During a time of heightened potential infection from COVID-19, improving immune function can be an important strategy for not only reducing the chance of infection, but for potentially reducing the severity of and resulting problems from infections. Lifestyle factors have a large effect on immune function. The immune system defends your body against infections. It’s comprised of the spleen, thymus, lymph nodes and vessels, skin and bone marrow. Bone marrow creates red blood cells (which help control immune response), white blood cells (white protect against bacterium, allergens and viruses) and platelets (which have a major role in coagulation and healing, and respond to bacterium, allergens and viruses). When a foreign invader enters your body, these organs and blood cells work together to recognize it and create antigens to get rid of it. Healthy vitamin D levels also help the immune system stay balanced. FOOD/NUTRITION Overall Recommendations: Research indicates that plant-based foods such as those high in phytonutrients, water- and lipid-soluble vitamins, and other antioxidants, as well as dietary fiber, can help downregulate an overactive immune response. Specific recommendations: Eat plenty of fruits and vegetables. Aim for 9-13 servings per day of a variety of types for a wide array of phytonutrients to enhance the gut microbiome. Phytonutrients include: whole grains, nuts, beans, black or green tea, carrots, berries, onions, pomegranates, red grapes, spinach, kale, broccoli, cabbage, Brussels sprouts, citrus fruits, apples, flaxseed and many others. Consume dietary fiber, a minimum of 28-35 grams daily, preferably from whole foods. Food and nutrition are major contributors for health and well-being. Low-level chronic inflammation and activation of the innate immune response is improved by shifting to a Mediterranean type diet. Food preparation methods may affect our innate immunity by contributing to the oxidative pro-inflammatory process. Cooking foods at lower temperatures and using moist methods of food preparation rather than dry, hot heat (such as grilling) may be helpful for reducing an inflammatory response of human innate immune cells. STRESS MANAGEMENT Overall Recommendations: Both acute and chronic stress can result in dysregulated, suppressed immune function. Under these conditions, susceptibility to illness is more likely. Ever wish there were a magic pill you could take to boost your energy levels, improve your mood, help you sleep better, increase your kindness and even help you make more money? Unfortunately, no such pill exists, but there is a way you can reap these benefits — without a visit to the doctor's office. The secret? A daily gratitude practice. Indeed, counting your blessings each day has been shown to significantly increase your happiness — and your physical health. In addition to helping you get more sleep, practicing gratitude can boost your immunity and decrease your risk of disease. Here are a few tips to help you get started: Keep a gratitude journal. Write in a gratitude journal every day. Jot down quick notes. They can be as simple as something funny one of your children did or a kind gesture from a stranger at the grocery store. Any positive thoughts or actions count, no matter how small. Use gratitude cues. Any new habit needs reminders, and cues are a great way to stay on course. Keep photos visible of things or people that make you happy. Post positive notes or inspirational quotes on the fridge or by your computer to reinforce feelings of gratitude. The goal is to move your mind from thinking about gratitude occasionally to making it second nature. Eventually, you'll lower your gratitude threshold so that you're grateful for little things — and you'll learn how to sprinkle a little gratitude throughout your day. SLEEP Overall Recommendations: Due to its restorative and regulatory abilities, sleep has a major influence on immune function and inflammatory signals. Therefore, getting good quality, sufficient quantity (seven to eight hours) and adequate deep sleep is of utmost importance as part of immune maintenance, as well as during times of recovery from illness. It is advised to practice good sleep hygiene and maintain consistent sleep hours by turning off screens, ensuring the room is cool, quiet, and dark, and setting reminders to go to bed on time. Sleep is inherently restorative and enables an internal resetting or regulatory aspect of one’s physiology. EXERCISE Overall Recommendations: Moderate, regular physical activity helps immune system function by raising levels of infection-fighting white blood cells and antibodies, increasing circulation, and decreasing stress hormones. A personalized exercise program, such as designed by Elite Fitness Plus, even during homestay can be performed in one’s home environment via the internet or participate in one of the E-fit programs. Outdoor activities potentiate these benefits. Physical activity provides the movement the body needs to oxygenate, circulate blood and nutrients, and eliminate waste from cells, all of which are essential to the function of the immune system. In addition to the blood vessels delivering blood to organ systems, the lymphatic system, present largely in the neck, armpits, and groin, plays a big role in the transport of immune factors. Indeed, the social distancing and homestay that has been recommended by many states and nations may invariably disrupt people’s activity schedules and lead to more sedentary behavior, such as more screen time or sitting, reclining, or being stationary, which could further negatively impact immune activity. We need to exercise personal responsibility to protect our health and others. There is a plethora of findings that support the benefit of physical activity for the immune system.
SPIRITUALITY/ SOCIAL CONNECTION Overall Recommendations: Our “World View”, life purpose and social connections are important aspects to consider and evaluate as part of our health status. For immune health, the focus should be on encouraging time with others who are positive or affirming. For those people who may be lonely or isolated, such as the elderly, as well as those who may be at increased risk of immune compromise, providing ideas for regular social connection may be helpful for establishing a routine. Ideas might include participating virtually in local community events or in a religious or spiritual group. Social relationships are a significant determinant of immune health. The absence of these essential relationships, collectively referred to as social isolation, loneliness, bereavement, and/or conflict, has been implicated in the upregulation of pro-inflammatory processes and reduced immune functionality. Furthermore, those who are socially isolated have heightened response to stressors. Older individuals may be particularly at risk for the effects of loneliness if their immune system is already compromised. SUMMARY In general, lifestyle interventions can be an effective means to help regain control during times of uncertainty like those experienced in a pandemic. Substantial research indicates that certain dietary patterns and lifestyle patterns offer viable options for improving overall health, especially by reducing inflammation. The anti-inflammatory effects of foods and aspects of how one chooses to live may, in turn, favorably influence and support immune system function as a preventative measure for reducing the risk of illness. Furthermore, in the case of (viral) infection, implementing these changes could significantly offset the severity and effects incurred from illness. While this unprecedented COVID-19 pandemic may be stressful and have mental-emotional ramifications both short- and long-term for individuals, people can effectively use this time as an opportunity to redirect their efforts into an evaluation of their current lifestyle and motivate changes that will reduce the immediate risk from acute viral infection, as well as the long term risk of chronic disease. Comments and questions are welcome. Email: firstname.lastname@example.org Paul R. Block MD, FACP, FCCP