Erik Peper, PhD and Richard Harvey, PhD
The number of hospitalizations and deaths from COVID-19 are decreasing as more people are being vaccinated. At the same time, herd immunity will depend on how vaccinated and unvaccinated people interact with one another. Close-proximity, especially indoor interactions, increases the likelihood of transmission of coronavirus for unvaccinated individuals. During the summer months, people tend to congregate outdoors which reduces viral transmission and also increases vitamin D production which supports the immune system (Holick, 2021)..
Most likely, COVID-19 disease will become endemic because the SARS-CoV-2 virus will continue to mutate. Already Pfizer CEO Albert Bourla stated on April 15, 2021 that people will “likely” need a third dose of a Covid-19 vaccine within 12 months of getting fully vaccinated. Although, at this moment the vaccines are effective against several variants, we need to be ready for the next COVID XX outbreak.
To reduce future infections, the focus of interventions should 1) reduce virus exposure, 2) vaccinate to activate the immune system, and 3) enhance the innate immune system competence. The risk of illness may relate to virus density exposure and depend upon the individual’s immune competence (Gandhi & Rutherford, 2020; Mukherjee, 2020) which can be expressed in the following equation.
Reduce viral load (hazardous exposure)
Without exposure to the virus and its many variants, the risk is zero which is impossible to achieve in democratic societies. People do not live in isolated bubbles but in an interconnected world and the virus does not respect borders or nationalities. Therefore, public health measures need to focus upon strategies that reduce virus exposure by encouraging or mandating wearing masks, keeping social distance, limiting social contact, and increasing fresh air circulation.
Wearing masks reduces the spread of the virus since people may shed viruses one or two days before experiencing symptoms (Lewis et al., 2021). When a person exhales through the mask, a good fitting N95 mask will filter out most of the virus and thereby reduce the spread of the virus during exhalation. To protect oneself from inhaling the virus, the mask needs be totally sealed around the face with the appropriate filters. Systematic observations suggest that many masks such as bandanas or surgical masks do not filter out the virus (Fisher et al., 2020).
Fresh air circulation reduces the virus exposure and is more important than the arbitrary 6 feet separation (CDC, May 13, 2021). If separated by 6 feet in an enclosed space, the viral particles in the air will rapidly increase even when the separation is 10 feet or more. On the other hand, if there is sufficient fresh air circulation, even three feet of separation would not be a problem. The spatial guidelines need to be based upon air flow and not on the distance of separation as illustrated in the outstanding graphical modeling schools by Nick Bartzokas et al. (February 26, 2021) in the New York Times article, Why opening windows is a key to reopening schools.
The public health recommendations of sheltering-in-place to prevent exposure or spreading the virus may also result in social isolation. Thus, shelter-in-place policies have resulted in compromising physical health such as weight gain (e.g. average increase of more than 7lb in weight in America according to Lin et al., 2021), reduced physical activity and exercise levels (Flanagan et al., 2021) and increased anxiety and depression (e.g. a three to four fold increase in the self-report of anxiety or depression according to Abbott, 2021). Increases in weight, depression and anxiety symptoms tend to decrease immune competence (Leonard, 2010). In addition, the stay at home recommendations especially in the winter time meant that individuals are less exposed to sunlight which results in lower vitamin D levels which is correlated with increased COVID-19 morbidity (Seheult, 2020).
Increase immune competence
Vaccination is the primary public health recommendation to prevent the spread and severity of COVID-19. Through vaccination, the body increases its adaptive capacity and becomes primed to respond very rapidly to virus exposure. Unfortunately, as Pfizer Chief Executive Albert Bourla states, there is “a high possibility” that emerging variants may eventually render the company’s vaccine ineffective (Steenhuysen, 2021). Thus, it is even more important to explore strategies to enhance immune competence independent of the vaccine.
Public Health policies need to focus on intervention strategies and positive health behaviors that optimize the immune system capacity to respond. The research data has been clear that COVID -19 is more dangerous for those whose immune systems are compromised and have comorbidities such as diabetes and cardiovascular disease, regardless of age.
Comorbidity and being older are the significant risk factors that contribute to COVID-19 deaths. For example, in evaluating all patients in the Fair Health National Private Insurance Claims (FH NPIC’s) longitudinal dataset, researchers identified 467,773 patients diagnosed with COVID-19 from April 1, 2020, through August 31, 2020. The severity of the illness and death from COVID-19 depended on whether the person had other co-morbidities first as shown in Figure 1.
Figure 1. The distribution of patients with and without a comorbidity among all patients diagnosed with COVID-19 (left) and all deceased COVID-19 patients (right) April-August 2020. Reproduced by permission from: https://www.ajmc.com/view/contributor-links-between-covid-19-comorbidities-mortality-detailed-in-fair-health-study
Each person who died had about 2 or 3 types of pre-existing co-morbidities such as cardiovascular disease, hypertension, diabetes, obesity, congestive heart failure, chronic kidney disease, respiratory disease and cancer (Ssentongo et al., 2020; Gold et al., 2020). The greater the frequency of comorbidities the greater the risk of death, as shown in Figure 2.
Figure 2. Across all age groups, the risk of COVID-19 death increased significantly as a patient’s number of comorbidities increased. Compared to patients with no comorbidities. Reproduced by permission from https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Risk%20Factors%20for%20COVID-19%20Mortality%20among%20Privately%20Insured%20Patients%20-%20A%20Claims%20Data%20Analysis%20-%20A%20FAIR%20Health%20White%20Paper.pdf
Although the risk of serious illness and death is low for young people, the presence of comorbidity increases the risk. Kompaniyets et al. (2021) reported that for patients under 18 years with severe COVID-19 illness who required ICU admission, mechanical ventilation, or died most had underlying medical conditions such as asthma, neurodevelopmental disorders, obesity, essential hypertension or complex chronic diseases such as malignant neoplasms or multiple chronic conditions.
Consistent with earlier findings, the Fair Health National Private Insurance Claims (FH NPIC’s) longitudinal dataset also showed that the COVID-19 mortality rate rose sharply with age as shown in Figure 3.
Figure 3 Percent mortality among COVID-19 patients by age, April-August 2020. Reproduced by permission from: https://s3.amazonaws.com/media2.fairhealth.org/whitepaper/asset/Risk%20Factors%20for%20COVID-19%20Mortality%20among%20Privately%20Insured%20Patients%20-%20A%20Claims%20Data%20Analysis%20-%20A%20FAIR%20Health%20White%20Paper.pdf
Optimize antibody response from vaccinations
Assuming that the immune system reacts similarly to other vaccinations, higher antibody response is evoked when the vaccine is given in the morning versus the afternoon or after exercise (Long et al., 2016; Long et al., 2012). In addition, the immune response may be attenuated if the person suppresses the body’s natural immune response–the flulike symptoms which may occur after the vaccination–with Acetaminophen (Tylenol (Graham et al, 1990).
Support the immune system with a healthy life style
Support the immune system by implementing a lifestyle that reduces the probability of developing comorbidities. This means reducing risk factors such as vaping, smoking, immobility and highly processed foods. For example, young people who vape experience a fivefold increase to become seriously sick with COVID-19 (Gaiha, Cheng, & Halpern-Felsher, 2020); similarly, cigarette smoking increases the risk of COVID morbidity and mortality (Haddad, Malhab, & Sacre, 2021).
There are many factors that have contributed to the epidemic of obesity, diabetes, cardiovascular disease and other chronic diseases. In many cases, the environment and lifestyle factors (lack of exercise, excessive intake of highly processed foods, environmental pollution, social isolation, stress, etc.) significantly contribute to the initiation and development of comorbidities. Genetics also is a factor; however, the generic’s risk factor may not be triggered if there are no environmental/behavioral exposures. Phrasing it colloquially, Genetics loads the gun, environment and behavior pulls the trigger. Reducing harmful lifestyle behaviors and environment is not simply an individual’s responsibility but a corporate and governmental responsibility. At present, harmful lifestyles choices are actively supported by corporate and government policies that choose higher profits over health. For example, highly processed foods made from corn, wheat, soybeans, rice are grown by farmers with US government farm subsidies. Thus, many people especially of lower economic status live in food deserts where healthy non-processed organic fruits and vegetable foods are much less available and more expensive (Darmon & Drewnowski, 2008; Michels, Vynckier, Moreno, L.A. et al. 2018; CDC, 2021). In the CDC National Health and Nutrition Examination Survey that analyzed the diet of 10,308 adults, researchers Siegel et al. (2016) found that “Higher consumption of calories from subsidized food commodities was associated with a greater probability of some cardiometabolic risks” such as higher levels of obesity and unhealthy blood glucose levels (which raises the risk of Type 2 diabetes).
Immune competence is also affected by many other factors such as exercise, stress, shift work, social isolation, and reduced micronutrients and Vitamin D (Zimmermann & Curtis, 2019). Even being sedentary increases the risk of dying from COVID as reported by the Kaiser Permanente Southern California study of 50,000 people who developed COVID (Sallis et al., 2021).
People who exercised 10 minutes or less each week were hospitalized twice as likely and died 2.5 times more than people who exercised 150 minutes a week (Sallis et al., 2021). Although exercise tends to enhance immune competence (da Silveira et al, 2020), it is highly likely that exercise is a surrogate marker for other co-morbidities such as obesity and heart disease as well as aging. At the same time sheltering–in-place along with the increase in digital media has significantly reduced physical activity.
The importance of vitamin D
Low levels of vitamin D is correlated with poorer prognosis for patients with COVID-19 (Munshi et al., 2021). Kaufman et al. (2020) reported that the positivity rate correlated inversely with vitamin D levels as shown in figure 4.
Figure 4. SARS-CoV-2 NAAT positivity rates and circulating 25(OH)D levels in the total population. From: Kaufman, H.W., Niles, J.K., Kroll, M.H., Bi, C., Holick, M.F. (2020). SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels. PLoS One. 15(9):e0239252. https://doi.org/10.1371/journal.pone.0239252
Vitamin D is a modulator for the immune system (Baeke, Takiishi, Korf, Gysemans, & Mathieu, 2010). There is an inverse correlation of all-cause, cardiovascular, cancer, and respiratory disease mortality with hydroxyvitamin D concentrations in a large cohort study (Schöttker et al., 2013). For a superb discussion about how much vitamin D is needed, see the presentation, The D-Lightfully Controversial Vitamin D: Health Benefits from Birth until Death, by Dr. Michael F. Holick, Ph.D., M.D. from the University Medical Center Boston.
Low vitamin D levels may partially explain why in the winter there is an increase in influenza. During winter time, people have reduced sunlight exposure so that their skin does not produce enough vitamin D. Lower levels of vitamin D may be a cofactor in the increased rates of COVID among people of color and older people. The darker the skin, the more sunlight the person needs to produce Vitamin D and as people become older their skin is less efficient in producing vitamin D from sun exposure (Harris, 2006; Gallagher, 2013). Vitamin D also moderates macrophages by regulating the release, and the over-release of inflammatory factors in the lungs (Khan et al., 2021).
Watch the interesting presentation by Professor Roger Seheult, MD, UC Riverside School of Medicine, Vitamin D and COVID 19: The Evidence for Prevention and Treatment of Coronavirus (SARS CoV 2). 12/20/2020. https://www.youtube.com/watch?v=ha2mLz-Xdpg
What can be done NOW to enhance immune competence?
We need to recognize that once the COVID-19 pandemic has passed, it does not mean it is over. It is only a reminder that a new COVID-19 variant or another new virus will emerge in the future. Thus, the government public health policies need to focus on promoting health over profits and aim at strategies to prevent the development of chronic illnesses that affect immune competence. One take away message is to incorporate behavioral medicine prescriptions supporting a healthy lifestyle into treatment plans, such as prescribing a walk in the sun to increase vitamin D production and develop dietary habits of eating organic locally grown vegetable and fruits foods. Even just reducing the refined sugar content in foods and drinks is challenging although it may significantly reduce incidence and prevalence of obesity and diabetes (World Health Organization, 2017. The benefits of such an approach has been clearly demonstrated by the Pennsylvania-based Geisinger Health System’s Fresh Food Farmacy. This program for food-insecure people with Type 2 diabetes and their families provides enough fresh fruits and vegetables, whole grains, and lean proteins for two healthy meals a day five days a week. After one year there was a 40 percent decrease in the risk of death or serious complications and an 80 percent drop in medical costs per year (Brody, 2020).
The simple trope of this article ‘eat well, exercise and get good rest’ and increase your immune competence concludes with some simple reminders.
- Increase availability of organic foods since they do not contain pesticides such as glyphosate residue that reduce immune competence.
- Increase vegetable and fruits and reduce highly processed foods, simple carbohydrates and sugars.
- Decrease sitting and increase movement and exercise
- Increase sun exposure without getting sunburns
- Master stress management
- Increase social support
For additional information see: https://peperperspective.com/2020/04/04/can-you-reduce-the-risk-of-coronavirus-exposure-and-optimize-your-immune-system/
Baeke, F., Takiishi, T., Korf, H., Gysemans, C., & Mathieu, C. (2010). Vitamin D: modulator of the immune system,Current Opinion in Pharmacology,10(4), 482-496. https://doi.org/10.1016/j.coph.2010.04.001
Brody, J. (2020). How Poor Diet Contributes to Coronavirus Risk. The New York Times, April 20, 2020. https://www.nytimes.com/2020/04/20/well/eat/coronavirus-diet-metabolic-health.html?referringSource=articleShare
CDC. (2021). Adult Obesity Prevalence Maps. Centers for Disease Control and Prevention. https://www.cdc.gov/obesity/data/prevalence-maps.html#nonhispanic-white-adults
CDC. (May 13, 2021). Ways COVID-19 Spreads. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html
Darmon, N. & Drewnowski, A. (2008). Does social class predict diet quality?, The American Journal of Clinical Nutrition, 87(5), 2008, 1107–1117. https://doi.org/10.1093/ajcn/87.5.1107
da Silveira, M. P., da Silva Fagundes, K. K., Bizuti, M. R., Starck, É., Rossi, R. C., & de Resende E Silva, D. T. (2021). Physical exercise as a tool to help the immune system against COVID-19: an integrative review of the current literature. Clinical and experimental medicine, 21(1), 15–28. https://doi.org/10.1007/s10238-020-00650-3
Elflein, J. (2021). COVID-19 deaths reported in the U.S. as of January 2, 2021, by age. Downloaded, 1/13/2021 from https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/
Fisher, E. P., Fischer, M.C., Grass, D., Henrion, I., Warren, W.S., & Westmand, E. (2020). Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Science Advance, (6) 36, eabd3083. https://doi.org/10.1126/sciadv.abd3083
Flanagan. E.W., Beyl, R.A., Fearnbach, S.N., Altazan, A.D., Martin, C.K., & Redman, L.M. (2021). The Impact of COVID-19 Stay-At-Home Orders on Health Behaviors in Adults. Obesity (Silver Spring), (2), 438-445. https://doi.org/10.1002/oby.23066
Gaiha, S.M., Cheng, J., & Halpern-Felsher, B. (2020). Association Between Youth Smoking, Electronic Cigarette Use, and COVID-19. Journal of Adolescent Health, 67(4), 519-523. https://doi.org/10.1016/j.jadohealth.2020.07.002
Gallagher J. C. (2013). Vitamin D and aging. Endocrinology and metabolism clinics of North America, 42(2), 319–332. https://doi.org/10.1016/j.ecl.2013.02.004
Gandhi, M. & Rutherford, G. W. (2020). Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine. New England Journal of Medicine, 383(18), e101 https://www.nejm.org/doi/full/10.1056/NEJMp2026913
Gold, M.S., Sehayek, D., Gabrielli, S., Zhang, X., McCusker, C., & Ben-Shoshan, M. (2020). COVID-19 and comorbidities: a systematic review and meta-analysis. Postgrad Med, 132(8), 749-755. https://doi.org/10.1080/00325481.2020.1786964
Graham, N.M., Burrell, C.J., Douglas, R.M., Debelle, P., & Davies, L. (1990). Adverse effects of aspirin, acetaminophen, and ibuprofen on immune function, viral shedding, and clinical status in rhinovirus-infected volunteers. J Infect Dis., 162(6), 1277-82. https://doi.org/10.1093/infdis/162.6.1277
Haddad, C., Malhab, S.B., & Sacre, H. (2021). Smoking and COVID-19: A Scoping Review. Tobacco Use Insights, 14, First Published February 15, 2021. https://doi.org/10.1177/1179173X21994612
Harris, S.S. (2006). Vitamin D and African Americans. The Journal of Nutrition, 136(4), 1126-1129. https://doi.org/10.1093/jn/136.4.1126
Kaufman, H.W., Niles, J.K., Kroll, M.H., Bi, C., Holick, M.F. (2020). SARS-CoV-2 positivity rates associated with circulating 25-hydroxyvitamin D levels. PLoS One. 15(9):e0239252. https://doi.org/10.1371/journal.pone.0239252
Khan, A. H., Nasir, N., Nasir, N., Maha, Q., & Rehman, R. (2021). Vitamin D and COVID-19: is there a role?. Journal of Diabetes & Metabolic Disorders, 1-8. https://doi.org/10.1007/s40200-021-00775-6
Kompaniyets, L., Agathis, N.T., Nelson, J.M., et al. (2021). Underlying Medical Conditions Associated With Severe COVID-19 Illness Among Children. JAMA Netw Open. 4(6):e2111182. https://doi.org/10.1001/jamanetworkopen.2021.11182
Leonard B. E. (2010). The concept of depression as a dysfunction of the immune system. Current immunology reviews, 6(3), 205–212. https://doi.org/10.2174/157339510791823835
Lewis, N. M., Duca, L. M., Marcenac, P., Dietrich, E. A., Gregory, C. J., Fields, V. L….Kirking, H. L. (2021). Characteristics and Timing of Initial Virus Shedding in Severe Acute Respiratory Syndrome Coronavirus 2, Utah, USA. Emerging Infectious Diseases, 27(2), 352-359. https://doi.org/10.3201/eid2702.203517
Lin, A.L., Vittinghoff, E., Olgin, J.E., Pletcher, M.J., & Marcus, G.M. (2021). Body Weight Changes During Pandemic-Related Shelter-in-Place in a Longitudinal Cohort Study. JAMA Netw Open, 4(3):e212536. doi:10.1001/jamanetworkopen.2021.2536
Long, J.E., Drayson, M.T., Taylor, A.E., Toellner, K.M., Lord, J.M., & Phillips, A.C. (2016). Morning vaccination enhances antibody response over afternoon vaccination: A cluster-randomised trial. Vaccine, 34(24), 2679-85. https://doi.org/10.1016/j.vaccine.2016.04.032.
Long. J.E., Ring, C., Drayson, M., Bosch, J., Campbell, J.P., Bhabra, J., Browne, D., Dawson, J., Harding, S., Lau, J., & Burns, V.E. (2012). Vaccination response following aerobic exercise: can a brisk walk enhance antibody response to pneumococcal and influenza vaccinations? Brain Behav Immun., 26(4), 680-687. https://doi.org/10.1016/j.bbi.2012.02.004
Merelli, A. (2021, February 2). Pfizer’s Covid-19 vaccine is set to be one of the most lucrative drugs in the world. QUARTZ. https://qz.com/1967638/pfizer-will-make-15-billion-from-covid-19-vaccine-sales/
Michels, N., Vynckier, L., Moreno, L.A. et al. (2018). Mediation of psychosocial determinants in the relation between socio-economic status and adolescents’ diet quality. Eur J Nutr, 57, 951–963. https://doi.org/10.1007/s00394-017-1380-8
Mukherjee, S. (2020). How does the coronavirus behave inside a patient? We’ve counted the viral spread across peoples; now we need to count it within people. The New Yorker, April 6, 2020. https://www.newyorker.com/magazine/2020/04/06/how-does-the-coronavirus-behave-inside-a-patient?utm_source=onsite-share&utm_medium=email&utm_campaign=onsite-share&utm_brand=the-new-yorker
Munshi, R., Hussein, M.H., Toraih, E.A., Elshazli, R.M., Jardak, C., Sultana, N., Youssef, M.R., Omar, M., Attia, A.S., Fawzy, M.S., Killackey, M., Kandil, E., & Duchesne, J. (2020) Vitamin D insufficiency as a potential culprit in critical COVID-19 patients. J Med Virol, 93(2), 733-740. https://doi.org/10.1002/jmv.26360
Renoud. L, Khouri, C., Revol, B., et al. (2021) Association of Facial Paralysis With mRNA COVID-19 Vaccines: A Disproportionality Analysis Using the World Health Organization Pharmacovigilance Database. JAMA Intern Med. Published online April 27, 2021. https://doi.org/10.1001/jamainternmed.2021.2219
Sallis, R., Young, D. R., Tartof, S.Y., et al. (2021). Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: a study in 48 440 adult patients. British Journal of Sports Medicine. Published Online First: 13 April 2021. http://dx.doi.org/10.1136/bjsports-2021-104080
Schöttker, B., Haug, U., Schomburg, L., Köhrle, L., Perna, L., Müller. H., Holleczek, B., & Brenner. H. (2013). Strong associations of 25-hydroxyvitamin D levels with all-cause, cardiovascular, cancer and respiratory disease mortality in a large cohort study. American Journal of Clinical Nutrition, 97(4), 782–793 2013; https://doi.org/10.3945/ajcn.112.047712
Siegel, K.R., McKeever Bullard, K., Imperatore. G., et al. (2016). Association of Higher Consumption of Foods Derived From Subsidized Commodities With Adverse Cardiometabolic Risk Among US Adults. JAMA Intern Med. 176(8), 1124–1132. https://doi.org/10.1001/jamainternmed.2016.2410
Ssentongo P, Ssentongo AE, Heilbrunn ES, Ba DM, Chinchilli VM (2020) Association of cardiovascular disease and 10 other pre-existing comorbidities with COVID-19 mortality: A systematic review and meta-analysis. PLoS ONE 15(8): e0238215. https://doi.org/10.1371/journal.pone.0238215
Steenhuysen, J. 2021, Jan 30). Fresh data show toll South African virus variant takes on vaccine efficacy. Accessed January 31, 2021. https://www.reuters.com/article/us-health-coronavirus-vaccines-variant/fresh-data-show-toll-south-african-virus-variant-takes-on-vaccine-efficacy-idUSKBN29Z0I7
World Health Organization. (2017). Sugary drinks1 – a major contributor to obesity and diabetes. WHO/NMH/PND/16.5 Rev. https://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf?sequence=1
Zimmermann, P. & Curtis, N. (2019). Factors That Influence the Immune Response to Vaccination. Clinical Microbiology Reviews, 32(2), 1-50. https://doi.org/10.1128/CMR.00084-18
Dysfunctional breathing, eating highly processed foods, and lack of movement contribute to development of illnesses such as cancer, diabetes, cardiovascular disease and many chronic diseases. They also contributes to immune dysregulation that increases vulnerability to infectious diseases, allergies and autoimmune diseases. If you wonder what breathing patterns optimize health, what foods have the appropriate phytonutrients to support your immune system, or what the evidence is that exercise reduces illness and promotes longevity, look at the following resources.
Breath: the mind-body connector that underlies health and illness
Read the outstanding article by Martin Petrus (2021). How to breathe.
You are the food you eat
Watch the superb webinar presentation by Deanna Minich, MS., PHD., FACN, CNS, (2021) Phytonutrient Support for a Healthy Immune System.
Movement is life
Explore the summaries of recent research that has demonstrated the importance of exercise to increase healthcare saving and reduce hospitalization and death.
Let food be thy medicine and medicine be thy food
-Hippocrates, the Greek physician and father of medicine.
What should I eat? More greens, more Vitamin D, more fish, no meats, no grains, or should I become a vegetarian, go on a ketogenic diet, or evolutionary diet? There are so many options. What are the best choices?
The foods we eat provide the building blocks and energy source for our body. If you eat high quality foods, the body has the opportunity to create and maintain a healthy strong structure; on the other hand, if you eat low quality foods, it is more challenging to create and maintain a healthy body. The analogy is building a house. If the materials are high quality, the structure well engineered and well built, the house has the opportunity to age well. On the other hand, if the house is built out of inferior materials and poorly engineered, it is easily damaged by wind, rain or even earthquakes.
Although we are bombarded with recommendations for healthy eating, many of the recommendations are not based upon science but shaped by the lobbying and advertisement efforts of agribusiness. For example, the scientific recommendations to reduce sugar in our diet were not implements in the government guidelines. This demonstrates the power of lobbying which places profits over health.
Officials at the Department of Agriculture and the Department of Health and Human Services rejected explicit caps on sugar and alcohol consumption. Although “the preponderance of evidence supports limiting intakes of added sugars and alcoholic beverages to promote health and prevent disease.” (Rabin, 2020).
To make sense out of the multitude of nutritional recommendations, watch the superb presentation by Dr. Marisa Soski, ND, Nutrition to Support Stress Response.* She discusses how and what we eat has direct impact on how our bodies manage our reactions to stress.
*Presented April 16, 2021 at the Holistic Health Series on Fridays: Optimize Health and Well-Being Lecture Series. The series is sponsored by the Institute for Holistic Health Studies and Department of Recreation, Parks, Tourism, San Francisco State University.
Rabin, R.C. (2020). U.S. Diet Guidelines Sidestep Scientific Advice to Cut Sugar and Alcohol. The New York Times. https://www.nytimes.com/2020/12/29/health/dietary-guidelines-alcohol-sugar.html
We are excited about our upcoming book, TechStress-How Technology is Hijacking our Lives, Strategies for Coping and Pragmatic Ergonomics, that will be published August 25, 2020.
Evolution shapes behavior — and as a species, we’ve evolved to be drawn to the instant gratification, constant connectivity, and the shiny lights, beeps, and chimes of our ever-present devices. In earlier eras, these hardwired evolutionary patterns may have set us up for success, but today they confuse our instincts, leaving us vulnerable and stressed out from fractured attention, missed sleep, skipped meals, aches, pains, and exhaustion and often addicted to our digital devices.
Tech Stress offers real, practical tools to avoid evolutionary pitfalls programmed into modern technology that trip us up. You will find a range of effective strategies and best practices to individualize your workspace, reduce physical strain, prevent sore muscles, combat brain drain, and correct poor posture. The book also provides fresh insights on reducing psychological stress on the job, including ways to improve communication with coworkers and family.
Although you will have to wait until August 25th to have the book delivered to your home, you can already begin to implement ways to reduce physical discomfort, zoom/screen fatigue and exhaustion. Have a look the blogs below.
How evolution shapes behavior
How to optimize ergonomics
Hot to prevent and reduce neck and shoulder discomfort
How to prevent screen fatigue and eye discomfort
How to improve posture and prevent slouching
How to improve breathing and reduce stress
How to protect yourself from EMF
“I am doing very well, and I am very healthy. The vulvodynia symptoms have never come back. Also,my stomach (gastrointestinal discomfort) has gotten much, much better. I don’t really have random pain anymore, now I just have to be watchful and careful of my diet and my exercise, which are all great things!” —A five-year follow-up report from a 28-year-old woman who had previously suffered from severe vulvodynia (pelvic floor pain).
Numerous clients and students have reported that implementing self-healing strategies–common sense suggestions often known as “grandmother’s therapy”—significantly improves their health and find that their symptoms decreased or disappeared (Peper et al, 2014). These educational self-healing approaches are based upon a holistic perspective aimed to reduce physical, emotional and lifestyle patterns that interfere with healing and to increase those life patterns that support healing. This may mean learning diaphragmatic breathing, doing work that give you meaning and energy, alternating between excitation and regeneration, and living a life congruent with our evolutionary past.
If you experience discomfort/symptoms and worry about your health/well-being, do the following:
- See your health professional for diagnosis and treatment suggestions.
- Ask what are the benefits and risks of treatment.
- Ask what would happen if you if you first implemented self-healing strategies before beginning the recommended and sometimes invasive treatment?
- Investigate how you could be affecting your self-healing potential such as:
- Lack of sleep
- Too much sugar, processed foods, coffee, alcohol, etc.
- Lack of exercise
- Limited social support
- Ongoing anger, resentment, frustration, and worry
- Lack of hope and purpose
- Implement self-healing strategies and lifestyle changes to support your healing response. In many cases, you may experience positive changes within three weeks. Obviously, if you feel worse, stop and reassess. Keep a log and monitor what you do so that you can record changes.
This self-healing process has often been labeled or dismissed as the “placebo effect;” however, the placebo effect is the body’s natural self-healing response (Peper & Harvey, 2017). It is impressive that many people report feeling better when they take charge and become active participants in their own healing process. A process that empowers and supports hope and healing. When participants change their life patterns, they often feel better. Their health worries and concerns become reminders/cues to initiate positive action such as:
- Practicing self-healing techniques throughout the day (e.g., diaphragmatic breathing, self-healing imagery, meditation, and relaxation)
- Eating organic foods and eliminating processed foods
- Incorporating daily exercise and movement activities
- Accepting what is and resolving resentment, anger and fear
- Taking time to regenerate
- Resolving stress
- Focusing on what you like to do
- Be loving to yourself and others
For suggestions of what to do, explore some of the following blogs that describe self-healing practices that participants implemented to improve or eliminate their symptoms.
Hot flashes and premenstrual symptoms https://peperperspective.com/2015/02/18/reduce-hot-flashes-and-premenstrual-symptoms-with-breathing/
Internet addiction https://peperperspective.com/2018/02/10/digital-addiction/
Irritable bowel syndrome (IBS) https://peperperspective.com/2017/06/23/healing-irritable-bowel-syndrome-with-diaphragmatic-breathing/
Math and test anxiety https://peperperspective.com/2018/07/03/do-better-in-math-dont-slouch-be-tall/
Trichotillomania (hair pulling) https://peperperspective.com/2015/03/07/interrupt-chained-behaviors-overcome-smoking-eczema-and-hair-pulling/
Peper, E., Lin, I-M, Harvey, R., Gilbert, M., Gubbala, P., Ratkovich, A., & Fletcher, F. (2014). Transforming chained behaviors: Case studies of overcoming smoking, eczema and hair pulling (trichotillomania). Biofeedback, 42(4), 154-160.
In a superb meta-analysis, Professor Ping-Tao Tseng and colleagues (2018), found that breast feeding reduces the risk of ADHD. The longer the breast feeding was the sole food source, the lower the risk of ADHD. Read the complete article, Material breastfeeding and attention-deficit/hyperactivity disorders in children: a meta-analysis.
One should not be surprised by this finding– breastmilk has been the primary food source for babies since the dawn of human evolution. To accept that formula is as good as breast milk is foolish. Breast milk provides the essential nutrients for infants’ growth, contains the appropriate fatty acids for brain development, and the bioactive factors to protect the baby against disease (Oddy, 2001). It modulates the sleep wake cycle since the evening breast milk contains nucleotides that promote baby’s sleep which are different from morning breast milk that promotes wakefulness (Sanchez et al, 2009). In addition, it reduces the risk of asthma, eczema, and allergic rhinitis (Lodge et al, 2015). Despite the commercial advertisements that formal is as good as breast milk, it contributes to neural malnutrition. That babies do develop with formula is a remarkable demonstration of human adaptability.
Food is our building blocks. When we consume low quality foods, we may increase the risk of developing illness. This is analogous to using superb building materials when constructing a house as the building is more resilient and may better survive the assault from the environment such as termites, storms, or earthquakes than if built from inferior materials.
People, businesses and government have a choice. We can pay the upfront costs to support women to breastfeed their babies for a year by providing paid leave from their jobs or pay much higher long term costs to remediate and treat the deficiencies induced by not supporting breast feeding.
If you are concerned about your child’s future health and want to reduce the risk of ADHD, asthma, eczema, or allergic rhinitis there is only one recommendation: Breast feed your baby for a long time period.
Lodge, C., Tan, D.J., Lau, M.X.., Dai, X., Tham, R., Lowe, A.J., Bowatte, G., Allen, K.J. & Dharmage, S.C. (2015). Breastfeeding and asthma and allergies: a systematic review and meta-analysis. Acta Paediatrica, 104(467), 38-53.
Sanchez, C.L., Cubero, J., Sanchez, J., Chanclon, B., Rivero, M., Rodriguez, A.B., & Barriga, C. (2009). The possible role of human milk nucleotides as sleep inducers. Nutritional Neuroscience, 12(1), 2-9.
Tseng, P-T., Yen, C-F., Chen, Y-W., Chen, Y-W, Stubbs, B., Carvalho, A.F., Whiteley, P., Chu, C-S…. (2018). Maternal breastfeeding and attention-deficit/hyperactivity disorder in children: a meta-analysis. European Child & Adolescent Psychiatry,
Is it really worthwhile to spent more money on locally grown organic fruits and vegetables than non-organic fruits and vegetables? The answer is a resounding “YES!” Organic grown foods have significantly more vitamins, antioxidants and secondary metabolites such as phenolic compounds than non-organic foods. These compounds provide protective health benefits and lower the risk of cancer, cardiovascular disease, type two diabetes, hypertension and many other chronic health conditions (Romagnolo & Selmin, 2017; Wilson et al., 2017; Oliveira et al., 2013; Surh & Na, 2008). We are what we eat–we can pay for it now and optimize our health or pay more later when our health has been compromised.
The three reasons why fresh organic food is better are:
- Fresh foods lengthen lifespan.
- Organic foods have more vitamins, minerals, antioxidants and secondary metabolites than non-organic foods.
- Organic foods reduce exposure to harmful neurotoxic and carcinogenic pesticide and herbicides residues.
With the advent of chemical fertilizers farmers increased crop yields while the abundant food became less nutritious. The synthetic fertilizers do not add back all the necessary minerals and other nutrients that the plants extract from the soil while growing. Modern chemical fertilizers only replace three components–Nitrogen, Phosphorus and Potassium–of the hundred of components necessary for nutritious food. Nitrogen (N) which promotes leaf growth; Phosphorus (P which development of roots, flowers, seeds, fruit; and Potassium (K) which promotes strong stem growth, movement of water in plants, promotion of flowering and fruiting. These are great to make the larger and more abundant fruits and vegetables; however, the soil is more and more depleted of the other micro-nutrients and minerals that are necessary for the plants to produce vitamins and anti-oxidants. Our industrial farming is raping the soils for quick growth and profit while reducing the soil fertility for future generations. Organic farms have much better soils and more soil microbial activity than non-organic farm soils which have been poisoned by pesticides, herbicides, insecticides and chemical fertilizers (Mader, 2002; Gomiero et al, 2011). For a superb review of Sustainable Vs. Conventional Agriculture see the web article: https://you.stonybrook.edu/environment/sustainable-vs-conventional-agriculture/
1. Fresh young foods lengthen lifespan. Old foods may be less nutritious than young food. Recent experiments with yeast, flies and mice discovered that when these organisms were fed old versus young food (e.g., mice were diets containing the skeletal muscle of old or young deer), the organisms’ lifespan was shortened by 18% for yeast, 13% for flies, and 13% for mice (Lee et al., 2017). Organic foods such as potatoes, bananas and raisins improves fertility, enhances survival during starvation and decreases long term mortality for fruit flies(Chhabra et al, 2013). See Live longer, enhance fertility and increase stress resistance: Eat organic foods. https://peperperspective.com/2013/04/21/live-longer-enhance-fertility-and-increase-stress-resistance-eat-organic-foods/
In addition, eating lots of fruits and vegetables decreases our risk of dying from cancer and heart disease. In a superb meta-analysis of 95 studies, Dr. Dagfinn Aune from the School of Public Health, Imperial College London, found that people who ate ten portions of fruits and vegetable per day were a third less likely to die than those who ate none (Aune et al, 2017). Thus, eat lots of fresh and organic fruits and vegetables from local sources that is not aged because of transport.
2. Organic foods have more vitamins, minerals, antioxidants and secondary metabolites than non-organic foods. Numerous studies have found that fresh organic fruits and vegetables have more vitamins, minerals, antioxidants, and secondary metabolites than non-organic ones. For example, organic tomatoes contain 57 per cent more vitamin C than non-organic ones (Oliveira et al 2013) or organic milk has more beneficial polyunsaturated fats non-organic milk (Wills, 2017; Butler et al, 2011). Over the last 50 years key nutrients of fruits and vegetables have declined. In a survey of 43 crops of fruits and vegetables, Davis, Epp, & Riordan, (2004) found a significant decrease of vitamins and minerals in foods grown in the 1950s as compared to 1999 as shown in Figure 1 (Lambert, 2015).
Figure 1. Change in vitamins and minerals from 1950 to 1999. From: Davis, D. R., Epp, M. D., & Riordan, H. D. (2004). Changes in USDA food composition data for 43 garden crops, 1950 to 1999. Journal of the American College of Nutrition, 23(6), 669-682.
3, Organic foods reduce exposure to harmful neurotoxic and carcinogenic pesticide and herbicides residues. Even though, the United States Department of Agriculture (USDA) and the United States Environmental Protection Agency (EPA) state that pesticide residues left in or on food are safe and non-toxic and have no health consequences, I have my doubts! Human beings accumulate pesticides just like tuna fish accumulates mercury—frequent ingesting of very low levels of pesticide and herbicide residue may result in long term harmful effects and these long term risks have not been assessed. Most pesticides are toxic chemicals and were developed to kill agricultural pests — living organisms. Remember human beings are living organisms. The actual risk for chronic low level exposure is probably unknown; since, the EPA pesticide residue limits are the result of a political compromise between scientific findings and lobbying from agricultural and chemical industries (Portney, 1992). Organic diets expose consumers to fewer pesticides associated with human disease (Forman et al, 2012).
Adopt the precautionary principle which states, that if there is a suspected risk of herbicides/pesticides causing harm to the public, or to the environment, in the absence of scientific consensus, the burden of proof that it is not harmful falls on those recommending the use of these substances (Read & O’Riordan, 2017). Thus, eat fresh locally produced organic foods to optimize health.
Aune, D., Giovannucci, D., Boffetta, P., Fadnes, L.T., Keum, N., Norat, T., Greenwood, D.C., Riboli, E., Vatten, L.J., & Tonstad, S. ( 2017). Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality—a systematic review and dose-response meta-analysis of prospective studies. International Journal of Epidemiology, 46(3), 1029–1056, https://doi.org/10.1093/ije/dyw319
Butler, G. Stergiadis, s., Seal, C., Eyre, M., & Leifert, C. (2011). Fat composition of organic and conventional retail milk in northeast England. Journal of Dairy Science. 94(1), 24-36.http://dx.doi.org/10.3168/jds.2010-3331
Davis, D. R., Epp, M. D., & Riordan, H. D. (2004). Changes in USDA food composition data for 43 garden crops, 1950 to 1999. Journal of the American College of Nutrition, 23(6), 669-682. http://www.chelationmedicalcenter.com/!_articles/Changes%20in%20USDA%20Food%20Composition%20Data%20for%2043%20Garden%20Crops%201950%20to%201999.pdf
Gomiero, T.; Pimentel, D.; Paoletti, M. G. (2011). Environmental Impact of Different Agricultural Management Practices: Conventional Vs. Organic Agriculture. Critical Reviews in Plant Sciences, 30(1-2), 95-124; http://www.tandfonline.com/doi/full/10.1080/07352689.2011.554355#tabModule
Lambert, C. (2015). If Food really better from the farm gate than super market shelf? New Scientist.228(3043), 33-37.
Lee, G., Kaya, A., Avanesov, A.S., Podolskiy, D.I., Song, E.J., Go, D-M., Jin, G-D., Hwang, J.Y., Kim, E.B., Kim, D-Y., & Gladyshev, V.N. (2017). Age-associated molecular changes are deleterious and may modulate life span through diet.Science Advances, 3(2), e1601833 DOI: 10.1126/sciadv.1601833
Oliveira, A.B., Moura, C.F.H., Gomes-Filho, E., Marco, C.A., Urban, L., & Miranda, M.R.A. (2013). The Impact of Organic Farming on Quality of Tomatoes Is Associated to Increased Oxidative Stress during Fruit Development. PLoS ONE, 8(2): e56354. https://doi.org/10.1371/journal.pone.0056354
Read, R. and O’Riordan, T. (2017). The Precautionary Principle Under Fire. Environment-Science and policy for sustainable development. September-October. http://www.environmentmagazine.org/Archives/Back%20Issues/2017/September-October%202017/precautionary-principle-full.html
Romagnolo, D. F. & Selmin, O.L. (2017). Mediterranean Diet and Prevention of Chronic Diseases. Nutr Today. 2017 Sep;52(5):208-222. doi: 10.1097/NT.0000000000000228. https://www.ncbi.nlm.nih.gov/pubmed/29051674
Wills, A. (2017). There is evidence organic food is more nutritious. New Scientist,3114, p53.
Wilson, L.F., Antonsson, A., Green, A.C., Jordan, S.J., Kendall, B.J., Nagle, C.M., Neale, R.E., Olsen, C.M., Webb, P.M., & Whiteman, D.C. (2017). How many cancer cases and deaths are potentially preventable? Estimates for Australia in 2013. Int J Cancer. 2017 Oct 6. doi: 10.1002/ijc.31088. https://www.ncbi.nlm.nih.gov/pubmed/28983918
An ounce of prevention is worth a pound of cure.
Albert Schweitzer began working in equatorial lowlands of West Africa in 1913. He was astonished to encounter no cases of cancer among the thousands of native patients he saw each year. However, as the natives [took to] living more and more after the manner of the whites, cancer in his patient population became ever more frequent (Taubes, 2016, pp 257).
Wise elders, grand parents or statesmen have been traditional roles for aging adults. Wisdom transforming into Alzheimer’s disease does not compute (Peper, 2014).
In 1960’s Surgeon Captain T. L. Cleave proposed that common western diseases (diabetes, colon cancer, ischemic heart disease, gallstones, obesity, diverticulosis, and dental carries), to which I would add Alzheimer’s disease, autoimmune diseases and allergies, could not be due primarily to genetic factors but to new factors in the environment to which man had not yet had time to adapt (Cleaves et al, 1969). As he states, “One such factor was the processing of food which resulted in the consumption of large quantities of pure sugar and starch. This led to disease because man was evolutionary adjusted to eating smaller amounts of carbohydrates intimately mixed with fiber and protein.”
Clinicians and epidemiologist have consistently reported that none western cultures, whether the Masai in Africa, the Inuit in Northern Canada, the Japanese in Japan, or the Native American, had very low incidences of these western diseases. Yet, when these people adapted a western diet of highly refined carbohydrates and sugar the prevalence of these diseases increased and approached the incidence in western cultures (Burkitt & Trowell, 1975; Taubes, 2016).
Historically these illness were initially observed in the ruling class. The affluent class was privileged and tended to eat more refined carbohydrates and sugars (white bread, cakes, pastries and sugar in coffee and tea). It is only recently that this class effect is reversed. Lower economic classes tend have a higher prevalence of these western diseases. Affluent people can afford and often eat low processed organic foods while economically disadvantaged people cannot afford low processed foods and instead eat predominantly highly processed carbohydrate and refined foods.
Highly refined processed foods and sugar–not fats–are significant risk factors for the development diabetes and cardiovascular disease and mortality (Imamura et al, 2015; Taubes, 2016; Yang et al, 2014) . What is not as well known is that some cancers and Alzheimer’s disease also correlates with the increase intake of refined carbohydrates and sugar (Das, 2015; Kandimalla et al, 2016; Peper, 2014).
It is highly likely that the increase in beta-amyloid protein plagues in the brain is not the cause of the Alzheimer’s but the brain’s defense mechanism to protect it from the fluctuating high insulin and glucose levels. A high sugar and simple carbohydrate diet are risk factors for inflammatory diseases such as diabetes, heart disease and metabolic syndrome. These inflammatory diseases are recognized as a precursor for Alzheimer’s. Alzheimer’s is sometimes described as Type 3 diabetes (Kandimalla et al, 2016; Steen et al, 2005).
Taking the perspective that foods are significant risk factors for the development of these western diseases, the focus should be on prevention and less on treatment. The research to develop drugs to treat Alzheimer’s have up till now been unsuccessful despite that the billions spent on attempting to develop new drugs. For example, the pharmaceutical company Eli Lilly has spent 3.7 billion dollars over the last decade while the National Institutes of Health spends more than half a billion dollars a year on pursuit of treatment (Coghlan, 2017).
The treatments cost of these western diseases, which at best ameliorate the disorders, is overwhelming. In the USA, we spent $147 billion to treat obesity and $116 billion to treat diabetes. While the medical costs to treat diabetes for a single patient is about $6000/year or $400,000/lifetime (Pollan, 2009).
As a refined carbohydrates and high sugar diet is a risk factor for western diseases, the focus should be on prevention. Thus, reduce sugar and refined carbohydrates intake and increase high fiber vegetable. To implement such a simple preventative measure means:
- Educate the public about the harm of sugars and refined carbohydrate foods.
- Ban advertising of foods that are high in sugar and refined carbohydrates.
- Reward companies to produce foods low in sugar and refined carbohydrates.
- Tax food products high in sugar and refined carbohydrates just as tobacco has been taxed.
I am positive that in the future when we look back at the 20th and early 21st century, we will be appalled that the government allowed people to poison themselves with sugar and highly refined carbohydrates. Just as we now warn against the harm of tobacco, limit the sales to minors, and have ongoing public health stop smoking campaigns.
Burkitt, D.P. & Trowell, H.C. (1975). Refined carbohydrate foods and disease: Some implications of dietary fibre. York: Academic Press.
Cleave, T.L., Campbell, G.D., & Painter, N.S. (1969). Diabetes, coronary thrombosis and the saccharine disease, 2nd ed. Bristol, UK: John Wright.
Coghlan, A. 2017). The Alzheimer’s problem. New Scientist, 233(3110), 22-23.
Das, U. N. (2015). Sucrose, fructose, glucose, and their link to metabolic syndrome and cancer. Nutrition, 31(1), 249-257.
Imamura, F., O’Connor, L., Ye, Z., Mursu, J., Hayashino, Y., Bhupathiraju, S. N., & Forouhi, N. G. (2015). Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction. Bmj, 351, h3576.
Kandimalla, R., Thirumala, V., & Reddy, P. H. (2016). Is Alzheimer’s disease a Type 3 Diabetes? A critical appraisal. Biochimica et Biophysica Acta (BBA)-Molecular Basis of Disease.
Peper, E. (2014). Affluenza: Transforming Wisdom into Alzheimer’s Disease with Affluent Malnutrition and Immobility. Neuroconnections, 9(2), 32-35.
Pollan, M. (2009). Big food vs. big insurance. New York Times, September 10, A29.
Steen, E., Terry, B.M. Rivera, E.J., Cannon, J.L., Neely, T.R., Tavares, R., Xu, X. J., Wands, J.R., & de al Monte, S. M. (2005). Impaired insulin and insulin-like growth factor expression and signaling mechanisms in Alzheimer’s disease-is this type 3 diabetes? Journal of Alzheimer’s Disease, 7(1), 53-80.
Taubes, G. (2016). The case against sugar. New York: Alfred A. Knopf.
Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt, R., & Hu, F. B. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA internal medicine, 174(4), 516-524.