 160lb person would need to drink at least 80 oz of water daily. If you are exercising or consuming caffeine, you will need to drink more water.
Sleep
Sleep is essential for healing. Aim for 8-9 hours a night. Try to get to sleep by 10:00PM, as every hour of sleep that occurs before midnight is of higher quality. If you experience sleep disturbances, consider scheduling a visit for individualized sleep support.
Movement
Daily movement helps to mobilize immune cells and supports detoxification through the lymphatic system. In other words, it helps to “take out the trash.” Aim for 30-60 minutes of moderate exercise daily. It is important to note that vigorous exercise can acutely increase inflammation. If you are not used to doing vigorous exercise routinely, make sure you start slowly. Go for a daily walk, jog or bike ride (while maintaining a 6-foot distance from others).
Diet
We are all feeling pretty stressed these days and most of us don’t make the best decisions when we are stressed. However, is important that you continue to work towards eating a healthy balanced diet rich in a wide variety of vegetables and fruits, and healthy sources of protein and fat. Make sure you are getting plenty of fiber, which feeds the good bacteria in our gut. Good sources of fiber include flax and chia seeds, lentils and legumes if tolerated, and leafy green vegetables. Support a healthy balance of gut bacteria by including fermented foods as tolerated, including sauerkraut, kimchi, miso, tempeh, kombucha and kefir. Try to limit the sugary foods as sugar inhibits immune action. That being said, this is a time to be gentle with yourself. If a little comfort food nourishes your soul, don’t beat yourself up over it!
Managing anxiety
Whether or not you have struggled with anxiety in the past, it is likely you are feeling some anxiety now. Most of us are! Naturopathic doctors have a lot of great tools for coping with anxiety including herbal and nutraceutical therapies and homeopathics. Consider scheduling a visit if you are experiencing anxiety and would like individualized support. Also check out my last blog post on managing anxiety during this time for free techniques you can implement at home. If you are experiencing a mental health crisis, please use your local crisis line resources.
As a naturopathic doctor, it is my responsibility to continue providing patients care at this time. While I may not be able to offer my more hands-on modalities via telemedicine, maintaining continuity of care is important. The more people who stay healthy, the less the burden falls upon our hospitals. Naturopathic doctors are also well equipped to support patients who are acutely ill with non-emergent symptoms. If you are feeling ill, please reach out. While there is no known prevention or cure for COVID-19 at this point, we have many wonderful tools that can help to relieve symptoms and support the immune system.
References:
Moore T, Krishnan K. Coronavirus Update with Kiran Krishnan, Virology and Molecular Medicine Scientist. Pain Free & Strong Radio. Available at: https://www.painfreestrongradio.com/pain-free-strong-radio/episode-87-corona-virus-update-with-kiran-krishnan-virology-and-molecular-medicine-scientist/. Accessed April 2, 2020.
Moore T, Zwickey H. Coronavirus with Dr. Heather Zwickey: The Facts from an Immunologist and Infectious Disease Specialist. Pain Free & Strong Radio. Available at: https://www.painfreestrongradio.com/pain-free-strong-radio/episode-86-corona-virus-with-dr-heather-zwickey-the-facts-from-an-immunologist-and-infectious-disease-specialist/. Accessed April 2, 2020.
