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Lifestyle Tips to Hedge Against Respiratory Illness

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Dr. Aseem Malhotra, MD, explains which lifestyle factors can impair immunity and which are protective against respiratory illness. As more data on the coronavirus becomes available, it is becoming clearer which groups are at greater risk of developing severe complications. Obesity, Type 2 diabetes, high blood pressure, and smoking appear to put people at greater risk, while exercise and good nutrition improve the body’s defenses.

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Laurence Omlor
March 23rd, 2020 at 7:13 pm
Commented on: Lifestyle Tips to Hedge Against Respiratory Illness


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Grace Patenaude
March 23rd, 2020 at 5:02 pm
Commented on: 200323

Great Listen! One of my favorite composers! Love listening to Chamber Music from the Baroque Era hearing the soothingly exquisite syncopation of strings like the violin and the harpsichord especially with the year 2020 chaos! Stay safe everyone.

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Mary Dan Eades
March 23rd, 2020 at 2:29 am
Commented on: Lifestyle Tips to Hedge Against Respiratory Illness

Nice summary from Dr. Malhotra and good advice. I'd add one lifestyle addition: sunshine and fresh air. For good immune health, we need sunshine on un-blocked skin to manufacture vitamin D. Eating oily fish, red meat, eggs, and liver helps, too, because we'll get some preformed D there. But weather permitting, even 15 minutes of lunchtime sun exposure to face, hands, lower legs and arms can be of benefit, even in winter. In far north climes (Norway, Canada) in winter it may not be possible to get enough sun to meaningfully convert cholesterol to vitamin D, so dietary sources become even more important (including even supplementation when necessary.) Fortunately for CrossFitters, a WOD prescribing running reps of 600m, 400m, or 200m out in the sun, weak as it may be in winter, is also a good thing.

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Tyler Hass
March 23rd, 2020 at 1:50 am
Commented on: Lifestyle Tips to Hedge Against Respiratory Illness

Aseem, thanks for writing this timely and useful article. I enjoyed going through the studies you mentioned as well. From this one, it’s clear that now is not the time to run a marathon or do an epic workout:


“Runners who trained >97 km per week had twice the risk of the development of URTI symptoms when compared to the referent group which trained <32 km per week. Furthermore, runners who completed the marathon increased their risk for URTI nearly 6-fold during the week following the race when compared with similarly-trained controls that registered, but did not participate in the marathon.”


The paper mentions that “intense exercise” is associated with a decrease in immune function, but they were describing marathon running. Super high volume, but low intensity (power output). CrossFit workouts are generally brief and intense (high power output); essentially the opposite of a marathon. As long as you are staying within a dose/intensity level you are accustomed to, it’s surely a good thing to keep up your training.


This reminded me of a description of the life of Tour de France riders:


In his book Lance Armstrong’s War, Daniel Coyle explains that Tour de France cyclists don’t like to walk. He even states that they will get out of breath walking up stairs! Their white blood cell counts tend to be 30 percent below average and their bodies become vulnerable to colds and disease. They push elevator buttons with their elbows to help avoid germs. And they are skinny—very skinny. Here is a quote from Coyle’s book. 


“Tour riders are skinny, far skinnier in person than they look on television or in photos. Their upper arms are so slender that you could almost wrap your thumb and index finger around them. The wife of one American rider says she can tell the Tour [Tour de France] is drawing near when she can start to see her husband’s internal organs—his liver, his kidneys—beneath his skin.” 

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Tyler Hass
March 23rd, 2020 at 4:01 am

On another note, I've heard a few recommendations that now might not be the best time for prolonged fasting. This video from Peter Attia warns that long fasts increase cortisol and can weaken your immune system. This is obviously speculative, since no one has studied the effects of fasting on this virus. He's advising patients against 48+ hour fasts. He doesn't see any evidence that time restricted feeding would pose any problems. His primary recommendation is to eat clean right now and not push too hard on fasting or time-restriction. Given the level of uncertainty, I think it's sensible advice.

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Emily Kaplan
March 23rd, 2020 at 1:13 am
Commented on: Lifestyle Tips to Hedge Against Respiratory Illness

This article carefully and diplomatically makes the point many seem to be shying away from. Those most impacted by COVID-19 are already sick. It’s estimated that 99.1 percent of those who have died had a co-morbidity and it’s not a leap to suggest the 0.1 percent remain also had a chronic illness, though not yet diagnosed.


Unfortunately, we are a nation of sick people. The CDC estimates 6 in 10 Americans have a chronic illness, the leading cause of death and disability. Close to 27 percent of Americans over 65 years of age have Type 2 Diabetes.


This report concurs with Dr. Malhotra: “Although the mechanism of this increased susceptibility remains unclear, research suggests that high blood glucose levels may lead to reduced functioning of the immune system.”


And:


“Experts interviewed by Medscape Medical News noted that diabetes is associated with double or triple the risk for infection from COVID-19, independent of CVD or other medical comorbidities.”


Most ICUs in the US were near capacity before Corona. According to ProPublica’s analysis of hospital capacity:


“As of 2018, Boston, MA had 10,200 total hospital beds, of which about 75% were occupied, potentially leaving only 2,550 beds open for additional patients. The bed count includes 1,160beds in intensive care units, according to data from the American Hospital Association and the American Hospital Directory. Intensive care units are best equipped to handle the most acute coronavirus cases.



Access to ICU beds vary widely by location, which will makes this all more complex. Kaiser News reports:


“Consider the homes of two midsize cities: The Louisville area of Jefferson County, Kentucky, for instance, has one ICU bed for every 442 people age 60 or older, while in Santa Cruz, California, that number stands at one bed for every 2,601 residents.”


While the media is focused on healthcare being overrun it has neglected to acknowledge that the problems started way before this virus. It is worth spending some time on the root causes. America is not healthy.

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anthony constantinou
May 12th, 2020 at 11:16 am

Anthony Constantinou says, “To help avoid spread from assumed

cases, health care practitioners should use normal, contact, and airborne or

droplet safety measures with eye guard. Airborne precautions are mainly applicable

for patients undergoing aerosol-generating trials. Patients with respiratory

symptoms should be recognized and masked straight away upon entrance to any

healthcare facility.”

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