Beginning with Vitamin D, fat-soluble vitamin capable of enhancing absorption of calcium in the small intestine and in doing so promotes calcium homeostasis (normal functioning) to promote bone health, a deficiency in this vitamin has been associated with an increased autoimmunity as well as an increased susceptibility to infection 12
. According to multiple cross-sectional studies carried out between 1988 to 1994 involving 19,000 subjects, which investigated the association of lower levels of vitamin D with increased infection, individuals with a lower vitamin D (<30ng/ml) were more likely to self-report a recent URTI than those with sufficient levels 13
. These findings where consistent when adjusting for variables including season, age, gender, body mass, race. In another cross sectional study involving 800 military recruits in Finland. Those recruits with lower vitamin D levels lost significantly more days from active duty secondary to URTI. It is worth mentioning that studies reporting potential benefits of administering vitamin D to decrease infections have not been consistent. Nevertheless, a well-designed prospective double blind placebo used nasopharyngeal (nose and throat) swab cultures and a therapeutic dose of vitamin D showed that the administration resulted in a statistically significant (42%) decrease in the incidence of influenza infection 14
. The beneficial effects of vitamin D on protective immunity are due in part to its effects on the innate immune system. Vitamin D plays an important in the innate antimicrobial response. The necessary vitamin D to meet these levels of protection can be obtained through supplement, sunlight above all dietary intake.
Dietary intake along with the aforementioned acute exercise not only manages weight management and obesity, but also provides a noticeable boost to the immune via the diversity of the gut microbiota. The gut microbiota influences human health and immune function, though fermentation of indigestible food components in the large intestine. The microbiome and derived metabolites include short chain fatty acids and biotransformed bile acids have been shown to influence immune function both within the gut and systematically. However, it is worth mentioning that research in this area is emerging and more needs to be done to determine potential linkage between immune function in physically fit individuals. Nevertheless, consuming a well-balanced diet with sufficient energy to maintain a healthy weight, with a focus on grains, fruits and vegetables to provide sufficient carbohydrate and polyphenols that reduce exercise-induced inflammation and improve viral protection, is thoroughly recommended.
Finally, lifestyle is the last holistic approach and the most impactful on the maintenance of and fortification of an effective immune system in an individual. These lifestyle recommendations adhere to consistently overtime, become positive daily habits. These lifestyle recommendation include facilitate regular high quality sleep avoid excessive intake of alcohol, consume a well-balanced diet and the development of stress management and copying techniques to decrease load of life hassles, stress, negative life events and emotions. Numerous studies have revealed that sleep deprivation reduces the levels of cytokines, infection fighting antibodies and cells. The consequences of this is that it makes the body less responsive to vaccines an consequently this has a profound on antiviral immune response 15
.
With regards to alcohol, its combined effects on both innate and adaptive immunity significantly weaken host defences predisposing chronic drinkers to a wide range of health problems including infections and systemic inflammation 16
. More pertinently to COVID-19, alcohol disrupts ciliary function in the upper airways impairs the function of immune cells (i.e. alveolar marcophages and neutrophils), and weakens the barrier function of the epithelia in the lower airways. Often, the alcohol-provoked lung damage goes undetected until a second insult, such as respiratory infection leads to more severe lung disease than those seen in non-drinkers 17
. Also alcohol alters the number of relative abundances of microbes in the gut microbiome, these organisms affect the maturation and function of the immune system.
The effects of stress, emotional trauma on the immune system are well documented. Studies have shown that stress is responsible for immunological dysregulation in children, adolescence and adults alike, which presents with an increase blood levels of pro-inflammatory cytokines and even more so with chronic stress. In addition to this chronic stress is activation of latent viruses. Latent virus activation can reflect the loss of immunological control over the virus and frequent activation can cause wear-and-tear on the immune system.18
In conclusion, the hoslitic approaches adopt the most effective strategy and something all healthcare professional prescribe to the public, prevention. Only through prevention can COVID-19 be well managed and contribute to the fatalities attributed to this virus. To reiterate these holistic measures are easy to incorporate into our daily lives, they are relatively inexpensive and so present a low barrier to adopt and they are indeed highly effective in preventing the spread of the virus. Adhering to these measures makes a serious effort and contribution towards reducing the pressure on NHS resources both financially and emotionally. What’s more, complying with hygienic & social practices in the form of wearing a mask and regularly hand washing are fitting and meaningful acts we can undertake to show our appreciation for and solidarity with NHS workers, key workers and each other. In the final part of this series, we shall look at the proposed vaccine and therapeutic options used to combat the virus.
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