Exercise & Nutrition During Coronavirus COVID-19 Pandemic

Exercise, nutrition during coronavirus COVID-19 pandemic - can you boost your immune system through supplements?

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Coronavirus, Nutrition and Exercise

COVID-19, a type of coronavirus, is a newly emerged threat to human health around the globe – as I’m sure most people on the planet are now well aware of. The virus itself is called SARS-CoV-2 and it is believed to have originated in the city of Wuhan in China. Unfortunately, this has now spread across the entire planet and created a worldwide pandemic situation forcing a lot of countries into lockdown with social distancing and strict hygiene measures in place.

What does coronavirus mean for your health, nutrition and exercise?

Let’s dive in…

Coronavirus PPE - hygiene, immune boosting nutrition and exercise

What are coronaviruses?

Coronaviruses are very common viruses that can cause many well known human as well as animal infections (Li, 2020). Coronaviruses are responsible for 10-30% of upper respiratory tract infections in humans such as common cold which is considered as a mild respiratory infection (Paules 2020). However, over the last decade or two, a new group of coronaviruses emerged which can be lethal to humans such as severe acute respiratory illness (SARS) and Middle East respiratory illnes (MERS).

Coronavirus Disease 2019 – COVID-19

Since this disease is novel (new), the characteristics of this disease are still being researched so we are constantly discovering new information day by day. However, so far we know that this disease presents itself with several flu-like symptoms such as fever and dry cough with rapid progression to sometimes very severe pneumonia and possibly death. Generally, fatalities with COVID-19 occur mainly in the elderly population who are 70+ years old and have other underlying health conditions (Hui 2020, Azhar 2019). However, there have also been severe cases and deaths reported in younger populations. So far, the case fatality rate is 3% (Wang 2020).

Coronavirus - COVID-19 SARS-CoV-2

Spread

The most common transmission is a direct contact with an infected person who is contagious.

The second type of possible transmission is by droplets. These virus droplets are spread from the respiratory tract of the infected person through cough or sneeze and picked up by a nearby uninfected individual from touching surfaces and materials with these droplets on and spreading them to their own nose or mouth when touching their face.

Although less likely than the two above, the next possible transmission is through aerosol, where airborne viruses can be inhaled by an uninfected person, usually in confined spaces. This has been the case with both SARS and MERS coronaviruses in indoor environments (Judfson 2019, La Rosa 2013). This particularly puts healthcare practitioners and other patients in hospitals at risk, therefore full protective equipment and serious hygiene measures are needed.

What can you do to protect yourself from COVID-19?

Coronavirus - Mona Lisa - stockpiling, face masks, hand sanitizer and toilet roll
  • Avoid air travel and overall public transport unless completely necessary
  • Practice social distancing – keep 2 meters apart from people you don’t live in the same household with.
  • Work from home, if possible
  • Wash your hands regularly – 20 – 30 seconds with anti-bacterial soap
  • Disinfect surfaces
  • Strengthen your immunity by nutrient-dense diet, regular exercise, adequate sleep and stress management
  • Stop smoking
  • If overweight, lose fat and improve general health markers
  • Wear a face mask when in public spaces eg. food shopping, on public transport (see below)

High risk groups

To start with something positive, it’s important to stress that the vast majority of people who get COVID-19 will be fine and experience minimal to moderate flu-like symptoms.

However, as Stanley Perlman (University of Iowa virologist) mentioned “The virus matters, but the host response matters at least as much, and probably more,”. This likely explains the wide range of effects this virus has on people. There are obvious exceptions, but the majority of people who are young with good health and a healthy immune system appear to experience minimal effects from the virus.

On the other hand, the elderly and those with compromised immunity and other underlying health conditions such as chronic smokers, hypertension, pre-existing lung disease, diabetes etc. can experience serious complications and even death. According to The Lancet, the most frequently observed complications included sepsis, respiratory failure, ARDS, heart failure and septic shock.

Many of these pre-existing conditions and diseases can be improved or even completely “treated” by improving your lifestyle choices and dietary habits via a balanced diet, regular exercise and adequate sleep – putting you in the best position to fight off any infectious disease, especially this coronavirus.

Coronavirus high risk - elderly, overweight

Bodyweight

Your bodyweight is probably the most crucial. Calculate your BMI using our online calculator to determine your “healthy weight”. (BMI should be used as a basic guide, however, if you are an athlete who carries a lot of muscle mass, your BMI may show an “unhealthy” result as it’s a simple calculation using height and weight without taking into account body fat percentage.)

BMI ranges: Anything below 18.5 – you’re in the underweight range. Results between 18.5 and 24.9 – you’re in the healthy weight range. If you’re between 25 and 29.9 – you’re in the overweight range. BMI between 30 and 39.9 – you’re in the obese range.

If you’re overweight or obese, you should consider going into a caloric deficit roughly about 500 kcal of your daily caloric needs. You shouldn’t go into extreme deficits as it could compromise your immune response at this time.

You can use our TDEE Calculator (Total Daily Energy Expenditure) to easily figure out your daily caloric needs.

If you are diabetic you could consider having your meals less frequently to avoid unnecessary insulin spikes and keep your blood glucose levels down throughout the day.

If you really struggle to lose weight, you might want to consider the helping hand of a top fat burning supplement, as a couple of them also contain Vitamin D in decent dosages too!

Sleep

Sleep, one of the most important parts of your lifestyle and probably the most underrated!

The majority of the population needs 7 – 9 hours of sleep each night. You probably already know this and have heard it a thousand times… but do you honestly practice this consistently?!

You should organize your daily routine in a way that you can easily hit those numbers. There are some genetically predisposed individuals out there who can survive long-term on 6 hours (or less) sleep/day, however, these people are very rare (less than 1% of the population).

If you are sleeping less than 7 hours a day you are severely compromising your health. And I really can’t stress this enough, but the science is pretty clear on this… “less sleep, less life”.

Also, it’s worth stressing that there is no such thing as “catching up” on your sleep deficit. Your regime should be the same, every day, if possible, to ensure your “body clock”, also referred to as circadian rhythm, is on point. The reason being, every adaption to stress happens during your sleep. Whether it is inflammation (incl. viral infection), muscle damage, memory, mental/physical stress, fat loss etc…your body needs enough sleep to adapt to these stresses and to become stronger.

Fixing your sleep can fix a lot of your problems, just give it a try and make it a habit!

If you battle with getting good quality, consistent deep sleep, perhaps take a look at a natural sleep supplement or consult with your doctor.

Sleep 7 - 9 hours every night to keep your immune system strong for fighting coronavirus COVID-19

Should you wear a face mask to prevent COVID-19 transmission?

According to WHO and CDC, they are still saying if you are well you do not need to wear a face mask. They say you should only wear a facemask if you have symptoms to reduce spreading the infection to others or if you are taking care of someone infected. Although this advice is constantly being reassessed and updated.

In my personal opinion, this recommendation could be an effort to avoid the general public from stockpiling and ensure healthcare systems around the world and their workers have sufficient supplies. You know how people were with toilet paper and hand sanitizer, so if WHO recommended face masks for all there would be even longer delays and problems getting Personal Protective Equipment (PPE) to healthcare workers and staff on the frontline internationally…

Recent tests in Czech Republic (as well as places like South Korea) have shown that even homemade facemasks can be a very effective measure to reduce transmission.

It has been shown that there is a high percentage of infected people spreading the virus without any symptoms at all. That’s the thing that makes this virus so dangerous and why it has spread into pretty much every country in the world.

So that is why in the Czech Republic you can not leave your house without a facemask. “I protect you, you protect me” is their new motto and based on their COVID-19 data, seems very promising in slowing down the spread of the virus. At the time of writing, Germany is also now introducing the same measures – you will only be allowed on public transport and in shops with a face mask from now on.

This obviously hugely reduces droplet transmission from anybody who is infected as well as reducing uninfected people from touching their mouth and nose whilst outside and catching the virus when in contact with surfaces carrying the bacteria.

COVID-19 exercise and training recommendations

Coronavirus and your health, nutrition and exercise

All the below recommendations are based on advice given by the Co-President of the Club of Sport Cardiologists (France) & Associated sports medicine doctors.

“Many athletes can be infected without knowing it, with little or no symptoms at rest, they are however, likely to suffer from exercise-related heart problems if they do not follow this simple advice.” Chevalier, MD; Blanchard, MD & Dusfour, MD (2020) – Cardiologist.

First of all, regular physical exercise is well known to be good for your general health, weight management, mood and your immune system against the virus (Zapatera, 2015).

However, as with most things, it is all about the dose!

That being said, too intense and overly long sessions can actually lower your defenses against the virus and therefore increasing the risk of infection as well as risking worsening an existing clinical condition, if you have one.

By lowering your defenses you are pretty much allowing the virus to spread through the body and it can, therefore, reach your other organs including the heart.

What to do?

Fever 🤒

Try and measure your temperature twice a day, even if you are feeling well. Do this especially when you feel like you have a fever or have a persistent cough.

If you have fever You MUST stop doing any physical activity for at least 14 days after the fever has subsided. Additionally, you must contact your doctor.

Avoid pain killers 💊

If you have no symptoms, do not take paracetamol as a preventive measure as it could mask the fever and make you unaware of your infection.

Although the science isn’t conclusive, some countries recommend avoiding anti-inflammatory drugs such as ibuprofen, cortisone or aspirin when COVID-19 is suspected as they believe it can worsen the symptoms.

Cardio 🏃

In terms of your Cardio training sessions, limit these to 1 hour maximum. If you need to train more, split up your training into 2 sessions instead with a minimum of 3 hours of rest and rehydration in between each session. Additionally, limit the maximum effort level to 80% of your maximal heart rate.

Resistance Training 🏋️‍♀️

Strength training sessions should be limited to 1 hour as well.

We’re not saying you should lose your hard-earned gains, but if you want to stay in the best health possible so you’re immune system is at it’s strongest to cope if you do catch COVID-19 do not work out with your maximal loads.

Avoid exercising until exhaustion 😪

Heavily intense training such as Crossfit should be avoided. By saying that, I do not mean that Crossfit is bad for you and you should avoid it (Crossfit is great!), but more so the intensity of the exercise that Crossfit is known for. Like I said above, not pushing too much at this moment is ideal (80% Heart Rate max).

Additionally, it depends on how experienced an athlete you are as experienced athletes will be more adapted to such exercise and therefore it will be less demanding for them. However, if you are one of those athletes or gym rats who are used to training almost every day more than once, I would probably recommend to cut down on your volume and intensity at this point a little bit.

coronavirus covid-19 and exercise - J-shaped hypothesis graph for risk of Upper Respiratory Tract Infection (URTI) vs Amount and Intensity of exercise

The J-Shaped hypothesis graph does a great job of explaining the point here. If your volume and intensity of exercise is kept at moderate (what we recommend here), you have the lowest risk of Upper Respiratory Tract Infection (URTI). URTI can refer to the common cold, flu as well as the current coronavirus, since it is the same “family” of viruses affecting the respiratory tract. But notice how the excessive volume of exercise dramatically increases your risk of upper respiratory tract infection even more than your risk if you were completely sedentary.

So, just keep in mind, if your purpose for exercise is to become healthier – overdoing it can actually have the opposite effect.

What about hydration? 💧

It is very important to stay hydrated as dehydration increases the risk of infection. So make sure you are properly hydrated before, during and after your training sessions.

Also, try to be aware of how much water you might lose through perspiration – do not put more clothing on with the purpose of sweating more during exercise.

I love the convenience of having a pouch of Coconut Water Powder on hand to add to any shake or glass of water to really help keep me hydrated better than just water alone (amazing hack if you’re hungover too!) plus it’s a good natural source of potassium!

And now finally something about nutrition and your immune system…

Can you boost your immune system through nutrition to protect against coronavirus COVID-19?

Unfortunately, I might disappoint you with this one, but you cannot “boost” your immune system through diet or supplements as there is no evidence of any supplement or specific food which would prevent you from catching COVID-19. That is based on the European Food Safety Authority which you can find more information about here.

Good hygiene practices and social distancing are still the main things you should focus on to avoid infection.

Also, an overactive immune system can actually lead to problems such as allergies or autoimmune conditions

On the other hand, you can support the normal functioning of your immune system with many nutrients using a balanced diet and eating a variety of foods. Such nutrients include vitamins A, B6, B12, C and D as well as copper, folate, selenium and zinc. For more tips and guidance on maintaining a balanced diet, please check out the healthy eating food fact sheet developed by British Dietetics Association, which you can also download.

Vitamin D and the immune system

There is one vitamin which is worth highlighting and that is Vitamin D.

Vitamin D is very important for your immune system, cardiac function, mood and it is also co-working with phosphorus and calcium in maintaining healthy bones, muscles, teeth and minimises bone fracture.

Vitamin D the sunshine vitamin

The majority of your vitamin D intake comes from exposure to sunlight and not from food.

Therefore, considering current circumstances, where most of the world is on lockdown, it would be very wise to supplement with vitamin D, even though it would be even wiser to supplement all year round and get your vitamin D blood levels checked regularly.

It seems that vitamin D deficiency or insufficiency is far more common amongst the general population than previously thought, especially if you have darker (Ginde et al., 2009). However, you should still think about getting out for a little bit and getting your essential vitamin D through the sunlight without getting sunburnt every day, if possible.

In terms of foods containing vitamin D, you can consider consuming higher amounts of oily fish such as salmon, sardines, mackerels, pilchards, trout, herring, kippers and eel. Other good sources of vitamin D include egg yolks, meat, offal and milk, however the amount of the vitamin in these sources varies a lot. There are also some foods with added vitamin D such as breakfast cereals, yogurts, margarine and infant formulas.

The dose of vitamin D is highly individual as it seems that the supplementation rises the vitamin D blood levels differently in each individual, therefore it would be a great idea to have your vitamin D blood levels checked and experiment with your supplementation protocol under the supervision of your doctor. However, you cannot go wrong with a daily dose anywhere between 1000 to 4000 I.U., make sure it is taken with some form of fat, preferably omega 3 since vitamin D is a fat-soluble vitamin.

My personal favourites are these PROM3GA capsules from Bulk Powders – which offer the highest strength quality EPA omega 3 AND 3000 I.U. Vitamin D3.

But several of the top supplements we recommend also contain between 1000 – 5000 I.U. Vitamin D3 too.

Supplements for URTI and antiviral immune activity

Probiotics

There is a growing body of evidence that probiotics such as Bifidobacterium and Lactobacillus could help you enhance your antiviral immune activity and therefore could be a great prevention, not only during this epidemic but also during normal “flu-season”. (Lenoir-Wijnkoop, 2019; Mousa, 2017).

Additionally, below you can see a graph from a study about Yakult supplementation in athletes, which is showing a great promise of much lower Upper Respiratory Tract Infection with such a simple supplementation (66% in probiotic group vs 90% in the placebo group over 16 weeks). Yakult is a probiotic drink easily available in most shops around the UK and now nationwide across the USA which contains Lactobacillus casein strain Shirota.

Probiotics and coronavirus COVID-19 - Yakult supplementation in athletes

Personally, I prefer to eat fermented foods and take Performance Lab Prebiotic or this Pro Culture supplement from Bulk Powders during and after any periods of taking prescribed antibiotics.

Selenium

As already mentioned above, selenium is a very important nutrient in your diet. It has antioxidant, anti-inflammatory and antiviral activities in the body and its deficiency has been associated with increased risk of viral infection (Wrobel 2016).

Epigalloecatechin gallate (EGCG)

Epi-what-now? EGCG is a polyphenol found in green tea known for its antiviral effects (Xu et al., 2O17) 10.3390/molecules22081337

Medications for COVID-19

At the time of writing, there is no proven medication for directly treating COVID-19, since it is a very new disease. However, scientists have been looking at old and new anti-viral drugs which could potentially be effective for COVID-19 and human trials of vaccines are already beginning in several countries across the globe, which is unbelievably fast progress.

As well as vaccine trials, according to multi-center clinical trials in China (Gao 2020), chloroquine phosphate (anti-malaria drug) is currently considered as one of the possible treatments for COVID-19.

Another antiviral drug, which has shown potential benefits is Remdesivir. This prodrug is of an adenosine analog which has shown to have a potent antiviral activity against many RNA virus families (Agostini 2018).

Even though these two drugs seem to be very promising, more research and clinical trials are needed to support its efficacy and most importantly its safety for the majority of the population. 

Cytokine storm syndrome

COVID-19 appears to trigger a “cytokine storm” in some people which is easiest to describe as a state where your immune system goes berserk. This “virus-activated” immune response can be deadly.

During this syndrome, your immune system is unable to modulate itself properly and pro-inflammatory cytokine are over-produced, lung tissues are being attacked by immune cells potentially causing a cascade effect and serious illness or death may follow. In such situations, corticosteroids are being used as well as more targeted immune-modulating drugs such as tocilizumab as well as already mentioned chloroquine phosphate.

Oral supplementation

Whether any other specific supplementation would help against COVID-19 remains unclear as there are still no peer-reviewed studies that could support anything specifically related to COVID-19 at the moment.

However, there are some supplements that one could consider taking such as whey protein (as glutathione enhancer), vitamin C, NAC and apo-lactoferrin which could be of value in terms of immunity enhancement specific to viral infections. IV route would be essential in these cases.

When you read “whey protein” you probably paused to think “hmmmm, I didn’t think that could be helpful!” and yes! Whey protein has many health benefits that general gym goer is probably not aware of…

In this scenario, it is specifically mentioned because whey protein can enhance glutathione, which positively affects the outcome of several viral diseases and plays an important role in their development.

Again, there is no direct link to COVID-19, but the evidence behind glutathione is very strong and could be potentially applicable to this case. With a little search on PubMed you can come across Glutathione articles (links below) related to the common cold (rhinovirus), flu (influenza), AIDS/HIV, hepatitis A, B and C, DNA viruses, RNA viruses, retroviruses and more. (Dr. Jimmy Gutman)

Coronavirus Take home messages

  • Stay home, practice social distancing and wash your hands regularly
  • Have adequate sleep 7-9 hours per day
  • Exercise regularly, but do not overdo it
  • Have a balanced diet
  • Try to maintain a healthy weight by tracking your calories
  • Take 2000-4000 IU of Vitamin D per day
  • Take probiotics and eat a good amount of fermented foods
  • Do not try to experiment or treat yourself with unapproved medications
  • Take some whey protein after your workouts or add to your meals
  • Stay calm and avoid stressing about the current situation, avoid reading and listening to questionable resources
  • Stay positive and stay in touch with your family and friends!
  • Use this time to learn, build and improve new skills

References

Ginde, A.A., M.C. Liu, and C.A. Camargo, Jr., Demographic differences and trends of vitamin D insufficiency in the US population, 1988-2004. Arch Intern Med, 2009. 169(6): p. 626-32.

Gao J, Tian Z, Yang X. Breakthrough: Chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Bioscience trends. 2020:10.5582/bst.2020.01047.

Li G, Fan Y, Lai Y, et al. Coronavirus Infections and Immune Responses. J Med Virol. 2020.

Paules CI, Marston HD, Fauci AS. Coronavirus Infections—More Than Just the Common Cold. JAMA. 2020.

Wang W, Tang J, Wei F. Updated understanding of the outbreak of 2019 novel coronavirus (2019-nCoV) in Wuhan, China. J Med Virol. 2020.

WHO. World Health Organization. Novel Coronavirus (2019-nCoV). Available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed January 29, 2020.

Wrobel JK, Power R, Toborek M. Biological activity of selenium: Revisited. IUBMB Life. 2016;68(2):97-105.

Hui DS, E IA, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health – The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-266.

Azhar EI, Hui DSC, Memish ZA, Drosten C, Zumla A. The Middle East Respiratory Syndrome (MERS). Infect Dis Clin North Am. 2019;33(4):891-905.

Judson SD, Munster VJ. Nosocomial Transmission of Emerging Viruses via Aerosol-Generating Medical Procedures. Viruses. 2019;11(10).

La Rosa G, Fratini M, Della Libera S, Iaconelli M, Muscillo M. Viral infections acquired indoors through airborne, droplet or contact transmission. Ann Ist Super Sanita. 2013;49(2):124-132.

Lenoir-Wijnkoop I, Merenstein D, Korchagina D, Broholm C, Sanders ME, Tancredi D. Probiotics Reduce Health Care Cost and Societal Impact of Flu-Like Respiratory Tract Infections in the USA: An Economic Modeling Study. Front Pharmacol. 2019;10:980.

Mousa HA. Prevention and Treatment of Influenza, Influenza-Like Illness, and Common Cold by Herbal, Complementary, and Natural Therapies. J Evid Based Complementary Altern Med. 2017;22(1):166-174.

Zapatera B, Prados A, Gomez-Martinez S, Marcos A. Immunonutrition: methodology and applications. Nutr Hosp. 2015;31 Suppl 3:145-154.

Glutathione (antiviral) references

https://www.ncbi.nlm.nih.gov/pubmed/21358592

https://www.ncbi.nlm.nih.gov/pubmed/18926849

https://www.ncbi.nlm.nih.gov/pubmed/16787218

https://www.ncbi.nlm.nih.gov/pubmed/9367343

https://www.ncbi.nlm.nih.gov/pubmed/11115795

https://www.ncbi.nlm.nih.gov/pubmed/26692473

https://www.ncbi.nlm.nih.gov/pubmed/9568464

https://www.ncbi.nlm.nih.gov/pubmed/8441757

https://www.ncbi.nlm.nih.gov/pubmed/18678861

https://www.ncbi.nlm.nih.gov/pubmed/12368227

https://www.ncbi.nlm.nih.gov/pubmed/31487871

https://www.ncbi.nlm.nih.gov/pubmed/29033950

https://www.ncbi.nlm.nih.gov/pubmed/9230243

https://www.ncbi.nlm.nih.gov/pubmed/12654482

https://www.ncbi.nlm.nih.gov/pubmed/21366409

https://www.ncbi.nlm.nih.gov/pubmed/24899897

https://www.ncbi.nlm.nih.gov/pubmed/24899897

https://www.ncbi.nlm.nih.gov/pubmed/28039563

https://www.ncbi.nlm.nih.gov/pubmed/8891667

https://www.ncbi.nlm.nih.gov/pubmed/9164274

https://www.ncbi.nlm.nih.gov/pubmed/26663823

https://www.ncbi.nlm.nih.gov/pubmed/8256245

https://www.ncbi.nlm.nih.gov/pubmed/19151318

https://www.ncbi.nlm.nih.gov/pubmed/25135637

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5425915/?

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