Research Review: The relationship between exercise, inflammation, and respiratory immunity

The relationship between exercise and the immune systems is intensely complex with many moving variables. Exercise generally improves the immune system. The more exercise done, and the more regularly, the more the immune system is boosted. However, there is always a tipping point. Athletes are often pushed into longer bouts of exercise, and/or more intense training. This goes as well for some “general exercisers” who don’t consider themselves “athletes,” but will grind out intense workouts that are on par for athletes. I have seen this with recreational marathon runners, obstacle course racers, and people going “all in” for 30-, 60-, or 90-day challenges with their gyms or trainers. They may not think of themselves as “athletes,” yet they are putting in long hours and hard sessions, sometimes multiple workouts per day. Anyone working out intensely for over 45 minutes, more than 4 times a week, I would argue should call themselves at least “recreational athletes.”

In addition to increases in bodily pains and risk of injury, it’s not uncommon to see upper respiratory illnesses (URIs, ie: coughing, congestion, sinus drainage) and upper respiratory tract infections (URTIs, ie: common cold and influenza) in recreational and elite athletes.  In fact, URTIs are suggested to be the most common type of infection in the athletic population. But if exercise boosts the immune system, why is this happening?

Some exercise is good.

Indeed, some movement is good. Quality and consistent movement is great. Studies show that “moderately active” living poses greater resistance to pathogens by boosting the immune system surveillance of the body. “Moderate exercise” is somewhat subjective, but tends to range around 30 minutes of movement at 60-75% intensity, 4-6 days a week.

Animal studies showed that exercising for 20-30 minutes right before being exposed to a virus decreased morbidity and mortality from it, even if it was just a single session of exercise and the mouse had been sedentary outside of that bout. That lead to suggestions that exercising before traveling on an airplane, or going into other high-crowd areas, could help prevent illness.

Now, extend that exercise from a single session to a routine: research that looked at 12-15 weeks of moderate exercise saw that incidence and duration of URTIs was significantly lowered compared to sedentary individuals. Longer duration of the routine meant better adaptations in the immune system.

Acute Exercise, or just getting started

Some of you have heard me say over and over that “stress causes inflammation and health problems” and expand that ‘stress’ can mean emotional, mental, chemical, or physical. In this case, we’re looking at the physical stress of exercise, which also elevates cortisol (chemical stress.) You are tearing muscles, straining lungs, and working your heart. As many people who have “fallen off the wagon” of exercise can attest, getting back into the workout routine is the most physically painful part, compared to a few weeks in after your body has adapted. This is called the “General Adaptation Syndrome” (GAS) where the body isn’t used to the physical stress. Every exercise stress applied results in specific biochemical, neurological, and mechanical adaptions in the body. The first 2-3 weeks of this are called the “Alarm Phase” or “Shock Phase”, and typically muscle and joint pain, fatigue, and discomfort are all more extreme at this time.

Training load or volume alone does not give full information on the level of stress that an athlete (and their immune system) is under. Indeed, the way training in distributed or periodized is of key important also. Periodization is breaking down a training plan into smaller, progressive stages to build safely over several weeks or months. Rapid changes in training load (i.e., increasing too quickly) was a better predictor of URI risk than total load alone. This shows that it’s not just the amount of training, but jumping in too quickly can be detrimental to the immune system.

This is different than someone who has adapted to longer or more intense levels of exercise over time. Much like their bodies are adapted to recover faster between training sessions, the immune system also learned to rebound more rapidly.

Can it be too much?

That tipping point of “too much” strenuous and/or prolonged bouts of exercise can temporarily reduce the immune system (“exercise-induced immunodepression”) for a few hours to a few days, depending on the nature of the exercise and the health status of the person, as well as the rest time before the next round of exercise. This immunodepressed state is the time the individual is at higher risk of contracting a URI or URTI.

The less adapted to high frequency/intensity/duration of training, the higher the stress levels spike, and the lower the immune system plummets after. What goes up, must come down. But in time, you can taper the peak and the drop.

After Intense, Acute Exercise

How many people have had the experience of going through a prolonged period of intense stress (semester at school, large work projects, extended home situation) and when this intense period finally eases up, they get sick? It’s like the immune system fires on all cylinders to help get you through the stressful time, and then it rests when you do. Likewise, this can be seen in athletes.

A research review by Walsh et al. suggested that athletes most often would report URTIs either during the high-intensity and tapering period prior to competition (e.g., swimming, team sports) or in the period following competition (e.g., long distance running). Essentially, the times of illness were more common during the high intensity period (high stress and inflammation in the body), or about 1-2 weeks after as the body gets to rest (incubation period.)

Nieman et al reviewed marathon runners and respiratory illness. “Taking into account other factors influencing risk of URI (age, stress levels, and illness at home), the likelihood of URI was doubled in those who ran >96 km compared to those who ran 32 km as part of their weekly training programmes leading up to the event.”

It is interesting to note, as well, that some studies then went on to break down infectious versus non-infectious URIs. Meaning, sometimes the URI or URTI is based on a pathogenic infection (ie: bacteria, virus), and other times there is some other reason for feeling sick that didn’t have to do with a microbe. Reports show it can be due to inhaled pollutants or allergies, chlorine vapors for swimmers, cold and dry air; age; sleep quality; and more. These factors are less related to the immune system directly than they are related to inflammation. Once again, lifestyle factors pop up as important keys for staying healthy and keeping optimal respiratory functions. Keeping inflammation low before exercising may help reduce the over-inflammatory state brought on by intense exercise, and protect respiratory health.

So… What is the “Goldilocks” level? Not too little, but not too much too fast.
The J-Curve versus the S-Curve

The J-curve model suggests that an individual involved in regular moderate exercise is less likely to contract a URTI compared to a sedentary individual, but prolonged high-intensity exercise or periods of strenuous exercise training are associated with an above-average risk of a URTI. Like so:

The J-curves are the bold purple and red lines, showing that infection risk is average with a sedentary life. Then the immune system gets a boost, thus reducing infection risk, as a person moves into active or moderate exercise. But following that curve then leads to a split in research. At first, heavy or prolonged training seems to have a rebound effect, causing infection risk to go above average – but not always!

It seems that some athletes can reach “elite” status, and as their body adapts to these bouts of exercise, the curve instead moves into an S-curve and infection risk normalizes again, and the immune system can recover, coming back to average as the athlete-in-training adapts.

Lifestyle and the Elite Athlete

There have been some that suggest a prerequisite to achieving “elite” athlete status is an immune system which can withstand the strenuous nature of training and competition. Essentially, one cannot push to elite levels of training if the immune system cannot keep up.

And as past articles and posts have shown, there are ways you can help enhance your immune system through lifestyle, diet, and supplements.

Again, let’s think about that Alarm Phase. If the body is not used to the intense exercise, there is more inflammation and damage to the muscle fibers and tissues. Elite athletes, however, are trained better for this stress on the body. Likewise, elite athletes are usually tackling many aspects of their lifestyle to optimize their performance: sleeping well; properly fueling before, during, and after workouts; keeping a focused mindset; drinking plenty of water; stretching and recovering. They often tap into additional resources for support: keeping up on the latest in sport science, seeking out medical professionals, getting advice from nutrition professionals, working with trainers, and more. Genes may play a role, but this support team shows that managing other aspects is important and can help in prevention.

In the complexity of the immune system, the research does note that humans have demonstrated lower resistance to URTI when there is weakness or problems with other life stressors such as dietary deficiencies, psychological stress, sleep disturbance. In fact, the presence of nearly any of these other risk factors will cause a weaker immune response, and increase the risk of illness following prolonged exercise.

Lifestyle matters.

Could these lifestyle behaviors be another layer of protection for athletes and people looking to begin exercising, or boost their current training? Absolutely.

Overall:

Athletes and individuals involved in heavy training programs and/or prolonged bouts of exercise appear to have an increased risk of contracting URIs. This is likely related to regular acute (and possibly chronic) periods of exercise-induced immunodepression. Regular moderate exercise, on the other hand, appears to have the opposite effect and reduces infection risk. So if you are looking to boost your training, pair gradual increases in exercise with healthy lifestyle habits to keep your infection risk as low as possible.

WHAT SHOULD I DO, ESPECIALLY DURING THIS CORONAVIRUS CRISIS?

  • Move at least 30 minutes, 4-6 times per week. If you want to go above that, do so mindfully. There are benefits, but you want to give your body time to rest and adapt to an increased load. It is tempting for some who are finally getting their new quarantine routines down to want to double up workouts, or go for longer runs than they normally have time for. Be mindful, and gradually work your way up. This will reduce your risk of injury and illness.
  • Be sure to warm up and cool down appropriately.
  • Recover well. Stretch and foam roll. Rest and sleep to give your body enough time to recover between bouts of exercise.
  • Learn about proper form, get proper shoes, and ensure all other ergonomic aspects of exercise are optimized to reduce physical stress and injury.
  • Work with a trainer who knows how to periodize properly and can create workout plans that challenge you without shocking your system
  • Get a quality 7-8 hours of sleep each night
  • Fuel properly before, during, and after workouts to enhance the workout efforts as well as maximize post-workout recovery.
  • Nourish your body throughout the rest of the day as well to feed your cells with antioxidants, anti-inflammatories, vitamins, minerals, and more. Again, part of the risk of URI is the inflammation that the physical stress causes on the body, within the tissues and lungs as well as the muscles. Consider joining the Wolf program.
  • Work with a dietitian/nutritionist to personalize your food and supplement needs.

Ready to take your exercise up safely, and protect your health? I invite you to schedule a complimentary New Client call with me, so we can discuss possible best options for you and your fitness!


SOURCES

Cohen, S., Tyrrell, D.A., Smith, A.P., 1991. Psychological stress and susceptibility to the common cold. N. Engl. J. Med. 325, 606-612.

Cohen, S., Doyle, W.J., et all, 2009. Sleep habits and susceptibility to the common cold. Arch. Intern. Med. 169, 62-67.

Jones, A.W., and Dvison, Glen. Exercise, Immunity, and Illness. Muscle Metabolism and Exercise Physiolog. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7149380/pdf/main.pdf Accessed 20th April, 2020.

McGill, E.A. & Montel, I.N. (Eds). 2017. NASM Essentials of Personal Fitness Training. 5th ed.

Nieman, D.C, et al. 1990. Infectious episodes in runners before and after the Los Angeles Marathon. J. Sports Med. Phys. Fitness 30, 316-328.

Walsh, N.P., et al. 2011. Position statement. Part one: immune function and exercise. Exerc. Immunol. Rev. 17, 6-63.

Research Review: COVID-19, enhancing prevention, protection through nutrition and lifestyle

Review of Webinar:

Current Controversies in Natural Therapeutics of Immune Support:
A roundtable discussion with three renowned clinicians

[Dr David Brady, Dr Todd Lepine, and Dr Peter D’Adamo)
Hosted by Designs for Health and Diagnostic Solutions, Jason Bosley Smith

The government, CDC, and Public Health leaders keep saying “it’s when, not if” you will get sick. So instead of just sitting back, hoping social distancing and hand washing keeps you out of the battle, start preparing your body now for the fire that is all but inevitable within the next few weeks, and take control. There are things you can do.

“We don’t necessarily die by having the virus in us, we die by our immune response’s over-reaction to the virus.”

–Dr Todd Lepine

ABOUT COVID-19 AND WHAT IT DOES TO YOU

INFLAMMATION IN THE LUNGS

The coronavirus produces a protein that kicks off this domino-chain reaction of inflammation in the lungs:

The virus triggers NLRP3 inflammasomes, which then triggers  IL-1β (Interleukin 1β, a pro-inflammatory cytokine), thus causing more inflammation. This cascade of inflammatory chemicals targets the thin membrane where your lungs and blood normally exchange oxygen and CO2, thickening the tissues and making the exchange difficult.  All of this uncontrolled progressive inflammation continues, and the diminished gaseous exchange leads to hypoxemia (below normal levels of oxygen in the body) and damages alveoli in the lungs. Patients often develop Acute Respiratory Distress Syndrome/Acute Lung Injury (ARDS/ALI). 

When you have the flu and feel “run over by a truck,” that is usually the result of excessive cytokines and inflammation. COVID-19 is similar, but those inflammatory agents more specifically attack the lungs.

What that means: the virus causes your body to release a host of chemicals that cause inflammation in the body. The inflammation seems to target the lungs in many patients, thickening up membranes there. This makes it harder to get oxygen from your lungs into your blood, and the CO2 back out – so breathing becomes more rapid and forced. This all results in shortness of breath and often an elevated heart rate.  [this is explained in a Facebook video here]. You need to reduce inflammation in your body now, and boost your immune system to prepare for anti-inflammatory protection later.

COVID-19 and GUT HEALTH

More recent research shows that the coronavirus is also very dominant in the GI (gastrointestinal) tract.

Digestive symptoms (such as nausea, vomiting, abdominal pain, or diarrhea) were tied to worse COVID-19 hospitalization outcomes: “Whereas 60% of patients without digestive symptoms recovered and were discharged, only 34.3% of the patients with digestive symptoms recovered.” The virus seems to be able to get into the GI tract; a strong and healthy gut may have a better likelihood of protecting your body from this invader.

What that means: in addition to inflammation in the lungs, many patients seem to have their gut lining attacked. The gut is one of the key aspects of health and immune protection. A damaged gut is often at the root of many other health problems. So if your gut is already weak, and gets attacked by the virus, it is a damaging circle that sets you up for more health problems later in life. Diabetes, autoimmune disorders, bone and joint problems, cardiovascular disease and more all have links to leaky gut and inflammation. You need to strengthen your gut health now to build better defenses and minimize your risks.

POSSIBLE NUTRIENT THERAPIES

Various nutrients are essential for immunocompetence, particularly vitamins A, C, D, E, B2, B6, and B12, folic acid, iron, selenium, and zinc. Micronutrient deficiencies are a recognized global public health issue, and poor nutritional status predisposes to certain infections. These nutrient deficiencies are also seen as part of the aging process; but in a way, aging IS inflammation, possibly cyclically because of leaky gut and nutrient deficiencies. Diet alone may be insufficient, and tailored micronutrient supplementation based on specific age-related needs may be necessary, as well as person-specific needs (gender, exercise routine, stress level, genetics, diet, etc).

Vit D plays a huge role in preventing respiratory viral infections and decreases gene expression of various pro-inflammatory cytokines (such as TNF-α, IFN- β, ISG15, CXCL8, IL-6, and RANTES.)

Melatonin is a potent inhibitor of the NLRP3 inflammasomes; melatonin spikes in childhood and then tapers off as we age. This may be another reason children seem to have milder versions of this illness.

Nitric Oxide can inhibit NLRP3 inflammasomes. It also reduces oxidative stress (oxidation damages the body), regulates hypoxia signaling (helps get more oxygen to your body), supports the strength and integrity of your mitochondria (mitochondria are the “energy factories” in your cells, making energy for your body), and modulates the immune defenses to stem the progression of cytokine storms (boosts your immune system to help calm over-production of pro-inflammatory cytokines). Nitric Oxide is most commonly found in beets. 

Ascorbic acid (vitamin C) can inhibit NLRP3 inflammasomes in proper doses, which decreases the inflammatory IL-1b secretions, without inducing any cytotoxic effects or cell death. Best Vitamin C food is papaya, followed by bell peppers. [you can read more in my Facebook post about Vitamin C here.]

Elderberry should be safe if you’re not in respiratory distress. If you’re not symptomatic, Dr. Brady says he would keep taking it. “Cytokine Storms” usually mean the cytokines are boosted 6,000x normal; elderberry is meant to be a gentle therapy, and so typically only boosts cytokine levels 1.5-3x normal.

[Side Note: “Cytokine Storm” warnings have been flying around social media, telling people to avoid Advil and Elderberry and probably other “anti-inflammatory” or “immune boosting” items. Yes, Cytokine Storms are a real thing, where the boosting of pro-inflammatory cytokine triggers the boost of another, and in an inflamed body, this can become a dangerous downward spiral of health. But, there are many types of cytokines as you may have noticed in this reading, some pro-inflammatory, but others anti-inflammatory. And it takes a lot to trigger a “Storm.” Elderberry does boost a few pro-inflammatory cytokines that normally help gently kill off microbes, but in normal dosing is not likely to have a negative effect on a person because it is such a gentle therapy, especially if a person is asymptomatic.]

Stinging Nettle tea made from the leaves can help reduce the production of pro-inflammatory markers, such as TNF-α , IL-6, and CRP. Stinging Nettle root also has protective properties; it may have cytokines that kill off viruses and inhibit viral fusion. It has been shown to help protect against SARS. In mice, it also helped reduce fluid in the lungs, a common trait of pneumonia. 

Quercetin is being studied for its anti-inflammatory and immune boosting properties. It’s a pigment, found in many plants and foods: green tea, apples, berries, Brassica vegetables, capers, grapes, red wine, onions, shallots, tomatoes; many seeds, nuts, flowers, barks, and leaves; various kinds of honey. 

Resveratrol significantly inhibited MERS-CoV infection, and decreased its ability to replicate itself. So it is speculated that resveratrol may have similar effects on SARS-CoV-2. Found in red grapes

What that means: the foods you eat matter. Quality supplements matter. Find a clean eating diet, join my group for anti-inflammatory eating, or get personalized food help tailored to your specific inflammatory food sensitivities. 

BOTTOM LINE:

When our immune system is balanced and working well, it can usually take care of things! 

“We don’t necessarily die by having the virus in us, we die by our immune response’s over-reaction to the virus.” A controlled inflammatory response towards infection is good. It is part of a healthy immune system. But an uncontrolled inflammatory response can cause complications, and COVID-19 poses a greater risk of triggering a systemic over-reaction. Complications include pulmonary edema (fluid, swelling), and the cytokine storm. It is these uncontrolled, over-reactions of the immune system and inflammatory response that have been associated with more severe disease states and higher mortality. Thus, lessening and suppressing the hyper-inflammatory response may be very beneficial in preventing immunopathology.

What that means: if you can build a strong immune system, and keep inflammation controlled, you may be able to help prevent getting sick, having such severe symptoms, and have a better chance for a longer, better quality life after all of this is over.

STRENGTHEN YOUR IMMUNE SYSTEM,
AND MAKE YOURSELF FIRE-PROOF
(or, at least, Fire-Resistant)

Think of the Coronavirus like an arsonist trying to set your home on fire. First, he has to make it to your home… then he has to get inside your home… then, he has to be able to ignite something. If you already have small fires in place, it is easier to fan those flames into something devastating. If you have flame-retardant materials everywhere, though, it will be more difficult. And, if he does happen to get something lit, it’s good to have a fire extinguisher available to try to squelch the little fire before it catches on to one thing then another, and quickly spreads through your house, destroying everything it can. How you protect your house, and have back-up plans, determines how great a chance you have at preserving your precious home.

Likewise, how you protect your body, and what healing systems you have in place, can reduce your risk of a devastating “fire” in your body, as the coronavirus sweeps through the country.

  1. So, keep your “home” (your body) away from the coronavirus exposure as much as you can! Stay home, avoid crowds, keep your physical distancing
  2. Keep the outside of your “home” strong and sanitized. Wash your hands; wipe grocery cart handles; clean after touching door knobs, car handles, delivery packages, etc; sanitize your countertops; wash work clothes immediately if your job keeps you in higher-risk areas; and practice other good general hygiene. 
  3. Put out current fires in your “home” as quickly as possible by reducing inflammatory foods and behaviors. 
    1. Cut way down on (or eliminate completely) processed foods, sugar, white flour/bread/pasta, high amounts of caffeine or alcohol, fried foods, margarine
    2. Remove common food sensitivities such as gluten, wheat, dairy, soy. Find out your specific food sensitivities
    3. Reduce exposure to toxic chemicals (cigarette smoke, pollutants, pesticides, sprays, fumes, etc)
    4. Reduce stress and cortisol
    5. Repay “sleep debt” from too many nights of too little sleep
  4. Make your “home” as fire-proof as possible.
    1. 70% of your immune system resides in your gut. So get it healed up.
    2. Get on high quality supplements (multivitamin, probiotic, omega-3s)
    3. Eat nutrient-rich foods with good antioxidants: dark, colorful vegetables; berries and other fruits; omega-3 fatty fish; whole grains or whole starches; nuts and seeds
    4. Get 7-8 hours of quality sleep every night
    5. Get sunshine daily
    6. Get your heart rate up at least 30 minutes a day
    7. Get off the couch, or out of the chair, and stretch every hour
    8. Drink more water
    9. Smile

SOURCES:

over 30 research sources from this webinar and on this topic can be found here: https://drive.google.com/open?id=1cQVap50vBpKDC1bgpfVtjIfDwaLSv6Dj

Flying and Frying

Many people on Saipan and the neighboring islands comment that one of the things they love about living out here is the ability to travel quickly to other countries and explore.  I myself just returned from a long flight to the states for a nutrition conference.

I love travel, and have found ways to be quite content on these 28-hour trips, but whenever you fly, you are being bombarded by microbes, dehydration, and dangerous radiation!, dehydration, and dangerous radiation! No, this isn’t some SciFi plot or crazy takeover. This is something everyone faces during their flights.

Airplane Exposure to Dangers

When one gets on a plane, one is preparing to assault the body with many dangers. I’m not talking about potential dangers of malfunctions; I’m talking about the constant dangers of germs, dehydration, and radiation.

Most of us are already aware that plane flights can be a breeding ground for disease – many people crammed close together for long periods of time, limited air circulation, and not the healthiest of snack options! So I often plan about a week ahead to start boosting my immune systems with extra sleep, water, and vitamin C. (Lemon water first thing in the morning is a great way to start!)

Dehydration was an issue for me on previous plane rides. First off, they swipe your water at the check in, so you have to try to find new water on the other side.  Take bottles that you can refill, and always ask for water from the stewards.  Delta tweetedDrink water. Then drink more. You can lose nearly 1.5 liters of water during a 3-hour flight.”  That’s about 6 cups every 3 hours!  So if you’re one of my Saipan compatriates, and you’re making a trip back to the states… you do the math.  Drink up!

And the one danger that most people are NOT aware of – when you hop on a plane, you are going to be flying at heights that are affected by various forms of radiation.

Eh?

from nasa.gov

 

While we are constantly getting a “steady drizzle of rain” of radiation from space, the Environmental Protection Agency states “The atmosphere shields us from cosmic radiation, and the more air that is between us and outer space, the more shielding we have. The closer we get to outer space, the more we are exposed to cosmic radiation. This holds true when we live at high altitudes or fly.”

The Federal Aviation Administration put out this report for Aircrews, entitled “What Aircrews Should Know About Their Occupational Exposure to Ionizing Radiation.” In it, they state “Ionizing radiation consists of subatomic particles that, on interacting with an atom, can cause the atom to lose one or more orbital electrons or even break apart its nucleus. Such events occurring in body tissues may lead to health problems. For aircrews, and their children irradiated in utero, the principal health concern is a small increase in the lifetime risk of fatal cancer. For both of these groups, exposure to ionizing radiation also leads to a risk of genetic defects in future generations. The FAA recommends limits for aircrews in their occupational exposure to ionizing radiation and provides computer software for estimating the amount of galactic cosmic radiation received on a flight.”

Now, I’m not saying one long flight is going to necessarily have fatal effects, but low doses over time can add up. And we’re exposed to these forms of radiation on a daily basis already, it is just increased during a flight. If they have to warn crew to limit their exposure, maybe it’s something to take seriously.

Looking out the plane window, over the Pacific
 

So what can you do? The EPA’s opinion is, “There are no practical ways to shield yourself from cosmic radiation during a flight. You can reduce your exposure while flying by taking shorter flights at lower altitudes. This is often not practical, and the risks from cosmic radiation do not warrant changing your travel plans to reduce your exposure.”

But for those of us who fly more often, on long trips?  Eat naturally, and keep yourself healthy! Load up on antioxidants that help stabilize those molecules in your body and prevent dangerous oxidation from radiation.

How to Handle These Damaging Assaults

Start your morning with a big glass of lemon water to get a last little kick of vitamin C, then get some good antioxidants in, to help protect your cells (berries, leafy greens, produce, ect.)

Keep foods light and easily digestible – don’t bog down your body with digestive needs when you want to reserve some energy for fighting off germs and damage.  Processed, heavy meals that do little to help keep your system running at its ideal level.  Ideas: raw pecans or almonds; trail mix; apples travel well; baby carrots and celery sticks or bell peppers; a treat of dark chocolate with over 70% cacao.

Boost your immune system early; keep water on hand; eat antioxidant-rich foods but eat light. And make sure you get up and stretch to keep your blood flowing and moving all those nutrients around!