You can’t control the virus, but you can control the host when it comes to COVID immunity
As the COVID-19 pandemic continues into 2021, a strong immune system remains crucial for avoiding infection or fighting it off efficiently should it occur. Unfortunately, many Americans entered the pandemic with immune systems that were already weakened — combined with the failure to implement necessary infection prevention measures consistently. In regard to COVID immunity this population group is at high risk for infection, severe possible illness and long-term impacts.
The COVID immunity issue
Healthy people have robust immune systems. In our society, 72% of the population is overweight or obese — an epidemic within the pandemic.
These Americans are more vulnerable to COVID-19 infection because a primary pathway for the virus to enter the body is through the angiotensin-converting enzyme 2 (ACE2) receptors on the surface of cells in the lungs, heart, blood vessels, kidneys, liver, gastrointestinal tract, brain, epithelial cells and fat cells. The primary role of ACE2 in the body is to break down angiotensin II (ANG II), a protein that increases blood pressure and inflammation. The SARS-CoV-2 virus binds to ACE2 receptors like a key into a lock. When the virus occupies the receptors, the effect of the enzyme on ANG II is blunted, leading to tissue injury, including damage to the epithelial cells that line blood vessels.
Because fat cells have even more ACE2 receptors than lung cells, those with high adipose tissue levels are more likely to be infected. Once they are infected, they are more likely to need hospitalization, intensive care and possible intubation. They also have a higher risk of becoming “long-haulers,” people who have persistent ongoing symptoms from COVID-19. Although older adults, in general, are more likely to become severely ill with COVID-19, obese younger adults are just as much at risk.
Obesity and COVID-19
Why is obesity at any age such a severe risk? Obese people may already have compromised respiratory function before infection. At the same time, abdominal obesity can compress the diaphragm, lungs and chest capacity, reducing the lungs’ ability to mobilize. Most significantly, obesity causes chronic low-grade inflammation and an increase in circulating proinflammatory cytokines. Preexisting inflammation plays a significant role in the worst COVID-19 outcomes.
In addition to the widespread prevalence of overweight and obesity, roughly 6 of 10 Americans have an underlying chronic illness, such as metabolic syndrome or type 2 diabetes, that causes chronic low-grade inflammation. Chronic conditions related to excess weight are so common that only about 12% of adult Americans are metabolically healthy. The impact of metabolic syndrome and type 2 diabetes on COVID-19 is apparent. Inadequately controlled blood sugar is a significant risk for more severe illness, increased need for medical interventions, and possible death.
Those who need hospitalization for COVID-19 are very likely to suffer neurological complications during their illness. In one recent study of 509 patients hospitalized at the Chicago-based Northwestern Medicine health system, 82% developed neurologic symptoms, including muscle pain, headaches, dizziness, encephalopathy and brain fog. Altered brain function and encephalopathy affected 30% of the patients. The death rate in patients with encephalopathy was about 22%.
The neurological impacts in COVID-19 have several potential causes. It’s possible that the exaggerated cytokine response triggered by COVID-19 is to blame. Also possible, or in addition, is how the virus begins hypercoagulability and blood clots in blood vessels throughout the body and the brain. And because ACE2 receptors are found abundantly in the brain, including in the cerebral cortex, they may play a role in the cognitive deficits many patients develop.
As the long-term neurologic and cognitive impacts of COVID-19 become more apparent, we’re learning that brain fog doesn’t only affect hospitalized patients. Whether or not they were hospitalized or were even seriously ill, any COVID-19 patient may experience a similar range of neurological problems, notably brain fog.
Chiropractic and supplemental care for COVID-19
Chiropractic care is incredibly valuable for suppoting COVID immunity, the immune system and the central nervous system while attenuating the neurological manifestations of COVID-19.
In the long run, weight loss and glycemic control are essential for reducing chronic inflammation and improving COVID immunity. Amid a pandemic, however, at-risk patients need immediate, actionable steps to build COVID immunity. A good starting point is immune-boosting supplements.
Based on recent studies, patients who have been exposed to COVID-19 or have active infections should begin dosing with vitamin D3 or increase their dose to achieve a blood level of at least 30 ng/mL. A recent JAMA study looked at nearly 500 patients who had their vitamin D level measured in the year before taking a COVID-19 test. The relative risk of testing positive for COVID-19 was 1.77 times greater for patients with likely low vitamin D status than patients with possible, sufficient vitamin D status. Another recent study showed that of 191,000 patients positive for COVID-19, being deficient in vitamin D raised the risk of infection by 54.5%.
Another potent antiviral supplement that may be particularly helpful against the SARS-CoV-2 virus is the polyphenol epigallocatechin-3-gallate (EGCG), found most abundantly in green tea. EGCG has been shown to bind to molecular docking sites on the virus and inactivate it.
The hormone melatonin, often used as a sleep aid, also has powerful antiviral effects. A recent study showed that people who took melatonin supplements were 28% less likely to test positive for COVID-19. Other studies suggest that melatonin limits virus-related diseases and could be beneficial in COVID-19 patients, particularly for obese patients with type 2 diabetes, who are at high risk of severe illness and death.
Curcumin, omega-3 benefits
Curcumin, one of the polyphenolic compounds found in the spice turmeric, may help prevent and treat viral infection. Turmeric has long been used in Ayurvedic medicine as an antibiotic and antiviral. Recent research suggests that curcumin may prevent the SARS-CoV-2 virus from binding to the ACE2 receptor. This may be particularly helpful for avoiding organ damage to the kidneys and heart. Curcumin may also help prevent lung inflammation and damage by inhibiting inflammatory cytokines.
Pro-resolving mediators, or PRMs, represent a portion of the omega-3 fatty acid spectrum that significantly reduces inflammation. PRMs downregulate inflammation without suppressing it. This helps the body maintain an effective immune response while potentially warding off the dangerous cytokine storm response that can be fatal in COVID-19 infection.
PRMs have been shown to help reduce inflammation in the alveoli of the lungs caused by SARS-CoV-2.
Brain fog, memory problems and headaches from COVID-19 neurological impacts can often be helped with lifestyle changes similar to the usual recommendations for chronic fatigue syndrome conditions.
My recommendations include:
A brain-healthy diet rich in leafy greens and omega-3 fatty acids
Regular mild to moderate physical activity
Sufficient or improved sleep
Prebiotic’s and probiotics for improved gut health
Help patients control the host
While you can’t control the virus, you can control the host. Lifestyle improvements should be strongly encouraged, including a healthy, anti-inflammatory diet that is mostly plant-based. Those with metabolic issues should be helped to learn ways to control their glycemic load.
In addition to all its other benefits, regular exercise has been shown to raise the production of the natural antioxidant extracellular superoxide dismutase (EcSOD), which helps prevent or reduce the severity of acute respiratory distress syndrome (ARDS). According to the CDC, between 20-42% of patients hospitalized for COVID-19 will develop ARDS; approximately 45% of patients who develop severe ARDS will die.
The disruption and stress of the pandemic have led to sleep problems for many. Because insufficient sleep disrupts the immune system by reducing the production of virus-fighting immune cells and proteins, adequate sleep is crucial for immune support. Patients should be aware of the importance of good sleep, and issues should be addressed with natural treatments.
As chiropractors, we are best-suited to teach, coach and support our patient base toward these significant health-improving modifications.